The CDL medical card: what 49 CFR Part 391 and the National Registry say

This page reports what the official source says. It is not legal advice: ask the office named here. It is not medical advice either, and it says nothing about whether any person meets a standard. The text is from the Electronic Code of Federal Regulations, Title 49. Licence groups by weight are on the guide to GVWR and GCWR, and class tables are on the guide to driving licence classes by country.

Who the rules cover

Section 390.3 says the federal motor carrier safety rules apply to all employers, employees and commercial motor vehicles that transport property or passengers in interstate commerce. Section 390.5 defines a commercial motor vehicle for these rules as a self-propelled or towed vehicle used on a highway in interstate commerce to carry passengers or property when its gross vehicle weight rating or gross combination weight rating, or its actual gross weight, whichever is greater, is 4,536 kilograms (10,001 pounds) or more. It also covers vehicles built or used to carry more than 8 passengers for pay, or more than 15 without pay, and vehicles carrying hazardous materials in placarded quantities. Section 391.1 says part 391 sets minimum qualifications for persons who drive commercial motor vehicles for motor carriers. Section 391.2 lists exceptions, such as farm custom operations and covered farm vehicles. See eCFR 390.3 on general applicability.

The requirement

Section 391.41(a) says a person subject to the part must not operate a commercial motor vehicle unless medically certified as physically qualified. It also says that, while on duty, the person must have the original or a copy of the medical examiner's certificate on his or her person, with these changes for commercial licence holders:

On or after June 23, 2025, a driver required to hold a CDL or a commercial learner's permit, and who has a medical examiner's certificate documenting that he or she meets the requirements, no longer needs to carry it.
A driver who qualifies through an FMCSA medical variance, in the form of an exemption letter or skill performance evaluation certificate, must carry a copy of the variance documentation when on duty.
If the electronic medical certification information from FMCSA and a paper copy conflict, the electronic information controls.

The physical qualification standards

Section 391.41(b) lists thirteen standards. It words them as conditions a person must meet to be physically qualified. The table follows the section's own headings in brief.

Paragraph	What the section says
(b)(1) and (2)	No loss of a foot, leg, hand or arm, and no impairment of a hand, finger, arm, foot or leg that interferes with normal tasks of operating the vehicle, unless a skill performance evaluation certificate has been granted
(b)(3)	No established history or diagnosis of diabetes treated with insulin, unless the person meets 391.46
(b)(4) to (7) and (9)	No cardiovascular disease known to cause fainting, breathlessness, collapse or heart failure; no respiratory dysfunction, high blood pressure, rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease, or mental, nervous or psychiatric disorder likely to interfere with driving safely
(b)(8)	No established history or diagnosis of epilepsy or any condition likely to cause loss of consciousness or loss of ability to control the vehicle
(b)(10)	Distant visual acuity of at least 20/40 in each eye, with or without lenses; binocular acuity of at least 20/40; field of vision of at least 70 degrees horizontally in each eye; ability to recognize red, green and amber. Section 391.44 applies to those who do not meet this
(b)(11)	First perceives a forced whispered voice in the better ear at not less than 5 feet, with or without a hearing aid, or, if tested with an audiometric device, an average loss in the better ear of not more than 40 decibels at 500, 1,000 and 2,000 Hz
(b)(12) and (13)	No use of a Schedule I drug, an amphetamine, a narcotic or other habit-forming drug; other scheduled substances only where prescribed by a practitioner who has advised the driver of no adverse effect on safe driving; no clinical diagnosis of alcoholism

The table above is drawn from eCFR 391.41 on physical qualifications.

The examination and who may do it

Section 391.43 says the examination must be done by a medical examiner listed on the National Registry of Certified Medical Examiners, with exceptions. One is that a licensed ophthalmologist or optometrist may perform the vision part. Results are recorded on the Medical Examination Report Form, and a medical examiner's certificate is completed on a separate form. The section requires the examiner to keep the report and certificate on file for at least 3 years and to produce them within 48 hours of a request from an authorized representative of FMCSA or an enforcement agency. Examiners must send the results to FMCSA electronically by midnight of the next calendar day. If the examiner decides a determination should be delayed for more information, the section sets a 45-day window.

The registry is set up in subpart D of part 390. Section 390.101 describes it as a national database of the names and contact information of medical examiners certified by FMCSA, and the section says its aim is to ensure examiners are trained and certified to decide whether a driver meets the standards. Section 390.103 lists who may be certified: a person licensed under state law to perform physical examinations, such as an advanced practice nurse, doctor of chiropractic, doctor of medicine, doctor of osteopathy or physician assistant, who completes training and passes the FMCSA certification test. See eCFR 391.43 on the medical examination and eCFR 390.103 on examiner certification.

How often

Section 391.45 lists who must be examined and certified. It includes any person who has never been certified, and any driver not examined and certified during the preceding 24 months. Shorter periods apply to some drivers. A driver with insulin-treated diabetes certified under 391.46, and a driver who does not meet the vision standard with the worse eye and holds a certificate under 391.44, must be examined if the most recent examination was not in the preceding 12 months. A driver who is authorized to operate only inside an exempt intracity zone has the same 12 months. Any driver whose ability to perform normal duties has been impaired by physical or mental injury or disease must also be examined. See eCFR 391.45 on persons who must be examined.