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It details steps for completion, dates, physician responsibilities, mailing or faxing procedures, and comprehensive patient history checklists covering physical impairments, neurologic conditions, seizures, mental health, vision, hearing, and diabetes. Additional sections guide physician statements and functional capacity assessment using checkbox-based questions and diagnostic prompts.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/dds-medical-report-medical-report-2026-patient-instructions/308569/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/dds-medical-report-medical-report-2026-patient-instructions/308569.png","ImageObject",300,407,{"name":92,"@type":93},"Bintang","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-20",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What must the patient complete on page 1 of the medical report?","Question",{"text":112,"@type":113},"The patient must complete, date, and sign page 1 of the report.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What are the physician requirements for pages 2 through 4?",{"text":117,"@type":113},"The physician must complete pages 2–4 and sign and date page 4.",{"name":119,"@type":110,"acceptedAnswer":120},"Which professional must complete the form for drivers who want to maintain a Commercial Driver’s License?",{"text":121,"@type":113},"A medical provider must complete the form using the approved FMCSA National Registry of Certified Medical Examiners.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},308569,1790148297,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52},962085564381,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","GEORGIA DEPARTMENT OF DRIVER SERVICES MEDICAL REPORT  \nPATIENT INSTRUCTIONS  \nIMPORTANT:  \n1. Complete, date, and sign page 1 of this report.  \n2. Give pages 1-4 of this report and a copy ofthe DDS letter that lists the medical concern(s) to your licensed physician.  \n3. The physician must complete pages 2-4; sign and date page 4.  \n4. All drivers who wish to maintain a Commercial Driver’s License MUST have this form completed by a medical provider on the approved Federal Motor Carrier Safety Administration (FMCSA)National Registry of Certified Medical Examiners.  \n(  [https://www.fmcsa.dot.gov](https://www.fmcsa.dot.gov)).  \n5. All pages of this report and a copy ofthe DDS letter MUST be mailed or faxed (with coversheet)by the medical provider directly to:  \nDepartment of Driver Services  \nMedical Review Unit  \nPO Box 80447  \nConyers, Georgia 30013-or  \nFax to :770-918-6266  \nPATIENT INFORMATION  \nName: Last   First   MI   DOB (mm/dd/yyyy)   Physical Street Address   City   State   Zip Code   Driver’s License \\#    \nPlease check the box next to the class of license you hold:  \nNon-Commercial Class: C/CP 􀂆 M/MP 􀂆 D 􀂆  \nCommercial Class: A/AP 􀂆 B/BP 􀂆 C 􀂆  \nPATIENT HISTORY  \nPlease check “Yes” or “No” to indicate any conditions you have that could affect the safe operation of a motor vehicle.  \nYes No  \n☐ ☐ Physical impairments ☐ ☐ Orthopedic, musculoskeletal, bone, joint or  \nmuscle problems or diseases ☐ ☐ Neurological problems or diseases ☐ ☐ Head or spinal injuries ☐ ☐ Cardiovascular problems or diseases  \nYes No  \n☐ ☐ Seizures, fits, blackouts, convulsions, or fainting spells ☐ ☐ Nervous, mental health or psychiatric problems or  \ndiseases ☐ ☐ Visual problems or diseases ☐ ☐ Hearing problems  \n☐ ☐ Diabetes  \nExplain any “Yes” answer(s):  \nPATIENT ATTESTATION  \nI hereby swear or affirm that the above answers are true to the best of my knowledge. I authorize   , a licensed physician, to complete this examination and to provide further clarification or information about my medical condition to the Georgia Department of Driver Services (DDS). I agree that this Medical Report may be submitted to the DDS Driver’s License Advisory Board, which consists of doctors licensed to practice throughout the State of Georgia, and that it may also be used for the guidance of the courts when necessary.  \nDriver/Licensee Signature Date  \nPHYSICIAN’S STATEMENT  \nGENERAL INFORMATION:  \n1. How long has this individual been under your care as a patient? Years:   Months:    \n2. When did you last examine this patient? (mm/dd/yyyy) Date:    \n3. Does this patient have a problem, condition, disorder or disease that could affect his or her ability to drive safely?  \n􀂆 Yes 􀂆 No If ‘yes’, please explain:    \n4. Does this patient require adaptive equipment in order to drive? 􀂆 Yes 􀂆 No If ‘yes’, please explain:  \n5. What is your diagnosis?    \n***IMPORTANT: Questions 6 and 7 REQUIRE a ‘YES’ or ‘NO’ answer.***  \n6. Do you find any difficulties, problems, or diseases, other than 1 through 5 above, which would interfere with this person’s ability to safely operate a motor vehicle? 􀂆 Yes 􀂆 No If ‘yes’, please explain:  \n7. In your opinion, is this patient medically capable of safely operating a motor vehicle? 􀂆 Yes 􀂆 No If ‘no’, please explain:  \n8. If this patient holds a commercial license, is he/she medically capable of safely operating a commercial motor vehicle? 􀂆 Yes 􀂆 No If ‘no’, please explain:   \nSECTION A  \nNEUROLOGICAL, CEREBROVASCULAR, ALTERATION IN CONSCIOUSNESS  \nA 1. Has patient experienced a blackout, fainting spell, or syncope? 􀂆 Yes 􀂆 No  \nIf ‘yes’, how often?   Date of last occurrence:    \nWas this a one-time episode? 􀂆 Yes 􀂆 No State the cause.    \nA 2. Has patient had seizures associated with epilepsy? 􀂆 Yes 􀂆 No  \nIf ‘yes’, date of onset and history:   What is the Frequency:   Date of last occurrence:    \nA 3. Has patient had seizures not associated with epilepsy? 􀂆 Yes 􀂆 No  \nIf ‘yes’, date of onset and history:   What is the Frequency:","cbCaij7HrQzLbZpS","https://ap.wps.com/l/cbCaij7HrQzLbZpS","pdf",307441,"English","# Patient Instructions\n# Patient Information\n# Patient History\n# Patient Attestation\n# Physician’s Statement\n## General Information\n# Section A: Neurological Conditions\n# Section B: Cardiovascular and Respiratory Disease","[{\"question\":\"What must the patient complete on page 1 of the medical report?\",\"answer\":\"The patient must complete, date, and sign page 1 of the report.\"},{\"question\":\"What are the physician requirements for pages 2 through 4?\",\"answer\":\"The physician must complete pages 2–4 and sign and date page 4.\"},{\"question\":\"Which professional must complete the form for drivers who want to maintain a Commercial Driver’s License?\",\"answer\":\"A medical provider must complete the form using the approved FMCSA National Registry of Certified Medical Examiners.\"}]","DDS Medical Report - Medical Report 2026 - Patient Instructions | PDF",1789869689]