Updated: May 2020
One of the complications of getting your medical certificate is if you have a medical condition that may pose a risk to safety while operating a commercial motor vehicle.
How does this play into the FMCSA DOT physical exam?
Here’s what the DOT doctor is checking for:
- Have you had a medical condition which poses a risk to safety?
- Do you have symptoms that may indicate an undiagnosed condition?
- Do you currently have a diagnosed condition?
- Is the condition being treated?
- Is the treatment effective, and safe, for you to drive a CMV?
- Is the medical condition stable, and safe, for you to drive a CMV?
If a medical condition is a concern, the medical examiner must evaluate whether the condition is a risk for incapacitation:
- Is the onset of incapacitation symptoms so rapid as to interfere with safe driving?
- Is the onset so gradual that you may be unaware of diminished capabilities?
Medical Release Opinion
To ensure that the medical examiner can complete the DOT physical exam at your appointment you should bring a Medical Release Opinion letter from your treating physician. You can download instructions and a letter template here, or refer your treating physician to this page for the necessary information.
If you do not have the necessary documentation with you, for the DOT physical exam, the medical examiner may have to temporarily disqualify your medical certificate. You will need this documentation before you can be reconsidered for qualification for a medical certificate.
Medical Conditions
These are the medical conditions listed on the FMCSA long form for which you should have supporting documentation for the medical examiner:
Illness or injury within the last 5 years • Head/Brain injuries, disorders or illnesses • Seizures, epilepsy • Eye disorders or impaired vision (except corrective lenses) • Ear disorders, loss of hearing or balance • Heart disease or heart attack; other cardiovascular condition • Heart surgery (valve replacement/bypass, angioplasty, pacemaker • High blood pressure • Muscular disease • Shortness of breath • Lung disease, emphysema, asthma, chronic bronchitis • Kidney disease, dialysis • Liver disease • Digestive problems • Diabetes or elevated blood sugar controlled by diet or pills or insulin • Nervous or psychiatric disorders e.g. severe depression • Loss of, or altered consciousness • Fainting, dizziness • Sleep disorders, pauses in breathing while asleep, daytime sleepiness, loud snoring • Stroke or paralysis • Missing or impaired hand, arm, foot, leg, finger, toe • Spinal injury or disease • Chronic low back pain • Regular, frequent alcohol use • Narcotic or habit forming drug use
Role Of A Commercial Driver
It’s important that your primary care physician, who is treating you for the medical condition, also understands the physical, mental, and emotional demands of your job, as well as the responsibilities, work schedule and job stresses you have to deal with.
These are extraordinary factors that a family practice physician or specialist does not encounter when dealing with their general patients. These factors must be considered in the doctor’s Medical Opinion Release letter. See Driver’s Role – FMCSA 49 CFR 391.41 (responsibilities, work schedules, physical and emotional demands, and lifestyles, etc).
Qualification For Your Medical Certificate
The DOT doctor, aka certified medical examiner, has been certified for evaluating the special circumstances of a commercial driver.
The Medical Opinion Release letter from your primary care physician helps the DOT doctor to evaluate your medical condition in view of the safety risk in driving a commercial vehicle. However, the decision to qualify or disqualify you for a medical certificate rests with the DOT doctor, not your primary care physician.
Additional Resources:
Guidebook: How To Take The Stress out of Getting Your DOT Medical Card
Comments Please! (not Questions)
Your comments are welcome in the Comments section below.
Please do not post questions about medical conditions below. If you have questions about specific medical conditions related to the DOT physical, please go to the Frequently Asked Questions section, and post your question in the appropriate category. Trucker Docs™ will answer your question as soon as possible.
My son recently had a stroke. We have progress notes from his cardiologist and the neurologist that say they have released him to go back to work. The company sent him to a dot physician to get another physical even though the one he had was still good. Can he qualify for a medical certificate or is there a waiting period for him to go back to work? We brought all of the records we had to the DOT that said he had been released. From what I am reading a cerficate is different than the medical card that the cdl drivers carry. I understand also that the medical examiner can limit the time that the certificate is good for and that he would need to be recertified. When I looked on the fmsca website there was a form for the certificate and a different form for a physical. Do we need to go to the DOT and just request a certificate?
@Missy
First, regarding the stroke. There is a one year waiting period from the point of release before he can get a medical card/certificate.
Second, without knowing what his drivers class is, I can’t tell you what his requirements are going to be. But the examiner should have all of the correct paperwork you would need. So check with them first. Good Luck.
DOT Physical Forms
2 forms are needed. The DOT doctor will have the forms, so you don’t need to worry about that.
1. The Medical Examiner’s Certificate is the same thing as a Medical Card, also known as a DOT Card. The driver must carry this with him/her at all times whilst driving.
The Medical Examination Report, also known as the Long Form, is completed by the driver and the doctor during the DOT physical exam.
For more information see our blog article What do I need for a DOT physical exam.
Thank you so much. It will be a long road for him but he is doing great. It’s kind if got him down because trucking has been the only thing he has been allowed to do. Thank you so much for your help. I’m keeping this bookmarked just in case I have other question….thanks
@Missy
You are very welcome. Best wishes.
I have sleep apnea, doctor gave me a 1 month medical card when I went to renew my card contingent upon me bring a copy of my Sleep study. My most recent sleep study was 2 years ago and he will not accept it. My insurance won’t cover cost of another study since I haven’t met my deductible. I have the study that shows the AHI and the read out that shows I’m in compliance with my CPAP.
@Daniel
Looks like everybody is between a rock and a hard place.
You could try getting your primary doctor to fill out your medical release explaining your compliance and see if the examiner will accept it, along with any other documentation you may have. Good Luck.
Hi i took a dot random drug test, the medical reveiw dr called me about a drug i am taking, it is generic adderall, i gave him all the information they needed to confirm it, it was confirmed i have a prescription for it, it is used for adah, they still called my employer don*t think they said name of drug but said i was adah, i drive a transit county bus for mrdd adults, been driving over 25 yrs, never had trouble like this before for random drug tests, they would call, i gave info and was always passed, they never called my employer before, but they called this time, can they do that when they say i passed negative this time and told my employer my personal issues, i live in marion ohio 43302 work for marion county mrdd, thanks
@Yvonne
It seems a bit out of line to me. Call and ask – By what permission did they have to do such a thing? and why?
I don’t know but they have me working at different depts til sept 18 2014 where they are sending me to be evaluated, I think this is wrong, they say something about a 327 code, or maybe some kind of code that started with 3. Well I guess I will go for valuation, I don’t get it but I have to do as they say, thanks, have a good one”
I am going to have open heart surgery for a bicuspid aortic valve and aortic aneurysm. Will I be eligible to keep my cdl? If not, is there anything I can do to keep it?
@Kevin
Once you have completely healed and your cardiologist completes your medical release form, you should be able to continue your driving career. You will need a new DOT physical exam. Take the medical release form for the DOT medical examiner.
Your medical card will probably be good for a year at the time, but you’re still driving. Good Luck.
I am a disabled veteran with a service connected hearing loss. I have been a truck driver for over 30 years and have had no accidents, tickets or any other problems. My current employer for the past 9 years has recently indicated that they don’t feel it is safe for me to drive. this is 9 years after having no tickets, accidents and getting excellent reviews from them. I went to see an ENT who indicated I am ok to drive as long as I wear my hearing aids. The employer still indicates they don’t feel It is safe for me to drive a truck.
@Cruz
This sounds more like company policy.
If you pass the DOT examination with the use of hearing aids, then there is no issue with the federal requirements.
So check with the company as to what policy they are using. Companies are allowed to have stricter requirements than the federal requirements. If it’s company, then you know where you stand.
I have stage 4 renal see a kidney specialist on a regular basis and preparing for dialysis.
I have a class B license in California driving a 18 person transport van for elderly and disabled. No strenuous work about it just pick them up and drop them off at store or day programs.
I was told once I start dialysis I would lose my class b per the dot dr after jumping through hoops for 3 months to get him to approve me for another year when I went it for renewal.
My question that I can not get anyone to clearly answer is when I go on dialysis do I lose my class b or can I still drive for a living?
@Jeremiah
This is a state related question. If you have an intra-state only license and the state of CA says you can operate the bus and still have dialysis then you are good to go.
Check with California driver’s license department to confirm.
I was just denied recertification because it was discovered that I have some osteoporosis in my back. The Dr. who gave me my examination said that in order to be DOT certified, I have to be found able to drive a truck cross-country and load and/or unload any cargo I’m transporting. Is that accurately Interpreting DOT regs? I am employed as a transit bus driver and am not even allowed to help any passenger, who may have fallen, get to their feet. It seems unreasonable to expect me to do more than my current job expects me to do. Thanks for your input!
@Joyce
If you are a class A driver, then the examiner is correct.
But if you are not a class A driver and only operate a transit bus, then he is off base.
Each state has different class driver and different specification for the varying classes. Check with your state DLD and get those specs for your class license and then go get your medical card.
Driver at my company had pacemaker installed on June 17th. Must he wait 3 months before returning to driving?
@Jeff
He has a waiting period of three months and he needs to be fully healed before returning to work.
Make sure he brings a medical release form, filled out by his doctor, to his next medical examination. He will have to have a new medical card before he can return to work, along with a return to work note from his primary doctor.
Recently had a drug test that reported out as negative but since I am taking an amphetamine based medication need a medical note from doctor saying safe to drive. How often will I need to provide this note to my employer – how long is it good for? Thanks!
@Trisha
You will need that note until you are off the meds. But one note, one time, until retested again. The MRO review officer will need to see the prescription each time you are drug tested, until you are off the meds.
Quick question. Went in for a new dot physical and am told I have to go take another sleep test. I have already taken a test 3 years ago and results came back with no sleep apnea. Am i required yet again to go spend more money and take another test? Or are my results still good?
hi I am off work right now due to an illness, my question is if I am on warfarin and I have a heart problem and now possibly a lung problem that I am waiting to here back on should I even try to get back a medical card to drive or based on what’s going on with my health should I just not even try to get it back.
@Joel
Potentially your conditions sound like they may be taking you off the road. The medications are going to cause problems too. So if you have another choice, I would be investigating those options. Best wishes.
I recently went in to have my DOT physical, now I won’t lie I have a wrestler type body. I took a sleep study about a year ago and was told I had mild sleep apnea but not cpap required. when I hand the results to the N.P. I was told that those results are useless and per DOT rules you must have a new sleep study done every year and I could not have temporay card too get it done per DOT rules. lost three weeks of pay dealing with it. is this true you cannot have a card while you are getting a sleep study done?
@Richard
Sounds like it’s time to go somewhere else for your examination. The NP is kinda overstepping boundaries on this one.
Get a note from your MD and have him fill out the medical release form for you.
Then go somewhere else for your examination and take the medical release form to the DOT doctor.
For more information see our blog articles on sleep apnea.
I am on a blood thinner Xarelto for parasoxmal Afib my PCP and my Cardiologist told me all is fine. according to the tests they do not see a problem. My job told me I cannot be on a blood thinner that I am taken out of service. The doctor told me it is not encouraged to pass people on blood thinners due to it being a federal mandate and ruling. I have searched high and low and have not the found anything which would agree with what he said. I think he is jerking me around. please advise.
@Mark
It isn’t so much a mandate or ruling, it’s more about the possible effects of the medication on a driver.
I would get a written medical release form completed by your primary care physician and take it with you when you get your DOT examination done.
You will, more than likely, only receive a one year medical card due to your condition and medications. Remember it’s about safety to you and the people around you while driving, nothing personal, just basic guidelines.
I had a stroke three years ago but have no issues in three years can I get a medical card?
@Derek
I would make sure you have a medical release form filled out by your primary healthcare provider and copies of your latest testing in hand when I went for the DOT examination. With everything in hand when you walk in the door, you shouldn’t have any real difficulties.
Just had a pacemaker implanted ninety days ago. Do you believe my cardiologist will allow me to return to my job as a city bus driver, here in Las Vegas?
@James
Not sure of the rules within NV.
As a class A driver you will have a waiting period following the pacemaker install. But if you are not a class A driver then the wait may be shorter.
Also, please be aware that once you were no longer able to operate a vehicle, due to surgery, that you need to acquire a new medical card. Or at least that is true with the class A drivers.
Make sure you check with your state DMV to get the best answers regarding your specific situation.
I am trying to get my CDL to be a bus driver, I went to see my PCP and got my physical. I am on Effexor for depression, which I have been on for years. And I am also on Suboxone due to a surgery that I had 7 years ago that caused me to have to come off of many pain medications in which my doctors failed to tell me how addictive they would be. Is this going to stop me from getting my CDL.
@Erica
I believe, that as long as you are on these medications, you will have difficulty passing your DOT medical examination.
What I would to is get your medical release filled out by your PCP and have that in hand when you go to take your DOT exam.
This information helps the examiner make a more informed decision. But the final qualifying decision remains with the DOT examiner.
So me even being on my Effexor is going to stop me from getting it then isn’t it. I thought so. Thank you for taking the time to answer my questions.
I am on Prozac and I have a cdl. It depends on why you take it, the cdl motor vehicle will send you a form after or if it’s detected during drug testing. Or the doctor can write on your physical paper why you take it and you will only pass if the doctor doesn’t think it will be detrimental in your duties, a hazaed during driving and your problem will be evaluated. But I was sent a letter and my doctor sent a reply on why I use it and I am allowed to use it.
No, its the suboxone.
If u have a stroke do u lose ur cdl the day u had the stroke?
@Kelly
If you have a stroke, you must wait for a period of at least one year from the time of medical release.
You don’t lose your CDL, just your medical certification for the next year.
Your company will probably send you to a doctor, theirs when you are well again and if you are cleared to drive you keep it, I was on disability and my physical came up, I lost my endorsements when renewing my license but they won’t take them premantly until after 2 or 3 years you have to ask your motor vehicle agency or call the dot like I did. When you are better and you take new physical papers to doctor and you are cleared then you can just go to motor vehicle and add them back on as long as the time lapsed is not over the amount allowed, you still have a drivers license just not the endorsement until you clear.
CME folllow Federal Regulations and the guide lines for the Fittness test. I believe CME’s have a huge roll in helping us CDL drivers with stay complient and healthy, just as we the driver has. It isnt like being lic. to drive a regular passenger car. Be healthy and know your job I say!
I am being sent for a sleep study after my medical exam for a dot medical drivers card. question: can I use the at home sleep study testing device from a certified sleep lab? this way I don’t have to go sleep in a lab.
@Mike
I believe that is correct, just make sure that the home study will answer all of the examiner’s questions and is a DOT approved testing process.
This can effect your cdl dramatically, if you fail your sleep test, they will give you a breathing machine, you cannot get one until diagnosed with a sleep study first. If you use it and they determine with another kind of test you are fine to drive they will clear you and you will have to go more frequently for physicals and bring results from sleep study doctor with you saying they cleared you to drive.
How can a DOT medical examiner be allowed to determine our careers. I think there should be no medical cards to drive truck! That’s our lively hood and now having a DOT saying we might not be able to drive why is that?? Just because we a health issue that can be resolved by our family dr.
I agree with you. They threaten our livelihood and careers. I am dealing with the threat of my job loss because my Dr who has been seeing me for 15 years now, has told the Dr at the place who did the Physical, that they will not give me a medication to bring my BP down TWO POINTS because it would be too dangerous for me and the DOT Dr that has seen me ONE time, says no that’s not right that it has to be lower. I don’t FEEL good when it’s lower than my normal. There needs to be some regulation protecting people from medical bullying like this.
It’s because DOT drivers and their health do not only affect them but every single person on the road.
The profile of the average truck or bus driver:
Male.
More than 40 years of age.
Sedentary.
Overweight.
Smoker.
Poor eating habits.
Statistically, drivers are:
Less healthy than the average person.
More than two medical conditions.
Cardiovascular disease prevalent.
Seems like common sense to me.
Reference: http://nrcme.fmcsa.dot.gov/documents/FMCSAMedicalExaminerHandbook-2014MAR18.pdf
I’m thinking it’s the DOT, and they just want safe drivers, so why would you think a person with issues which effect their driving should be driving long hauls with lethal trucks and school buses. Hey I am dealing with issues too now for my breathing, it doesn’t effect my job yet I might lose my med. cert if I cannot get resolve. I’m just as mad but well those are the rules. you might as well just hand out licenses to anyone if you don’t want to follow the rules.
I feel it’s not just CDL drivers that may or may not have health issues.
There’s other professions out that require the same amount of responsibilities.
Think about manufacturing and the auto industry. And may also pose the same health issues. DOT PHYSICAL are a money market and the cost for one. Can range anywhere from 55-250 dollars. Now we all know that the FMCSA will make our lives more complicated than it is already. They have no clue what this business is all about.