This document is a Medical Self-Certification form for Commercial Driver License (CDL) holders. The form requires personal information including last name, first name, middle name, Oklahoma driver license number, mailing address with city, state, and zip code, home telephone number, and cellular telephone number. The form also asks the CDL holder to check one of four self-certification categories based on their commercial transportation status. The categories are: Non-excepted Interstate (NI), Excepted Interstate (EI), Non-excepted Intrastate (NA), or Excepted Intrastate (EA). The form includes a yes/no question about submitting a copy of the medical certificate and requires the signature, date, and certification of truthfulness.
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