Florida HSMV Form 72481 Mental Status Exam Guide – The Florida Department of Highway Safety and Motor Vehicles (FLHSMV) uses Form HSMV 72481, officially titled the Mental Status Examination Form, as a critical tool in evaluating whether a driver or applicant with a history of severe mental disorders can safely operate a motor vehicle. This form is required under Florida Administrative Code Rule 15A-5.010 and plays a key role in the state’s Medical Review Program.
What Is Florida HSMV Form 72481?
HSMV 72481 is the official Mental Status Examination Form used by the Florida Department of Highway Safety and Motor Vehicles. It is completed by a licensed psychiatrist and provides a detailed clinical assessment of a driver’s mental status, judgment, insight, and ability to operate a motor vehicle safely.
The form is incorporated by reference in Florida Administrative Code Rule 15A-5.010 (Severe Mental Disorders) and has been effective since July 2018. It is one of several medical forms used in the FLHSMV Medical Review Program, which evaluates drivers whose physical or mental conditions may affect safe driving.
Unlike general medical reports, Form 72481 focuses specifically on psychiatric evaluation and includes structured sections covering appearance, mood, thought processes, memory, judgment, medication, and the psychiatrist’s professional opinion on driving safety.
When Is Form 72481 Required?
Under Florida Administrative Code 15A-5.010, applicants or licensed drivers who have suffered from severe mental disorders that required hospitalization or treatment for six months or more must submit a completed Mental Status Examination Form (HSMV 72481) from a licensed psychiatrist.
Severe mental disorders covered by the rule may include:
- Acute and/or chronic psychotic reactions
- Personality disorders that manifest violent or aggressive behavior
- Other serious mental disorders that interfere with judgment or reaction time
Additionally, any driver who has been adjudged incompetent is not considered capable of safely operating a motor vehicle unless their competency has been judicially restored.
The form is typically requested during the Medical Review process after a referral is made to the FLHSMV Medical Review Program. Referrals can come from physicians, law enforcement, concerned citizens, or the department itself when there is reason to believe a medical or psychiatric condition may affect driving ability.
Who Must Complete the Mental Status Examination Form?
Only a licensed psychiatrist may complete and sign Form HSMV 72481. The form requires the physician’s printed name, medical license number, specialty, address, telephone number, and signature.
The examining psychiatrist is asked to provide information about:
- How long they have treated the patient
- Other physicians who have treated the patient in the past two years
- A brief history of the illness
- Current diagnosis and medications
- The patient’s compliance with treatment
- Past and current use of alcohol or drugs
- A professional opinion on whether the individual can safely operate a motor vehicle
The psychiatrist’s clinical judgment is central to the department’s decision regarding driving privileges.
Key Sections of Florida HSMV Form 72481
The form is structured to capture a comprehensive mental status examination. Major sections include:
- Patient Identification – Name, date of birth, driver’s license number, and telephone number
- Treatment History – Duration of care and other treating physicians
- Clinical Observations – General appearance, manner, attitude, and behavior
- Mental Status Findings – Consciousness and sensorium, affectivity and mood, associations and thought processes (including delusions or hallucinations), memory (recent and remote), calculation ability, fund of information, judgment and insight, and personality maturity
- Diagnosis and Treatment – Current diagnosis, medications and dosages, and whether the examining physician is the prescribing doctor
- Substance Use – Comments on past and current alcohol or drug use
- Driving Safety Opinion – The psychiatrist’s yes/no determination of whether the individual can operate a motor vehicle safely, relative to any psychiatric considerations
- Physician Certification – Signature, license number, specialty, and contact information
The completed form must be mailed or faxed to the FLHSMV Medical Review Program.
How to Submit the Completed Form?
Once the licensed psychiatrist has completed and signed Form 72481, it should be submitted 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
It is important to submit the form promptly. Failure to provide required medical documentation within the time specified by the department can result in suspension or revocation of driving privileges.
The Role of the Florida Medical Review Program
The FLHSMV Medical Review Program evaluates drivers whose medical or psychiatric conditions may interfere with the safe operation of a motor vehicle. The program’s goal is not to automatically remove driving privileges but to determine whether a condition affects safety and, if necessary, to require appropriate medical documentation or re-examination.
Cases involving severe mental disorders are reviewed under the guidelines of Rule 15A-5.010. The Medical Advisory Board, composed of licensed physicians, may review submitted medical reports and provide recommendations to the department.
For more information about the Medical Review process, visit the official FLHSMV Medical Review page.
Where to Download Florida HSMV Form 72481?
The official, current version of the Mental Status Examination Form is available directly from the Florida Department of Highway Safety and Motor Vehicles:
Download HSMV Form 72481 – Mental Status Examination Form (PDF)
The form is also listed on the FLHSMV Forms page under form number 72481.
Always download the form from the official FLHSMV website to ensure you are using the most current version (effective 07/18).
Related Forms and Resources
Drivers involved in the Medical Review process may also encounter related forms, including:
- HSMV 72423 – Medical Report
- HSMV 72480 – Alcohol and Drug Usage Form
- HSMV 72190 – Report a Driver Whose Ability is Questionable
These forms, along with Form 72481, support the department’s evaluation of physical and mental fitness to drive under Florida Statutes Chapter 322 and Florida Administrative Code Chapter 15A-5.
Frequently Asked Questions
Can any doctor complete Form 72481?
No. The form must be completed by a licensed psychiatrist.
Is the form required for all mental health conditions?
No. It is specifically required for severe mental disorders that have required hospitalization or treatment for six months or more, or in other cases where the department requests a psychiatric evaluation as part of a medical review.
What happens after the form is submitted?
The Medical Review Program reviews the documentation. The case may be referred to the Medical Advisory Board for recommendation. The department then issues a decision regarding driving privileges, which may include approval, restrictions, re-examination, or suspension.
Where can I find the official rule?
The governing rule is Florida Administrative Code 15A-5.010 – Severe Mental Disorders.
Conclusion
Florida HSMV Form 72481, the Mental Status Examination Form, is an essential document for drivers with a history of severe mental disorders who are undergoing medical review by the Florida Department of Highway Safety and Motor Vehicles. Completed only by a licensed psychiatrist, the form provides critical clinical information that helps determine whether an individual can safely operate a motor vehicle.
If you have been requested to submit this form, download the official PDF, have it completed by a qualified psychiatrist, and return it promptly to the Medical Review Program in Tallahassee.