Pennsylvania requires clinicians to report, within 10 days, any patient over 15 diagnosed with a condition that could impair driving, and the DL-13 is the general-purpose form for that report. It suits emergency rooms and clinicians without access to the patient's history; PennDOT reviews it against its medical standards and may write to the driver for more information.
The reporting physician, physician assistant, certified registered nurse practitioner, chiropractor or other authorized treatment provider completes all three sections, A to C, and signs. The patient does not complete any part of the form.
Enter the patient's driver's license number, last name with any suffix, first name, height in feet and inches, sex, eye color, date of birth, telephone number and Social Security number. The street address must be the actual address; a P.O. box may be added but cannot be the only address. Finish with the date of examination and how long you have been treating the patient. Type or print in blue or black ink.
Check every item that applies: loss or impairment of a foot, leg, finger, thumb or hand; diabetes mellitus; cerebral vascular disease; cardiovascular disease; loss of consciousness with its cause; neurological or neuromuscular disorder; cognitive impairment; neuropsychiatric or psychiatric disorder; vision deficiency (acuity or visual fields); sleep apnea; alcohol use; drug or controlled substance use; or another condition that would interfere with driving. Several items have a line to name the condition, so write the diagnosis there rather than only checking the box.
Mark a single seizure with its date, or a seizure disorder with the date of the last seizure. The form defines a seizure disorder as more than one seizure, or a single seizure with electrically diagnosed epilepsy. If the patient meets a waiver, check it: a two-year nocturnal or on-awakening pattern, a two-year prolonged aura with sufficient warning, or three seizure-free months after a seizure caused by a prescribed medication change (since reinstated) or by a nonrecurring illness, toxic ingestion or metabolic imbalance. A checked waiver tells PennDOT to take no action on the privilege.
Answer two questions at the end of Section B. First, should this individual cease driving immediately? Second, if not, does the condition warrant further investigation of driving competency by the Department? After its review, PennDOT writes to the driver, and that letter may recall the driving privilege or ask for more medical information.
Print your name, specialty and license number, then your street address, city, state, zip code, telephone and fax numbers. The section notes that all information is confidential under Section 1518(d) of the Vehicle Code. Sign and date the statement that the facts are true and correct to the best of your knowledge, made subject to the penalties of 18 Pa. C.S. § 4904 for unsworn falsification to authorities.
Download the current version from the source each time; forms change without notice.
Initial Reporting Form
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Sources for this guide
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Under Section 1518(b) of the Pennsylvania Vehicle Code, physicians, chiropractors, physician assistants, certified registered nurse practitioners and other persons authorized to diagnose or treat must report, in writing within 10 days, the full name, address and date of birth of every person over 15 diagnosed with a condition that could impair their ability to drive. Conditions expected to last under 90 days are excluded.
PennDOT describes the DL-13 as the form for emergency rooms or other health care personnel who do not have access to the patient's medical history. If you treat the condition and know its course, PennDOT recommends the matching condition-specific form, saying it helps the Department make licensing decisions. After a DL-13, PennDOT then requests those details.
Yes. Section C of the form states that all information is confidential under Vehicle Code Section 1518(d). PennDOT uses reports only to decide the driver's qualification and does not reveal who reported or what the report says, even to the patient. If the driver appeals a Department action in court, the medical information is provided to the court.
The report starts an evaluation against the medical standards in 67 Pa. Code Chapter 83. PennDOT sends the driver a letter that may recall the driving privilege or ask for more medical information. Depending on what comes back, PennDOT may restrict the license (for example, daylight driving only), recall it until competency is shown, require a driver's exam, or take no action.