FMCSA Announces Optional Non-Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5872

In coordination with FMCSAs Medical Review Board, FMCSA developed and is providing certified medical examiners (MEs) with a form (Non-Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5872) that requests additional information regarding the diagnosis, monitoring, and stability of non-insulin-treated diabetes mellitus. Use of the Non-Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5872, is voluntary and may be utilized by MEs responsible for issuing Medical Examiner’s Certificates, Form MCSA-5876, to individuals diagnosed with non-insulin-treated diabetes mellitus who operate commercial motor vehicles (CMV) in interstate commerce.  This form is being provided as a resource to enable clear communication between MEs and treating healthcare providers who manage the diabetes care of individuals diagnosed with non-insulin-treated diabetes mellitus who operate CMVs.  The information obtained by MEs will assist them in determining whether an individual diagnosed with non-insulin-treated diabetes mellitus meets FMCSA’s physical qualification standards.

The Non-Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5872, can be found on the:

FMCSA website at https://www.fmcsa.dot.gov/medical/driver-medical-requirements/medical-applications-and-forms

Resource Center page of the National Registry website at https://nationalregistry.fmcsa.dot.gov/resource-center

Medical Regulations and Guidance Resource Table at https://www.fmcsa.dot.gov/regulations/medical/medical-regulations-and-guidance-resource-links.