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.
I have a driver who recently was denied a medical card because he has a defibrillator. He has driven with this for several years with no problem. Can he obtain a medical release form from his doctor regarding this issue?
@Melissa
Tough one. The FMCSA has decided that defib’s are an instant disqualifier. You could try, but not real sure that it’s going to work. If the driver is traveling intra-state only, then you would want to check with the state DLD and see what their stance on this issue is. In some states where the driver is intra-state only and maybe downgrade to a class B license, might be a chance there. Check with your state DLD for that information.
My primary care provider is not the doctor I receive medications from that may be in question by the examiner. How should I proceed? Is there another form or will the examiner accept a letter from the doctor? I do not see my primary care wanting to fill out a form based on another doctors plan of care.
@Raymond
Your primary care provider is not going to fill out a medical release form based on someone else’s treatment.
So go to the prescribing doctor to get your medical release form filled out by that physician. That is the information that the CME is going to be looking for.
Thank you
I went to a doctor two and a half weeks ago, complaining about sleep problems. He prescribed me Trazodone to help me go to sleep. Now I’m trying to get into Prime’s trucking school, and they tell me that I will likely be disqualified if I am taking Trazodone, and need to get a Dr.’s note stating that I’m off the meds before I will be able to pass the medical exam. Is there anything I can do so I can keep taking Trazodone, I feel like a new man already, or do I need to find a new med or get off sleep meds completely?
@Trent
You could start with a medical release form from your prescribing doctor explaining the needs and usage of the present medications that you are taking. With a proper explanation and proper usage, you may be able to continue using what is working for you. The big issue is the possible re-actions and /or side effects to a new medication. Or how you may act under a medication that is new to you. You could also ask your prescribing doctor what other medications you could possibly use.
Hi i have a pacemaker, recived it oct 7 2014. i had a dot physical done to day with a release form and had to have doctors office fax over my medical reasons why and my pacemaker reports, i have to find out tomorrow but i did receive a 2week card till they get the rest of the report to get my 1yr card, told i have to do a one year follow up and dot physical every year. my question is they did not say i may receive a card yet and i want to know if i may get denied. in 8 months i have had this my reading have been good about 11% that the pacemaker worked and 98% left on batteries and is set to not go no less then 60 bpm. i ment on this that 11% of the time the pacemaker was operational in those 8 months.
@Robert
This is the normal process for pacemakers and DOT. With all of the proper documentation, you should receive your medical card for one year and you will need to have a recertification done each year thereafter.
I drive a truck with GVWR under 26k and travel almost exclusively within a 200 mile radius. Because of frequent kidney stones and nerve damage in my shoulder, and a mildly herniated disk in my lower back, I take Percoset up to 40 mg a day. It does not make me sleepy, it actually has the opposite effect most of the time, and I don’t take it while driving just to make sure. I went to get my medical card renewed and they said having Percoset prescribed to me is an automatic disqualifier. They said the only way they will give me my card is if I get a letter from Dr. stating that I will stop taking this medicine and the Dr. will not prescribe me any more. They said it was a DOT rule and they had no control. My quality of life will suffer as I have weaned myself off before and got next to no sleep because of the pain and had to sit with a heating pad and take more ibuprofen than directed just to not be in tears, so not having the Percoset is not an option. I don’t abuse it, I use it as a tool to make my quality of life better.
@lbzdually
This is not a RULE and the CME seems to be over-stepping the CME’s boundaries. You drive and are home every evening and you should not be held to an interstate drivers rules and regulations.
Get a medical release form from your doctor explaining your situation and issues. That should answer any questions that the CME should have. I would take my next examination somewhere else. Your situation is going to pose questions, but with proper documentation you should be good to go.
Hi
I just recently applied for a new job so part of the pre employment physical was to have a urineanalysis dot doctor said i have high protein in my urine that i need medical clerance from my primary doctor got checked out and my doctor said i have high protein also wont sign off on my clearance did he can do all sort of follow up test… I have one week for the job offer to take of this? Is there anything i can do or im i officially disqualified from getting said job?
@ Robert
Your medical doctor needs to find out why you have a high protein count. Once he gets a handle on your situation, then all he will need to do is complete a medical release form for you and you should be good to go. But without knowing what is causing the situation, no one is going to sign off on this issue.
I was involved in an accident on a city bus the brakes failed and I steered away to avoid a fatality and was knocked out due to the impact was taken to the er had an extended hospital stay now they are trying to say it was a syncopal episode the video from the bus shows I was awke and alert until the impact had a dot card removed three days after issued for further records review was released by PCP and CME now off in limbo for maybe one year been misdiagnosed and railroaded been a bus driver 15 yes 1st accident and not my fault!
@ marc
Start with the ER doctor and have him write a medical release form stating the facts. Then have your primary doctor do the same thing. This should over-ride the CME’s opinion because he has two other physicians stating the cold hard facts. That should take care of the issue.
I have a valid cdl health card until October 2015but I had a heart attack and had to have open heart surgery in march 2015. Do I have to reapply for a new health card before returning back to work.
@Curtis
Yes, and you will need to be fully healed with a medical release form from your cardiologist and a recent stress test in hand.
Your medical certificate will be good for one year at a time and you’ll need a stress test done every two years for you to continue driving.
Last week I took my husband to renew his CDL now his own doctor says that he has a good bill of health for someone with diabetes however this doctor is looking at his BMI and says that he needs a sleep study. What? His own doctor, my laywer , the federal dot and the ohio dot which I called. All say that their guidelines are not a rule let alone a law so how can these doctors do this and get away with it. I just read the ohio and the federal does not require this. Now this is funny, why this place is going by these guidelines is because some doctor wrote a book saying that it’s dot guidelines for commercial drivers. Isn’t that like going the law and taking matters into your own hands ?
@Carrie
Sleep apnea screening is a much misunderstood issue in the world of DOT medical certification.
To better understand this issue read these articles in our blog on Sleep Apnea Issues Affect Commercial Drivers.
I drive school bus, I have been diagnosed with congestive heart failure and coronary artery disease. Also have Emphysema, Cataracts on both eyes, will I be able to continue driving a bus.
@Jackie
That is really going to depend on the extent of your conditions and the state that you drive in. A bus load of children and a driver with a multitude of conditions that could render you as an unsafe driver is going to raise some serious question.
I live in Nys an just got my physical , been on suboxone for 12 years. Why is it I can take Xanax an klonopin or narcs! But not that? He gave me a med form for my klonopin to be filled out by my physican yet he totally disqualified me for my suboxone. No form nothing. It does not affect me in any way like taking a vitamin. Is there still a waiver I can get ? I am awaiting a call back from my doctor, this doctor was super unreasonable when it came up . Wouldn’t hear me out not one bit . Should I talk to my doctor an then go an hope to see a more reasonable doctor . I was straight up honest an unless I taped off for the next 2-5 months I am screwed… Help please an yes I tried to read the above messages an help but didn’t see any that pertain to my specific predicament if you will.
@Andy
You must get your primary prescribing doctor to fill out a medical release form for you to take to the next DOT examiner. Your doctor must explain the dosage and the need for such a medication, as well as the length of time that you have been on these meds, and its side-effects to your driving, if any. Without proper documentation, you are going to be flagged without the DOT examiner’s understanding what is going on.
Can a hernia disqualify you from driving in Texas
@Leo
You should not have any issues, as long as it does not interfere with your ability to operate a commercial motor vehicle safely and you can perform the duties of a CMV operator.
If you take a D.O.T Physical at one doctor office will your medical records show up at another medical examiner office?
@jarell
Your information goes into a central Federal database, but is not visible to anyone other than the Feds. But if you are ‘doc shopping’ the fed will be the ones you will be dealing with.
On Jan. 19th 2015, I had some tingling in my arm and hand, I went to the local urgent care and the
ER doctor diagnosed it as a TIA. They did a CT scan and a doppler scan on the arteries in my neck, and a chest x-ray. All of the tests came back negative. ALL my symptoms had subsided within about 20 mins., but since the Dr diagnosed, me with a TIA, she referred me to a neurologist in Lacrosse which when I went to that appt. the neurologist ordered more tests, which all came back negative for an embolic source for my TIA. The CT was neg.for carotid narrowing, the ECHO of the heart showed normal functioning. I also did the DOT occupational therapy driver prescreen evaluation,with the results being above average for my age group. But since I now have this diagnosis of TIA or stroke on my record I can’t even get a DOT DR. to even look at the test results. They won’t even give an appt.for the DOT physical. Is there any way I can get an unbiased DOT DR. to at least look at my situation? One more thing I never passed out or lost consciousness, and was given no medications or therapy for any of this. Thank You Dave
@Dave
This is going to be tough, until you can get the ER doctor to rethink his initial diagnosis. It can be done, but you will have to be patient and bring all of the available information to him for further examination. He has to have everything you have to re-think his preliminary diagnosis.
In the last year, my boyfriend has had 3 dot physicals (new job, coming back from an injury and now another new job). He passed the 1st two with no problem. The third examiner stated he had protein in his urine and wanted further info. We sent her what we had from lab results. He has been diagnosed by his primary with chronic kidney disease and has had it most of his life (he’s in his early 50’s). She has disqualified him from driving stating that he is in kidney FAILURE. She’s telling him that she has derived this from the lab results we gave her but according to the charts I’ve seen, he has not reached that final stage yet. He is stuck…2,000 miles from home with a new company that isn’t sure what they should do with him but are trying to stick by him. He’s a terrific driver. What are our options? Shouldn’t he at least be given something short-term until he can see his primary again?
@Suzanne
Take the records and lab findings to another CME along with the primary doctors opinion on a medical release form. This should be enough for a second opinion.
I just started a new job driving regionally my company sent me to there DOT Medical EX. I’m Taking a oxycodone 10mg 180 pills a month have for 6 years I broke bones in my neck and back I don’t take them while I’m driving only after work as needed. I Got the letter from my primary DR for him, he would only give me a medical card for 30 days til I changed my script to 45 pills a month did that got another letter from my primary DR. again for him he gave me a medical card good for 90 days so he can check that I am only getting 45 pills a month he has told my work about my prescription what I’m taking an the amount. I’m on paid Leave right now the DOT EX. has to talk to the companies corp. DR. an decide if I am gonna keep my job because the card is only good for 90 days. I work in Utah. Does the Medical EX. have the right to do what he is doing.
@Justin
If you did not sign a medical release form for the examiner to release your medical information to the company, you may have a pretty good legal case against the medical examiner. If you did sign a release, then he had the right to do what he did.
Thank you for your response. How about the other part of my question? Is the Doc allowed to dictate my prescriptions? Is he allowed to determine what pain regiment I am supposed to take? If my doctors have written a letter stating that I am fully capable of driving a semi while taking these medications, that I have taken for over 6 years, is it ethical/ legal for this doc to say NOPE, I say you can ONLY do this. Without ever seeing my medical history, an X-Ray or a CT Scan or anything to determine the type of pain I am in or what my pain management should be? Without even taking into consideration the side effects of taking me off this medication suddenly?
@Justin
The CME is not the person to make that determination. His job description is to determine “medical fitness for duty” period. He has over stepped his boundaries and job description.
Also you want to have your medical doctor complete a medical release form for you, not just a note saying you can drive, that isn’t his job to make the CME’s determination.
I am currently a school bus driver in california and recently diagnosed with adhd for which my doctor wants to prescribe vyvance. My doctor is willing to fill out the medical release form stating I am ok to drive the bus. Will this fly with the motor vehicle department in my state? And if so do i need to do present the release form to anyone other than the lab that draws my random drug tests? Thanks.
@Jay
You will have to check with the state of California’s DLD to make the final decision.
The medical doctor’s report will be very helpful to any examiner who will be questioning your medications and their uses.
If you have a current dot card gooduntil next year. My doctor has given me a script for trazodone to help me sleep because of a slight anxiety issue. Can I be taking this while holding a class A cdl. I have taken this before with no problem. Didn’t realize it could be an issue before ,thought I would check before starting again.
@Michael
Have your doctor fill out a medical release form for you.
If there are any issues with how it effects your ability to operate a commercial motor vehicle safely, then it’s going to be an issue. So until you know that you and the world around you are safe while taking this medication, avoid driving.
What about absence epilepsy? which forms does my neurologist need for me to get my permit? until i get permission from her I’m legally not allowed to be behind the wheel. which one does she need and how long do you think it takes to get back?
@Nicole
You will need to get your questions answered by the FMCSA on this one. Time frames and proper paperwork are going to vary, but once you get it started, it should go pretty quickly.
I am trying to find information for someone that has their CDLs and is in a category A. He was told that he is overweight and will lose his CDLs if he cannot lose 70 lbs before he takes his medical exam to get the medical card. My question, Is there a way to get around this? He only has 18 months until he can retire and would like to keep the CDLs. I have been searching and I have not yet seen anything about there being a weight limit that would cause him to be restricted.
@Crystal
There is no weight limits on any driver. So someone is blowing smoke up the information tube.
There may be other conditions that may limit the length of the medical card, but weight is not one of them.
I have heard of some medical examiners requesting sleep studies to make sure there is not an issue, I have also read that the DOT is looking into possibly changing the rules for over weight drivers as well.
State of Maryland senate bill effective 10/01/2003 stating. If you are a Maryland NON- Commercial Driver operating a commercial motor vehicle in interstate commerce (within the State of Maryland) and the vehicle weighs 10,001 and up to 26,000 pounds,you are now required to have a valid Federal Motor Carrier (DOT) physical card in your possession. If licensed prior to October 1.2003, have a preexisting Medical Condition, and the onset was prior to 10/01/03, you would be EXEMPT from this requirement for a 20 year period,provided your preexisting condition dos not worsen. You are still required to maintain a DOT physical. This is also found on the Maryland MVA’s Web Site.
Would this Suggest that I’m Exempt due to my preexisting Medical condition I take a anti-seizure medication due a brain surgery in 2000 and have for the past15yrs
@Jerry
You need to check the wording on some of your statements. Interstate is not in the state only. Interstate means that you are traveling outside of your home state. Intra-state only is with in the states boundaries and that the cargo is from and staying inside the state boundaries. If the cargo being hauled is leaving the state, then you are driving interstate commerce.
As far as the medications you are taking, you may, after checking with the state Drivers License Department, be correct as far as the condition and the time frames. Check with your state DLD and confirm. If not just make sure you get your primary prescribing doctor to complete your medical release form for you and take it to the examination. That will answer most of the examiner’s questions.
Is it legal for my company to give the dot physical doctor a list of medication I am taking without my consent
@Chris
Unless you sign some type of medical release form from the company giving them permission to release any of your medical records, then the answer should be NO. And if they did so with out your permission, then they are way outside of HIPPA compliance and you may have a case against them for doing so. Make sure you have all your information together before making any accusations.
Additional info. on comment from march 4, 2015 at 5:56pm
Thanks for the Info. I printed my compete history from 2000 to date of everything with doc. names, address,phone #,, dates. I passed everything until he read anti-seizure med. on the back of the dot physical form and also pointed it out. One more thing at the time of the surgery in 2000. i turned in my B -CDL’s down graded to a C license – non CDL. The tow trucks are all under 26,0001lb. We Tow for the State Police ,Baltimore co. and Harford Co. the state police are the only one to ask for a dot medical card. I still have the letter from the Maryland Medical advisory board say to go to the local MVA a get your down graded license.