Sometimes a DOT physical can’t be fully completed in one visit because the medical examiner needs more medical information before making a final certification decision. That extra information often comes from your treating doctor (or a specialist) and can help document that a condition is stable, treated, and unlikely to interfere with safe driving.

Federal rules require that a driver be medically certified and carry a current medical examiner’s certificate to operate a commercial motor vehicle (in most interstate situations). If a medical examiner can’t make a decision without more information, you may be delayed or placed into a “pending” status until the paperwork is provided.

What “additional paperwork” means in a DOT exam

The official DOT certification document is the Medical Examiner’s Certificate (MEC), Form MCSA-5876. You only receive an MEC if the examiner determines you meet the medical qualification standards. The exam details are recorded on the Medical Examination Report (MER), Form MCSA-5875.

If the examiner needs more information, they may use an official status called “determination pending” while waiting for your paperwork. FMCSA guidance explains that “determination pending” can delay the final decision for up to 45 days. If the pending exam isn’t updated on or before that deadline, the exam becomes invalid and you’ll need a new examination.

Important: “Determination Pending” is NOT a medical card

This point causes a lot of confusion:

• No new DOT card is issued just because the exam is “pending.”
• If you still have a current, unexpired MEC, you may be able to keep driving until it expires (or until the examiner makes a final decision).
• If you do not have a current MEC, “pending” does not authorize you to drive in interstate commerce.

Common situations where examiners ask for paperwork from your doctor

Medical examiners can request documentation whenever it’s needed to understand a condition, confirm stability, or evaluate treatment. These are some of the most common scenarios:

1) Insulin-treated diabetes (ITDM)

If you are treated with insulin, FMCSA requires the Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870) completed by your treating clinician, confirming a stable insulin regimen and properly controlled diabetes. FMCSA also states the form must be provided to the certified medical examiner within 45 days of completion by the treating clinician.

2) Vision issues under the alternative vision standard

If you do not meet the standard vision requirements in one eye (such as monocular vision or not meeting acuity/field requirements with the worse eye), FMCSA’s alternative vision standard uses the Vision Evaluation Report (MCSA-5871) completed by an ophthalmologist or optometrist. FMCSA states the medical exam must begin no more than 45 days after the eye doctor signs and dates the vision report.

3) Recent hospitalization, surgery, or major medical events

If you’ve had a recent medical event (for example, a hospitalization, procedure, or new diagnosis), the examiner may request a treating clinician note or specialist report to confirm your current status and whether you are stable.

4) Heart, neurologic, respiratory, or sleep-related conditions

For conditions that could affect alertness, endurance, or risk of sudden incapacitation, examiners often ask for documentation such as recent test results, specialist notes, or treatment compliance records (depending on the condition and the examiner’s medical judgment).

5) Medication changes or medications with possible safety effects

If you recently started a new medication, changed doses, or take a medication that could affect alertness or cause dizziness, the examiner may request a note from the prescribing clinician describing how you tolerate the medication and whether there are side effects that could interfere with safe driving.

What your doctor’s paperwork should include (a practical checklist)

Different clinics request different details, but these items are commonly helpful:

• Diagnosis/condition being treated
• Date of diagnosis and current status (stable vs. changing)
• Treatment plan and whether you are following it
• Medication list (name, dose, frequency) and any relevant side effects
• Recent test results or specialist findings (if applicable)
• Functional limitations (if any) and any recommended restrictions
• Clinician contact info, signature, and date (on letterhead when possible)

Tip: The medical examiner makes the final DOT certification decision. Your doctor’s note usually works best when it provides clear medical facts and current status, rather than a simple “cleared to drive” statement.

Timing matters: the 45-day issue

If your DOT exam is placed into “determination pending,” remember:

• The examiner can set a follow-up date, but it must be on or before 45 days.
• If the pending exam is not updated by the deadline, the exam becomes invalid and you’ll need a new DOT exam.

Also note two other important “45-day” rules:

• Vision (MCSA-5871): The DOT exam must begin within 45 days of the eye doctor signing the form.
• Insulin-treated diabetes (MCSA-5870): The driver must provide the form to the medical examiner within 45 days of completion by the treating clinician.

How to avoid delays at your DOT exam

• Bring documentation to the first visit if you know you have a condition that often needs follow-up paperwork.
• Schedule your doctor/specialist visit early so you can meet any timing requirements.
• Keep copies of key records (medication list, recent labs, specialist notes, compliance reports if applicable).
• Ask the DOT clinic exactly what they need so your doctor’s note includes the right details.

Bottom line

You may need additional paperwork from your doctor when the medical examiner needs more information to make a safe, compliant certification decision. If your exam is placed in determination pending, treat it as time-sensitive—FMCSA guidance allows up to 45 days, and if it isn’t resolved by then, you’ll likely need to start over with a new exam.

This article is for general educational purposes and is not medical advice. For questions about your specific situation, talk with your certified medical examiner and your treating clinician.

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Primary References (Open in a New Tab)

• 49 CFR §391.41 — Physical qualifications (medical certification requirement)
• FMCSA — Medical Examiner’s Handbook (2024 Edition) (PDF)
• FMCSA National Registry — FAQs on forms & “determination pending” (PDF)
• FMCSA — Medical Examination Report (MER), Form MCSA-5875
• FMCSA — Medical Examiner’s Certificate (MEC), Form MCSA-5876
• FMCSA — Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870)
• FMCSA — Vision Evaluation Report (MCSA-5871)