To get a DOT medical card, you need to pass a physical exam performed by a certified medical examiner listed on the FMCSA’s National Registry. The exam covers vision, hearing, blood pressure, and a urinalysis, and the entire process can usually be completed in a single appointment. If you pass, you’ll receive a Medical Examiner’s Certificate (commonly called a “medical card”) that’s valid for up to two years.
Who Needs a DOT Medical Card
All commercial drivers operating vehicles in interstate commerce with a gross vehicle weight rating over 10,000 pounds are required to hold a valid medical card. This includes most truck drivers, bus drivers, and anyone hauling heavy loads across state lines. If you hold a commercial driver’s license (CDL), you also need to file a self-certification with your state’s driver licensing agency declaring which type of commercial driving you do. That self-certification determines whether you’re subject to the federal medical exam requirement.
Some drivers operating only within their home state (intrastate) may also need a medical card depending on state regulations, so check with your state DMV if you’re unsure.
How to Find a Certified Examiner
You can’t just visit any doctor. The exam must be conducted by a medical examiner who is certified and listed on the FMCSA’s National Registry of Certified Medical Examiners. These include physicians, chiropractors, physician assistants, nurse practitioners, and other licensed providers who have completed FMCSA-specific training.
To find one near you, use the search tool at nationalregistry.fmcsa.dot.gov. You can search by city, state, or zip code and filter by distance. Most urban areas have dozens of certified examiners within a 10-mile radius, including urgent care clinics, occupational health centers, and trucking company health offices. Costs typically range from $75 to $150, though prices vary by location and provider. Most health insurance plans do not cover the exam since it’s considered an occupational requirement.
What Happens During the Exam
The DOT physical is straightforward but thorough. Plan on spending 30 to 60 minutes at the appointment. Here’s what the examiner will check:
- Vision: You need at least 20/40 acuity in each eye (with or without glasses or contacts) and at least 70 degrees of peripheral vision in each eye. You also need to correctly identify standard red, green, and amber traffic signal colors.
- Hearing: You must be able to hear a forced whisper from at least 5 feet away, or have an average hearing loss of less than 40 decibels in your better ear. Hearing aids are allowed.
- Blood pressure: The examiner will take at least two readings. If your blood pressure is below 140/90, you qualify for the full two-year certification. Higher readings shorten your certification period or require a follow-up (more on that below).
- Urinalysis: You’ll provide a urine sample. This checks for protein, blood, or sugar that might indicate an underlying condition like kidney disease or diabetes. This is not a drug test, though your employer may require a separate drug screening.
Beyond these specific tests, the examiner will review your full medical history and perform a general physical. They’ll check your heart, lungs, abdomen, spine, and extremities. You’ll be asked about medications you take, any surgeries you’ve had, and conditions like sleep apnea, seizures, or heart disease. Bring a list of your current medications, the name and phone number of your treating doctor, and any relevant medical records, especially if you have a condition that requires documentation.
Blood Pressure and Certification Length
Blood pressure is one of the most common reasons drivers receive a shorter certification or get temporarily disqualified. The thresholds work like this:
- Below 140/90: Full two-year certification.
- 140-159 over 90-99 (Stage 1): You’ll receive a one-time certificate for up to one year. If your reading falls between 141-159/91-99, you may initially get a three-month certificate and need to return with a lower reading to extend it.
- 160-179 over 100-109 (Stage 2): You’ll get a one-time three-month certificate. You need to bring your blood pressure below 140/90 to receive a one-year certification.
- 180/110 or higher (Stage 3): You’re disqualified at that visit. Once you get below 140/90 with treatment, you can be certified for six months.
If you know your blood pressure runs high, work with your personal doctor to get it under control before scheduling your DOT physical. There’s no rule against retaking the exam after getting treatment.
Conditions That Can Disqualify You
Four conditions are specifically disqualifying under federal regulations: significant hearing loss, vision loss beyond correctable limits, epilepsy, and insulin-treated diabetes. However, disqualification doesn’t always mean permanent. Drivers with insulin-treated diabetes or certain vision deficiencies can apply for a federal exemption through the FMCSA. Once granted, these exemptions allow you to drive with a one-year medical certification that must be renewed annually.
Other conditions don’t automatically disqualify you but may lead to a shorter certification period or require additional documentation. Heart disease, sleep disorders like sleep apnea, and diabetes controlled without insulin all fall into this category. If you use a CPAP machine for sleep apnea, for example, bring your compliance data showing regular use. The examiner has discretion to issue a shorter certificate if they believe a condition needs more frequent monitoring.
After You Pass: Filing Your Card
When you pass the exam, the examiner will issue you a paper Medical Examiner’s Certificate (Form MCSA-5876). Keep this with you. If you hold a CDL or commercial learner’s permit, you have an additional step: you must submit a copy of your new certificate to your state’s driver licensing agency before your current one expires. If you don’t, your CDL can be downgraded, which means you’d lose your commercial driving privileges until you provide the updated documentation.
The system is currently transitioning to electronic submission. Under the National Registry II rule, certified medical examiners are now required to transmit your exam results electronically to the FMCSA, which then shares the data with your state. However, this transition is still underway. As of mid-2025, the FMCSA issued a temporary waiver allowing drivers and carriers to rely on a paper copy of the medical certificate as proof of medical certification for up to 60 days after it’s issued, while state agencies and examiners continue adapting to the electronic system. The FMCSA recommends that examiners continue issuing paper certificates alongside electronic submissions until further notice. In short, still keep your paper card and still submit it to your state DMV yourself to avoid any gaps.
How Long the Card Lasts
A standard DOT medical card is valid for two years from the date of the exam. Drivers with certain health conditions will receive shorter certifications, typically one year, with the expectation of annual renewals. Conditions that commonly trigger one-year certifications include hypertension that’s stable on medication, heart disease, diabetes (whether on insulin with an exemption or managed by other means), and sleep disorders requiring treatment compliance monitoring.
There’s no grace period once your card expires. If it lapses, you cannot legally operate a commercial vehicle until you pass a new exam and file the updated certificate with your state. Many drivers set a reminder 60 to 90 days before expiration to schedule their next appointment, giving themselves time to address any issues that come up during the exam without risking a gap in their certification.