---
title: Medical certificate and National Registry checks
description: Physical qualification, examiner certification, CDLIS medical status after June 2025, and what carriers file under 49 CFR 391.41, 391.43, 391.45, and 391.51.
date: 2026-10-20
lastReviewed: 2026-10-23
canonical: /resources/guides/medical-certificate-and-national-registry
---
Drivers must be medically certified before operating a CMV, and carriers must file proof before allowing operation ([49 CFR 391.41](https://www.ecfr.gov/current/title-49/section-391.41), [391.43](https://www.ecfr.gov/current/title-49/section-391.43), [391.51(b)(6)](https://www.ecfr.gov/current/title-49/section-391.51)).

## Short answer



Non-CDL drivers: obtain the examiner’s certificate (or legible copy), verify the examiner was listed on the National Registry on the date of issuance, note that verification, and file both before the driver operates. CDL and CLP holders: after June 23, 2025, medical status is transmitted electronically; obtain the CDLIS motor vehicle record from the current licensing state, verify the self-certified operation type, and file that record. Re-examination is required at least every 24 months, and more often when § 391.45 applies. DQid tracks dates and document status; carriers decide when a driver is cleared to drive.



## Examinations and certificates



### 
  

### 
    Except for narrow specialist exceptions, the exam must be performed by a
    medical examiner listed on the National Registry of Certified Medical
    Examiners.
  


  

### 
    On or after June 23, 2025, examiners still issue a paper certificate to
    drivers who will not operate vehicles requiring a CDL or CLP.
  


  

### 
    CDL and CLP holders with current certification no longer carry the paper
    certificate on duty after June 23, 2025; FMCSA transmits results to the
    state for CDLIS.
  


  

### 
    Drivers must be examined at least every 24 months unless paragraph (c), (e),
    (f), (g), or (h) requires a shorter interval—for example, 12 months for
    insulin-treated diabetes under § 391.46.
  





## What the qualification file holds

For CDL holders, file the CDLIS record showing medical certification status ([49 CFR 391.51(b)(6)(ii)](https://www.ecfr.gov/current/title-49/section-391.51)). For other drivers, file the certificate and the National Registry verification note ([391.51(b)(6)(i), (b)(8)(i)](https://www.ecfr.gov/current/title-49/section-391.51)). Include FMCSA medical variance or SPE documentation when certification rests on them.

## Paper certificate transition

Through June 22, 2025, carriers could rely on short-term paper copies in defined circumstances. A Federal Register notice published **October 8, 2026** ([2026-20649](https://www.federalregister.gov/d/2026-20649)) states that **as of October 12, 2026**, drivers licensed outside Alaska—and motor carriers that employ them—may no longer rely on a paper copy of the medical examiner’s certificate. The same notice **renews the exemption for Alaska-licensed drivers for one year**, so drivers licensed in Alaska may continue to rely on a paper copy under that renewed exemption during the period FMCSA describes in the notice.


  When electronic CDLIS data conflicts with a paper certificate, the electronic
  information controls ([49 CFR
  391.23(m)(4)](https://www.ecfr.gov/current/title-49/section-391.23)).


## Example in DQid

Medical items show review status beside expiration dates so renewals do not get lost among unrelated documents.



## Sources

- [49 CFR 391.41 — Physical qualifications](https://www.ecfr.gov/current/title-49/section-391.41) (eCFR text reviewed 2026-10-20)
- [49 CFR 391.43 — Medical examination](https://www.ecfr.gov/current/title-49/section-391.43) (eCFR text reviewed 2026-10-20)
- [49 CFR 391.45 — Who must be examined](https://www.ecfr.gov/current/title-49/section-391.45) (eCFR text reviewed 2026-10-20)
- [49 CFR 391.51 — Driver qualification files](https://www.ecfr.gov/current/title-49/section-391.51) (eCFR text reviewed 2026-10-20)
- [Federal Register, Oct. 8, 2026 — Paper medical examiner’s certificate](https://www.federalregister.gov/d/2026-20649)