The DOT physical itself hasn’t changed — the vision test, blood pressure check, urinalysis, and FMCSA medical standards are the same as they’ve always been. What changed in 2026 is how your results get reported to your state DMV. And for drivers licensed in 8 specific states, the old paper process is still in effect.
Here’s the full breakdown so you know exactly what to do after your exam.
What Is NRII — and Why Does It Matter?
NRII stands for National Registry II — the federal government’s new electronic system for transmitting DOT physical results. Before NRII, the process worked like this:
- You passed your DOT physical
- Your examiner handed you a paper Medical Examiner’s Certificate (Form MCSA-5876)
- You took that paper card to your state DMV
- Your state updated your CDL record manually
Under NRII, steps 3 and 4 are eliminated for most states. Your medical examiner submits the results electronically to FMCSA, and FMCSA sends them directly to your state DMV. Your CDL record updates automatically — no trip to the DMV required.
Which States Still Require Paper in 2026?
As of mid-2026, 42 states plus Washington D.C. have fully switched to electronic NRII reporting. The following 8 states still require paper:
| State | Electronic (NRII)? | What You Must Do |
|---|---|---|
| New Jersey | Paper required | Submit paper MEC to NJ MVC after your exam |
| New York | Paper required | Submit paper MEC to NY DMV after your exam |
| California | Paper required | Submit paper MEC to CA DMV after your exam |
| Alaska | Paper required | Submit paper MEC to AK DMV after your exam |
| Kentucky | Paper required | Submit paper MEC to KY Transportation Cabinet |
| Louisiana | Paper required | Submit paper MEC to LA DMV after your exam |
| New Hampshire | Paper required | Submit paper MEC to NH DMV after your exam |
| Oklahoma | Paper required | Submit paper MEC to OK DPS after your exam |
| All other 42 states + DC | Electronic ✓ | No action needed — your CDL updates automatically |
What Happens at Your Exam If You’re in a Paper State?
If you hold a CDL issued in one of the 8 paper states, here’s what happens when you get your DOT physical:
- Your examiner conducts the exam as normal and issues you a paper Medical Examiner’s Certificate (the green-and-white card, Form MCSA-5876)
- Your examiner submits results to the FMCSA National Registry electronically by midnight of the next business day — this is required regardless of your state
- You take your paper MEC to your state DMV to update your CDL record. Do not wait. Your CDL will not reflect current medical certification until your state processes it.
The 60-Day Waiver: What It Means
FMCSA has issued a temporary waiver (currently in effect through October 11, 2026) that allows CDL and CLP holders to use a paper copy of their Medical Examiner’s Certificate as proof of medical certification for up to 60 days after it is issued.
What this means in practice:
- Your paper MEC is valid proof of medical certification for 60 days from the exam date
- Motor carriers may accept the paper MEC as proof during this 60-day window
- After 60 days, your CDL record must reflect your current certification status
What Employers and Fleet Managers Must Do Differently
If you manage CDL drivers, NRII changes your compliance tracking process:
For drivers licensed in NRII-compliant states (42 states + DC):
- Results post automatically to FMCSA and the state DMV — no action required from the driver
- Verify certification through your fleet management system or the FMCSA portal
- No paper MEC collection needed
For drivers licensed in the 8 paper states (NJ, NY, CA, AK, KY, LA, NH, OK):
- Drivers must still physically submit paper MECs to their state DMV
- Add a step to your onboarding checklist: confirm the driver has submitted their MEC and request a copy of the updated CDL record
- Do not assume the CDL record will update automatically — it will not
- Allow 10–14 business days for state processing before verifying the CDL record
What Actually Happens During the 2026 DOT Physical?
The underlying medical standards remain identical to previous years. Your DOT physical in 2026 includes the same components it always has:
- Vision: At least 20/40 acuity in each eye, with or without correction. 70° horizontal field of vision in each eye.
- Hearing: Forced whispered voice at 5 feet in the better ear, with or without a hearing aid.
- Blood pressure: Must be below 180/110 to receive any certification. Below 140/90 earns a full 2-year certificate.
- Urinalysis: Checks for glucose, protein, and blood — not a drug screen.
- Cardiovascular and respiratory exam
- Neurological and musculoskeletal evaluation
See our complete guide: What to Expect at Your First DOT Physical Exam.
How to Verify Your Medical Certification After Your Exam
After any DOT physical, confirm your results were recorded correctly:
- Check the FMCSA National Registry at nationalregistry.fmcsa.dot.gov — your examiner’s name and exam date should appear within 1–2 business days
- Check your CDL record with your state DMV — in paper states, allow 10–14 business days after submitting your MEC
- Contact your examiner if your results don’t appear in the National Registry within 5 business days — they are required to submit by midnight of the next business day