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DOT Physicals

DOT Physical in St. Louis: What to Bring, What Can Disqualify You, and How to Pass the First Time

By Dr. Joe Sas, DC ·

Here's something most drivers don't expect: the most common reason a DOT physical goes sideways isn't a failed test. It's a missing piece of paper.

No medication list. No letter from the cardiologist. No CPAP report. And now you're making a second trip, and your card is about to expire.

I'm a Certified Medical Examiner on the FMCSA National Registry, and I do DOT physicals here on Gravois Rd. This is the checklist I wish every driver read before walking in.

What a DOT physical actually checks

The exam follows federal standards from the FMCSA. Every driver gets the same core checks:

  • Health history. You fill out the driver section of the federal exam form ahead of time. Answer it honestly and completely, because it's a federal document.
  • Vision. At least 20/40 in each eye and with both eyes together, with or without glasses or contacts, plus a 70-degree field of vision in each eye. You also need to tell red, green and amber apart, which is enough to read traffic signals.
  • Hearing. You need to hear a forced whisper at 5 feet in your better ear, with or without hearing aids, or pass an audiometric test.
  • Blood pressure and pulse.
  • Urinalysis. This is a quick dipstick check for protein, blood and sugar. It is not a drug test. A DOT drug test is a separate test, usually set up by your employer.
  • Physical exam. Heart, lungs, abdomen, spine, extremities and a neurological check, including reflexes, strength and coordination.

The checklist: what to bring

Everyone:

  • Driver's license or state photo ID
  • The glasses, contacts or hearing aids you drive with
  • A complete medication list, including prescriptions, over-the-counter drugs and supplements, with doses and the prescribing doctor for each
  • Your current medical card if you're renewing

Bring these if they apply to you. This is where second trips come from:

  • Diabetes on insulin: the federal Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870), filled out by the clinician who manages your diabetes within 45 days before your exam. Without it, I can't certify you that day.
  • Diabetes not on insulin: a recent A1c and your blood-sugar logs.
  • Heart conditions (stents, bypass, heart attack, arrhythmia, pacemaker): a clearance letter from your cardiologist and recent test results.
  • Sleep apnea: a CPAP compliance report showing consistent nightly use. Pull it from your machine's app or ask your supplier for it.
  • Seizures, stroke, recent surgery or blood thinners: records or a clearance letter from your treating specialist.
  • Vision in only one eye: ask about the federal alternative vision standard before your visit. It needs a form from your eye doctor.

What can disqualify you (or shorten your card)

A finding doesn't always mean "no." Often it means a shorter certification or a follow-up. Here's how it usually breaks down:

Blood pressure has the biggest effect on how long your card lasts:

  • Under 140/90: you can get the full card, up to 2 years.
  • 140–159 / 90–99: you get a 1-year card.
  • 160–179 / 100–109: you get a one-time 3-month card to get it under control.
  • 180/110 or higher: you can't be certified until it's brought down.

Other things that can affect certification:

  • Vision or hearing below the standards above
  • A seizure history or epilepsy medications
  • Diabetes or heart conditions that aren't well controlled or documented
  • Untreated or non-compliant sleep apnea
  • Certain medications. Methadone, Schedule I drugs, and anything that makes you drowsy or impaired can be a problem. Marijuana being legal in Missouri doesn't make it OK under federal DOT rules.

Many drivers get a shorter card while they handle something. That's normal. If something affects your certification, I'll tell you exactly what it is and what to do next.

How to pass the first time

  1. Fill out the health history before you come in, and don't leave boxes blank.
  2. Bring the paperwork above. Missing records cause more delays than anything else.
  3. Take your meds as usual, including blood pressure meds.
  4. Skip the energy drinks and extra coffee that morning. Caffeine and nicotine can push your blood pressure up.
  5. Get a decent night's sleep. Rushing in stressed after a night shift doesn't help your blood pressure either.
  6. Wear or bring your glasses and hearing aids.
  7. Book early. Don't wait until your card expires tomorrow. If you need records, you'll have time to get them.

Why get it done here

You're in and out. We have self-check-in, easy scheduling and a live text line to the front desk. You get straight answers from a certified examiner, with no runaround.

And if years of long hauls have left you with a stiff low back or neck, you're already in an office that tests first and fixes it. (More on that on our back pain page.)

Ready? See everything about DOT physicals in St. Louis, or book your exam.

Frequently Asked Questions

Your driver's license, the glasses, contacts or hearing aids you drive with, a complete medication list with doses and prescribing doctors, and your current medical card if renewing. If you have diabetes, a heart condition, sleep apnea or a neurological condition, bring the records or clearance letters from your treating provider.

No. The DOT physical includes a urinalysis that checks for protein, blood and sugar — it is not a drug screen. A DOT drug test is a separate test, usually arranged by your employer.

Under 140/90 qualifies for a card of up to 2 years. 140–159/90–99 typically gets a 1-year card, 160–179/100–109 a one-time 3-month card, and 180/110 or higher can't be certified until it's brought down.

Yes, many drivers on insulin qualify. You need the federal Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870) completed by the clinician who treats your diabetes within 45 days before your exam.
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