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Medical Examination Report for Commercial Driver Fitness Determination Mobile App

Ensure that your commercial drivers are in tip top condition with this Medical Examination Report for Commercial Driver Fitness Determination app. It is a comprehensive assessment of the driver's health history, vision, hearing, blood pressure, lab results, physical examination and more. This app can be easily customized to meet your specific needs.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Medical Examination Report for Commercial Driver Fitness Determination Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Driver completes this section.

  • Ico textbox

    Driver's Name (Last, First, Middle)

  • Ico textbox

    Social Security No.

  • Ico textbox

    Birthdate

  • Ico integer

    Age

  • Ico dropdown

    Sex

  • Ico checkbox

    New certification

  • Ico checkbox

    Recertification

  • Ico checkbox

    Follow Up

  • Ico date

    Date of Exam

  • Ico textbox

    Address

  • Ico textbox

    City, State, Zip Code

  • Ico textbox

    Work Tel

  • Ico textbox

    Home Tel

  • Ico textbox

    Driver License No.

  • Ico dropdown

    License Class

  • Ico dropdown

    State of Issue

  • Ico statictext

    Driver completes this section, but medical examiner is encouraged to discuss with driver.

  • Ico dropdown

    Any illness or injury in last 5 years?

  • Ico dropdown

    Head/Brain injuries, disorders or illnesses

  • Ico dropdown

    Seizures, epilepsy

  • Ico checkbox

    Medication

  • Ico textbox

    (specify)

  • Ico dropdown

    Eye disorders or impaired vision (except corrective lenses)

  • Ico dropdown

    Ear disorders, loss of hearing or balance

  • Ico dropdown

    Heart disease or heart attack; other cardiovascular condition

  • Ico checkbox

    Medication

  • Ico textbox

    (specify)

  • ...and More!

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