Paper medical cards no longer count as proof for most CDL drivers
Since Oct. 12, drivers licensed outside Alaska and their carriers must rely on the electronic medical certification posted to the driver's state record.
As of October 12, 2026, interstate CDL and CLP holders licensed in 49 states and the District of Columbia, and the carriers that employ them, can no longer use a paper medical examiner's certificate (MEC) as proof of medical certification. The record that counts now is the electronic one on the driver's state record.
FMCSA announced the change in an October 8 Federal Register notice (Docket FMCSA-2026-0265). The same notice kept paper-card relief in place for one group only: drivers licensed in Alaska.
Why paper went away
This is the last step of the Medical Examiner's Certification Integration rule, known as NRII. FMCSA published that rule in 2015, pushed the compliance date back several times, and finally required compliance on June 23, 2025.
Under NRII, certified medical examiners report exam results to FMCSA's National Registry. FMCSA sends the results electronically to the state driver licensing agency, which posts them to the driver's record in the Commercial Driver's License Information System (CDLIS). Drivers no longer have to hand a paper certificate to the state, and examiners no longer have to give drivers the original paper form.
How the grace period ended
While states were switching over, FMCSA allowed drivers and carriers to keep using a paper copy for a short time after an exam. According to the notice:
- The original 15-day paper allowance ended June 22, 2025.
- FMCSA issued a waiver in July 2025, widened it to 60 days in August 2025, and reissued it in October 2025 and January 2026.
- On April 14, 2026, at CVSA's request, FMCSA granted a six-month exemption that let drivers in every state and D.C. rely on a paper copy for up to 60 days after the exam.
Since then, 49 states and D.C. have put NRII in place. FMCSA said relief was no longer needed in those places and renewed it only for Alaska, the one state that has not.
What carriers need to do
FMCSA's NRII Learning Center explains the carrier side. Carriers:
- no longer have to check that a paper MEC came from an examiner on the National Registry; and
- must get the CDLIS motor vehicle record, with the driver's medical certification information, from the driver's current licensing state and keep it in the driver qualification file.
In practice, after a CDL driver's new physical, pull an updated MVR and make sure the new certification shows up before the old one runs out. If it doesn't, the driver and the examiner need to fix the record with the state. FMCSA has told medical examiners to fix submissions that don't match a driver at the state agency.
What drivers should do
The electronic result sent to your state is now the official proof. FMCSA still recommends that examiners give drivers a paper copy, and that copy can help you sort out problems with your state. Outside Alaska, though, it no longer counts as proof of certification. After your exam, check with your licensing agency that the new certificate made it onto your record.
The Alaska exception
If your CDL or CLP was issued by Alaska, you and your carrier can still use a paper copy of a current MEC for up to 60 days from the exam date. That exemption runs from October 12, 2026, through October 12, 2027. It applies only if the driver carries a copy of a valid MEC issued in the previous 60 days, and the carrier also has a copy. The exemption doesn't change any medical standard. Drivers still have to be medically certified.
FMCSA is taking comments on the Alaska renewal in the regulations.gov docket.