The DOT Physical for CDL Drivers: What to Expect

Written by the America’s Driving Force team · Reviewed by Joel Curtis, retired professional truck driver · Published October 5, 2026 · Last reviewed October 5, 2026 · Sources are listed at the end

A DOT physical is the medical exam that qualifies you to drive a commercial motor vehicle. It must be done by an examiner listed on FMCSA's National Registry, follows the standards in 49 CFR 391.41, and is valid for up to 24 months, or less if the examiner wants to monitor a condition. This guide covers the vision and hearing standards, medications, diabetes, certificate length and what happens after the exam.

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What the DOT physical is

The DOT physical is the medical exam that shows you are healthy enough to drive a commercial motor vehicle (CMV). FMCSA’s driver physical qualification page explains that the exam you take for your Medical Examiner’s Certificate, Form MCSA-5876, confirms that you are healthy enough to safely perform the demanding job of a CMV driver. If the examiner finds you physically qualified, you receive the certificate and, in most cases, you can keep driving or move on to getting your CDL.

Under 49 CFR 391.41, a person subject to the rule must not operate a CMV unless medically certified as physically qualified to do so. This guide walks through who can perform the exam, what the federal standards say, how long the certificate lasts and what happens afterward. It is general information based on federal pages we read in October 2026, not medical advice, so confirm details with a certified medical examiner and your state licensing agency.

Who can perform the exam

You cannot go to just any doctor. According to FMCSA’s page on the DOT medical exam, the exam must be conducted by a licensed medical examiner listed on FMCSA’s National Registry of Certified Medical Examiners. FMCSA says the term includes, but is not limited to, doctors of medicine (MD), doctors of osteopathy (DO), physician assistants (PA), advanced practice nurses (APN) and doctors of chiropractic (DC).

The federal regulation says the same thing. 49 CFR 391.43 requires the exam to be performed by an examiner on the National Registry, with two exceptions. A licensed ophthalmologist or optometrist may perform the part of the exam that covers visual acuity, field of vision and color recognition, and a certified VA medical examiner must only examine veteran operators. You can look up examiners through the National Registry website.

What the federal standards say

The exam is recorded on the Medical Examination Report, Form MCSA-5875. The standards the examiner applies are in 49 CFR 391.41(b). In summary, the regulation says a person is physically qualified if they:

have no loss of a foot, leg, hand or arm, and no impairment of a hand, finger, arm, foot or leg that interferes with the normal tasks of operating a CMV, unless they have been granted a skill performance evaluation certificate;
have no current clinical diagnosis of a heart condition of a kind known to be accompanied by fainting, shortness of breath, collapse or congestive heart failure, and no current diagnosis of high blood pressure likely to interfere with safe operation;
have no respiratory condition, rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease that interferes with controlling and operating a CMV safely;
have no history or diagnosis of epilepsy or any other condition likely to cause loss of consciousness or loss of ability to control a CMV;
have no mental, nervous, organic or functional disease or psychiatric disorder likely to interfere with safe driving, and no current clinical diagnosis of alcoholism;
do not use a Schedule I drug, an amphetamine, a narcotic or another habit-forming drug, and do not use other controlled substances unless prescribed by a licensed practitioner who knows the driver’s medical history and has advised that the substance will not adversely affect safe driving.

The wording says “likely to interfere” and “known to be accompanied by,” which means the examiner makes a judgment about each condition rather than applying a single list of banned diagnoses. FMCSA’s own regulation points examiners to its medical advisory criteria as guidelines.

Vision and hearing requirements

Two of the standards are numerical, and both appear in 49 CFR 391.41(b).

Area	Standard in the regulation
Vision	Distant acuity of at least 20/40 in each eye, with or without correction, and at least 20/40 in both eyes together; a field of vision of at least 70 degrees in the horizontal meridian in each eye; and the ability to recognize standard red, green and amber traffic signals.
Hearing	First perceives a forced whispered voice in the better ear at not less than 5 feet, with or without a hearing aid; or, if tested with an audiometric device, an average hearing loss in the better ear of no more than 40 decibels at 500, 1,000 and 2,000 Hz, with or without a hearing aid.

A driver who does not meet the vision standard in the worse eye or the field of vision standard may qualify through a separate process under 49 CFR 391.44, which the regulation references. FMCSA lists a General Vision Exemption Package on its medical page for that route.

Diabetes and medications

Insulin-treated diabetes used to be a blanket barrier. As FMCSA’s diabetes standard page describes, a final rule published on September 19, 2018 revised the standard so that certified medical examiners on the National Registry, in consultation with the driver’s treating clinician, can evaluate whether to grant an insulin-treated driver a medical examiner’s certificate. FMCSA says that is why a separate federal diabetes exemption program is no longer necessary. The regulation (391.41(b)(3)) points to 49 CFR 391.46 for drivers who are treated with insulin.

Medications matter too. The regulation does not ban prescription medicine outright. It focuses on whether a substance is a Schedule I drug, an amphetamine, a narcotic or another habit-forming drug, and, for other controlled substances, on whether a practitioner who knows your history has advised that it will not adversely affect your ability to drive safely. Bring a list of what you take so the examiner can review it with you.

How long the certificate lasts

FMCSA’s page says a DOT physical exam is valid for up to 24 months, and that the examiner may issue a certificate for less than 24 months when it is desirable to monitor a condition, such as high blood pressure. 49 CFR 391.45 backs this up. It requires a new exam for any driver who has not been certified during the preceding 24 months, and it sets a 12-month window for other groups, including:

drivers with insulin-treated diabetes who obtained a certificate under the 391.46 standards;
drivers who do not meet the vision standard in the worse eye or the field of vision standard and who obtained a certificate under 391.44; and
drivers authorized to operate only within an exempt intracity zone.

The same section also requires a new exam for any driver whose ability to perform normal duties has been impaired by a physical or mental injury or disease. A shorter certificate is not a failure; it is the examiner’s way of scheduling a follow-up.

What happens after the exam

After the exam, 49 CFR 391.43 sets out what the examiner does:

If you qualify: the examiner signs the Medical Examination Report, completes the Medical Examiner’s Certificate (Form MCSA-5876) and gives you the original. FMCSA’s exam page says the examiner furnishes one copy of the results to the person examined.
If you do not qualify: on or after June 23, 2025, the examiner must tell you that you are not physically qualified and that this will be reported to FMCSA. Any certificates previously issued to you are no longer valid.
If more information is needed: the examiner must tell you that the additional information or further examination must be completed within 45 days, and that the pending status will be reported to FMCSA.
Reporting and records: the examiner must electronically transmit your results to FMCSA by midnight local time of the next calendar day, and must keep the report and a copy of the certificate on file for at least 3 years.

Do you have to carry the certificate? Under 391.41(a), a driver required to hold a CDL or commercial learner’s permit, with a current certificate, no longer needs to carry it on or after June 23, 2025. Drivers who obtained the certificate through an FMCSA exemption or skill performance evaluation must still carry the variance paperwork. If FMCSA’s electronic information conflicts with a paper certificate, the electronic information controls. Drivers who do not need a CDL are still expected to carry the original or a copy, so check which group you fall into.

Preparing for your exam

A practical way to prepare, based on what the exam covers: find an examiner on the National Registry, bring your glasses or hearing aids if you use them, and bring a list of your medications and the names of the clinicians who treat any ongoing condition. If you have a condition that the examiner needs more information about, ask the examiner exactly what documentation is needed and by when, remembering the 45-day limit in the regulation.

The exam is one piece of getting licensed. For the other pieces, see our guides on entry-level driver training, Class A and Class B licenses and what CDL training costs, and browse trucking companies in every state when you are ready to look for work. FMCSA’s medical pages were last updated between 2019 and 2023 when we read them, and the regulations change from time to time, so confirm current details with FMCSA or your examiner.

Frequently asked questions

How long is a DOT physical good for?

According to FMCSA, a DOT physical exam is valid for up to 24 months. The examiner may issue a certificate for less than 24 months when it is desirable to monitor a condition such as high blood pressure, and some drivers must be re-examined every 12 months under 49 CFR 391.45.

Who is allowed to do a DOT physical?

A licensed medical examiner listed on FMCSA's National Registry of Certified Medical Examiners. FMCSA says this can include MDs, DOs, physician assistants, advanced practice nurses and chiropractors. A licensed ophthalmologist or optometrist may do only the vision part of the exam.

What are the vision requirements for a CDL driver?

The regulation requires distant acuity of at least 20/40 in each eye with or without correction, 20/40 in both eyes together, a horizontal field of vision of at least 70 degrees in each eye, and the ability to recognize red, green and amber signals. A separate process exists for drivers who do not meet the standard in the worse eye.

Can a driver with insulin-treated diabetes get a DOT medical certificate?

Since a final rule published on September 19, 2018, certified medical examiners can evaluate insulin-treated drivers, in consultation with the treating clinician, and decide whether to grant a certificate. Under 49 CFR 391.45 the exam for these drivers is repeated within 12 months.

What happens if the examiner finds I am not physically qualified?

On or after June 23, 2025, the examiner must tell you that you are not physically qualified and that this will be reported to FMCSA, and any certificates previously issued to you are no longer valid. If more information is needed, the examiner must tell you to provide it within 45 days.

Related guides

About the reviewer

Joel Curtis is a retired professional truck driver with more than 30 years of over-the-road experience in Canada and the United States. He reviews our guides for practical accuracy from a driver’s point of view. Every guide is built from the official sources listed below.

Sources

49 CFR 391.41: Physical qualifications for drivers, Electronic Code of Federal Regulations
49 CFR 391.43: Medical examination; certificate of physical examination, Electronic Code of Federal Regulations
49 CFR 391.45: Persons who must be medically examined and certified, Electronic Code of Federal Regulations
DOT Medical Exam and Commercial Motor Vehicle Certification, Federal Motor Carrier Safety Administration
Driver Physical Qualification, Federal Motor Carrier Safety Administration
FMCSA Eliminates the Federal Diabetes Exemption Program, Federal Motor Carrier Safety Administration
National Registry of Certified Medical Examiners, Federal Motor Carrier Safety Administration

This guide is general information, not legal or financial advice. Rules, fees and requirements change, so confirm current details with the agencies listed above and your state before you act.

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