Paper Medical Card Backup to End for Most CDL Drivers

Paper Medical Card Backup Ends for Most CDL Drivers

A federal exemption for the paper medical card will end for most CDL and commercial learner’s permit holders on October 12, 2026. After that date, drivers licensed outside Alaska will no longer be able to use a paper Medical Examiner’s Certificate as temporary proof of medical status.

FMCSA is keeping the paper option only for Alaska. The state is the only one that has not fully moved to the federal electronic medical system. Alaska CDL and CLP holders may keep using a paper medical card for up to 60 days after it is issued. That exemption will run through October 12, 2027.

FMCSA Moves Medical Records Online

The change is part of FMCSA’s Medical Examiner’s Certification Integration rule. It is also known as National Registry II, or NRII.

Under this system, certified medical examiners send exam results to FMCSA. FMCSA then sends the driver’s medical status to the state licensing agency. The state adds that information to the driver’s CDL record.

This process was designed to replace the old paper system. In most cases, CDL and CLP holders no longer need to submit a paper medical certificate to their state licensing agency.

Medical Card Backup Served During the Transition

The move to electronic records did not happen all at once. FMCSA gave drivers and carriers extra time while states completed the new system.

In July 2025, FMCSA let drivers and carriers use a paper medical card for up to 15 days after it was issued. In August 2025, the agency increased that period to 60 days. The paper option was later extended again.

CVSA then asked FMCSA for more relief. In April 2026, FMCSA approved a six-month exemption. That exemption allowed drivers and carriers in all states and Washington, D.C., to use the paper card for up to 60 days.

The goal was to protect drivers from problems they could not control. A driver could be medically qualified, but the electronic record might still be delayed.

Alaska Is Now the Only Exception

FMCSA says 49 states and Washington, D.C., have now put NRII in place. Alaska is the only state that has not finished the switch.

Because of that, FMCSA is ending the broad exemption. Starting October 12, it will apply only to drivers with an Alaska-issued CDL or CLP and to their motor carriers.

The Alaska exemption will stay in effect through October 12, 2027. During that time, covered drivers may use a paper medical card for up to 60 days after the exam.

Carriers may also use a copy of that card during the same 60-day period. They may keep it in the driver’s qualification file as proof of medical status.

What the Medical Card Change Means for Truck Drivers

The rule does not change the medical standards for commercial drivers. Drivers must still pass the required exam and be medically qualified to operate a commercial vehicle.

FMCSA says the exemption does not change those physical qualification rules. The main change is how drivers prove that they are medically qualified.

For drivers licensed outside Alaska, the 60-day paper medical card backup will end on October 12. After that, medical status will depend on the electronic record sent through FMCSA and the state licensing agency.

This makes the electronic process more important when a driver gets or renews a DOT physical. Drivers may want to make sure their medical status is updated correctly after the exam.

What This Means for Motor Carriers

Motor carriers also need to be ready for the October 12 change. Outside Alaska, a paper medical card will no longer serve as a temporary federal backup under this exemption.

Safety and compliance staff may need to review their driver qualification procedures. Any process that still depends on the 60-day paper exemption should be updated for drivers licensed outside Alaska.

For Alaska drivers, the paper option will remain in place for another year. However, the paper card must meet the rules of the exemption.

Alaska Medical Card Rules Keep the 60-Day Limit

The Alaska exemption does not let drivers use an old paper card without limits.

A driver must carry a current and valid medical card. It must have been issued by a certified medical examiner within the past 60 days. The motor carrier must also have a copy of that current certificate.

The exemption also covers interstate operations under federal law. States may choose to use the same exemption for intrastate operations, but they are not required to do so.

Electronic Medical Certification Becomes the Standard

The October 12 deadline marks a major step in FMCSA’s move away from paper medical records.

The nationwide paper exemption was temporary. It was meant to help drivers and carriers while states finished the electronic system. FMCSA now says all jurisdictions except Alaska are using NRII, so the broad exemption is no longer needed.

For most CDL and CLP holders, that means the paper medical card will no longer serve as a temporary federal backup after October 12. Alaska drivers will remain the only exception while the state completes its move to the electronic system.