Massachusetts lets health care providers and law enforcement officials report a driver they believe is no longer physically or cognitively capable of driving safely. On MAB107 the reporter identifies the driver, explains the medical concern and certifies that the person is not medically qualified, needs adaptive equipment or restrictions, or should take a competency road examination. The RMV says a good-faith report results in licensing action.
A health care provider licensed under M.G.L. c. 112 (physician, PA, RN, LPN, psychologist, OT, PT, optometrist, ophthalmologist, osteopath or podiatrist) or a law enforcement official completes the one-page form and signs under the penalties of perjury, giving an NPI or Board of Registration number.
Download the current version from the source each time; forms change without notice.
Request for Medical Evaluation
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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Only health care providers licensed under M.G.L. chapter 112, including physicians, physician assistants, nurses, psychologists, therapists, optometrists, ophthalmologists, osteopaths and podiatrists, and law enforcement officials. The report should rest on the reporter's own evidence or observations and be made in good faith.
Possibly. The RMV states it cannot guarantee anonymity because Massachusetts public records law requires release of the form if the licensee submits a formal written request asking what initiated the RMV's action.
The report leads to a licensing action review. Medical Affairs may request more information from a medical provider, often through the driver's own physician on forms such as MAB106, and follows up with the driver to decide whether they are safe to drive.