National Registry II Starts Sending Medical Results to States

In June 2025, the Federal Motor Carrier Safety Administration (FMCSA) reached the compliance date for the final phase of its Medical Examiner's Certification Integration rule, known as National Registry II or NRII. The FMCSA announcement was dated June 23, 2025.

What changed

The final phase covered the electronic transmission of driver medical certification information from FMCSA's National Registry of Certified Medical Examiners to State Driver Licensing Agencies (SDLAs). Under NRII, the agency said, results flow from the medical examiner to the National Registry, and from there to the state for posting on the driver's motor vehicle record.

FMCSA listed these main improvements:

• electronic transmission of medical certification information, from examiners to the National Registry and from the National Registry to SDLAs;
• elimination of paper records, which the agency said reduces errors and opportunities for document fraud;
• real-time access to a driver's medical certification status for roadside inspectors and law enforcement;
• more accountability, because only certified medical examiners can report exam results through the National Registry system.

A rule first published in 2015

The NRII rule was first published in 2015. It requires certified medical examiners to use specific forms to document physical qualification examinations and to issue medical certificates to qualified drivers. Examiners must electronically submit exam results to the National Registry by midnight, local time, of the next calendar day after the exam.

Not every state was ready

FMCSA said 37 states were fully compliant on June 23. The remaining states were expected to meet all requirements "in the coming months," according to the announcement.

What officials said

Secretary Sean P. Duffy said the digital system would make life easier for lawful drivers and harder for people trying to commit fraud. FMCSA Chief Counsel Jesse Elison said integrating electronic medical records into state-managed systems "helps ensure only qualified drivers are on our roads."

Who does what

Under the rule, the medical examiner, not the driver, reports the exam result to the National Registry. The registry then passes the information to the state licensing agency, which posts it on the driver's record. FMCSA said this gives inspectors and state partners the real-time information they need, and it described the change as replacing paper documents that it said were open to fraud, a hassle for drivers to keep, and harder for law enforcement to assess.

FMCSA pointed readers to its NRII Learning Center, which included a fact sheet on the rule.

Archive: this article describes rules and events as of June 2025. Regulations may have changed since, so check the current rule before relying on it.