• Drivers must carry specific items based on licenses held and medical standards.
• Many forms are needed for certifications and exemptions.

For non-CDL drivers, motor carriers must document that they verified the medical examiner (ME) appeared on the National Registry and was certified to perform the exam on the day it was administered. This note is kept in the driver qualification (DQ) file as part of the proof of medical certification as follows:

• For non-commercial driver’s license (CDL) drivers, it is kept alongside the ME’s certificate; and

For CDL drivers, on and after June 23, 2025, the verification of the examiner being on the National Registry is not required unless the driver is licensed in a state that has not transitioned to National Registry Phase II (NRII). Keep record of any verification documentation prior to the NRII transition date for three years from the document date.

What the driver must do with the medical certificate depends on what type of driver they are. For example:

Once drivers’ CDL/CLP medical status has been entered into their driving record by the driver licensing authority, they must be recertified before the prior certificate expires. Until their licensing authority transitions to the direct update process from the National Registry, CDL/CLP drivers must submit their medical certificates to their licensing authority. If they do not, their operator’s licenses will be downgraded, which affects their ability to operate a commercial motor vehicle (CMV). From the National Registry not later than June 23, 2025, medical certification information will be forwarded to the CDL driver's licensing agency automatically, and CDL/CLP drivers will no longer need to provide their medical cards to the agency, nor will carriers have to verify the examiner was on the National Registry on the date of the exam.

Types of forms

The MCSA-5876: The Medical Examiner’s Certificate must be completed whenever a driver is medically certified. On and after June 23, 2025, per FMCSA's recommendation, CDL drivers should request a medical certificate from the examiner since the regulations do not require examiners to issue them medical cards after that date.

When using the form, medical examiners (MEs) may select whether the driver is:

• Qualified for interstate commerce, or
• Qualified only to operate within a single state (intrastate) under a medical variance issued by that state or driver licensing authority.

The MCSA-5875: The Medical Examination Report Form, also known as the “long” form, must be completed by the driver and examiner during the exam. The form is shown in 391.43, and is required for all driver medical exams. The form uses:

• The first three pages to record the driver’s health history and exam results;
• The fourth page to show whether the driver is medically certified under federal rules; and
• The fifth page to show if the driver is qualified for in-state operations only, under a state medical variance.
  • This page is not always used.

Medical advisory criteria

The FMCSA provides “Medical Advisory Criteria” as guidelines to aid MEs in determining if drivers are qualified. These are found in Appendix A to Part 391.

Alternative vision standard

FMCSA published the alternative vision standard final rule effective March 22, 2022, for CMV drivers who do not meet the vision standard in the worse eye. If specified conditions and vision criteria are met, the driver can qualify for the vision portion of the DOT exam based on the vision in the better eye with or without corrective lenses.

To be qualified for the alternate vision standard (391.44), the driver must:

• Have in the better eye a field of vision of at least 70 degrees in the horizontal meridian and vision of at least 20/40 with or without corrective lenses; ,
• Be able to recognize the colors of traffic signals with red, green and amber,
• Have a stable vision deficiency, and
• Have had sufficient time for the vision deficiency to be stable.

The steps to meet the alternate standard are:

1. An ophthalmologist or optometrist must evaluate the driver;
2. The ophthalmologist or optometrist completes the new Vision Evaluation Report Form MCSA-5871;
3. Not more than 45 days from the date on the MCSA-5871, the certified medical examiner performs a DOT exam and determines if the driver meets the alternative vision standard, as well as FMCSA’s other medical qualification standards;
4. If determined to be medically qualified, the driver receives a Medical Examiner’s Certificate (MEC), Form MCSA-5876, for a maximum of 12 months; and
5. When first using the alternate standard, the driver must pass a road test per 391.31, unless the driver has three years of intrastate or specific excepted interstate driving experience with the vision deficiency.

This final rule eliminates the need for the current Federal vision exemption program and the grandfather provision in 391.64. Individuals currently qualified under the grandfather provision and exemption holders had until one year after the effective date, or March 22, 2023, to comply.

Certification of drivers with insulin-treated diabetes mellitus

The use of insulin to control diabetes mellitus is normally disqualifying, but 391.46 offers a path to annual certification. Drivers must:

• Obtain a completed Insulin-Treated Diabetes Mellitus Assessment Form (MCSA–5870) from their treating clinician. The form is available on the FMCSA website.
• Use an electronic glucometer and give their treating clinician at least the preceding three months’ worth of blood-glucose data to be certified for a full year.
• Bring the completed form to be examined by a Federal Motor Carrier Safety Administration (FMCSA) ME within 45 days. The FMCSA ME has discretion to make the final certification decision.

Medical waivers and exemptions

Drivers may be granted waivers or exemptions from certain medical standards through the FMCSA. However, information about most waivers is not found in the regulations.

On a case-by-case basis, the FMCSA is granting waivers from most medical standards, including:

• Hearing
• Epilepsy/Seizures
• Limb disorders

In some cases, a specific waiver application is to be used. For more information about applying for a waiver, refer to the medical information on the FMCSA website.

Can carriers accept an existing medical certification?

Carriers can accept a copy of an existing medical certification along with the risks of any potentially disqualifying conditions that occurred since the last DOT exam.

For non-CDL drivers and CDL drivers certified before their licensing authority transitioned to NRII, carriers still verify from the National Registry of Certified Medical Examiners (NRCME) to ensure the ME:

• Appears on the list,
• Was certified on the day of the exam, and
• Could legally perform the FMCSA physical.

Employers must document that they verified the examiner. If they hire a driver who has been issued a medical exemption or variance from the FMCSA, they need a copy of that as well.