Utah medical form 2025

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4.9 out of 5

36 votes

The document is a Functional Ability Evaluation Medical Report required by the Utah Driver License Division. It includes sections for the applicant to authorize healthcare professionals to disclose health information relevant to their ability to drive safely. The report also requires healthcare professionals to assess and indicate the safety assessment level of the applicant based on various medical conditions, along with any recommended driving restrictions. The form must be completed and signed by both the applicant and a healthcare professional.

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Click ‘Get Form’ to open the Utah Medical Form in the editor.
Begin by filling out the top portion of the form. Enter your last name, first name, middle or maiden name, date of birth, and driver license or DPC number.
Sign the authorization section to allow your healthcare professional to disclose relevant health information regarding your ability to operate a motor vehicle safely.
Next, have your healthcare professional complete the bottom portion. They will assess safety levels and indicate any medical conditions that may affect driving privileges.
Ensure that all required signatures are provided. The form cannot be processed without them.
Finally, review all entries for accuracy before submitting the completed form to the Utah Driver License Division.

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Versions	Form popularity	Fillable & printable
2015	4.9 Satisfied (36 Votes)
2014	4.4 Satisfied (321 Votes)
2014	4 Satisfied (20 Votes)
2010	4.3 Satisfied (44 Votes)
2009	4 Satisfied (30 Votes)
2008	4 Satisfied (29 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the phone number for Medicaid members in Utah?

Just call our customer care line at 1.866. 633.3548.

What is the phone number for medical solutions customer service?

Utah Medical Products Inc, established in 1978, develops, manufactures and markets specialty medical devices recognized by healthcare professionals in Critical Care, Gynecology, Neonatology, Obstetrics, Surgery and Urology as the standard for obtaining optimal long term outcomes for their patients.

How to get a medical card in Utah?

Get your card through Natural Medicinal Clinic of Utah and they will request medical records. You have to be approved through chronic pain, or cancer, and some other life-threatening or chronic illness or disease prior to your appointment. Its pretty easy to BS chronic pain, anything lasting more than 2-weeks.

What is the phone number for Utah Medical customer service?

For more information, please contact us by EMAIL or call 1-800-533-4984 | 1-801-566-1200.

Is there a grace period for expired dot medical card Utah?

Most cards are valid for up to 24 months, though some drivers receive shorter periods if certain medical conditions need monitoring. Unfortunately, theres no official grace period once your medical card expires. If its expired, youre no longer medically certified to drive a commercial vehicle.

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How to apply for Utah drivers license?

To apply for a driver license, permit, driving privilege card, or identification card you must: Fill out and submit this application. Schedule an appointment. Appear at a Driver License office in person at your scheduled time to complete the process.