PennDOT DL-122ADS School Bus Diabetic Waiver Form Guide – School bus drivers in Pennsylvania who manage diabetes with insulin or other hypoglycemic medications must meet strict medical standards under state law. The Pennsylvania Department of Transportation (PennDOT) provides a pathway for qualified drivers through a medical waiver process. Form DL-122ADS is the official electronic submission version of the School Bus Driver Diabetic Waiver Form (also known as DL-122A). This form allows healthcare providers to complete, sign, and submit the required medical documentation digitally to PennDOT for faster processing.
This guide explains what Form DL-122ADS is, who needs it, the eligibility criteria under Pennsylvania regulations, how to complete the electronic submission, and where to access the official form. All information is based on current PennDOT resources and Title 67 of the Pennsylvania Code.
What Is PennDOT Form DL-122ADS?
Form DL-122ADS is the digital (DocuSign-enabled) version of the School Bus Driver Diabetic Waiver Form used by the Pennsylvania Department of Transportation’s Driver and Vehicle Services. It is initiated by the primary physician and collects detailed medical information about a school bus driver’s diabetes management.
The form supports electronic completion and submission so that signed medical documentation reaches PennDOT quickly. Healthcare providers use it to certify that a driver meets the waiver criteria outlined in 67 Pa. Code § 71.3. The “DS” suffix indicates the form is designed for electronic submission through PennDOT’s secure digital process.
Official guidance for the form notes that the primary physician initiates it. If the primary physician also completes the eye examination section, the eye exam physician role can be left blank. Otherwise, the name and email of an eye exam physician can be entered so that portion can be completed separately.
Who Needs the School Bus Driver Diabetic Waiver Form?
Under Pennsylvania regulations, a person is generally not qualified to drive a school bus if they have an established medical history or clinical diagnosis of diabetes mellitus that currently requires the use of insulin or other hypoglycemic medication. However, PennDOT may grant a waiver when specific safety criteria are met.
School bus drivers (or applicants for a school bus endorsement) who use diabetic medications must obtain this waiver to remain eligible. The form is completed by qualified healthcare providers—typically a physician, CRNP, or physician assistant familiar with the driver’s diabetic history—and submitted to PennDOT as part of the medical qualification process for the school bus endorsement.
Drivers must also meet the broader physical examination requirements for school bus operators under Chapter 71, including the periodic school bus physical (Form DL-704).
Eligibility Requirements for the Diabetic Waiver
According to PennDOT’s medical reporting guidance and 67 Pa. Code § 71.3(b)(4), a waiver may be granted if the individual meets all of the following conditions:
- The healthcare provider verifies in writing that there has been no incident of a severe hypoglycemic reaction or symptomatic hyperglycemia, and the individual has been free from an insulin reaction resulting in loss of consciousness, attention or awareness, or the need for assistance from another person, for the preceding 12 months.
- The driver submits to a diabetic examination every 6 months and provides the results of the examination along with Hemoglobin A1C (HbA1C) test results on the form provided by the Department. The reviewing healthcare provider must be familiar with the person’s diabetic history for the prior 24 months (or have access to that history) and certify that the individual is under good diabetic control.
- If the driver has had two consecutive HbA1C test results greater than 8%, additional diabetic examinations are required every 3 months. The provider must review self-monitoring blood glucose logs, report the highest and lowest levels for that period, and certify that the levels are not suggestive of hypoglycemic or hyperglycemic driving impairment.
- Once two consecutive HbA1C results are 8% or less, the more frequent examinations may be discontinued.
- The driver must submit to an annual dilated eye examination and report the results on the appropriate form.
Additional ongoing management requirements for drivers operating under the waiver include:
- Self-monitoring blood glucose approximately 1 hour before driving and at least every 4 hours while driving or on duty, using a portable device with computerized memory. Driving is not permitted if blood glucose is below 80 mg/dL or above 350 mg/dL until appropriate measures are taken and the reading returns to the acceptable range.
- Submitting computerized glucometer results and a manual blood glucose log every 6 months to the healthcare provider conducting the diabetic examination.
- Carrying a source of rapidly absorbable glucose at all times while driving a school bus.
A limited exception exists for individuals who recently experienced a severe hypoglycemic reaction or symptomatic hyperglycemia, provided they have been free of such episodes for the preceding 12 months and the episode occurred while under a treating physician’s care during a nonrecurring transient illness, toxic ingestion, or metabolic imbalance.
How to Complete and Submit Form DL-122ADS Electronically?
PennDOT has modernized many medical forms to support secure electronic submission. Form DL-122ADS is completed through a digital signing platform (DocuSign). The process works as follows:
- The primary physician accesses the electronic form using the official link provided by PennDOT.
- The physician (and any additional signers, such as an eye exam physician) enters full name and email address when prompted.
- The form is displayed for completion of all required fields, including medical history, examination results, HbA1C data, and certifications.
- After completing the fields, the provider adds an electronic signature.
- Upon finishing, the completed and signed form is automatically emailed to PennDOT for processing.
For questions about the form content, contact PennDOT’s Driver and Vehicle Services Customer Call Center at 717-412-5300 and reference “Driver Licensing Form.” For technical issues with the digital signature process, reference “DocuSign DVS.”
Healthcare providers who need access credentials for medical reporting forms can request them through the official PennDOT process on the Medical Reporting Forms page.
Download the Official Form DL-122ADS
The current official PDF instructions and electronic submission link for the School Bus Driver Diabetic Waiver Form are available directly from the Commonwealth of Pennsylvania:
Download PennDOT Form DL-122ADS – School Bus Driver Diabetic Waiver Form (Electronic Submission)
Always use the version hosted on the official pa.gov domain to ensure you have the most current instructions and submission link. Printable or non-electronic versions of related forms (such as DL-122A) may also be available on the same medical reporting resources page, but the DS version is preferred for faster electronic processing.
Related Forms and Ongoing Compliance
Drivers who receive a diabetic waiver typically also interact with related documentation, including:
- School Bus Driver’s Physical Examination Form (DL-704) – required periodically.
- Follow-up forms such as the 3-month diabetic reporting form (DL-122B series) when more frequent monitoring is required due to elevated HbA1C results.
- Annual dilated eye examination results.
Maintaining the waiver requires consistent compliance with the 6-month (or 3-month) examination schedule, proper glucose monitoring while on duty, and timely submission of required reports. Failure to meet these conditions can result in loss of the waiver and the school bus endorsement.
Why Electronic Submission Matters
PennDOT has expanded electronic submission options for many driver licensing and medical forms to reduce processing times and improve service. Forms marked with a “DS” suffix, including DL-122ADS, allow healthcare providers to complete and transmit signed documents digitally. This change, announced as part of broader modernization efforts, helps school bus drivers and their medical providers avoid mail delays and supports quicker review by PennDOT staff.
Additional Resources from Official Sources
- PennDOT Medical Reporting Forms – Official list of forms and regulatory summaries for school bus drivers and general drivers.
- 67 Pa. Code § 71.3 – Physical examination – Full regulatory text governing school bus driver qualifications and the diabetic waiver.
- School Transportation FAQs – PennDOT answers on licensing, physicals, and credentials required for school bus drivers.
For the most accurate and up-to-date information, always consult the official Pennsylvania Department of Transportation website and the current version of Title 67 of the Pennsylvania Code. Individual medical situations can vary, so drivers should work closely with their treating healthcare provider and, when needed, contact PennDOT’s Special Driver Programs for case-specific guidance.