Primary care providers commonly perform the mandatory Department of Transportation Federal Highway Administration physical examination for individuals who drive commercial motor vehicles. Although these examinations may be offered at the worksite or in occupational health clinics, many drivers prefer to have them performed in the primary care setting. Performing the examination and subsequently certifying the driver is a highly regulated process with potentially serious consequences for the driver, the examiner, and the public. This article discusses the regulations and recommendations for certification of commercial drivers and the problems commonly encountered in the clinical setting.