Before your DOT physical / Forms and documents

Medication Information for Your DOT Physical

Bring a current list of prescription medicines, over-the-counter medicines and supplements, including doses. If the examiner requested more information, confirm which prescriber or medication the request concerns.

The optional medication form

MCSA-5895 is an optional information tool. The examiner completes the request section and the prescribing healthcare provider completes the provider information section. The prescribing provider’s response informs the examination; it does not replace the examiner’s qualification decision.

Keep treatment decisions with your clinician

Do not stop, skip or change medication to influence an examination result. Discuss medication questions or side effects with your prescribing clinician and tell the examiner about your current treatment.

Use the FMCSA source link above to confirm the current form. The OMB date printed on the PDF is an administrative form date, not the expiration of your medical certificate.

Sources checked October 22, 2026: FMCSA optional medication form.

These instructions help you prepare. The certified medical examiner determines which records are needed and whether you meet the applicable standards. Bringing a form does not guarantee certification.

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