Preparing for Your DOT Medical Exam

Preparing for Your DOT Medical Exam

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.

The goal, hopefully is that 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.

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.

Diabetic on insulin is disqualifying, unless you have a federal diabetes waiver.

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. 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.

More questions, call ahead, communication is what makes everything run smoother.

By Michael Tigges DC, NRCME


Call 615-452-1575