How to Pass Your DOT Physical: What the Medical Examiner Checks

Every interstate truck driver goes through it: the DOT physical. Most drivers pass without trouble. The ones who get caught off guard usually have high blood pressure they didn't know about, forget their paperwork, or hear a rumor and don't know the real rules. Here's what the medical examiner actually checks, based on 49 CFR 391.41 and FMCSA guidance.

Who can do your exam

• The exam must be done by a certified medical examiner (ME) listed on FMCSA's National Registry of Certified Medical Examiners. You can search it by ZIP code. An exam by someone not on the Registry doesn't count.
• The longest certificate is 24 months (49 CFR 391.45). The examiner can give you a shorter one if a condition needs monitoring.
• The certificate expires at midnight on the date shown, with no grace period, according to FMCSA's Medical Examiner's Handbook.

Your medical card is electronic now

Under the National Registry II rule, since June 23, 2025 examiners upload results to the National Registry by midnight of the next day, and for CLP and CDL holders FMCSA sends them electronically to your state licensing agency to post on your driving record (FMCSA). In states that have implemented it, the paper Medical Examiner's Certificate (Form MCSA-5876) may no longer be used as proof. States that weren't ready yet continue with paper. FMCSA suggests getting your exam well before your current card expires so there's time to fix any data mismatch (wrong license number, name spelling, date of birth).

What happens at the exam

1. Health history. You fill out the driver section of the Medical Examination Report Form (MCSA-5875): surgeries, conditions, medications, sleep problems, past injuries. Answer honestly. The form warns that false or missing information can invalidate the exam and the certificate.
2. Vision. At least 20/40 in each eye and both eyes (glasses or contacts OK), at least 70° field of vision horizontally in each eye, and the ability to recognize red, green and amber signals.
3. Hearing. Hear a forced whisper at 5 feet or more in your better ear, or pass an audiometry test (average loss no more than 40 dB at 500, 1,000 and 2,000 Hz in the better ear). Hearing aids are allowed.
4. Blood pressure and pulse.
5. Urinalysis. A dipstick test for things like protein, blood and sugar. It is not a drug test.
6. Physical exam. Heart, lungs, abdomen, spine, limbs, neurological checks, and more.

Blood pressure: the certification tiers

High blood pressure is the most common reason drivers get a short card. FMCSA's guidance (FMCSA FAQ and the Medical Examiner's Handbook):

The examiner should confirm a high reading with more measurements. A few things that help you get a true reading:

• The American Heart Association says not to smoke, drink caffeine or exercise within 30 minutes before a reading, to empty your bladder, and to sit quietly for 5 minutes first (AHA).
• Take your blood pressure medication as prescribed, including on exam day.
• If your numbers run high, see your doctor months before the exam, not the week of. A validated upper-arm home monitor helps you and your doctor track it.

Diabetes on insulin: the 2018 rule

Before 2018, insulin-treated drivers needed a federal exemption. FMCSA's diabetes standard (published September 19, 2018, effective November 19, 2018) changed that. Under 49 CFR 391.46:

• Your treating clinician (the provider who manages and prescribes your insulin) completes the Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870, attesting to a stable insulin regimen and proper control.
• The medical examiner must receive the form and do your exam no later than 45 days after the clinician signs it.
• You're examined at least every year; the certificate is for up to 12 months.
• To get the full 12 months, bring at least the preceding 3 months of electronic blood glucose records (from your meter or CGM) to your clinician.
• Severe non-proliferative or proliferative diabetic retinopathy is permanently disqualifying.

Diabetes not treated with insulin is handled under the examiner's general judgment.

Vision: if one eye doesn't meet the standard

Since 2022, drivers who don't meet the vision standard in one eye may still qualify under the alternative vision standard in 49 CFR 391.44. An ophthalmologist or optometrist completes the Vision Evaluation Report, Form MCSA-5871, before the DOT exam.

Medications, marijuana and other conditions

• Schedule I drugs, including marijuana, are disqualifying — even if your state allows it or a doctor recommended it (FMCSA).
• Other controlled substances (like some pain or anxiety medications) are only allowed when prescribed by a licensed practitioner who knows your medical history and has advised that the drug won't affect safe driving (49 CFR 391.41(b)(12)). Bring a letter from your prescriber.
• Epilepsy or seizure history, or any condition likely to cause loss of consciousness, is covered by a separate standard. Talk to the examiner and bring your neurologist's records.
• Heart conditions, stroke, surgery: bring clearance letters and recent test results from your specialist.
• Sleep apnea: there's no specific FMCSA rule; the examiner uses judgment. If you're treated, bring your CPAP usage report. See our sleep apnea guide.

How to prepare: the week before

• Find a certified examiner on the National Registry and book early — well before your card expires
• Bring your driver's license (the examiner matches your name, license number and DOB)
• Bring glasses or contacts and hearing aids if you use them
• Write a list of all medications and doses, with prescriber names
• Bring specialist letters and records for any condition (heart, sleep apnea, seizures, surgeries)
• Insulin users: MCSA-5870 signed within the last 45 days plus 3 months of glucose records
• Vision exemption candidates: MCSA-5871 from your eye doctor
• CPAP users: compliance report from the machine or your provider
• Take your regular medications as prescribed
• No caffeine, nicotine or exercise for 30 minutes before; arrive early and sit quietly
• Fill out the health history honestly
• After the exam, check that your certification shows up on your state driving record

If you don't pass the first time

A short certificate or a "determination pending" isn't the end of your career. Most commonly it means: get your blood pressure treated, get a specialist letter, or finish a sleep study, then go back. The examiner can hold a decision pending for up to 45 days while you get more information. Fix the issue, bring the paperwork, and keep a copy of everything.

Want healthier habits that make the next physical easier? Start with the 10-minute workout and our healthy eating playbook.