Florida HSMV Form 77066 | IID Medical Evaluation

What Is Florida HSMV Form 77066?

HSMV Form 77066 is the official medical evaluation form issued by the Florida Department of Highway Safety and Motor Vehicles, Medical Review Section. It is specifically designed for individuals who claim a medical condition interferes with their ability to provide the required breath sample into an approved ignition interlock device.

An IID is a breath alcohol analyzer connected to a vehicle’s ignition system. To start the engine (and during periodic retests while driving), the driver must blow a sufficient volume of air into the device for approximately 5 seconds. The standard air volume setting is 1.5 liters per breath. Under certain medical circumstances, this may be reduced to 1.0 liter.

If a driver cannot meet even the reduced volume requirement due to a documented medical condition, they may request a review for a possible waiver or modification of the IID requirement.

The current version of the form is HSMV 77066 (rev 06/11). It remains the active form listed on the official FLHSMV forms page.

Who Needs to Complete Form 77066?

This form is required when a Florida driver subject to an IID restriction believes a medical condition prevents proper use of the device. Common situations include pulmonary conditions (such as severe COPD, asthma, or reduced lung capacity) or other medical issues that affect the ability to produce a sustained breath sample of adequate volume.

Key points:

• The form must be completed by a board-eligible or board-certified pulmonologist if the condition is pulmonary-related.
• If the condition is non-pulmonary, it must be completed by a physician whose specialty relates directly to the patient’s condition.
• A recent pulmonary function test is typically required when lung capacity is the issue.

Florida law (Section 322.2715, Florida Statutes) allows the department to consider documented medical conditions that would prohibit the device from functioning normally. Rule 15A-9.0041 of the Florida Administrative Code further outlines medical considerations, including the possibility of reducing the required breath volume to 1.0 liter or granting a waiver after Medical Review Board evaluation.

Key Sections of the Ignition Interlock Medical Evaluation Form

The form collects essential patient and physician information and requires specific clinical findings:

• Patient Information – Name, date of birth, driver’s license number, and telephone number.
• Current Diagnosis – Brief history of the illness, current medications, and whether the patient is receiving optimal treatment.
• Pulmonary Function Test – A copy of a recent test is required in most cases involving breathing capacity.
• Breath Capacity Assessment – The physician must answer whether the patient can blow 1.5 liters for 5 seconds, and if not, whether they can manage 1.0 liter for 5 seconds.
• Physician Recommendation – Detailed explanation based on test results or other medical conditions. Part A (pulmonary) or Part B (non-pulmonary) must be completed.
• Other Driving-Related Conditions – Any additional medical issues that could affect safe driving.
• Physician Signature and Credentials – Printed name, address, telephone number, and signature.

Important note on the form: If the patient cannot meet the 1.0-liter requirement, they are only eligible for a waiver if they are employed.

How to Submit Completed Form 77066?

Once the physician has fully completed and signed the form (and attached any required test results), mail it to:

Division of Motorist Services
Medical Review Section, MS 86
Neil Kirkman Building
Tallahassee, Florida 32399-0570

For general Medical Review inquiries, the Bureau of Motorist Compliance Medical Review Section can be reached at (850) 617-3814 or by fax at (850) 617-3944. Official contact details are available on the FLHSMV Medical Review Contact page.

Do not submit incomplete forms. Missing test results, incomplete physician responses, or lack of specialty qualification can delay or result in denial of the request.

Florida Ignition Interlock Requirements Overview

Under Florida law, certain DUI convictions trigger mandatory IID installation before a permanent or restricted license can be issued. The required periods (as outlined by FLHSMV) include:

• First conviction – If court-ordered
• First conviction with BAL of 0.15 or higher, or minor in the vehicle – At least 6 months
• Second conviction – At least 1 year
• Second conviction with BAL of 0.15 or higher, or minor in the vehicle – At least 2 years
• Third conviction – At least 2 years
• Four or more convictions (as a condition of a hardship license) – At least 5 years

The IID “P” restriction is placed on the driving record, and the required time begins when that restriction is issued. Drivers must use an FLHSMV-approved service provider. A current list of approved providers is maintained on the official FLHSMV Ignition Interlock Program page.

What Happens After Medical Review?

The Medical Review Section and, when applicable, the Medical Advisory Board evaluate the submitted Form 77066 and supporting documentation. Possible outcomes include:

• Approval of a reduced breath volume setting (1.0 liter).
• Approval of a medical waiver of the IID requirement (subject to the employment condition noted on the form and statutory limitations).
• Denial of the request, meaning the standard IID requirement remains in effect.

Important statutory limitations apply: If a medical waiver is granted for someone seeking a restricted (hardship) license, the person is generally not entitled to that restricted license until the full IID installation period would have expired. Similar timing restrictions apply to permanent reinstatement. Always refer to Section 322.2715, Florida Statutes, and Rule 15A-9.0041, F.A.C., for precise legal effects.

Tips for a Successful Submission

• Use only the official form downloaded from the FLHSMV website.
• Ensure the completing physician meets the specialty requirements stated on the form.
• Attach a recent pulmonary function test when lung capacity is relevant.
• Provide complete and legible responses; incomplete forms cause delays.
• Keep copies of everything submitted for your records.
• Contact the Medical Review Section if you need clarification on required supporting documents.

Official Resources and Related Links

• Download HSMV Form 77066 (PDF)
• FLHSMV Official Forms Page
• FLHSMV Ignition Interlock Program
• Ignition Interlock Device FAQs
• FLHSMV Medical Review Program
• Florida Statute § 322.2715 – Ignition Interlock Device
• Florida Administrative Code Rule 15A-9.0041 – Medical Considerations

Conclusion

Florida HSMV Form 77066 serves as the critical medical documentation tool for drivers seeking relief from standard ignition interlock device requirements due to health limitations. Completing the form accurately with the appropriate specialist and supporting clinical evidence gives the Medical Review Section the information needed to evaluate requests for reduced settings or waivers.

Because requirements and procedures can affect driving privileges and reinstatement timelines, drivers are strongly encouraged to rely on official FLHSMV sources and, when appropriate, consult with a qualified attorney or medical professional familiar with Florida DUI and licensing rules.

For the most current version of the form and program details, always visit the official Florida Department of Highway Safety and Motor Vehicles website.