Federal Motor Carrier Safety Administration

DOT Physical Requirements

& Examiner Regulations

Have Changed



This site provides detailed information, direction and support for professional drivers who have jeopardized DOT medical certification issues. 

FMCSA - Medical Regulations Summary

The Code of Federal Regulations (CFR) is the codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the Federal government. It is divided into 50 titles that represent broad areas subject to Federal regulation. Title 49 is Transportation.

Each title is divided into chapters, which usually bear the name of the issuing agency. Chapter III of Title 49 is "Federal Motor Carrier Safety Administration, Department of Transportation."

Each chapter is further subdivided into parts that cover specific regulatory areas. Part 391 is Qualifications of Drivers and Longer Combination Vehicle (LCV) Driver Instructors. Large parts may be subdivided into subparts. Subpart E of Part 391 is Physical Qualifications and Examinations.

Parts are organized in sections. Citations for the CFRs include the title, part, and section numbers (e.g., 49 CFR 391.41). When the title is understood, the citation may just include the part and section (e.g., 391.41).

The CFR (Regulations) are law and must be followed.

Medical Standards/Advisory Criteria/Guidelines

Standards or Federal Motor Carrier Safety Regulations (FMCSRs) are legal requirements for interstate commercial vehicles, drivers, and motor carriers.

FMCSA provides medical guidelines or advisory criteria to assist in the evaluation of medical fitness to operate a commercial bus or truck. These guidelines are based on expert review and considered best practice. The examiner may or may not choose to use these recommended guidelines. When the certification decision does not conform with the recommendations, the reason(s) for not following the medical guidelines should be included in the documentation.

49 CFR 391.41
Describes the physical qualification requirements for drivers. The 13 standards are used to determine driver medical fitness for duty. Four of the standards: vision, hearing, epilepsy, and diabetes mellitus have objective disqualifiers that do not depend on medical examiner clinical interpretation. These standards are the "non-discretionary" standards. For the other nine "discretionary" standards, the medical examiner makes a clinical judgment in accordance with the physical qualification requirements for driver certification.

49 CFR 391.43
Describes the responsibilities of the medical examiner, including general instructions for performing the medical examination, a description of driver tasks and work environment, medical advisory criteria, the sample Medical Examination Report form, and the medical examiner's certificate.

49 CFR 391.45
Identifies who must have the commercial motor vehicle (CMV) driver physical examination.

49 CFR 391.47
Describes the process for conflict resolution when there is a disagreement between the primary care provider for the driver and the medical examiner for the motor carrier concerning driver qualifications.

49 CFR 391.49
Describes the Skill Performance Evaluation (SPE) Certification Program, which is an alternative physical qualification standard for the driver with a fixed musculoskeletal deficit of an extremity who cannot physically qualify to drive under 391.41(b)(1) or (b)(2). The driver must be otherwise qualified to drive a CMV and meet the provisions of the alternate standard.

The first program to address fixed musculoskeletal deficits was created and administered by the Interstate Commerce Commission (ICC) in 1964 and was known as the Handicapped Driver Waiver Program. See Skill Performance Evaluation Certification Program (SPE) History.

49 CFR 391.62
Describes limited exemptions for intra-city zone drivers.

49 CFR 391.64
Describes grandfathering for certain drivers who participated in vision and diabetes waiver study programs. These drivers may be certified as long as they continue to meet the provisions outlined in 49 CFR 391.64 and continue to meet all other qualification standards.

49 CFR 390
Includes general information and definitions.

49 CFR 40
Includes regulations for medical review officers and substance abuse professionals, including drug and alcohol testing procedures.

An exemption provides temporary regulatory relief from one or more of the FMCSRs for commercial drivers. Relief from a regulation is for 2 years and may be renewed. Currently, FMCSA has two medical Driver Exemption Programs:

Federal Vision Exemption Program (1998).
Diabetes Exemption Program (September 2003).
The medical examiner cannot issue an exemption. The role of the medical examiner is to determine if the driver is "otherwise qualified." As part of the application procedure, the driver must obtain a medical examination, whereby the medical examiner determines whether the driver is "otherwise qualified" if accompanied by the Federal vision or diabetes exemption. Both Federal exemptions require the driver to have an annual medical examination for maintenance and renewal of the exemption.


For Assistance with FMCSA Exemptions or other medical issues, see www.truckmed.com