Medical Applications and Forms

Medical Examination

• Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870
• Medical Examination Report (MER) Form, MCSA-5875
• Medical Examiner's Certificate (MEC), Form MCSA-5876
• 391.41 CMV Driver Medication Form, MCSA-5895 (optional)

Medical Exemptions

Diabetes Package

This package has been removed due to the update of the Diabetes Standard. For more information please visit the New Diabetes Standard Overview Webinar.

Vision Package

• General Vision Package
• Indiana Residents Only
• Florida Residents Only

Hearing Package

• Federal Hearing Exemption Application (NEW)
• Federal Hearing Exemption Application (RENEWAL)
• Medical Release Form (Hearing) SAMPLE
• Medical Release Form

Seizure Package

• Federal Seizure Exemption Application (NEW)
• Federal Seizure Exemption Application (RENEWAL)
• Medical Release Form (Seizure) SAMPLE
• Medical Release Form