When Does a Driver Need a DOT Medical Examiner's Certificate, and How Often?

A person subject to Part 391 must not operate a commercial motor vehicle unless medically certified as physically qualified to do so (49 CFR 391.41(a)(1)(i)). The certification comes from a physical examination under 49 CFR 391.43, and 49 CFR 391.45 sets how often it is repeated. Which drivers are covered is explained in FMCSA covered drivers, and the basics of DOT coverage in understanding DOT regulated.

Who performs the exam. The exam is performed by a medical examiner listed on the National Registry of Certified Medical Examiners. A licensed ophthalmologist or optometrist may perform the vision portion (49 CFR 391.43(a) and (b)).

How often. A driver must be examined and certified when (49 CFR 391.45):

• The driver has not previously been examined and certified
• 24 months have passed since the last exam, unless a shorter interval applies
• 12 months have passed, for a driver limited to an exempt intracity zone, a driver with insulin-treated diabetes certified under 391.46, or a driver certified under the vision standard in 391.44
• The driver's ability to perform normal duties has been impaired by a physical or mental injury or disease
• On or after June 23, 2025, a medical examiner has found the person not physically qualified

What happens after the exam. The medical examiner reports results to FMCSA electronically by midnight local time of the next calendar day (49 CFR 391.43(g)(5)). If the examiner finds the driver not physically qualified, earlier certificates are no longer valid (49 CFR 391.43(g)(3)).

CDL and CLP holders. On or after June 23, 2025, a CDL or CLP holder with a current certification no longer needs to carry the medical examiner's certificate (49 CFR 391.41(a)(2)(i)(B)). The paper certificate is issued only to drivers who will not operate a CMV requiring a CDL or CLP (49 CFR 391.43(g)(2)(ii)). For CDL holders, the carrier uses the CDLIS MVR from the licensing state as proof of medical certification in the DQ file (49 CFR 391.51(b)(6)(ii)).

Non-CDL drivers. A driver who does not need a CDL carries the original or a copy of a current certificate when on duty (49 CFR 391.41(a)(1)(i)). The carrier keeps a copy in the DQ file and notes that it verified the examiner's National Registry listing (49 CFR 391.51(b)(6)(i) and (b)(8)(i)).

Paper certificates and Alaska. FMCSA renewed a one-year exemption on a provisional basis, subject to public comment, effective from 12:00 a.m. October 12, 2026 through 11:59 p.m. October 12, 2027, letting Alaska-licensed CDL and CLP drivers and their employers rely on a paper certificate for up to 60 days after it was issued. Alaska is the only state that has not implemented the electronic integration rule. Drivers licensed elsewhere may not rely on a paper certificate for any period as of October 12, 2026 (91 FR 64454). The earlier exemption request is described in FMCSA seeks comments on the CVSA exemption.