Form DPSMV2302 at a glance
What it is: The bearer of Medical Examination Form DPSMV2302 of the Louisiana Department of Public Safety and Corrections Office of Motor Vehicles is being required to undergo an examination by a physician.
Who signs: The patient signs section 3, To be Signed by the Patient, and the physician completes, signs and dates section 4.
A filled-in Form DPSMV2302 example: a patient and a physician sign page 3
How to fill out Form DPSMV2302, box by box
To be Completed by the Office of Motor Vehicles
The physician must complete this form and the applicant must return it to the Office of Motor Vehicles within thirty (30) days from the Date Issued.
Failure to comply within thirty (30) days from the Date Issued will result in the suspension of your driving privileges.
The Motor Vehicle Analyst completes this section at the time the form is issued to the applicant: Applicant's Name, DOB, R/S, D/L#, Address, City, Zip, Date Issued, MVCA'S Initials, Badge #, Office # and Reason for Issuance.
To be Completed by the Physician (Required)
In accordance with the provisions of R. S. 40:1356, a health care provider is exempt from any liability as a result of reporting to the Department of Public Safety and Corrections any visual ability, physical condition, impairment or disability which may impair a person's ability to exercise ordinary and reasonable control in the operation of a motor vehicle. This form must be completed in its entirety by the physician and must reference any illness in the History section as well as why this form was issued. Incomplete forms may be rejected and could result in the denial of this applicant's driving privileges.
In History, write the Patient's Name and Date of Birth, then mark Yes or No for medical or physical disorders, medication and past surgical procedures; if yes, list them.
Mark Yes or No for any illness that could affect the ability to operate a motor vehicle safely and for driving privileges ever withdrawn for a medical or physical disorder. If yes, describe the illness.
In Orthopedic, mark Yes or No for any amputation or skeletal deficits that could interfere with the ability to operate a motor vehicle safely. If yes, describe the deficits in detail.
Also mark Yes or No for stiff or frail joints, spastic or paralyzed muscles, and any orthopedic appliances or supports. If yes, list any device or support and how long used.
Mark Yes or No: does this device provide adequate compensation for operating a motor vehicle safely?
In Hearing, mark Yes or No for any hearing impairment. If yes, mark Yes or No for deaf or hard of hearing. Mark Yes or No for a hearing aid worn. If yes, mark Yes or No for sufficient correction.
In Cardiopulmonary, mark Yes or No for angina, dyspnea, syncope and dizziness. If yes for angina or dyspnea, mark when it occurs: Strenuous activity, Normal activity or At rest.
If yes for syncope, enter the frequency, Duration and Last occurrence. If yes for dizziness, describe it.
Enter the patient's blood pressure as 1st reading and 2nd reading, and the pulse as Rate and Rhythm. Mark Yes or No for cardiovascular catheterization or surgery. If yes, describe it. List medications and dosage.
In Neurological, mark Yes or No for epilepsy. If yes, enter what type of seizures and the Date of last seizure, and mark Yes or No for seizures completely controlled and for regular medical care.
Enter the anticonvulsant serum blood levels. Mark Yes or No for any signs of Parkinsonism. If yes, describe condition and severity.
Mark Yes or No for coordination normal. If no, describe. Mark Yes or No for any neurological disorder. If yes, describe. List medications and dosage. Mark Yes or No for reliable in taking medication and following medical regimen.
In Mental, mark Yes or No for symptoms of any mental disorder. If yes, describe condition and severity at present. Mark Yes or No for ever treated in a mental hospital. If yes, enter where and when. Enter the diagnosis and cure.
Mark Yes or No for use of alcohol or drugs. If yes, describe usage. Mark Yes or No for mentally deficient. If yes, enter the highest grade attained in school and the Age at attainment.
Mark Yes or No for sufficient regard for his/her personal safety as well as that of others to operate a motor vehicle safely, and for likely to act on sudden impulse without regard for the consequences of his/her behavior. Give details.
On the basis of your examination and/or knowledge of this patient, mark Yes or No for periodic psychiatric examinations. Give details. List medications and dosage.
In Diabetes, mark Yes or No for a history of diabetes, insulin taken and oral medication taken. Enter Recent urine sugars and Recent blood sugars.
Mark Yes or No for any occurrences of diabetic coma and insulin shock. If yes, give dates. Mark any associated abnormalities: Visual, Renal, Vascular, Neurological or Other. If yes, describe.
Mark Yes or No for hypoglycemia. If yes, describe treatment. List medications taken and dosage. Mark Yes or No for reliable in taking diabetes medication and for diabetes controlled.
To be Signed by the Patient
The patient signs section 3 to authorize the examining physician, whose signature appears below, to release all information and findings contained herein to the Louisiana Department of Public Safety and Corrections.
Enter the Date. Sign as Signature of Patient.
To be Completed, Signed, and Dated by the Physician
This form is considered valid only if the date of the physician's signature has not exceeded sixty (60) days.
Mark Yes or No: are you this patient's treating physician? In your opinion, from a medical standpoint, mark Yes or No: is it safe for this patient to operate a motor vehicle?
On the basis of your examination and/or knowledge of this patient, mark Yes or No: do you recommend periodic medical reports be submitted? If yes, mark how often: 6 months, 1 year, 2 years or Other.
Write Remarks, then the Physician's Signature, Date, Physician's Printed Name, Telephone # and Physician's Address.
More rules for Form DPSMV2302
The Department of Public Safety and Corrections will use the completed report of examination as a guide in making a final determination on the bearer's application, which is now pending.
Sources
[1] Form DPSMV2302 (R 07/2026), Medical Examination Form, Louisiana Department of Public Safety and Corrections Office of Motor Vehicles (the Official source link on this page).
