Ontario MTO Form 5108E: Medical Condition Report

Ontario's Highway Traffic Act requires physicians, nurse practitioners and optometrists to report patients aged 16 or over who have certain high-risk medical, functional or visual conditions, and lets them, and occupational therapists, report other conditions that may make driving dangerous. Physicians, nurse practitioners and occupational therapists make that report to the Registrar of Motor Vehicles on this two-page form. A ticked mandatory condition leads to a licence suspension.

Who completes it

The reporting physician, nurse practitioner or occupational therapist completes all four parts; occupational therapists may make discretionary reports only, and optometrists use the separate Vision Report (5109E). There is no patient section, but you must have met the patient for an examination or for medical or other services.

How to fill it in

Part 1. Patient Information

Enter the patient's last and first name, date of birth (yyyy/mm/dd), gender and current address; these are asterisked, mandatory fields, and the Highway Traffic Act requires the name, address and date of birth in every report. Add the driver's licence number if available. Complete page 1 first: the name and date of birth automatically fill the patient block on page 2.

Part 2. Practitioner's Information

Give your name, licence number and practice address (asterisked fields), plus phone. Tick your relationship to the patient: family or treating physician, ER physician, nurse practitioner, occupational therapist, urgent care or walk-in clinic physician, or other. Answer three yes or no questions: whether the patient is aware of the report, whether you approve the ministry releasing it to the patient or their legal representative, and whether you want to be notified if the patient requests a copy because release may threaten someone's health or safety. Sign and enter the date of the report examination.

Part 3. Medical Condition or Impairment: Cognitive Impairment

Part 3 lists the mandatory categories; check all that apply, knowing that ticking any of them results in a licence suspension. Cognitive impairment means a disorder affecting attention, judgement, problem solving, planning and sequencing, memory, insight, reaction time or visuospatial perception that substantially limits the person's ability to perform activities of daily living. Tick the cause: dementia, brain injury or tumour, unknown, or other (specify).

Part 3: Sudden Incapacitation

For disorders with a moderate or high risk of sudden incapacitation, or that have caused it and carry a moderate or high risk of recurrence. Options include seizure (alcohol or drug withdrawal, epilepsy, stroke), syncope (single undiagnosed episode, recurrent episodes, heart disease with pre-syncope, syncope or arrhythmia), CVA with physical, cognitive or visual field impairment, narcolepsy with uncontrolled cataplexy or daytime sleep attacks, untreated or unsuccessfully treated obstructive sleep apnea with an AHI of 30 or more and daytime sleepiness, and hypoglycemia needing third-party help or causing loss of consciousness.

Part 3: Motor or Sensory Impairment and Visual Impairment

Motor or sensory impairment covers severe impairment of coordination, muscle strength and control, flexibility, motor planning, touch or positional sense due to neurological disease, spinal cord injury, loss of limb or another cause. Visual impairment has three thresholds: best corrected acuity below 20/50 with both eyes open; a visual field under 120 continuous degrees horizontally, under 15 degrees above and below fixation, or under 60 degrees either side of the vertical meridian, including hemianopia; and diplopia within 40 degrees of fixation that prisms or patching cannot correct.

Part 3: Substance Use Disorder and Psychiatric Illness

Report an uncontrolled substance use disorder, excluding caffeine and nicotine, where the patient is also non-compliant with treatment recommendations, ticking alcohol or other substances. Psychiatric illness applies to a current condition involving acute psychosis, severe abnormalities of perception, or a suicidal plan involving a vehicle or an intent to use a vehicle to harm others; tick the box and enter the cause after Due to.

Part 4. Discretionary Report of Medical Condition or Impairment

Use this free-text box when a condition is not one of the mandatory categories but, in your opinion, may make driving dangerous, and describe the condition or impairment. Discretionary reports are assessed against national medical standards and may prompt a request for more information. They do not automatically suspend the licence, and a well-controlled condition may not lead to a suspension.

Common mistakes

Sending only one page: the report is two pages, both must be faxed, and incomplete reports cannot be processed.
Photocopying an old or blank copy instead of completing the current form electronically, then printing and signing it.
Faxing the report and then also mailing the original; the ministry asks you not to send it both ways.
Ticking a Part 3 box to flag a concern: any ticked mandatory condition triggers a licence suspension, so use Part 4 for discretionary concerns.
Skipping asterisked fields such as your licence number, the patient's street address or the date of report examination.
An optometrist using this form: optometrists report on the Vision Report to the Registrar of Motor Vehicles (5109E) instead.

Submitting and payment

How to submit it: Complete it electronically, print, sign and fax both pages to the MTO Driver Medical Review Office, or mail them, and if you fax, do not also mail the original. Physicians and nurse practitioners at participating clinics can submit through eForms.
Who pays: The form prints OHIP fee code K035 at the top of page 1.

Good to know

The six mandatory categories come from Ontario Regulation 340/94; the listed conditions are examples, and the categories include an Other option for conditions that are not listed.
Discretionary reports are assessed against national medical standards and do not always lead to suspension; the ministry may request more information or a functional assessment, which the patient pays for.
The ministry reviews cases within about 15 business days, longer if more information is needed, and a suspended driver gets a letter listing the medical information needed for reinstatement.
Medical suspensions can be appealed to the Licence Appeal Tribunal, except suspensions for failing mandatory vision standards or for missing a report deadline.

Get the official form

Download the current version from the source each time; forms change without notice.

Medical Condition Report

Official page PDF Version française

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

What conditions must be reported to the MTO?

Ontario Regulation 340/94 sets six mandatory categories: cognitive impairment, sudden incapacitation, motor or sensory impairment, visual impairment, uncontrolled substance use disorder, and psychiatric illness such as acute psychosis or a suicidal plan involving a vehicle. Each is defined on page 2 of the form. Other conditions that may make driving dangerous can be reported at your discretion in Part 4.

Can an occupational therapist complete the Medical Condition Report?

Yes, for discretionary reports. Under section 203(2) of the Highway Traffic Act, occupational therapists may report a patient whose condition may make driving dangerous, and Part 2 of the form has an Occupational Therapist option. Mandatory reporting under section 203(1) applies to physicians, nurse practitioners and optometrists, not occupational therapists.

Will my patient see the Medical Condition Report?

Possibly. Under Ontario's Freedom of Information and Protection of Privacy Act, MTO must give the patient a copy on request unless releasing it would threaten someone's health or safety. If you have that concern, tick the notification box in Part 2 or call the ministry. Part 2 also asks whether the patient is aware of the report.

Is the Medical Condition Report available in French?

Yes. The ministry publishes a French version, form 5108F, alongside the English 5108E on Ontario's Central Forms Repository, and the English form and its interpretive guide are both marked as available in French.