Florida HSMV Form 72190 – Report Unsafe Driver Ability – If you know a driver in Florida whose physical or mental condition may affect their ability to operate a vehicle safely, the official way to report those concerns is through the Florida Department of Highway Safety and Motor Vehicles (FLHSMV) Form 72190, also known as the Medical Referral Form. This form helps protect public safety on Florida roads while protecting the privacy of both the reporter and the driver under review.
What Is Florida HSMV Form 72190?
Florida HSMV Form 72190 is the official Medical Referral Form used to report a licensed driver or driver license applicant whose ability to drive safely may be impaired by a medical, physical, or mental condition. The form is issued by the Florida Department of Highway Safety and Motor Vehicles and is effective as of July 2018.
According to the official form and FLHSMV guidance, medical reviews are based on medical conditions or symptoms that could affect the safe operation of a motor vehicle — not the age of the driver. The form is available in English (72190) and Spanish (72190SP).
Official download link: Download Florida HSMV Form 72190 (PDF)
Who Can File a Report Using Form 72190?
Florida law authorizes a wide range of people and organizations to submit a medical referral. Under Sections 322.126(2) and (3), Florida Statutes, any of the following may report concerns:
- Physicians and other health care providers
- Family members or friends
- Law enforcement officers or agencies
- Any other person or agency with knowledge of a licensed driver’s or applicant’s mental or physical disability that may affect driving ability
Reports must concern individuals 15 years of age or older. The information provided is used solely to determine whether the person is qualified to operate a motor vehicle on Florida highways.
What Information Is Required on Form 72190?
To be valid, Form 72190 must contain sufficient identifying information about the driver. Incomplete forms may be invalidated. The form asks for:
- Full name of the driver
- Date of birth
- Address, city, and ZIP code
- Sex
- Driver license number and state (if known)
- Description of the physical or mental deficit or disorder noted
Common conditions listed on the form include seizures, severe cardiac conditions, stroke, loss of consciousness, uncontrollable diabetes, dementia or memory deficits, psychiatric disturbance, drug or alcohol addiction, severe visual deficit, sleep disorders, and other conditions that may impair safe driving.
Reporters must also explain the marked conditions in detail and indicate how they know the individual (for example, family member, patient, or friend). The name and signature of the reporting person are required for the report to be investigated. Law enforcement or health care providers should include their agency name and identification or license number when applicable.
How to Submit Florida Form 72190?
Once completed, mail or fax the form to the FLHSMV Medical Review Program:
Bureau of Motorist Compliance
Medical Review Program
Neil Kirkman Building, MS 86
Tallahassee, Florida 32399-0500
Telephone: (850) 617-3814
Fax: (850) 617-3944
Include the date of the report. Always use the most current version of the form available from the official FLHSMV website.
Download the official English Form 72190 here.
Confidentiality and Legal Protections
Florida law provides strong protections for people who submit medical referrals in good faith. Under Section 322.126, Florida Statutes:
- Reports are confidential.
- No civil or criminal action may be brought against any physician, person, or agency that provides the information authorized by the statute.
This confidentiality encourages honest reporting that prioritizes public safety. The information is used only for evaluating driving qualifications and is not shared publicly.
For the full statute text, visit the official Florida Legislature site: Section 322.126, Florida Statutes.
What Happens After a Report Is Submitted?
After FLHSMV receives a valid Form 72190, the Medical Review Program reviews the information. If a formal medical review is warranted, the driver is notified in writing and is typically required to provide medical documentation from a physician familiar with their condition.
Possible outcomes include:
- No further action if the concern is not supported
- Requirement to submit medical reports or undergo vision or other evaluations
- Restriction, suspension, or revocation of driving privileges if the driver is found unqualified
- Referral for a certified driver evaluation in some cases
More details about the overall process are available on the official FLHSMV Medical Review pages: The Medical Review Process and Report an Unsafe Driver.
Important Notes for Family Members and Caregivers
Many people use Form 72190 when concerned about an aging parent, spouse, or other family member. Florida emphasizes that reports must be based on medical conditions or symptoms that affect safe driving — not age alone. The form is one of the resources listed under FLHSMV’s mature driver information.
If the person no longer drives and needs identification, they can exchange a Florida driver license for a Florida ID card at a driver license service center. Additional resources for alternative transportation options for seniors are available through the Florida Senior Safety Resource Center at rightservicefl.org.
Related Official Forms and Resources
- HSMV Form 72190 – Medical Referral Form (English)
- HSMV Form 72190SP – Medical Referral Form (Spanish)
- Forms for Older Drivers (Official FLHSMV Page)
- Medical Review Overview
- Complete List of FLHSMV Forms
Frequently Asked Questions
Is reporting confidential?
Yes. Reports submitted under Section 322.126 are confidential, and reporters are protected from civil or criminal liability for providing the information in good faith.
Can I report someone based only on their age?
No. FLHSMV states that medical reviews are initiated based on medical conditions or symptoms that could affect safe driving, not the age of the driver.
What if the form is incomplete?
Missing required information, such as the driver’s full name, date of birth, address, or a clear description of the concern, may invalidate the form.
Where can I get help or more information?
Contact the Medical Review Program at (850) 617-3814 or visit the official FLHSMV Medical Review section of the website.
Conclusion
Florida HSMV Form 72190 provides a clear, confidential, and legally protected way for concerned individuals, physicians, and agencies to report drivers whose ability may be questionable due to medical conditions. Completing the form accurately and submitting it to the Bureau of Motorist Compliance Medical Review Program helps FLHSMV evaluate driving safety while protecting the rights of all parties involved.
Always download the latest version of the form directly from the official FLHSMV website to ensure you are using the current document: