Florida form 72190 2025

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4.9 out of 5

24 votes

The document is a Medical Referral Form from the Florida Department of Highway Safety and Motor Vehicles, designed to report individuals whose physical or mental conditions may impair their ability to drive safely. It emphasizes compliance with the Americans with Disabilities Act (ADA) and outlines the confidentiality of reports made by physicians or agencies regarding a driver's medical conditions. The form collects personal information about the individual being reported, details about their condition, and requires the reporting person's information for follow-up.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the individual's name and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in the address, city, and zip code. Select the gender by checking either 'Male' or 'Female'.
Input the driver's license number and state. This helps link the report to the correct individual.
Mark any physical or mental deficits observed from the provided list. If applicable, explain each area marked in the space provided.
Indicate your relationship to the individual being reported (e.g., friend, family member). This context can be important for review purposes.
Complete your information as the reporting person, including name, agency (if applicable), and signature. Ensure all required fields are filled out before submission.
Finally, mail the completed form to the Bureau of Motorist Compliance at the address provided on the form.

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Versions	Form popularity	Fillable & printable
2018	4.9 Satisfied (24 Votes)
2013	4.8 Satisfied (102 Votes)

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Do doctors report seizures to DMV Florida?

Patients with seizure disorders should be aware of the legal ramifications if they choose to drive and are involved in an accident. Each state approaches seizures and driving restrictions in a different manner. In Florida, a neurologist is not required to report patients directly to the Department of Motor Vehicle.

What states require doctors to report seizures to DMV?

Doctors are only required to report epilepsy in six states: California. Delaware. Nevada. New Jersey. Oregon.

Who reports seizures to DMV in Florida?

Florida law authorizes any physician, person, or agency to report an applicant or licensed driver who may be unsafe to operate a motor vehicle due to a medical condition to FLHSMV.

How to surrender a Florida drivers license?

To voluntarily surrender your license, please log in to your MyProfile account. Alternatively, you may send a letter to the Bureau of Licensing stating that you wish to surrender your license.

What is the new rule for senior drivers in Florida?

Florida: Drivers 80 and up must renew every six years instead of eight and pass a vision test. Georgia: Residents 64+ face a vision exam every renewal.

florida dmv medical review form

Florida DMV forms Florida dmv Medical Review form Florida dmv vision Form HSMV Form 72010 Florida dmv mature Driver vision test form Florida DMV vision test line 5 FLHSMV Report of Eye Exam Form 72010 Florida dmv Medical Review Board phone number

Can you drive after a seizure in Florida?

Florida requires drivers to have been 6 months seizure free and, if taking medications, demonstrate that they are compliant with taking them this requires a blood test showing the anti-epilepsy drug to be in the effective range. Often, an EEG is required, and a form will need to be completed by their neurologist.

How to fill out a certification of address form in Florida?

How to fill out the Florida Certification of Address Form Instructions? Complete Section A with your details. Provide two approved proof of residential address documents. If applicable, have a representative docHubing your residence. Sign and date the form. Submit the form with your supporting documents.