How to run DOT physicals, from booking to Registry report.

By ClinicMira · Last reviewed September 25, 2026

This guide summarizes the Federal Motor Carrier Safety Administration (FMCSA) rules for commercial driver medical exams to help clinics plan their workflow. It is not legal advice; the linked rules are the source of truth, and qualification decisions rest with the certified medical examiner.

1. Book only certified examiners

The exam must be performed by a medical examiner listed on the National Registry of Certified Medical Examiners. Eligible examiners include MDs, DOs, physician assistants, advanced practice nurses, chiropractors and other professionals their state licenses to perform physicals, who have completed FMCSA training and passed its test (49 CFR 390.103). Certification needs refresher training between years 4 and 5, and training plus a retest between years 9 and 10 (390.111), so track each examiner's dates alongside their schedule.

2. Record the exam on the right forms

Results are recorded on the Medical Examination Report, Form MCSA-5875, including the driver's health history. A driver who meets the standards in 49 CFR 391.41 receives the Medical Examiner's Certificate, Form MCSA-5876 (391.43). Both forms are on FMCSA's forms page.

Since June 23, 2025, results for drivers who hold or are applying for a commercial driver's license (CDL) or learner's permit move electronically from the Registry to state licensing agencies. Even so, FMCSA recommends examiners keep issuing the paper certificate until further notice, and drivers who don't need a CDL still receive one. A temporary exemption letting drivers rely on a paper certificate for up to 60 days runs until October 11, 2026, and some states had not yet implemented electronic transmission when FMCSA last published its list, so check the current state list.

3. Set the certification period

The maximum certification is 24 months (391.45). It is capped at 12 months for drivers with insulin-treated diabetes, drivers qualified under the alternative vision standard, and drivers limited to exempt intracity zones, and examiners may certify for shorter periods. FMCSA's non-binding blood pressure guidance, for example, points to 1-year, 3-month and 6-month certificates depending on stage (Appendix A to Part 391). Because so many drivers are on short cycles, recertification recalls are one of the most valuable things to automate.

4. Report to the Registry by the next-day deadline

• Submit results for every exam by midnight (local time) of the next calendar day, using Form MCSA-5850 through the Registry.
• In any month with no exams, report that by close of business on the last day of the month.
• A “not qualified” finding is reported too, and it invalidates the driver's earlier certificates.
• When a decision is pending further information, the driver has 45 days to provide it.

Registered third-party organizations can upload results to the Registry in bulk on examiners' behalf, which removes the late-night re-keying.

5. Keep the records

The examiner keeps the Medical Examination Report and a copy of the certificate for at least 3 years (391.43). Store them with the driver's record so they are easy to produce for a recertification, an audit or an employer query.

6. Don't confuse the physical with drug testing

DOT drug and alcohol testing is a separate program under 49 CFR Part 40, with its own forms, collectors, laboratories and Medical Review Officers. Many clinics offer both, so keep them as separate services on the same driver record.

A checklist for your clinic

1. Only Registry-listed examiners on the DOT schedule, with their certification dates tracked.
2. MCSA-5875 captured completely, including the driver's health history.
3. Certification period set per driver, with recertification recalls booked.
4. MCSA-5876 issued, and results reported to the Registry by the next-day deadline.
5. No-exam months reported by the last day of the month.
6. Reports and certificates kept for at least 3 years.
7. Drug and alcohol testing run as its own program.

See how ClinicMira runs DOT exams and drug testing on the same record as the rest of your services.