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General information
The examination determines whether a driver is physically qualified to operate a commercial motor vehicle (CMV) under 49 CFR 391.41 through 49 CFR 391.49. The medical examiner must know these requirements and the FMCSA guidance that helps examiners make the decision, and must be familiar with the driver's duties and work environment.
In addition to reviewing the health history with the driver and conducting the physical examination, the examiner should discuss common prescription and over-the-counter medications and their hazards while driving, and encourage the driver to read warning labels.
Medical conditions should be recorded even if they are not a cause for denial, and discussed with the driver to encourage appropriate care. The examiner then records the determination and, since June 23, 2025, reports every result, including "not qualified," to FMCSA through the National Registry (49 CFR 391.43(g)).
Key standards
| Standard | Summary |
|---|---|
| Loss of limb and limb impairment: §391.41(b)(1) and (2) | No loss or impairment that interferes with normal driving tasks, or the driver holds a Skill Performance Evaluation (SPE) certificate under §391.49. |
| Diabetes: §391.41(b)(3) and §391.46 | A driver with insulin-treated diabetes can qualify if the treating clinician completes the ITDM Assessment Form (MCSA-5870) and the examiner finds the driver qualified; certification is for up to 12 months. |
| Cardiovascular: §391.41(b)(4) | No current diagnosis of cardiovascular disease known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure. |
| High blood pressure: §391.41(b)(6) | No current diagnosis of high blood pressure likely to interfere with safe driving. Examiners may certify for a shorter period to monitor treatment. |
| Mental disorders: §391.41(b)(9) | No mental, nervous, organic, or functional disease or psychiatric disorder likely to interfere with safe driving. |
| Vision: §391.41(b)(10) and §391.44 | At least 20/40 in each eye and both eyes, with or without correction, 70° horizontal field in each eye, and recognition of red, green, and amber. A driver who cannot meet the standard in the worse eye may qualify under the alternative vision standard (§391.44), with an annual exam. |
| Hearing: §391.41(b)(11) | Perceives a forced whispered voice at 5 feet in the better ear, or average hearing loss in the better ear no greater than 40 dB at 500, 1,000, and 2,000 Hz, with or without a hearing aid. |
| Drug use: §391.41(b)(12) | No use of Schedule I drugs, amphetamines, narcotics, or other habit-forming drugs, except other scheduled drugs prescribed by a practitioner familiar with the driver's history who has advised that they will not affect safe driving. |
| Alcoholism: §391.41(b)(13) | No current clinical diagnosis of alcoholism. |
If corrective lenses or a hearing aid are needed to meet the standard, the examiner notes that on the certification. FMCSA publishes guidance for examiners on the FMCSA medical program site.