Form HSMV 72120. Application for Developmental Disability Designation - Florida

The Form HSMV 72120, also known as the Application for Developmental Disability Designation, is used in Florida to request a designation for individuals with developmental disabilities. Its purpose is to obtain a special indication on the driver's license to facilitate interactions with law enforcement and emergency personnel, providing them with information about the individual's condition.

The form consists of sections that require accurate completion, including personal information of the applicant, details about the developmental disability diagnosis, information about the treating physician or licensed psychologist, and the applicant's consent for the disclosure of medical records. It also includes a declaration of accuracy and requires signatures from both the applicant and the treating professional.

When filling out this form, it is important to provide truthful and complete personal information and ensure that the developmental disability diagnosis is accurately documented. The treating physician or licensed psychologist should review and validate the information before signing the form. Any additional supporting documentation, such as medical reports or diagnostic evaluations, may need to be attached to the application.

An example of an application for this form would be an individual with a developmental disability who wants to have their driver's license designated accordingly. This designation helps law enforcement and emergency personnel understand the unique needs and considerations when interacting with the individual during traffic stops or emergencies.

A related form is the Medical Reporting Form (Form HSMV 72010), which is used to report any medical condition or impairment that may affect an individual's ability to safely operate a motor vehicle. While the Application for Developmental Disability Designation focuses specifically on individuals with developmental disabilities, the Medical Reporting Form covers a broader range of medical conditions.