DOT Medical Certification for CMV Drivers is the FMCSA requirement that every commercial motor vehicle driver be examined by a certified medical examiner and found physically qualified before driving. The rules in 49 CFR Part 391, Subpart E set the physical standards, the exam process and how long a certification lasts. They protect drivers and the public from crashes caused by conditions such as uncontrolled diabetes, seizures, poor vision or sudden heart problems.
Medical certification applies to CDL and non-CDL drivers alike. For motor carriers, using a driver without valid medical certification is one of the most common and most serious driver qualification violations, and the way carriers prove certification for CDL holders changed with FMCSA's move to electronic records.
What Is DOT Medical Certification?
Subpart E of Part 391 contains seven sections:
- 391.41: the physical qualification standards
- 391.43: the medical examination and certificate
- 391.44: an alternative standard for drivers who do not meet the vision standard in one eye
- 391.45: who must be examined and how often
- 391.46: standards for drivers with insulin-treated diabetes
- 391.47: resolving conflicting medical evaluations
- 391.49: the Skill Performance Evaluation program for loss or impairment of limbs
The exam is commonly called a DOT physical. Results are recorded on the Medical Examination Report Form (MCSA-5875), and a driver who qualifies receives a Medical Examiner's Certificate (MCSA-5876), often called a med card. Only examiners listed on FMCSA's National Registry of Certified Medical Examiners may perform the exam.
Who Must Comply?
Every person who drives a commercial motor vehicle in interstate commerce must be medically certified. That includes non-CDL drivers of vehicles rated at 10,001 pounds or more, larger passenger vehicles and placarded hazmat vehicles.
Under 391.45, a driver must be examined and certified if the driver:
- Has never been medically certified
- Has not been certified within the preceding 24 months
- Drives only in an exempt intracity zone and has not been certified in the preceding 12 months
- Has insulin-treated diabetes or qualifies under the alternative vision standard, and was last examined more than 12 months ago
- Has an injury or illness that impairs the ability to perform normal duties
- Was found not physically qualified by a medical examiner
Some farm-related drivers are excluded under 391.2, and FMCSA grants individual exemptions in limited cases. Intrastate drivers are covered by state rules, which often mirror the federal standards but may include waivers or grandfathering.
Key Requirements
Physical qualification standards (391.41(b))
A driver is physically qualified if the driver meets 13 standards. The most frequently discussed are:
- Vision: distant visual acuity of at least 20/40 in each eye, with or without correction, a horizontal field of vision of at least 70 degrees in each eye and the ability to recognize standard traffic signal colors
- Hearing: perceiving a forced whispered voice at 5 feet or more in the better ear, with or without a hearing aid, or an average hearing loss no greater than 40 decibels at 500, 1,000 and 2,000 Hz in the better ear
- Diabetes: no insulin-treated diabetes unless the driver meets 391.46
- Cardiovascular and blood pressure: no current diagnosis of a heart condition or high blood pressure likely to interfere with safe driving
- Neurological: no epilepsy or other condition likely to cause loss of consciousness or loss of control
- Substances: no use of Schedule I drugs, amphetamines, narcotics or other habit-forming drugs, except as prescribed by a licensed practitioner who has advised that the drug will not affect safe driving, and no current clinical diagnosis of alcoholism
The others cover limbs, respiratory, musculoskeletal and psychiatric conditions.
The examination (391.43)
The exam must be performed by a medical examiner on the National Registry. Ophthalmologists and optometrists may perform the vision portion. When the examiner needs more information, such as a specialist report, the driver has 45 days to provide it. The examiner must transmit the results to FMCSA electronically by midnight local time of the next calendar day after the exam, and must keep the report and certificate for at least 3 years.
Certificate periods
A medical certificate is valid for up to 24 months. Examiners may issue a shorter certificate to monitor a condition. Drivers qualifying under the insulin-treated diabetes standard or the alternative vision standard must be examined at least every 12 months.
Insulin-treated diabetes (391.46)
A driver with insulin-treated diabetes may qualify if the treating clinician completes the Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870) and the medical exam takes place no more than 45 days after the clinician signs it. The driver must provide at least the preceding 3 months of electronic blood glucose records. After a severe hypoglycemic episode, the driver must stop driving until cleared.
Alternative vision standard (391.44)
A driver who cannot meet the acuity or field of vision standard in one eye may qualify if an ophthalmologist or optometrist completes the Vision Evaluation Report (MCSA-5871) and the medical exam begins no more than 45 days later. Drivers qualifying this way for the first time generally must pass a road test, with exceptions for experienced drivers.
Skill Performance Evaluation (391.49)
Drivers with loss or impairment of a limb may qualify through FMCSA's Skill Performance Evaluation program, which issues a certificate the carrier keeps in the driver's file and the driver must carry.
Proof of Certification and Recordkeeping
Non-CDL drivers
Drivers who do not need a CDL receive a paper medical examiner's certificate and must carry the original or a copy while on duty. The motor carrier must keep a copy in the driver qualification file and note that it verified the examiner was on the National Registry on the date the certificate was issued.
CDL and CLP holders: National Registry II
Under FMCSA's National Registry II rule, which took effect June 23, 2025, medical examiners send exam results to FMCSA, and FMCSA sends them electronically to the state driver licensing agency, which posts the driver's medical status to the CDL record. CDL and CLP holders no longer need to carry a medical certificate. Motor carriers must obtain an MVR from the driver's current licensing state showing medical certification status and place it in the qualification file. If electronic information conflicts with a paper certificate, the electronic information controls.
To ease the transition, FMCSA issued waivers and then a temporary exemption allowing a paper certificate to serve as proof for up to 60 days after issuance. That exemption expired October 11, 2026. As of October 12, 2026, carriers and drivers in all states except Alaska can no longer rely on a paper certificate as proof for CDL and CLP holders. FMCSA renewed the exemption for Alaska-licensed drivers through October 12, 2027 because Alaska had not implemented the electronic process.
Retention
Medical certificates, and the CDLIS MVRs used as proof for CDL drivers, may be removed from the qualification file 3 years after the date they were executed. Medical examiners keep their own records for at least 3 years.
Common Violations and Penalties
- Dispatching a driver whose certification has expired or whose MVR shows not-certified status
- Accepting a paper certificate as proof for a CDL holder after the exemption ended
- Failing to verify the examiner was on the National Registry for non-CDL drivers
- Missing the shorter certificate period when an examiner issues a card for less than 24 months
Using a driver who is not medically qualified can result in civil penalties against the carrier and the driver, roadside out-of-service orders and safety rating consequences. FMCSA adjusts penalty maximums for inflation each year. See FMCSA's civil penalties page for how cases are resolved. For CDL holders, a lapse in medical status can also lead the state to downgrade the license.
How to Comply: Step by Step
- Identify every driver who needs certification. Include non-CDL drivers of vehicles at or above 10,001 pounds.
- Send drivers to registered examiners. Confirm the examiner is listed on the National Registry before the exam.
- Verify status before the first trip. For CDL and CLP holders, pull an MVR from the current licensing state showing certified status. For non-CDL drivers, obtain the certificate and record the Registry verification.
- Record the actual expiration date. Use the date on the certificate or MVR, not a default of 24 months.
- Schedule renewals early. Allow time for specialist reports, the 45-day pending window and posting to the state record.
- Audit files regularly. Include medical records in internal audits and remove medical documents only when eligible.
How SMS360 Helps
The SMS360 Driver Qualification Files module helps fleets keep each driver's medical certification records with the rest of the driver qualification file. Teams can store certificates and MVRs, track expiration dates and get reminders before a certification lapses. Dashboards show which drivers need renewals, and mobile access helps drivers submit documents from the road. For the wider qualification rules, see our overview of driver qualification files under Part 391.
Frequently Asked Questions
How long is a DOT medical card good for?
A medical examiner's certificate is valid for up to 24 months. The examiner can issue a shorter period when a condition needs monitoring. Drivers with insulin-treated diabetes, and drivers qualifying under the alternative vision standard, must be examined at least every 12 months.
Do CDL drivers still need to carry a medical card?
No. Since June 23, 2025, CDL and CLP holders do not need to carry the certificate because medical status is transmitted electronically to the state and posted to the driving record. Alaska-licensed drivers using FMCSA's exemption must carry a copy. Non-CDL drivers must still carry their certificate.
What vision is required for a DOT physical?
Drivers need distant visual acuity of at least 20/40 in each eye, with or without corrective lenses, at least 70 degrees of horizontal field of vision in each eye and the ability to recognize red, green and amber traffic signals. Drivers who do not meet the standard in one eye may qualify under the alternative vision standard in 391.44.
Can a driver with insulin-treated diabetes get a DOT medical card?
Yes. Under 391.46, the treating clinician completes an assessment form, the driver provides at least 3 months of electronic glucose records, and the medical examiner decides whether the driver qualifies. Certification lasts no more than 12 months.
