What Every ME Needs to Know About FMCSA Regulations

The Department of Transportation (DOT) physical is a critical examination ensuring that commercial motor vehicle (CMV) drivers meet the Federal Motor Carrier Safety Administration (FMCSA) standards for safe operation. Medical Examiners (MEs) conducting these evaluations must adhere to stringent FMCSA regulations outlined in the Medical Examiner’s Handbook 2024 Edition.

In this post, we will break down the essential FMCSA regulations for Medical Examiners, covering the medical certification process, physical qualification standards, and best practices for compliance.

Understanding DOT Physicals and the Medical Examiner’s Role
A Medical Examiner (ME) is a licensed, certified, or registered professional authorized to perform DOT physical examinations. Only those listed on FMCSA’s National Registry can conduct physical qualification examinations and issue Medical Examiner’s Certificates (MCSA-5876).

FMCSA regulations require that MEs:

  • Assess the driver’s physical and mental fitness to operate a CMV safely.
  • Follow FMCSA’s physical qualification standards outlined in 49 CFR 391.41
  • Use proper examination forms, including the Medical Examination Report Form (MCSA-5875) and Medical Examiner’s Certificate (MCSA-5876)
  • Maintain compliance with FMCSA reporting requirements, including timely submission of examination results.

Key Components of the DOT Physical Examination
The DOT physical is designed to evaluate whether a CMV driver is physically qualified under 49 CFR 391.41(b). Some core areas include:

1. Vision Standards (49 CFR 391.41(b)(10))
Drivers must have:

  • 20/40 vision acuity in each eye (with or without correction).
  • A 70-degree peripheral vision field in each eye.
  • The ability to distinguish red, green, and amber traffic signals.

2. Hearing Standards (49 CFR 391.41(b)(11))
Drivers must:

  • Perceive a forced whisper at 5 feet with or without a hearing aid.
  • If using hearing aids, they must be worn while driving.

3. Blood Pressure and Cardiovascular Health (49 CFR 391.41(b)(4)-(6))

  • Hypertension must be controlled to avoid disqualification.
  • Anticoagulant therapy patients must be monitored for stability.
  • Drivers with a history of severe cardiovascular conditions may need additional evaluation.

4. Diabetes (49 CFR 391.41(b)(3))
Drivers with insulin-treated diabetes must submit an Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870) completed by a treating clinician.

5. Neurological Disorders (49 CFR 391.41(b)(8))
Seizure disorders and conditions affecting consciousness can disqualify a driver unless an FMCSA seizure exemption is granted.

Medical Certification and Recordkeeping
MEs are responsible for certifying drivers based on FMCSA guidelines and must:

  • Issue Medical Examiner’s Certificates (MCSA-5876) to qualified drivers for up to 24 months.
  • Retain medical examination records for at least 3 years.
  • Submit CMV Driver Medical Examination Results (MCSA-5850) electronically by midnight of the next calendar day.
  • Medical Examiners who utilize administrative staff to upload CDL exam results are still required to log into their FMCSA DOT account at least once per month to review any NRCME alerts and ensure their contact information remains current.

If a driver does not meet FMCSA standards, the ME must NOT issue a certificate unless the driver obtains a medical exemption from FMCSA.

Medical Exemptions and Variances
FMCSA grants exemptions in special cases, including:

  • Vision Exemption (49 CFR 391.44) – Drivers with vision impairments in one eye may qualify.
  • Hearing Exemption – Required for drivers who cannot meet the forced whisper test.
  • Seizure Exemption – FMCSA may grant clearance for drivers with well-controlled epilepsy.

MEs cannot issue exemptions—they only indicate whether the driver is eligible to apply for one.

Compliance with FMCSA Guidelines
To remain compliant, MEs must:

  • Ensure the driver’s health status aligns with FMCSA’s safety regulations
  • Follow FMCSA’s medical qualification standards.
  • Stay up-to-date with the Medical Examiner’s Handbook.
  • Maintain proper recordkeeping and timely reporting.
  • Medical Examiners who delegate the submission of CDL exam results to a Medical Examiner’s Administrative Assistant (MEAA) are still personally responsible for logging into their FMCSA/DOT account at least once per month to review any NRCME alerts and to verify that their contact information is up to date. Failure to do so can result in being removed from the registry.


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10-Year Recertification Notice

Certified Medical Examiners on the National Registry are required to be recertified no sooner than 9 years and no later than 10 years from the date of issuance of their medical examiner certification credential. Recertification requires that providers complete an accredited training program such as ours and pass the in-person national NRCME certification examination.

Call (941) 600-8411 for a single-provider discount.

Enroll to Recertify