Everything the FMCSA requires, what the examiner checks, and how to avoid the mistakes that cost drivers a two-year card.
Any driver operating a commercial motor vehicle in interstate commerce that weighs over 10,000 lbs, carries hazardous materials, or transports passengers (8+ for compensation, 15+ otherwise). That includes every CDL holder — and your medical card must stay current or your CDL is downgraded. In Kansas City that covers everyone from the intermodal drivers working the rail yards and Fairfax plants to regional haulers running I-70 to St. Louis and the grain and livestock crews moving through the stockyard corridors.
| Test | Standard to pass |
|---|---|
| Vision | 20/40 or better in each eye and both together (glasses/contacts fine), 70° peripheral vision in each eye |
| Hearing | Hear a forced whisper from 5 feet (hearing aid allowed), or pass audiometry |
| Blood pressure | Under 140/90 for a 2-year card; see the chart below |
| Urinalysis | Screens for protein, blood, and sugar — this is a kidney/diabetes check, not a drug test |
| Physical exam | Heart, lungs, spine, neuro, hernia check, range of motion |
| Reading | Result |
|---|---|
| Below 140/90 | 2-year certificate |
| 140–159 / 90–99 (Stage 1) | 1-year certificate |
| 160–179 / 100–109 (Stage 2) | One-time 3-month certificate to get it controlled |
| 180/110 or higher (Stage 3) | Disqualified until controlled; 6-month card once it is |
Driver tip: skip the energy drinks and cigarettes the morning of your exam, get a night of real sleep, and hydrate. Borderline readings are the #1 reason drivers lose a year off their card.
Very few things are permanent disqualifiers: unmanaged insulin use without the ITDM process, epilepsy without the exemption, current alcohol dependence, and use of Schedule I drugs (including marijuana — legal state or not, it's federally disqualifying for CDL drivers). Almost everything else is a documentation problem, not a career-ender.