Help My DOT Physical Won't Show Up at the DMV

CDL Licenses Incorrectly Downgraded Because Local DMV or State Drivers Licensing Agencies (SDLA) Can’t Find My Current Medical Certificate or Medical Card

State Drivers Licensing Agencies (SDLAs) or Department of Motor Vehicles (DMV) continue to incorrectly downgrade CDL licenses, because they do not see the driver’s new medical certificate (medical card).

What is happening?

Even though examiners are completing exams and have submitted them to the National Registry as required, SDLAs (State Drivers Licensing Agencies) are NOT seeing that the driver has a current medical certificate. Drivers are receiving notifications that their license has been downgraded or will soon be downgraded if they do not obtain a new medical certificate. When the driver contacts the SDLA (local DMV) to resolve the error, the SDLA indicates that since they do not see the driver’s new certificate, their medical examiner must not have submitted it.

Why is this happening?

The exam reporting process between the National Registry and the states consists of two steps:

1. The new medical certificate from the National Registry is “pushed” or transmitted to the SDLAs and

2. The “pull” of updated medical certificate expiration date that allows the SDLAs to retrieve a driver’s medical examiner’s certificate information from FMCSA’s National Registry.

The trouble appears to be with step 2. After the medical examiner submits a medical certification via their National Registry account, The state does not automatically “pull” the transaction from the FMCSA’s National Registry.

The solution

First, check your paper medical certificate for any errors that don’t exactly match your driver’s license.

Second, ask your Medical Examiner to search for the driver in their National Registry account to verify that the exam has in fact been submitted with no errors preventing it from being fully accepted and matches with the information on file at State Drivers Licensing Agency (SDLAs) or Department of Motor Vehicles (DMV).

Can I bring my paper Medical Certificate or Medical Card to the DMV to link it with my driver’s license? No, don’t waste your time with that. Florida and any other state that has implemented NRII will NOT take any paper medical certificates.  Your Medical Certificate must be received electronically directly from the National Registry.

Best Practices for SDLAs that Have Implemented NRII

The best practices for State Driver Licensing Agencies (SDLAs) to follow when assisting commercial learner’s permit (CLP) applicants and commercial driver’s license (CDL) holders in States that have implemented the Medical Examiner’s Certification Integration Rule (NRII). As of June 23, 2025, all SDLAs are required to receive medical examiner’s certificate information electronically from FMCSA’s National Registry and to post the information on the driver’s CDLIS record.

These best practices apply in States that have implemented NRII. States that have not implemented NRII continue to accept paper medical examiner’s certificates until the State implements NRII, as described in FMCSA’s guidance here: https://www.fmcsa.dot.gov/regulations/medical/if-state-has-not-implemented-national-registry-ii-june-23-2025-compliance-date

1. Pulling Drivers’ Medical Certifications via CD43

SDLAs should be aware of two NRII transactions: (1) the push transactions from the National Registry to the SDLAs (referred to as pushing via CD42) and (2) the pull transactions that allow the SDLAs to retrieve a driver’s medical examiner’s certificate information from FMCSA’s National Registry (referred to as pulling via CD43).

SDLAs should pull the information via CD43 (National Registry Retrieval System) when:

• A driver has confirmed that the medical examiner submitted the driver’s medical examiner’s certificate to the National Registry, but the certification was NOT pushed by the FMCSA to the SDLA via CD42 (National Registry Transmission Service).
• A driver’s medical examiner’s certificate was submitted to the National Registry before the State implemented NRII.
• A driver applies for a CLP (commercial learner’s permit).

State Driver Licensing Agency needs to pull the Medical Certificate via CD43 (National Registry Retrieval System):

• SDLA needs to log into your State’s NRII-integrated system.
• Initiate a pull using the driver’s:

o First name and last name and date of birth (Important note: using the driver’s middle name or initial may not return any results for the driver), or;

o Driver’s license number and licensing State (some States may require additional data fields).

• If a record is retrieved:

o Link it to the driver’s record.

o If mismatches are identified, advise the driver to have the medical examiner (ME) correct the record and re-submit to the National Registry.

2. Supporting Variance-Dependent Drivers

Medical certifications requiring a variance from FMCSA (an exemption, waiver, or skill performance evaluation certificate) will not transmit to the SDLA until FMCSA issues the variance.

• The Medical Examiner’s Certificate (Form MCSA-5876) will indicate “Accompanied by a waiver/exemption” or “Accompanied by a Skill Performance Evaluation (SPE) Certificate” if the driver requires a variance from FMCSA.

o NOTE: If the Form MCSA-5876(Medical Certificate/ Medical Card) indicates that the driver requires a vision or diabetes exemption, the ME will need to correct the error. FMCSA no longer issues vision and diabetes exemptions because FMCSA published revisions to the vision and diabetes standards under which the ME evaluates the driver.

• Once FMCSA has issued the variance, the National Registry will link the variance with the driver’s examination results and transmit the information to the SDLA.

Summary Table: SDLA Actions

3. Additional Resources

• Drivers may contact FMCSA Technical Support if the SDLA is unable to retrieve the driver’s medical certification:

National Registry Technical Support Helpdesk:

FMCTECHSUP@dot.gov  

(617) 494-3003, select option #2

• Refer to the NRII Learning Center for a list of States that have not implemented NRII, FAQs, troubleshooting guides, and more:

https://nationalregistry.fmcsa.dot.gov/nriilearning-center