Florida HSMV Form 72190SP – Report Unsafe Driver (Spanish) – Florida prioritizes roadway safety for all residents and visitors. When concerns arise about a driver’s physical or mental ability to operate a vehicle safely, the Florida Department of Highway Safety and Motor Vehicles (FLHSMV) provides an official process for reporting. The Spanish-language version of this tool is HSMV Form 72190SP, officially titled the Medical Referral Form (Forma de Referencia Médica).
This form allows any physician, person, or agency to submit a confidential report about a licensed driver or applicant whose ability may be questionable due to a medical condition or symptoms—not based on age alone. It is the Spanish counterpart to the English HSMV Form 72190 and is authorized under Florida Statutes Section 322.126.
Download the official form here: Florida HSMV Form 72190SP PDF
What Is Florida HSMV Form 72190SP?
HSMV Form 72190SP is the official Spanish Medical Referral Form issued by the Florida Department of Highway Safety and Motor Vehicles. It is used to report an individual whose driving ability is questionable because of a physical or mental deficit or disorder.
According to FLHSMV, referrals must be based on medical conditions or symptoms that could affect safe driving. The form is designed for use by physicians, family members, friends, law enforcement, or any concerned person or agency. The report must include the full name, date of birth, address, and a complete description of the alleged physical or mental disability for any person over 15 years of age. Incomplete information may invalidate the form.
The form is effective as of July 2018 and is incorporated by reference in Florida Administrative Code Rule 15A-5.002.
Who Can File the Form and Legal Protections?
Florida law (Section 322.126, Florida Statutes) authorizes any physician, person, or agency who has knowledge of a licensed driver’s or applicant’s mental or physical disability to drive to report that knowledge to FLHSMV.
Key protections include:
- Reports are confidential.
- No civil or criminal action may be brought against any physician, person, or agency who provides the information in good faith.
These safeguards encourage reporting when genuine safety concerns exist while protecting those who come forward.
Conditions Commonly Reported on Form 72190SP
The form includes checkboxes for specific physical or mental deficits or disorders, including:
- Seizures (Incautación)
- Severe Cardiac Condition (Condición Cardiaca Severa)
- Stroke (Accidente Cerebrovascular)
- Loss of Consciousness (Pérdida de la Conciencia)
- Uncontrollable Diabetes (Diabetes Incontrolable)
- Dementia / Memory Deficits (Demencia / Déficit de Memoria)
- Psychiatric Disturbance (Perturbaciones Psiquiátricas)
- Drug / Alcohol Addiction (Adicción a Drogas y Alcohol)
- Severe Visual Deficit (Déficit Visual Severo)
- Sleep Disorder (Trastorno del Sueño)
- Other (Otro)
Reporters must explain each marked area and indicate how they know the individual (for example, friend, family member, or patient).
How to Complete and Submit HSMV Form 72190SP?
Follow these steps for accurate submission:
- Download the official Spanish form from the FLHSMV website: https://www.flhsmv.gov/pdf/forms/72190sp.pdf.
- Provide as much information as possible about the driver: full name, date of birth, address, city, ZIP code, gender, driver license number, and state.
- Mark the applicable physical or mental deficits or disorders and explain them in detail.
- State your relationship to the individual.
- Complete the reporter section (name, signature, address, telephone, and date). Note that the reporter’s name and signature are required for the department to investigate the report. Agency or medical license information should be included when applicable.
- Mail or fax the completed form to:
Bureau of Motorist Compliance
Medical Review Program
Neil Kirkman Building, MS 86
Tallahassee, Florida 32399-0500
Telephone: (850) 617-3814
Fax: (850) 617-3944
Official FLHSMV guidance is available on the Report an Unsafe Driver page and the Spanish version Reportar un Conductor Inseguro.
What Happens After the Form Is Submitted?
Once FLHSMV receives Form 72190SP, the department reviews the report. If the complaint appears valid, an investigation may be initiated. The driver is typically notified in writing that they are under medical review and must provide medical information from their physician within 45 days.
The medical report is reviewed by the Medical Advisory Board. Possible outcomes include:
- Requirement for additional medical documentation
- Vision, written, or driving re-examination
- Restriction, suspension, or denial of driving privileges if the condition poses a risk to public safety
Reports are used solely to determine qualifications to operate a motor vehicle on Florida highways.
Related Forms and Resources for Florida Drivers
FLHSMV also provides related forms for mature drivers and medical reviews:
- HSMV Form 72190 (English Medical Referral Form)
- HSMV Form 72119 – Mature Driver Vision Test (required for drivers age 80 and older renewing their license)
- HSMV Form 72010 – Report of Eye Exam
Additional information is available on the official Forms for Older Drivers page and the Spanish equivalent.
Why Reporting Matters for Public Safety in Florida?
Florida law emphasizes that medical reviews focus on conditions or symptoms that could impair safe driving rather than age alone. In recent years, thousands of reports have been received annually, helping identify drivers who may need evaluation while protecting those who report in good faith.
Using the correct official form—especially the Spanish version for Spanish-speaking reporters—helps ensure the report is processed accurately and confidentially. Always obtain the form directly from the official FLHSMV website to guarantee you have the current version.
For the most up-to-date information, visit the Florida Department of Highway Safety and Motor Vehicles website or contact the Medical Review Program at (850) 617-3814.