DOT Medical Card Requirements: What Drivers and Carriers Need to Know
Drivers of commercial motor vehicles must be medically certified to drive. The "medical card" is the medical examiner's certificate. Here is how long it lasts, who can do the exam, how CDL medical status now reaches the state, and what employers must keep on file.
Updated September 28, 2026 · Checked against the federal regulations
Who needs a DOT medical card
A driver covered by Part 391 must not drive a commercial motor vehicle unless they are medically certified as physically qualified. The driver must meet the physical standards in 391.41 and pass the exam in 391.43.
How long a medical card lasts
A driver must be re-examined if they have not been certified in the past 24 months. So the longest a card lasts is 2 years. Some cards are shorter. Always go by the expiration date.
- Drivers with insulin-treated diabetes certified under 391.46: re-examined at least every 12 months
- Drivers certified under the vision standard in 391.44: re-examined at least every 12 months
- Drivers limited to an exempt intracity zone: re-examined at least every 12 months
- Any driver whose ability to do the job is impaired by an injury or illness: must be re-examined
Who can do the DOT physical
The exam must be done by a medical examiner listed on FMCSA's National Registry of Certified Medical Examiners. The examiner sends the results to FMCSA by midnight of the next calendar day.
If the examiner finds the driver is not qualified, all medical cards the driver had before are no longer valid.
CDL drivers: medical status goes to the state
Since June 23, 2025, CDL and CLP drivers who run non-excepted interstate get their medical certification sent electronically. FMCSA sends the certificate information to the state. The state posts "certified" and the expiration date on the driver's CDLIS record.
CDL and CLP holders with a current certificate no longer need to carry the card. Drivers who do not need a CDL still must carry the original or a copy when on duty. If a driver got a medical variance, they must still carry that paperwork.
When a CDL driver's medical certification expires, the state marks them "not certified" within 10 days. The state must finish downgrading the CDL within 60 days unless the driver gets re-certified or changes their self-certification.
What employers must keep in the DQ file
Each driver needs a driver qualification (DQ) file. For medical items, keep:
- Non-CDL drivers: the medical examiner's certificate (or a legible copy), plus a note that you verified the examiner was on the National Registry
- CDL drivers: the CDLIS motor vehicle record from the current licensing state that shows medical certification status
- Any medical variance, such as an exemption or Skill Performance Evaluation certificate
- Medical records can be removed from the DQ file 3 years after the date they were executed
Tracking medical card expirations
An expired medical card means the driver is not qualified to drive. For CDL drivers, it can also lead to a CDL downgrade. The easy fix is to track every driver's expiration date in one place.
Set reminders 60 and 30 days before each date. When a CDL driver re-certifies, pull a new CDLIS MVR to confirm the state shows "certified" and put it in the DQ file.
Pact Compliance tracks medical card expiration dates and pulls MVRs for small fleets.
Common questions
How long is a DOT medical card good for?
Up to 24 months. Some drivers, like those with insulin-treated diabetes or certified under the vision standard, must be re-examined every 12 months. Always check the expiration date.
Do CDL drivers still have to carry their medical card?
Not since June 23, 2025, if they hold a CDL or CLP and have a current certificate. Drivers who don't need a CDL still must carry it on duty.
Can any doctor do a DOT physical?
No. The exam must be done by a medical examiner listed on the National Registry of Certified Medical Examiners. An eye doctor may do only the vision part.
What happens if a CDL driver's medical card expires?
The driver is not medically qualified to drive. The state marks the driver "not certified" and must complete a CDL downgrade within 60 days unless the driver is re-certified.
How do employers verify a CDL driver's medical certification?
Get the CDLIS motor vehicle record from the driver's current licensing state and place it in the driver qualification file.
How long must I keep medical certificates in the DQ file?
They may be removed 3 years after the date of execution. The DQ file itself is kept while the driver works for you and 3 years after.
Sources
- 49 CFR 391.41 – Physical qualifications for drivers
- 49 CFR 391.43 – Medical examination
- 49 CFR 391.45 – Who must be examined
- 49 CFR 391.23 – Investigation and inquiries
- 49 CFR 391.51 – Driver qualification files
- 49 CFR 383.71 – Driver application and certification
- 49 CFR 383.73 – State procedures