Paper medical cards no longer prove a commercial driver's medical certification in most states. The Federal Motor Carrier Safety Administration's temporary nationwide exemption that let CDL and CLP holders and their carriers rely on a paper Medical Examiner's Certificate expired at midnight on October 11, and the electronic National Registry II (NRII) process took full effect on October 12, 2026.

Source: WFQA

Under NRII, a certified medical examiner reports the DOT physical results through the National Registry by midnight, local time, on the next calendar day. FMCSA then sends the certification information electronically to the state licensing agency, which posts it to the driver's CDLIS motor vehicle record. That state record is now the proof carriers must verify.

Source: DISA Global Solutions

Alaska is the only exception

Alaska, the one state that has not yet implemented NRII, received an exemption from October 12, 2026 through October 12, 2027. Alaska-licensed CDL and CLP holders and their carriers may still use a paper certificate as proof for up to 60 days after it is issued, provided the other conditions in the exemption are met.

A medical certificate can last up to 24 months, and some drivers receive a shorter period. The medical qualification requirement itself has not changed — drivers must still complete the required examination and be medically certified. What has changed is the proof: outside Alaska, drivers and carriers should check that the new certification actually appears on the state driving record after a DOT physical, and have the examiner fix any mismatch.