DC DMV uses this one-page report when a driver has a condition that could affect safe driving, even a temporary one, to decide whether to issue, restrict or limit a license. The medical half covers Alzheimer's, insulin-dependent diabetes, seizures or fainting and other conditions; the eye half records acuity with and without glasses, horizontal field, eye disease and any failed DMV vision test.
The customer completes the top section. A licensed medical practitioner completes the Medical Report and a licensed ophthalmologist or optometrist completes the Eye Report, each giving license number and state, signature and a recheck interval.
Download the current version from the source each time; forms change without notice.
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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The form says it is valid only within 60 days of the date the medical practitioner, ophthalmologist or optometrist signs it. Submit it promptly by mail, fax or through DC DMV's online Medical Report Submission Form so it arrives while still valid.
Yes. DC DMV publishes the form in English and Spanish (Informe Médico/de Visión), and also in Amharic, Chinese, French, Vietnamese and Korean. The content is the same: a customer section, a medical report section and an eye report section.