PA DOT Form DL-104 DS. General Psychiatric Form

General Psychiatric Form (DL-104 DS) is a form used by the Pennsylvania Department of Transportation (PennDOT) to evaluate the psychiatric fitness of individuals applying for or renewing their driver's license. This form serves the purpose of gathering comprehensive information about the applicant's mental health history and current condition, enabling an assessment of their ability to safely operate a motor vehicle.

The DL-104 DS form consists of several sections that cover various aspects of the applicant's psychiatric background. It begins with personal information such as name, address, date of birth, and driver's license number. The subsequent sections delve into the applicant's psychiatric history, encompassing details about diagnoses, treatments, medications, hospitalizations, and counseling received. The form may also inquire about any substance abuse or addiction issues.

Accuracy and completeness when filling out this form are crucial. It is essential to provide honest and thorough information regarding psychiatric conditions and treatments, as incomplete or misleading information can compromise the evaluation process. Both the applicant and their healthcare provider must sign the form, attesting to the accuracy of the information provided.

Application Example: An individual recently diagnosed with a psychiatric disorder who wishes to continue driving would be required to complete the DL-104 DS form. They would need to provide detailed information about their diagnosis, treatment plan, and how their condition may impact their driving abilities. This form ensures that individuals with psychiatric conditions undergo appropriate evaluation to determine if they meet the necessary criteria for safe driving.

Related Forms: While there may not be direct alternatives to Form DL-104 DS, other forms related to medical evaluations for driver's licenses may exist in different jurisdictions or for specific purposes, such as commercial driver's licenses or specialized endorsements.