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Outline

The Oregon DOT Card for CDL form plays a crucial role in ensuring that commercial drivers meet the necessary health standards to operate vehicles safely. This form is specifically designed for Oregon licensed drivers and must be completed by a licensed medical examiner. The medical examiner certifies that the driver has undergone a thorough examination in accordance with federal regulations, confirming their fitness to drive. Key components of the form include the medical examiner's signature, the driver's information, and any necessary waivers or exemptions that may apply. For instance, drivers who require corrective lenses or hearing aids must have these conditions noted on the form. Additionally, the form outlines submission options to the DMV, including mailing, faxing, or emailing, ensuring that the process is straightforward for both the examiner and the driver. Understanding the requirements and procedures associated with this form is essential for maintaining compliance and ensuring road safety in Oregon.

Sample - Oregon Dot Card For Cdl Form

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

 

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: [email protected]

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.

735-7375 (2-13)

Form Information

Fact Name Details
Governing Law Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49) govern the CDL Medical Examiner’s Certificate in Oregon.
Medical Examiner Requirement The form must be completed by a licensed medical examiner only.
Fraud Penalties Fraudulent use of the certificate is punishable under applicable state and federal laws.
Submission Options Drivers can submit the form via mail, fax, or email to the DMV.
Examination Validity The medical certificate expiration date cannot exceed two years from the examination date.
Waivers and Exemptions Oregon offers waivers for vision, diabetes, limb impairments, hearing, or seizure disorders for intrastate commerce.
Driver's Responsibility After completion, the driver must submit the entire form to the DMV.

Detailed Guide for Filling Out Oregon Dot Card For Cdl

Filling out the Oregon Dot Card for CDL form is a straightforward process. The form requires specific information from both the medical examiner and the driver. Once completed, it must be submitted to the DMV for proper processing. Follow the steps below to ensure accurate completion of the form.

  1. Obtain the Oregon Dot Card for CDL form.
  2. Have the medical examiner conduct a thorough examination in accordance with federal regulations.
  3. In the section labeled "MEDICAL EXAMINER’S CERTIFICATE," the examiner should fill in their findings, including:
    • The driver's name.
    • The driver's CDL number and state.
    • Any applicable waivers or exemptions.
  4. The medical examiner must sign and date the form.
  5. The medical examiner should print their name and indicate their professional designation (e.g., MD, DO, Chiropractor).
  6. Include the medical examiner’s license or certificate number and issuing state.
  7. The driver must sign the form in the designated area.
  8. Write the medical certificate expiration date, ensuring it is no more than two years from the examination date.
  9. Choose a submission option for the completed form:
    • Mail it to: DMV Driver Safety CDL Medical Certification, 1905 Lana Ave NE, Salem, OR 97314.
    • Fax it to: 503.945.5329.
    • Email it to: [email protected].

Obtain Answers on Oregon Dot Card For Cdl

  1. What is the Oregon DOT Card for CDL form?

    The Oregon DOT Card for CDL form, also known as the Medical Examiner’s Certificate, is a document that certifies a commercial driver’s medical fitness to operate a commercial vehicle. It is completed by a licensed medical examiner and must adhere to federal and state regulations.

  2. Who can complete the Medical Examiner’s Certificate?

    Only licensed medical examiners are authorized to complete the Medical Examiner’s Certificate. This includes various types of medical professionals, such as medical doctors (MD), doctors of osteopathy (DO), chiropractors, and nurse practitioners.

  3. What are the qualifications needed to pass the medical examination?

    The examination assesses whether the driver meets the Federal Motor Carrier Safety Regulations. A driver may be qualified under specific conditions, such as wearing corrective lenses, using a hearing aid, or having a Skill Performance Evaluation Certificate. In some cases, waivers or exemptions may apply.

  4. What should a driver do after the medical examination?

    After the medical examiner completes the form, the driver must submit the entire certificate to the Department of Motor Vehicles (DMV). This can be done via mail, fax, or email, as specified in the instructions provided by the examiner.

  5. How long is the Medical Examiner’s Certificate valid?

    The certificate is valid for a maximum of two years from the date of the examination. For example, if the examination occurs on March 15, 2022, the certificate will expire no later than March 15, 2024.

  6. What if a driver does not meet the medical qualifications?

    If a driver does not qualify under the standard medical requirements, they may still be eligible through a waiver or exemption. These waivers are specific to certain medical conditions, such as vision or diabetes, and are valid for intrastate commerce only.

  7. What types of waivers or exemptions are available in Oregon?

    Oregon offers waivers for conditions including vision impairments, insulin-dependent diabetes, limb impairments, hearing issues, and seizure disorders. Drivers should consult with their medical examiner or contact the appropriate state agency for more information on obtaining these waivers.

  8. Are there any specific submission options for the Medical Examiner’s Certificate?

    Yes, drivers can submit the completed certificate to the DMV through various methods: by mail to the DMV Driver Safety CDL Medical Certification address, via fax, or through email. Each option is detailed in the instructions provided by the medical examiner.

  9. What is the significance of the National Registry Number?

    The National Registry Number indicates that the medical examiner is certified to perform commercial driver medical examinations. This ensures that the examiner is familiar with the relevant regulations and standards.

  10. What should drivers know about the “exempt intracity zone”?

    In Oregon, the “driving within an exempt intracity zone” provision does not apply. This means that drivers cannot use this exemption as a reason for qualification under the regulations.

Common mistakes

Filling out the Oregon DOT Card for CDL form can be a straightforward process, but there are common mistakes that can complicate matters. One significant error occurs when drivers neglect to ensure that their medical examiner is properly licensed. The medical examiner must be a licensed professional, and their certification is crucial for the validity of the form. Without a qualified examiner, the entire process may be rendered invalid.

Another frequent mistake is failing to provide accurate personal information. It’s essential for the driver to check that their name, driver’s license number, and state are entered correctly. Even a small typo can lead to delays or complications with the DMV. Double-checking this information before submission can save time and prevent unnecessary issues.

Many drivers overlook the expiration date of their medical certificate. The form specifies that this date cannot exceed two years from the examination date. If the medical examiner completes the examination on March 15, 2023, the expiration date should not extend beyond March 15, 2025. Ignoring this guideline can result in the need for re-examination sooner than expected.

It’s also common for individuals to misunderstand the waiver and exemption requirements. Drivers may mistakenly assume they are eligible for certain waivers without proper documentation. For example, if a driver has a vision impairment, they need to check the appropriate box on the form and ensure they have the necessary waiver. Failing to do so can lead to disqualification.

In addition, some drivers might not fully understand the submission options available. The form provides several methods for submitting the completed document to the DMV, including mail, fax, and email. Not utilizing these options correctly can cause delays in processing the application.

Another mistake is neglecting to sign the form. Both the medical examiner and the driver must provide their signatures for the document to be valid. A missing signature can lead to immediate rejection of the application, requiring the driver to go through the process again.

Additionally, drivers often forget to include the correct information regarding any accompanying waivers or exemptions. It’s crucial to fill in the blank on the Medical Examiner’s Certificate accurately. For instance, if a driver has a waiver for diabetes, they should specify this clearly. Incomplete or incorrect information can result in complications during the review process.

Lastly, not following the specific instructions for medical examiners can lead to errors. The medical examiner must complete the examination according to regulations and ensure that all information, except for signatures, is filled out correctly. Skipping this step can compromise the integrity of the examination and lead to issues with the CDL application.

Documents used along the form

The Oregon Dot Card for CDL form is an essential document for commercial drivers in Oregon. However, it is often accompanied by other important forms and documents that help ensure compliance with state and federal regulations. Below is a list of these documents, each serving a specific purpose in the licensing process.

  • CDL Application Form: This form is required to apply for a Commercial Driver's License (CDL). It collects personal information, driving history, and other relevant details necessary for the licensing process.
  • Medical Examiner's Certificate: Issued by a licensed medical examiner, this certificate confirms that the driver has passed a medical examination and meets the health standards required to operate a commercial vehicle.
  • Skill Performance Evaluation Certificate (SPE): This certificate is for drivers who have physical impairments. It evaluates their ability to safely operate a commercial vehicle despite these limitations.
  • Waiver/Exemption Form: This document is for drivers who do not meet certain medical standards but are granted permission to drive under specific conditions. It may cover conditions like vision or hearing impairments.
  • Driving Record Request Form: This form allows drivers to request their driving history from the state. It is often necessary to verify a driver's qualifications and history before obtaining a CDL.
  • Commercial Learner's Permit (CLP): This permit allows a new driver to practice driving a commercial vehicle under the supervision of a licensed CDL holder. It is a crucial step before obtaining a full CDL.

Each of these documents plays a vital role in the process of obtaining and maintaining a Commercial Driver's License in Oregon. Ensuring that all forms are completed accurately and submitted on time can help avoid delays and complications in the licensing process.

Similar forms

The Oregon Dot Card for CDL form is similar to several other documents that serve specific purposes in the realm of commercial driving and medical certification. Here are ten documents that share similarities:

  • DOT Medical Card: This document certifies that a driver has passed a medical examination and is physically fit to operate a commercial vehicle, similar to the Oregon Dot Card.
  • Medical Examination Report (MER): This report provides detailed findings from the medical examination, ensuring compliance with federal regulations, akin to the information required on the Oregon form.
  • Commercial Driver’s License Application: This application collects personal and medical information necessary for obtaining a CDL, paralleling the data collected in the Oregon Dot Card.
  • Skill Performance Evaluation (SPE) Certificate: This certificate is issued for drivers with specific impairments, similar to the waiver/exemption section of the Oregon Dot Card.
  • Intrastate Waiver Application: This application allows drivers with certain medical conditions to operate within state lines, mirroring the purpose of waivers mentioned in the Oregon form.
  • Vision Exemption Application: This document is for drivers seeking to operate a commercial vehicle despite vision impairments, similar to the vision-related waiver noted in the Oregon Dot Card.
  • Diabetes Exemption Application: This form allows drivers with diabetes to obtain an exemption, reflecting the diabetes waiver mentioned in the Oregon document.
  • Hearing Exemption Application: This application is for drivers with hearing impairments, similar to the hearing waiver section of the Oregon form.
  • FMCSA Medical Waiver Application: This application is for drivers seeking waivers for various medical conditions, akin to the waivers discussed in the Oregon Dot Card.
  • State-Specific CDL Forms: Many states have their own forms for CDL certification that include medical information, similar in structure and purpose to the Oregon Dot Card.

Dos and Don'ts

When filling out the Oregon DOT Card for CDL form, there are specific actions to take and avoid to ensure a smooth process. Below is a list of six important do's and don'ts.

  • Do ensure the medical examiner is licensed and completes the examination according to regulations.
  • Do enter all required information accurately, including the driver's name, license number, and state.
  • Do submit the entire completed form to DMV using the provided options: mail, fax, or email.
  • Do check if the driver qualifies for any waivers or exemptions before completing the form.
  • Don't leave any sections of the form blank; all fields must be filled out completely.
  • Don't forget that the expiration date of the medical certificate cannot exceed two years from the examination date.

Misconceptions

  • Misconception 1: The Oregon Dot Card for CDL can be filled out by anyone.
  • This form must be completed by a licensed medical examiner only. Unauthorized use is illegal.

  • Misconception 2: Drivers can submit the form without a medical examination.
  • A valid medical examination is required. The examiner must certify the driver's qualifications.

  • Misconception 3: The medical certificate is valid for an indefinite period.
  • The expiration date cannot exceed two years from the examination date.

  • Misconception 4: All drivers are automatically qualified under 49 CFR 391.64.
  • Only a very small number of drivers qualify under this regulation in Oregon.

  • Misconception 5: The form can be submitted in any format.
  • Submission must be done via mail, fax, or email as specified in the instructions.

  • Misconception 6: There are no specific waivers or exemptions available in Oregon.
  • Oregon does offer waivers for certain medical conditions, but they are limited to intrastate commerce.

  • Misconception 7: A driver can drive without any restrictions if they have a waiver.
  • Waivers are only valid for intrastate commerce and do not apply to interstate driving.

  • Misconception 8: The medical examiner does not need to keep a copy of the examination form.
  • The medical examiner must retain a copy of the examination findings for their records.

  • Misconception 9: Any medical professional can sign the form.
  • Only licensed medical examiners can complete and sign the Medical Examiner’s Certificate.

  • Misconception 10: The driver can ignore the instructions provided for the medical examiner.
  • Medical examiners must follow specific instructions to ensure compliance with regulations.

Key takeaways

  • Completion by a Licensed Medical Examiner: The CDL Medical Examiner’s Certificate must be filled out by a qualified medical examiner who is licensed in Oregon. This ensures that the examination meets the necessary federal regulations.
  • Submission Process: After the medical examiner completes the form, the driver must submit it to the DMV. This can be done via mail, fax, or email, as outlined in the instructions.
  • Waivers and Exemptions: Drivers who do not meet the medical qualifications may still qualify for a CDL through waivers or exemptions. These are available for specific medical conditions and must be properly indicated on the certificate.
  • Expiration Dates: The medical certificate is valid for a maximum of two years from the date of examination. It is important to ensure that the expiration date is clearly noted to avoid any issues with CDL validity.