The DOT physical: every standard in 49 CFR 391.41(b)

A DOT physical is not a general check-up with a form attached. It is an examination against thirteen specific standards written into 49 CFR 391.41(b), performed by a person who has to be on a federal registry, recorded on two named federal forms, and reported to the FMCSA by the end of the next day. This page goes through what the rule actually asks for, in the order the examiner works through it.

The rule that creates the requirement

Section 391.41(a)(1)(i) states that a person subject to Part 391 must not operate a commercial motor vehicle unless medically certified as physically qualified to do so. Section 391.41(a)(3) then defines what qualified means: either the person meets the standards in 391.41(b) and has complied with the examination requirements of 391.43, or the person has obtained a medical variance from FMCSA from those standards and has complied with 391.43.

Carrying the certificate is a separate question from holding it, and the answer changed recently. Under 391.41(a)(2)(i)(B), on or after 23 June 2025, a driver required to hold a CDL or a commercial learner's permit who has a current medical examiner's certificate no longer needs to carry that certificate, or a copy, on their person. Before that date the rule ran differently: 391.41(a)(2)(i)(A) allowed a CDL holder who had submitted the certificate to the state under 383.71(h) to stop carrying it after 15 days. Drivers who are not required to hold a CDL still fall under the general rule in 391.41(a)(1)(i) and still carry the original or a copy when on duty.

One exception survives both versions. Section 391.41(a)(1)(ii) and (a)(2)(iii) both require a driver who qualifies by virtue of a medical variance — an exemption letter or a skill performance evaluation certificate — to carry a copy of that variance documentation whenever on duty. And where the electronic record and the paper certificate disagree, 391.41(a)(2)(iv) says the electronic information FMCSA provides controls.

The thirteen standards

Section 391.41(b) is a list. A person is physically qualified if that person:

1. Has no loss of a foot, leg, hand or arm, or has been granted a skill performance evaluation certificate under 391.49 (391.41(b)(1)).
2. Has no impairment of a hand or finger interfering with prehension or power grasping, and no impairment of an arm, foot or leg interfering with the ability to perform normal driving tasks, and no other significant limb defect or limitation that interferes with those tasks — again subject to a 391.49 certificate (391.41(b)(2)).
3. No established medical history or clinical diagnosis of diabetes mellitus currently treated with insulin for control, unless the person meets the requirements of 391.46 (391.41(b)(3)). Insulin-treated diabetes is therefore not a disqualification in itself; it is a route through a different section.
4. No current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis, or any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse or congestive cardiac failure (391.41(b)(4)).
5. No established history or clinical diagnosis of respiratory dysfunction likely to interfere with the ability to control and drive safely (391.41(b)(5)).
6. No current clinical diagnosis of high blood pressure likely to interfere with safe operation (391.41(b)(6)). Note the wording: the standard is not a blood pressure number, it is a clinical judgement about interference.
7. No established history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease which interferes with the ability to control and operate safely (391.41(b)(7)).
8. No established history or clinical diagnosis of epilepsy or any other condition likely to cause loss of consciousness or loss of ability to control the vehicle (391.41(b)(8)).
9. No mental, nervous, organic or functional disease or psychiatric disorder likely to interfere with safe driving (391.41(b)(9)).
10. Vision. Under 391.41(b)(10)(i): distant visual acuity of at least 20/40 Snellen in each eye without correction, or separately corrected to 20/40 or better; distant binocular acuity of at least 20/40 in both eyes with or without correction; field of vision of at least 70 degrees in the horizontal meridian in each eye; and the ability to recognize the colors of traffic signals and devices showing standard red, green and amber. A driver who fails the worse-eye acuity or field standard, or both, goes through 391.44 instead, under 391.41(b)(10)(ii).
11. Hearing. Under 391.41(b)(11): first perceives a forced whispered voice in the better ear at not less than five feet, with or without a hearing aid; or, if tested audiometrically, does not have an average hearing loss in the better ear greater than 40 decibels at 500 Hz, 1,000 Hz and 2,000 Hz, with or without a hearing aid, with the device calibrated to ANSI Z24.5-1951.
12. Drugs. Under 391.41(b)(12)(i), does not use any drug or substance in Schedule I of 21 CFR 1308.11, an amphetamine, a narcotic or other habit-forming drug. Under (b)(12)(ii), does not use any non-Schedule I substance in the other schedules of 21 CFR Part 1308 except where prescribed by a licensed medical practitioner, as defined in 382.107, who is familiar with the driver's medical history and has advised that the substance will not adversely affect the ability to operate safely. That exception is the reason a prescription is worth discussing with the examiner in advance rather than at the appointment.
13. No current clinical diagnosis of alcoholism (391.41(b)(13)).

Who is allowed to perform it

Section 391.43(a) is short and absolute: except as provided in paragraph (b), the examination must be performed by a medical examiner listed on the National Registry of Certified Medical Examiners under Subpart D of Part 390. There are exactly two exceptions in 391.43(b): a licensed ophthalmologist or licensed optometrist may perform the vision portion covering visual acuity, field of vision and color recognition specified in 391.41(b)(10); and a certified VA medical examiner must only perform examinations of veteran operators.

Section 391.43(c) adds two competence duties on the examiner: to be knowledgeable of the specific physical and mental demands of operating a commercial vehicle and of the requirements of Subpart E, including the FMCSA medical advisory criteria issued as guidelines; and to be proficient in and to use the medical protocols necessary to perform the examination.

The two forms, by number

Section 391.43(f) requires the examination to be performed and its results recorded on the Medical Examination Report Form, MCSA-5875. Section 391.43(h) requires the certificate itself to be completed on Form MCSA-5876, Medical Examiner's Certificate. Knowing the two numbers is genuinely useful: the report is the long clinical document and the certificate is the card-sized result, and people asking for "my DOT physical paperwork" often mean one when they need the other.

What happens at the end of the exam

Section 391.43(g) sets out four outcomes.

• Signature and identification. Under (g)(1) the examiner must date and sign the report and provide full name, office address and telephone number on it.
• Qualified. Under (g)(2)(ii), on or after 23 June 2025, where the examiner identifies that the person will not be operating a vehicle requiring a CDL or CLP and finds them physically qualified under 391.41(b), the examiner completes the 391.43(h) certificate and gives the original to the person examined, and must provide a copy to a prospective or current employing carrier that asks.
• Not qualified. Under (g)(3), on or after 23 June 2025, if the examiner finds the person not physically qualified, the examiner must tell them so, tell them it will be reported to FMCSA, and — this is the part people do not expect — all medical examiner's certificates previously issued to that person are no longer valid and no longer satisfy 391.41(a).
• Delayed. Under (g)(4), where the determination should wait for more information or further examination, the examiner must tell the person that the information must be provided or the examination completed within 45 days, and that the pending status will be reported to FMCSA.

Reporting, and how fast

Section 391.43(g)(5)(i)(B) is the current reporting rule: beginning 22 June 2018, by midnight local time of the next calendar day after completing an examination for any driver required to be examined by a National Registry examiner, the examiner must electronically transmit a completed CMV Driver Medical Examination Results Form, MCSA-5850 to FMCSA through a designated website. The earlier once-a-month regime in (g)(5)(i)(A) ran only to 22 June 2018. Under (g)(5)(ii), an examiner who performs no such examinations in a calendar month must report that fact by the close of business on the last day of the month.

Retention, and the 48-hour clock

Section 391.43(i) requires each original completed Medical Examination Report, paper or electronic, and a copy or electronic version of each certificate, to be retained on file at the medical examiner's office for at least three years from the date of examination. The same paragraph obliges the examiner to make all records and information in those files available to an authorized FMCSA representative or an authorized federal, state or local enforcement representative within 48 hours of the request.

That three-year retention is a practical reason to note which clinic you attended. If a certificate is lost, the examiner who issued it is required to still hold the file.

One more requirement that is easy to miss

Section 391.43(d) applies to a driver authorized to operate only within an exempt intracity zone under 391.62. That driver must furnish the examining medical examiner with a copy of the medical findings that led to the issuance of the first certificate which allowed them to operate wholly within that zone. If this applies to you, bring the old paperwork.

Choosing a clinic

The only hard requirement is the one in 391.43(a): the examiner must be listed on the National Registry. Everything else is convenience. That said, the sections above suggest a few useful questions, and none of them are matters of opinion:

• Is the examiner currently listed on the National Registry, and what is their National Registry number? Listing is the statutory condition in 391.43(a), and continued listing has its own requirements in 390.111.
• Will they handle a vision referral to an ophthalmologist or optometrist under 391.43(b)(1) if the worse-eye standard in 391.41(b)(10) is in question, or does that mean a second appointment elsewhere?
• If a prescription is involved, can it be discussed before the appointment? The 391.41(b)(12)(ii) exception turns on a practitioner familiar with your history having advised that the substance will not affect safe operation.
• Do they file the MCSA-5850 by the next-day deadline in 391.43(g)(5)(i)(B)? A late filing is the examiner's problem on paper and yours in practice.

Each listing in this directory shows the certification dates the register publishes for that examiner and the date the record was last checked. That tells you whether the listing was live when we looked. It is not a substitute for the National Registry itself, and the directory does not claim to be one.