What 391.43(h) means in plain language
FMCSR 391.43(h) requires that your medical examiner's certificate be issued on the correct form. When an inspector finds that your medical certificate—the document proving you passed your DOT physical—doesn't match the official form that FMCSA has designated, you can be cited for this violation.
This isn't about whether you're medically fit to drive. It's about paperwork compliance: whether the person who examined you used the right template and filled it out correctly. Your state's driver licensing agency maintains a record of your valid medical certificate, and inspectors cross-check this during roadside checks.
If your certificate was issued on an outdated form, by an examiner who used the wrong format, or if information is missing or improperly recorded on an otherwise valid certificate, you're at risk for this citation.
What our enforcement data actually shows
Across our 13 million inspection records, 391.43(h) has generated only 135 citations in total history. In the last 12 months, our database shows zero citations for this code, and zero in the last 90 days. This makes 391.43(h) one of the least-enforced codes in the FMCSR universe—ranking #1344 out of 3,036 codes by citation volume.
Even rarer: when inspectors do cite this violation, they place drivers out of service only 2.2% of the time (3 out of 132 citations). For context, the national average out-of-service rate across all FMCSR codes is 31.4%, meaning this code is cited far less aggressively than most driver fitness violations.
The lack of recent enforcement activity suggests this citation is becoming less common, possibly because medical examiners have standardized their use of the correct forms, or inspectors are prioritizing more frequent compliance gaps.
Who gets cited most
Our inspection records do not indicate geographic concentration. The all-time data shows that KANNZ TRUCKING LLC (USDOT 3158646) received 3 citations for this code—the highest count among carriers—followed by INDUSTRIAL SCRAP PROCESSORS INCORPORATED, CHERRY HILL CONSTRUCTION CORP, BRAVA TRUCKING & TRANSPORT INC, and DAVID BULGER INC, each with 2 citations.
Because the total citation count is so low (135 all-time), no single state or region dominates the enforcement landscape. This violation appears scattered across the trucking industry rather than concentrated in any one fleet type or geography.
How severe is this compared to similar codes
Within the Driver Fitness category, 391.43(h) is far less consequential than related violations. For example, 391.41APC—operating without a valid medical certificate in possession—has resulted in 49,539 citations with a 97.1% out-of-service rate. Similarly, 391.41(a) (general physical qualification issues) has 42,270 citations and a 16.2% OOS rate.
Compare 391.43(h)'s 2.2% OOS rate to 391.41(a)'s 16.2%, and you see that certificate form violations are treated as documentation errors rather than fitness-to-drive disqualifications. Inspectors almost never remove you from service for a form technicality alone—they issue the citation and allow you to continue.
How to avoid it
Before your next roadside inspection:
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Verify your medical certificate is on file. Contact your state's driver licensing agency and confirm that your current DOT medical certificate is recorded in their system. Ask them to confirm the form version they have on record.
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Request a certified copy from your medical examiner. If you had your physical recently, obtain a certified copy of the Medical Examiner's Certificate (MCSA Form 5875) directly from the clinic or examiner's office. Verify visually that it matches the current FMCSA template.
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Check the issue and expiration dates. Ensure your certificate shows valid dates that align with when you were examined and when it expires. Mismatched or missing dates on the form itself—even if your physical was recent—can trigger this citation.
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Know the current form version. FMCSA periodically updates the medical certificate form. Visit FMCSA's website or ask your examiner which version is current, and ensure your certificate uses that version.
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Carry documentation during inspections. Have both your certificate in your possession and documentation showing that it's on file with your state. This dual proof minimizes ambiguity during a roadside stop.
Because citations for this code are so infrequent and rarely result in out-of-service orders, the focus should be on prevention through accurate paperwork rather than worry about enforcement intensity.