Form HSMV 72423. Medical Report - Florida
The Form HSMV 72423, known as the Medical Report, is used in Florida to report an individual's medical condition or impairment that may affect their ability to safely operate a motor vehicle. The purpose of this form is to provide comprehensive information about the individual's medical history and current health status to determine their fitness to drive.
The form consists of sections that require accurate completion, including personal information of the applicant, details about the medical condition or impairment, information about treating physicians or healthcare providers, medication usage, and any additional relevant information. It also requires the signature and contact information of the healthcare provider or physician providing the medical assessment.
When filling out this form, it is important to provide detailed and truthful information about the medical condition or impairment. It is crucial for the healthcare provider or physician to conduct a thorough evaluation and accurately document the medical history, treatment plans, and any potential restrictions or recommendations for driving. Supporting medical records or test results may need to be attached to the form.
An example of an application for this form would be when an individual has a medical condition or impairment, such as epilepsy or a visual impairment, which may impact their ability to safely operate a vehicle. By submitting the Medical Report, the individual provides necessary information to the Department of Highway Safety and Motor Vehicles for evaluation and consideration of their driving privileges.
A related form is the Report a Driver Whose Ability is Questionable (Form HSMV 72190), which allows concerned individuals to report drivers whose driving abilities are questionable due to potential impairments. While the Medical Report focuses on providing comprehensive medical information about an individual's condition, the Report a Driver Whose Ability is Questionable form is more oriented towards reporting concerns about specific drivers.