At a DOT physical you fill in a health history on Form MCSA-5875, and an examiner listed on the National Registry then records your pulse, blood pressure, a urinalysis, vision and hearing, and checks fourteen body systems against the standards in 49 CFR 391.41(b). The urine sample is not a drug test: the form asks for specific gravity, protein, blood and sugar, and 49 CFR 40.13(e) says a test done as part of the physical to decide medical qualification is not a DOT drug test. A DOT drug test, when an employer needs one, is a separate collection under Part 40.
This page walks through the visit in the order it happens. The standards themselves are covered one by one on the DOT physical requirements page, and how long the resulting certificate lasts is on the certificate validity page.
Who needs one, and who may do it
Under 49 CFR 391.41(a)(1)(i), a person subject to Part 391 must not operate a commercial motor vehicle unless medically certified as physically qualified. For Part 391, a commercial motor vehicle is defined in 390.5: a vehicle used on a highway in interstate commerce that has a weight rating or weight of 10,001 pounds or more, or is designed or used to carry more than 8 passengers (including the driver) for compensation, or more than 15 passengers not for compensation, or carries placarded hazardous materials. That is why people who never need a CDL, such as some pickup-and-trailer operators, still need a DOT physical.
The exam must be performed by a medical examiner listed on the National Registry of Certified Medical Examiners (391.43(a)). Two exceptions sit in 391.43(b): a licensed ophthalmologist or optometrist may do the vision part, and a certified VA examiner may examine veterans only. How examiners get and keep that listing is on the examiner certification page. You can find listed examiners near you in the DOT physical directory.
DOT physical, CDL physical, medical card: the same thing
There is one federal examination. "CDL physical" and "DOT physical" both mean the exam in 391.43. The "medical card" is the certificate the exam produces, Form MCSA-5876 under 391.43(h). The long form people ask for is the Medical Examination Report, MCSA-5875, which 391.43(f) requires the exam to be recorded on. The version set out in the rule today took effect on 16 January 2024 (88 FR 80169); it removed a certification option for an old vision waiver programme and is otherwise the form clinics use.
Before you go: what to bring
The rule does not publish a checklist for drivers, but the form and the sections around it tell you what the examiner will ask for.
- Photo ID. The form has a "Driver ID verified by" line where the examiner notes the type of photo ID used, such as a driver's license or passport.
- Your medication list, with doses. Section 1 asks whether you take prescription or over-the-counter medicines, herbal remedies or diet supplements, and the instructions ask for the name and dosage of each. The examiner is told to compare the list against your health history answers.
- Glasses, contacts and hearing aids you drive with. The vision and hearing standards in 391.41(b)(10) and (11) can be met with them, and the certificate records it.
- Records for any condition you are treated for. Question 5 onward asks about heart problems, high blood pressure, diabetes, sleep disorders and more. An examiner who cannot decide on the day may put the exam on hold for up to 45 days under 391.43(g)(4) to get more information.
- Insulin users: a completed MCSA-5870 signed by your treating clinician within the last 45 days (391.46(c)). See diabetes and the CDL.
- Drivers using the alternative vision standard: a completed MCSA-5871 from an ophthalmologist or optometrist signed within the last 45 days (391.44(c)). See vision and hearing requirements.
- Any exemption letter or skill performance evaluation certificate. Under 391.41(a)(1)(ii) you must carry a copy of variance documentation when on duty anyway.
- Exempt intracity zone drivers: a copy of the medical findings behind your first certificate, which 391.43(d) requires you to give the examiner.
Step 1: the health history (Section 1 of the form)
You complete Section 1 yourself. It asks for personal details, whether you hold or are applying for a CLP or CDL, and whether a DOT medical certificate has ever been denied or issued for less than two years. Then come the surgery and medication questions and 32 yes, no or not-sure questions. They include head or brain injuries, seizures, eye and ear problems, heart disease and heart procedures, high blood pressure, lung disease, kidney problems, diabetes and insulin use, mental health, fainting, stroke, missing or limited use of a limb, sleep disorders and loud snoring, whether you have had a sleep test, whether you drink alcohol, whether you have used an illegal substance in the past two years, and whether you have ever failed a drug test.
You then sign a certification that the answers are accurate and complete. The form warns that inaccurate, false or missing information may invalidate the exam and the certificate. That is backed by 390.35, which bars fraudulent or intentionally false statements on records the regulations require, and 390.37, which makes violations subject to civil or criminal penalties. A "yes" answer is not a failure. The form itself says the presence of a condition may not disqualify a driver, particularly if it is adequately controlled.
Step 2: the examiner reviews your answers
The instructions tell the examiner to discuss every "yes" and "not sure", compare the medication list with the conditions you listed, and record anything you left out. The examiner is also told to complete the whole examination even after finding a condition that looks disqualifying, so the record is complete if an exemption is possible.
Step 3: the measured tests
| Test | What is recorded | Standard it feeds |
|---|---|---|
| Pulse, height, weight | Pulse rate and whether the rhythm is regular; height and weight | General findings, cardiovascular (391.41(b)(4)) |
| Blood pressure | Systolic and diastolic; a second reading is optional and recorded if needed | 391.41(b)(6); see blood pressure limits |
| Urinalysis | Numerical readings for specific gravity, protein, blood and sugar | General findings; the form notes protein, blood or sugar may indicate further testing |
| Vision | Acuity right, left and both eyes, uncorrected and corrected; horizontal field in degrees for each eye; red, green and amber recognition | 391.41(b)(10) |
| Hearing | Forced whisper distance for each ear, or audiometric results at 500, 1,000 and 2,000 Hz | 391.41(b)(11) |
The urinalysis is the part that causes most of the confusion. It is a medical screen whose numerical readings go on the report. It does not look for drugs, and it is not sent to a drug-testing laboratory as a DOT specimen.
Step 4: the physical examination
The examiner checks fourteen body systems and marks each normal or abnormal: general appearance, skin, eyes, ears, mouth and throat, cardiovascular, lungs and chest, abdomen, the genito-urinary system including hernias, back and spine, extremities and joints, the neurological system including reflexes, gait, and the vascular system. Any abnormal finding has to be described, with a note on whether it affects your ability to drive a commercial vehicle safely.
Step 5: the determination
The Federal determination section of the form offers these outcomes:
- Meets standards, qualifies for a 2-year certificate. The default ceiling, matching 391.45(b).
- Meets standards, but periodic monitoring required. The examiner ticks 3 months, 6 months, 1 year or another period and gives the reason. Treated high blood pressure is a common cause.
- Does not meet standards. Under 391.43(g)(3) the examiner must tell you, and that it will be reported to FMCSA, and all certificates previously issued to you stop being valid.
- Determination pending. Up to 45 days to supply information or finish the exam (391.43(g)(4)). FMCSA's January 2024 notice on the Medical Examiner's Handbook (89 FR 3892) says pending status does not extend the expiry date of your current certificate.
- Incomplete examination, for example when the driver leaves before it is finished. The same notice says that once an examiner starts an exam, the result must be reported to the National Registry even if it is not completed.
The form's instructions also say English language proficiency, which is a separate driver qualification under 391.11(b)(2), is not part of the medical determination.
After the exam, 391.43(g)(5)(i)(B) requires the examiner to send the results to FMCSA on Form MCSA-5850 by midnight local time of the next calendar day. Since 23 June 2025, 391.43(g)(2)(ii) requires a paper certificate to be completed and handed over when the driver will not be operating a vehicle that needs a CDL or CLP. CDL and CLP holders with a current certificate no longer need to carry it (391.41(a)(2)(i)(B)), because the result travels electronically.
Does a DOT physical include a drug test?
No. They are two different programmes that sometimes happen in the same building on the same day.
| DOT physical | DOT drug test | |
|---|---|---|
| Rule | 49 CFR 391.41 to 391.49 | 49 CFR Part 382 and Part 40 |
| Question it answers | Are you medically fit to drive a CMV? | Have you used one of five drug classes? |
| Urine is checked for | Specific gravity, protein, blood, sugar | Marijuana, cocaine, amphetamines, opioids, PCP (40.82) |
| Who reviews the result | The medical examiner | A laboratory, then a Medical Review Officer |
| Triggered by | Your certificate interval (391.45) | Pre-employment, random, post-accident and other tests in Part 382 |
Three provisions draw the line:
- 40.13(e): a non-DOT drug or alcohol test given as part of a physical to decide whether someone is medically qualified is not a DOT test, and its results have no consequences under Part 40.
- 40.13(d): when a DOT urine collection is done as part of a physical, medical tests such as glucose may be run on urine left in the collection container after the DOT portion has been sealed into the specimen bottles. The drug specimen is protected first.
- Appendix A to Part 391, paragraph J.4: the examiner may request a non-DOT drug test to help decide qualification, including when there are signs you have not disclosed use of a scheduled drug. Paragraph K.3 says the same about a non-DOT alcohol test. These are the examiner's tools, not DOT tests.
FMCSA's 2024 Handbook notice (89 FR 3892) states it directly: DOT-regulated drug and alcohol testing is not part of the physical qualification exam, but may be done at the same visit for pre-employment or other authorized purposes. The pre-employment drug test itself comes from 382.301, which requires a verified negative result before a driver first performs safety-sensitive functions for an employer. What that test looks for is on the DOT drug test panel page.
Cost, time and walk-ins
No federal rule sets a price or a duration for the exam. Clinics set their own fees, and many take walk-ins. The one thing that matters legally is the 391.43(a) listing, so confirm the examiner's National Registry number before you pay. If you have a condition that needs outside paperwork (insulin, the alternative vision standard, a recent heart procedure), the visit goes faster when the paperwork arrives with you, because otherwise the likely outcome is a 45-day pending status.
Example: one driver's visit
This is an illustration of how the rules apply, not a prediction for any individual. A 52-year-old Class A driver takes a blood pressure tablet and an allergy medicine, and wears glasses. She lists both medicines with doses, answers "yes" to high blood pressure, and brings her glasses. Her first reading is 146/92. Under paragraph E.1 of the Medical Advisory Criteria, an elevated reading should be confirmed by at least two subsequent measurements; they come back in the same range, which the criteria call Stage 1. Her corrected acuity is 20/25 in each eye, her fields are normal and she hears a forced whisper at five feet in both ears. The urinalysis shows no protein, blood or sugar. The examiner marks "meets standards, periodic monitoring required", ticks one year because of the treated hypertension, notes "wearing corrective lenses", and files the MCSA-5850 that night. Because she holds a CDL, she does not have to carry the certificate.
Mistakes that cause problems later
- Leaving a medication or diagnosis off the form. The certification you sign makes that a potential false statement under 390.35, and it can invalidate the certificate.
- Treating the urine cup as a drug test, or the reverse: assuming a clean physical means a clean drug test. They measure different things.
- Going on the last valid day. A pending determination does not extend your old certificate.
- Using a clinic whose examiner is not on the registry. The exam does not count under 391.43(a).
- Assuming an old card survives a failed exam. 391.43(g)(3) ends it.
- Shopping for a second opinion without the same information. The 2024 Handbook notice says a driver may ask another examiner for a second opinion but is expected to give both examiners the same medical information.