Colorado DR 2401 at a glance
What it is: DR 2401 is the Colorado Department of Revenue Division of Motor Vehicles Confidential Medical Examination Report.
Who signs: The Physician/Ophthalmologist section is to be completed by a Physician (M D or D O), Physicians Assistant (PA), Advanced Practice Registered Nurse (A P R N) or an Ophthalmologist/Optometrist (O D).
Where and when to file: Division of Motor Vehicles, P.O. Box 173350, Denver CO 80217-3350, FAX: (303) 205-8301. (Form is valid for 180 days from date of exam)
A filled-in Colorado DR 2401 example: a driver and a physician fill out DR 2401
How to fill out Colorado DR 2401, box by box
Patient name, address, Customer Identification Number and Date of Birth
The Driver/Patient Section is to be completed by the Driver/Patient.
The Driver/Patient should fill in their Name, Address, Customer Identification Number, if known, and Date Of Birth. The Driver/Patient should sign this section.
Driver Statement of Understanding and signature
Driver Statement of Understanding (Driver signature not required for DMV processing): My physician will conduct a medical examination to determine my fitness to operate a motor vehicle safely and responsibly. My physician will respond to any additional questions from the Department of Motor Vehicle (DMV). I understand that this form will be considered in any decision regarding the issuance of my driver license, pursuant to C.R.S. 42-2-111 & 42-2-112.
Sign on Signature of Driver or Patient and enter the Date (MM/DD/YY).
Driver/Patient questions
Respond to all questions before seeing your physician. 1. How many driving trips do you make in a typical week?
Mark Yes or No: 2. Do any of your regular trips involve driving at night? Yes No
3. What is the one-way distance of your furthest regular trip? Miles
Mark Yes or No: 4. Do any of your regular trips involve speeds ≥ 55 MPH? Yes No
Mark Yes or No: 5. Were you pulled over by a police officer in the past year? Yes No
Mark Yes or No: 6. Were you involved in a crash as a driver in the past year? Yes No
Examination Date
Enter the Examination Date (MM/DD/YY).
(Form is valid for 180 days from date of exam)
If a DR 2401 is requested by the Department of Motor Vehicles, Drivers License Office, the examination date on the form needs to be after the issue date of the notice of cancellation and denial. Valid for 180 days from the date of the examination.
Primary care provider
Are you the primary care provider for this patient? Yes No. If yes, how many times have you seen this patient in the past year?
If no, are you evaluating this patient for the first time today? Yes No. If no, have you reviewed the patient's medical records? Yes No
To your knowledge, is this patient
To your knowledge, is this patient: Aware of his or her medical diagnosis & status? Aware of functional impairments that may impact driving? Compliant with medications & basic requirements of self-care? Yes Somewhat No
Does this patient have
Does this patient have: Cardiovascular Disease Yes No; Cardiac Arrhythmia Yes No; Heart Failure Yes No; AHA Functional Capacity (check level if applicable): N/A I II III IV
Require DMV retesting in one year?
Require DMV retesting in one year? Yes No
Current Medications
Current Medications. To your knowledge, is this patient subject to any consistent medicine side effects or interactions that may impair driving ability? Yes Possibly Not Likely No
Fitness to operate a motor vehicle
Based on my observations of this patient and information relayed to me by this individual, I, reasonably and in good faith, believe that: Patient Name
is Must Choose One: Fit to operate a motor vehicle safely. Fitness to drive determination pending; rehab permit required. Fit to operate a motor vehicle safely contingent upon passing a DMV Road Test. Not Fit to operate a motor vehicle safely and responsibly due to significant medical-functional compromise or deficit.
1. The form is valid for 180 days from the date of the examination. 2. If the RequireD M V retesting in one year? question is not answered, No will be assumed and selected as a default answer. 3. The Physician/Ophthalmologist observation section required fields must be completed. 4. Only one of the fitness to operate options must be selected. 5. Any alterations, erasures or multiple selections of the fitness to operate options will result in an invalid and rejected form. 6. The form must be signed by a Physician (M D or D O), Physicians Assistant (PA), Advanced Practice Registered Nurse (A P R N) or an Ophthalmologist/Optometrist (O D).
Recommended license restriction(s)
Recommended license restriction(s): Daylight Driving Only, Specialty Cushion, Mile Radius Only, No Highway/Freeway Driving, Foot Device, Hand Control, Automatic Transmission Only, Steering Device, Restricted MPH, Other
Patient also requires an eye exam
Patient also requires an eye exam
Cognitive, Cerebrovascular or Neurological Condition
Cognitive, Cerebrovascular or Neurological Condition is: Stable Progressive N/A. Mental Status (list test and score)
Cognitive Impairment: Confusion or Disorientation, Memory Loss or Forgetfulness, Inattention or Distractibility, Impaired Judgment, Visual-Spatial Deficit, Slowed Processing Speed. Cerebrovascular Disease: Alzheimer's Disease, Vascular Dementia, Frontotemporal or Pick's, Dementia (other or unknown), Cerebral Infarction or Stroke, Hemorrhage or Aneurysm, Transient Ischemic Attack, Carotid Occlusion or Hypoxia. Neurological Condition: Brain Injury (open or closed), Tumor or Malformation, Parkinson's Disease, Multiple Sclerosis.
Combined Impairment for Driving, Select Highest Level for Section. Unimpaired (Likely fit to Drive), Very Mild (Likely fit to Drive), Mild (Questionable Fitness), Moderate (Likely Unfit to Drive), Severe (Unfit to Drive)
Consciousness, Metabolic or Respiratory Condition
Consciousness, Metabolic or Respiratory Condition is: Stable Progressive N/A. For Disorder of Consciousness or Alertness* and Blackout or Syncope*, enter the *Date of last event with impaired consciousness (MM/DD/YYYY):
Disorder of Consciousness or Alertness*, Blackout or Syncope*, Chronic Sleep Deprivation, Sleep Apnea or Narcolepsy, Epilepsy or Seizure Disorder, Medication Effect, Dizziness or Postural Hypotension. Metabolic Condition: Diabetes (Type 1 or 2), Thyroid Condition (Hypo or Hyper), Morbid Obesity or Fluid retention. Respiratory Condition: Asthma or shortness of Breath, COPD, Oxygen Dependent.
Musculoskeletal, Movement or Neuromuscular Condition
Musculoskeletal, Movement or Neuromuscular Condition is: Stable Progressive N/A. Arthritis (Osteo or Rheumatoid), Frailty or General Weakness, Motor Neuron Disease, Orthopedic or Movement, Uses Cane or Walker, Paralysis - Arm, Multiple Sclerosis, Muscular Dystrophy, Wheelchair Dependent, Paralysis - Leg, Restricted or Weakness - Arm, Parkinson's Disease, Difficulty Transferring, Prosthesis or Brace - Arm, Restricted or Weakness - Leg, Loss of Limb, Problems with Balance, Prosthesis or Brace - Leg, Restricted Neck Range of Motion, History of Falls, Other
Psychiatric, Emotional or Addiction Condition
Psychiatric, Emotional or Addiction Condition is: Stable Progressive N/A. Depression, Bipolar Mood Disorder, Psychosis or Schizophrenia, Alcohol Abuse or Addiction, Drug Abuse or Addiction, Suicidal or Homicidal, Anxiety or Post- Traumatic Stress, Chronic Pain (causing distress), Other
Physician Specialty, License Number, Phone Number and address
Physician Specialty (Required), License Number (Required), Phone Number (Required), Street Address, City, State, ZIP Code
Patient and Physician Name
Patient Last Name, First Name, Middle Initial. Physician Name (Printed)
Physician Signature (Required)
Sign on Physician Signature (Required) and enter the Date (MM/DD/YY).
Form must be completed by the Physician (M D or D O), Physician's Assistant (PA) or Advanced Practice Registered Nurse (A P R N).
More rules for Colorado DR 2401
Instructions: Use your best clinical judgment as you Review and Complete All Sections.
Common questions about Colorado DR 2401
Where do I file it?
Division of Motor Vehicles, P.O. Box 173350, Denver CO 80217-3350, FAX: (303) 205-8301.
Sources
[1] DR 2401 (08/15/25) Confidential Medical Examination Report, Colorado Department of Revenue, Division of Motor Vehicles (the Official source link on this page).