New Mexico's Motor Vehicle Division uses this two-page report for issuing, renewing or continuing a Class D, E or M license, permit or provisional license when a medical condition is in question. The physician states whether the patient can drive safely and recommends restrictions and a renewal interval; the Medical Advisory Board may review it, and MVD makes the final decision.
The physician or other licensed health care provider completes the whole form: applicant information, Physician's Report items 1 to 10, and their name, license number, signature and date.
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Medical Report
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No. MVD-10124 is for Class D, E and M licenses, driving authorization cards, permits and provisional licenses. MVD's procedures state it cannot be used for commercial Class A, B or C licenses, and vision findings go on the separate MVD-10125 Vision Report.
The form says a physician or panel of physicians may review it and request more medical information, and its instructions name MVD's Medical Advisory Board, which may make recommendations. The final decision to accept or deny the application belongs to MVD. The report is confidential and may not be used as evidence in any trial.
MVD treats the report as valid from the date signed for the period the physician approved. Item 10 asks for that interval, 1 year or 4 years, and a physician who believes the patient cannot drive safely from a medical standpoint checks DENIAL instead.