DOT Physical Form: MCSA-5875 and MCSA-5876

Two forms and a report

"The DOT physical form" is really three documents, and they go to three different places. The long one is the MCSA-5875 Medical Examination Report. The short one is the MCSA-5876 certificate, the "medical card". The third is one you never see: the MCSA-5850 results form the examiner files with FMCSA after every exam.

Both forms are prescribed. They are printed in the regulation itself, at §391.43(f) and (h), and the examiner must use them as written. A clinic's own "DOT physical" template is not a substitute.

The part you fill in

Your share of MCSA-5875 is the opening section: who you are, your licence, and the health history questions. Each question is tied to one of the qualification standards in §391.41(b), which is why it asks about things that seem unrelated to driving. A yes answer is not a failure. It tells the examiner what to look at more closely.

Then you sign a certification. FMCSA rewrote it in 2015 to stress complete and accurate answers:

I certify that the above information is accurate and complete. I understand that inaccurate, false or missing information may invalidate the examination and my Medical Examiner's Certificate…

The rest of that sentence points at §390.35 and civil or criminal penalties. In practice the bigger risk is the first half: a certificate issued on a history that left something out can be invalidated after the fact, and the driver is the one parked when it is.

The examiner's part

Everything after your signature is the examiner's. They review your answers, record the measurements (vision, hearing, blood pressure and pulse, the urinalysis) and the physical findings, then complete the determination. The test thresholds themselves, such as 20/40 Snellen, with or without correction vision, are covered in what a DOT physical covers.

The determination has a federal section and a separate state section. The state one is for drivers certified under a state's own variances, and that certificate is good for intrastate work only. There are three possible outcomes:

• 01Qualified, for up to 24 months, or less if the examiner wants to see you sooner.
• 02Determination pending: they need a specialist letter or more tests. You have 45 days to provide them, and the pending status goes to FMCSA.
• 03Not qualified. The examiner must tell you, report it, and every certificate issued to you before is no longer valid.

The examiner signs and dates the report with their name, office address and phone number, then keeps it. That original, plus a copy of any certificate, stays on file for at least 3 years and must be handed to FMCSA or an enforcement officer within 48 hours of a request. Nothing in §391.43 requires the examiner to give you the report, so ask for a copy if you are changing clinics.

Where the result goes now

This is the part most older advice gets wrong. Until June 23, 2025, a CDL holder took the paper certificate to the state licensing agency and the state typed it in. From that date the examiner's MCSA-5850 report is the delivery: FMCSA sends the certificate details to your state electronically, and the state posts "certified" on your CDLIS driver record.

If the paper and the electronic record disagree, the electronic one wins, under both §383.71(h)(4) and §391.41(a)(2)(iv). Two things have not changed. A driver with an FMCSA medical variance (an exemption letter or a skill performance evaluation certificate) still carries that document when on duty. And the self-certification is still yours to make: only drivers who certify non-excepted interstate operation need the federal certificate on the record at all. The four categories are explained in the CDL medical card guide.

What the carrier files

For a driver without a CDL, the carrier keeps the certificate or a legible copy in the driver qualification file, plus a note that it checked the examiner was listed on the National Registry. For a CDL holder, the carrier pulls the CDLIS motor vehicle record from the current licensing state, and that record is the proof. The paper card is not.

The file is kept while the driver works there and for 3 years after. An individual certificate, or the CDLIS record that stands in for it, can be removed 3 years after it was issued. The qualification file checklist puts every item on one sheet.

Paperwork checklist

Getting ready for the exam itself is a different job. The guide to passing the DOT physical covers what to fix in the weeks before.