DOT Medical Card: Who Needs One, How Long It Lasts, What Changed

The DOT medical card is the requirement most often missed by people driving trucks that do not need a CDL. If you drive a commercial motor vehicle in interstate commerce, you need a current medical examiner's certificate, whether the vehicle is an 80,000-lb tractor or a one-ton pickup pulling a trailer. This page covers who needs one, where to get it, how long it lasts and what changed in 2025.

Who needs a DOT medical card

Under 49 CFR 391.41, a person may not drive a commercial motor vehicle unless they are medically certified as physically qualified. For interstate commerce, a commercial motor vehicle includes any vehicle or combination with a GVWR, GCWR or actual weight of 10,001 lb or more (49 CFR 390.5T). That pulls in:

• Class 3 and heavier pickups, vans and box trucks, even when driven solo.
• Lighter pickups and vans when the combined rating with a trailer reaches 10,001 lb, which covers most hotshot and car-hauling rigs. See GVWR vs GCWR.
• Every CDL holder who operates in interstate commerce subject to the medical rules.
• Vehicles designed or used to carry more than 8 passengers including the driver for compensation, or more than 15 not for compensation, and placarded hazmat loads.

Intrastate drivers follow their state's rules. Many states adopt the federal medical standards for intrastate commerce, sometimes with different weight thresholds or grandfather provisions. Check with your state's motor carrier enforcement agency.

Where to get the exam

Since May 21, 2014, DOT physicals must be performed by a medical examiner listed on FMCSA's National Registry of Certified Medical Examiners. A certificate from a provider who is not on the registry is not valid, even if they are a licensed physician. Search the registry at nationalregistry.fmcsa.dot.gov before booking. Examiners include physicians, nurse practitioners, physician assistants and chiropractors who have completed the training and testing, depending on what their state license allows.

How long the certificate lasts

A driver whose ability to drive is impaired by an injury or illness must be re-examined before driving again, regardless of the date on the card (49 CFR 391.45).

What the exam covers

The examiner reviews your health history form and checks you against the physical standards in 49 CFR 391.41(b). Key measurable standards:

• Vision: at least 20/40 distant acuity in each eye and both eyes together, with or without corrective lenses; a horizontal field of at least 70 degrees in each eye; and the ability to recognize red, green and amber signal colors. Drivers who fail in one eye may qualify under the alternative vision standard in 391.44.
• Hearing: perceive a forced whisper at 5 feet or more in the better ear, with or without a hearing aid, or an average hearing loss of no more than 40 dB at 500, 1,000 and 2,000 Hz in the better ear.
• Urinalysis: a dipstick test for protein, blood and sugar as a screen for other conditions. It is not a drug test. DOT drug testing is a separate program for CDL drivers.
• Conditions reviewed: cardiovascular disease, high blood pressure, respiratory problems, diabetes, epilepsy or other conditions that can cause loss of consciousness, musculoskeletal problems, psychiatric conditions, use of controlled substances and alcoholism. Insulin-treated diabetes is no longer an automatic disqualification if the requirements of 391.46 are met.

Bring a list of medications, glasses or hearing aids, and records for any condition you are treated for, such as a sleep apnea compliance report, cardiology clearance or diabetes treatment form. Missing paperwork is the most common reason for a short-term card or a delayed decision.

What changed in 2025: National Registry II

FMCSA's Medical Examiner's Certification Integration rule, also called National Registry II, had a compliance date of June 23, 2025. The change mostly affects CDL and commercial learner's permit holders:

• The examiner reports results to the National Registry, which sends them electronically to the state driver licensing agency, where they post to the driver's record.
• CDL and CLP holders are no longer required to carry the paper certificate, and in states that have implemented the system the paper form is no longer proof of certification. Drivers can still ask the examiner for a copy.
• If the electronic record conflicts with a paper certificate, the electronic record controls.
• Drivers with a medical variance, such as a skill performance evaluation certificate, must still carry it.

Non-CDL drivers still carry paper. If you drive a CMV without a CDL, such as most hotshot and box truck drivers under 26,001 lb, you still receive the paper certificate and must carry it while on duty. Your carrier must keep a copy in your driver qualification file.

Common mistakes

• Thinking no CDL means no medical card. The medical card line is 10,001 lb interstate, not 26,001 lb.
• Using a doctor who is not on the National Registry. The certificate will not count.
• Letting the card lapse. CDL holders who do not keep current certification on file with the state face a downgrade of their CDL. Book the next exam well before the expiration date to allow time to fix any reporting errors.
• Not updating the carrier. Owner-operators running under another carrier's authority must give that carrier the new certificate or verification for the qualification file.
• Hiding a condition. False statements on the health history form can void the certificate. Many conditions are manageable with documentation.

Related: which rules apply by vehicle class, starting hotshot trucking, box truck business.

Questions

Do I need a DOT medical card for a pickup and trailer?

Yes, if the combination's GVWR, GCWR or actual weight is 10,001 lb or more and you drive it in interstate commerce for business. Many 3/4-ton and one-ton pickups reach that line with any trailer.

How long is a DOT medical card good for?

Up to 24 months. Drivers certified under the insulin-treated diabetes or alternative vision standards must be re-examined at least every 12 months, and examiners can issue shorter certificates to monitor a condition.

Do CDL drivers still need to carry the medical card?

Since June 23, 2025, CDL and CLP holders with current certification are not required to carry it, because the certification is sent electronically to the state. Carrying a copy is still sensible in states that were late to implement the system. Medical variance documents must still be carried.

Can my regular doctor do the DOT physical?

Only if they are listed on FMCSA's National Registry of Certified Medical Examiners. Check the registry before the appointment.

Is the DOT physical a drug test?

No. The urinalysis checks for protein, blood and sugar. Drug and alcohol testing is a separate requirement that applies to CDL drivers under 49 CFR Part 382.