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Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870

About the Insulin Treated Diabetes Mellitus (ITDM) Assessment Form, MCSA-5870

As a part of the medical certification process for insulin treated diabetes mellitus (ITDM) individuals, the Federal Motor Carrier Safety Administration requires that the Insulin Treated Diabetes Mellitus Assessment Form (ITDM), MCSA-5870, be completed by the ITDM individual’s Treating Clinician attesting that the individual has a stable insulin regimen and properly controlled diabetes. ITDM individuals are required to provide the ITDM Assessment Form, MCSA-5870, to the Certified Medical Examiner within 45 days of completion by the Treating Clinician.

Last updated: Wednesday, December 18th, 2019