NJ Form MR-5 Driver Medical Evaluation Request

NJ Form MR-5 Driver Medical Evaluation Request – The New Jersey Motor Vehicle Commission (MVC) uses Form MR-5, titled “Driver Examination and/or Medical Evaluation Request,” as an official tool for law enforcement officers and court officials. This form allows qualified professionals to recommend that a New Jersey-licensed driver undergo a driver reexamination, medical evaluation, or both when concerns arise about the driver’s ability to operate a motor vehicle safely.

Form MR-5 is designated for official use only. It plays a key role in the MVC’s Medical Review Unit process, which identifies high-risk drivers and takes appropriate administrative action when medical or physical conditions may compromise safe driving.

Download the official Form MR-5 (PDF): https://www.nj.gov/mvc/pdf/violations/MVC-Form_MR-5.pdf

What Is New Jersey Form MR-5?

Form MR-5 is an official New Jersey Motor Vehicle Commission document used exclusively by law enforcement and court officials. It serves as a formal recommendation that a licensed New Jersey driver submit to a driver reexamination and/or medical evaluation.

According to the New Jersey MVC, the form is listed under “For official use only” on the agency’s forms page and is intended for situations where an officer or court official observes behavior or conditions that raise questions about a driver’s fitness to drive.

The current version of the form (revised December 2017) collects driver identification details, reasons for the request, incident information, and the recommending officer’s or official’s contact information.

Who Can Submit Form MR-5?

Only authorized individuals may complete and submit Form MR-5:

Law enforcement officers (police officers)
Court officials

Physicians and emergency room personnel use a different form — Form MR-4 (Medical Emergency Report) — when reporting medical conditions that may affect driving ability under New Jersey law (N.J.S.A. 39:3-10.4).

Family members or concerned citizens who wish to report a driver should follow the MVC’s general reporting process rather than using Form MR-5.

When Is Form MR-5 Used?

Law enforcement officers and court officials typically complete Form MR-5 when they believe a driver may not be medically or physically fit to drive safely. Common situations include:

Drivers showing signs of mental or physical disorders that may affect safe vehicle operation
Involvement in a traffic accident resulting in a fatality where a violation of N.J.S.A. 39:4-1 et seq. is established
Drivers who have accumulated 12 or more points under N.J.A.C. 13:19-10.1
Conviction of a careless, reckless, or indifferent driving offense where a judge determines reexamination is warranted
Observations during traffic stops or at accident scenes suggesting medical impairment
Concerns raised by family members or others that an officer determines should be referred to the MVC

The form explicitly lists these categories so the recommending official can check all that apply.

How to Complete Form MR-5?

The form requires accurate information about both the driver and the recommending official. Key sections include:

Driver Information — Driver’s license number, class, endorsements, restrictions, date of birth, expiration date, full name, address, city/state/zip, sex, eye color, height, and date the license was issued
Reasons for Reexamination — Checkboxes for the four main categories listed above
Narrative Section — Detailed explanation of why the driver should undergo reexamination or medical evaluation, including any relevant observations, admissions of medical conditions by the driver, or third-party information
Incident Details — Date(s) of incident(s), whether the driver was charged with motor vehicle violations (including statute codes and summons numbers), and whether an accident occurred (with a request to attach the accident report if applicable)
Recommending Official Information — Signature, badge number or court code, title, full name, police department or court name, address, city/zip, and phone number
Outcome Notification Preference — Option to request that the MVC advise the department of the outcome by letter or email

Officials should complete the form thoroughly and attach supporting documentation, such as accident reports, when relevant.

Where and How to Submit Form MR-5?

Completed Form MR-5 may be submitted by mail or email:

Mail: Motor Vehicle Commission
Medical Review Unit
P.O. Box 173
Trenton, New Jersey 08666-0173
Email: [email protected]

The New Jersey MVC also accepts completed forms via fax. Contact the Medical Review Unit directly for the current fax number or any questions about the process.

For additional guidance, visit the official page: Law Enforcement and Physicians/Emergency Room Reporting.

What Happens After Form MR-5 Is Submitted?

Once the MVC Medical Review Unit receives a completed Form MR-5, the reported driver typically enters the medical review process. According to the New Jersey MVC:

The MVC may send the driver a letter requiring a medical review. The letter includes medical forms that must be completed by a physician.
The driver must visit a physician and return the completed forms within 45 days. Failure to return the forms on time results in license suspension.
The physician’s findings guide the next steps. Outcomes can range from no action to restricted privileges, reexamination, regular medical monitoring, or indefinite suspension.
In cases involving seizure disorders, syncope, or recurrent loss of motor coordination, a 15-day direct order of suspension may be issued under N.J.A.C. 13:19-5.2.
Approximately 55% of cases are referred to the MVC’s Medical Advisory Panel. Panel physicians review records and test results provided by the driver’s personal physician. The panel does not examine drivers directly. This review typically takes 3–4 weeks.

Possible results of the medical review include restricted driving privileges, suspension of driving privileges, a re-exam, and/or ongoing medical monitoring and reporting requirements.

Drivers who disagree with an administrative action may request a written hearing in accordance with N.J.A.C. 13:19-1.1. However, a hearing request does not stop a direct order of suspension.

Learn more about the overall process on the official MVC page: Medical Review Process.

Why Form MR-5 Matters for Road Safety in New Jersey?

Motor vehicle crashes remain a leading cause of injury-related deaths, particularly among older adults and individuals with certain medical conditions. Law enforcement officers are often among the first to observe drivers who may be medically impaired during routine traffic stops or at crash scenes.

By submitting Form MR-5, officers and court officials help the MVC identify high-risk drivers and take appropriate steps to protect both the individual and the public. The Medical Review Unit emphasizes that it values the professional insight of law enforcement and will make every effort to provide updates when requested.

For broader information about the Medical Review Unit’s role, visit: NJ MVC Medical Review.

Official Resources and Additional Forms

Key official New Jersey MVC resources related to Form MR-5 and medical review include:

Physicians use Form MR-4 for medical emergency reports. The two forms serve complementary but distinct purposes in New Jersey’s system for evaluating driver fitness.

Frequently Asked Questions About Form MR-5

Is Form MR-5 available to the general public?
No. The form is designated for official use only by law enforcement and court officials.

Can a police officer request updates on a reported driver?
Yes. Officers who wish to receive status updates should contact the Medical Review Unit by phone. The MVC notes that medical reviews can be lengthy processes and appreciates officers’ commitment to these cases.

What if the form cannot be downloaded?
Contact the New Jersey MVC Medical Review Unit by phone for assistance or alternative methods of obtaining the form.

Does submitting Form MR-5 automatically suspend a driver’s license?
No. Submission begins a review process. Suspension may occur later if the driver fails to respond to medical forms within 45 days or if medical findings support administrative action.

For the most current guidance, always refer to official New Jersey Motor Vehicle Commission resources. Forms, addresses, and procedures can be updated, so verifying information on the official NJ MVC website is recommended before use.