Medical Review by the Florida Department of Highway Safety and Motor Vehicles


5/22/14 – Update: I finally received a copy of these forms form the DHSMV. I’m providing these forms for informational purposes only.

DHSMV Form – Medical Report

DHSMV Form – Crash Report Questionnaire

DHSMV Form – Alcohol and or Drug Usage Questionnaire


What happens when someone reports that a citizen is unable to safely operate or drive a motor vehicle as a result of a some physical condition, mental impairment, medical condition or addiction to alcohol or drugs?

The Florida Department of Transportation provides funding for Florida’s Medical Review Process. Allegations of unsafe driving often involve:

  • a variety of different types of medical conditions;
  • vision problems;
  • substance abuse;
  • medication that affects the ability to drive safely;
  • reckless or poor driving as a result of medical issues;
  • observations of dings, dents or scratches that might have resulted because of a medical condition;
  • observations of a citizen acting confused or getting lost while driving in familiar areas and thinking there may be a possible medical cause for the behavior.

Florida law allows the reports to be kept strictly confidential. In fact, no civil or criminal action may be brought against any physician, person or agency for providing this information. The HSMV Form 72190 that was last revised in July of 2013 can be found at http://www.flhsmv.gov/forms/72190.pdf.

The Medical Reporting Form Used in Florida

According to the Medical Reporting Form, physical or mental disabilities that could lead to being unable to safely operate or drive a motor vehicle could include, but are not limited to, any of the following:

Once a report is made using Florida’s Medical Reporting Form, the DHSMV conducts an investigation of the accusation of being medically unsafe to drive.

If the Department finds that “cause” is found, then the driver receives notice that he or she is under medical review. The driver is asked to provide medical information from their physician to the Florida Department of Highway Safety and Motor Vehicles.

Florida’s DHSMV’s Medical Advisory Board

The information is also provided to the Florida DHSMV’s Medical Advisory Board. After reviewing the information, the Florida DHSMV’s Medical Advisory Board provides a recommendation regarding the citizen’s ability to drive. The recommendation may do one of the following:

  • Require the driver to provide additional information;
  • Require the driver to re-take the driving test; or
  • Revoke or deny the driver of a driver’s license or privilege to drive in the State of Florida.

Florida Statute Section 322.126

Florida Statute Section 322.126 (2), (3), provides that “Any physician, person, or agency having knowledge of any licensed driver’s or applicant’s mental or physical disability to drive…is authorized to report such knowledge to the Department of Highway Safety and Motor Vehicles… The reports authorized by this section shall be confidential… No civil or criminal action may be brought against any physician, person or agency who provides the information herein.

Administrative Hearings in the Medical Review Process

If the Florida DHSMV takes any action to deny or revoke the driver’s license then the driver should demand an administrative hearing to appeal the decision. During the administrative hearing the driver can present evidence and testimony that he is capable of driving and may bring witnesses to testify on his behalf.

If you need an experienced attorney for a Medical Review investigation and administrative hearing, then give us a call to discuss the case.

14 Comments

  1. Scott Bartholomew
    Posted October 10, 2013 at 06:39 | Permalink | Reply

    A good website. My question is how broadly available are licenses for people with epilepsy who have not had a seizure for 8yrs, only 3 over the last 21. Can I obtain construction lic to operate forklifts, e.g.?
    Thank you.
    Sincerely,
    Scott Bartholomew
    scottsb59@comcast.net

  2. Kim Vullo
    Posted December 3, 2013 at 06:59 | Permalink | Reply

    Where can a person download the forms to take to the doctor to request a license review?

    • Dana Dewing
      Posted February 13, 2014 at 16:11 | Permalink | Reply

      I had a black out due to the medication I was on.I moved out of state for a time and have a valid licence but to get my Florida licence back I need a medical review form to give my doctor.Do you know how I can get one

    • lsammis
      Posted July 15, 2014 at 14:34 | Permalink | Reply

      You need to get the forms from the DHSMV medical review office. They do not have the forms available to be downloaded from their website.

      At least from my experience calling over there, they never answer their phone. But maybe they have resolved that issue since I last tried to get in contact with them.

      At the top of the post is sample forms they sent to me in response to a public record request. I put them here for everyone to see (not as legal advice but just for informational or educational purposes).

      Feel free to leave a public message and explain what you had to do to get the forms. I think it is helpful to people to see what a mess this process is.

  3. Hector L.Mestre Ventura
    Posted December 29, 2013 at 15:45 | Permalink | Reply

    I am 68 yrs old and have type 2 diabetes,never had a problem driving or had any seizures while driving or other wise,my Doctor at the V.A. made a statement that i might get my driving privilage revoked.Recieved a letter from DMV and i feel that is not appropiate that i have my driving previlage revoked,i am extremely responsible for driving,doing my shopping and medical appointsments,where can i get help to change this revocation of my driving previlages?

  4. Tina
    Posted March 28, 2014 at 15:41 | Permalink | Reply

    You can contact the Florida DMV, Medical Review Department and they can send to you or fax to your physicians office. Find the phone number online of through information.

  5. Deborah Hoffman
    Posted April 10, 2014 at 18:50 | Permalink | Reply

    I had a black out due to the medication I was on. back in 2000, I want to get my Florida licence back I need a medical review form to give my doctor.Do you know how I can get one

    • Sherri
      Posted May 22, 2014 at 13:15 | Permalink | Reply

      You have to call them and request a copy at 850-617-3814 or email (I don’t advise) they don’t reply. But email is medical@flhsmv.gov. If you call to speak to a live person, plan on having a few days clear to dial the phone every 2 minutes and try to get through. Every time I have called its been “we are experiencing a high call volume, please try your call again later”….can’t even leave a message. Of the 3 times I did get through, apparently there is only a couple of girls in the office and one guy, Steve. They told me they mailed me the forms 3 times before I FINALLY got them to fax them to me at my job, which they were very reluctant to do. I was told they have ONE PHONE LINE coming into there office and “yes, they are VERY BUSY”. Doesn’t make a lot of sense. But GOOD LUCK TO YOU!

  6. gene paul davis
    Posted April 28, 2014 at 14:24 | Permalink | Reply

    i have this letter saying there is a medical form enclosed and there is’nt.im running out of time fast.

    • lsammis
      Posted April 29, 2014 at 11:50 | Permalink | Reply

      So I’m not giving legal advice on this topic. I’m just reporting what I found out when I asked the DHSMV the same questions. I’ve been getting so many questions about this form that I called the DHSMV. You would need to call them directly –

      Medical Review Section at 850-617-3814 then hit “3″. Most of the time you will hold for 20 minutes and then a recording will say “We are experiencing a high call volume, please try your call at a later time. Thank you and have a wonderful day.” If you can even get through you are lucky.

      Each case will be evaluated and you’ll be advised of the necessary procedures based on what that office tells you. But if you ask me they are not very helpful.

      I’m not giving any legal advice because I don’t know anything about your case or any of the cases for anyone asking questions here. This is just a forum to exchange information. If you need an attorney, then call an attorney and hire an attorney to help you. If you are just looking for general information it might be provided here. The State has made this process ridiculously complicated and secret. So I think that is why so many people have questions about it.

      The specialist at the DHSMV told me on the phone that if the right form didn’t come with your letter then it means a mistake was made and the DHSMV might agree to extend the 45 day period if you call them and ask for an extension. For whatever reason, they do not publish this form online. You have to call them and ask them for it which seems strange to me. I’m not sure what the policy reason behind that is – they could not explain it to me. They don’t want people to have access to that form online for some reason. They wouldn’t even tell me on the phone what the form number is. I got passed around to two different people and then told a supervisor would call me about my public record request.

      Maybe it is because there are several different forms that might be required. It was explained to me that there is a medical reporting form that a doctor can fill out saying why the person does not have a medical condition that would make it unsafe to drive. A ADUQ or Alcohol and drug questionnaire form, a medical status examination form, and a crash report questionnaire form. I was told that the treating physician should fill out the medical form completely and more information might be requested.

      While I was on the phone with the DHSMV, I made a public record request for the form and I’m waiting for a supervisor to call me back about my public record request. That’s all I know. You probably need to call them and talk to them about it if you are representing yourself in the matter. If I’m having this much trouble finding the form, I see why I’m suddenly getting so many questions about it.

      • M. Andrews
        Posted May 23, 2014 at 14:51 | Permalink

        Does the Advisory Board work with the DHSMV toward prosecuting for DUI?

  7. gene paul davis
    Posted May 2, 2014 at 14:32 | Permalink | Reply

    i went the DMV in delray beach and they gave me two forms,.one for my dr. and one for my cardiogist.both drs.say they will fax info in as soon as i wear a heart monitor ,i’mg getting it fri.the ninth.i want to know if its to late being my lic.has to be turned in the fifth.thank you

  8. gene paul davis
    Posted May 5, 2014 at 09:44 | Permalink | Reply

    i forgot to mention the lady who gave me the forms said i have 45days it’s still her word again’st mine.

  9. linda domanico
    Posted June 18, 2014 at 14:55 | Permalink | Reply

    It is absurd to have to waste so much time to get a DUI monitor or doctor input to adjust monitor to meet your medical needs. This is just something that needs a better system, more outlets and fewer rules to allow for different medical conditions. I have been working since Feb to get my license reinstated and my interlock system up and runing. It is al,ost July and I have not made any headway toward actually driving my car

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