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Missouri Form 1528: Physician's Statement for Drivers

Missouri's Driver License Bureau requests this two-page statement during a driver medical review. The provider rates impairment in cognitive, consciousness and metabolic, musculoskeletal and psychiatric domains, records vision and medications, and must choose one conclusion: likely capable, unclear and needing further evaluation, or not capable of driving safely.

Who completes it

The driver signs the authorization and may answer seven questions about their driving habits; the physician or other eligible medical provider completes every section of the physician part on both pages and signs.

Submitting and payment

How to submit it
Return it to the Driver License Bureau by mail or fax, as printed in the form header.

Good to know

  • Section 302.291 RSMo, quoted on the form, says completing the report does not violate physician or patient privilege and gives good-faith reporters immunity from civil liability.
  • Each domain is rated from unimpaired through very mild, mild and moderate to severe, mapped to likely fit, questionable fitness or likely unfit to drive.
  • The form asks whether you are the patient's regular provider, how often you saw them in the past year, and whether you reviewed their records.
  • If capability is unclear, you can recommend a driving skills exam, written exam, vision specialist or other specialist; restrictions include daylight only, no highway, and speed or radius limits.

Get the official form

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

Physician's Statement

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.

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Frequently asked questions

Who can complete Missouri Form 1528?

A physician or other eligible medical provider completes the physician section, which asks whether they are the patient's regular provider or have reviewed the medical records. The driver signs an authorization allowing the provider to answer Driver License Bureau questions and, if necessary, send copies of medical records.

Does Missouri protect physicians who complete a driver medical report?

Form 1528 quotes Section 302.291 RSMo: completing the report does not violate physician or patient privilege, and a physician acting in good faith is immune from civil liability that might otherwise result from making it. The Driver License Bureau makes the final licensing decision.

What are the outcome options on Form 1528?

The provider must choose one: likely capable of driving safely with no further evaluation needed, unclear if capable with recommended evaluations (driving skills, written exam, vision specialist or another specialist), or not capable due to significant medical-functional compromise. Recommended license restrictions can be checked as well.