Florida HSMV Form 72118 Diabetes Form

Florida HSMV Form 72118 Diabetes Form – Official Guide – If you have diabetes and experienced a hypoglycemic episode that led to a motor vehicle crash in Florida, the Florida Department of Highway Safety and Motor Vehicles (FLHSMV) may require you to submit HSMV Form 72118, commonly known as the Diabetes Form. This official medical form helps the state’s Medical Review Program determine whether you can safely continue operating a motor vehicle.

This comprehensive guide covers what the form is, when it is required, how to complete it, where to submit it, and how to download the official PDF. All information is based on current Florida Administrative Code and official FLHSMV resources.

What Is Florida HSMV Form 72118?

HSMV Form 72118 is the official Diabetes Form (also appearing as Diabetes/Hypoglycemia Follow-Up Form on the document itself) issued by the Florida Department of Highway Safety and Motor Vehicles. It is specifically referenced in Florida Administrative Code Rule 15A-5.005 regarding loss of consciousness.

According to the rule, applicants or licensed drivers who experienced a loss of consciousness due to hypoglycemia must generally provide a Medical Report (HSMV 72423) and/or the Diabetes/Hypoglycemia Follow-Up Form (HSMV 72112). However, if the hypoglycemic episode resulted in a motor vehicle crash, the driver must present the Diabetes Form — HSMV 72118 — completed by their treating physician.

The form is effective as of July 2018 and is incorporated by reference in Rule 15A-5.005, F.A.C.

When Is HSMV Form 72118 Required?

You will typically need to submit Form 72118 in the following situation:

You (or a licensed driver) experienced an episode of hypoglycemia that resulted in a motor vehicle crash.
The incident was reported to FLHSMV, triggering a medical review of your ability to safely operate a motor vehicle.

The form is not a routine requirement for every driver with diabetes. Most drivers with well-managed diabetes do not need to file it. It becomes necessary only when a crash linked to hypoglycemia has occurred and the Medical Review Program requests physician input.

Related forms you may also encounter include:

HSMV 72112 – Diabetes/Hypoglycemia Follow-Up Form (general cases without a crash)
HSMV 72423 – Medical Report
HSMV 72117 – Loss of Consciousness Follow-Up Form

Purpose of the Florida Diabetes Form

The primary purpose of HSMV Form 72118 is to help the FLHSMV Medical Review Program and Medical Advisory Board evaluate whether a driver with diabetes can safely continue driving after a hypoglycemia-related crash. The form asks the treating physician key questions about:

How long the physician has treated the patient and the date of the last office visit
Whether any further episodes of hypoglycemia have occurred since the crash
The physician’s assessment of how well the patient’s diabetes is being managed
Advice given to the patient to prevent recurrence of hypoglycemia while driving
Whether the patient is sufficiently well instructed and conscientiously applying those instructions so that another episode while driving is highly unlikely

This information allows the Department to make an informed decision about continued licensing, possible restrictions, or further medical follow-up.

How to Download the Official HSMV Form 72118 PDF?

The official, current version of the form is available directly from the Florida Department of Highway Safety and Motor Vehicles website. Always download the form from the official source to ensure you have the most recent version.

Download HSMV Form 72118 (Diabetes Form) here:
https://www.flhsmv.gov/pdf/forms/72118.pdf

The form is a fillable PDF in many browsers and software programs. Print a clear copy if your physician prefers a paper version.

How to Complete Florida HSMV Form 72118?

The form is designed to be completed primarily by the treating physician. Here is a breakdown of the key sections:

Header Information – The driver’s name (RE:), driver license number (DL#), and date of birth (DOB) are entered at the top.
Crash Date – The physician or department notes the date of the hypoglycemia-related motor vehicle crash.
Physician Questions – The physician answers five specific questions about treatment history, additional hypoglycemic episodes, diabetes management, preventive advice, and the likelihood of future episodes while driving.
Physician Signature Block – Includes signature, printed name, medical license number, address, telephone number, and date.

Accuracy and completeness are essential. Incomplete forms can delay the medical review process.

Where to Submit the Completed Form?

Once the physician has completed and signed Form 72118, mail it to the following address:

Bureau of Motorist Compliance
Medical Review Program
Neil Kirkman Building, MS 86
Tallahassee, Florida 32399-0500

Contact information listed on the form:

Telephone: (850) 617-3814
Fax: (850) 617-3944

Keep a copy of the completed form for your records. Do not send original medical records unless specifically requested.

Florida Medical Review Process for Drivers with Diabetes

The FLHSMV Medical Review Program exists to ensure that medical conditions do not interfere with the safe operation of a motor vehicle. Referrals can come from physicians, law enforcement, courts, concerned citizens, or the Department itself.

Medical reporting is confidential under Section 322.126, Florida Statutes. No legal action can be taken against a person who submits a good-faith report.

After receiving Form 72118 and any other required medical documentation, the Medical Advisory Board reviews the case and makes recommendations regarding the driver’s licensing status. Outcomes may include unrestricted driving privileges, restricted privileges, temporary suspension, or further evaluation.

For more information on the Medical Review Program, visit the official FLHSMV page:
https://www.flhsmv.gov/driver-licenses-id-cards/medical-review/

Tips for Drivers with Diabetes in Florida

Always carry a source of fast-acting glucose in your vehicle.
Check your blood glucose before driving and avoid driving if levels are low or dropping.
Follow your physician’s instructions carefully regarding meal timing, medication, and monitoring.
If you experience any loss of consciousness or severe hypoglycemia, do not resume driving until cleared by your doctor and, if required, by FLHSMV.
Consider requesting a voluntary “SAFE” designation on your vehicle registration if you have diabetes (available under Florida law for certain medical conditions).

Having diabetes does not automatically disqualify you from driving in Florida. The focus is on whether the condition is adequately managed so that you can operate a vehicle safely.

Frequently Asked Questions About HSMV Form 72118

Is Form 72118 the same as Form 72112?
No. Form 72112 is the general Diabetes/Hypoglycemia Follow-Up Form. Form 72118 is specifically required when a hypoglycemic episode caused a motor vehicle crash.

Do I need this form just because I have diabetes?
No. It is only required in the specific circumstance of a crash resulting from hypoglycemia, or when requested by the Medical Review Program.

Can my doctor complete the form electronically?
The official form is a PDF. Many physicians complete it digitally, print it, sign it, and return a scanned or mailed copy.

How long does the medical review take?
Processing times vary. Contact the Medical Review Program at (850) 617-3814 for status updates after submission.

Official Sources and Additional Resources

Official Form Download: HSMV Form 72118 PDF
Florida Administrative Code Rule 15A-5.005 – Loss of Consciousness: Available via the official Florida rules gateway
FLHSMV Medical Review Program: https://www.flhsmv.gov/driver-licenses-id-cards/medical-review/
FLHSMV Forms Directory: https://www.flhsmv.gov/resources/forms/

Always rely on official FLHSMV documents and your treating physician for the most accurate and current guidance regarding your driving privileges.