PennDOT Form DL-120 DS – Cardiovascular Electronic

What Is PennDOT Form DL-120 DS?

Form DL-120 DS is the electronic-submission version of the Cardiovascular Form. Healthcare providers use it to document diagnoses, treatments, medications, symptoms, and any functional limitations related to cerebral vascular insufficiency or cardiovascular disease.

According to official PennDOT guidance, the form gathers details that help the Department evaluate whether a driver meets minimum medical standards for safe vehicle operation. The electronic (DS) version became available as part of PennDOT’s modernization efforts that expanded online form submission options for medical and other driver services.

You can download the official form here: PennDOT Form DL-120 DS PDF.

Who Must Complete and Submit the Form?

Only authorized healthcare personnel may complete and submit Form DL-120 DS. This includes physicians, physician assistants, certified registered nurse practitioners, chiropractors, and other persons authorized under Pennsylvania law to diagnose or treat disorders and disabilities.

Pennsylvania law (Section 1518(b) of the Vehicle Code) requires these professionals to report, within 10 days and in writing, any patient age 15 or older diagnosed with a condition that could impair the ability to drive safely—unless the condition is expected to last fewer than 90 days.

Drivers themselves do not complete this form. Patients may be asked by PennDOT to have their healthcare provider submit medical documentation after an initial report or license recall notice.

Medical Standards for Cardiovascular Conditions

PennDOT relies on standards set out in 67 Pa. Code § 83.5. Key provisions relevant to Form DL-120 include:

• § 83.5(a)(2): A person who has cerebral vascular insufficiency or cardiovascular disease that, within the preceding 6 months, has resulted in a syncopal attack, loss of consciousness, vertigo, paralysis, or loss of qualifying visual fields will not be qualified to drive.
• § 83.5(b)(4): A provider may recommend license recall if the condition has, within the preceding 6 months, resulted in lack of coordination, confusion, loss of awareness, dyspnea upon mild exertion, or any other sign or symptom that impairs the ability to control and safely operate a motor vehicle.

These criteria guide healthcare providers when completing the form and help PennDOT’s Medical Unit and Medical Advisory Board make licensing determinations.

How to Access and Electronically Submit Form DL-120 DS?

Healthcare professionals must first obtain medical reporting login credentials from PennDOT. Credentials can be requested through the official process on the Driver and Vehicle Services website.

Once credentials are issued:

1. Access the protected form link or download the DL-120 DS version.
2. Follow the on-screen instructions to begin the electronic process (typically powered by a secure digital signature platform such as DocuSign).
3. Enter the provider’s full name and email address. Additional signers can be added if needed.
4. Complete all required fields documenting the patient’s cardiovascular history, current status, medications, and any recommended driving restrictions.
5. Apply the electronic signature and select “Finish.” The completed form is then emailed directly to PennDOT for processing.

For technical issues with the digital signature process, contact the PennDOT Driver and Vehicle Services Customer Call Center at 717-412-5300 and reference “DocuSign DVS.” For questions about the form content, reference “Driver Licensing Form.”

Official medical reporting forms and credential request information are available on the PennDOT Medical Reporting Forms page.

Benefits of Electronic Submission

Since 2023, PennDOT has enabled electronic submission for more than 20 commonly used forms, including DL-120. Advantages include:

• Faster processing and reduced mail delays
• Secure digital signatures
• Immediate confirmation of submission
• Convenience for busy healthcare practices

Printable paper versions remain available, but the DS electronic option is preferred for quicker review by the Medical Unit.

Confidentiality and Legal Protections

Reports submitted to PennDOT are confidential and used solely to evaluate driving fitness. PennDOT does not release the source or content of a report to the patient. Healthcare providers who report in good faith under the law receive immunity from civil and criminal liability.

HIPAA does not prohibit these required disclosures to a state agency. Providers are not required to obtain patient consent before reporting.

Where to Send Alternative (Non-Electronic) Reports?

If electronic submission is not used, medical reports may be mailed or faxed to:

Bureau of Driver Licensing
Driver Qualifications Section
P.O. Box 68682
Harrisburg, PA 17106-8682
Fax: (717) 705-4415

Additional contact options include the Medical Unit phone line at 717-787-9664 or email at [email protected] during business hours.

Related PennDOT Medical Forms

Depending on the patient’s conditions, providers may also need to complete related forms such as:

• DL-13 – Initial Reporting Form
• DL-123 – General Medical Form
• DL-124 – General Neurological Form
• DL-122 – Diabetic Form
• DL-129 – Loss of Consciousness Form

Many of these also have electronic (DS) versions.

Additional Official Resources

• PennDOT Medical Reporting Information Center
• Information for Health Care Personnel
• Medically Impaired Driver Law Overview
• Submission of Medical Reports Guidance

Download the Official Form

Download the current official Pennsylvania PennDOT Form DL-120 DS – Cardiovascular Form (Electronic Submission) directly from the Commonwealth:

Download PennDOT Form DL-120 DS PDF

Always verify that you are using the most recent version from the official pa.gov domain. Requirements and form versions can be updated by PennDOT.