Physicians, police and other people who know of a Minnesota driver's medical, vision or skill problems use this one-page form to ask the DVS Driver Evaluation Unit to re-examine that driver under Minnesota Statutes section 171.13. The reporter describes the incident or condition and signs a statement submitting it as good cause for re-examination.
The reporting person completes the whole form, including driver details, incident information, condition checkboxes, a written summary and their signature with title or relationship.
Download the current version from the source each time; forms change without notice.
Request for Examination of Driver
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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Not from the driver. The form states that family members' reports are confidential under Minnesota Statutes 13.69, but DVS is required to disclose the identity of all other reporters at the driver's request. That includes physicians and law enforcement officers who file PS31924.
No. The form says age alone cannot be considered good cause. The reporter must describe the driving actions or conditions, such as loss of consciousness, vision problems or memory loss, and attach any pertinent reports that would help the driver evaluator.