Paper DOT Medical Cards No Longer Count for CDL Drivers: What Employers Need to Do Now

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As of October 12, 2026, a paper Medical Examiner's Certificate (the familiar "med card") no longer counts as proof that a CDL or CLP driver is medically qualified, in every state except Alaska. If your driver qualification process still starts with "get a copy of the med card," now is the time to update it.

Medical Certificate now verified throuigh MVR — Medical certification is now verified through the MVR

What happened to Paper DOT Medical Cards

FMCSA's Medical Examiner's Certification Integration rule, often called National Registry II or NRII, took effect June 23, 2025. Under it, certified medical examiners send DOT physical results to the FMCSA National Registry, which passes them electronically to the driver's state licensing agency. The state then posts the driver's medical certification status to the driving record (MVR).

Because several states were not ready on time, FMCSA issued a series of temporary waivers that let drivers and carriers rely on a paper med card for up to 60 days after the exam. The last nationwide waiver expired at 11:59 p.m. on October 11, 2026, and FMCSA had said it did not expect to issue another.

Alaska is the one exception. It is the only state that has not finished implementing the rule, so FMCSA provisionally renewed the paper card exemption for Alaska-issued CDL and CLP holders and their employers from October 12, 2026 through October 12, 2027. The same 60-day limit applies.

Why it matters to employers

The MVR is now the proof. For CDL and CLP drivers licensed outside Alaska, a paper card does not establish medical qualification for any period of time.
Gaps can happen without anyone noticing. If an examiner does not submit results, or the state does not post them, the driver's record may show no current certification, and the state may start a downgrade of the CDL. A driver who looks qualified on paper may not be.
Your files need to match the new process. A driver qualification (DQ) file built around paper cards may no longer reflect what an auditor or investigator expects to see.

Practical steps to take now

Update your written DQ procedure so DOT medical card certification for CDL and CLP drivers is confirmed through the MVR, not a paper card.
Pull an MVR a few days after each DOT physical. Examiners have until midnight of the day after the exam to submit results, and states can take additional time to post them. Keep that MVR in the driver's DQ file.
Ask your MVR monitoring provider whether medical certification changes are included in its alerts. Do not assume they are.
Follow up fast when certification is missing. Have the driver contact the examiner to confirm the results were submitted, and confirm the examiner is listed on the FMCSA National Registry.
Identify any Alaska-licensed drivers. For them, keep a copy of a paper card issued within the prior 60 days in the DQ file, and still check the MVR.
Remember non-CDL drivers. The electronic process covers CDL and CLP holders only, so keep collecting paper cards for drivers who need medical certification but do not hold a CDL.
Brief your team. Safety staff, dispatchers, and drivers should all know that the paper card is no longer the finish line.

Paper DOT Medical Cards No Longer Count for CDL Drivers: What Employers Need to Do Now

What happened to Paper DOT Medical Cards

Why it matters to employers

Practical steps to take now

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