The medical card is the most common reason drivers were put out of service during the 2026 International Roadcheck. That’s not because drivers are unfit. It’s because certificates expire, short certificates get missed, and since June 2025 the proof has moved from a paper card in the cab to the driver’s state record. This guide covers how long a DOT medical card lasts, what the physical checks, how the electronic system works, what carriers must keep, what happens when a card lapses, and a checklist you can use as a template. To see how FleetRabbit fits your compliance records, book a short demo with our team.
DOT medical card · commercial drivers
The medical card moved from the wallet to the driving record
Since 23 June 2025, examiners send results electronically for CDL and CLP holders. The state posts the status to the driver’s record, and that record is the proof.
1
Exam
Certified medical examiner on the National Registry
→
2
Next day
Result sent to FMCSA by midnight of the next calendar day
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3
State
FMCSA passes it to the state licensing agency
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4
Driver record
Medical status posted to the CDL driving record
The medical certificate topped the 2026 Roadcheck list of driver out-of-service reasons
During CVSA’s International Roadcheck in May 2026, 3,184 drivers were placed out of service. Medical certificate violations accounted for 27% of those orders, ahead of hours of service, according to CCJ’s report on the results. Most of these are paperwork failures a carrier can prevent.
15.6%
No commercial license
Share of driver out-of-service orders, International Roadcheck 2026. Source: CVSA results as reported by CCJ.
How long a DOT medical card lasts, from 24 months down to none
The maximum is 24 months, but the examiner can issue a shorter certificate when a condition needs monitoring. Short certificates are where carriers most often lose track.
Standard certificate
Up to 24 months
Stage 1 blood pressure, 140/90 to 159/99
1 year
Insulin-treated diabetes, with form MCSA-5870
Up to 1 year
Stage 2 blood pressure, 160/100 to 179/109
One-time 3 months
Stage 3 blood pressure, 180/110 or higher
Not certified until controlled
Bars scaled to 24 months. Blood pressure stages and insulin-treated diabetes rules as summarised by J.J. Keller.
What the DOT physical checks, station by station
The exam must be done by a medical examiner listed on FMCSA’s National Registry of Certified Medical Examiners. It covers five areas.
V
Vision
At least 20/40 in each eye, with or without glasses, a 70-degree field of view in each eye, and the ability to tell red, green and amber signals apart. An alternative vision standard applies to drivers who don’t meet it in one eye.
H
Hearing
Hear a forced whisper at five feet in the better ear, with or without a hearing aid, or an average loss of no more than 40 decibels in the better ear on an audiometer test.
B
Blood pressure
Readings decide the certificate length: one year for stage 1, a one-time three months for stage 2, and no certificate at stage 3 until it’s brought down.
U
Urinalysis
Checks for protein, blood and sugar as signs of other conditions. It is not a drug test; DOT drug testing is separate.
M
Medical history and exam
The driver’s history form, medications and a physical exam covering heart, lungs, neurological function and more. Conditions like sleep apnea are judged by the examiner.
Drivers with insulin-treated diabetes can be certified for up to a year if their treating clinician completes form MCSA-5870, based on at least three months of glucometer readings, and the driver brings it to the examiner within 45 days.
Who needs a DOT medical card: weight, passengers and hazmat
The requirement isn’t limited to CDL holders. Under the federal rules, a driver needs a medical certificate to operate a commercial motor vehicle in interstate commerce, which includes a truck or combination with a gross vehicle weight rating or actual weight of 10,001 pounds or more, a vehicle designed to carry more than 8 passengers for pay or more than 15 without pay, and any vehicle carrying hazardous materials in placarded amounts. That means many box trucks, pickups towing equipment trailers and service bodies need a medical card even though the driver doesn’t need a CDL. Those drivers are the ones still on paper, and the easiest to miss in a fleet that tracks medical status only through CDL records.
CDL and non-CDL drivers: how the medical card works for each
The electronic system applies to CDL and CLP holders. Drivers of commercial vehicles who don’t need a CDL still get a paper certificate.
| CDL and CLP holders | Non-CDL CMV drivers |
|---|
| Who gets the result | The state, electronically, from FMCSA | The driver, on a paper certificate |
| What the driver carries | No paper certificate needed in states using the system | The paper certificate, while driving |
| How the carrier verifies | A current driving record showing valid medical status | A copy of the certificate in the driver file |
| If it lapses | State marks the driver not certified, then downgrades the CDL | The driver can’t drive until recertified |
| Variances and exemptions | Shown on the driving record | Kept with the certificate |
States still on paper, and the 60-day paper copy
As of April 2026, FMCSA listed five states that had not yet implemented the electronic system, where drivers still get a paper certificate and submit it to the state. A temporary exemption let drivers and carriers rely on a paper certificate copy for up to 60 days after the exam; it ran until 11 October 2026, and FMCSA said it didn’t expect to extend it nationwide. Check your state’s current status.
Alaska
California
Kentucky
Louisiana
New Hampshire
Keep every driver’s medical status next to their truck’s records
A 20-minute demo of FleetRabbit’s inspection and maintenance records, and what to confirm for driver files.
Variances and exemptions for vision, hearing, seizures and limbs
Failing one standard doesn’t always end a driving career. FMCSA has several routes for drivers who don’t meet a standard but can drive safely. Since 2022, drivers who can’t meet the vision standard in one eye can be certified under the alternative vision standard, with an evaluation by an ophthalmologist or optometrist first. Drivers with hearing loss and drivers with a history of seizures can apply to FMCSA for an exemption. Drivers with a missing or impaired limb can be certified with a Skill Performance Evaluation certificate, which tests their ability to drive the vehicle type they’ll operate. Any variance has to be on the driver’s record and in the qualification file, and an expired variance makes the medical certificate invalid even if the certificate itself hasn’t expired.
A renewal timeline that keeps drivers from expiring between loads
Exams fill up, and results can mean a shorter certificate than expected. Working back from the expiry date gives the driver time to book, and the carrier time to check the record.
90 days out
Book the exam
Remind the driver and check the examiner is on the National Registry.
60 days out
Plan around results
A shorter certificate is possible if blood pressure or a condition has changed.
30 days out
Confirm the exam is done
Ask the driver for the result date.
Before the next dispatch
Check the record
Pull the driving record and file it as proof of the new status.
What happens when a CDL driver’s medical certification lapses
The state acts on its own once a certificate expires without a new result. The steps below follow FMCSA’s rules for state licensing agencies.
Certificate expires
No new result reaches the state.
Within 10 days
State marks the driver as not certified.
Within 60 days
State starts removing commercial privileges from the license.
Until recertified
Driver can’t drive a CMV; a roadside stop means an out-of-service order.
The carrier’s duty starts earlier. A driver whose certificate has expired must not drive, and the carrier must not dispatch them, even if the state hasn’t acted yet.
A DOT medical card checklist you can use as a template
Driver
Know the expiry date and book the exam early
Bring medication list, glasses and hearing aid
Bring treating-clinician forms for conditions like insulin-treated diabetes
Ask the examiner to confirm the result was sent
Non-CDL drivers: carry the paper certificate
Carrier
Check each driver’s medical status on the driving record before dispatch
Keep the record, and any variance, in the driver qualification file
Track every expiry date, including short certificates
Remove a driver from duty the day their status lapses
Review the files at least yearly, alongside the annual record review
The same driver file sits beside the vehicle records an auditor asks for: daily DVIR and DOT inspections, preventive maintenance schedules and each unit’s repair history.
Who handles each part of medical compliance, and where FleetRabbit fits
Task
Who owns it
FleetRabbit
Medical exam and result
Examiner and FMCSA
Outside FleetRabbit
Medical status on the CDL record
State licensing agency
Outside FleetRabbit
Driver qualification file
Carrier
Confirm in a demo
Medical card expiry reminders
Carrier
Confirm in a demo
Pre-trip and post-trip inspections
Carrier and driver
Documented
Preventive maintenance and repairs
Carrier
Documented
Driver hours from your ELD
Carrier
Documented
FleetRabbit for compliance-ready fleets
Drivers cleared to drive, trucks cleared to run, and the records to show both
Digital DVIRs
Photos, signatures and mechanic sign-off on every tractor, trailer and chassis.
Maintenance
Preventive schedules and full repair history.
Driver hours
Hours-of-service data from your ELD provider.
The 20-minute demo
Inspection and repair records for each unit
How driver files and medical expiry dates are handled
The free plan for three vehicles
DOT medical card questions from drivers and fleet managers
How long is a DOT medical card valid?
Up to 24 months. The examiner can issue a shorter certificate, for example one year for stage 1 high blood pressure or insulin-treated diabetes.
Do CDL drivers still need to carry a paper medical card?
Not in states using the electronic system since 23 June 2025. The result goes to the state and onto the driving record. Non-CDL drivers still carry the paper certificate.
How does a carrier verify a driver’s medical certification now?
By getting the driver’s driving record from the state and documenting the valid medical status, and any variance, in the driver qualification file before the driver operates a CMV.
What happens if a CDL driver’s medical card expires?
The state marks the driver not certified within 10 days and begins downgrading the CDL within 60 days. The driver can’t drive a CMV until recertified.
What blood pressure fails a DOT physical?
180/110 or higher means no certificate until it is brought down to 140/90 or lower. Lower readings mean shorter certificates, not automatic failure.
Is the urine test at a DOT physical a drug test?
No. The urinalysis checks for signs of other medical conditions. DOT drug testing is a separate process.
Does FleetRabbit track medical card expirations?
A FleetRabbit article on driver qualification files describes medical certificate tracking; ask to see it working in a demo. FleetRabbit’s inspection, maintenance and ELD hours features are documented on its product pages.
Cleared
Make sure every driver’s medical status is current before the next load
Check the records, track the dates, and keep the truck’s inspection file beside the driver’s.
October 21, 2026By Derek Goes
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