When a condition affecting safe driving does not fit PennDOT's other condition-specific forms, Pennsylvania clinicians report it on this general medical form, listed by PennDOT as Other Conditions That Affect Safe Driving. The Bureau of Driver Licensing reviews it against 67 Pa. Code Chapter 83 to decide whether the driver meets the state's medical standards.
The treating physician or other health care provider completes the whole form, describing the condition and its effect on driving.
Download the current version from the source each time; forms change without notice.
General Medical Form
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PennDOT prefers a condition-specific form. DL-13, the generic Initial Reporting Form, is meant for emergency rooms or providers who do not know enough about the condition to complete a specific form. DL-123 is the specific form for conditions that affect safe driving but are not covered by another PennDOT medical form.
Physicians, chiropractors, physician assistants and certified registered nurse practitioners must report, in writing within 10 days, any patient over 15 diagnosed with a condition that could impair the ability to drive. Conditions expected to last less than 90 days are excluded.
PennDOT states that HIPAA regulations do not apply to medical reporting to PennDOT and that no individual consent is needed. Reports are confidential, used only to determine whether the driver is medically fit to drive, and reporting providers are immune from civil or criminal liability.