Trucking Careers · Nationwide · October 23, 2026

DOT Physical and Medical Card Basics for Truck Drivers

A clean semi truck parked in the lot of a small one story medical clinic on a sunny morning — Illustration for this story. Not a photo of a specific location.

The DOT physical is a routine part of a trucking career, and it comes around every couple of years or sooner. For drivers 45 and older, and retired drivers thinking about a return to the road, knowing the rules ahead of time takes much of the worry out of exam day. This guide covers who needs a medical certificate, what the exam checks and how renewal works. It is general information, not medical or legal advice.

Who needs a DOT physical

The federal physical standards are in 49 CFR 391.41. A person covered by that part may not drive a commercial motor vehicle unless medically certified as physically qualified.

Under 49 CFR 390.5, a commercial motor vehicle in interstate commerce includes a vehicle with a weight rating or actual weight of 10,001 pounds or more, vehicles designed or used to carry more than 8 passengers for pay or more than 15 without pay (both counts include the driver), and vehicles hauling placarded hazardous materials.

CDL self-certification

CDL and CLP holders tell their state which of four categories fits them, under 49 CFR 383.71:

Non-excepted interstate: drives across state lines and must get a medical certificate
Excepted interstate: drives across state lines only in operations excepted from that rule
Non-excepted intrastate: drives within one state and follows that state's rules
Excepted intrastate: drives within one state in operations excepted from state rules

The full licensing path is in the guide on how to get a CDL step by step.

Who does the exam

Under 49 CFR 391.43, the exam must be done by a medical examiner listed on the National Registry of Certified Medical Examiners, run by the Federal Motor Carrier Safety Administration (FMCSA). FMCSA says that includes medical doctors, doctors of osteopathy, physician assistants, advanced practice nurses and chiropractors. Under 49 CFR 390.103, each examiner must complete training and pass an FMCSA test. FMCSA's driver medical page links to a tool to find one.

How long a medical card lasts

FMCSA says a DOT physical is valid for up to 24 months. The examiner may issue a certificate for less time when it makes sense to monitor a condition, such as high blood pressure. Under 49 CFR 391.45, drivers certified under the insulin rule or the alternative vision rule must be examined at least every 12 months.

What the exam checks

The standards in 49 CFR 391.41 cover limbs, heart and lung conditions, blood pressure, epilepsy, mental health, vision, hearing, certain drugs and alcoholism. Common ones are below.

Vision

The standard is distant vision of at least 20/40 in each eye, with or without glasses or contacts, and 20/40 using both eyes together. Each eye also needs a field of vision of at least 70 degrees in the horizontal meridian, and the driver must be able to recognize red, green and amber traffic signal colors.

A driver who misses the acuity or field standard in the worse eye may still qualify under 49 CFR 391.44. An eye doctor completes a Vision Evaluation Report (Form MCSA-5871), and the medical exam must begin within 45 days after the eye doctor signs it. The exam is then needed at least once a year. The better eye must still meet 20/40 and 70 degrees, the condition must be stable, and a first-time driver under this rule generally needs a road test.

Hearing

The driver must first hear a forced whisper in the better ear at 5 feet or more. If an audiometric test is used, the average hearing loss in the better ear cannot be more than 40 decibels at 500, 1,000 and 2,000 Hz. Hearing aids may be used for either test. Appendix A to Part 391 notes that FMCSA has a hearing exemption program for drivers who do not meet the standard.

Blood pressure

The rule itself says a driver may not have a current clinical diagnosis of high blood pressure likely to interfere with safe driving. Appendix A gives examiners advisory guidance, which it says does not have the force of law:

Stage 1 (140 to 159 over 90 to 99): may be certified for 1 year, with yearly exams after that at 140/90 or lower
Stage 2 (160 to 179 over 100 to 109): may get a one time 3 month certificate to start or adjust treatment, then 1 year once blood pressure is 140/90 or lower
Stage 3 (180 over 110 or higher): should not be certified until blood pressure is 140/90 or lower, then may be certified for 6 months at a time

Diabetes treated with insulin

Drivers who use insulin can qualify under 49 CFR 391.46. The treating clinician who prescribes the insulin completes an Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870). The medical exam must happen at least yearly and within 45 days after the clinician signs that form.

Drivers must keep blood glucose records on an electronic meter that stores the date and time of each reading. Without at least 3 months of those records, a certificate can last no more than 3 months, and a severe low blood sugar episode stops driving until a clinician clears the driver.

Missing or impaired limbs

Drivers missing a foot, leg, hand or arm, or with certain limb impairments, may qualify with an FMCSA Skill Performance Evaluation certificate under 49 CFR 391.49.

After the exam

If the driver does not qualify, 49 CFR 391.43 says the examiner must tell the driver and report it to FMCSA, and earlier certificates become invalid. If the examiner needs more information, the driver has 45 days to provide it. When a driver's examiner and a carrier's examiner disagree, 49 CFR 391.47 lets either side ask FMCSA to resolve it.

The digital medical card

FMCSA says examiners submit results to the National Registry by midnight of the next day, and since June 23, 2025, results for CDL and CLP holders go electronically to state licensing agencies. The FAQ says a state that has not made the switch still uses a paper certificate the driver submits. Under 49 CFR 391.41, CDL and CLP holders with a current certificate no longer have to carry the card, but covered drivers without a CDL still do, and a driver with a medical variance must carry that paperwork.

Renewal tips for drivers 45 and older

The National Registry FAQ for drivers advises:

Start early. Get the exam well before the current certificate expires, to leave time to fix any errors in transmitting it to the state.
Bring records. A driver with a medical condition should bring supporting paperwork from the treating clinician.
Match the license. Last name, date of birth, licensing state and license number on the exam form should match the license exactly.
Ask for a copy. A paper copy can help sort out transmission problems.
Watch the mail. A driver told they qualified who later gets a CDL downgrade letter should call the examiner first, then the state licensing agency.

For a refresher, try the CDL practice test and the CDL general knowledge test study guide, or browse the trucking companies hiring directory. More free tools are on the Tools page.

Frequently Asked Questions

How long is a DOT medical card good for?

Up to 24 months, according to FMCSA. An examiner can issue a shorter certificate to monitor a condition.

Can a driver who uses insulin get a DOT medical card?

Yes, under 49 CFR 391.46, with a yearly exam, a form from the prescribing clinician and electronic glucose records.

What blood pressure is needed to pass a DOT physical?

The rule bars a current diagnosis of high blood pressure likely to interfere with safe driving. Advisory guidance in Appendix A to Part 391 uses 140/90 as the target, with shorter certificates for higher readings.

Can drivers wear glasses or hearing aids for the DOT physical?

Yes. The vision standard can be met with corrective lenses, and the hearing standard can be met with a hearing aid.

Do CDL drivers still need to carry a paper medical card?

Not since June 23, 2025, for CDL and CLP holders with a current certificate, under 49 CFR 391.41. Drivers with a medical variance must still carry that paperwork.

This guide is general information, not medical or legal advice. Talk with a doctor and a certified medical examiner about any health condition, and check FMCSA and state rules before an exam.