A DOT physical is the medical exam commercial drivers need to show they're physically qualified under 49 CFR §391.41. It must be done by an examiner on FMCSA's National Registry. It checks vision (20/40), hearing, blood pressure, a urine sample for health markers and your medical history. A pass is valid for up to 2 years, or less if a condition needs monitoring.
Who needs a DOT physical
Drivers of commercial motor vehicles in interstate commerce must be medically certified. That generally means vehicles over 10,000 lbs, vehicles carrying placarded hazmat, or vehicles carrying 9+ passengers for pay (16+ without pay). CDL holders must keep their medical certification current with their state licensing agency, which in Texas is the Department of Public Safety. Texas applies similar medical standards to intrastate drivers, with some exceptions; see Texas intrastate vs federal rules.
What's checked at a DOT physical
| Test | Standard |
|---|---|
| Vision | At least 20/40 in each eye and both eyes together, with or without glasses or contacts; at least 70° horizontal field of vision in each eye; able to tell red, green and amber signal colors. Drivers who can't meet the standard in one eye may qualify under FMCSA's alternative vision standard. |
| Hearing | Hear a forced whisper at 5 feet or more in the better ear (hearing aids allowed), or an average hearing loss of no more than 40 dB in the better ear on an audiometric test. |
| Blood pressure and pulse | Checked for hypertension and irregular heartbeat. See the table below. |
| Urinalysis | Screens for protein, blood and sugar as signs of underlying conditions. This is not a drug test. |
| Physical exam | General appearance, eyes, ears, mouth and throat, heart, lungs, abdomen, spine, extremities and neurological reflexes. |
| Health history | You complete the history section of the Medical Examination Report Form (MCSA-5875), including medications and past surgeries. Leaving things out can invalidate the certificate. |
Blood pressure and how long your certificate lasts
FMCSA's guidance to medical examiners uses these ranges. The examiner makes the final decision.
| Blood pressure | Typical outcome |
|---|---|
| Below 140/90 | Certificate for up to 2 years |
| 140–159 / 90–99 (stage 1) | 1-year certificate |
| 160–179 / 100–109 (stage 2) | One-time 3-month certificate to get it under control; then 1 year if reduced to 140/90 or below |
| 180/110 or higher (stage 3) | Not qualified until reduced to 140/90 or below; then 6-month certificates |
Common conditions
- Insulin-treated diabetes: drivers can be certified for up to 12 months if their treating clinician completes the Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870) and the condition is stable (49 CFR §391.46).
- Sleep apnea: there's no specific federal rule, but examiners can require evaluation and proof of effective treatment.
- Epilepsy and seizures: a diagnosis of epilepsy is disqualifying under the standard, though FMCSA runs an exemption program.
- Medications: Schedule I drugs, amphetamines, narcotics and other habit-forming drugs disqualify a driver unless prescribed by a licensed practitioner who believes they won't affect safe driving. Marijuana, including medical marijuana, is disqualifying under federal rules.
How to get a DOT physical
- Find an examiner on FMCSA's National Registry of Certified Medical Examiners. Many urgent care clinics and occupational health centers in Texas are listed.
- Bring your glasses, contacts or hearing aids, a list of medications, and records for any ongoing condition (for example, a sleep study or recent blood sugar logs).
- Complete the driver health history honestly.
- Prices vary by clinic. Some employers pay for it.
The 2025 electronic medical certificate change
Since June 23, 2025, examiners send the results of CDL and CLP holders' exams electronically through the National Registry to the state licensing agency, which records them on the driver's record. Examiners no longer have to issue the paper Medical Examiner's Certificate (MCSA-5876) to CDL holders, and carriers verify medical certification from the driver's motor vehicle record. Drivers must still carry any medical variance or exemption document. Non-CDL drivers still receive and carry a paper certificate. See FMCSA's National Registry for details.
Why it matters
A driver who isn't medically qualified can't legally drive a CMV, and carriers must keep proof of medical certification in the driver qualification file. After a crash, medical certification is one of the records checked, especially when fatigue or a medical event may have played a part.