Oregon Dot Card For Cdl PDF Details

If you are looking to get your CDL, you will need to complete a few forms. One of these is the Oregon Dot Card for CDL form. This form can be completed online or in person, and it is used to provide information about your CDL requirements. In order to complete the form, you will need to have some information handy, including your name, date of birth, social security number and driver's license number. You will also need to provide information about your driving history and criminal record. Once you have completed the form, you will need to print it out and submit it to the DMV. NOTE: You must include payment with your submission. Fees vary depending on which type of CDL you are applying for.

The table has got details about the oregon dot card for cdl. It's a good idea that you read through this material before you start fiddling with the form.

QuestionAnswer
Form NameOregon Dot Card For Cdl
Form Length1 pages
Fillable?Yes
Fillable fields29
Avg. time to fill out6 min 7 sec
Other namesoregon cdl medical card requirements, oregon cdl medical card, oregon dmv cdl medical card, oregon dot medical card

Form Preview Example

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: 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.

735-7375 (2-13)

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