The information provided must be based on a current examination performed by your physician/physician assistant/nurse practitioner within the last 120 days from the date this statement is submitted.
Who completes it: please complete the information below and have your physician/physician assistant/nurse practitioner complete the statement on page 2.
Emergency care personnel: information provided by emergency care personnel is NOT acceptable.
Letterhead: physician/physician assistant/nurse practitioner: please attach a sample of your letterhead or a voided prescription blank.
Sleep disorder: must be answered if the patient has a sleep disorder: date first diagnosed, receiving treatment, compliant with the treatment.
| Question | Answer |
|---|---|
| Form Name | Form MV-80U.1 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 78 |
| Avg. time to fill out | 13 min |
| Edition | 4/25 |
| Where to send | Medical Review Unit, Driver Improvement Bureau, NYS Department of Motor Vehicles, 6 Empire State Plaza, Albany, NY 12228 |
| Matches the agency's file | Yes, checked October 1, 2026 |
| Other names | MV-80U.1, MV80U.1, MV-80U1, MV 80U.1, Physician's Statement for Medical Review Unit |
| Official source | Form MV-80U.1 (Rev 4/25), New York State Department of Motor Vehicles |
Form Mv 80U 1 isn’t the one you’re looking for?