DOT Medical Card Changes: Electronic Reporting and What Happens to Paper Certificates

Since June 23, 2025, FMCSA has been electronically transmitting DOT medical certification results directly to State Driver Licensing Agencies (SDLAs) under a system it calls National Registry II (NRII). In states that have finished connecting to NRII, medical examiners are no longer required to hand a paper Medical Examiner’s Certificate (Form MCSA-5876) to CLP applicants and CDL holders, because the certification now reaches the state electronically. Because some states are still connecting, FMCSA has repeatedly issued temporary relief letting a paper certificate stand in as proof of certification in the meantime. The exemption in effect now runs April 11, 2026 through October 11, 2026, and covers a paper certificate for up to 60 days after the date it was issued. Separately, every medical examiner listed on the National Registry must migrate their National Registry account to login.gov to keep using the system. Both changes are covered below, one section for drivers and one for examiners.

What Changed on June 23, 2025

National Registry II is the FMCSA system built to close a long-standing gap: a driver’s DOT medical certification status living in the National Registry while their state driver’s license record did not automatically reflect it. Under the NRII final rule, FMCSA electronically transmits DOT examination results and medical variance information for CLP applicants and CDL holders from the National Registry to the driver’s SDLA, and the SDLA posts that information to the Commercial Driver’s License Information System (CDLIS) driver record. States were required to have procedures in place to receive and post this information by June 23, 2025, under 49 CFR 384.234.

This is a reporting change, not a change to who needs to be examined or how often. Medical examiners still conduct the DOT examination, still complete the required examination forms, and still submit examination results to the National Registry by midnight local time on the following calendar day, a submission requirement that has been in place since 2018 and is unchanged by the June 23, 2025 rule. What is new is what happens after submission: in a state that has implemented NRII, the result now flows to the SDLA automatically instead of depending on the driver to deliver a paper card.

For Drivers: Do You Still Get a Paper Card

It depends on whether your state has finished implementing NRII. In a state that has implemented it, your medical examiner is no longer required to issue you the paper MCSA-5876 as a CLP applicant or CDL holder, because your state already receives the certification electronically and posts it to your CDLIS record. Some examiners may still hand you a copy for your own records even though it is no longer the primary proof; ask your examiner what their office provides. In a state that has not yet implemented NRII, nothing has changed yet: you still receive and carry the paper certificate as before, until that state connects to the system. One important carve-out: the electronic transmission applies to CLP applicants and CDL holders. For qualified non-CDL drivers who require medical certification, the examiner must still issue the original paper certificate at the time of the examination, in every state.

Because the state-by-state rollout has taken longer than FMCSA’s original timeline, FMCSA has kept extending a temporary safety net so drivers are not caught between systems. The version in effect now allows interstate CDL holders, CLP holders, and motor carriers to rely on a paper copy of the Medical Examiner’s Certificate as proof of medical certification for up to 60 days after the date it was issued, for the period April 11, 2026 through October 11, 2026. FMCSA has stated it does not expect to issue further nationwide relief after this exemption period ends, so drivers should not assume a paper backup will remain available indefinitely. As of FMCSA’s April 2026 exemption notice, 45 states and the District of Columbia had implemented NRII, while Alaska, California, Kentucky, Louisiana, and New Hampshire had not. That list continues to move, so if you are unsure whether your state has implemented NRII, confirm directly with your SDLA or check FMCSA’s National Registry site rather than relying on a general assumption either way.

For Medical Examiners: The Login.gov Migration

Separate from the NRII rollout, FMCSA requires every certified medical examiner listed on the National Registry to migrate their National Registry account to login.gov, the federal government’s shared identity verification service, to meet current federal standards for secure account access. To migrate, go to the National Registry site and follow the account transfer prompts; have your National Registry number, your professional license number, and your state on hand. Once your login.gov account is linked, you sign in with your login.gov email, password, and security code each time rather than your prior National Registry credentials.

The consequence of not migrating is significant for your ability to practice as an examiner. FMCSA has stated that medical examiners who do not migrate risk suspension of their National Registry account, and has previously moved to formally propose removing examiners from the Registry for noncompliance with the login.gov requirement. A suspended or removed National Registry listing means you cannot perform or submit DOT medical certifications, regardless of your clinical certification status. If you are currently studying for the NRCME certification exam, add this to your post-certification checklist now: it is an account administration step, not exam content, but it is the difference between passing the exam and actually being able to practice once you are certified.

What Has Not Changed

The physical qualification standards examiners apply under 49 CFR 391.41, the certification exam content itself, and the requirement to be listed on the National Registry to perform DOT examinations are unaffected by either the NRII rollout or the login.gov requirement. The examination process a candidate studies for is the same process; what changed is how the resulting paperwork travels afterward, and how examiners authenticate into the system that records it.

Preparing to become a certified medical examiner? Try a free NRCME practice test to check your readiness, start full NRCME practice tests built around the current exam content, or work through our NRCME exam study guide to build a study plan.

Frequently Asked Questions

Do CDL drivers still get a paper DOT medical card?

Only in states that have not yet implemented National Registry II, drivers continue to receive a paper Medical Examiner’s Certificate as before. In states that have implemented NRII, examiners are no longer required to issue one to CLP applicants and CDL holders because the certification transmits electronically to the state.

What if my state has not finished connecting to NRII yet?

Nothing changes for you yet. You continue to receive and carry a paper certificate until your state implements NRII, and a temporary FMCSA exemption (currently effective through October 11, 2026) allows a paper certificate to serve as proof of certification for up to 60 days after issuance in the meantime.

Do all medical examiners have to migrate to login.gov?

Yes. Every medical examiner listed on the National Registry must create a login.gov account and link it to their National Registry account to keep accessing the system.

What happens if a medical examiner does not migrate to login.gov?

FMCSA has stated that examiners who do not migrate risk suspension of their National Registry account, which would prevent them from performing or submitting DOT medical certifications.

Sources

• fmcsa.dot.gov, FMCSA Issues Temporary Exemption to Support NRII Transition
• nationalregistry.fmcsa.dot.gov, National Registry of Certified Medical Examiners / NRII Learning Center
• federalregister.gov, National Registry of Certified Medical Examiners Integration (final rule, 49 CFR 384.234)

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For educational and exam preparation purposes only. Not a substitute for formal clinical training.