DOT Medical Card Requirements: What Drivers Need to Know

Who has to hold a medical card

49 CFR §391.41(a) requires “a person...shall not drive a commercial motor vehicle unless he/she is physically qualified to do so and...has on his/her person the original, or a copy, of a medical examiner’s certificate that he/she is physically qualified.” 49 CFR §390.5 defines a commercial motor vehicle as (a) 10,001+ lbs GVWR/GCWR, (b) designed to transport 9+ passengers including the driver for compensation or 16+ regardless of compensation, or (c) placarded hazmat. That definition catches Class 8 tractors, straight trucks over 10,001 lbs, many vocational vehicles, passenger vans, and hazmat loads.

CDL holders must additionally comply with 49 CFR §383.71(h), which requires self-certification of commerce type (interstate/intrastate × non-excepted/excepted) and, for non-excepted interstate drivers, upload of current MEC status to the state licensing agency so the card status lives on the CDLIS record. First-time Class A and Class B applicants are also subject to the ELDT entry-level driver training rule before they can take the CDL skills test, so a current medical card alone is not enough to actually license a new driver.

Excepted interstate drivers (government, firefighters, certain farm operations) and intrastate-only drivers may be subject to state-specific rules that sometimes differ from Part 391 - always check the state DOT rules where the CDL is held.

The exam itself - and what happens during it

49 CFR §391.43 requires the physical to be performed by a medical professional listed on the FMCSA National Registry of Certified Medical Examiners. The registry was created by the Medical Review Board rule at 49 CFR §390.101–111; examiners pass an FMCSA-administered test and must recertify periodically. The exam is documented on Form MCSA-5875 (Medical Examination Report) and includes:

• Medical history review (driver attests under penalty of perjury at 49 CFR §391.41(b)).
• Vision test - at least 20/40 in each eye and 70-degree field of vision per 49 CFR §391.41(b)(10).
• Hearing test - whisper at 5 feet or audiometric threshold under 49 CFR §391.41(b)(11).
• Blood pressure and pulse (no explicit cap, but examiner discretion applies).
• Urinalysis for protein, blood, and glucose - not a drug test.
• Physical examination covering neurological, cardiovascular, musculoskeletal, and mental health.

The driver receives a copy of the MEC (MCSA-5876). The examiner must also electronically submit the result to FMCSA per 49 CFR §390.111(a)(4).

Exam cycle and certification length

The maximumcertification period is 24 months. In practice, the examiner can - and frequently does - shorten that window based on the driver’s health status:

• 24 months: no disqualifying conditions or monitoring needs.
• 12 months: controlled hypertension, Stage 1; monitored diabetes; sleep apnea with compliant CPAP.
• 3–6 months: elevated risk requiring closer follow-up - Stage 2 hypertension, post-cardiac event recovery, certain endocrine conditions.
• Single-trip: rarely, a driver may be certified only for a specific trip under §391.41(b)(11) exemption procedures.

The card expires at 11:59 PM on the date printed. Driving a commercial motor vehicle after that date is a violation of 49 CFR §391.41(a). FMCSA considers a lapsed MEC a serious CSA Driver Fitness BASIC violation.

Disqualifying conditions at a glance

49 CFR §391.41(b) lists the physical qualifications. The conditions that most frequently disqualify drivers:

• Vision below 20/40 in either eye without correction, or color blindness affecting red/amber/green recognition (§391.41(b)(10)).
• Uncontrolled hypertension - Stage 3 (180/110+) is immediately disqualifying.
• Insulin-treated diabetes without an individual exemption under 49 CFR §391.46.
• Current clinical diagnosis of alcoholism (§391.41(b)(13)).
• Current use of a Schedule I controlled substance, including state-legal cannabis (§391.41(b)(12)).
• Unresolved epilepsy or other seizure disorder without individual exemption.
• Hearing loss below the whisper-test or audiometric standards.
• Certain cardiovascular conditions - acute MI within 2 months, implanted pacemakers or ICDs within the healing window, severe unrepaired aneurysm.

What happens at card expiration

For non-excepted interstate CDL holders, an expired MEC triggers automatic downgrade of the CDL under 49 CFR §383.73(o). The state is required to downgrade the license to non-CDL status after the grace period in its state rules (commonly 30–60 days). Operating a CMV after downgrade is driving without a valid CDL - a far more serious violation than a lapsed card alone.

For non-CDL drivers (e.g., drivers of 10,001–26,000 lb CMVs in interstate commerce), an expired MEC simply means they can’t legally drive a CMV until recertified. No license-level downgrade, but the 49 CFR §391.41(a) violation still applies.

Keeping the card current is a driver qualification file (DQF) item under 49 CFR §391.51. Carriers keep MEC copies in the DQF for the tenure of the driver plus three years post-separation. Missing MECs is a standard finding in new-entrant safety audits and a recurring CSA Driver Fitness BASIC hit.

How to find a certified examiner

The FMCSA National Registry (nationalregistry.fmcsa.dot.gov) is the authoritative source. Only examiners listed there may perform DOT physicals under 49 CFR §391.43. Urgent-care clinics, occupational-health clinics, and some chiropractors with the MRB certification are all common venues. Cost typically runs $75–$150. The registry lookup is by zip code and shows license type, certification expiration, and in-person availability.

Drivers should book at least 30 days before their current card expires so any follow-up (e.g., a blood-pressure recheck or sleep study referral) can be completed without an operational gap.