DOT PHYSICALS
DOT PHYSICALS
Urgent Care Plus does federal DOT Exams.
Please feel free to call us with any concerns and we will get back to you with the response from our DOT Physician.
Call to make an appointment 302-510-8827.
Extra forms you may need.
If you have insulin treated diabetes you will need the MCSA-5870 form filled out and signed by your treating provider.
If you have non-insulin treated diabetes you will need the MCSA-5872 form filled out and signed by your treating provider.
If you would be unable to pass an in office vision exam please have your eye doctor fill out this MCSA-5871.
If you are on any concerning medication please have your prescriber fill out the MCSA-5895.
If you wear a hearing aid and are unable to pass a whisper test, please bring your audiologist exam results from within the past year with you.
What to bring with you.
A copy of the MCSA-5875 form. The blue section of this form is to be completed by you.
Your driver’s license
Payment method
A complete list of all medications with dosage amount and prescribing doctors’ name.
Contact lenses, Glasses, hearing aids, and any device you normally use.
An appointment (call to make an appointment 302-510-8827)
Additional forms as required for your DOT physical. These are listed in the below sections.
If you have Hearing Problems.
If you wear a hearing aid and are unable to pass an whisper test, please bring your audiologist exam results from within the past year with you.
If you have history of Heart Attack/issues, Stents, Angioplasty, and/or Angina.
Cardiology Consultation documentation with clearance to operate CMV.
Exercise Stress Test Results with ejection fraction
A detailed history of your health/injury.
Brain tumors/injury history of stroke/tia.
A detailed history of your health/injury.
A letter from your neurologist saying you are safe to operate a CMV.
If you have Vision Problems.
Please have your eye doctor fill out this FMCSA-5871.
Bring your glasses, contacts, and/or tools you use to see.
If you have Sleep Apnea.
CPAP machine stats from the last 30 days. It needs to state your machine was used for at least 4 hours per night 70% of the time.
A note from your treating provider state you are safe to operate a CMV.
Drug testing.
The provider may conduct an on site rapid drug test (saliva or urine) at the time of your physical.
Methadone and marijuana/medical marijuana are automatic disqualifiers
Pricing.
$150 Total for DOT physical
$50 is due when you make your appointment. This is non-refundable and will be considered a no-show fee.
$100 remaining will be collected when you come in for your appointment. This is also non-refundable in the event you don’t pass.
Medications and Dosage.
All psychological/depression/ADD(ADHD) medication. Must be accompanied by a note from your provider with diagnoses, treatment, medications, and with clearance to operate CMV without drowsiness or side effects.
Any medication with risk of drowsiness must be accompanied by clearance from doctor. This needs to include duration to take the medication, dosage, and safe to drive.
Methadone and marijuana/medical marijuana are automatic disqualifiers
Disclaimers.
Provider may review your available electronic medical records.
This includes DHIN, CRISP, PMP, and/or FMCSA prior to physical results.
The payment for your physical is non-refundable.
Based on the DOT exam and assessment, the certified medical examiner will determine whether you meet standards according to 49 CFR 391.41 as being medically fit to operate a CMV.
All necessary forms and history/documentation are required for your DOT exam and assessment.