This PennDOT condition-specific report covers cardiovascular and cerebrovascular disease, such as conditions with syncope, loss of consciousness, vertigo or dyspnea, in a driver who may not meet Pennsylvania's medical standards. The Bureau of Driver Licensing checks it against 67 Pa. Code 83.5 and Chapter 83, then decides on a restriction, a driver's exam, recall of the license or no action.
The treating physician or other health care provider managing the driver's cardiovascular condition completes the whole form; there is no patient section.
Download the current version from the source each time; forms change without notice.
Medical Cardiovascular Form
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PennDOT's criteria list cardiovascular conditions and cerebral vascular insufficiency, and DL-120 is built around 67 Pa. Code 83.5, which addresses disease with syncope, loss of consciousness, vertigo or dyspnea. Reporting is required for a condition that could impair driving, but not one expected to last less than 90 days.
Within 10 days, in writing, giving the driver's full name, address and date of birth. PennDOT says including the condition and specific details helps its licensing decision, and it prefers the condition-specific form, here DL-120, over a general report.
School bus drivers fall under 67 Pa. Code Chapter 71, and PennDOT's forms page lists DL-705, the Cardiovascular Waiver, for them. DL-120 applies to drivers reviewed under Chapter 83, which covers drivers other than school bus drivers.