What is the purpose of this Form?
This reporting form was designed for use by the general public for the purpose of reporting medically impaired drivers who may pose a threat to public safety.

Will my report be kept confidential?
YES! Section 322.126(2), (3), Florida Statutes, provides that "Any physician, person, or agency having knowledge of any licensed driver’s or applicant’s mental or physical disability to drive…is authorized to report such knowledge to the Department of Highway Safety and Motor Vehicles…" It further states that these reports shall be confidential and that no civil or criminal action may be brought against any physician, person, or agency who provides the information.

What kinds of medical conditions are generally reported?
Seizure disorders/blackouts (if a seizure or blackout has occurred within the last two years), dizzy spells, severe cardiovascular impairments, impairments of memory or judgment, drug and alcohol addiction, progressive neurological disorders, severe psychiatric disorders, visual impairments, sleep disorders, diabetes (if uncontrolled or severe complications are present), and severe head injuries.

What if I don't know what the person's diagnosis is?
You do not need to know the person’s diagnosis to report them as a possible unsafe driver. It is important, however, to write what you have observed and to provide any useful examples. For instance, you may want to note if any of the following symptoms are present: unsteadiness, limited movement in arms or legs, tremors, amputation, stiffness, slowed reaction time, obvious balance problems, loss of strength, memory problems, confusion, breathing difficulty, slurred speech, or bizarre behaviors. Do they repeatedly fall or lose their balance? Do they get lost when they drive? Are they able to respond quickly to emergencies? Any anecdotal information of this kind is very helpful.

Why do you need my address and telephone number?
There are times when the department may be unable to locate a driver’s record due to insufficient information or additional information may be needed for clarification. Please include as much identifying information as possible so that we may locate the correct driving record.

What happens when I send the report in to the department?
Reports are carefully screened by medical disability specialists and forwarded to investigators who work for the department. These investigators make contact with the driver and submit reports on their findings to the medical review section in Tallahassee. Investigators may interview family members, neighbors, or the driver’s physician as part of the investigation. As a result, drivers may be requested to submit a medical report from their physician, or they may be required to report to a driver license office for re-testing if necessary. If the investigator does not find any substance or validity to the complaint, no further action is taken.

Who do I contact if I have additional questions about the report?
Additional questions can be answered by the Division of Motorist Services - Medical Review Section. The telephone number is (850) 617-3814.