Commercial driver s license medical self certification form

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The information on this form is also included on the driver license application form. This form is only required if you are reporting your “medical self-certification” and do not need a driver license issued (or if you are reporting your medical status for the first time or have had a change of medical certification status). Are you submitting a copy of your medical certificate? For the medical certification process to be complete, this form must be submitted to the Division: • every two (2) years;or • upon renewal of your DOT card or Utah Intrastate Waiver card; or • upon the issuance of any CDL driver license;or • if the status indicated belowchanges. Send form to: Fax # () , Email. dlmedcert@www.doorway.rue Size: KB. Federal Regulations along with the State of Texas Administrative Rules require a commercial driver to certify in one of the 4 categories listed below to determine if a medical certificate is required. If you select category one (1) or three (3), you must present a valid medical certificate. Last Name. First NameFile Size: KB.

For the medical certification process to be complete, this form must be submitted to the Division: • every two (2) years;or • upon renewal of your DOT card or Utah Intrastate Waiver card; or • upon the issuance of any CDL driver license;or • if the status indicated belowchanges. Send form to: Fax # () , Email. dlmedcert@www.doorway.ru The information on this form is also included on the driver license application form. This form is only required if you are reporting your “medical self-certification” and do not need a driver license issued (or if you are reporting your medical status for the first time or have had a change of medical certification status). Are you submitting a copy of your medical certificate?. As a commercial driver, if there is a change in your medical status or interstate/intrastate status, you must provide DVS with a new self-certification form (PS), and if necessary new medical examination documents. The valid medical examination certificate must be kept current, regardless of a valid CDL.

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