Physicians, law enforcement, other officials and citizens use this one-page affidavit to report a driver with a physical or mental impairment to Kentucky's Medical Review Board. The reporter explains in detail why the driver can't drive safely, including unsafe driving seen and the date of the last known seizure, and the Board then opens a case and sends the driver medical forms.
The reporter completes the whole form: driver information, a detailed explanation, and their own details and signature. A physician signs as a listed official, while citizens need notarized signatures from at least two people.
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Medical Review Affidavit
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No. Under 601 KAR 13:090, physicians are among the reporters exempt from notarization, along with law enforcement officers, KSP license examiners, judges and certain other officials. Citizens who aren't in those groups must include notarized signatures of at least two people.
Possibly. The form states that the Transportation Cabinet may be required to release it on request by the driver or the driver's representative, so it cannot be kept confidential. Anonymous reports are not accepted.