The DOT Physical: The CDL Medical Exam, Explained (2026)
A DOT physical is the federal medical exam that decides whether you are physically qualified to drive a commercial motor vehicle. Here is who needs one, what happens at the exam, and how the certificate works — in plain English, with links to the exact standards.
Quick answer
- What it is
- A federal medical exam that decides if you are physically qualified to drive a commercial vehicle (49 CFR Part 391, Subpart E)
- Who performs it
- A medical examiner listed on the FMCSA National Registry of Certified Medical Examiners
- What you get
- A Medical Examiner's Certificate (Form MCSA-5876) — the document commonly called the “DOT medical card”
- How long it lasts
- Up to 24 months. The examiner can issue a shorter card (often 1 year or less) if a condition needs monitoring
- Since June 23, 2025
- Under National Registry II, examiners send results to FMCSA electronically; the data flows to your state licensing agency
Requirements verified July 20, 2026 against FMCSA (49 CFR Part 391)
Who needs a DOT physical
The federal rule (49 CFR Part 391, Subpart E) requires drivers who operate a commercial motor vehicle in interstate commerce — across state lines, or as part of a trip that crosses state lines — to be medically examined and certified, unless they fall under a specific exception. A driver must be re-examined if they have not been certified within the previous 24 months.
If you drive only within your own state (intrastate), your state sets the medical rules, and they differ from state to state. That is why the medical requirement is tied to the category you pick when you self-certify with your state licensing agency — more on that below and on our CDL medical card page.
| Code | Category | Who it fits | Medical card? |
|---|---|---|---|
| NI | Non-excepted Interstate | You drive (or plan to) across state lines and are subject to the federal Part 391 rules. | Yes — you must have a current DOT medical certificate on file. |
| EI | Excepted Interstate | You drive across state lines but only in operations the federal rules specifically except (e.g., certain government, custom-harvester, or non-business driving). | No federal medical card required — you certify you are excepted. |
| NA | Non-excepted Intrastate | You drive only within your own state and are subject to your state’s driver rules. | Per your state — some states require a medical card, some don’t. |
| EA | Excepted Intrastate | You drive only within your state and only in operations your state excepts from its driver rules. | No — you certify you are excepted under state rules. |
Source: 49 CFR 383.71. Most people getting a truck-driving job pickNI (Non-excepted Interstate). If you’re unsure which applies, ask your employer or your state licensing agency — choosing wrong can put a hold on your CDL.
The short version: only non-excepted drivers carry a federal medical certificate. Most people taking a truck-driving job with a CDL choose NI (Non-excepted Interstate) and need the card.
What happens at the exam
A DOT physical is a standardized exam, not a general check-up. A certified medical examiner reviews your health history and current medications, then measures and checks the areas the federal standard covers. In general terms, the exam typically includes:
- Health history — you complete a form on past and current conditions, surgeries, and medications.
- Vision — acuity in each eye, field of vision, and the ability to recognize traffic-signal colors.
- Hearing — a forced-whisper test or an audiometry (decibel) test.
- Blood pressure and pulse.
- Urinalysis — a basic screen (this is not the same as a drug test).
- A physical examination covering the body systems listed in the standard — heart, lungs, neurological, and more.
The examiner then makes a determination: certified, certified for a shorter period, certified with a condition (such as “must wear corrective lenses”), or not certified. See the exact medical standards on ourDOT physical requirements page, and the conditions that can affect certification on theDOT physical disqualificationspage.
The National Registry of Certified Medical Examiners
Not just any doctor can perform a DOT physical. Federal rule 49 CFR 391.43(a) requires the exam to be done by a medical examiner listed on theNational Registry of Certified Medical Examiners. These are clinicians — physicians, physician assistants, nurse practitioners, chiropractors, and others allowed by state law — who have completed the FMCSA training and testing and are listed in a national database.
You can confirm any examiner is currently listed using the free public lookup:
nationalregistry.fmcsa.dot.gov/search-medical-examiners
Search by name, city, state, or ZIP to find a nearby certified examiner or to verify the one you plan to see. An exam performed by someone not on the registry does not count.
The Medical Examiner's Certificate (Form MCSA-5876)
When you pass, the examiner issues a Medical Examiner's Certificate on Form MCSA-5876. This is the document most people call the“DOT medical card.” It records that you met the physical qualification standard on the exam date, any restrictions (for example, corrective lenses), and the date the certification expires.
How long it lasts
The maximum validity is 24 months (49 CFR 391.45). The examiner can issue a shorter card when a condition needs to be re-checked sooner — for instance, high blood pressure is often certified for one year or less, and insulin-treated diabetes is capped at 12 months. A shorter interval is a medical determination the examiner makes; it is not a penalty.
The June 23, 2025 change: National Registry II
On June 23, 2025, the FMCSA National Registry II (NRII) compliance date took effect. Under NRII, certified examiners transmit exam results to the National Registry electronically— by the end of the next calendar day — and that data flows automatically to State Driver Licensing Agencies.
What this means for drivers: in states that have fully moved to the electronic system, the paper MCSA-5876 is no longer the authoritative proofthat goes into your license file — the electronic record is. The rollout is phased, so the exact experience depends on your state. Check with your examiner and your state agency about whether you still need to hand in a paper card. Either way, keep any certificate the examiner gives you.
What to read next
- CDL medical cardWhat the card is, self-certification, submitting it to your state, and what happens if it lapses.
- DOT physical requirementsThe exact qualification standards: vision, hearing, blood pressure, diabetes, seizures, sleep apnea, and waivers.
- DOT physical disqualificationsConditions that can affect certification — and the legitimate exemption and waiver paths.
See also: CDL disqualifications (driving offenses, a separate topic from medical), how to get a CDL, and your state’s rules — for exampleTexas.
DOT physical FAQ
Who needs a DOT physical?
Most drivers who operate a commercial motor vehicle across state lines (interstate) and are subject to the federal safety rules must be medically examined and certified. If you drive only within one state (intrastate), your state’s medical rules apply instead, and they vary. When you get a CDL you also self-certify which category you fall into.
How long is a DOT physical good for?
A Medical Examiner’s Certificate is valid for a maximum of 24 months. The examiner can issue a card for a shorter period — for example, one year or less — when a condition such as high blood pressure or diabetes needs to be re-checked sooner. The exact interval is the examiner’s call.
Do I still get a paper medical card?
It depends on your state. Since National Registry II took effect on June 23, 2025, examiners transmit results to FMCSA electronically, and that record flows to state licensing agencies. In states that have fully moved to the electronic system, the paper MCSA-5876 is no longer the required proof for your license file. Ask your examiner and your state agency what applies where you live.
How do I check that my examiner is certified?
Use the free public lookup at nationalregistry.fmcsa.dot.gov/search-medical-examiners. Only an examiner listed there can perform your DOT physical and issue a valid certificate. Searching by name or location before your appointment is a good habit.
What happens if my medical card expires?
If your certification lapses or is missing from your record, your state marks your status as “not-certified” and, under federal rules, downgrades your CDL to a regular license — typically within 60 days. You keep a personal driver license but lose commercial driving privileges until you re-certify and the record is updated.
Official sources
Every requirement on this page traces to one of these official sources.