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Blank Ds 326 PDF Template

The DS 326 form, also known as the Driver Medical Evaluation form, is a document used by the California Department of Motor Vehicles (DMV) to ensure that drivers have the necessary physical and mental health to operate a motor vehicle safely. It requires detailed information about a driver’s medical condition, as reported by a medical professional, to determine if any health issues could impair driving abilities. If you or someone you know needs to submit this form, ensure it is filled out accurately and completely by clicking the button below.

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The DS 326 Driver Medical Evaluation form plays a crucial role in the bridge between medical confidentiality and public safety in the state of California, particularly in determining an individual's fitness to operate a motor vehicle safely. Governed by the California Vehicle Code §1808.5, the form mandates a thorough evaluation by a medical professional of the driver's physical and mental health, including an extensive review of the driver's medical history, current medications, and any health conditions that could impair driving capabilities. With the form clearly divided for both the driver and the medical professional to complete, it ensures a comprehensive assessment, from vision acuity without lenses to more complex matters like seizure disorders, diabetes management, and potential cognitive impairments. Furthermore, it requires the driver to authorize the release of their medical information to the Department of Motor Vehicles (DMV), highlighting the fine balance between the individual’s privacy rights and the state’s duty to public safety. This detailed process underscores the importance of transparent and accurate medical reporting, aimed at making informed decisions about a person's ability to safely operate a motor vehicle, thereby serving the dual purpose of protecting the driver's health and welfare as well as that of the general public.

Preview - Ds 326 Form

	DS326
A Public Service Agency	DRIVER MEDICAL EVALUATION
	DRIVER MEDICAL EVALUATION
	(Medical information is CONFIDENTIAL under California Vehicle Code §1808.5 CVC)

INSTRUCTIONS TO THE DRIVER: Please take this form to the medical professional most familiar with your health history and current medical condition. Before giving this form to your medical professional, complete and sign Sections 1-3. PLEASE PRINT LEGIBLY.

INSTRUCTIONS TO THE MEDICAL PROFESSIONAL: Please complete Sections 5-13, on pages 2 through 5. The Department of Motor

Vehicles (DMV) records indicate your patient may have a condition that could affect the safe operation of a motor vehicle. In this case, the

department is concerned about the following condition:
department is concerned about the following condition:				RETURN BY:

PHYSICIAN RETURN FORM TO:				FAX NUMBER:
PHYSICIAN RETURN FORM TO:


SECTION 1 — DRIVER INFORMATION

NAME (LAST, FIRST, MIDDLE)		DRIVER LICENSE NO.	BIRTH DATE		FIELD FILE

STREET ADDRESS	CITY	ZIP	PATIENT’S DAYTIME OR HOME PHONE NO.

DRIVER MUST COMPLETE HEALTH HISTORY BELOW. (Please explain any “YES” answers)

YES	NO		YES	NO

		Head, neck, spinal injury, disorders or illnesses			Kidney disease, stones, blood in urine, or dialysis
		Seizure, convulsions, or epilepsy			Muscular disease
		Dizziness, fainting, or frequent headaches			Any permanent impairment
		Eye problem (except corrective lenses)			Nervous or psychiatric disorder
		Cardiovascular (heart or blood vessel) disease			Regular or frequent alcohol use
		Heart attack, stroke, or paralysis			Problems with the use of alcohol or drugs
		Lung disease (include tuberculosis, asthma or emphysema)			Other disorders or diseases
		Nervous stomach, ulcer, or digestive problems			Any major illness, injury, or operations in last 5 years
		Diabetes or high blood sugar			Currently taking medications

EXPLANATION: (Include onset date, diagnosis, medication, doctor’s name and address and any current condition or limitation. Attach additional sheet, if needed).

I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I further certify that all information concerning my health is true and correct.

DATE

DRIVER’S SIGNATURE

SECTION 2 — DRIVER’S ADVISORY STATEMENT

Medical information is required under the authority of Divisions 6 and 7 of the California Vehicle Code (CVC). Failure to provide the information is cause for refusal to issue a license or to withdraw the driving privilege.

All records of the DMV, relating to the physical or mental condition of any person, are confidential and not open to public inspection (CVC §1808.5). Information used in determining driving qualifications is available to you and/or your representative with your signed authorization.

The department has sole responsibility for any decision regarding your driving qualifications and licensure. The department will also consider non-medical factors in reaching a decision.

SECTION 3 — MEDICAL INFORMATION AUTHORIZATION

MEDICAL PROFESSIONAL, HOSPITAL, OR MEDICAL FACILITY (NAME AND ADDRESS)

DATE	MEDICAL RECORD/PATIENT FILE NO.

I hereby authorize my medical professional or hospital to answer any questions from the DMV, or its employees, relating to my physical or mental condition, and/or drug and/or alcohol use, and to release any related information or records to the DMV or its employees. Any expense involved is to be charged to me and not to the DMV.

I hereby authorize the DMV to receive any information relating to my physical or mental condition, and/or drug and/or alcohol use or abuse, and to use the same in determining whether I have the ability to operate a motor vehicle safely.

NOTE: You may wish to make a copy of the completed Driver Medical Evaluation for your records.

SIGNED

DATE

DS 326 (REV. 6/2020) WWW

Page 1 of 5

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SECTIONS 5 -13 TO BE COMPLETED BY PHYSICIAN, PHYSICIAN’S ASSISTANT OR ADVANCED PRACTICE REGISTERED NURSE

SECTION 4 — MEDICAL PROFESSIONAL’S MEDICAL EVALUATION INSTRUCTIONS

INSTRUCTIONS TO THE MEDICAL PROFESSIONAL (MP): The DMV records indicate your patient may have a condition that could affect the safe operation of a motor vehicle. (See Instructions to the Medical Professional, page 1 for the specific medical condition that is a concern to the department.) With your assistance, the department hopes to resolve the matter with a minimum of inconvenience to all concerned.

The Health History and Medical Information Authorization sections on page 1 must be completed and signed by the patient before you complete this Driver Medical Evaluation form.

Your experience and knowledge of the patient’s condition, results of medical examinations and treatment plans, will be of great value in assisting the department to determine a proper licensing decision. PLEASE ANSWER ALL QUESTIONS on this form. If questions do not apply, indicate “N/A”. You may furnish a narrative report if you prefer, but please include all information pertinent to your patient. The department has sole responsibility for any decision regarding the patient’s driving qualifications and licensure. The department will also consider non-medical factors in reaching a decision.

SECTION 5 — VISION

VISUAL ACUITY (without bioptic telescope)	BOTH EYES	RIGHT EYE		LEFT EYE
Without Lenses	20/	20/		20/
With Present Lenses	20/	20/		20/
ANY EYE INJURY OR DISEASE? (LIST)		IS FURTHER EYE EXAMINATION SUGGESTED?
		Yes	No

SECTION 6 — TREATMENT BY OTHER MEDICAL PROFESSIONAL(S)

IS THIS PATIENT BEING TREATED FOR ANY CONDITION BY ANOTHER MP?

Yes No

IF YES, PLEASE INDICATE NAME OF TREATING MP(S)

CONDITION BEING TREATED

SECTION 7 — TREATMENT UNDER YOUR SUPERVISION

DIAGNOSIS (IF THE DIAGNOSIS IS A DISORDER CHARACTERIZED BY LAPSES OF CONSCIOUSNESS, DEMENTIA, OR DIABETES, COMPLETE PAGE 3,4 OR 5.)

DO YOU NEED TO SEE YOUR PATIENT AT REGULAR INTERVALS? IF YES, HOW OFTEN?

Yes	No

PROGNOSIS

IS THE CONDITION					(IF MULTIPLE CONDITIONS, PLEASE DESCRIBE STATUS AND PROGNOSIS IN
Improving		Stable	Worsening or deteriorating	Subject to change
Improving		Stable	Worsening or deteriorating	Subject to change	COMMENTS BELOW.)
MANIFESTATIONS (SYMPTOMS):

(PRESENT)

(PAST)							MAY CONDITION IMPAIR VISION?
							Yes	No

HOW LONG HAS THIS PERSON BEEN YOUR PATIENT?					DATE OF LAST EXAMINATION

IS YOUR PATIENT UNDER A CONTROLLED MEDICAL PROGRAM?					HOW LONG HAS CONTROL BEEN MAINTAINED?
Yes	No

IS THE PATIENT ADHERING TO THE MEDICAL REGIMEN?					IS THE PATIENT KNOWLEDGEABLE ABOUT THE MEDICAL CONDITION?
Yes	No	If no, please explain:			Yes	No

LIST THE MEDICATIONS PRESCRIBED. PLEASE INCLUDE DOSAGE AND FREQUENCY OF USE


WHEN WAS THE LAST MEDICATION CHANGE MADE?

WOULD THE SIDE EFFECTS FROM THE PRESCRIBED MEDICATIONS INTERFERE WITH YOUR PATIENT’S ABILITY TO DRIVE SAFELY?
Yes	No	If yes, please describe:

DOES YOUR PATIENT’S MEDICAL CONDITION CURRENTLY AFFECT SAFE DRIVING?
Yes	No	If yes, please explain:

DO YOU CURRENTLY ADVISE AGAINST DRIVING?					WOULD YOU RECOMMEND A DRIVING TEST BE GIVEN BY DMV?
Yes	No				Yes	No

MP COMMENTS:

Page 2 of 5

DS 326 (REV. 6/2020) WWW

SECTION 8 — LEVELS OF FUNCTIONAL IMPAIRMENTS

Functional impairments that may affect safe driving ability. Please check where applicable.

MILD MODERATE SEVERE

Visual neglect	.........................................
Left side	Right side

Loss of upper extremity motor control ....

Left side

Right side

Loss of lower extremity motor control.....

Left side

Right side

WOULD ADAPTIVE DEVICES AID YOUR PATIENT IN COMPENSATING FOR THEIR DISABILITY AS IT PERTAINS TO SAFE DRIVING?

Yes No

Uncertain

IF YES, PLEASE DESCRIBE

SECTION 9 — DEMENTIA OR COGNITIVE IMPAIRMENTS

Alzheimer’s Disease

Other Dementia (Please describe the type of dementia below, e.g., multi-infarct, metabolic, post-traumatic.)

HISTORY OF DISEASE, RESULTS OF TESTING, ETC.

Using the definitions given below, please rate the severity of the following forms of cognitive impairments in this patient.

Mild:	Judgment is relatively intact but work or social activities are significantly impaired. Ability to safely operate a motor vehicle may
	or may not be impaired.

Moderate: Independent living is hazardous and some degree of supervision is necessary. The individual is unable to cope with the environment and driving would be dangerous.

Severe:	Activities of daily living are so impaired that continual supervision is required. This person is incapable of driving a motor vehicle.
	NONE	MILD MODERATE SEVERE UNCERTAIN

Memory Loss ...................................

Depression, secondary to dementia

Diminished Judgment ......................

Impaired Attention............................

Impaired Language Skills ................

Impaired Visual Spatial Skills ..........

Impulsive Behavior ..........................

Problem Solving Deficits..................

Loss of Awareness of Disability .......

OVERALL DEGREE OF IMPAIRMENT

DS 326 (REV. 6/2020) WWW

Page 3 of 5

SECTION 10 — LAPSE OF CONSCIOUSNESS DISORDER

PLEASE IDENTIFY THE LAPSE OF CONSCIOUSNESS DISORDER BEING REPORTED (Type of seizure, nocturnal, isolated,syncope, blackouts,		DATE(S) OF EPISODE(S) IN THE PAST THREE YEARS
etc.)

DATE OF ONSET, IF KNOWN	DATE AND TIME OF LAST EPISODE

Please indicate the impairments identified below that are presently shown by your patient.

YES

UNCERTAIN

Sporadic loss of conscious awareness.......................................................................................

Loss of consciousness ...............................................................................................................

Impaired motor function..............................................................................................................

EFFECTS AFTER EPISODE

Confusion ...................................................................................................................................

Diminished concentration ...........................................................................................................

Diminished judgment ..................................................................................................................

Memory loss ...............................................................................................................................

If medication is taken to control seizures, are the serum levels recorded?................................

Are the serum levels medically acceptable? ..............................................................................

COMMENT

SECTION 11 — DIABETES

PLEASE INDICATE THE TYPE OF DIABETES THIS PATIENT HAS				DATE OF DIAGNOSIS
Type I	Type 2	Gestational

WHAT METHOD OF TREATMENT IS REQUIRED?
Controlled diet		Oral diabetes medication	Insulin injections		Insulin pump	Other:

HAS THIS PATIENT RECEIVED DIABETES EDUCATION FROM A HEALTH CARE TEAM?

Yes No

DOES THIS PATIENT COMPLY WITH THE PRESCRIBED TREATMENT PLAN?

Yes No

IF NO, PLEASE EXPLAIN

IS THE DIABETES MANAGED AT THIS TIME?
Yes	No

IF YES, HOW LONG HAS DIABETES BEEN MANAGED OR MAINTAINED?			IF NO, PLEASE EXPLAIN

WHAT ARE THIS PATIENT’S FASTING BLOOD GLUCOSE LEVELS?			AFTER HOW MANY HOURS OF FASTING?

WITHIN THE LAST THREE YEARS, HAS THIS PATIENT EXPERIENCED			REASON FOR EPISODES (e.g., non-compliance w/regimen, change in condition, insulin unavailable, illness, etc.)
Hypoglycemic episodes?		Hyperglycemic episodes?

Please indicate the complications manifested by the hypoglycemic or hyperglycemic episodes and rate the severity of each.

NONE

MILD

MODERATE SEVERE UNCERTAIN

Abdominal pain................................

Cognitive deficits .............................

Confusion ........................................

Disorientation...................................

Incoordination..................................

Hypoglycemic unawareness............

Lack of stamina ...............................

Loss of consciousness ....................

Stupor ..............................................

Visual changes ................................

Ketoacidosis ....................................

Slowed reactions .............................

Seizures...........................................

Weakness or fatigue........................

Other................................................

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DS 326 (REV. 6/2020) WWW

DOES THIS PATIENT MANAGE HYPOGLYCEMIC OR HYPERGLYCEMIC EPISODES?
Yes	No	If no, please explain:

HAS THIS PATIENT’S DIABETES CAUSED ANY OF THE FOLLOWING CHRONIC COMPLICATIONS?
Visual changes		Kidney disease	Nervous system disease	Vascular disease

PLEASE DESCRIBE THE EXTENT OF THE COMPLICATIONS

HAS THE PATIENT BEEN HOSPITALIZED WITHIN THE LAST THREE YEARS DUE TO DIABETES COMPLICATIONS?		WHAT COMPLICATIONS NECESSITATED
Yes	No If yes, please give dates:	HOSPITALIZATION?

HAS AMPUTATION BEEN NECESSARY?

Yes No

IF YES, PLEASE EXPLAIN

SECTION 12 — ADDITIONAL COMMENTS BY MEDICAL PROFESSIONAL CONCERNING ANY CONDITION AFFECTING SAFE DRIVING

SECTION 13 — MEDICAL PROFESSIONAL’S SIGNATURE

MP’S SIGNATURE	MP’S NAME (PRINTED)	DATE
X
CLASSIFICATION OR SPECIALTY	MEDICAL LICENSE NUMBER	TELEPHONE NUMBER
		(	)

DS 326 (REV. 6/2020) WWW

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Download Ds 326 PDF Form

Form Data

Fact	Description
Form Title	DS 326 Driver Medical Evaluation
Confidentiality	Medical information is confidential under California Vehicle Code §1808.5 CVC
Purpose	To evaluate a driver's medical fitness to safely operate a motor vehicle
Sections to be Completed by Driver	Sections 1-3 must be completed and signed by the driver before visiting their medical professional
Medical Professional's Role	Completes Sections 5-13, evaluating the driver’s health and any conditions that could affect safe driving abilities

Instructions on Utilizing Ds 326

Filling out the DS 326 form is a critical step for drivers undergoing medical evaluation in California. This document ensures that your ability to drive safely is assessed with consideration to your health. It's paramount to provide accurate and detailed information to aid the Department of Motor Vehicles (DMV) in making informed decisions regarding your driving privileges. Here are the steps you'll need to follow to complete this form correctly:

Read the instructions carefully on the first page to understand the form's requirements and the importance of the information you're about to provide.
Complete Section 1 with your driver information, including your full name, driver license number, birth date, address, and contact details. Ensure the details match those on your driver's license to avoid any discrepancies.
In the health history portion under Section 1, answer "YES" or "NO" to each condition listed. For any "YES" answers, provide a thorough explanation including onset dates, diagnosis, medications, doctor’s information, and any limitations. Attach additional sheets if more space is needed.
Review and sign Section 2, the Driver’s Advisory Statement, acknowledging that you understand the confidentiality and usage of your medical information by the DMV.
In Section 3, Medical Information Authorization, fill out the name and address of the medical professional, hospital, or medical facility alongside the date and your medical record/patient file number. Sign to authorize the release of your medical information to the DMV.
Make sure to make a copy of the completed form for your records before handing it over to your medical professional.
Deliver the form to your physician, physician's assistant, or advanced practice registered nurse to complete Sections 5 through 13. These sections are crucial for the medical evaluation and must be filled out by a medical professional familiar with your health history and current condition.
After your medical professional has completed their portion, review the form to ensure all sections are filled out properly. Missing or inaccurate information could delay the processing of your form.
Submit the form by the specified return method, typically faxing to the number provided by your medical professional or directly to the DMV, depending on your state’s submission guidelines.

Once submitted, the DMV will review your DS 326 form as part of their assessment to determine your fitness to drive. It is essential to remember that the ultimate goal is to ensure the safety of all road users. The process might seem daunting, but it's designed to help maintain a safe driving environment for everyone. If there are concerns or additional information required, the DMV will contact you directly. Keep an open line of communication with your medical professional during this time to address any follow-ups promptly.

Obtain Answers on Ds 326

What is the DS 326 form?

The DS 326 form, also known as the Driver Medical Evaluation form, is a document issued by the Department of Motor Vehicles (DMV) in California. It is designed to gather comprehensive medical information to assess an individual's medical fitness to safely operate a motor vehicle. Medical professionals complete this form based on their evaluation of the patient's health history and current medical condition.
Who needs to complete the DS 326 form?

This form must be completed by a licensed medical professional—this can be a physician, physician's assistant, or an advanced practice registered nurse—most familiar with the patient's health history and current medical condition. The driver (patient) is required to complete the initial sections, which include personal information and a health history overview, before the medical professional completes the latter sections.
Why is the DS 326 form required?

The DMV requires the DS 326 form to make informed decisions about an individual's ability to safely operate a motor vehicle. It is particularly necessary when there are concerns about medical conditions that might impair driving capabilities, ensuring that drivers on the road do not pose a risk to public safety due to health-related issues.
What happens if I do not submit the DS 326 form?

Failure to submit the completed DS 326 form to the DMV when requested can lead to the refusal to issue or renew a driver's license, or it may result in the withdrawal of driving privileges. It is crucial for maintaining legal driving status for individuals with health conditions that may affect their driving.
Is the information provided on the DS 326 form confidential?

Yes, all medical information provided on the DS 326 form is confidential, as mandated under California Vehicle Code §1808.5 CVC. This information is used exclusively for the purpose of determining driving qualifications and is not open to public inspection.
How often do I need to submit a DS 326 form?

The requirement to submit a DS 326 form is typically based on the specific instructions from the DMV, which may request an evaluation due to concerns arising from a medical condition reported or observed. The frequency of submission depends on the nature of the medical condition and the DMV's assessment of how often reevaluation is needed to ensure public safety.
Can I drive while waiting for the DS 326 form to be processed?

Driving privileges may vary based on individual circumstances and the nature of the medical condition reported. In some cases, temporary licenses are issued while the DS 326 form is being processed. However, it is essential to follow any specific restrictions or guidance from the DMV regarding your ability to drive.
What should I do if my medical condition improves or changes?

If there is a significant improvement or change in your medical condition, it is advisable to undergo a new medical evaluation and submit an updated DS 326 form to the DMV. This can help in reassessing driving privileges, especially if previous medical concerns have been resolved or improved significantly.

Common mistakes

When filling out the DS 326 form, which is a critical step in evaluating a driver's medical fitness for operating a vehicle, people often overlook important details that could impact the assessment's outcome. Here are common mistakes to avoid:

Not completing the health history section thoroughly. It's essential to provide comprehensive answers to all questions about health conditions that could affect driving ability.
Failing to explain "YES" answers in the health history section. If you check "YES" to any health issues, providing detailed explanations, including onset dates, diagnosis, and current treatments, is crucial.
Omitting information about current medications. Including details such as medication names, dosages, and frequency helps the medical professional assess their impact on driving safety.
Not signing the authorization in Section 3. This authorization allows the DMV to receive and use medical information to determine driving qualifications, making it a key component of the form.
Forgetting to attach additional sheets if needed. When the space provided is not enough to thoroughly explain a health condition or treatment, attaching extra sheets ensures all relevant information is included.
Incorrectly filling out contact information. Providing accurate and legible contact information facilitates communication between the DMV, the driver, and the medical professional.
Overlooking the advisory statement in Section 2. Understanding the confidentiality and use of medical information helps in making an informed decision about completing the form.
Medical professionals not completing Sections 5-13 accurately. It's imperative for the evaluating medical professional to fill out these sections comprehensively to provide an accurate assessment of the driver's medical condition.
Misunderstanding the scope of the evaluation. Recognizing that the form's objective is to evaluate the safety of the driver's condition in relation to driving can guide both the driver and the medical professional in providing relevant information.

By avoiding these mistakes, drivers and medical professionals can ensure that the DS 326 form is filled out accurately and completely, leading to a fair and informed decision by the DMV regarding a driver's medical fitness for operating a vehicle.

Documents used along the form

When it comes to the realm of driver safety and health evaluations, the DS 326 form plays a crucial role, especially within the jurisdiction of the State of California. This form is essentially a bridge between medical professionals and the Department of Motor Vehicles (DMV), facilitating a comprehensive review of an individual's medical fitness to drive. However, to paint a complete picture of an individual's medical condition and driving capability, the DS 326 form is often accompanied by various other forms and documents. Understanding these supplementary materials can provide invaluable context and insight.

DMV 14 Form: This is essentially a Change of Address form that drivers may need to submit alongside the DS 326 if there has been a recent move. It ensures all correspondence from the DMV reaches the driver at their current address.
DL 51 Form: The Medical Examination Report for Commercial Driver Fitness Determination. This form is often used in conjunction with the DS 326 for individuals who hold or are applying for a commercial driver's license (CDL) and need to meet federal and state medical standards.
DL 939 Form: The 10 Year History Record Check form is essential for individuals who have had their driving privileges suspended or revoked. If there are medical issues involved, this form might be required along with the DS 326 to review the driver's history comprehensively.
REG 256 Form: A Statement of Facts form that can provide additional details or explanations about a driver's medical condition, history of substance abuse, or other relevant information that could affect their driving abilities.
DS 699 Form: A Request for Reexamination form that is sometimes filed by a law enforcement officer or medical professional who believes a driver may no longer be fit to drive safely. This can trigger the need for a DS 326 form evaluation.
DL 120 Form: The Senior Driver Ombudsman Program referral form. For older drivers, this form might be used in tandem with the DS 326 to ensure that the senior driver receives the appropriate evaluation and assistance with their driving needs.

Together, these forms create a network of information that allows for a well-rounded assessment of a driver's medical fitness for the road. They ensure that the evaluation process is thorough, factoring in various aspects of an individual’s health, driving history, and current medical conditions. This collaborative approach among medical professionals, the DMV, and the drivers ensures that only those who are indeed fit to drive are on the road, promoting public safety for all.

Similar forms

The FAA Medical Certificate application is similar to the DS 326 form in that both evaluations are concerned with assessing the medical fitness of an individual for a specific task. For the DS 326, it's about driving safety, while the FAA Medical Certificate focuses on the ability to safely operate an aircraft. Both require thorough medical examination results and history, along with professional opinions on the individual's health status and its impact on safety.
Commercial Driver's License (CDL) Medical Examination Report shares similarities with the DS 326 form by evaluating medical conditions that might affect the safe operation of a commercial vehicle. Both forms are designed to assess risks associated with specific health conditions and their impact on the operation of heavy machinery or vehicles, requiring information on medications, diagnoses, and physician's assessments.
The Medical Examination Report for Merchant Mariner Credential is akin to the DS 326 form in its purpose to ensure the safety of operations by evaluating the medical fitness of individuals. Both involve a detailed medical history, assessment of current health status, and potential risks posed by medical conditions in the execution of duties, whether it be maritime operations or driving.
The Social Security Disability Benefits application process includes forms that require detailed medical information similar to what is found in the DS 326. While not directly related to operating vehicles, these documents also rely on medical professionals' evaluations of conditions that significantly affect an individual's daily functions, focusing on the capability to work or perform activities safely and effectively.
Sports Physical Examination forms used in schools or professional sports share the goal of the DS 326 of ensuring safety through health evaluation. They assess an individual's medical fitness and readiness to participate in physical activities without risking their health or safety. Like the DS 326, these forms require detailed medical information, including medical history, current health status, and doctor's recommendations.

Dos and Don'ts

When approaching the task of filling out the DS 326 form, a Driver Medical Evaluation form, it's crucial to maintain clarity and accuracy. This document plays an essential role in assessing an individual's ability to safely operate a motor vehicle, especially in the light of medical conditions that might interfere with driving capabilities. Here are five critical dos and don'ts to keep in mind:

Do:

Ensure all sections requiring your input (Sections 1-3) are completed thoroughly. Details regarding your health history and any medical conditions you have are crucial for an accurate evaluation.
Print legibly in all sections of the form to avoid any misunderstandings or delays in processing. The clarity of your written information can significantly impact the review process.
Attach additional sheets if necessary, especially when explaining “YES” answers in the health history section. Providing comprehensive details helps in making an accurate assessment of your driving capabilities.
Review your responses carefully before signing the form to certify the accuracy of the information provided. Remember, this certification is made under penalty of perjury under the laws of the State of California.
Consider making a copy of the completed form for your records. It’s always useful to have your own reference, especially if questions arise later or there is a delay in processing.

Don't:

Leave sections incomplete or provide vague answers. Incomplete information may result in unnecessary delays or require you to submit additional documentation.
Guess or estimate details regarding your medical history or condition. Accuracy is key in these evaluations, and incorrect information could adversely affect the assessment of your driving abilities.
Forget to attach additional documentation if needed. Detailed explanations and medical records can provide crucial context for your responses in the health history section.
Ignore the need for clear and legible handwriting. If the form is hard to read, it could lead to misinterpretation of your medical information.
Overlook the significance of reviewing the form with your healthcare provider. Their input is invaluable in completing the medical evaluation sections accurately and comprehensively.

By following these guidelines, you can contribute to a smoother review process, ensuring that your ability to drive is evaluated fairly and accurately based on your medical conditions and history.

Misconceptions

When it comes to the DS 326 form, understanding what it is—and what it isn't—is critical. Misconceptions about this document can lead to confusion for drivers, healthcare professionals, and the general public. Here's a closer look at some common myths:

It's only for people with severe disabilities. The DS 326 form is not limited to individuals with severe or noticeable disabilities. It applies to anyone whose medical condition could affect their ability to drive safely, regardless of the condition's severity.
The form is public record. Medical information provided on the DS 326 form is confidential under California Vehicle Code §1808.5 CVC, ensuring the privacy of the driver’s medical information.
Completing the form automatically results in a revoked license. Submitting a DS 326 form does not automatically lead to the loss of driving privileges. The Department of Motor Vehicles (DMV) uses it to assess whether a driver can safely operate a vehicle, taking into account medical advice and recommendations.
Only doctors can complete the form. While the form must be filled out by a medical professional, it can be a physician, physician’s assistant, or an advanced practice registered nurse who is familiar with the driver’s medical condition.
It's a one-time evaluation. The need for reevaluation depends on the driver's medical condition and the DMV's discretion. Some conditions may require regular updates to ensure the continued safe operation of a vehicle.
Drivers cannot contest the medical evaluation. Drivers have the right to provide additional medical information or seek a second opinion if they believe the evaluation does not accurately reflect their ability to drive safely.
All medical conditions must be reported. Only conditions that could impair a driver’s ability to operate a vehicle safely need to be reported. Not every medical condition warrants completion of a DS 326 form.
The process lacks privacy. Health information provided on the form is kept confidential, in line with the protection offered by the California Vehicle Code. Access to this information is strictly controlled.
The form is complicated to complete. While the form is comprehensive, it is designed to be filled out by the medical professional most familiar with the driver's health. The DMV provides clear instructions to both the driver and the medical professional to simplify the process.
Submitting the form is voluntary. If the DMV requests a DS 326 form based on concerns about a condition affecting safe driving, failing to submit the form can result in refusal to issue a license or withdrawal of the driving privilege.

Understanding these points ensures that drivers and medical professionals approach the DS 326 form with clear expectations and an understanding of its importance in promoting road safety.

Key takeaways

Understanding how to properly fill out and use the DS 326 form is essential for both drivers and medical professionals in ensuring the safety and compliance with the California Vehicle Code. Here are seven key takeaways:

The DS 326 form is a crucial document for drivers with medical conditions that may affect their driving abilities. It serves as a bridge between the medical community and the Department of Motor Vehicles (DMV) to assess a person's ability to drive safely.
Drivers are responsible for completing and signing Sections 1-3 of the form before their medical evaluation. These sections include the driver's personal information, health history, and an authorization for the release of medical information to the DMV.
Drivers should provide accurate and honest information about their health status, including any medical conditions, treatments, and medications, under penalty of perjury. Misinformation can lead to legal consequences and impact public safety.
The form requires a medical professional to complete Sections 5-13, offering a detailed medical evaluation of the driver's condition. This includes vision tests, treatment history, current medications, and any functional impairments.
Medical professionals play a critical role in this process and are asked to give a comprehensive assessment of the patient's ability to operate a vehicle safely. This includes evaluating whether any medical conditions or prescribed medications could impair driving.
Confidentiality is paramount; the form underscores that all medical information provided is treated as confidential under California Vehicle Code §1808.5. Only authorized personnel within the DMV have access to this information for the purpose of making licensing decisions.
The ultimate decision regarding a driver's qualification to hold a license rests with the DMV. This decision is based on a combination of medical evaluations, driving history, and any other relevant information. The form also allows for the DMV to request additional information from the driver's healthcare provider if necessary.

Both drivers and medical professionals are encouraged to make a copy of the completed DS 326 form for their records. Ensuring that the form is filled out accurately and thoroughly is essential for maintaining road safety and compliance with state regulations.

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