NC medical card and DOT physical: rules and where to go

The short version

If you drive a commercial vehicle across state lines, you need a DOT physical from an examiner listed on FMCSA's National Registry. Any other doctor's note does not count. [1][2]

The card lasts up to 24 months. Some conditions cut that to a year or less, including insulin-treated diabetes and drivers who pass under the alternative vision standard. [3]

Since mid-2025 the paperwork runs itself. The examiner sends your results to FMCSA, and FMCSA sends them to NCDMV. As of September 2026, NCDMV no longer takes a medical certificate handed in by the driver. [10][15]

Let it lapse and you lose the commercial part of your license. State law gives you 60 days after NCDMV's notice before your CDL drops to a regular Class C. [12]

Book the next exam well before the current card runs out. FMCSA itself recommends the early start, because it leaves time to fix a record that did not post. [15]

Who needs a physical

Under federal rules, a commercial motor vehicle in interstate commerce is one rated or weighing 10,001 pounds or more. It also covers vans carrying more than 8 people for pay, vehicles carrying more than 15 people, and any load that needs hazmat placards. [8]

Anyone driving one of those vehicles has to be medically examined and certified. That includes a pickup and gooseneck combination over 10,001 pounds that crosses into Virginia or South Carolina for work. [1][8]

North Carolina draws its own line for trips that stay inside the state. The federal safety rules apply to intrastate for-hire and private carriers once the vehicle reaches 26,001 pounds, carries 16 or more people, or hauls placarded hazmat. [14]

Every North Carolina CDL holder and applicant must meet the federal medical standards in 49 CFR 391.41. The state wrote that into G.S. 20-37.13A, with a narrow waiver for intrastate drivers covered later in this guide. [13]

Some operations are excepted from the federal rules. The list includes school bus operations, trucks run by federal, state or local government, fire and rescue during emergencies, and hauling your own property now and then with no pay involved. [22]

Pick your self-certification category

Every CDL applicant has to choose one of four categories: non-excepted interstate, excepted interstate, non-excepted intrastate, or excepted intrastate. The choice decides whether NCDMV expects a medical card from you. [6][10]

Most truck drivers belong in non-excepted interstate. You cross state lines, or expect to, and you are fully covered by the federal rules. You need a current medical card. [6][21]

Non-excepted intrastate means you drive a commercial vehicle only inside North Carolina and still need a medical card. NCDMV's form says that license carries a K restriction, which limits you to intrastate driving. [21]

The two excepted categories do not require a medical card with NCDMV. They only fit if every commercial mile you drive is an excepted operation. A county dump truck driver might qualify. A driver who hauls freight for pay does not. [10][21][22]

You pick a category when you apply for, renew, upgrade, transfer, or add an endorsement to a CDL. To change it between those times, NCDMV uses form CDL-MED-1, which you can email to CDLmedical@ncdot.gov. [10][21]

Finding a certified examiner

The exam has to be done by a medical examiner listed on FMCSA's National Registry of Certified Medical Examiners. There are two narrow exceptions: an eye doctor can do only the vision part, and VA examiners can examine veterans. [2]

Search the registry by location at nationalregistry.fmcsa.dot.gov before you book. The site checks your browser, so use a current version of Chrome, Edge, Safari or Firefox. [16]

Check the registry even at a clinic you have used before. In early 2024 FMCSA moved to remove about 15,727 examiners who had not updated their registry accounts, out of roughly 92,625 listed. [18]

We are not listing clinics or prices. We could not find an official or news source for what a DOT physical costs in North Carolina, and clinic listings change often. Call two or three registry examiners near you and compare. [16]

What the exam checks

Vision is the most common trouble spot. You need at least 20/40 in each eye and with both eyes together, glasses or contacts allowed. You also need 70 degrees of side vision in each eye and must be able to tell red, green and amber signals apart. [1]

For hearing, you must hear a forced whisper at 5 feet or more in your better ear, hearing aid allowed. Failing that, an audiometer test must show an average loss of no more than 40 decibels at three set frequencies. [1]

The examiner also looks at heart disease that could make you pass out, breathing problems, blood pressure, epilepsy, limbs, mental health, and drug or alcohol problems. Schedule I drugs are out. Other controlled drugs are allowed only when prescribed by a doctor who knows your history. [1]

Expect a health history form, a pulse and blood pressure check, height and weight, and a urine sample. The urine test records specific gravity, protein, blood and sugar. It is a health screen, not the DOT drug test. [17]

Fill out the history honestly and completely. The form asks about sleep problems, past sleep tests, failed drug tests, and whether a card was ever denied or issued for less than two years. [17]

How long the card lasts

The maximum is 24 months. The regulation requires a new exam for any driver who has not been certified in the past 24 months. [3]

Insulin-treated diabetes caps the card at 12 months. The doctor who manages your insulin fills out form MCSA-5870, and the DOT exam has to happen within 45 days of that doctor signing it. [3][4]

With insulin, you also need blood sugar records from an electronic glucometer. After a severe low, such as passing out or needing help, you must stop driving until your treating doctor clears you. [4]

The alternative vision standard is for a driver with one eye that fails the test. The better eye still has to meet 20/40 and 70 degrees. An eye doctor fills out form MCSA-5871, the card is good for a year, and a first-time qualifier usually needs a road test from the carrier. [5]

Blood pressure follows FMCSA's 2024 Medical Examiner's Handbook, which is guidance, not law. As Land Line reported it, 140 to 159 over 90 to 99 gets a one-year card. 160 to 179 over 100 to 109 gets a one-time three-month card to bring it down. At 180 over 110 or higher you are not certified until it is under control. [18]

Sleep apnea has no FMCSA rule. When FMCSA dropped its planned sleep apnea rule in 2017, it said the decision is left to the examiner's medical judgment. FMCSA tells drivers with a known condition to bring records from their treating doctor, and a CPAP usage report fits that advice. [19][15]

How the card gets to NCDMV now

The federal change, called National Registry II, had a compliance date of June 23, 2025. From then on, states receive medical certificate information electronically from FMCSA instead of paper from drivers. [6][7][15]

NCDMV set its own date. As of June 28, 2025, it stopped accepting medical examiner certificates directly from commercial drivers. Your examiner must submit them through the National Registry. [10]

The examiner has until midnight of the next calendar day to report your results to FMCSA. The registry then matches your last name, date of birth, licensing state and license number against CDL records before sending anything to NCDMV. [2][15]

A typo stops the whole thing. If the details do not match, your record waits until the examiner fixes it. Give the office a copy of your license, and check what they typed if they enter it while you are there. [15]

CDL holders no longer have to carry the paper card. The electronic record is the official one. You can still ask the examiner for a paper copy, and FMCSA suggests you do, because it helps if the upload goes wrong. [1][15]

Drivers without a CDL are different. They still get a paper card and must carry it, because there is no CDL record to send it to. [15]

If it lapses, or the upload fails

When your medical status goes to not-certified, federal rules require NCDMV to notify you and finish the downgrade within 60 days. G.S. 20-37.13(h) says the same thing: 60 days to comply, then an automatic drop to a regular Class C license. [7][12]

NCDMV's own CDL page is sharper. As of September 2026, it says you have 30 days to respond to the notice, or your entire North Carolina driving privileges will be canceled. We could not reconcile the two, so treat any NCDMV letter as urgent. [10][12]

If you passed the exam and still get a downgrade letter, the upload probably failed. First, call the examiner and ask them to check their registry account for an error message on your exam. [15]

Next, call NCDMV to confirm the record posted. If it still has not, FMCSA's National Registry help desk is at fmctechsup@dot.gov or 617-494-3003. [15]

The same steps apply if an officer checks your record at a roadside stop and it shows you as not certified. Keep your paper copy in the cab until your record is fixed. [15]

Variances, exemptions and the NC waiver

A driver missing a hand, arm, foot or leg can apply to FMCSA for a Skill Performance Evaluation certificate. You apply alone or with your carrier, and you need an evaluation from a rehab specialist or an orthopedic surgeon. The certificate lasts up to two years and can be renewed. [9]

FMCSA also grants two-year exemptions from the hearing standard. In May 2026 it exempted 37 drivers, one of them from North Carolina, through March 4, 2028. They have to report crashes and citations within 7 days and carry a copy of the exemption. [20]

Any FMCSA variance has to ride with you whenever you are on duty. If your examiner says you need one, your results are not sent to NCDMV until FMCSA issues it. [1][15]

North Carolina has its own waiver for drivers who stay in the state. Under G.S. 20-37.13A, a driver who cannot meet the federal standards can apply in writing for a waiver of up to two years. The license is marked intrastate only. [13][14]

The catch is strict. Miss a required recertification or a document deadline and the CDL drops to a Class C automatically. NCDMV's Medical Review Program handles these waivers at 919-861-3570, and says reviews take about 45 days once your paperwork is complete. [13][11]

As of September 2026, the waiver NCDMV describes is a limb waiver, for one condition only, and you need a DOT physical from within the past year. NC no longer issues vision waivers. Drivers who cross state lines cannot use it and have to go through FMCSA. [11]