PennDOT Form DL-120 Cardiovascular | Official PA Guide – The Pennsylvania Department of Transportation (PennDOT) Form DL-120, known as the Medical Cardiovascular Form, plays a critical role in ensuring roadway safety across the Commonwealth. This specialized medical reporting form allows healthcare professionals to document and report cardiovascular conditions or cerebral vascular insufficiency that may impair a person’s ability to safely operate a motor vehicle. Whether you are a physician, physician assistant, nurse practitioner, or a Pennsylvania driver dealing with heart-related health issues, understanding Form DL-120 is essential for compliance with state law and maintaining driving privileges.
What Is PennDOT Form DL-120 – The Medical Cardiovascular Form?
Form DL-120 is the official Medical Cardiovascular Form used by authorized healthcare personnel in Pennsylvania to report patients aged 15 and older who have been diagnosed with cardiovascular disease or cerebral vascular insufficiency that could affect safe driving. It falls under Pennsylvania’s mandatory medical reporting program administered by the Bureau of Driver Licensing.
According to official PennDOT resources, the form helps the department evaluate whether an individual remains medically qualified to hold a driver’s license. Healthcare providers use it to supply detailed clinical information so PennDOT can make informed decisions about license restrictions, recalls, or restorations.
You can download the official PDF version of the form here: Pennsylvania PennDOT Form DL-120 – Cardiovascular Form (PDF).
Note that access to certain medical reporting forms may require healthcare personnel credentials. Providers can request login credentials through the official PennDOT medical reporting portal.
Legal Basis and Medical Criteria for Reporting Cardiovascular Conditions
Pennsylvania law requires healthcare professionals authorized to diagnose or treat disorders to report patients who have conditions that may impair safe driving. This obligation is outlined in Section 1518(b) of the Pennsylvania Vehicle Code. Reports must generally be submitted within 10 days of diagnosis or identification of the impairing condition.
Specific standards for cardiovascular conditions appear in Title 67 of the Pennsylvania Code, Chapter 83 (Medical Regulations for Drivers other than School Bus Drivers):
- § 83.5(a)(2): A person who has cerebral vascular insufficiency or cardiovascular disease which, within the preceding 6 months, has resulted in syncopal attack or 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 a license recall if a person has cerebral vascular insufficiency or cardiovascular disease which, within the preceding 6 months, has 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 are established and periodically reviewed by PennDOT’s Medical Advisory Board, which includes specialists such as cardiologists, neurologists, and other medical experts. The board’s standards help balance individual mobility needs with public safety.
For the full list of medical criteria, visit the official PennDOT Medical Criteria and Regulations page.
Who Must Complete and Submit Form DL-120?
Form DL-120 is intended for use by healthcare professionals only. Eligible reporters include:
- Physicians
- Physician assistants
- Certified registered nurse practitioners
- Chiropractors
- Other persons authorized to diagnose or treat disorders and disabilities
Drivers themselves or family members cannot complete this specific form. However, drivers or concerned parties may initiate the process by contacting PennDOT or encouraging a treating provider to submit a report. An initial general reporting form (DL-13) is also available when a condition-specific form is not yet appropriate.
Healthcare providers who fail to report when required may face liability risks, while those who do report in good faith are protected by statutory immunity from civil or criminal liability related to the disclosure.
How to Download and Access the Official DL-120 Form
The most reliable source for Form DL-120 is the official Pennsylvania government website. Direct download link:
Download PennDOT Form DL-120 Medical Cardiovascular Form (PDF)
Healthcare providers should also visit the PennDOT Medical Reporting Forms page for the latest versions and additional condition-specific forms. Some versions or online submission portals may require a medical reporting login credential. Providers can request credentials through the official request form on the PennDOT site.
Always use the most current version from pa.gov to ensure compliance. Third-party sites may host outdated copies.
How to Submit PennDOT Form DL-120?
PennDOT offers multiple submission methods to make the process efficient:
- Online submission: Many medical forms, including DL-120, can now be completed, signed, and submitted electronically. Forms eligible for digital submission often carry a “DS” designation. Online options are available 24/7 and streamline processing.
- Mail: Send completed forms to:
Bureau of Driver Licensing
Driver Qualifications Section
P.O. Box 68682
Harrisburg, PA 17106-8682 - Fax: (717) 705-4415
- Email: [email protected]
Include the patient’s full name, address, date of birth, and detailed information about the cardiovascular condition and its impact on driving ability. Clear clinical details help PennDOT reach a timely determination.
For the latest submission instructions and online access, refer to the PennDOT Medical Reporting Information Center.
What Happens After Form DL-120 Is Submitted?
Once PennDOT receives a medical report, the Driver Qualifications Section reviews the information. Possible outcomes include:
- No action if the condition does not currently impair safe driving
- Addition or removal of license restrictions
- Request for additional medical information or a driving examination
- Temporary or permanent recall of driving privileges
- Restoration of privileges after a qualifying period free of disqualifying symptoms
Reports are confidential and used solely for determining medical fitness to drive. PennDOT does not disclose the source or content of the report to the patient or others, except as required by law.
Drivers whose privileges are affected receive official notification and information about appeal or restoration processes. Resources are also available for individuals who can no longer drive, including guidance on maintaining independence and alternative transportation options.
Frequently Asked Questions About Form DL-120
Is Form DL-120 required for every heart condition?
No. Reporting is required only when the condition has produced, or is likely to produce, symptoms that impair the ability to control and safely operate a motor vehicle, consistent with the criteria in Chapter 83.
Can a driver submit their own medical information?
Drivers may provide supporting medical documentation, but the official condition-specific reporting forms such as DL-120 are completed by authorized healthcare providers.
Does HIPAA prevent medical reporting to PennDOT?
No. HIPAA does not restrict disclosures required by state law. Pennsylvania’s medical reporting requirements fall under this exception, and no patient consent is needed for the report.
Where can I find more official information?
Visit the official pages:
Contact the Medical Unit at 717-787-9664 or [email protected] during business hours (Monday–Friday, 8 a.m.–4:15 p.m.).
Why Accurate Medical Reporting Matters for Pennsylvania Road Safety?
PennDOT receives tens of thousands of medical reports each year. More than half of new reports involve impairments significant enough to warrant action on driving privileges. Cardiovascular conditions are among the key areas monitored because sudden symptoms such as syncope, vertigo, or loss of awareness can lead to serious crashes.
By using Form DL-120 correctly and promptly, healthcare providers help protect patients, other road users, and the broader community. Drivers benefit from a transparent process that focuses on current functional ability rather than diagnosis alone.
For the most accurate and current version of the form and related guidance, always rely on official Commonwealth of Pennsylvania sources. Download the form directly from the link provided above and consult a qualified healthcare provider or PennDOT for case-specific questions.