FMCSA Rules for DOT Physical Examinations
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FMCSA Rules for DOT Physical Examinations

  • Be sure to arrive 20 to 30 min prior to your visit to complete the paperwork
  • Arrive able to give a urine sample, this is for health screening, it is not a drug test
  • If you have any medical conditions, please review the information below and bring any required documentation with you, failure to bring all required documentation will result in a second scheduled visit and an additional fee of $95 to complete the exam and paperwork.

The most common required documentation requirements are: 

If you have diabetes: a copy of a HgA1c (not more than 3 mo old) 

If you have sleep apnea: a recent report from a CPAP or AutoPAP machine which includes an AHI (not more than 1 mo old)

If you have ever had a heart attack or stents: a note from your cardiologist giving clearance to drive commercially from a cardiac standpoint AND results of a Stress Test (not more than 2 yrs old) 

SEE BELOW MORE LESS COMMON CONDITIONS THAT REQUIRE ADDITIONAL TESTING OR INFORMATION

-THE USE OF INSULIN IS AN AUTOMATIC DISQUALIFICATION-

FMCSA Certified DOT Physical Exams for drivers

Head/Brain injuries, disorders or illnesses

A waiting period is required after a brain or head injury, after which a driver can be certified for 1 year. The following documentation is required: Neurological examination including neuro-ophthalmological evaluation, and neuropsychological test completed by a neurologist who understands the functions and demands of commercial driving.
Waiting period: 1 year seizure-free and off anticonvulsant (seizure) medication following:

  • Mild injury without early seizure or stroke without risk for seizure.
  • Intra-cerebral or subarachnoid brain bleed without risk for seizure.

Waiting period: 2 years seizure-free and off anticonvulsant medication following:

  • Moderate injury without early seizure
  • Mild insult with early seizure

Waiting period: 5 years seizure-free and off anticonvulsant medication following:

  • Moderate injury with early seizure
  • Stroke with risk for seizure
  • Intra-cerebral or subarachnoid brain bleed with risk for seizure

History of a severe brain injury with or without early seizures is disqualifying.

Seizures, Epilepsy

A diagnosis of epilepsy or an established medical history of epilepsy is disqualifying. (Epilepsy is defined as 2 or more unprovoked seizures.) If a person has one unprovoked seizure, they may still be able to get a 1-year certification after 5 years have passed with no seizure and no anti-seizure medications. The driver must provide documentation of clearance from a neurologist who specializes in epilepsy and understands the functions and demands of commercial driving.
Medication for seizure or epilepsy

Anti-seizure medication or medication for epilepsy is an automatic disqualifier.

Eye disorders or impaired vision (except corrective lenses)

The driver must have a distant visual acuity of at least 20/40 in each eye alone and both eyes together, glasses or contacts are acceptable if you use them. Telescopic lenses are disqualifying. Exemption: A driver with monocular vision (has one eye that does not meet standards) may be able to get a Federal Vision Exemption Certificate, for more information email medicalexemptions@dot.gov or call 703-448-3094.

If a driver has any of the following conditions, the driver will need documentation or letter from the treating physician stating that treatment has been shown to be adequate/effective, safe, and stable:

    • Retinopathy
    • Cataracts
    • Glaucoma
    • Macular Degeneration

    Ear disorders, loss of hearing or balance

    The driver must be able to hear a forced whisper from at least 5 ft away, with or without hearing aids. If the driver cannot hear the forced whisper, then a referral will be made for an audiometer test which must be passed prior to certification. If a driver needs hearing aids to get certified, then the medical certificate will state that hearing aides are required to drive and the driver will be responsible for carrying an extra set of batteries at all times.

    Heart disease or heart attack; other cardiovascular condition

    After a heart attack, a driver will need to be off work for at least two months. The driver will be required to provide the following documentation prior to certification:

      1.  Ejection Fraction of at least 40%.
      2.  Exercise Tolerance Test with acceptable results*.
      3.  Clearance by the cardiologist to return to work. Angina is not an automatic disqualifier but there are strict criteria. The angina has to be stable for at least 3 months, this means no pain at rest and no change in pattern of angina. The driver will also have to provide a note from the cardiologist stating the angina is stable, that medicine is well tolerated and the driver is cleared for driving.

      * Abnormal Exercise Tolerance Test (ETT) is defined by an inability to exceed 6 METS (beyond completion of Stage II, or 6 minutes) on a standard Bruce protocol or the presence of ischemic symptoms and/or signs (e.g., characteristic angina pain or 1 mm ST depression or elevation in 2 or more leads), inappropriate SBP and/or heart rate responses (e.g., inability in the maximal heart rate to meet or exceed 85% of age-predicted maximal heart rate), or ventricular dysrhythmia.

      Heart surgery (valve replacement/bypass, angioplasty, pacemaker)

      Coronary artery bypass surgery

      The driver will need to be off work for at least three months and will need to provide the following:

        1.  Ejection Fraction of at least 40%
        2.  Exercise Tolerance Test with acceptable results*
        3.  Clearance by cardiology

        * Abnormal Exercise Tolerance Test (ETT) is defined by an inability to exceed 6 METS (beyond completion of Stage II, or 6 minutes) on a standard Bruce protocol or the presence of ischemic symptoms and/or signs (e.g., characteristic angina pain or 1 mm ST depression or elevation in 2 or more leads), inappropriate SBP and/or heart rate responses (e.g., inability in the maximal heart rate to meet or exceed 85% of age-predicted maximal heart rate), or ventricular dysrhythmia.

        Angioplasty surgery or stents;

        The driver may return to work once cleared by the cardiologist, which may be as soon as one week after the procedure. The driver will need to get an Exercise Tolerance Test three to six months after the procedure, and again at least every other year. The test must indicate an ejection fraction of at least 40%

        Pacemaker placement;

        The driver must wait 1-3 months to be certified, depending on the reason the pacemaker was placed. Certification is for 1 year; the following documentation is required:

        1.  Clearance from the cardiologist
        2.  Documentation indicating the presence of a functioning pacemaker (not a defibrillator)
        3.  Documentation indicating completion of routine pacemaker checks.

        A Defibrillator is an automatic disqualifier.

        High blood pressure;

        Drivers that are on medicine for high blood pressure are limited to a 1-year certification.

          • Stage 1 hypertension: Systolic (top number) of 140-159 and/or a diastolic (bottom number) of 90-99. If there is no prior diagnosis of hypertension and the driver is not on any blood pressure medicines, the driver will get a one-time 1 year certificate and have to get the blood pressure down to less than 140/90 before the next renewal. If the driver has a diagnosis of hypertension or have already gotten the one time, 1-year certificate due to hypertension then certification is limited to a 1 time 3 month certification to allow time to get the blood pressure under 140/90. After that, the driver is disqualified until the pressure is below 140/90.
          • Stage 2 hypertension: Systolic (top number) of 160-179 and/or a diastolic (bottom number) of 100-109 diastolic. Certification is limited to a one-time certification of three months. Once the blood pressure is less than 140/90 a 1-year certificate will be issued from the date of the initial examination, not the expiration date of the one-time, 3-month certificate. If the driver fails to lower blood pressure by the expiration date of the one-time, 3-month certificate, the driver will be disqualified until blood pressure is at or less than 140/90.
          • Stage 3 hypertension: Blood pressure is higher than 180 systolic and / or 110 diastolic The driver is disqualified until the blood pressure is reduced to less than 140/90 and treatment is well tolerated. After a diagnosis of stage 3 hypertension, the driver may only be certified for 6 months and biannually (every 6 months) thereafter (the blood pressure must stay under 140/90).

          Drivers with Diabetes or Kidney Disease;

          Must maintain a blood pressure of less than 130/80, since they already have a high risk of heart disease.

          IF YOU ARE A SMOKER;

          Do not smoke just prior to your exam. Each cigarette causes an immediate temporary increase in your blood pressure.

          Muscular Disease;

          The driver will need a letter from the treating physician, who understands the functions and demands of commercial driving, stating the diagnosis and stating the treatment is safe and effective. Depending on the type of diagnosis the letter will have to come from a neurologist or physiatrist. Drivers with the following disorders may not be certified:

            • Myotonia
            • Isaac’s syndrome
            • Stiff-man syndrome
            • Neuromuscular junction disorders

            Shortness of breath;

            Bring the results of a recent pulmonary function test and a note from the treating physician who understands the functions and demands of commercial driving, stating the diagnosis and that the etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.

            Lung disease, emphysema, asthma, chronic bronchitis;

            Bring a note from the treating physician or pulmonologist stating the diagnosis and that treatment has been shown to be adequate/effective, safe, and stable. Bring the results of a recent pulmonary function test.

            Kidney disease, dialysis;

            If you have kidney disease bring documentation or letter from your treating physician stating that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable. Dialysis is an automatic disqualifier.

            Liver disease;

            Documentation or letter from the treating physician stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

            Digestive problems;

            Documentation or letter from the treating physician stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

            Diabetes or elevated blood sugar;

            Part of the medical certification is a urinalysis in which glucose is checked. If the blood sugar is not well controlled then glucose may be present in the urine, in which case, certification will be delayed until HgA1c blood test results can be obtained. Bringing a recent HgA1c lab result with you may save you some time and prevent a delay. The result of the HgA1c must be less than 10. It must have been tested within the last 3 months, if you do not have one, and sugar is present in your urine, we will give you the required paperwork to get one done.

            Below are the automatic disqualifiers for drivers with diabetes;

            The use of insulin OR in the last 12 months, experienced a hypoglycemic reaction resulting in 1 of the following OR in the last 5 years, had recurring (two or more) of the following hypoglycemic reactions:

              • Seizure
              • Loss of consciousness
              • Need of assistance from another person
              • Period of impaired cognitive function

              Nervous or psychiatric disorders, e.g. severe depression;

              Anti-Depression or antipsychotic medications: Maximum certification is 1 year. Documentation or letter from the treating physician stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable. First generation antidepressants are disqualifying.

              Anxiolytic (anti-panic or anti-anxiety agent) and sedative hypnotic (sleeping pills) therapies:

              May certify for 2 years only if half-life is < 5 hrs and the medication is used for no longer than 2 weeks.

              ADHD meds or CNS stimulators:

              Maximum certification is 1 year. Documentation or letter from the treating physician stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

              Electroconvulsive therapy:

              Must wait for 6 months and not be under ongoing ECT therapy. Documentation or letter from the psychiatrist or psychologist stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

              Lithium:

              Limited to one-year certification. Documentation of lithium level in therapeutic range and documentation or letter from the psychiatrist or psychologist stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

              ADHD:

              Limited to 1-year certification. Documentation or letter from the treating physician stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

              Bipolar and major depression:

              Limited to 1-year certification. Must have 6 months symptom free following a major depression. Must have 1-year symptom free following major depression that included a suicide attempt, or mania.

              Documentation or letter from your psychiatrist or psychologist stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

              Personality disorder:

              Limited to 1-year certification Documentation or letter from the psychiatrist or psychologist stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

              Schizophrenia:

              A diagnosis of schizophrenia is disqualifying. If diagnosis is schizophreniform disorder, brief reactive psychosis, schizoaffective disorder or delusional disorder then:

              • Waiting period minimum of 6 months symptom free if brief reactive psychosis or schizophreniform disorder.
              • Waiting period minimum of 1 year if any other psychotic disorder.

              Limit 1-year certification. Must provide documentation or letter from the psychiatrist or psychologist stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

              Loss of, or altered consciousness

              Documentation or letter from the treating physician stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

              Fainting, dizziness

              Must be symptom free for 2 months and provide documentation or letter from the treating physician stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable. The following conditions are disqualifying:

                • Meniere’s disease
                • Labyrinthine fistula
                • Nonfunctioning labyrinths

                Sleep disorders, pauses in breathing while asleep, daytime sleepiness, loud snoring:

                Sleep Apnea: Certification is limited to 1 year. The driver must be compliant with treatment. After a new diagnosis of sleep apnea, a driver cannot be certified until 1 month after starting use of the CPAP or 3 months after surgical treatment.

                If a driver takes Provigil (Modafinil) then the driver must be monitored for at least 6 weeks while taking Provigil. The treating physician must provide a written statement including the following “Provigil is effective in preventing daytime somnolence and no untoward side effects are present.” Drivers taking Provigil must be re-certified annually.

                Stroke or paralysis;

                Stroke: If the stroke affected the cerebellum or brainstem (no risk for seizure) must wait 1 year. If the stroke affected the cortical or subcortical deficits (at risk for seizure) must wait 5 year. Maximum certification period is 1 year. Evaluation by a neurologist is necessary to confirm the area of involvement.

                Clearance from a neurologist who understands the functions and demands of commercial driving. The neurological examination should include assessment of:

                • Cognitive abilities
                • Judgment
                • Attention
                • Concentration
                • Vision
                • Physical strength
                • Agility
                • Reaction time

                The neurological examination must include neuro-ophthalmological evaluation, and neuropsychological testing.

                There should be no neurological residuals or, if present, residuals of a severity that does not interfere with ability to operate a commercial motor vehicle.

                The driver cannot be certified if on oral anticoagulant (blood thinner).

                Missing or impaired hand, arm, foot, leg, finger, toe

                A driver may be allowed to drive if the qualification requirements for a Skill Performance Evaluation (SPE) certificate under 49 CFR 391.49 are met.

                Spinal injury or disease;

                Documentation or letter from the treating physician stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.

                Chronic low back pain;

                Documentation or letter from the treating physician stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable. May not be qualified if using a schedule 1 drug, including methadone and medical marijuana.

                Regular, frequent alcohol use;

                Cannot be certified with a current diagnosis of alcoholism. If the driver has had a diagnosis of alcoholism, they may be certified for 2 years after successfully completing counseling and/or treatment. The driver may continue ongoing voluntary self-help program. The SAP (substance abuse professional) provides the driver with documentation allowing the driver to return to work.

                Narcotic or habit forming drug use;

                May not be qualified if using a schedule 1 drug, including methadone and medical marijuana. Documentation or letter from the treating physician stating the diagnosis, that etiology is confirmed, and treatment has been shown to be adequate/effective, safe, and stable.