PennDOT DL-122 DS Diabetic Form | Electronic Submission – Pennsylvania drivers living with diabetes mellitus may need medical documentation to obtain, retain, or restore driving privileges. The official form used for this purpose is the PennDOT Form DL-122 DS (Diabetic Form). The “DS” designation indicates the version designed for secure electronic submission. This guide explains what the form is, who must complete it, the medical standards that apply, and how healthcare professionals can submit it online quickly and securely.
What Is PennDOT Form DL-122 DS?
Form DL-122 is the official Diabetic Form issued by the Pennsylvania Department of Transportation (PennDOT) Driver and Vehicle Services. Healthcare professionals use it to report and certify information about a patient’s diabetes management, control, and any related episodes that could affect safe driving.
The DS version supports electronic completion and submission through a secure digital signature platform (DocuSign). This option was expanded by PennDOT to speed processing and reduce mailing delays for medical reporting forms.
According to official guidance, the form is intended for healthcare professionals only. Access typically requires medical reporting login credentials issued by PennDOT.
When Is the DL-122 Form Required?
Under Pennsylvania regulations (67 Pa. Code § 83.5), a person with unstable diabetes mellitus that leads to severe hypoglycemic reactions or symptomatic hyperglycemia is generally not qualified to drive unless there has been a continuous period of at least six months free from a disqualifying episode.
The treating healthcare provider must complete Form DL-122 (or the electronic DS version) to certify the patient’s condition. Common situations that trigger the form include:
- Initial medical reporting of diabetes that may impair driving ability
- Follow-up diabetic examinations after a disqualifying episode
- Requests to restore driving privileges once the condition has stabilized
- Periodic monitoring as required by PennDOT (often at 6-, 12-, 24-, and 48-month intervals)
Follow-up examinations typically include an HbA1C test and a vision screening. More frequent reporting may be required if recommended by the treating provider.
A waiver from disqualification may be possible if a subsequent episode occurred while under medical care, during a nonrecurring transient illness, or due to toxic ingestion or metabolic imbalance—and the provider certifies it is unlikely to recur.
Who Completes Form DL-122 DS?
Only authorized healthcare professionals may complete and submit the form. Patients themselves do not fill out the medical sections. The form gathers details about diagnosis, treatment regimen, blood glucose control, episodes of hypoglycemia or hyperglycemia, and the provider’s professional opinion regarding the patient’s fitness to drive.
Healthcare providers who do not yet have PennDOT medical reporting credentials must first register. Official instructions direct providers to request credentials through the PennDOT Driver and Vehicle Services medical email form.
How to Complete and Submit Form DL-122 DS Electronically?
PennDOT has streamlined the process so eligible forms can be completed, signed, and transmitted online. The steps generally follow this sequence:
- Access the official DL-122 DS form link or the protected medical forms area on the PennDOT website.
- Enter your full name and email address when prompted. If multiple signatures are required, provide the additional signer’s information.
- Click “Begin Signing” to open the form in the secure electronic platform.
- Complete all required fields on Page 1 in full. Page 2 is completed only when applicable.
- If the vision portion cannot be completed, the item is directed to a vision specialist.
- Add your electronic signature when prompted.
- Select “Finish.” The completed form is emailed directly to PennDOT for processing.
This electronic pathway helps reduce processing time compared with traditional mail or fax submission.
Download the official form here:
Pennsylvania PennDOT Form DL-122 DS – Diabetic Form (PDF)
Key Medical Standards for Diabetes and Driving in Pennsylvania
Pennsylvania law prioritizes public safety while allowing qualified drivers with well-managed diabetes to retain privileges. Important points include:
- A continuous six-month period free from severe hypoglycemic reactions or symptomatic hyperglycemia is generally required before restoration of privileges after a disqualifying episode.
- Follow-up diabetic examinations (including HbA1C and vision screening) occur on a prescribed schedule after restoration.
- Providers must certify that the patient is under good diabetic control when submitting follow-up forms.
- Waivers are available in limited, well-documented circumstances involving temporary or isolated incidents.
For school bus drivers, different and often stricter standards apply under Chapter 71 regulations, which may involve Form DL-122A or related waiver forms.
Contact Information and Support
Healthcare professionals and drivers with questions about Form DL-122 DS or the medical review process can reach PennDOT through the following channels:
- Customer Call Center: 717-412-5300 (reference “Driver Licensing Form” for form questions or “DocuSign DVS” for technical issues with electronic signatures)
- Medical Reporting Unit: 717-787-9664
- Email: [email protected]
- Mail: Bureau of Driver Licensing, P.O. Box 68682, Harrisburg, PA 17106-8682
Hours for the medical unit are typically 8:00 a.m. to 4:15 p.m., Monday through Friday.
Additional official resources are available on the PennDOT Medical Reporting Forms page and the main Medical Reporting Information Center.
Why Electronic Submission Matters?
Since 2023, PennDOT has expanded electronic submission options for more than 20 commonly used driver licensing and motor vehicle forms, including several medical reporting documents. Forms marked with the “DS” suffix support digital completion and secure transmission. This modernization reduces paper handling, shortens wait times, and allows faster review by the Bureau of Driver Licensing.
Healthcare providers are encouraged to use the electronic option whenever possible to ensure prompt processing for their patients.
Final Notes for Drivers and Providers
Accurate and timely medical reporting helps protect both individual drivers and the traveling public on Pennsylvania roadways. Drivers with diabetes should work closely with their healthcare team to maintain good control and to submit required documentation on schedule. Providers should complete every required field thoroughly and retain copies of submitted forms for their records.
Always verify the most current version of Form DL-122 DS and any related instructions directly on the official Commonwealth of Pennsylvania website, as forms and procedures can be updated.
For the latest information, visit the official PennDOT Driver and Vehicle Services medical reporting pages or contact the numbers listed above.