To download revised Medical Examination Report Form MCSA-5875 click:
DOT Medical Examiner
DOT PHYSICALS, AVIATION MEDICINE, MARINER/SEAFARER MEDICAL,
DRUG & ALCOHOL TESTING and MEDICAL REVIEW OFFICER
Call Us: 718-701-5949 /
(AKA" Long Form")
"A final update regarding posting and use of driver examination forms was published in the Federal Register allowing MEs to use both the current and newly revised versions of the Medical Examination Report Form and Medical Examiner’s Certificate from December 22, 2015 until April 20, 2016."