Manitoba Public Insurance's Driver Fitness unit sends this medical report when it needs a physician's assessment of a driver: for a licence class application or recall, a Registrar recall or requirement, a suspension, or a Medical Review Committee review. The physician records the driver's health history and physical examination and gives recommendations. The form also prints the duty to report under The Drivers and Vehicles Act.
A physician completes the health history and physical examination sections and the recommendations, and signs the form. The driver signs the authorizations.
Download the current version from the source each time; forms change without notice.
Medical Examination Report Concerning a Person's Fitness to Drive a Motor Vehicle
If your copy of the form is a fillable PDF, upload it 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.
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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The driver. The form states that the examination is not covered by Manitoba Health or MPI, so the individual pays for it. The fee is a matter between the physician and the driver, and MPI Driver Fitness receives the completed health history, physical examination and recommendations.
When MPI's Driver Fitness unit needs it: for licence class applicants, class recalls, a recall or requirement by the Registrar, a suspension, or a review by the Medical Review Committee. MPI sends the form with a date by which the completed report must be returned.
Mail or fax it to MPI Driver Fitness by the date printed on the form. The form is a printed PDF rather than a fillable one, so it is completed by hand and signed by the physician, and the driver signs where the form asks for their authorization.