Try for free

California CDPH 110c: DMV Confidential Morbidity Report

California physicians must report patients aged 14 and over diagnosed with disorders marked by lapses of consciousness, Alzheimer's disease or related conditions that may impair safe driving, under Health and Safety Code 103900. This confidential morbidity report goes to the local health officer, who forwards it to DMV for licensing action. Its DMV section covers episode dates, driving episodes, dementia and driving advice.

Who completes it

The physician or surgeon who diagnosed the condition completes the whole report: patient identifiers and demographics, the reporting provider and facility, and the DMV questions with remarks.

Submitting and payment

How to submit it
Send it to your local health officer at the county public health department within 7 days; the county forwards it to DMV. Get forms from your local health department, since some counties, such as Sacramento and San Francisco, use their own versions.
Who pays
No fee is associated with the report.

Good to know

  • The DMV section asks for the most recent episode, dates of multiple episodes in the past three years, and any loss of consciousness or control while driving in the past 12 months.
  • It also asks whether more lapses are likely, whether you would advise the patient not to drive, whether the condition is a permanent driving disability and whether you recommend a DMV driving evaluation.
  • Include the patient's eight-character California driver license or ID card number when you have it.
  • Copies of the 07/16 edition circulate widely, but county documents cite later revisions (10/19 and 6/24), so take the current edition from your local health department.

Get the official form

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

Confidential Morbidity Report (lapses of consciousness, Alzheimer's disease or other conditions which may impair the ability to operate a motor vehicle safely)

Official pagePDF

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 and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Is reporting to DMV mandatory for California physicians?

Yes, for the conditions covered by Health and Safety Code 103900: disorders characterized by lapses of consciousness, Alzheimer's disease and related disorders, and similar conditions that may impair safe driving, in patients aged 14 and over. The report goes to the local health officer, not directly to DMV.

What is the difference between CDPH 110c and DS 699?

CDPH 110c is the physician's mandatory report, sent to the county health officer within 7 days and then forwarded to DMV. DS 699, Request for Driver Reexamination, is a voluntary report that physicians, relatives or others can send directly to DMV Driver Safety.