Quick Answer
A DOT physical is the medical exam every CMV driver must pass, performed only by a certified medical examiner on the FMCSA's National Registry. It checks vision (20/40 in each eye, 70° peripheral field, glasses allowed), hearing (forced-whisper at 5 feet or audiometry, aids allowed), blood pressure, urinalysis for kidney indicators — not drugs — plus medical history and a physical exam. A clean exam earns a certificate good for up to 24 months; monitored conditions like managed hypertension commonly earn shorter cards.
Key Takeaways
- Only a National Registry–certified medical examiner can perform the exam — verify the examiner before booking.
- Maximum certificate is 24 months; conditions under monitoring (blood pressure, diabetes, sleep apnea treatment) typically mean 12-month or shorter cards.
- The urinalysis screens kidney health markers, not drugs — drug testing is a separate program tracked in the Clearinghouse.
- Certification is going electronic: examiners transmit results to FMCSA, flowing to state CDL records — carry proof during the transition and never let the card lapse.
What the exam covers
Vision. At least 20/40 acuity in each eye and both together (corrective lenses fine), 70 degrees of peripheral vision per eye, and the ability to distinguish traffic-signal colors.
Hearing. Perceive a forced whisper at 5 feet in at least one ear, or pass the audiometric alternative. Hearing aids are allowed.
Blood pressure and pulse. The gatekeeping number for more drivers than any other. Well-controlled pressure earns full-length cards; elevated readings earn shorter certificates with recheck requirements, and high readings can mean no card until it's managed. If you know your numbers run hot, work on them before exam day, not in the parking lot.
Urinalysis. Screens for protein, blood, and sugar — kidney and diabetes indicators. It is not a drug test; DOT drug testing is a separate program under the Clearinghouse.
History and physical. Medications, surgeries, sleep apnea risk factors, cardiovascular history, neurological conditions, plus the hands-on exam. Insulin-treated diabetes is certifiable today under the ITDM standard with proper documentation from your treating clinician; seizure conditions and certain cardiac events carry specific waiting periods and requirements.
How long the card lasts
Up to 24 months is the ceiling. Examiners routinely issue 12-month (or shorter) certificates for conditions they want monitored — controlled hypertension being the classic. A short card isn't punishment; it's the mechanism that keeps a manageable condition from becoming a disqualification.
DOT physical blood pressure requirements
The regulation only says you can't have high blood pressure "likely to interfere" with safe driving (49 CFR 391.41(b)(6)). Examiners apply FMCSA's advisory guidance in the Medical Advisory Criteria and the 2024 Medical Examiner's Handbook, which set these typical certificate lengths:
Blood pressure reading | FMCSA guidance stage | Typical certificate |
|---|---|---|
Under 140/90, no blood pressure medication | Not hypertensive | Up to 24 months if nothing else needs monitoring |
Treated, controlled at or under 140/90 | Controlled hypertension | 1 year, rechecked annually |
140-159 / 90-99 | Stage 1 | 1 year |
160-179 / 100-109 | Stage 2 | One-time 3-month card; if at or under 140/90 at recheck, certified for the rest of 1 year from the first exam |
180 / 110 or higher | Stage 3 | Not qualified until at or under 140/90 with treatment tolerated; then 6 months, rechecked every 6 months |
A reading over 139/89 should be confirmed with a second measurement later in the exam. These numbers are guidance applied with the examiner's judgment, not a pass/fail line written into the regulation.
Vision requirements and the MCSA-5871 vision form
The standard is at least 20/40 in each eye and with both eyes (glasses or contacts allowed), a 70-degree horizontal field of vision in each eye, and the ability to recognize red, green and amber signal colors (49 CFR 391.41(b)(10)).
If one eye can't meet the acuity or field standard, you can still qualify under the alternative vision standard in 49 CFR 391.44:
- Before your DOT physical, a licensed ophthalmologist or optometrist evaluates you and completes the Vision Evaluation Report, Form MCSA-5871.
- The DOT physical must begin no more than 45 days after the eye doctor signs and dates the form.
- Your better eye must still have 20/40 acuity and a 70-degree field, you must recognize signal colors, and the condition must be stable with enough time passed to adapt.
- You must be re-examined and certified at least once a year.
- The first time you qualify this way, the carrier must road-test you before you drive, unless an exception applies, such as 3 years of driving a CMV intrastate (or in excepted interstate work) with the same vision deficiency.
DOT physical hearing requirements
You must hear a forced whisper at 5 feet or more in your better ear, with or without a hearing aid. If tested with an audiometer, the average hearing loss in your better ear can't exceed 40 decibels at 500, 1,000 and 2,000 Hz (49 CFR 391.41(b)(11)).
Insulin-treated diabetes and form MCSA-5870
Since a 2018 rule, drivers who use insulin can be certified without an exemption under 49 CFR 391.46:
- The clinician who prescribes your insulin completes the Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870, before each DOT physical.
- The DOT physical must happen no later than 45 days after the clinician signs the form, and at least once a year.
- You need at least 3 months of electronic blood glucose self-monitoring records for a card of up to 12 months. Without them, the card is limited to 3 months.
- Severe non-proliferative or proliferative diabetic retinopathy is permanently disqualifying, and you must be on a stable insulin regimen with the diabetes properly controlled.
Sleep apnea and the DOT physical
No FMCSA regulation requires sleep apnea testing. Examiners judge it under the general respiratory standard in 49 CFR 391.41(b)(5), and FMCSA withdrew its sleep apnea rulemaking in August 2017. FMCSA's 2024 Medical Examiner's Handbook leaves screening to the examiner, based on risk factors such as loud snoring, daytime sleepiness, obesity and high blood pressure.
If the examiner needs a sleep study or other records, the decision can be held pending for up to 45 days (49 CFR 391.43(g)(4)). Treated sleep apnea does not stop you from being certified, so bring your CPAP compliance report.
How your results reach your state
For CDL and CLP holders, the examiner sends your result to FMCSA, which forwards it to your state's driving record. That electronic record is now your official proof of medical certification. See our DOT medical card guide for how to check your card status.
Exam-day practicality
Bring your license, glasses or hearing aids you use, your medication list, and documentation for any monitored condition (recent readings, specialist letters, CPAP compliance data if applicable). Sleep normally, skip the triple espresso — caffeine and no sleep both show up in a blood pressure cuff — and book renewal 30–45 days before expiration so a recheck never becomes a lapse.
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Educational content, not medical or legal advice. Updated October 2026. Confirm current requirements at FMCSA.gov and with a certified medical examiner.
FAQ
Q: What does the DOT physical consist of?
A: A review of your health history and medications, then five checks: vision (at least 20/40 in each eye and a 70-degree field), hearing (a forced whisper at 5 feet), blood pressure and pulse, a urinalysis for protein, blood and sugar, and a hands-on physical exam of your heart, lungs, abdomen, spine, limbs and reflexes.
Q: Who must have a DOT physical?
A: Every driver of a commercial motor vehicle in interstate commerce, CDL or not, at least every 24 months (49 CFR 391.45). See our DOT medical card guide for who is covered and what the card means.
Q: Does a DOT physical include a drug test?
A: No — it screens kidney and diabetes indicators (protein, blood, sugar). DOT drug testing is a separate program with its own rules and Clearinghouse reporting.
Q: Why did I get a 1-year card instead of 2?
A: Examiners issue shorter certificates to monitor conditions like elevated blood pressure or treated sleep apnea. Manage the condition and document it, and full-length cards return.
Q: Can I drive while renewing an expired medical card?
A: No — an expired certificate means you're not medically qualified, and lapses can trigger CDL downgrade processes at the state. Renew 30–45 days early, every time.
