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Florida Form 72190 2018-2026

Use a Florida Form 72190 2018 template to make your document workflow more streamlined.

And (3), Florida Statutes, provide, in part, that “Any physician, person, or agency having knowledge of any licensed driver’s or applicant’s mental or physical disability to drive . . . is authorized to report such knowledge to the Department of Highway Safety and Motor Vehicles . . .. The reports authorized by this section shall be confidential . . .. No civil or criminal action may be brought against any physician, person or agency who provides the information herein.” When reporting an...

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What is the Florida Form 72190

The Florida Form 72190, commonly referred to as the DMV medical form, is a document required by the Florida Department of Highway Safety and Motor Vehicles (DHSMV). This form is used to assess an individual's medical fitness to operate a motor vehicle. It is particularly relevant for individuals with certain medical conditions that may affect their driving abilities. The completion of this form is essential for ensuring that all drivers meet the necessary health standards for safe driving.

How to use the Florida Form 72190

The Florida Form 72190 should be used when a driver has a medical condition that could impair their ability to drive safely. This includes conditions such as epilepsy, vision impairments, or other serious health issues. To use the form, individuals must fill it out accurately, providing detailed information about their medical history and current health status. After completing the form, it must be submitted to the appropriate authorities as part of the driver's license application or renewal process.

Steps to complete the Florida Form 72190

Completing the Florida Form 72190 involves several key steps:

  • Obtain the form from the Florida DHSMV website or a local office.
  • Fill in personal information, including name, address, and date of birth.
  • Provide detailed medical history, including any diagnosed conditions and treatments.
  • Have the form signed by a licensed medical professional who can verify the information provided.
  • Submit the completed form to the DHSMV, either online or in person, as required.

Legal use of the Florida Form 72190

The legal use of the Florida Form 72190 is governed by state laws that require drivers to disclose any medical conditions that may affect their driving capabilities. This form must be completed truthfully, as providing false information can lead to penalties, including fines or suspension of driving privileges. The form serves to protect both the driver and the public by ensuring that only those who are medically fit are allowed to operate vehicles.

Key elements of the Florida Form 72190

Key elements of the Florida Form 72190 include:

  • Personal identification details of the applicant.
  • A comprehensive medical history section.
  • Signature of a licensed healthcare provider.
  • Instructions for submission and any applicable fees.

Who Issues the Form

The Florida Form 72190 is issued by the Florida Department of Highway Safety and Motor Vehicles (DHSMV). This state agency oversees the licensing of drivers and the regulation of motor vehicle safety. The DHSMV ensures that all drivers meet the required health standards through the completion and submission of this medical form, thus promoting road safety across Florida.

Quick guide on how to complete florida form 72190

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VersionsForm popularityFillable & printable
FL HSMV 72190 20184.8 Satisfied (712 Votes)
FL HSMV 72190 20134.8 Satisfied (4398 Votes)
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How to create an eSignature for the florida form 72190

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Related links to Florida Form 72190
MEDICAL REFERRAL FORM

HSMV 72190 (Effective 07/18), 15A-5.002, F.A.C.. STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND. MOTOR VEHICLES. MEDICAL REFERRAL FORM. Our agency is ...Read more

Fla. Admin. Code Ann. R. 15A-5.002 - Report of Deficit or ...

(3) Receipt by the Department of a report submitted pursuant to section 322.126, F.S. This information may be submitted on a Medical Referral Form, HSMV 72190, ...Read more

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