Is a health questionnaire allowed in the driver application?

No, not at a company of 15 or more employees. Before an offer, the ADA bars medical exams and questions about whether an applicant has a disability. You may list what the work involves, such as folding and loading a wheelchair, and ask if the applicant can do it, with or without an accommodation. Health questions and the physical come only after the conditional offer, and California applies the same order once a company has five employees.

Do all NEMT drivers need a DOT physical?

No. The federal medical card is for people driving commercial vehicles across state lines: vans that seat more than 8, driver included, on paid trips, whether by design or in use, and anything rated or loaded at 10,001 pounds and up. Trips that carry sick or injured riders can fall outside those rules, one trip at a time. Some states add their own exam for certain drivers, such as New York ambulette drivers and California Medi-Cal wheelchair van drivers.

Can I require a physical only for drivers over 60?

No. A post-offer exam is lawful under the ADA only when every entering employee in the same job category takes it, regardless of disability. Singling out older hires also invites an age discrimination claim, since federal age law protects workers 40 and older at companies with 20 or more employees. Give the same exam to every new driver or to none.

Can I make a current driver get a new physical?

Only for a job-related reason. Once someone is on the payroll, the ADA allows an exam that is job related and consistent with business necessity, such as after a seizure at work or a return from medical leave. Exams the law already requires are also fine: DOT certificates last 24 months at most, and New York Article 19-A drivers need a physical at least once every two years.

Must the driver use a clinic I pick for the DOT exam?

Federal rules do not require it. FMCSA guidance says the exam does not have to be done by a medical examiner the carrier employs or designates, so any examiner listed on the National Registry may perform it. For a company exam that no rule requires, you can name the clinic, and paying for it keeps the process simple. California requires the employer to pay.

Pre-employment physical for drivers: ADA and DOT rules

When a physical is allowed: after the offer, for everyone in the job

Federal disability law fixes the order. Under 42 U.S.C. 12112(d), a covered employer may not give a job applicant a medical exam, or ask whether the applicant has a disability, before making a job offer. Once the offer is made, and before the person starts work, the employer may require an exam and make the job depend on the results. The condition is that every entering employee in that job category gets the same exam. The ADA covers employers with 15 or more employees in each working day of 20 or more weeks this year or last.

Three conditions make the process hold up:

The offer has to be real. The EEOC treats an offer as real when the employer has already weighed all the non-medical information it reasonably could get first. For a driver, the driving record, road test, interview, and references come before the offer. The EEOC also accepts an offer as real when some non-medical information truly could not be obtained earlier.
Same job, same exam. If new drivers get a physical, every new driver gets it, whatever their age or how fit they look. Dispatchers can be a separate job category with a different rule or no exam at all.
The condition is in writing. The offer letter should say the job starts once the physical, the drug test, and any checks still pending come back clear.

Exams at the post-offer stage do not have to be job related under the ADA, though any standard used to screen someone out does (29 CFR 1630.14(b)(3)). State law can reach smaller companies and ask for more. California’s Fair Employment and Housing Act reaches employers of five or more and allows a post-offer exam only if it is job related and consistent with business necessity. California also bars an employer from making an applicant or employee pay for a pre-employment physical or for any exam a law requires (Labor Code 222.5).

Exams the law already requires for some drivers

Most NEMT drivers have no exam requirement in federal law. The DOT medical card applies only where federal motor carrier rules reach both the vehicle and the trip, and a few states require a physical for specific Medicaid or ambulette drivers. Use this to find out which applies to a given driver:

Driver	Exam required	Form and renewal
Paid interstate trips in a van that seats more than 8, counting the driver, by design or in use	DOT exam by an examiner on FMCSA’s National Registry	MCSA-5875 report and MCSA-5876 certificate, valid up to 24 months
Interstate trips in anything with a 10,001-pound or higher weight rating or actual weight	The same DOT exam	The same forms and limits
New York ambulette company drivers under Article 19-A	Pre-employment physical, then at least every two years	DS-874 or MCSA-5875, no more than two years old on the hire date
California Medi-Cal wheelchair van drivers and attendants	An exam passed in the last two years	DMV form DL-51, Medical Examination Report
Ohio ambulette drivers	A DOT physical, or a signed fitness statement from a physician, NP, or PA	Documentation kept by the ambulette service

Trips that carry sick or injured riders can fall outside the federal motor carrier rules under 49 CFR 390.3T(f)(4), judged one trip at a time, while a non-medical errand in the same van does not. Our guide to CDL rules for NEMT drivers explains that exception and the seat and weight thresholds.

How the DOT exam works

The examiner. The exam must be done by a medical examiner listed on the National Registry (49 CFR 391.43). FMCSA says the term includes medical doctors, osteopathic doctors, physician assistants, advanced practice nurses, and chiropractors. FMCSA guidance issued in 1997 says the examiner does not have to be one the carrier employs or designates.
The paperwork. The examiner records the exam on form MCSA-5875 and keeps that report on file for at least three years. A driver who does not need a CDL, which covers most 9 to 15 passenger van drivers, receives the original certificate on form MCSA-5876 and must carry it, or a copy, while on duty. The examiner must give a copy of the certificate to a prospective or current employing motor carrier that asks for one.
CDL holders. Since June 23, 2025, CDL and learner’s permit holders no longer need to carry the certificate, because the examiner reports the result to FMCSA electronically.
How long it lasts. A certificate is good for 24 months at most (49 CFR 391.45). Drivers with insulin-treated diabetes or certified under the alternative vision standard are re-examined every 12 months, and the examiner can issue a shorter certificate to keep an eye on a condition such as high blood pressure.
A failed exam. When an examiner finds a driver not physically qualified, every certificate issued to that driver before is no longer valid.
Your file. The driver qualification file keeps the certificate or a legible copy, plus, for drivers who do not need a CDL, a note that you checked the examiner’s listing on the National Registry (49 CFR 391.51).

FMCSA has stated that DOT drug testing is not part of the physical, although it can happen at the same visit. The medical standards themselves, condition by condition, are in our guide to drivers with seizures, diabetes, or sleep apnea.

Why companies add a physical when no rule requires one

NEMT driving is physical work. Virginia’s Medicaid requirements for its NEMT contractors have drivers help members with limited mobility and load, secure, and store wheelchairs and other mobility aids, and they have drivers or attendants open and close doors whenever members get in or out. A company exam gives you a clinician’s view of whether a new hire can do that every shift.

Insurers pay attention too. One NEMT workers’ compensation supplemental application asks directly whether the company completes pre-employment physicals, next to its questions about driving record checks and drug testing. Whatever you decide, apply it to the whole job category and write it into the offer letter.

Lifting and agility tests

Checking whether an applicant can handle the physical work is not a medical exam, which means it can happen before the offer. The EEOC’s 1995 guidance says a physical agility test, in which the applicant carries out real or simulated job tasks, does not count as a medical exam, and neither does a fitness test that measures lifting or running. The test becomes medical the moment you measure the body’s response, such as taking blood pressure or heart rate after the lift. You may describe the test and ask the applicant’s own doctor to state only whether the applicant can safely take it, and you may ask the applicant to accept responsibility for injuries during the test.

Build the test from the job, not from a generic standard:

Weigh what drivers actually handle. Use the heaviest folded wheelchair and stair chair in your fleet, the bags drivers carry to the door, and the push up your steepest ramp with a loaded chair.
Write those numbers into the job description before the job is advertised. A written description prepared before advertising or interviewing is evidence of which functions are essential (29 CFR 1630.2(n)). Our driver job description template has a physical demands section with blanks for those figures.
Give the same test, the same way, to every applicant for the job. Score it as pass or fail against the job’s own figures, never against the other applicants.
Look at accommodation before rejecting someone. A standard that screens out a person with a disability must be job related and consistent with business necessity, and the question is whether the essential functions can be done with a reasonable accommodation (29 CFR 1630.15(b)). For example, ask whether an applicant who cannot lift a folded chair could run an ambulatory sedan route where no wheelchair is carried, if that route exists in your schedule.

What to send the clinic, and what to keep out

Send the clinic the job description with its physical demands and a one-page form that asks for one of three answers: fit for duty, fit with listed restrictions, or not fit. You need the conclusion and any restrictions, not a diagnosis. ADA rules let you tell supervisors about necessary work restrictions and accommodations, and first aid staff about a condition that could need emergency treatment, so that is all the form should carry back.

Genetic information is off limits. Under 29 CFR 1635.8, an employer with at least 15 employees must tell the clinic not to collect genetic information, family medical history included, during an exam meant to judge whether someone can do the job. The regulation gives model wording for that notice; when you use it, any genetic information that still reaches you counts as received by accident. If a clinic keeps asking for family history after being told not to, reasonable steps include no longer using that clinic.

Keep the drug test as its own step with its own paperwork. Our guide to drug testing NEMT drivers covers panels, labs, and broker rules.

If the results rule a driver out

A failed DOT exam settles the federal question. A driver without medical certification cannot drive a commercial vehicle across state lines, and the ADA treats an action that another federal law requires as a defense (29 CFR 1630.15(e)). That defense covers only the vehicles and trips the federal rule reaches. The same person might still qualify for a sedan or minivan route that stays in-state.

A company exam with no law behind it needs more care. If you withdraw an offer for safety reasons, the EEOC expects you to show the person poses a direct threat: a significant risk of substantial harm to themselves or others that a reasonable accommodation cannot reduce enough. That judgment has to rest on this person’s current condition and the job’s real tasks, so write down what the clinician found, what the job requires, and which accommodations you considered.

Keeping results out of the personnel file

Medical information from a post-offer exam must be collected on separate forms, kept in separate medical files, and treated as confidential. The EEOC says no medical material belongs in an employee’s regular personnel file; when a document you want to file contains some medical information, strip that part out first. The duty continues after someone leaves the company or is never hired.

The DOT certificate works differently. Federal rules make the certificate part of the driver qualification file, and they let you keep that file together with the personnel file. The certificate is a short statement of qualification, and the full exam report stays at the examiner’s office. Keep the certificate, and any FMCSA medical exemption letter, where the rule requires them. Keep everything else (clinic notes, your own exam form, accommodation requests) in a locked medical file that only the people who need it can open. New York adds its own retention rule: Article 19-A carriers keep physicals and follow-up exams in the driver’s file for three years plus the current year.

Our driver file checklist lists the other documents each file needs, and how to hire NEMT drivers puts the physical in order with the rest of the screening.

Medical card dates in HealthRide

Enter each driver’s medical card in HealthRide as a credential, along with the date it expires, and a reminder goes out before it lapses. If it does expire, a dispatcher sees a warning when assigning that driver a trip, so a lapsed card shows up before the van leaves. Drivers on 12-month certificates get the same reminder on their shorter cycle. Credentials sit with each driver’s record in fleet management.

Pre-employment physicals for NEMT drivers: what the ADA allows, DOT medical cards, and lifting tests