DOT Physical and Medical Card: What’s Checked and How Long It Lasts
Vision, hearing, blood pressure and diabetes decide most exams. Since June 2025 the result travels to your state electronically, but the driver still has to self-certify.
A DOT physical is the medical exam interstate commercial drivers must pass to drive a commercial motor vehicle, and it must be done by a medical examiner listed on FMCSA’s National Registry. A passing exam earns a medical examiner’s certificate, the medical card, valid for up to 24 months. Examiners issue shorter cards for conditions that need monitoring, such as high blood pressure.
Who needs a DOT physical?
Drivers of commercial motor vehicles in interstate commerce need a current medical certificate under 49 CFR Part 391. That includes vehicles with a gross vehicle weight rating or gross combination weight of 10,001 pounds or more, vehicles designed to carry 9 or more passengers for pay or 16 or more without pay, and vehicles hauling placarded hazardous materials. CDL and CLP applicants need one before testing if they will drive interstate, as covered in how to get a CDL.
The exam must be done by a certified medical examiner. Find one in the FMCSA National Registry of Certified Medical Examiners. A card from an examiner not on the registry is not valid.
What does the DOT physical check?
The examiner reviews your health history form and checks you against the physical standards in 49 CFR 391.41. The fixed standards:
| Area | Standard |
|---|---|
| Vision | At least 20/40 in each eye and both eyes together, with or without glasses; 70 degrees of horizontal field in each eye; able to tell red, green and amber signals |
| Hearing | Hear a forced whisper at 5 feet in the better ear, or an average loss of no more than 40 decibels at 500, 1,000 and 2,000 Hz, hearing aid allowed |
| Blood pressure | No current diagnosis of high blood pressure likely to interfere with safe driving |
| Diabetes | Insulin-treated diabetes allowed only under 49 CFR 391.46 |
| Epilepsy | No established history or diagnosis of epilepsy or a condition likely to cause loss of consciousness |
| Drugs and alcohol | No Schedule I drugs; other habit-forming drugs only if prescribed and cleared as safe; no current diagnosis of alcoholism |
| Other | Heart, lung, muscle, nerve and mental health conditions judged against safe operation |
A urine sample is taken to test for protein, blood and sugar as health indicators. That is not a drug test. DOT drug testing is a separate process under Part 382.
Drivers who fail the vision standard in one eye may still qualify under the alternative vision standard in 49 CFR 391.44, which requires an evaluation by an ophthalmologist or optometrist before the physical.
How long is a DOT medical card good for?
The longest card is 24 months. An examiner can issue a shorter one when a condition needs follow-up, and some conditions carry fixed limits:
- Insulin-treated diabetes: up to 12 months, and the treating clinician must complete the Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870, no more than 45 days before the exam.
- High blood pressure: FMCSA’s examiner guidance points to a one-year card for drivers with treated or mildly high blood pressure, and shorter or no certification at higher readings.
- Sleep apnea: there is no specific FMCSA rule. The examiner decides, often asking for a sleep study or proof that the driver uses treatment, and may issue a shorter card.
Bring your medication list, glasses or hearing aids, and records from specialists. Without specialist records, the examiner may delay the decision or issue a shorter card.
How does the medical card get to my state now?
Since June 23, 2025, examiners report results for CDL and CLP holders to the National Registry, and FMCSA sends them electronically to the state driver licensing agency. CDL and CLP holders no longer need to carry the paper card or hand it to the DMV, as long as the certification is current. While states finished the switch, FMCSA let drivers and carriers rely on a paper copy of a new certificate for up to 60 days after the exam. The last nationwide exemption ran through October 11, 2026. Since October 12, 2026, the paper copy no longer counts as proof in any state except Alaska, the only state that had not connected to the system, which received a one-year exemption, according to FMCSA’s October 2026 Federal Register notice. If a new exam does not show up on your state record, ask your state DMV.
Drivers who need a medical card but do not hold a CDL or CLP still receive and carry the paper certificate. It is still worth asking the examiner for a copy before leaving the clinic, because transfer errors happen.
Do I need to self-certify with my state?
Yes. Every CDL and CLP holder must tell the state which type of driving they do. There are four categories:
| Category | Meaning | Medical card needed? |
|---|---|---|
| Non-excepted interstate (NI) | Interstate driving with no exception | Yes, federal |
| Excepted interstate (EI) | Interstate but in an excepted job, such as some government or emergency work | No federal card |
| Non-excepted intrastate (NA) | In-state only, under state medical rules | Per state rules |
| Excepted intrastate (EA) | In-state only, in an excepted job | Per state rules |
Most over-the-road drivers are NI.
What happens if my medical card expires?
An expired medical certification makes you unable to drive a CMV legally until you pass a new exam. For CDL holders, the state marks you as not certified and must start a downgrade of the CDL, which removes the commercial privilege until a valid certification is on file. Restoring it can mean extra trips to the DMV, so schedule the exam several weeks before the expiration date. A motor carrier that lets a driver run with an expired card is also in violation. Other actions that can cost you the CDL are covered in CDL disqualification offenses.
Bottom line
The electronic system means your state record, not the card in your wallet, now decides whether you are medically qualified. If the examiner enters something wrong, you may not find out until the DMV sends a downgrade notice. Check your status with the state a week or two after each exam.
FAQ
Can my family doctor do a DOT physical?
Only if they are certified and listed on the FMCSA National Registry. Many clinics have certified examiners, and you can search the registry by location.
Does the DOT physical include a drug test?
No. The urine sample in the physical checks for medical signs such as sugar and protein. Pre-employment and random drug tests are separate and recorded through the Drug and Alcohol Clearinghouse.
Can I drive a truck with insulin-treated diabetes?
Yes, if you meet 49 CFR 391.46. Your treating clinician completes Form MCSA-5870 within 45 days before the exam, and the certificate lasts up to 12 months.
Can I get a second opinion if I fail?
You can see another certified examiner, but you must disclose prior exams on the health history form. Conflicting medical opinions can be taken to FMCSA under 49 CFR 391.47.
