Medical information submitted on this form should be restricted to information that is needed in relation to safe driving.
Submission: submission will not be accepted if older than 6 months or if the required medical information is missing.
Fraud: fraudulent submission can result in criminal and administrative action.
Review time frame: recommendations made by the individual's HCP supersede standardized guidelines.
More information: for more information on how to submit this form and a full listing of current medical guidelines, visit dld.utah.gov/health-care-professionals.
| Question | Answer |
|---|---|
| Form Name | Form DLD 134 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 122 |
| Avg. time to fill out | 21 min |
| Edition | Rev 9.26 |
| Other names | DLD 134, DLD134, Form DLD 134, DLD form Utah, Utah DLD 134, Functional Ability Evaluation Medical Report, Utah functional ability evaluation medical report, Utah driver license medical form |
| Official source | Form DLD 134 (Rev 9.26), Utah Driver License Division |
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