When reporting an individual whose driving ability is questionable due to some physical or mental deficit or disorder, complete as much of the information as possible.
Who may report: any physician, person, or agency having knowledge of a licensed driver's or applicant's mental or physical disability to drive is authorized to report it.
Confidential: Sections 322.126(2) and (3), Florida Statutes, provide that the reports authorized by this section shall be confidential.
No action: no civil or criminal action may be brought against any physician, person, or agency who provides the information.
Signature: the name and signature of the reporting person is required to investigate the report.
Explain: please explain each area that was marked.
| Question | Answer |
|---|---|
| Form Name | HSMV 72190 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 33 |
| Avg. time to fill out | 6 min |
| Edition | Effective 07/18 |
| Where to send | Mail the completed form to Bureau of Motorist Compliance Medical Review Program, Neil Kirkman Building, MS 86, Tallahassee, Florida 32399-0500 |
| Other names | HSMV 72190, HSMV72190, Form 72190, Medical Referral Form, Florida DMV medical review form |
| Official source | HSMV 72190 (Effective 07/18), Florida Department of Highway Safety and Motor Vehicles |
Hsmv Form 72190 isn’t the one you’re looking for?