PennDOT DL-122 Diabetic Form | PA Official Guide – The Pennsylvania Department of Transportation (PennDOT) requires specific medical documentation for drivers with diabetes mellitus to ensure road safety. The PennDOT Form DL-122 – Diabetic Form is the official document used by healthcare professionals to report and evaluate a driver’s medical fitness related to diabetes. This guide provides current, accurate information for U.S. residents, particularly those in Pennsylvania, on when the form is needed, how it works, and how to obtain it.
What Is the PennDOT Form DL-122 Diabetic Form?
The DL-122 is PennDOT’s specialized medical reporting form for diabetes mellitus. It is designed exclusively for healthcare professionals authorized to diagnose and treat medical conditions. The form collects detailed information about a patient’s diabetes control, including episodes of severe hypoglycemia or symptomatic hyperglycemia, treatment history, HbA1C results, and vision screening data.
According to official PennDOT resources, this form supports compliance with Pennsylvania regulations governing medical fitness to drive. It helps determine whether an individual meets the standards to hold or retain a non-commercial driver’s license.
Official download link for the form (healthcare professionals only): Download PennDOT Form DL-122 PDF.
When Is the DL-122 Diabetic Form Required?
Under 67 Pa. Code § 83.5, a person with unstable diabetes mellitus that leads to severe hypoglycemic reactions or symptomatic hyperglycemia is not qualified to drive unless they have been free from a disqualifying episode for a continuous period of at least six months.
Healthcare providers must report patients age 15 or older who have a condition that could impair safe driving. The DL-122 is the condition-specific form used for diabetes cases. It is commonly required in these situations:
- Initial reporting of unstable diabetes affecting driving ability
- Restoration of driving privileges after a disqualifying episode
- Follow-up diabetic examinations after license restoration
- Ongoing monitoring when recommended by the treating provider
Note that not every person with diabetes needs this form. Stable, well-controlled diabetes without severe episodes typically does not trigger the reporting requirement or disqualification.
Key Medical Standards for Diabetes and Driving in Pennsylvania
Pennsylvania law sets clear standards for drivers with diabetes. A driver may regain or retain privileges once the condition stabilizes and no disqualifying episode has occurred in the prior six months. The treating healthcare provider must certify this status on the completed DL-122 form.
Required follow-up examinations include an HbA1C test and vision screening on this schedule after the initial restoration exam:
- 6 months later
- 12 months after the previous exam
- 24 months after the previous exam
- 48 months after the previous exam
More frequent exams may be ordered if the treating provider recommends them. Once the condition remains under good control, additional examinations may no longer be required.
A limited waiver is available if a severe episode occurs after six months of stability, provided it happened while under medical care, during a temporary illness, or due to toxic ingestion or metabolic imbalance. The provider must submit written certification that the event is isolated and unlikely to recur.
Who Completes and Submits the DL-122 Form?
Only licensed healthcare professionals (physicians, physician assistants, certified registered nurse practitioners, and other authorized providers) complete the DL-122. The form is password-protected and intended solely for medical reporting use.
Providers without login credentials can request them through the official PennDOT process available on the Medical Reporting Forms page.
Page 1 of the form must be completed in full. Page 2 is completed only when applicable. If the vision portion cannot be completed by the primary provider, it is directed to a vision specialist.
How to Submit the PennDOT DL-122 Form
PennDOT offers electronic submission for credentialed providers using a secure DocuSign process. After accessing the form online, the provider enters their name and email (and any additional signer information if needed), completes the required fields, applies an electronic signature, and finishes the process. The completed form is then emailed directly to PennDOT for processing.
Alternative submission methods (when electronic submission is not used) include mail, fax, or email to the Medical Unit:
- Mail: Bureau of Driver Licensing, P.O. Box 68682, Harrisburg, PA 17106-8682
- Email: [email protected]
- Phone for questions: 717-787-9664 or Customer Call Center 717-412-5300
Hours for the Medical Unit are generally Monday–Friday, 8:00 a.m. to 4:15 p.m.
Differences for School Bus Drivers
School bus drivers follow stricter rules under Chapter 71 of the Pennsylvania Code. The related form is DL-122A. Insulin-using or medication-requiring school bus drivers must meet additional criteria, including six-month diabetic exams, annual dilated eye exams, specific blood glucose monitoring protocols, and maintenance of glucose logs. Separate waiver processes apply.
For standard non-commercial drivers, the DL-122 remains the primary form.
What Happens After the Form Is Submitted?
PennDOT’s Medical Unit reviews the completed DL-122 along with any supporting information. Possible outcomes include:
- No action (driver remains fully qualified)
- Restoration of driving privileges with or without follow-up requirements
- Temporary or permanent restriction or recall of the license
- Request for additional medical information or a driving examination
Drivers and families can find helpful resources on the official PennDOT Medical Reporting page, including fact sheets on what to expect after a medical report and options for maintaining independence if driving is no longer possible.
Tips for Drivers Living with Diabetes in Pennsylvania
Maintain consistent communication with your healthcare provider about any severe low or high blood sugar episodes. Keep records of HbA1C results and any related medical events. If your provider indicates a report may be necessary, discuss the process openly so you understand next steps.
Stable diabetes management, regular medical care, and adherence to treatment plans significantly reduce the likelihood of driving restrictions. Always prioritize safety—never drive if you feel symptoms of hypoglycemia or hyperglycemia.
Official Resources and Contact Information
For the most current information, always refer to official Commonwealth of Pennsylvania sources:
- PennDOT Medical Reporting Forms
- Medical Reporting Information Center
- 67 Pa. Code § 83.5 – Physical and Medical Standards
- Direct form download: DL-122 Diabetic Form PDF
Email the Medical Unit at [email protected] or call 717-787-9664 for specific questions about medical reporting. For general driver licensing help, contact the Customer Call Center at 717-412-5300.
This article is based on official PennDOT and Pennsylvania Code information current as of the latest available updates. Regulations and form versions can change; always verify details directly with PennDOT before taking action related to your driver’s license or medical reporting obligations.