New York DMV asks a driver for this short statement when it needs a clinician's view on whether a medical condition or medication affects driving, including for a DMV interview. The clinician confirms a physical exam, lists medications, notes any loss of body control or consciousness and gives an opinion on safe driving. The information must come from an exam within the last six months.
The driver's physician, physician assistant or nurse practitioner completes and signs the whole form, adding specialty, license number and state; the driver only carries it to the clinician and back.
Download the current version from the source each time; forms change without notice.
Physician's Statement
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 information must come from an examination done by the health care provider within the last six months. The form records the date of examination at the top, and question 1 asks whether a physical examination was conducted and for a description of it.
MV-80 is the general Physician's Statement covering the exam, medications and an opinion on driving. If the patient has had any loss of body control, awareness or consciousness, question 3 directs the clinician to also complete MV-80U.1, the Physician's Statement for Medical Review Unit, which covers those episodes.
Yes. The form is addressed to the driver's health care provider, defined on the form as a physician, physician assistant or nurse practitioner, and the signature line covers all three, along with address, specialty, license number, state and phone.