All patients:
• For your visit, please bring a complete
list of all your medication with as much
information as you can, including your
doctors’ names and addresses as well as
doses. Please print and complete this form prior to your visit.

For patients with high blood pressure:
• Blood pressure must be below 140/90
the day of your exam. If not, you may not
qualify for a DOT card.

For patients with diabetes:
• Bring your most current results of a
Hemoglobin A1C (HgAIC), as well as blood
sugar logs and/or other related records
regarding your diabetes.
• Blood sugar should be controlled.
For patients who require corrective
lenses, contacts or hearing aids:
• Bring your glasses, contacts, or hearing
aids to your test (as it is required to pass
a hearing and vision test).

For patients with nighttime sleep
disturbance (sleep apnea) and use a
CPAP machine:
• Bring a machine-documented reading
that shows your proper use of the
machine; it may also be required to have
a letter from your sleep specialist.
• Bring >90 days of data; data from the
past year is optimal.

For patients who suffered from a
stroke, seizure disorder, a brain tumor,
or bleeding in the brain:
• Bring a letter from your neurologist
outlining medical history, current
neurologic and psychiatric state as well as
current medications.

For patients taking the blood thinner
Coumadin (Warfarin):
• Bring a recent Internationalized
Normalized Ratio (INR) letter from your

For patients with heart-related issues,
(this can include stents, pacemaker,
valve replacement, heart attack,
open-heart surgery, or cardiac bypass
• Bring a letter from your cardiologist that
outlines current medications, medical
history and indicates you’re ability to
safely drive a DOT vehicle.
• Additionally, you might need to bring
results of any recent ECHO cardiogram, or
other heart-related testing completed
within the past 1-2 years.

For patients who experienced
permanent loss of use in a limb:
• Bring summary note from your
physician of the injury. Please make sure
any work restrictions due to the injury
are noted on the summary.
• To qualify for your DOT certification
card, you may need a Skilled Performance

For patients taking medications that
may cause sleepiness/sedation or
controlled substances (such as
sleeping pills, narcotics, anxiety or
ADHD medication):
• Bring a letter and medical records from
the treating physician in regards to the
safety of using these medications while
driving a DOT vehicle.

Helpful advice:
-If for any reason you’re concerned that
you may not qualify for a DOT
certification card, please consider
scheduling a visit with your primary or
specialty physician before a
re-certification with CommunityMed. This
document is a list of guidelines and are
not meant to be a guarantee of passing
the exam or all-inclusive of what might be
needed. Additional information and/or
testing may be required by your DOT

CommunityMed Family Urgent Care