Pennsylvania clinicians use this PennDOT form to report an orthopedic impairment or loss of a limb that affects a driver's control of a vehicle. PennDOT's criteria cover loss or impairment of a joint or extremity, and rheumatic, arthritic, orthopedic, muscular, vascular or neuromuscular disease expected to last longer than 90 days. The Bureau then decides whether a restriction, exam or recall is needed.
The treating physician or other health care provider completes the whole form; Pennsylvania's reporting duty includes chiropractors along with physicians, physician assistants and CRNPs.
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Orthopedic Form
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PennDOT's physical criteria include loss or impairment of a joint or extremity, and rheumatic, arthritic, orthopedic, muscular, vascular or neuromuscular disease expected to last longer than 90 days. The duty applies when the condition could impair the patient's ability to drive safely.
Pennsylvania's reporting duty names physicians, chiropractors, physician assistants and certified registered nurse practitioners, and DL-126 is completed by the treating provider. PennDOT makes the condition-specific forms available to all health care personnel with online access, so a medical reporting login is needed.
PennDOT reviews a report within 15 days and either takes no action, asks the driver for more medical information within 45 days, or deems the driver medically incompetent and recalls the privilege seven days after mailing the notice. A driver who meets the criteria may still receive restrictions.