State of Rhode Island: Division of Motor Vehicles
Commercial Driver License Medical Certificate

Commercial Driver License Medical Certificate

Instructions
Please complete all information in the form below and upload a clear, readable copy of your new medical certificate. This form can only be used by customers whose self-certification is currently Non-Excepted. It cannot be used to change your self-certification.
Customer Information
Medical Information

Please fill in these fields using information from your Medical Examiner's Certificate.

"Date Certificate Signed" must be the current or a past date (MM/DD/CCYY).

"Medical Examiner's Certification Expiration Date" must be a future date (MM/DD/CCYY).

If possible, we strongly recommend uploading a scanned document rather than a photo.