DOT Physical and Medical Card Requirements
Interstate truck drivers must pass a DOT physical given by an examiner listed on FMCSA's National Registry (49 CFR 391.41 and 391.43). You need a new exam at least every 24 months. Since June 23, 2025, CDL and learner's permit holders no longer carry a paper card, because the examiner reports to FMCSA and your state shows your status. Drivers without a CDL still get a certificate and carry it.
Facts checked October 16, 2026
Key Points
- A person subject to Part 391 must not drive a commercial motor vehicle (CMV) unless medically certified as physically qualified (49 CFR 391.41(a))
- A CMV in interstate commerce means a vehicle rated 10,001 pounds or more, one that carries 9 or more people for pay or more than 15 people not for pay, or one that carries placarded hazmat (49 CFR 390.5)
- The exam must be done by a medical examiner on the National Registry of Certified Medical Examiners. An eye doctor may do the vision part (49 CFR 391.43(a) and (b))
- You must be examined and certified at least every 24 months. Insulin-treated diabetes and a vision exemption call for an exam every 12 months (49 CFR 391.45)
- Since June 23, 2025, a driver who needs a CDL or CLP does not have to carry the medical certificate (49 CFR 391.41(a)(2)). A driver who does not need a CDL still carries it
- If the examiner finds you are not qualified, the examiner reports it to FMCSA and all your earlier certificates stop being valid (49 CFR 391.43(g))
- FMCSA can grant a medical variance, an exemption letter or a skill performance evaluation certificate. If you have one, carry the papers (49 CFR 391.41(a)(1)(ii))
How often you need a DOT physical
| How often | Rule | |
|---|---|---|
| Most drivers | At least every 24 months | 49 CFR 391.45(b) |
| Insulin-treated diabetes, with a certificate under the 391.46 standards | Every 12 months | 49 CFR 391.45(e) |
| Vision exemption, for a driver who does not meet the standard in the worse eye | Every 12 months | 49 CFR 391.45(f) |
| Driver who works only in an exempt intracity zone | Every 12 months | 49 CFR 391.45(c) |
| Driver whose ability to do the job is impaired by an injury or illness | Before returning to work, in a new exam | 49 CFR 391.45(g) |
| Driver found not physically qualified on or after June 23, 2025 | A new exam to qualify again | 49 CFR 391.45(h) |
Who needs a DOT physical?
Anyone subject to 49 CFR Part 391 who drives a commercial motor vehicle (49 CFR 391.41(a)). In interstate commerce, a CMV is a vehicle rated 10,001 pounds or more. It is also a vehicle that carries more than 8 people for pay, or more than 15 people not for pay. A vehicle with hazmat that needs placards counts too (49 CFR 390.5). If you hold a CDL and you certify that you drive across state lines in non-excepted work, you must be medically certified (49 CFR 383.71(b) and (h)). A pickup and a trailer can count, if their combined rating is 10,001 pounds or more.
Who can give the exam, and what happens at it?
The exam must be done by a medical examiner on the National Registry of Certified Medical Examiners (49 CFR 391.43(a)). A licensed eye doctor may do the vision part, and a certified VA examiner may examine veterans (49 CFR 391.43(b)). The examiner records the exam on the Medical Examination Report, Form MCSA-5875. By midnight of the next calendar day, the examiner sends the results to FMCSA online (49 CFR 391.43(g)). The examiner may delay the decision to get more information. You then have 45 days to give it or finish more tests, and FMCSA is told the exam is pending (49 CFR 391.43(g)(4)). You can search for an examiner on the National Registry website.
What do you have to meet to pass?
The standards are in 49 CFR 391.41(b). You must not have lost a foot, leg, hand or arm, unless FMCSA gave you a skill performance evaluation certificate. You must have no condition likely to cause loss of control. Epilepsy and a heart condition that can cause fainting are examples. The same goes for lung disease, high blood pressure and mental illness if they would interfere with safe driving. You must have no current clinical diagnosis of alcoholism. Insulin-treated diabetes is allowed only under 49 CFR 391.46. For vision, you need 20/40 in each eye, with or without glasses. You need a field of vision of at least 70 degrees in each eye. You must tell red, green and amber lights apart. For hearing, you must hear a forced whisper at 5 feet in your better ear. Or you must pass a hearing test with a loss no greater than 40 decibels. You must not use Schedule I drugs, amphetamines, narcotics or other habit-forming drugs. You may use other prescribed drugs. The practitioner must know your history and say they will not hurt your driving.
Do you still have to carry a medical card?
It depends on your license. Since June 23, 2025, a driver who must hold a CDL or a CLP does not have to carry the medical examiner's certificate (49 CFR 391.41(a)(2)). The examiner does not give a paper certificate to these drivers. FMCSA sends the results to your state, which posts your medical status on your driver record (49 CFR 383.71(h)). A driver who does not need a CDL or CLP gets the original certificate from the examiner and must carry the original or a copy when on duty (49 CFR 391.41(a)(1) and 391.43(g)). If you have a medical variance, such as an exemption letter, carry that paper too. If FMCSA's electronic record and a paper certificate disagree, the electronic record controls (49 CFR 391.41(a)(2)).
How long does a DOT medical certificate last?
You must be examined and certified at least every 24 months (49 CFR 391.45(b)). Some drivers need an exam more often, as the table above shows. If you do not meet the standards when you are examined, you are not qualified. The examiner tells you, FMCSA is told, and all of your earlier certificates stop counting (49 CFR 391.43(g)(3)). You must pass a new exam before you drive again (49 CFR 391.45(h)). A CDL holder whose medical status is not certified can have the CDL downgraded by the state (49 CFR 383.71(h)(2)).
What if you do not meet a standard?
FMCSA runs programs for some conditions. A driver with vision in one eye below the standard can apply for a vision exemption (49 CFR 391.44). A driver with insulin-treated diabetes can be certified under 49 CFR 391.46. A driver who lost a limb or has a limb impairment can ask for a skill performance evaluation certificate (49 CFR 391.49). These are medical variances. If your examiner and your carrier's examiner disagree about whether you qualify, the rule has a way to settle it. You, or the carrier, apply with the opinion of an impartial medical specialist (49 CFR 391.47).
Who is exempt from the DOT physical?
Some drivers are outside the rule. They are custom harvesting drivers hauling farm machinery, supplies or crops, and beekeepers moving bees by season (49 CFR 391.2(a) and (b)). Farm vehicle drivers are also outside it, unless they drive an articulated combination (49 CFR 391.2(c)). Drivers of covered farm vehicles are exempt from the physical qualification rules (49 CFR 391.2(d)). So are drivers of pipeline welding trucks (49 CFR 391.2(e)). A state can have its own rules for drivers who stay in one state, so check with your state.
Related Free Tools
DOT Audit Readiness Checklist
An interactive compliance checklist to get ready for a DOT compliance review.
Hours of Service (HOS) Tracker
Full 49 CFR Part 395 tracking. It covers the daily log, 14-hour window, 30-minute break, and the real 60/70-hour weekly rule with 34-hour restart detection.
Drug & Alcohol Testing Tracker
Track DOT-required random testing compliance. FMCSA minimums: 50% drug, 10% alcohol.
CDL & Compliance Deadline Tracker
Track all compliance deadlines in one place with color-coded alerts.
Frequently Asked Questions
Does every CDL driver need a DOT physical?+
A CDL driver who certifies to non-excepted interstate driving must be medically certified (49 CFR 383.71(b) and (h)). Drivers who only do excepted work, such as some farm driving, or who drive only inside one state may follow different rules. Check your state's rules for in-state driving.
Can my regular doctor do my DOT physical?+
Only if the doctor is a medical examiner listed on FMCSA's National Registry. An exam from anyone else does not count (49 CFR 391.43(a)). An eye doctor may do the vision part of your exam.
Do I still carry my medical card if I have a CDL?+
Not since June 23, 2025, if you must hold a CDL or a CLP (49 CFR 391.41(a)(2)). Your medical status shows on your driver record. If you do not need a CDL, you still carry your certificate. Carry any medical variance papers too.
How often do I need a DOT physical?+
At least every 24 months. Every 12 months if you have insulin-treated diabetes certified under 49 CFR 391.46, or a vision exemption (49 CFR 391.45). Sooner if an injury or illness hurts your ability to do the job.
What happens if I fail the DOT physical?+
The examiner tells you that you are not qualified and reports it to FMCSA. Your earlier certificates stop counting. You need a new exam to qualify again, and you may be able to apply for a medical variance in some cases (49 CFR 391.43(g), 391.45 and 391.49).
Can I drive with a prescription medicine?+
Yes, if the practitioner who prescribed it knows your medical history and says it will not affect your driving. Schedule I drugs, amphetamines, narcotics and other habit-forming drugs are not allowed (49 CFR 391.41(b)(12)).
More federal trucking rules
- Hours of Service Rules for Truck Drivers
- ELD Mandate: Who Needs an ELD
- DOT Roadside Inspection Levels Explained
- DOT Drug and Alcohol Testing Rules
- Driver Qualification File Requirements
- DVIR and Vehicle Maintenance Rules
- New Entrant Safety Audit Requirements
- Hours of Service Exceptions and Exemptions
- Motor Carrier Insurance Requirements
- CDL Classes, Endorsements and ELDT Training
- Drug and Alcohol Clearinghouse Requirements
- Cargo Securement Rules for Trucks
- Hazmat Basics for Truck Drivers and Carriers
- USDOT Number and Biennial Update Requirements
- Safety Ratings, Compliance Reviews and DataQs
- Federal Truck Size and Weight Limits
- California Clean Truck Check (HD I/M)
- Truth-in-Leasing Rules for Owner-Operators
- Form 2290 Heavy Highway Vehicle Use Tax
- Truck Driver Phone, Texting and Seat Belt Rules
- Railroad Crossing Rules for Truck Drivers
- Truck Emergency Equipment and Warning Triangle Rules
- Truck Windshield, Dash Cam and Mirror Rules
- CDL Disqualification: Major and Serious Offenses
- Truck Tire Rules: Tread Depth, Retreads and Pressure
- Trailer Reflective Tape (Conspicuity) Rules
- Truck Brake Rules: Pushrod Stroke, Lining Thickness and ABS
- Driver Conduct Rules: Alcohol, Drugs, Fatigue, Passengers and Pre-Trip Checks
- English Language Proficiency for Truck Drivers: The 391.11(b)(2) Rule
- Weigh Station Rules: Who Must Stop and What Happens If You Skip
- Truck Lighting Rules: Required Lamps and Reflectors (49 CFR 393)
- Driver Road Test Rules: The Company Road Test and Certificate (49 CFR 391.31)
Sources
- 49 CFR 391.41, Physical qualifications for drivers (eCFR)
- 49 CFR 391.43, Medical examination; certificate of physical examination (eCFR)
- 49 CFR 391.45, Persons who must be medically examined and certified (eCFR)
- 49 CFR 391.2, General exceptions (eCFR)
- 49 CFR 390.5, Definitions: commercial motor vehicle (eCFR)
- FMCSA National Registry of Certified Medical Examiners
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This is a plain-language summary for reference, not legal advice. Check the official rule text before you rely on any detail. Ask a compliance professional about your own operation.