Your DOT medical card is good for up to 24 months, and you renew it by passing a new DOT physical with a certified medical examiner before the old one expires. Some drivers get shorter cards (often 1 year, sometimes 3 or 6 months) because of blood pressure, insulin-treated diabetes, vision or other conditions. As of October 2026, the examiner reports your result to FMCSA's National Registry, which sends it electronically to your state licensing agency. If your card lapses, your state marks you "not certified" and must downgrade your CDL within 60 days. Here's how DOT medical card renewal works for working CDL-A drivers, and how to keep it from costing you loads.
How long is a DOT medical card good for?
The federal maximum is 24 months. Under 49 CFR 391.45, you must be re-examined if you haven't been certified in the preceding 24 months, and the examiner can issue a shorter card whenever your health calls for closer monitoring. Rules and guidance as of October 2026:
- 2 years: the standard maximum for a driver who meets every standard with no condition needing follow-up.
- 1 year (maximum): required for drivers with insulin-treated diabetes under 49 CFR 391.46 and for drivers qualifying under the alternative vision standard in 49 CFR 391.44. FMCSA guidance also says drivers treated for high blood pressure should be certified at least annually.
- 3 or 6 months: used in FMCSA's blood pressure guidance as one-time or recheck cards (more below), and at the examiner's judgment for other conditions.
The expiration date on your card is the one that counts, even if it's earlier than you expected.
How do I renew my DOT medical card?
- Check your expiration date at least 30 to 45 days out. Put it on your phone calendar and tell your dispatcher, so you can plan a home-time or layover day for the exam.
- Find a certified examiner. Only examiners listed on the FMCSA National Registry of Certified Medical Examiners can certify you. Many occupational health clinics near truck routes take walk-ins, but call first.
- Bring your paperwork: your CDL, glasses or contacts, hearing aid if you use one, a list of medications with doses, and records for any condition you're treated for (more on that below).
- Take the exam. You fill out the health history section of the Medical Examination Report (Form MCSA-5875). The examiner checks vision, hearing, blood pressure and pulse, does a urinalysis (this is not a drug test) and a physical exam.
- Confirm your state record updated. Since the National Registry II rule took effect on June 23, 2025, the examiner submits your result to FMCSA, which sends it to your state licensing agency to post on your CDL driving record (49 CFR 383.71(h)). You no longer have to carry the card under 49 CFR 391.41(a)(2), but your carrier must verify your status on your state record. Ask the examiner for a copy anyway, and check your record a few days later.
What happens if my DOT medical card expires?
You can't legally drive a CMV in interstate commerce without a current medical certification. On the licensing side, 49 CFR 383.73(o) requires your state to change your status to "not certified" within 10 calendar days after the card expires, notify you, and complete a downgrade of your CDL within 60 days unless you get re-certified (or switch your self-certification to excepted or intrastate driving, where your state allows it). Getting a downgraded CDL restored means extra trips to the DMV, possible fees and time off the road, depending on your state's procedures.
What can disqualify you or shorten your card?
The physical standards are in 49 CFR 391.41(b). The ones that most often trip up experienced drivers:
- Blood pressure. FMCSA's blood pressure guidance: under 140/90 can get 2 years; 140-159/90-99 on the first elevated reading gets 1 year; 160-179/100-109 gets a one-time 3-month card to get it down to 140/90 or lower, then 1 year; 180/110 or higher is disqualifying until it's controlled, then 6-month cards.
- Vision. At least 20/40 in each eye (with or without correction), 70 degrees of horizontal field in each eye, and the ability to recognize red, green and amber. Drivers who fail in one eye may qualify under the alternative standard with a Vision Evaluation Report (Form MCSA-5871) from an eye doctor.
- Hearing. You must hear a forced whisper at 5 feet in your better ear, or pass an audiometric test with no more than a 40 dB average loss. A hearing aid is allowed.
- Insulin-treated diabetes. Allowed, but your treating clinician must complete Form MCSA-5870, and your exam has to happen no more than 45 days after they sign it.
- Heart, lung, seizure or psychiatric conditions, and medications. Conditions likely to cause loss of consciousness or control, Schedule I drugs, and habit-forming drugs not prescribed by a practitioner who has said they won't affect safe driving can all disqualify you.
Sleep apnea isn't a separate written standard, but examiners can and do ask for testing or treatment records when they see risk factors. If you use CPAP, bring your compliance report.
This is general information. Ask a qualified medical professional about your own health situation.
Worked example: planning a renewal (hypothetical)
Hypothetical driver: a solo OTR driver's 2-year card expires on March 15. At the renewal exam on March 1, blood pressure reads 152/94 twice. Under FMCSA guidance that's Stage 1, so the examiner issues a 1-year card.
- New expiration: about March 1 next year (12 months from the exam), not March 15, two years out.
- Next exam target: at or below 140/90. If it's above 140/90 but below 160/100, the guidance allows only a one-time 3-month card.
- Plan: book the next exam roughly 30 days before the new date, about February 1, and bring medication and blood pressure logs if treatment started.
Now say this driver had skipped the March 1 exam and let the card lapse on March 15. Their state would mark them "not certified" within 10 days (by March 25) and must finish the downgrade within 60 days of that status change. Every day in that window is a day they can't legally run interstate loads.
Common mistakes
- Waiting until the last week. If the examiner wants records or a specialist report, the decision can be delayed while you get them. Start early.
- Assuming the old card is still good after a failed exam. Under 49 CFR 391.43(g), as of June 23, 2025, a "not qualified" result is reported to FMCSA, and all your previously issued certificates become invalid.
- Using an examiner who isn't on the National Registry. The exam won't count.
- Leaving things off the health history. You sign the form, and false or incomplete answers can create bigger problems than the condition itself.
- Not checking your state record. A name or license-number mismatch can keep your result from posting. Check your driving record after the exam, especially if you're switching trucking companies and a new carrier is pulling your record.
- Skipping meds the week of the exam. Keep taking your prescribed treatment as directed. The truck driver health guide covers the long-term habits that make renewals easier.
How the medical card fits the rest of your compliance
An expired or unposted medical certification can surface at a roadside check, so it pays to understand the DOT inspection levels and what officers check. If a short card means you need a schedule around appointments, use our driver job match or browse CDL-A jobs with home time that fits, and plan exam stops using our truck stop finder and truck parking map. More free tools are on the drivers page.
Frequently asked questions
Do I still need to carry my DOT medical card?
For CDL holders, no. Since June 23, 2025, the federal rule no longer requires you to carry the certificate. Your status lives on your state driving record. Keeping a copy is still smart in case your state's record is slow to update.
Can I renew my DOT physical early?
Yes. You can take a new exam any time, and the new card's dates start from the new exam. Renewing a few weeks early gives you time to deal with any follow-up the examiner asks for.
Is there a grace period after my medical card expires?
Not for driving. You can't operate a CMV in interstate commerce without a current certification. The 60-day window applies only to your state's downgrade process for your CDL.
Does the DOT physical include a drug test?
No. The urinalysis checks for medical issues like protein, blood and sugar. DOT drug testing is a separate process.
How much does a DOT physical cost?
Prices are set by each clinic and vary by location, so call a few examiners on the National Registry and ask before you go.
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