Minnesota's Driver Evaluation Unit uses this two-page form to decide whether a driver who has lost consciousness or voluntary control, for example from seizures, syncope or a diabetic episode, is eligible to drive. The driver certifies the date of the last episode, and the physician gives an advisory opinion and sets a review interval.
The driver completes the top section on page 1, including the date of the last episode; the physician completes the section on page 2, where every question must be answered.
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Loss of Consciousness or Voluntary Control
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The physician selects 6 months, 1, 2, 3 or 4 years, or no further review. The form notes that a six- or 12-month review is required until the driver is episode-free or has been on medication for four years. The current version is PS31015-13, July 2026.
The form defines it as being unable to stay upright without support or to respond rationally to one's surroundings. The driver certifies the date of the last episode and that they have been episode-free since, and the physician reports diagnosis, prognosis and cooperation with treatment.
The note to physician states that under Minnesota law the physician is immune from liability for reporting any physical or mental condition that significantly impairs a person's ability to drive safely. The report is advisory and helps DVS decide the patient's eligibility.