The Oregon Dot Card For CDL form is a crucial document required for commercial drivers in Oregon, certifying their medical fitness to operate commercial vehicles. This form must be completed by a licensed medical examiner who verifies that the driver meets the necessary health standards set forth by federal regulations. Understanding the requirements and submission process for this form is essential for maintaining compliance and ensuring road safety.
The Oregon DOT Card for CDL form is a crucial document for commercial drivers in the state, ensuring they meet the necessary medical standards to operate commercial vehicles safely. This form must be completed by a licensed medical examiner who certifies that the driver has undergone a thorough examination in line with federal regulations. Key elements include the medical examiner's certification, which confirms the driver's qualifications based on their medical history and any necessary corrective measures, such as wearing glasses or hearing aids. Additionally, the form addresses specific exemptions and waivers that may apply to certain medical conditions, allowing drivers with specific impairments to still obtain their CDL under certain circumstances. The document also outlines submission procedures, including options for mailing, faxing, or emailing the completed form to the DMV. It is vital for drivers to understand the expiration date of their medical certificate, which cannot exceed two years from the examination date. Overall, the Oregon DOT Card for CDL form plays an essential role in maintaining safety standards on the roads while providing flexibility for drivers with medical challenges.
CDL MEDICAL EXAMINER’S
CERTIFICATE
Completed by Licensed Medical Examiner Only!
Fraudulent use is punishable under applicable
State and Federal laws
(For Oregon Licensed Drivers Only)
MEDICAL EXAMINER’S CERTIFICATE
I certify I have examined __________________________________________________ in accordance with the Federal
Motor Carrier Safety Regulations (49 CFR 391.41-391.49) and with knowledge of the driving duties, I find this person is
qualified; and, if applicable, only when:
Wearing corrective lenses
Driving within an exempt intracity zone (49 CFR 391.62)
Wearing hearing aid
Accompanied by a Skill Performance Evaluation Certificate (SPE)
Accompanied by a ________ waiver/exemption
Qualified by operation of 49 CFR 391.64
The information I have provided regarding this physical examination is true and complete. A complete examination form with any attachment embodies my findings completely and correctly, and is on file in my office.
SIGNATURE OF MEDICAL EXAMINER
TELEPHONE
DATE
MEDICAL EXAMINER’S NAME (PRINT)
MD
DO
Chiropractor
Physician
Naturopath
Advance Practice
Assistant
Nurse
MEDICAL EXAMINER’S LICENSE OR CERTIFICATE NO./ISSUING STATE
NATIONAL REGISTRY NO.
SIGNATURE OF DRIVER
INTRASTATE ONLY
CDL
DRIVER’S LICENSE NO.
STATE
YES
NO
ADDRESS OF DRIVER
MEDICAL CERTIFICATE EXPIRATION DATE
Notes for Examiner:
Instructions for Medical Examiner:
1.Complete examination in accordance with regulations.
2.Enter all information except signatures and print.
3.Sign the form and either submit to DMV using one of the options below or give it to the patient to submit to DMV.
4.You should also complete a medical examiner's certificate for retention of the driver and motor carrier, as you have in the past.
Instructions for Driver:
After completion by your examiner, submit this entire form to DMV, using one of the options below.
Submission Options:
Mail: DMV Driver Safety
CDL Medical Certification
1905 Lana Ave NE
Salem, OR 97314
Fax: 503.945.5329
E-mail: DSMEC@odot.state.or.us
1.Please ensure you have positively identified the patient by checking the driver license or commercial driver license before conducting the examination and entering the driver’s name, license number and state on the certificate.
2.“Driving within an exempt intracity zone” is not applicable in Oregon.
3.Only a very small number (< 10) of drivers are “qualified by operation of 49 CFR 391.64 in Oregon. If your patient was a participant in this 1990s waiver pilot program, he/she should be able to present documentary evidence of that participation.
4.If the patient is not medically qualified under 49 CFR 391.43, he or she may qualify through issuance of a waiver/ exemption or a skill performance evaluation (SPE). Oregon waivers are valid for intrastate commerce only while FMCSA waivers/exemptions/SPEs are valid for both interstate and intrastate commerce.
a.Waivers or exemptions may be available from FMCSA for vision, diabetic, seizure or hearing conditions. Check “Accompanied by a _____________ waiver/exemption” on the Medical Examiner’s Certificate, filling in the blank with “vision,” “diabetes,” “hearing” or “seizure” and have the patient call 503.399.5775.
b.A Skill Performance Evaluation Certificate may be available from FMCSA for loss/impairment of limbs. Check “Accompanied by a Skill Performance Evaluation Certificate (SPE)” and have the patient call 503.399.5775.
c.An Oregon waiver may be available for vision, insulin dependent diabetes mellitus, limb impairments or amputation, hearing or seizure/seizure disorder. This waiver permits operation of a commercial vehicle in intrastate commerce only. Check “Accompanied by a _____________ waiver/exemption” on the Medical Examiner’s Certificate, filling in the blank with “vision,” “diabetes,” “limb,” “hearing” or “seizure” and have the patient call 503.945.0891.
5.Expiration date may not be more than 2 years after date of examination. If, for instance, the examination was completed on March 15, 2012, the expiration date may be no later than March 15, 2014.
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