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The DOT Medical Card: Who Needs One, How Long It Lasts, and Where It Goes

Updated September 2026

"A person subject to this part must not operate a commercial motor vehicle unless he or she is medically certified as physically qualified to do so" (49 CFR 391.41(a)). The trigger is operating a commercial motor vehicle — 10,001 lbs and up in interstate commerce — not holding a CDL. The helper who drives the 14,000-lb box truck on Saturdays needs a medical card.

How long it lasts

A driver must have been examined and certified within the preceding 24 months (391.45). That is the maximum. The medical examiner can issue a certificate for a shorter period when a condition needs watching, and some situations carry a 12-month limit in the rule itself — for example a driver with insulin-treated diabetes. A driver whose ability to do the job has been impaired by an injury or illness also has to be re-examined before driving again.

The date that matters is the expiry date printed on the certificate, not two years from the exam.

Who can do the exam

The exam has to be done by a medical examiner listed on FMCSA's National Registry of Certified Medical Examiners. You are expected to check that, and to put a note in the driver's qualification file that you did (391.23(m), 391.51(b)).

Where the certificate goes

  • In the driver qualification file — a copy of the medical examiner's certificate for each non-CDL driver. For a CDL driver, the file holds the CDLIS motor vehicle record from the state, which carries the medical status (391.51(b)).
  • With the driver — a non-CDL driver carries the certificate. A CDL holder who has given a current certificate to their state licensing agency no longer has to carry the paper (391.41(a)(2)).
  • Kept for three years from the date it was issued, along with the rest of the renewing items in the file (391.51(d)).

Where small fleets slip

  • The part-timer. Occasional drivers are still drivers.
  • The owner. An owner who drives is a driver, with a file and a medical card of their own (391.1(b)).
  • The short certificate. A one-year card filed as if it were a two-year card.
  • The expired card nobody noticed. Put every driver's expiry date somewhere that reminds you a month ahead.

Work it out on your own numbers: Do you need a USDOT number, a medical card or a CDL?

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This is general information, not legal advice or medical advice, and RelayPoint is not a law firm or a compliance consultant. Sources: 49 CFR 391.1, 391.23, 391.41, 391.45 and 391.51, as published in September 2026. The physical qualification standards themselves (391.41(b)) and the variance programs are not covered here. States set their own rules for in-state drivers. Confirm with the FMCSA or your state's motor carrier authority.