Preparing For Your DOT Medical Exam

Preparing For Your DOT Medical Exam

The launch of the DOT’s National Registry of Certified Medical Examiners (NRCME) program has ushered in a new era of driver and employer responsibility in regard to understanding the DOT medical examination process. The NRCME program aims to elevate the DOT medical exam to its originally intended level of scrutiny that can ensure safer drivers and safer roads across the country. By requiring certification of all medical examiners, the DOT made an obvious statement about quality and their continued efforts to eliminate “doctor shopping” by drivers, the practice of visiting provider after provider until someone finally issues a medical card, whether it is warranted or not.

Certain conditions have always led to shorter card terms or disqualification, and the new certification program has brought these to the forefront for many examiners who either never knew the regulations or never paid close enough attention to allow the regulations to guide their decision making. Hopefully, medical examiners across the country will be holding drivers to a more consistent standard when issuing cards.

In preparation, drivers and employers should pay particular attention to the conditions below that may exclude drivers from certification or require intermittent medical monitoring. Assembling the necessary documentation in advance of the exam can save drivers and employers considerable time and money.

These are the most common health problems associated with DOT medical certification or recertification that require documentation during the DOT exam to help expedite certification. Please have your treating physician fill out this form prior to your exam. Failure to do so will delay your receiving your health card.

History of Asthma / COPD

If you have a history of lung disease (asthma or COPD) or have symptoms of shortness of breath, cough, chest tightness, wheezing, or drivers over the age of 35 who smoke, you will need spirometry. You can arrange to have this done at your doctor’s office or occupational medicine clinic.

Sleep Apnea

  • A letter from the doctor treating for the sleep apnea stating that your current CPAP treatment is effectively controlling your sleep apnea
  • Documentation that verifies your equipment (CPAP machine) is operating effectively and shows that you are compliant with the use of the CPAP (smart card printout)


  • A letter from the doctor treating you for the diabetes stating you are being treated for diabetes is required. A list of the medications you are taking and that the medications are tolerated and would not interfere with the ability to drive must also be provided. The frequency of your glucose control and efficacy of treatment monitoring must be documented, along with verification that you have had no severe hypoglycemic reactions in the last 12 months. The date and results of your last hemoglobin A1C level must be provided. Any complications from diabetes (example: renal, cardiovascular or neurological concerns) must be documented.

Effective November 19 2018 a diabetic on insulin is no longer required to have a diabetic waiver. However, the driver on insulin must present a ITDM Assessment Form from the drivers treating physician stating that the driver maintains a stable insulin regiment and proper control of his or hers diabetes.

Drivers with an ITDM will be required to provide their treating physician with at least three (3) months of blood glucose monitoring records and may be certified up to one year. If the driver does not have three months of records, he may receive up to a three month certificate until the driver has three months of records.

If a diabetic driver has a severe hypoglycemic event, he or she is not allowed to drive and must report to the treating physician for evaluation as soon as possible. The driver will be prohibited to drive until the treating physician determines that driver is once again stable and properly controlled. The final rule defines “severe hypoglycemic event” as one requiring the assistance from others or resulting in loss of consciousness, seizure or coma.

  • A letter from your eye doctor or the doctor treating you for your diabetes must state the date of your last eye exam and that there is no retinopathy. Unstable proliferative or unstable nonproliferative retinopathy is disqualifying.
  • If you are on incretin mimetic treatment, such as Byetta (exenatide) or Bydureon (exenatide extended-release), a letter from your doctor prescribing this medication describing your tolerance to the medication is required. How frequently you are monitored for adequate blood glucose control and efficacy of treatment must also be documented.

Cardiovascular Disease

  • History of heart attack, angina, or post-PCI: You will need a letter from your cardiologist stating that you are cleared to drive a commercial motor vehicle with no restrictions. DOT requires an exercise stress test every 2 years. You will need to bring a copy of the stress test results to your exam. If the above has occurred in the past year, a copy of the most recent Echocardiogram is also required.
  • History of cardiac bypass surgery: A letter is required from you cardiologist stating that you are cleared to drive a commercial motor vehicle with no restrictions. After 5 years from the date of surgery you will need a yearly exercise stress test. Please bring the stress test results to the DOT exam. If the bypass surgery is within the past year, a copy of your most recent echocardiogram will be required.

Anticoagulant Therapy

If you are taking warfarin for cardiovascular disease, please bring a copy of the most recent INR results to your DOT exam.

Anticonvulsant Medication

If you a taking topamax, neurontin (gabapentin), or other seizure medication for other than a seizure disorder (example: chronic pain or migraine prophylaxis), bring a letter from the doctor prescribing the medication stating that the medication is not being prescribed for seizure. Also, if you are experiencing side effects, the letter must state that the side effects would not interfere with driving a commercial motor vehicle.

Histories Requiring Limited Certification (one year or less):

  • High blood pressure
  • Diabetes
  • Sleep Apnea
  • Cardiovascular Disease
  • Heart Surgeries

Medications Requiring Limited Certification (one year or less):

  • Lithium
  • Byetta
  • Provigil
  • Warfarin (cardiovascular disease)
  • Antidepressants: Pristiq, Cymbalta, Effexor, Effexor XR, Celexa, Lexapro, Prozac, Prozac Weekly, Sarafem, Paxil, Paxil CR, Zoloft
  • Antipsychotics: Abilify, Abilify Discmelt, Saphris, Zyprexa, Zyprexa Zydis, Seroquel, Seroquel XR, Risperdal, Risperdal M-Tabs, Geodon, Symbyax, Nardil, ESAM, Parnate

Note: The medications listed above require a safety letter from the driver’s Primary Medical Provider indicating the prescribed medication is tolerated and no side effects interfere with driving a commercial motor vehicle. Source: Eastern Medical Support, LLC. • Amsterdam, NY


DOT Physical Examination- An Important Test To Operate Commercial Vehicles

What exactly is a DOT physical examination? Is it something like the PLAID physical examination or a STRIPE physical examination? Well, No. DOT stands for the Department Of Transportation. Commercial drivers, such drivers of trucks or buses, are required to undergo a DOT physical exam to receive a special license to operate the vehicle.

What exactly is the DOT physical exam?

If you are a commercial driver, then you might have been asked to get a DOT physical exam done. Strictly mandated by the Federal Motor Carrier Safety Administration (FMCSA), the DOT physical checkup will give you clearance for driving commercial vehicles. It also helps make sure that you and other professional commercial drivers can handle long hours of driving, the miscellaneous schedules as well as the stress of operating the commercial vehicles.

The FMCSA requires all the commercial drivers to receive a certificate of good health, which you will get only after passing the DOT physical exam. So those drivers who are listed on the registry, have undergone the right training as per FMCSA regulations and have the right to know if they are healthy enough to operate safely and make sure that they are not wrongly disqualified.

A DOT physical might sound like overwhelming processing owing to the strict guidelines and regulations set by the FMCSA for it. So, to make it a simplified process, below is a brief overview of the DOT physical.

Do you need a DOT physical exam?

Yes, you are required to get a DOT physical examination if you fall into one of the below-mentioned categories:

  • If you operate a vehicle used for commercial purposes and that has a manufacturer’s gross vehicle weight rating or a combination weight rating of more than ten thousand pounds.
  • If you operate a vehicle that is designed to transport more than eight people.
  • If you are who operate a vehicle that is used to transport hazardous materials.
  • How Much Does The Dot Physical Exam Cost?

    In the modern economy, this is on the forefront of every person’s mind. Does your existing medical insurance cover a DOT exam? Usually, the insurance does not cover such appointments.

    Your employer may cover the cost of the exam. If neither your insurance nor your employer cover the cost of the exam, the cost of the exam may be a job related expense and therefore a tax deduction. (Please consult with your tax prepared for details.)

    At The Charlotte DOT Exam Center we charge $60.00 for the exam.

    Drug testing is available for the charge of $60.00.

    What should you bring to a DOT Physical?

    You are required to provide a complete list of the medication, which includes the medicine doses and the names and addresses of the doctors. To avoid having an incomplete examination it is recommended that you make a list of all medications prior to your appointment. If you are being treated for a medical condition, please have your treating physician fill out this form prior to your exam. Failure to do so will delay your receiving your health card.

    To ensure that the DOT exam runs satisfactorily and steadily, you should carry appropriate items or documents if you have any specific medical problems. For instance,

    • If you have a certain kind of problem in your hearing or vision, then you should carry hearing aids, contact lens, eyeglasses with to you the clinic.
    • If you have diabetes, then you are required to bring the most recent lab test results (a1c) as well as the blood sugar logs.
    • If you have any heart-related issue, then you are required to get a letter from your cardiologist that reflects the medical history as well as the present medications, and shows that you are safe to work.
    • If you have any kidney disease, digestive issues or any chronic pain or any other health related issues, please bring a letter from the treating physician explaining the issue, the treatment and your compliance and how well you are tolerating the treatment.

    It is critically important, to be honest, and share details of your prior or current health conditions. If you fail to do so, then you may have your certificate revoked.

    What the Dot Physical Exam Covers?

    The DOT physical exam checks a driver’s health and body for any kind of abnormalities in the below-mentioned areas like:

    • Overall appearance:

    The doctor/medical examiner who will be conducting the DOT physical and examining you at the clinic will check to determine whether you are overweight and have any other obvious health issues like tremors, shaking, excessive, etc.

    • Eyes:

    Your eyes will be checked to see if they have proper dilation, movement or any structural problems. Moreover, the doctor will also check your overall vision. You need to have at least 20/40 vision in each of your eyes, with/without correction, at least 70” field of vision in the Horizontal meridian in each of your eyes. You are also required to have the ability to recognize the colors displayed by traffic signals- i.e., standard green, red, and yellow’ as well as other devices.

    DOT Physical Exam Covers

    • Ears:

    The doctor will check for any kind of blockage and structural abnormalities, like any holes present in the eardrum. You are required to have ‘forced whisper’ ranging at a distance of five feet or more, with/without any hearing aid. Plus, you should not have more than 40 dB of hearing loss, with/without any hearing aid.

    You will be checked for breathing or swallowing problems or any other kind of throat or mouth problems, which typically will deal with sleep apnea.

    The doctor will check your heart for any erratic beating, murmurs, or any other unusual sounds. You will be questioned to know if have a pacemaker or other device installed in the heart.

    The doctor will check your blood pressure as well as the pulse rate to know if you have high blood pressure as well as irregular heartbeats.

    The DOT exam medical examiner will listen as well as watch the breathing pattern you have. If he/she suspects any issues they might have to get a chest x-ray done.

    If you snore or are using a CPAP machine, make sure to bring in your CPAP report so that your exam may be completed without you having to return. Without the report, your exam will be pended until the report is presented to the examiner.

    Your vision will be tested and will need to be no worse than 20/40 in either eye or in both. If your vision is worse than 20/40, you need to be evaluated and fitted for corrective lenses.

    • Urinalysis:

    A urinalysis is needed for drug screen and glucose levels. Additionally, this test helps to know if you have any underlying medical conditions like diabetes. If you are a diabetic, please bring in your most recent A1C which should be 8% or below. Higher numbers or insulin dependent diabetics may be disqualified without a diabetic waiver.

    • Abdomen and Organs:

    The doctor will check for any masses or enlargements, odd tenderness upon palpitation, or any strange sounds.

    • Vascular (blood movement):

    Again, your blood flow and pulse will be examined at several points in your body to check if you have the varicose veins.

    • Extremities or Limbs:

    The doctor will check if you have any missing limbs. He or she will also check for lack of strength, any weakness, and the range of movement in your limbs and extremities.

    • Neurological:

    You will be checked for your stability, balance, mental clarity, reflexes, and your speech coordination.

    • Spine/Skeletal:

    The doctor will check your spine to check if there are any unusual or crooked areas or any weakness.

    If you are being treated for a medical condition, please have your treating physician fill out this form prior to your exam. Failure to do so will delay your receiving your health card.

    How often do you need the exam?

    Generally, the physical examination is good for two years. However, if you have chronic diseases and other specialty health conditions, then you may have to be tested more often than that. The doctor conducting the DOT physical will have that information. The doctor will also have the necessary paperwork which you need to submit to the Department of Motor Vehicles to be issued the DOT license you are looking for.

    What if you fail the test?

    Failing the test does not necessarily mean that you are prohibited from becoming a driver. You should ask the doctor about the reason why you failed and improve the disqualifying health condition with treatment if possible and then try again.

    The DOT physical examination accesses your general health and your emotional and mental fitness for meeting the demands of professional driving. It is primarily easy, fast and painless. Come in, listen to the simple instructions given to you by the doctor, and you will be out of the clinic in no time having the proper certification completed.