Pennsylvania clinicians report substance use that may affect a patient's safe driving on this PennDOT condition-specific form. PennDOT's criterion is use of any drug or substance known to impair skill or function, and the Bureau of Driver Licensing reviews the report against 67 Pa. Code Chapter 83 before deciding what happens to the driver's license.
The treating physician or other health care provider completes the whole form; the patient does not sign or complete any part.
Download the current version from the source each time; forms change without notice.
Substance Use Form
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PennDOT's physical criteria include use of any drug or substance known to impair skill or function. The report goes on DL-128 for Chapter 83 drivers, and PennDOT also accepts the generic DL-13 from clinicians who lack detailed knowledge of the condition.
Yes. PennDOT says reports are confidential and used solely to determine whether the driver can drive safely, HIPAA does not apply, and no individual consent is needed. Providers who report are immune from civil or criminal liability.
Pennsylvania law requires a written report within 10 days, giving the patient's full name, address and date of birth. PennDOT reviews it within 15 days and then decides whether to take no action, request more information, order an exam or recall the license.