Drivers Licence Medical Report Form

• Driving Licence Medical Report Form Ndls

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The medical guidelines and standards the Driver License Division uses to assess safe driving were written by the Utah Medical Advisory Board, and developed for use by the Utah Health Care Professionals to assist them in completing the Functional Ability Evaluation and Visual Examination forms for the Utah Driver. Driver number. (if available) a) My application is for a driving licence/learner permit as a driver of a. No b) Has your most recent licence/permit been revoked or have you been advised by a medical professional to cease driving for a period? If yes state reason. Alternatively, medical providers with access to the Internet can print the DME, complete and sign it, and forward it to the driver. If your physician chooses to use this process, be sure that you complete the form prior to returning it to the Driver Safety office. Driver Medical Evaluation (DS 326) (PDF) Back to Main forms.

Driver licenses

• Agricultural Permit Questionnaire(English, Español, Русский, and more)
• Change of Gender Designation Request(English, Español, Русский, and more)
• Driver Evaluation Request(English, Español, Русский, and more)
• Driver License Extension Request
  Used only to apply for a license extension when out of state.
• Driver License Renewal/Replacement Request While Out-of-State
  Used only to renew a Washington State driver license when out of state.
• Notice of Surrender(English, Español, Русский, and more)
• Parental Authorization Affidavit(English, Español, Русский, and more)
• Physical Examination Report(English, Español, Русский, and more)
• Restricted Driver License Application(English, Español, Русский, and more)
  Used to apply for an Ignition Interlock License or Occupational/Restricted License.
• Signature Form for Minors(English, Español, Русский, and more)
  Used to get an agricultural permit.
• Visual Examination Report(English, Español, Русский, and more)
• Washington Driver License/ID Card Change of Address
  • orChange your Washington driver license/ID card address online

Commercial driver licenses

• Commercial Driver License Notice of Surrender(English, Español, Русский, and more)
• Driver Medical Examination for Commercial Driver Fitness Determination (report and certificate):
  • Medical Examination Report (Federal Motor Carrier Safety Administration)
  • Medical Examiner's Certificate (Federal Motor Carrier Safety Administration)

Suspensions and hearings

• Administrative Review Request(English, Español, Русский, and more)
• Financial Assistance Application(English, Español, Русский, and more) (to apply for financial assistance)
• Habitual Traffic Offender Hearing Request(English, Español, Русский, and more)
• Intent to Seek a Deferred Prosecution(English, Español, Русский, and more)
• Request for DUI Hearing(English, Español, Русский, and more) (DUI or refusing a blood/breath test)
  • orRequest a hearing online (if eligible)
• Subpoena Proof of Service(English, Español, Русский, and more)
• Subpoena to a Driver's Hearing(English, Español, Русский, and more)

Driving records

• Driving Record Release of Interest(English, Español, Русский, and more)
• Address Request from Driver Record(English, Español, Русский, and more)
• Driving Record Request(English, Español, Русский, and more)
  • orRequest your driving record online
• Driver Records Contract Application
  For businesses to apply for a contract to get bulk driving records.
• SR22/26 Insurance Batch Submittals Application
  For insurance companies to request access to the SR22/26 database to enter individual SR22 and SR26 policies.
• SR22/26 Insurance System Access Request
  For government agencies, courts, and insurance companies to request access to the SR22/26 databases.

Parking for people with disabilities

• Disabled Parking Application for Individuals(English, Español, Русский, and more)

Motorcycle safety training

Related information

• National Driver Register (NDR): National Highway Traffic Safety Administration

Texas Medical Evaluation Process for Driver Licensing

The Department is responsible for maintaining the safety of all individuals who share the roadways in Texas. As a result, it is sometimes necessary to request information from you regarding certain medical conditions so that we may determine how it may affect your ability to safely operate a motor vehicle.

The Department's Driver License Office Customer Service Representatives (CSR) are trained to evaluate applicants and conduct a basic investigation, if necessary. The CSR may ask additional questions, require a physician's statement, or require you to take a driving, written, and vision test. Based on the results of these tests you may be called back to the driver license office for further investigation.

Medical Advisory Board

If the investigation determines that you may have a medical condition that could affect your ability to safely operate a motor vehicle, the Department will refer you to the state's Medical Advisory Board (MAB) for further evaluation. MAB is composed of a panel of licensed doctors appointed by the Texas Department of State Health Services (DSHS) to review medical documentation relating to a person's ability to drive. If your case is submitted to MAB for review, a recommendation will be returned to the Department regarding your ability to drive.

The most common ways an individual is referred to MAB are:

1. The individual self-reports his/her medical condition,
2. DPS refers an individual due to an evaluation conducted at the driver license office,
3. The individual has multiple convictions for alcohol or drugs on their driver record, or
4. Law enforcement or a physician who has cause for concern and reports an individual to DPS for further evaluation.

Medical Revocation and Hearing

If it is determined that you are medically incapable of safely operating a motor vehicle, failed to respond to MAB, or failed to comply with any required testing, the Department will initiate proceedings to revoke your driver license. When this occurs, you will be notified by mail to the address on your driver license. This notification will provide you with the reason for the pending revocation and an option for a hearing. You may request a hearing up to 20 days after the date of the notice of revocation. Please allow up to 120 days for the hearing to be scheduled. You will be notified by mail of the date, time, and location of the hearing.

If your request is made outside the allowable 20 days, your request will be denied and your license will be revoked 45 days from the notice date.

Hearings are conducted in a municipal or justice court in the county where you live. During the hearing, you will be responsible for providing facts to the presiding officer who will determine if the grounds for the revocation are valid.

Driver License Reinstatement Requirements

If your driver license or driving privilege is revoked for one of the following reasons, you will be required to pay a $100 Reinstatement fee, in addition to complying with the revocation and paying any other outstanding reinstatement fees owed.

1. Revoked Incapable – It has been determined that you are incapable of safely operating a motor vehicle at this time. In order to be reinstated, you must be medically approved by MAB.
2. Revoked MAB No-Reply - It has been determined that you failed to provide medical information or undergo medical or other examination. You must submit current medical information to MAB.
3. Revoked Test Required – It has been determined that you failed to demonstrate the ability to safely operate a motor vehicle by taking and/or passing a required exam(s). You must pass any required exams at the driver license office.

For information on submitting compliance and fees to the Department, visit the Reinstating your Driver License or Driving Privilege webpage.

Report Concerns of Unsafe Drivers

If you know of someone who may have a medical condition that could affect their ability to safely operate a motor vehicle, you may submit your concerns in writing. Please include sufficient information to be able to identify the driver, such as full name, date of birth, address, and driver license number, if available. All written concerns may be submitted anonymously to the Department (i.e. the document is not required to be signed by the individual reporting the concern).

Verbal notification is not sufficient for the Department to take action. Please provide a detailed explanation as to why it is unsafe for the individual reported to operate a motor vehicle. Avoid personalizing information in the written statement and focus on the facts. Be advised all information submitted to the Department is subject to release under the Texas Public Information Act.

Information may be submitted to the Department by mail, fax or email.

Texas Department of Public Safety
Enforcement and Compliance Service
P.O. Box 4087
Austin, TX 78773-0320

512-424-5311

Occupational Driver License

If your driver license has been denied and/or revoked for medical reasons, you are not eligible for an occupational driver license.

Driver Eligibility Status

To check the status of your driver license or to determine if you are eligible for reinstatement, visit the License Eligibility webpage. This page will provide you with information on what you will need to reinstate your driver license or driving privilege, including any fees you may owe. Once all compliance items have been processed and your mandatory suspension period has ended, your driver eligibility status will be updated to reflect 'eligible'.

Driving Licence Medical Report Form Ndls

For more information on the Medical Evaluation Process, please visit the Frequently Asked Questions webpage or download the Driver License Enforcement Actions chart for a complete list of driver license suspensions and revocations.