[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-295787-105":59,"doc-detail-295787-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","driver-analysis-division-driver-analysis-division-agreementrelease-of-information","DRIVER ANALYSIS DIVISION DRIVER ANALYSIS DIVISION - Agreement/Release of Information","","Confidential driver medical review agreement and health certification form used to determine medical and mental fitness to safely operate a motor vehicle in Illinois. It collects driver identification, authorization for physicians to release medical condition information, and details about validity duration. Sections I–V require completion by the driver and by medical professionals, including cardiovascular, neurological, musculoskeletal, respiratory, seizure, diabetes, dizziness/fainting, alcohol/drug abuse, medication lists, controlled versus not controlled status, and unconsciousness attack history, with a separate mental health section when applicable.",{"@graph":69,"@context":123},[70,84,106],{"@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/driver-analysis-division-driver-analysis-division-agreementrelease-of-information/295787/",{"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/driver-analysis-division-driver-analysis-division-agreementrelease-of-information/295787.png","ImageObject",300,407,{"name":92,"@type":93},"Melati","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-18",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What does the agreement/release authorization require from the driver?","Question",{"text":113,"@type":114},"The driver agrees to remain under the care of a physician and follow treatment as prescribed. The driver authorizes the physician to release medical condition information to the Illinois Secretary of State and to report changes that could impair safe driving.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How long is the medical report valid?",{"text":118,"@type":114},"The report remains valid for three months (90 days).",{"name":120,"@type":111,"acceptedAnswer":121},"When must the mental health section be completed?",{"text":122,"@type":114},"Section III must be completed only if the driver has a mental health disorder marked “YES” by the MD/DO and/or a medical professional (NP/PA).","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},295787,1789723728,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":130,"read_time":24},962085570644,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Office of the Secretary of State Driver Services Department  \nDRIVER ANALYSIS DIVISION 2701 S. DIRKSEN PARKWAY SPRINGFIELD, IL 62723  \n217-782-7246 [www.cyberdriveillinois.com](www.cyberdriveillinois.com)  \n\n| Medical Report |\n| --- |\n| Per 625 ILCS 5/6-908 of the Driver’s License Medical Review Law and 625 ILCS 5/2-123(j), all medical statements or reports received by the Secretary of State shall be confidential. This information will be disclosed only as authorized by the above-referenced statutes as now or hereafter amended. |\n| SECTION I — To be Completed by Driver (Please print or type) |\n\nPursuant to 92 Illinois Administrative Code 1030.16, please complete the following information and sign the medical agreement as a condition of licensure.  \nName   Driver’s License Number  \n_________________________________  \nLast First Middle  \nStreet Address   Date of Birth   Gender ■ Male ■ Female  \nMonth Day Year  \nCity   ZIP Code    \nAgreement/Release of Information  \nI agree to remain under the care of my physician and follow the treatment exactly as prescribed. I hereby authorize and request my physician to release information regarding my medical condition to the Illinois Secretary of State, and to report any change in the status of my condition that would impair my ability to safely operate a motor vehicle. I understand that failure to abide by the conditions set forth in this agreement are grounds for the Secretary of State to deny or cancel my driving privileges. This report shall remain valid for three months (90 days).  \nSignature of Individual Date of Signature  \nSECTION II MEDICAL HEALTH — To be Completed by MD/DO and/or Medical Professional (NP/PA)  \nPer Illinois Administrative Code Title 92, Part 1030, all sections of this report must be completed in its entirety. DATE OF COMPLETION OF MEDICAL HEALTH SECTION II:    \n1. In your professional opinion, is this individual MEDICALLY FIT to safely operate a motor vehicle?  \nYES ■ NO ■  \n2. Conditions: Yes or No required for each condition listed.  \n(a) Cardiovascular YES ■ NO ■ (provide condition)  (b) Neurological YES ■ NO ■ (provide condition)  (c) Musculoskeletal YES ■ NO ■ (provide condition)  (d) Respiratory YES ■ NO ■ (provide condition)  (e) Seizure YES ■ NO ■ (provide condition)  (f) Diabetes YES ■ NO ■  \n(g) Dizzy/Fainting Spell YES ■ NO ■  \n(h) Alcohol/Drug Abuse YES ■ NO ■  \n(i) Other Medical Condition(s) (provide condition)    \n* For mental health disorders, please refer to Section III-Mental Health. Section III must be completed if the individual has a MENTAL HEALTH disorder.  \n3. List all current medications prescribed relating to any condition indicated above in Question \\#2 . (If medications are listed a condition must be disclosed above in Question \\#2.)    \n_______________________________________________________________________________________________________________  \n_______________________________________________________________________________________________________________  \n_______________________________________________________________________________________________________________  \n4. ■ No medications prescribed  \n(continued on back)  \nPrinted by authority of the State of Illinois. February 2018-25M-DSD DC-163.7  \nPATIENT’S NAME:    \n5. Current Status of Condition:  \n(A) Controlled ■ (B) Not Controlled: will not affect driving ■ (C) Not Controlled Condition: may affect driving ■  \n(If Not Controlled is marked, you must provide details, which may include pertinent clinical information, i.e. test results, lab values, etc.)  \n_______________________________________________________________________________________________________________  \n6. In the past six months, has there been an attack of unconsciousness? YES ■ NO ■ Date of Attack    \n(If YES, you must provide details, which may include pertinent clinical information.)  \n_______________________________________________________________________________________________________________  \n_______________","cbCaipxOna7iByEk","https://ap.wps.com/l/cbCaipxOna7iByEk","pdf",230227,"English","# SECTION I — To be Completed by Driver (Please print or type)\n# SECTION II MEDICAL HEALTH — To be Completed by MD/DO and/or Medical Professional (NP/PA)\n# SECTION III MENTAL HEALTH — To be completed ONLY if driver has a Mental Health Disorder marked “YES”\n# SECTION IV — Additional information, special restrictions, etc.\n# SECTION V — MD/DO and/or Medical Professional (NP/PA)","[{\"question\":\"What does the agreement/release authorization require from the driver?\",\"answer\":\"The driver agrees to remain under the care of a physician and follow treatment as prescribed. The driver authorizes the physician to release medical condition information to the Illinois Secretary of State and to report changes that could impair safe driving.\"},{\"question\":\"How long is the medical report valid?\",\"answer\":\"The report remains valid for three months (90 days).\"},{\"question\":\"When must the mental health section be completed?\",\"answer\":\"Section III must be completed only if the driver has a mental health disorder marked “YES” by the MD/DO and/or a medical professional (NP/PA).\"}]","DRIVER ANALYSIS DIVISION DRIVER ANALYSIS DIVISION - Agreement/Release of Information | PDF"]