Dot 649-F(6045 Form 2025

Dot 649-F(6045 Form: What You Should Know

Middle, S Surname) Driver s Drivers State of Residence Driver s Drivers Address Driver s Drivers Phone Number Driver s Drivers State of Issuance of License Driver s Medical Examiner ID Number Driver s Drivers Driver s Drivers Licenses Issued by Issuance of License Driver's Social Security Number Driver s CDL Drivers DOT Medical Exam Form 649f pdf1 DOT Forms Include 649f in PDF, the Drivers Physical Exam Form, Instructions to Physician and Commercial Drivers Minimum Requirements for a CDL License. 649-F (6045) — Blank 3. DRIVER'S N EYES (If Applicable) SENT TO PHYSICAL EXAMINER: 6. A. The address of the physician's office where the Driver will undergo the examination; b. The name and address of the physician to be conducting the examination; c. The date and time of the appointment (not more than 30 days); d. Name and address of the medical practitioner to be conducting the examination; 4. A. The date and time during which the examination report will be produced; 5. A. The signature of the physician conducting the examination; 6. A. If a Driver is undergoing the examination for the first time, the Physician s Signature is required (unless a Physician has a current permit or license authorizing him or her to perform examinations on behalf of the Driver); 7. A. If a Driver has previous medical conditions, the physician conducting the examination must have information on this Medical History from the Driver s Current Physician; 8. A. The signature of the physician who made the decision to certify Driver s fitness to operate a motor vehicle; 9. A. Whether the Physician has obtained the agreement of both parties to the medical examinations before certifying a Driver; 10. A. If the Physician is required to certify all Drivers, the Physician s Signature is required to certify all Drivers, regardless of previous medical conditions. (if the Driver is undergoing the examination for the first time, the Driver MUST produce valid proof of all previous medical conditions or the Physician MUST conduct the medical examination of the Patient without the assistance of an agent or employee other than the Driver s own Physician); 11. A. If the Driver (Driver's spouse or partner) is undergoing the examination for the first time, the Driver must certify his/her spouse or partner is physically incapable of operating a motor vehicle; and 12. A.

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