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PDF Physician's Reporting Form - NY 2026
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- Click ‘Get Form’ to open the PDF Physician's Reporting Form - NY in our editor.
- Begin with Part 1, Driver Identification. Fill in the required fields such as Driver License Number, Last Name, First Name, and Date of Birth. Ensure all information is accurate for proper identification.
- Proceed to Part 2, Description of the Driver’s Condition. Indicate whether you have treated the patient by selecting 'YES' or 'NO'. If 'YES', provide the date of the last examination and describe the condition being treated.
- In this section, also specify if the patient is receiving medication for their condition. If so, detail the type and dosage of medication.
- Conclude Part 2 by checking one of the options regarding the patient's ability to operate a vehicle and providing any additional details as necessary.
- Finally, complete Part 3 by entering your certification details including your name, specialty, license number, mailing address, and contact information. Don’t forget to sign and date the form before submission.
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Can a doctor revoke a drivers license in NY?
Yes. If a physician reports that you have a medical condition that affects your driving skills, DMV can suspend your driver license. The suspension remains in effect until a physician certifies that the condition is treated or controlled and does not affect your driving skills.
How long does a suspended license stay on your record in NY?
Most suspensions and revocations are only displayed on the driving record abstract for 4 years from the date the suspension or revocation ended. Suspensions for a chemical test refusal are displayed for 5 years from the date of suspension.
What medical condition means you cant drive?
Dementia, multiple sclerosis, motor neurone disease, Parkinsons disease, stroke and a host of other conditions affecting your nervous system can all affect your ability to drive.
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People also ask
What disorders affect driving?
In particular, conditions such as Alzheimer disease (AD), Parkinson disease (PD), illicit drug use, multiple sclerosis (MS), cerebrovascular disease, sleep disorders, and epilepsy may impair an individual to the point of affecting the safe operation of a motor vehicle.
What does it mean if your license is revoked in NY?
If you receive an order from DMV saying your license or driving privilege is revoked, this means your license has been cancelled and you must get a new one when the revocation period ends. In most cases, before you can get a new license you must first request approval from DMV when the revocation period is over.
How long does NYS DMV medical review take?
Note: Please allow 10 days from the date DMV receives your medical certificate for your license status to be updated.
What is the DMV driver review in NY?
About driver re-evaluation For the benefit of highway safety, the DMV can require an evaluation of a driver whose skills and abilities are in doubt. The DMV will examine reliably reported information to determine if a driver needs to be re-evaluated.
Do you lose your license in NY if you have a seizure?
Driving and Epilepsy However, individuals with epilepsy are expected to provide that information to the DMV. Driving is then restricted until 12 months after the last seizure with impaired awareness. Under some circumstances, the DMV will reinstate a persons license sooner than 12 months.
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