DOT Physical Exam — Decoder

When a CDL driver completes a DOT physical, the examiner issues a Medical Examiner's Certificate (Short Form 5875) with a duration + restrictions. This skill decodes what's on the cert.

The certificate fields (Short Form 5875)

1. Driver name + DOB + signature
2. Examiner name + NRCME registration number
3. Exam date
4. Expiration date (max 24 months out)
5. Restrictions (list, can be blank)
6. Examiner's signature + seal

Common duration variations

• 24 months — full pass. No conditions requiring monitoring.
• 12 months — minor conditions (e.g., controlled hypertension). Re-eval in 1 year.
• 3-6 months — monitoring required (e.g., sleep apnea + CPAP pending, recovering from cardiac event).
• Disqualified — fails one of the 49 CFR 391.41(b) conditions; cert NOT issued.

Restrictions decoded

Common restrictions you'll see on the cert:

Code	What it means	Operational implication
B	Wearing corrective lenses	Driver must wear glasses/contacts while driving
C	Hearing aid	Driver must wear hearing aid
E	No manual transmission	Driver may operate only automatic
F	Outside mirrors required	Vehicle must have both side mirrors
G	Daytime driving only	Sunrise to sunset only
H	Insulin-using (with exemption)	OK to drive with diabetes exemption letter
K	Intrastate only	Cannot operate interstate
L	No tractor-trailer	Single-unit vehicles only
M	No Class A	Class B and below only
N	No Class A or B	Class C only
O	No tractor-trailer	Same as L
P	No passengers	School bus drivers etc. with passenger restriction
R	No exemption program	Active exemption (e.g., diabetes, vision)
V	Medical variance	Approved exemption from a disqualifying condition
X	Vision in one eye	Monocular vision (with exemption)

A driver with restriction B can drive — but only with corrective lenses on. If pulled over without glasses = violation.

Vision requirements (49 CFR 391.41(b)(10))

• Visual acuity: Each eye must have ≥ 20/40 vision (with correction allowed)
• Field of vision: ≥ 70° in horizontal meridian in each eye
• Color recognition: Must distinguish traffic signal colors (red, green, amber)
• No monocular vision (one eye) unless granted a Vision Exemption

Vision Exemption Program — separate FMCSA process; 3-year monitoring; ~6-12 month application timeline.

Hearing requirements (49 CFR 391.41(b)(11))

Driver must hear:

• Forced whisper at ≥ 5 feet (with or without hearing aid), OR
• Audiometer test: average hearing loss ≤ 40 dB at 500 Hz, 1000 Hz, and 2000 Hz in the better ear

Hearing Exemption Program — separate FMCSA process.

Blood pressure categories (FMCSA Medical Examiner Handbook)

BP Category	Reading	Cert Duration	Conditions
Stage 1	140-159 / 90-99	1-year cert	Recheck in 1 year; lifestyle modification recommended
Stage 2	160-179 / 100-109	3-month cert	Treatment required; cert renewed only after BP controlled
Stage 3	≥ 180 / ≥ 110	Disqualified	Cannot certify until controlled below Stage 2

Controlled hypertension (BP under control with medication) typically gets a 1-year cert.

Sleep apnea screening

Drivers with risk factors for obstructive sleep apnea (OSA) — particularly BMI ≥ 33 and a sleep history — are typically:

• Issued a short-term cert (3 months) pending sleep study
• Required to complete a sleep study + CPAP compliance documentation
• Re-evaluated with CPAP compliance data (machine download report)

A driver who refuses sleep study or fails CPAP compliance may be disqualified.

Diabetes (49 CFR 391.46)

• Type 2 diabetes, no insulin — qualified if controlled
• Type 2 diabetes, oral medication — qualified if controlled
• Insulin-using diabetes — DISQUALIFIED unless granted Diabetes Exemption

Diabetes Exemption Program — requires endocrinologist letter, A1C monitoring, no severe hypoglycemic events for 12+ months. Quarterly monitoring during certification.

Cardiovascular (49 CFR 391.41(b)(4))

History of:

• Myocardial Infarction (MI / heart attack)
• Angina pectoris
• Congestive heart failure
• Syncope (fainting)
• Dyspnea (severe shortness of breath)
• Cardiac surgery

Requires cardiologist clearance, ECG, stress test results, ejection fraction documentation. Cert duration: 1 year typically; some conditions warrant 2 years.

Mental health

• Active psychosis or severe mood disorder → disqualifying
• Controlled depression/anxiety with medication compliance → typically qualified
• Recent suicide attempt or violent psychiatric history → individualized review

When a cert is downgraded

A driver's cert can be downgraded if:

• Medical condition develops between exams
• CDLIS shows the cert as expired or invalid
• Driver had a non-DOT health event (cardiac, neurological) that surfaces
• A second-opinion exam by a different NRCME examiner

When this happens, driver is unqualified until re-certified.

What carriers should do

1. Verify NRCME registration of the examiner before the exam (or right after) at nationalregistry.fmcsa.dot.gov.
2. Photocopy the certificate for the DQF immediately.
3. Note the expiration date in a tracking system — flag for 30/14/7/1-day reminders.
4. Don't accept generic doctor notes — only NRCME-issued certs are valid.
5. For drivers with restrictions — communicate to dispatch (e.g., "Driver Y has restriction E: no manual transmission").
6. For short-term certs — schedule the next exam within the cert duration; don't let the driver lapse.

Where this fits in X3

X3's dq-files.html decodes the Medical Examiner's Certificate including restrictions. agent-driver-reminders fires medical-cert expiry reminders at 30/14/7/1-day thresholds (now policy-routed via the notification_routing helper). The X3 dashboard surfaces drivers with active restrictions to dispatchers so they don't assign vehicles outside their certified class.

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