IMPORTANT INFORMATION FOR DEPARTMENT OF TRANSPORTATION (DOT) PHYSICALS AT OLDE TOWNE MEDICAL CENTER

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We request that the first 2 pages of the Medical Examination Report Form be completed prior to your appointment and that you bring the two pages with you to the Olde Towne  appointment. If it is not completed prior to the appointment and/or you do not know the names of your current medications or other necessary information your appointment might be rescheduled for a different day.

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• You can get a copy of the first two pages THREE DIFFERENT WAYS:

  • You can click here to access a copy to download and print.

  • You can request a copy from your supervisor.

  • You can search for Medical Examination Report Form 5875 in any internet browser and print and download the first two pages from the FMSCA website.

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• Please come prepared to provide a urine sample at the time of your appointment. We make every effort to bring you back on time.  

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• If you have any medical conditions that may affect medical clearance, please discuss them with your primary care clinician or specialist in the forty five days prior to your DOT physical. You have the option to give your primary care clinician or specialist this Olde Towne DOT form to complete BEFORE YOUR DOT EXAM that you can bring to your appointment at Olde Towne. We created this form to HELP drivers pass their physicals and to reduce their anxiety at the time of appointments. 

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​Some common medical conditions to consider before your DOT physical:

• ​If you have high blood pressure and feel it goes up unusually high during your DOT exam (“white coat hypertension”), you can have your primary care clinician complete and sign the Olde Towne DOT form to document that your blood pressure is generally well controlled at 140/90 or lower and that they feel you are safe to drive a commercial motor vehicle.

• If you have diabetes, you can choose to print out your most recent A1C results and/or have your primary care clinician sign the Olde Towne DOT form to state they feel your diabetes is well controlled and you are safe to drive a commercial vehicle. Another option is to use the optional FMSCA Non-Insulin-Treated Diabetes Assessment Form, MCSA-5872.

• If there are any concerns about prescribed medications that might affect a driver’s ability to safely operate a commercial motor vehicle, including amphetamines, narcotics or other habit forming drugs, please have the prescribing clinician fill out the 391.41 CMV Driver Medication Form MCSA-5876.

• If there is a vision concern requiring documentation, it is necessary for you to be seen by an ophthalmologist or optometrist no more than 45 days before your exam and have them fill out the Vision Evaluation Report Form MCSA-5871.

• If you have sleep apnea, the FMCSA no longer requires you to show a printout from your CPAP machine, per the 2024 update to the Medical Examiner’s Handbook. However, you are welcome to bring in your logs if you would like.

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Having all relevant information and forms completed PRIOR to your appointment will avoid the need to reschedule the appointment or having the driver make additional medical appointments to provide necessary information.