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Medical Examiner Name
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Medical Examiner is DOT Certified
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Employer
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Employer (other)
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Type of Certification Requested
• • •
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Occupation Intended
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RMI Consent for Release of Medical Information
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Official Documents Uploaded
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Certification Issued
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State DOT: 2 Year
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Federal DOT: 2 year
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State DOT: 1 Year
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Federal DOT: 1 year
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State DOT: 6 months
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Federal DOT: 6 month
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State DOT: 3 months
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Federal DOT: 3 month
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Fit For Duty: 2 years
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Fit For Duty: 1 year
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Fit For Duty: 6 months
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Fit For Duty: 3 months
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CERTIFICATION FAILURE
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Determination Pending
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MEDICAL HOLD
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Medical Hold Reason(s)
• • •
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Medical Hold Plan (free text)
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Additional Medical Hold Reason(s)(Free Text)
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Additional Comments (Free Text)
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