Form MCSA-5895. 391.41 CMV Driver Medication Form (optional)
The 391.41 CMV Driver Medication Form, MCSA-5895, is an optional form provided by the Federal Motor Carrier Safety Administration (FMCSA) to help evaluate the use of certain medications by commercial motor vehicle (CMV) drivers. The form is designed to facilitate communication between medical examiners, drivers and prescribing healthcare providers, ensuring the safe operation of commercial vehicles on public roads.
The MCSA-5895 form is divided into several sections, which include the following:
- Driver Information: This section requires basic driver information such as name, date of birth, license number, address, and contact details.
- Medication Information: This part of the form focuses on the medication used by the driver, its purpose, dosage, frequency, and duration of treatment. It also includes any past or present side effects experienced by the driver.
- Treating Healthcare Provider Information: This section covers the information of the healthcare provider who prescribed the medication, including their name, contact information, and medical specialty.
The most important fields in the form are related to the information about the driver's medication, as this information will determine whether the driver is fit to operate a commercial vehicle under FMCSA regulations.
The MCSA-5895 form is completed by drivers who take medications that may affect their ability to safely operate a commercial motor vehicle. It serves as an additional document to be submitted along with the Medical Examination Report (MER) Form, MCSA-5875, and Medical Examiner's Certificate (MEC), Form MCSA-5876, during the CMV driver's medical examination.
When completing the form, drivers must be honest and accurate about their medication usage. This allows medical examiners to make informed decisions based on complete information. Inaccurate or incomplete information may lead to disqualification from operating a CMV.
The advantages of using the MCSA-5895 form include facilitating communication and promoting transparency between drivers, medical examiners, and healthcare providers. It ensures that all parties involved are aware of the driver's medication usage and potential impact on their ability to operate a commercial vehicle safely.
The main problem driver's may face when filling out the form is the possibility of disqualification based on their medication use. However, it is crucial to prioritize public road safety and preventing accidents due to impaired driving.
Related forms include the Medical Examination Report (MER) Form, MCSA-5875 and the Medical Examiner's Certificate (MEC), Form MCSA-5876.
The completed MCSA-5895 form should be submitted to the certified medical examiner during the driver's medical examination, along with the required FMCSA documentation. The form will be reviewed, and if necessary, shared with the treating healthcare provider, before making a final decision on the driver's qualification. The form will be stored by the medical examiner for their records or as required by local regulations.