Try for free

New Hampshire DSMV 643: Disorder Indicator on License

Under RSA 263:41-b, New Hampshire driver license and non-driver ID holders can ask to have a medically recognized disorder shown on their card, currently autism spectrum disorder or deaf or hard of hearing. DSMV 643 carries the holder's authorization and a licensed physician's certification of the diagnosis, and the DMV then reprints the card with the indicator.

Who completes it

The license or ID holder completes and signs the top section authorizing the DMV to add the indicator. A licensed physician checks the diagnosis and signs a certification that the person is under their treatment and care for it.

Submitting and payment

How to submit it
The holder drops the completed, physician-signed form in any DMV Drop Box, and the card is reprinted with the indicator.
Who pays
The DMV charges the license holder a reprint fee to add the indicator; the form does not address payment for the physician's certification.

Good to know

  • The physician checks one box: Autism Spectrum Disorder, Deaf or Hard of Hearing, or another medically recognized disorder authorized in RSA 263:41-b.
  • Both the holder and the physician sign under penalty of unsworn falsification under RSA 641:3, and the physician adds their practice name, address and telephone number.
  • The indicator is voluntary and goes on an existing New Hampshire driver license or non-driver ID, identified by its number on the form.
  • The form cannot be used for name or address changes, which go on the Record Change Request, DSMV 30. The current edition is DSMV 643 (Rev 6/23).

Get the official form

Download the current version from the source each time; forms change without notice.

Medically Recognized Disorder Indication

Official pagePDF

How this list is checked

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Can autism be noted on a New Hampshire driver's license?

Yes, if the holder asks for it. RSA 263:41-b allows autism spectrum disorder, and deaf or hard of hearing, to appear on a New Hampshire driver license or non-driver ID. A licensed physician certifies the diagnosis on DSMV 643, and the holder drops the form in a DMV Drop Box.

Who can sign New Hampshire form DSMV 643?

A licensed physician who has the person under their treatment and care for the indicated diagnosis. The physician prints their name and practice details, checks the diagnosis and signs under penalty of unsworn falsification. The holder signs separately to authorize the DMV to add the indicator.

Is the New Hampshire disorder indicator required?

No. It is added only when the license or ID holder signs DSMV 643 asking for it, with the physician's certification attached. The DMV then reprints the card with the indicator, and the holder pays the reprint fee.