PennDOT Form DL-126 Orthopedic Form | PA Official Guide – The Pennsylvania Department of Transportation (PennDOT) Form DL-126, known as the Orthopedic Form, is a critical medical reporting document used exclusively by licensed healthcare professionals. It helps evaluate and report orthopedic conditions that may impair a driver’s ability to safely operate a motor vehicle in Pennsylvania. This form supports public safety by ensuring drivers with significant musculoskeletal limitations meet state medical standards for licensing.
Under Pennsylvania law, healthcare providers play a key role in identifying drivers whose physical conditions could pose risks on the road. Form DL-126 specifically addresses orthopedic issues and aligns with regulations in 67 Pa. Code Chapter 83.
What Is PennDOT Form DL-126?
Form DL-126 is the official Orthopedic Form issued by PennDOT’s Bureau of Driver Licensing. It is designed for healthcare professionals only—physicians, chiropractors, physician assistants, certified registered nurse practitioners, and other authorized providers—to document and report orthopedic conditions that may affect driving fitness.
The form is password-protected and available only to registered healthcare personnel through PennDOT’s medical reporting system. It is not intended for public or patient use. Providers use it to detail conditions such as loss or impairment of a joint or extremity, or rheumatic, arthritic, orthopedic, muscular, vascular, or neuromuscular diseases expected to last longer than 90 days.
Official access and submission details are maintained on the Commonwealth of Pennsylvania’s Driver and Vehicle Services website.
Purpose of the Orthopedic Form Under Pennsylvania Law
Pennsylvania Vehicle Code Section 1518(b) requires healthcare providers to report, within 10 days and in writing, any person over 15 years of age diagnosed with a condition that could impair the ability to drive safely. Form DL-126 fulfills this requirement for orthopedic-related issues.
According to 67 Pa. Code § 83.5(b)(1), (2), and (3), a provider may recommend disqualification if the individual has:
- Loss of a joint or extremity as a functional defect or limitation;
- Impairment of the use of a joint or extremity as a functional defect or limitation (if lasting or expected to last longer than 90 days);
- Rheumatic, arthritic, orthopedic, muscular, vascular, or neuromuscular disease (if lasting or expected to last longer than 90 days).
The provider must inform the patient of any driving prohibition and notify PennDOT in writing when the condition meets the 90-day threshold. Temporary conditions expected to resolve in less than 90 days (such as a simple fracture) generally do not require reporting.
In some cases, PennDOT may require a driving examination to assess competency under § 83.5(c).
Who Must Complete Form DL-126?
Only authorized healthcare professionals may complete and submit Form DL-126. Patients cannot fill it out themselves. Providers must first obtain medical reporting login credentials from PennDOT.
To request credentials, healthcare personnel should use the official request process on the PennDOT medical reporting forms page. Once registered, providers can access the protected form and related documents.
There is a related form, DL-126A, used specifically for school bus drivers under Chapter 71 medical regulations. The standard DL-126 applies to non-school bus drivers.
How to Access and Download PennDOT Form DL-126?
The official Form DL-126 is available as a PDF from the Pennsylvania government website. Because it is a protected medical form, full online completion typically requires registration and may involve a secure electronic signature process (such as DocuSign).
Download the official Pennsylvania PennDOT Form DL-126 – Orthopedic Form here:
https://www.pa.gov/content/dam/copapwp-pagov/en/penndot/documents/public/dvspubsforms/bdl/bdl-medical-protected/dl-126.pdf
Note that the direct PDF link may prompt for credentials or redirect to the secure portal. Healthcare professionals without credentials should first request access via the official medical reporting forms page.
For the most current version and electronic submission options, visit the official Medical Reporting Forms page: https://www.pa.gov/agencies/dmv/resources/medical-reporting/medical-reporting-forms.
How to Complete and Submit Form DL-126
After obtaining credentials:
- Access the form through the secure PennDOT portal or the provided download link.
- Complete all required fields with accurate patient information, diagnosis details, functional limitations, expected duration, and clinical findings.
- Provide a professional recommendation regarding the patient’s ability to control and safely operate a motor vehicle.
- Sign the form (electronic signature is available via the online process).
- Submit the completed form. Online submission via the DocuSign-enabled process emails the form directly to PennDOT for processing.
Providers may also submit reports by letter or the general Initial Reporting Form (DL-13) if preferred, but the condition-specific DL-126 is recommended for orthopedic cases to assist PennDOT’s review.
For questions about the form, contact PennDOT’s Driver and Vehicle Services Customer Call Center at 717-412-5300 (reference “Driver Licensing Form”). For technical issues with electronic signing, reference “DocuSign DVS.”
Medical reporting inquiries can also be directed to [email protected] or the Bureau of Driver Licensing, P.O. Box 68682, Harrisburg, PA 17106-8682. Phone: 717-787-9664 (hours typically 8 a.m. – 4:15 p.m., Monday–Friday).
Key Regulations Governing Orthopedic Reporting
The primary legal framework is 67 Pa. Code Chapter 83 (Physical and Mental Criteria, Including Vision Standards Relating to the Licensing of Drivers). Section 83.5 specifically addresses other physical and medical standards, including the orthopedic provisions outlined above.
Reporting is mandatory when the condition is likely to impair safe vehicle operation and meets the duration criteria. Failure to report may expose providers to summary criminal offense liability under Pennsylvania law.
PennDOT’s Medical Advisory Board, which includes an orthopedic surgeon among its members, helps formulate these standards. The process is subject to public review through the Commonwealth’s regulatory review procedures.
Additional resources and the full medical reporting process are available on the official Medical Reporting Information Center: https://www.pa.gov/agencies/dmv/resources/medical-reporting.
Why Accurate Reporting Matters for Pennsylvania Drivers and Road Safety?
Medical reporting through forms such as DL-126 helps PennDOT identify drivers who may need license restrictions, further evaluation, or temporary suspension until fitness is restored. This protects the individual driver, passengers, and the traveling public.
Conditions reported on DL-126 can lead to a driving examination, adaptive equipment requirements, or other licensing actions tailored to the functional limitation. Once a condition improves or resolves, updated medical documentation can support restoration of full driving privileges.
Healthcare professionals in Pennsylvania are essential partners in this public safety effort. Timely, accurate use of Form DL-126 ensures compliance with state law and contributes to safer roadways across the Commonwealth.
Additional Resources and Related Forms
- Official Medical Reporting Forms page: https://www.pa.gov/agencies/dmv/resources/medical-reporting/medical-reporting-forms
- Medical Reporting FAQs and process information: Available through the PennDOT Driver and Vehicle Services site.
- Related school bus form: DL-126A (Orthopedic Form for school bus drivers under Chapter 71).
- Full text of 67 Pa. Code § 83.5: Available via official Pennsylvania Code resources.
Always use the most current official form and instructions from pa.gov. Information on this page is based on publicly available Commonwealth of Pennsylvania resources as of the latest available updates and is intended for informational purposes. Healthcare providers should verify requirements directly with PennDOT.