Medical Vision Eye Test Form (MCSA-5875): Standards and Submission

The medical vision eye test form you need depends on what you drive. If you hold a regular driver’s license, most states test your vision at the DMV counter and only send you to an eye doctor for a state-specific report if you fail that screening. If you drive commercially, your vision is evaluated as part of the FMCSA Medical Examination Report (Form MCSA-5875), completed by a certified medical examiner and measured against the federal standards in 49 CFR 391.41.¹

Standard Drivers: The DMV Screening Comes First

For a personal driver’s license, there is no separate paper vision form to fill out unless something goes wrong at the counter. The clerk has you read a Snellen chart, and most states want at least 20/40 with or without glasses or contacts. Pass, and vision is done. If you needed corrective lenses to reach the threshold, a corrective-lens restriction is added to your license.²

If you fail, the DMV refers you to an optometrist or ophthalmologist and hands you a state-specific vision report to bring back once it is completed. California, for example, uses the Report of Vision Examination (DL 62).² The form name and the acuity thresholds vary by state, so pull the current form from your own DMV’s website rather than assuming another state’s version applies. Once the eye doctor completes it, the DMV uses it to decide whether to issue the license, add restrictions, or deny it.

Commercial Drivers: The MCSA-5875 and the Federal Vision Standard

Commercial motor vehicle drivers do not use a standalone eye-test slip. Vision is one part of the physical examination recorded on the Medical Examination Report Form (MCSA-5875).³ Passing that exam produces a Medical Examiner’s Certificate (Form MCSA-5876), which you must keep current to hold a CDL with interstate driving privileges.

The vision standard at 49 CFR 391.41(b)(10) has three parts, and you must meet all of them:

Distant visual acuity of at least 20/40 on the Snellen scale in each eye separately and in both eyes together, with or without corrective lenses.
A horizontal field of vision of at least 70 degrees in each eye.
The ability to recognize the colors of traffic signals and devices showing red, green, and amber.

If you need glasses or contacts to reach 20/40, the examiner notes that on the certificate and your CDL carries a corrective-lens restriction.¹

How the MCSA-5875 Gets Filled Out

You and the medical examiner each complete part of the form. Download a blank copy from the FMCSA website or pick one up at the examiner’s office ahead of your appointment.⁴

Your Section: Driver Information and Health History

The first section asks for your full legal name, date of birth, age, and driver’s license number. A health history section follows, covering past surgeries, current medications, and any conditions that could affect your ability to drive. Answer everything. The driver certification statement at the bottom warns that inaccurate or false information violates 49 CFR 390.35 and can invalidate both the exam and your certificate.⁴ Sign and date the certification line before handing the form to the examiner.

Examiner’s Section: The Vision Fields

The examiner completes Section 2 during your appointment. The vision entries record acuity for the right eye, left eye, and both eyes together (each written as 20/__), the horizontal field of vision in degrees for each eye, and whether you can distinguish red, green, and amber. The examiner also notes whether you have monocular vision, whether corrective lenses were used, and whether a referral to an ophthalmologist or optometrist is needed.⁴ The examiner then completes the Medical Examiner Determination — federal or state version, depending on whether you drive interstate or intrastate — and issues or denies the certificate.

If You Do Not Meet the Standard Vision Requirements

The old federal vision exemption program is gone. The Vision Standard final rule, effective March 22, 2022, replaced it with a permanent pathway written into 49 CFR 391.44.⁵

If you have monocular vision or fall short of the acuity or field-of-vision thresholds in your worse eye, the process runs in two steps. First, an ophthalmologist or optometrist examines you and completes the Vision Evaluation Report (Form MCSA-5871). Then a certified medical examiner on the National Registry reviews that report and conducts your full physical. The physical must begin no more than 45 days after the ophthalmologist or optometrist signs the MCSA-5871.⁵ Drivers certified this way must be re-examined at least every 12 months instead of the usual two-year cycle.⁶

Who Can Perform the Exam

For a standard license, any licensed optometrist or ophthalmologist can complete your state’s vision report when the DMV refers you out.

For a CDL, the physical, including the vision portion, must be performed by a medical examiner listed on the FMCSA’s National Registry of Certified Medical Examiners. That roster includes physicians, physician assistants, nurse practitioners, and other qualified providers who have passed an FMCSA certification test.⁷ An exam performed by someone not on the registry produces an invalid certificate.

Before booking, confirm the examiner’s status at nationalregistry.fmcsa.dot.gov. You can search by city and state, zip code, or use the advanced search to look up a provider by name, business name, or National Registry number.⁷

Submitting the Form and How Long It Lasts

How your results reach the state licensing agency is changing. FMCSA is rolling out National Registry II (NRII), which transmits exam results electronically from the medical examiner directly to your state driver licensing agency. Under NRII, your physical qualification status is posted to your driving record automatically, and you no longer hand-deliver or mail a paper certificate to the state. During the transition, FMCSA has issued temporary waivers allowing drivers to keep using a paper Medical Examiner’s Certificate as proof of certification for up to 60 days after it is issued, and similar waivers may be extended until all states are fully connected. Check the NRII learning center for current dates.⁸

Whether or not results are transmitted electronically, keep a copy of the signed MCSA-5875 and your MEC. If your state’s record lags behind the exam, that paper copy is your only proof of certification.

A standard Medical Examiner’s Certificate is valid for up to two years. Drivers certified under the alternative vision standard in 49 CFR 391.44 must be re-examined every 12 months, and an examiner can issue a shorter certificate at their discretion if a condition warrants closer monitoring.⁶ If the certificate expires and you have not updated it with your state, the state removes the commercial classification from your license, and you cannot legally operate a vehicle that requires a CDL until you obtain a new valid certificate.⁹ Schedule the next physical well ahead of the expiration date so there is room to address anything the examiner flags.

What Happens If You Answer Falsely

The driver certification statement on the MCSA-5875 is not boilerplate. Submitting fraudulent or intentionally false information violates 49 CFR 390.35, and 49 CFR 390.37 authorizes civil and criminal penalties.¹ A false statement also invalidates the exam and the Medical Examiner’s Certificate, so CDL privileges disappear the moment the fraud is found.⁴ Disclosing a condition honestly usually leads to a corrective-lens restriction, a referral for an MCSA-5871 evaluation, or a shorter certification period, none of which ends a driving career.

1
eCFR. 49 CFR 391.41 – Physical Qualifications for Drivers
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California DMV. Vision Impairment and DMV Requirements
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Federal Motor Carrier Safety Administration. Medical Examination Report (MER) Form, MCSA-5875
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Federal Motor Carrier Safety Administration. Medical Examination Report Form (MCSA-5875)
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Federal Motor Carrier Safety Administration. Vision Evaluation Report, Form MCSA-5871
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eCFR. 49 CFR Part 391 Subpart E – Physical Qualifications and Examinations
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Federal Motor Carrier Safety Administration. National Registry of Certified Medical Examiners
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FMCSA National Registry. NRII Learning Center
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Federal Motor Carrier Safety Administration. Medical