New DOT physical requirements: same standards, new paperwork
Most of what you read about "new" DOT physical rules is old. The medical standards have barely moved. What changed is how a driver qualifies with certain conditions, and how the result travels from the examiner to the state.
Written by Inely Baez
The DOT physical in numbers
The new DOT physical requirements change the paperwork more than the medicine. Since June 23, 2025, CDL and CLP holders' results go electronically to the state, and since October 12, 2026, a paper card is no longer proof outside Alaska. The core standards, such as 20/40 vision and a forced whisper at 5 feet, are unchanged.
Search for the new DOT physical requirements and you will find old blood pressure numbers presented as news. The standards an examiner applies have barely moved in years. The real changes are two new ways to qualify that replaced exemption programs, and an electronic certificate that replaced the paper card for CDL holders.
I lead operations at Simplex, so I read this rule as a records system: who can examine a driver, where the result goes, and what proof a driver and a carrier need on any given day. This guide explains the rule. Your medical examiner makes the medical call.
The full briefing, read aloud
8 chapters. Select one to jump to it.
Generated with AI text-to-speech from this article's key insights, in order, rather than reading it word for word. Chapter times come from a transcript of the audio. The article itself was written and reviewed by Inely Baez.
Key takeaways
The medical standards are not new
20/40 vision in each eye, a forced whisper at 5 feet, and no blood pressure number in the rule itself.
Two exemption programs became standards
Insulin users (2018) and drivers with vision loss in one eye (2022) now qualify through set forms and yearly exams.
CDL holders no longer carry the card
Since June 23, 2025, the result goes electronically to the state, and the driver record controls.
The paper grace period is over
Since October 12, 2026, a paper copy is not proof for CDL or CLP holders, except those licensed in Alaska.
A failed exam cancels older cards
A "not qualified" finding voids every certificate issued to the driver before it.
In this articleContents
What are the new DOT physical requirements?
The new DOT physical requirements are mostly about records, not health standards. The vision, hearing, and other standards in 49 CFR 391.41 read much as they have for years. Since 2018, the changes have created two new ways to qualify and moved the certificate from paper to an electronic record.
| Effective | What changed | Who it affects |
|---|---|---|
| November 19, 2018 | An insulin-treated diabetes standard (49 CFR 391.46) replaced the diabetes exemption program | Drivers who use insulin |
| March 22, 2022 | An alternative vision standard (49 CFR 391.44) replaced the vision exemption program | Drivers who can't meet the vision standard in one eye |
| January 2024 | FMCSA published the Medical Examiner's Handbook, 2024 Edition | Examiners' guidance |
| June 23, 2025 | Results go from FMCSA to the state electronically; the driver no longer carries the certificate; a failed exam voids earlier certificates | CDL and CLP holders |
| October 12, 2026 | A paper certificate stops counting as proof, except for drivers licensed in Alaska (through October 12, 2027) | CDL and CLP holders and their carriers |
If a page calls a blood pressure limit or a vision number "new," check its date. Those figures come from long-standing rules and examiner guidance, covered below.
What does a DOT physical check?
A DOT physical checks you against the standards in 49 CFR 391.41(b). You fill in a health history first, then a medical examiner listed on FMCSA's National Registry tests and examines you.
| Area | Federal standard |
|---|---|
| Vision | At least 20/40 in each eye and in both eyes together, with or without corrective lenses; a 70-degree field of vision in each eye; able to recognize red, green, and amber |
| Hearing | Hears a forced whisper at 5 feet or more in the better ear, or an average loss of no more than 40 decibels on an audiometer; hearing aids allowed |
| Blood pressure | No current diagnosis of high blood pressure likely to interfere with safe driving; the rule sets no number |
| Heart, lungs, nerves | No heart disease, breathing condition, epilepsy, or other condition likely to cause loss of consciousness or control |
| Diabetes | Insulin users qualify through 49 CFR 391.46 |
| Limbs | No loss or impairment that interferes with driving, unless FMCSA grants an SPE certificate |
| Drugs and alcohol | No Schedule I drugs, amphetamines, narcotics, or habit-forming drugs; other controlled substances only as prescribed and cleared for driving; no current diagnosis of alcoholism |
| Mental health | No disorder likely to interfere with safe driving |
What tests are done at the exam?
Expect a vision test, a hearing test, pulse and blood pressure, height and weight, and a urinalysis that records specific gravity, protein, blood, and sugar. The examiner then checks each body system on the Medical Examination Report, Form MCSA-5875.
The urinalysis is not a drug test. DOT drug testing applies to CDL and CLP holders under a separate program, although a pre-employment test can be collected at the same visit. Our guide to the DOT drug and alcohol testing program covers it.
How does the examiner judge blood pressure?
The rule sets no number, but FMCSA's 2024 handbook gives examiners this guidance:
- Stage 1 (140-159 / 90-99): may be certified for 1 year, and should be at or below 140/90 at later exams
- Stage 2 (160-179 / 100-109): a one-time 3-month certificate to start or adjust treatment, then 1 year once at or below 140/90
- Stage 3 (180/110 or higher): not qualified until at or below 140/90, then certified 6 months at a time
These are recommendations. The examiner makes the decision.
What disqualifies you, and what are the alternatives?
A condition disqualifies you when it fails a standard and no alternative applies. Several standards now have a formal route back:
- Vision in one eye: qualify under 49 CFR 391.44 with an eye specialist's Vision Evaluation Report, Form MCSA-5871, and an exam at least once a year. Drivers qualifying this way for the first time generally need a road test too.
- Insulin-treated diabetes: qualify with a treating clinician's Form MCSA-5870 and a yearly exam. Our guide to the DOT physical with diabetes walks through it.
- Lost or impaired limbs: qualify with a Skill Performance Evaluation certificate from FMCSA.
- Hearing and seizures: apply to FMCSA's exemption programs, which decide within 180 days of a completed application.
Outside these routes, the examiner applies the standard to the facts. The rule does not list diagnoses such as depression or bipolar disorder. It asks whether a condition is likely to interfere with safe driving, and the examiner may ask your treating provider for records, with your consent.
How long is a DOT physical good for?
A DOT medical certificate lasts up to 24 months. The examiner can issue a shorter one to monitor a condition such as high blood pressure.
- Up to 24 months: drivers who meet every standard
- 12 months or less: insulin-treated diabetes and the alternative vision standard
- A new exam early: whenever an injury or illness impairs your ability to do the job
What happens if you fail a DOT physical?
Since June 23, 2025, a "not qualified" finding is reported to FMCSA and cancels every medical certificate issued to you before it. You can't drive a commercial motor vehicle until an examiner certifies you again.
If the examiner needs more information, the result can be held as pending for up to 45 days while you provide it. You may get a second opinion from another certified examiner, but FMCSA expects you to give both the same medical information.
Who needs a DOT physical, and what proof counts?
You need a DOT physical to drive a commercial motor vehicle in interstate commerce: one rated or weighing 10,001 pounds or more, one built or used to carry more than 8 people (including the driver) for pay or more than 15 without pay, or a placarded hazmat load. That includes many trucks that don't need a CDL, as our CDL vs non-CDL guide explains.
| Driver | Proof that counts | What the carrier keeps |
|---|---|---|
| CDL or CLP holder | The medical status on the state driver record (Alaska-licensed drivers may use a paper copy for up to 60 days, through October 12, 2027) | The CDLIS motor vehicle record from the current licensing state |
| Non-CDL driver | The original or a copy of the medical certificate, carried while on duty | A copy of the certificate and a note verifying the examiner was on the National Registry |
| Driver with a variance | A copy of the SPE certificate or exemption letter, carried while on duty | A copy of the variance |
If the electronic record and a paper copy disagree, the electronic record controls. Carriers must verify a driver's medical certification before the driver operates, and the DQF checklist covers the rest of the file.
How to prepare for a DOT physical
Preparing is mostly paperwork. These steps help the exam end in a decision instead of a pending status.
Step 1: Find a certified medical examiner
Only an examiner on FMCSA's National Registry can perform the exam. That can be a medical doctor, a doctor of osteopathy, a physician assistant, an advanced practice nurse, or a chiropractor.
Step 2: Complete the health history honestly
List every surgery, condition, and medication, including over-the-counter drugs and supplements. False or missing information can invalidate the certificate and lead to civil or criminal penalties.
Step 3: Bring what you use to drive
Wear your glasses or contacts and your hearing aids. If you need them to meet the standard, the certificate says so, and you must use them whenever you drive.
Step 4: Bring the forms your condition requires
Insulin users bring Form MCSA-5870, and drivers on the alternative vision standard bring Form MCSA-5871. The exam must take place no more than 45 days after the clinician or eye specialist signs it. Also bring any SPE certificate or exemption letter, and records for conditions you manage.
Step 5: Confirm the result reached the right place
CDL and CLP holders: check that your state driver record shows the new certification before the old one expires. Non-CDL drivers: keep the certificate with you and give your carrier a copy.
How Simplex helps carriers keep drivers medically qualified
We don't make medical decisions. We help you verify certifications, track expiration dates, and keep driver files ready for an audit.
Medical exam verification
We check the records behind each driver qualification requirement, including CDL and medical exam verification for new and current drivers.
Driver qualification files
Our team builds and maintains driver qualification files, so each driver's medical proof is in the file when an auditor asks.
Monitoring and alerts
Our compliance programs include driver file monitoring and alerts through Simplex Hub, and CDL and medical exam verification in the Essentials Program.
Frequently asked questions
Do non-CDL drivers need a DOT physical?+
How long is a DOT physical good for?+
What happens if you fail a DOT physical?+
Can you pass the DOT physical with glasses or hearing aids?+
Is there a drug test at the DOT physical?+
Do CDL drivers still need to carry their medical card?+
Where this information comes from
The requirements below come from federal regulations, FMCSA's medical program, and the Federal Register, checked on October 16, 2026.
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1
eCFR — 49 CFR 391.41
The physical qualification standards, and who must carry the certificate.
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2
eCFR — 49 CFR 391.43
Who performs the exam, pending results, and what a failed exam does to earlier certificates.
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3
eCFR — 49 CFR 391.45
When drivers must be examined: every 24 months, 12 for insulin and alternative vision.
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4
eCFR — 49 CFR 391.51
The medical records a carrier keeps in each driver qualification file.
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5
Federal Register — Paper medical certificate exemption, October 8, 2026
Paper certificates no longer count after October 12, 2026, except in Alaska.
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6
Federal Register — Vision Standard final rule (87 FR 3390)
The alternative vision standard, effective March 22, 2022.
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7
FMCSA — DOT Medical Exam and CMV Certification
Who can be a medical examiner, and the 24-month maximum.
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8
FMCSA — Medical Examiner's Handbook, 2024 Edition
Blood pressure guidance, exam tests, lenses and hearing aids, and second opinions.
Written by
Inely Baez
Chief Operating Officer, Simplex Group
Chief Operating Officer at Simplex Group, with nearly eight years at the company leading operational strategy and execution across compliance, technology, logistics, and performance systems. She is a Certified Public Accountant with a background spanning operations and finance, including leadership roles within Simplex's Freight 4 U division and Velox Transport Solutions. Her work focuses on building scalable, disciplined systems that support long-term performance and growth.
Published · Updated
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Track the record, not the card
For most CDL drivers, the proof of a DOT physical now lives on the state driver record. A wallet card that looks current means nothing if the record says otherwise.
If you want help verifying medical certifications and keeping driver files current across your fleet, talk to our team.