DOT physical and the medical examiner's certificate

A DOT physical is the medical examination that 49 CFR Part 391 requires before a person may drive a commercial motor vehicle in interstate commerce. A medical examiner listed on the National Registry of the Federal Motor Carrier Safety Administration (FMCSA) performs it and records it on Form MCSA-5875, and a driver found to meet the physical qualification standards of section 391.41 is certified on the Medical Examiner’s Certificate, Form MCSA-5876, often called the medical card. Certification lasts at most 24 months, or 12 months for drivers under the insulin or vision standards and for intracity-zone drivers, and an examiner can set a shorter period when periodic monitoring is required. Since June 23, 2025 FMCSA sends the results of holders of a commercial driver’s license (CDL) or commercial learner’s permit (CLP) electronically for the State to post on the driver record, and since October 12, 2026 a paper copy no longer serves as proof for them, except for drivers licensed in Alaska.

Status: 5 November 2026. The rules below are those of 49 CFR Parts 383, 390 and 391 in the annual Code of Federal Regulations edition revised as of October 1, 2025, with the amendments published since that touch the sections cited: a rule of February 19, 2026, effective March 23, 2026, that removed section 391.64, and a technical rule of July 21, 2026, in force that day, that changed sections 390.5T, 391.23, 391.41(a)(1)(i) and 391.45(b). The List of CFR Sections Affected for changes through September 30, 2026, and the Federal Register’s lists of CFR parts affected in October 2026 and up to November 3, 2026, show no other change to them, apart from a final rule of February 13, 2026 on non-domiciled licenses that changed paragraphs (f) and (m) of section 383.73, which are not quoted here. Section 390.5 is suspended; section 390.5T is the version in effect. The forms are given as printed in section 391.43. Rules for intrastate driving are not covered.

Who needs a DOT physical?

Section 391.41(a)(1)(i) opens the medical rules: “A person subject to this part must not operate a commercial motor vehicle unless he or she is medically certified as physically qualified to do so”. The regulations “are applicable to all employers, employees, and commercial motor vehicles that transport property or passengers in interstate commerce” (section 390.3T(a)(1)), and being physically qualified under Subpart E is one of the conditions of being qualified to drive in section 391.11(b)(4).

Section 390.5T defines a driver as “any person who operates any commercial motor vehicle” and a medical examiner as “an individual certified by FMCSA and listed on the National Registry of Certified Medical Examiners in accordance with subpart D of this part.” A commercial motor vehicle there starts at a rating or weight of 4,536 kg (10,001 pounds), or at more than 8 passengers including the driver for compensation, more than 15 not for compensation, or placarded hazardous materials; the full definition is set out in hours of service rules. The CDL weight classes start at 26,001 pounds, as set out in what a CDL is, and section 391.43(g)(2)(ii) provides for a certificate for a person who will not be operating a vehicle that requires a CDL. FMCSA’s rule of July 21, 2026 revised the GVWR definition in section 390.5T to “the value specified by the manufacturer as the maximum loaded weight of a single motor vehicle” and states that the change clarifies that a vehicle with a GVWR of 10,001 pounds or more is a commercial motor vehicle whatever its actual weight at a given time.

The rules leave out some drivers, in whole or in part:

• Section 390.3T(f), unless otherwise specifically provided: school bus operations as defined in section 390.5T, transportation performed by the Federal government, a State or a political subdivision, the occasional transportation of personal property not for compensation, the transportation of human corpses or sick and injured persons, fire trucks and rescue vehicles in emergency operations, vehicles for 9 to 15 passengers not for direct compensation that do not otherwise meet the definition, and drivers of vehicles used primarily for propane winter heating fuel or to respond to a pipeline emergency, if the rules would prevent them from responding to an emergency condition.
• Section 391.2: custom-harvesting operations, seasonal transportation of bees, farm vehicle drivers other than drivers of articulated vehicles, pipeline welding trucks, and covered farm vehicles, for which Subpart E does not apply.
• Section 391.68: for a private motor carrier of passengers (nonbusiness), “So much of §§ 391.41 and 391.45 as require a driver to be medically examined and to have a medical examiner’s certificate on his/her person” does not apply.
• Section 391.62: paragraphs (b)(1) through (b)(11) of section 391.41 do not apply to a person who operated in an exempt intracity zone throughout the year ending November 18, 1988, with a condition that existed on July 1, 1988 or at the first required examination after that date and has not substantially worsened, and who meets the other conditions of the section.

A driver who operates only in intrastate commerce, as section 383.71(b)(1)(iii) puts it, “is subject to State driver qualification requirements”. The note to section 391.41(a)(1)(i) recognizes the Mexican Licencia Federal de Conductor and a Canadian commercial driver’s license as proof of medical fitness, so those drivers “are not required to have in their possession a medical examiner’s certificate” if the license and medical status can be electronically verified. Since July 21, 2026 the note says that U.S. drivers who received an exemption or waiver from FMCSA are not qualified to drive in Canada; FMCSA changed the words from medical variance because skill performance evaluation certificates are not covered by that limit in the agreement. The note in section 383.95(g) still refers to drivers “with a medical variance restriction code on their CDL”.

The physical qualification standards in section 391.41(b)

Section 391.41(b) sets 13 standards: “A person is physically qualified to drive a commercial motor vehicle if that person—”

Section 391.41(a)(3)(ii) also counts as physically qualified a person who “obtained from FMCSA a medical variance from the physical qualification standards in paragraph (b) of this section and has complied with the medical examination requirement in § 391.43.” A medical variance is, by section 390.5T, an exemption letter under Part 381, Subpart C, or a skill performance evaluation certificate under section 391.49, which covers the loss or impairment of limbs.

Appendix A to Part 391 holds FMCSA’s Medical Advisory Criteria, replaced in full by the rule of January 19, 2024. These “are strictly advisory and do not have the force and effect of law.” Drug and alcohol testing under Part 382 is described in the Drug and Alcohol Clearinghouse.

What the examination covers: Form MCSA-5875

Under section 391.43(a) the examination “must be performed by a medical examiner listed on the National Registry of Certified Medical Examiners”. A licensed ophthalmologist or licensed optometrist may perform the part on visual acuity, field of vision and color recognition, and “A certified VA medical examiner must only perform medical examinations of veteran operators” (section 391.43(b)). Results “shall be recorded on the Medical Examination Report Form, MCSA-5875” (section 391.43(f)). The form as printed in the regulation has two sections:

• Section 1, filled out by the driver: personal details, whether the driver is a CLP or CDL applicant or holder, whether a medical certificate was ever denied or issued for less than 2 years, surgery, medications, 32 numbered health history questions and a signed certification.
• Section 2, filled out by the examiner: a review of the health history; pulse rate and rhythm, height and weight; blood pressure; urinalysis with specific gravity, protein, blood and sugar (“Urinalysis is required. Numerical readings must be recorded.”); vision; hearing by whisper test or audiometer; and 14 body systems marked normal or abnormal.

The testing part of the form does not list a drug test. It has a field for “Other testing if indicated”, and Appendix A says the examiner “may request a non-Department of Transportation drug test to aid in the physical qualification determination”. The form’s instructions add that “English language proficiency (49 CFR part 391.11: General qualifications of drivers) is not factored into that determination.”

The examiner completes one determination, Federal or State; the State one is for variances “which will only be valid for intrastate operations”.

Whatever the result, the examiner sends Form MCSA-5850 to FMCSA “by midnight (local time) of the next calendar day” after the examination (section 391.43(g)(5)(i)(B)). The report and a copy of each certificate stay on file at the examiner’s office for at least 3 years from the examination, available to FMCSA or to authorized enforcement representatives within 48 hours of a request (section 391.43(i)). A disagreement between the driver’s and the motor carrier’s medical examiners can be taken to FMCSA by application under section 391.47.

How long a medical certificate lasts

Section 391.45 lists who must be examined and certified. The periods below are its limits, those in the sections it refers to, the choices printed on Form MCSA-5875 and, marked advisory, those in Appendix A. The certificate itself carries a “Medical Examiner’s Certificate Expiration Date”.

The certificate, Form MCSA-5876, and who carries it

The certificate states that the examiner has examined the driver under the Federal rules, or under them with State variances, and finds the person qualified “and, if applicable, only when” one or more of these apply: wearing corrective lenses, wearing a hearing aid, accompanied by a waiver or exemption, accompanied by a skill performance evaluation certificate, driving within an exempt intracity zone, or, for State certificates, grandfathered from State requirements. It gives the expiration date, the examiner’s license and National Registry numbers, the driver’s license details and whether the driver is a CLP or CDL applicant or holder.

• Drivers who do not need a CDL or CLP. The examiner “must complete a certificate in the form prescribed in paragraph (h) of this section and furnish the original to the person who was examined” (section 391.43(g)(2)(ii)). The driver has the original or a copy on his or her person when on duty (section 391.41(a)(1)(i)). The motor carrier obtains an original or a copy, verifies that the examiner was on the National Registry at the date of issue and places the records in the driver qualification file before the person drives (section 391.23(m)(1)).
• CDL and CLP holders. Since June 23, 2025 “medical examiners are no longer required to issue the original, paper MEC, Form MCSA-5876,” to them, and such a driver “no longer needs to carry on his or her person the medical examiner’s certificate specified at § 391.43(h)” (91 FR 64454; section 391.41(a)(2)(i)(B)). The motor carrier verifies the self-certification and the valid certificate from the Commercial Driver’s License Information System (CDLIS) motor vehicle record (section 391.23(m)(2)).
• Drivers with a medical variance. A person certified on the basis of an exemption letter or a skill performance evaluation certificate must have a copy of that document on his or her person when on duty, with or without a CDL (section 391.41(a)(1)(ii) and (a)(2)(iii)).

If the electronic information and a paper copy differ, “the medical certification information provided electronically by FMCSA shall control” (section 391.41(a)(2)(iv)).

The insulin standard: section 391.46

A person with diabetes mellitus treated with insulin can be physically qualified under section 391.46, in force since November 19, 2018. FMCSA’s final rule says that before it, such individuals “were prohibited from driving CMVs in interstate commerce unless they obtained an exemption from FMCSA.” The section works as follows:

• Treating clinician, meaning “a healthcare professional who manages, and prescribes insulin for, the treatment of the individual’s diabetes mellitus as authorized by the healthcare professional’s State licensing authority”. The clinician completes and signs the Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870, before the examination or the expiration of a certificate (paragraph (b)).
• Examination. “At least annually, but no later than 45 days after the treating clinician signs and dates” the form, by a medical examiner, who must consider the form and apply the standards of the section (paragraph (c)).
• Not physically qualified. A person “not maintaining a stable insulin regimen and not properly controlling his or her diabetes mellitus”, and, “on a permanent basis”, a person with “severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy” (paragraph (c)(2)).
• Records. At least the preceding 3 months of records from “an electronic glucometer that stores all readings, that records the date and time of readings, and from which data can be electronically downloaded” (paragraphs (c)(2)(iii) and (d)).
• Severe hypoglycemic episode, defined as “one that requires the assistance of others, or results in loss of consciousness, seizure, or coma.” A certified individual who has one “is prohibited from operating a commercial motor vehicle”, must report it to and be evaluated by a treating clinician, and the prohibition continues until the clinician has made the determinations in paragraph (e) and completed a new Form MCSA-5870.

The alternative vision standard: section 391.44

Section 391.44, in force since March 22, 2022, covers an individual “who does not satisfy, with the worse eye, either the distant visual acuity standard with corrective lenses or the field of vision standard, or both”. FMCSA’s final rule says the standard “replaces the current vision exemption program as the basis for determining the physical qualification of these individuals.”

• Evaluation. A licensed ophthalmologist or licensed optometrist completes and signs the Vision Evaluation Report, Form MCSA-5871 (paragraph (b)).
• Examination. “At least annually” by a medical examiner, and it “must begin not more than 45 days after an ophthalmologist or optometrist signs and dates” the report (paragraph (c)).
• Not physically qualified, under paragraph (c)(2): if, “in the better eye, the distant visual acuity is not at least 20/40 (Snellen), with or without corrective lenses, and the field of vision is not at least 70° in the horizontal meridian”; if the individual cannot recognize the colors of traffic signals and devices showing standard red, green and amber; if the vision deficiency is not stable; or if sufficient time has not passed since it became stable for the individual to adapt to and compensate for the change in vision.
• Road test. An individual qualified under the section for the first time must complete a road test under section 391.31 and receive the certificate before driving (paragraph (d)(1)). This does not apply if the motor carrier determines that the individual drove a commercial motor vehicle with the deficiency, on a valid license, in intrastate or excepted interstate commerce for the preceding 3 years, or to holders of a vision exemption or a section 391.64(b) certification on March 22, 2022 (paragraphs (d)(3) to (5)).

The grandfathering of section 391.64 ended on March 22, 2023, and FMCSA removed the section with effect from March 23, 2026.

The National Registry of Certified Medical Examiners

Subpart D of Part 390 (section 390.101 onward) sets the qualifications for certification and listing. The Registry is “a national database of names and contact information for medical examiners who are certified by FMCSA to perform medical examinations of operators.” To be certified a person must (section 390.103(a)):

• be licensed, certified or registered under State law to perform physical examinations, as “an advanced practice nurse, doctor of chiropractic, doctor of medicine, doctor of osteopathy, physician assistant, or other medical professional authorized by applicable State laws and regulations to perform physical examinations”;
• register on the National Registry website and receive a National Registry number before the training;
• complete a training program meeting section 390.105, from an accredited provider; and
• pass the FMCSA test, with the results forwarded to FMCSA no more than 3 years after completing the training.

The credential “will expire 10 years after the date of its issuance” (section 390.109). To stay listed, an examiner completes periodic training no sooner than 4 years and no later than 5 years after issue, completes training and passes the test again no sooner than 9 years and no later than 10 years after issue, and reports registration changes within 30 days (section 390.111(a)). FMCSA may remove an examiner for reasons including errors or other indications of improper certification, or issuing a certificate to an operator who failed to meet the standards (section 390.113). A notice of proposed removal gives 30 days to respond and 60 days for corrective action, and removal can be immediate in cases of willfulness or where public health, interest or safety requires it (section 390.115). Sections 390.123 to 390.135 give parallel rules for qualified Department of Veterans Affairs examiners.

CDL self-certification and the State record

Section 383.71(g) applies to all holders: “Every person who holds a CLP or CDL must provide to the State the certification contained in § 383.71(b)(1) of this subpart.” That certification has four categories, and only the first needs a medical certificate under section 391.45.

For a non-excepted interstate driver, section 383.71(h) requires medical examination and certification by a medical examiner. “Upon receiving an electronic copy of the medical examiner’s certificate from FMCSA, the State will post a medical qualifications status of ‘certified’ on the CDLIS driver record for the driver”, and for later examinations “FMCSA will provide the State with an electronic copy of the medical examiner’s certificate information for all subsequent medical examinations in which the driver has been deemed qualified.”

Section 383.73 sets the State’s side, on or after June 23, 2025:

• Issuing and renewing. The State posts the information matching the certificate that FMCSA provides electronically (sections 383.73(a)(7)(ii) and (b)(5)(ii)).
• What goes on the CDLIS record (paragraph (o)(1)(ii)): the type of driving; the examiner’s name, telephone number, license number and issuing State and National Registry number; the date of issue and the expiration date; the status “certified” or “not-certified”; any medical variance; any restrictions such as corrective lenses or a hearing aid; and the date of posting. The electronic record is kept for 3 years beyond the date the certificate was issued.
• Variances. Posted within 1 business day of receipt (paragraph (o)(3)(ii)), and shown with restriction code V on the record and on the license (section 383.95(g)).
• Status change. Within 10 calendar days of a certificate or variance expiring, a certificate becoming invalid or being voided, or a variance being rescinded, the State updates the status to “not certified” (paragraph (o)(2)(ii)).
• Downgrade. The State notifies the holder that the CDL privileges will be removed unless the driver is examined and certified or changes the self-certification to excepted or intrastate driving, if the State permits it. “The CLP or CDL downgrade must be completed and recorded within 60 days of the driver’s medical certification status becoming ‘not-certified’ to operate a CMV.” (paragraph (o)(4)(i)(B)).

The June 23, 2025 compliance date and the paper certificate

The electronic link between the National Registry and the States comes from FMCSA’s Medical Examiner’s Certification Integration rule of 2015, which the agency also calls NRII. FMCSA says it extended the original compliance date “several times, most recently on June 22, 2021”, and that the rule replaces “the outdated paper-based process with a secure, electronic transmission system”.

The notice of October 8, 2026 states: “Drivers licensed in all other States and the District of Columbia, and their employers, may no longer rely on the paper MEC as proof of the driver’s medical certification for any period of time as of October 12, 2026.” Under its conditions the Alaska exemption does not apply to a driver who does not have on his or her person a copy of a current, valid certificate issued by a certified medical examiner within the prior 60 days, or to a motor carrier without such a copy. The exemption “does not alter the requirement that a person may not operate a commercial motor vehicle unless he or she is certified by a medical examiner as physically qualified to do so”. The notice describes the renewal as provisional and requests comments.

Related pages

Other federal requirements for US drivers are described in what a CDL is, hours of service rules and the Drug and Alcohol Clearinghouse. The medical rules for licence holders in the European Union are described in truck driving licences explained.

What this page does not cover

• State medical rules and State variances for intrastate operations.
• Individual exemptions under Part 381, including hearing and seizure exemptions, and the application procedure for a skill performance evaluation certificate.
• The medical criteria in Appendix A to Part 391 beyond the points cited above.
• Examination fees, clinics and medical guidance.
• Drug and alcohol testing under Part 382.