Table of Contents

Appendix 2 Forms

Appendix 2.1. Medical report form

The driver licensing authority has a legal responsibility to ensure all drivers have the appropriate skills and ability, and are medically fit to hold a driver licence. To meet this responsibility, legislation gives the driver licensing authority the authority to ask any motor vehicle licence holder or applicant to provide medical evidence of their suitability to drive and/ or to undergo a driver assessment.

This is facilitated by a medical report. The relevant driver licensing authority provides the medical report form to the driver, who will present it to the health professional for completion at the time of the examination. This form is the key communication between health professionals and driver licensing authorities. It should be completed with details of any medical criteria not met, as well as details of recommended conditions and monitoring requirements for a conditional licence. Medical information that is not relevant to the patient’s fitness to drive should not be included on this form for privacy reasons.

The forms used by each state or territory vary; however, they will generally include the information outlined below. Electronic and online forms are now available in certain states and territories. For more information contact your local driver licensing authority (refer to Appendix 9. Driver licensing authority contacts).

Information required in a medical report form

Driver details:

  • name, date of birth and contact details (postal address, phone number)
  • consent for the driver licensing authority to contact the health professional for further information relevant to the person’s fitness to drive (inclusions and wording will depend on jurisdiction)
  • licence details (to guide the health professional in selecting the appropriate standard for assessment – private or commercial).

Health professional details:

  • date of examination
  • health professional’s name and contact details
  • physical or digital signature of examining health professional or health professional identity validation for online electronic medical reports.

Assessment of fitness to drive – the health professional records the following:

  • whether they were familiar with the driver’s medical history prior to the examination
  • which standards (private/commercial) were applied in the examination
  • whether the driver meets or does not meet the criteria for an unconditional licence (noting criteria that are not met and other relevant medical details)
  • whether the driver meets or does not meet the criteria for a conditional licence, noting:
  • criteria that are not met and other relevant medical details
  • proposed restrictions to the person’s licence (if appropriate)
  • suggestions for management and periodic review intervals (conditional licence)
  • whether the driver requires additional assessment including:
  • specialist assessment (specify type)
  • practical driving assessment (specify type)
  • occupational therapist assessment
  • whether the driver’s condition has now improved so as to meet criteria for a conditional or unconditional licence noting:
  • criteria previously not met
  • response to treatment and prognosis
  • duration of improvement
  • other relevant information including consideration of the driving task.

Other information contained within the form:

  • legal information
  • instructions to:
  • the driver/applicant
  • the health professional
  • information about:
  • occupational therapy driver assessments
  • driver licensing authority driver assessments.

Appendix 2.2. Medical condition notification form

If, in the course of treatment, a patient’s condition is found to affect their ability to drive safely, the health professional should, in the first instance, encourage the patient to report their condition to the driver licensing authority. A standard form, Medical condition notification form, has been produced to facilitate this process. The health professional completes the form, explains the circumstances to the patient and asks the patient to forward the form to the driver licensing authority. Most driver licensing authorities will also accept a letter from the treating practitioner or specialist. The letter should, however, include the details laid out in the form to enable the driver licensing authority to make a decision.

If necessary, the health professional may feel obliged to make a report directly to the driver licensing authority using a copy of this form (refer to section 3.3 and step 6). Even when making a report directly to the driver licensing authority, the health professional should inform the patient that they are doing so.