DOT Physical and CDL Medical Card: Rules and Renewal

Written by the Logity Dispatch team for owner-operators and small fleets. We book freight for owner-operators, and a lapsed medical certificate parks a truck as surely as a breakdown does. Every rule below was checked against its own primary source on 28 September 2026: 49 CFR parts 383, 390 and 391 as served by the eCFR API at title 49’s 24 September 2026 issue date. Where we could not source a number, we left it out.

What is a DOT medical card?

“Medical card” is driver shorthand. The regulations call it the medical examiner’s certificate, and the form is MCSA-5876. It is the one-page result of the DOT physical: it says a certified medical examiner looked at you, found you physically qualified under 49 CFR 391.41, and set an expiration date. The full exam is recorded on a longer form, the Medical Examination Report, MCSA-5875, which stays with the examiner.

The basic rule sits in 49 CFR 391.41(a)(1)(i). A person may not operate a commercial motor vehicle unless that person is medically certified as physically qualified to do so. Everything else in this article is detail about who certifies you, for how long, and what happens to your license when the certification runs out.

Which self-certification category are you in?

Before the medical card matters to your license, you have to tell your state what kind of driving you do. Under 49 CFR 383.71(b)(1), every CDL or CLP applicant certifies to exactly one of four categories, and the same certification is required again at renewal under 383.71(d). The category decides whether the state needs your medical certification at all.

Category (383.71(b)(1))	What it means	Does the state need your federal medical certification?
Non-excepted interstate	You drive, or expect to drive, in interstate commerce and you are subject to the federal physical qualification rules in part 391	Yes. This is the category 383.71(h) applies to
Excepted interstate	You drive in interstate commerce, but exclusively in operations excepted under 390.3(f), 391.2, 391.68 or 398.3	No. This certification states you are not required to obtain a medical examiner’s certificate under 391.45
Non-excepted intrastate	You drive only inside one state and you are subject to that state’s driver qualification rules	Your state’s own rules decide
Excepted intrastate	You drive only inside one state, in operations excepted from all or part of the state’s driver qualification rules	Your state’s own rules decide

An owner-operator hauling broker freight across state lines is usually in the first box. If you pick the wrong one, the paperwork follows the wrong track: a non-excepted interstate driver whose record shows no current medical certification is headed for a downgrade, which we cover below.

What does the DOT physical check?

The standards are the thirteen items in 49 CFR 391.41(b). Most are written as “no current clinical diagnosis” or “no established medical history” of a condition that is likely to interfere with safe driving, which leaves the examiner room for judgment. A few are hard numbers.

Area	What 391.41(b) requires
Limbs	No loss of a foot, leg, hand or arm, and no impairment that interferes with grasping or normal driving tasks, unless you hold a Skill Performance Evaluation certificate under 391.49
Diabetes treated with insulin	Allowed only if you meet 391.46
Heart	No current diagnosis of myocardial infarction, angina, coronary insufficiency, thrombosis, or cardiovascular disease known to come with fainting, shortness of breath, collapse or congestive heart failure
Breathing	No respiratory dysfunction likely to interfere with safe driving
Blood pressure	No current diagnosis of high blood pressure likely to interfere with safe driving
Joints, muscles, nerves	No rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease that interferes with control of the truck
Seizures and blackouts	No history or diagnosis of epilepsy or any other condition likely to cause loss of consciousness or loss of control
Mental health	No mental, nervous, organic or functional disease or psychiatric disorder likely to interfere with safe driving
Vision	At least 20/40 in each eye with or without correction, at least 20/40 with both eyes, at least 70 degrees of horizontal field in each eye, and the ability to recognize red, green and amber signals. If one eye falls short, 391.44 is the alternative route
Hearing	Hear a forced whisper in the better ear at not less than 5 feet, or an average loss in the better ear of no more than 40 decibels at 500, 1,000 and 2,000 Hz. A hearing aid is allowed
Drugs	No use of a Schedule I substance, an amphetamine, a narcotic or another habit-forming drug. Other scheduled drugs only when prescribed by a licensed practitioner who knows your history and has advised you they will not affect safe driving
Alcohol	No current clinical diagnosis of alcoholism

Two items have their own sections in part 391 and their own shorter clock. Under 391.44, a driver who does not meet the vision standard with the worse eye can still qualify if a licensed ophthalmologist or optometrist fills in a Vision Evaluation Report, MCSA-5871, and the medical exam begins not more than 45 days after that report is signed. The better eye must still reach 20/40 and 70 degrees, and a first-time qualification under this section generally requires a road test before driving. Under 391.46, a driver with insulin-treated diabetes needs the treating clinician to complete MCSA-5870, and the medical exam must follow no later than 45 days after the clinician signs it.

Who is allowed to do a DOT physical?

Only a medical examiner listed on FMCSA’s National Registry of Certified Medical Examiners, under 49 CFR 391.43(a). The one carve-out in 391.43(b)(1) is the eye portion: a licensed ophthalmologist or optometrist may perform the part of the exam that covers acuity, field of vision and color recognition. Your family doctor can do the full physical only if he or she is on the registry.

Getting onto the registry is not a formality. Under 49 CFR 390.103, the examiner must be licensed by the state to perform physical examinations (an advanced practice nurse, chiropractor, medical doctor, doctor of osteopathy, physician assistant or other professional the state authorizes), complete accredited training, and pass FMCSA’s certification test. Under 390.109, the credential expires 10 years after it is issued. The registry itself is described in 390.101(a) as a national database of names and contact information for the examiners FMCSA has certified, and it lives at nationalregistry.fmcsa.dot.gov.

The practical point for a driver: a certificate from someone who is not on the registry does not satisfy 391.43(a). Before you book, confirm the examiner’s name is on the registry. The examiner’s National Registry number is one of the fields the state posts to your driver record under 383.73(o)(1)(ii)(B), so an examiner who cannot give you one is a warning sign.

How long is a DOT medical card good for?

At most 24 months. 49 CFR 391.45(b) requires a new exam for any driver who has not been examined and certified during the preceding 24 months. Several groups run on a shorter clock, and the examiner can always certify for less than the maximum when a condition needs closer watching.

Driver	Longest period between exams	Rule
Most drivers	24 months	391.45(b)
Insulin-treated diabetes certified under 391.46	12 months	391.45(e), 391.46(c)
Vision qualified under 391.44	12 months	391.45(f), 391.44(c)
Driver limited to an exempt intracity zone under 391.62	12 months	391.45(c)
Insulin-treated driver without 3 months of electronic glucose records	No more than 3 months	391.46(c)
Skill Performance Evaluation certificate (the SPE itself, not the medical card)	Not more than 2 years	391.49

Blood pressure is a common example. Appendix A to part 391 gives examiners FMCSA’s advisory guidance: a reading of 140 to 159 systolic or 90 to 99 diastolic may be certified for one year, and a reading of 160 to 179 systolic or 100 to 109 diastolic may get a one-time 3-month certification to bring it down to 140/90 or lower. The appendix states plainly that this guidance is strictly advisory and does not have the force of law, so the examiner’s judgment decides. Still, it tells you what a short card usually means.

Two more triggers reset the clock regardless of the date on your card. Under 391.45(g), any driver whose ability to perform normal duties has been impaired by a physical or mental injury or disease must be re-examined. And under 391.46(e), an insulin-treated driver who has a severe hypoglycemic episode (one that needs someone else’s help or causes loss of consciousness, a seizure or a coma) is prohibited from driving until the treating clinician clears the cause and completes a new MCSA-5870.

Do you still have to carry the medical card?

If you hold a CDL or CLP and your certificate is current, no. Under 49 CFR 391.41(a)(2)(i)(B), on or after June 23, 2025, a driver required to have a CDL or CLP who has a current medical examiner’s certificate no longer needs to carry it on his or her person.

The mechanics behind it are in three places. Under 391.43(g)(5)(i)(B), the examiner must send the result to FMCSA electronically on Form MCSA-5850 by midnight local time of the next calendar day after the exam. Under 383.71(h)(3)(ii), FMCSA provides the state with the certificate information for every exam where you were found qualified. And under 383.73(o)(1)(ii), the state posts it to your CDLIS driver record, including the examiner’s name and registry number, the expiration date, any restrictions such as corrective lenses or a hearing aid, and any medical variance.

Three exceptions are worth knowing:

• A driver who does not need a CDL or CLP still gets a paper certificate. Under 391.43(g)(2)(ii), the examiner hands over the original when the person will not be operating a vehicle that requires a CDL or CLP.
• A medical variance still travels with you. Under 391.41(a)(2)(iii), a CDL or CLP holder whose certificate depends on a medical variance from FMCSA (an exemption letter or a Skill Performance Evaluation certificate, as defined in 390.5) must keep the original or a copy of that document at all times when on duty.
• The electronic record wins any argument. Under 391.41(a)(2)(iv) and 383.73(o)(6), if FMCSA’s electronic information and a paper copy disagree, the electronic information controls. A paper card in the cab does not help you if your state record says something else.

For the carrier side, 391.51(b)(6)(ii) says a motor carrier meets its driver qualification file requirement for a CDL holder by pulling the CDLIS motor vehicle record from the current licensing state and placing it in the file. A non-excepted interstate CDL holder without medical certification status on that record is designated “not-certified.”

What happens if the examiner cannot decide on the day?

The exam can be put on hold. Under 49 CFR 391.43(g)(4), when the examiner needs more information or further testing, he or she must tell you that the missing piece has to be provided within 45 days and that the pending status will be reported to FMCSA. A pending exam is not a certificate. Plan the timing so that a pending result does not overlap the end of your current card.

A failed exam has a sharper edge than it used to. Under 391.43(g)(3), on or after June 23, 2025, when the examiner finds you not physically qualified, he or she must tell you so and report it to FMCSA, and all medical examiner’s certificates previously issued to you are not valid. That means an older card that still shows a future date stops counting the moment a new exam finds you unqualified. Under 391.45(h), you then need a new exam before you can be certified again.

If the examiner you chose and an examiner your carrier chose disagree, 49 CFR 391.47 provides a formal route: an application to FMCSA supported by the report of an impartial specialist. Read the whole section before you file. Under 391.47(f), once the application is submitted, the driver is deemed disqualified until FMCSA makes a determination or orders otherwise, so it is not a way to keep driving while you argue.

What happens when your medical card expires?

Two things, on two different clocks. The first is immediate: from the day the certification expires, 391.41(a)(1)(i) no longer lets you operate a commercial motor vehicle. There is no grace period in that rule. The second is the paper chain at your state, which is where the license itself is at stake.

1. Status change. Under 49 CFR 383.73(o)(2)(ii), within 10 calendar days of the certificate or a medical variance expiring, the certificate becoming invalid, or FMCSA voiding it, the state must update your medical certification status to “not certified.”
2. Notice. Under 383.73(o)(4)(i)(A)(2), the state must notify you of the “not-certified” status and tell you that CDL privileges will be removed unless you are examined and certified again, or you change your self-certification to excepted or intrastate driving if the state permits it.
3. Downgrade. Under 383.73(o)(4)(i)(B), the state starts its downgrade procedure, and the downgrade must be completed and recorded within 60 days of your status becoming “not-certified.”

“Downgrade” has a specific meaning in 49 CFR 383.5. It is one of four outcomes: the state lets you change your self-certification to excepted interstate driving; it lets you change to intrastate only, if you meet the state’s own physical rules; it lets you change to excepted intrastate driving; or it removes the CLP or CDL privilege from your license. For an interstate owner-operator, the first three do not keep the truck earning on the loads you actually haul, so in practice the fourth is the one that hurts.

What it takes to get the privilege back after a completed downgrade, and whether retesting is involved, is set by each state’s procedures. We could not source that from the federal text, so we are not going to guess. Ask your licensing agency before the 60 days run out, not after.

How do you keep your medical card from lapsing?

None of this is hard. It just has to happen before the date, not after it. A routine that works:

1. Put the expiration date from your certificate in the same calendar you use for your registration and insurance renewals, with a reminder at least two months out.
2. Book the exam with an examiner you have confirmed on the National Registry. If a condition means you might get a pending result, book earlier, because 391.43(g)(4) gives you 45 days to close it.
3. If you are on insulin or qualify under the vision exception, get the clinician’s MCSA-5870 or the eye doctor’s MCSA-5871 first. The medical exam has to happen within 45 days of that signature.
4. Bring your medication list and any specialist letters you already have. Under 391.43(g)(4), an examiner who needs more information can put the exam on hold, and paperwork you bring on the day is paperwork you do not have to chase afterwards.
5. After the exam, check that your state record shows “certified” with the new expiration date. Under 383.73(o)(6), the electronic record is what counts, so it is worth confirming the update actually landed.
6. Make sure your self-certification category is right at every renewal. 383.71(d) requires it again, and it decides whether the medical rules above apply to your license at all.

If you are new to the job, the medical exam is one step among several. Our guide to how long it takes to get a CDL puts it in order, and CDL license classes A, B and C explains which license you need for which truck. For the wider picture of what an audit looks at in your files, see our DOT compliance guide and what triggers a DOT audit.

Where does a dispatcher fit into this?

Honestly, at the edges. A dispatcher cannot pass your physical for you, and nobody but a registry examiner can decide whether you qualify. What a dispatcher can do is make sure a date on a form does not take the truck off the road in the middle of a good run of freight. A lapsed card does not only stop the next load. It stops every load already booked behind it.

That is the part we help with. Our safety and DOT compliance service keeps driver qualification files in order and sends reminders for renewals and deadlines, and our dispatch service plans loads around the dates you already know about. If you would rather track it yourself, track it. A downgrade that starts with a missed date is the easiest one to prevent.

Frequently asked questions

How long is a DOT medical card valid?

Up to 24 months under 49 CFR 391.45(b). Drivers qualified under the insulin rule in 391.46 or the vision rule in 391.44, and drivers limited to an exempt intracity zone, must be re-examined at least every 12 months. The examiner can certify for a shorter period when a condition needs closer monitoring.

Do I need to carry my DOT medical card?

Not if you hold a CDL or CLP and your certificate is current. Under 49 CFR 391.41(a)(2)(i)(B), on or after June 23, 2025, those drivers no longer need to carry the certificate. You must still carry any medical variance document, such as an exemption letter or a Skill Performance Evaluation certificate.

Can any doctor do a DOT physical?

No. Under 49 CFR 391.43(a), the exam must be performed by a medical examiner listed on FMCSA’s National Registry of Certified Medical Examiners. A licensed ophthalmologist or optometrist may perform only the vision portion.

What happens if my CDL medical certificate expires?

You may not operate a commercial motor vehicle until you are certified again. Under 49 CFR 383.73(o), the state must mark you “not certified” within 10 calendar days, notify you, and complete a downgrade of the CDL within 60 days unless you are re-certified or change your self-certification category.

What does non-excepted interstate mean on a CDL?

It is one of the four self-certification categories in 49 CFR 383.71(b)(1). It means you drive, or expect to drive, in interstate commerce and are subject to the federal physical qualification rules in part 391. Drivers in this category must be medically certified for the state to keep the CDL privilege.

Sources checked on 28 September 2026: 49 CFR 383.5, 383.71 and 383.73; 49 CFR 390.5 and 390.101 through 390.111; 49 CFR 391.41, 391.43, 391.44, 391.45, 391.46, 391.47, 391.49, 391.51 and Appendix A to part 391, all retrieved from the eCFR API at title 49’s 24 September 2026 issue date. Quoted phrases are quoted from those texts. This article explains what the regulations say. It is not medical or legal advice, and only a certified medical examiner can decide whether you qualify.