PennDOT DL-126 DS Orthopedic Form | Electronic Submission

What Is the PennDOT Form DL-126 DS Orthopedic Form?

Form DL-126 is the standard Orthopedic Form used by healthcare professionals in Pennsylvania. The DL-126 DS version enables fully electronic submission through a secure DocuSign-based process. It is intended exclusively for use by authorized healthcare personnel who have obtained medical reporting login credentials from PennDOT.

According to official PennDOT guidance, the form addresses conditions outlined in 67 Pa. Code § 83.5(b)(1), (2), and (3). These regulations allow a provider to recommend disqualification from driving 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 expected to last longer than 90 days
• Rheumatic, arthritic, orthopedic, muscular, vascular, or neuromuscular disease expected to last longer than 90 days

The form collects patient information, details of the orthopedic condition, examination findings, and the provider’s professional assessment regarding the impact on driving ability.

A related form, DL-126A, exists specifically for school bus drivers under Chapter 71 regulations.

Who Needs to Complete the DL-126 DS Form?

Only licensed healthcare professionals may complete and submit Form DL-126 DS. This includes physicians, orthopedic specialists, and other qualified providers treating patients with relevant musculoskeletal or related conditions.

Patients do not complete this form themselves. Instead, healthcare providers initiate the process when a medical condition potentially impairs safe driving. PennDOT requires medical reporting credentials (a user ID and password) before providers can access protected medical forms, including the electronic DL-126 DS.

To request credentials, healthcare professionals should use the official registration process available on the PennDOT Medical Reporting Forms page. Allow approximately three business days for processing after submitting the request.

How to Access and Submit the DL-126 DS Form Electronically?

PennDOT introduced electronic submission for many forms, including DL-126, in 2023 to reduce processing times and improve convenience. Forms marked with the “DS” suffix support secure online completion and digital signatures.

Follow these steps for electronic submission of the Orthopedic Form:

1. Ensure you have active PennDOT medical reporting login credentials. If you do not have them, request access through the official health care personnel credentials process.
2. Access the official form instructions at the protected medical forms section or via the direct download link provided below.
3. Click the designated link to begin the electronic process. You will be prompted to enter your full name and email address. If multiple signatures are required, additional signer information may be requested.
4. Select “Begin Signing” to open the DL-126 form in the secure electronic platform (typically DocuSign).
5. Complete all required fields with accurate patient and clinical information.
6. Add your electronic signature at the designated location.
7. Click “Finish.” The completed and signed form is automatically emailed to PennDOT for prompt processing.

Printable versions of the form remain available for situations where electronic submission is not feasible, but the DS version is recommended for speed and efficiency.

Official Download Link for Form DL-126 DS:
Download Pennsylvania PennDOT Form DL-126 DS – Orthopedic Form (PDF)

Key Sections of the Orthopedic Form

While the exact layout is protected and available only to credentialed providers, the form generally requires:

• Patient identification details (driver’s license number, name, address, date of birth, and contact information)
• Provider information and treatment history
• Description of any loss or impairment of joints or extremities
• Diagnosis of relevant diseases (rheumatic, arthritic, orthopedic, muscular, vascular, or neuromuscular)
• Assessment of functional limitations that may impair safe vehicle operation
• Expected duration of the condition (particularly whether it exceeds 90 days)
• Professional opinion on the patient’s ability to drive and any recommended restrictions
• Provider signature and date

Complete and accurate information is essential. Incomplete forms may delay processing or require resubmission.

Benefits of Electronic Submission for DL-126 DS

Electronic submission through the DS process offers several advantages over traditional paper mailing:

• Faster delivery and processing by PennDOT
• Secure digital signatures that meet legal requirements
• Reduced risk of lost or delayed mail
• Immediate confirmation upon completion
• Convenience for healthcare providers working from any location with internet access

This modernization aligns with broader PennDOT efforts to improve customer service and reduce wait times for driver licensing medical reviews.

Contact Information and Support

For questions about Form DL-126 itself or medical reporting requirements, contact PennDOT’s Driver and Vehicle Services Customer Call Center at 717-412-5300. Reference “Driver Licensing Form” for form-related questions.

For technical issues with the digital signature or electronic submission process, reference “DocuSign DVS” when calling the same number.

Additional resources and other medical reporting forms are available on the official PennDOT Medical Reporting Forms page.

Important Notes for Healthcare Professionals

Form DL-126 DS is password-protected and intended solely for authorized healthcare providers. Unauthorized access or use is not permitted. Always verify that you are using the most current version of the form from official PennDOT sources.

Providers should maintain appropriate medical documentation supporting the information reported on the form. PennDOT may request additional information or clarification during the review process.

Drivers with orthopedic conditions should work closely with their treating healthcare provider to ensure any necessary medical reporting is completed accurately and on time. This helps avoid unexpected interruptions to driving privileges and supports overall road safety in Pennsylvania.

Conclusion

The Pennsylvania PennDOT Form DL-126 DS Orthopedic Form provides a streamlined electronic pathway for healthcare professionals to report orthopedic conditions that may affect driving ability. By using the secure digital submission process, providers contribute to timely medical evaluations while helping maintain safe roads across the Commonwealth.

Always obtain the form and credentials directly from official PennDOT sources. For the latest information and access, visit the Pennsylvania Department of Transportation Driver and Vehicle Services website or contact the Customer Call Center at 717-412-5300.