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The form addresses medical conditions potentially affecting safe motor-vehicle operation, includes patient consent and confidentiality notices under California Vehicle Code §1808.5, and provides structured fields for driver information, authorization, and medical findings such as vision results and treatment history.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/driver-medical-evaluation-ds326-public-service-agency/438880/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/driver-medical-evaluation-ds326-public-service-agency/438880.png","ImageObject",300,407,{"name":42,"@type":43},"\tJames","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What are the driver’s responsibilities on the DS326 Driver Medical Evaluation form?","Question",{"text":63,"@type":64},"The driver must take the form to the medical professional most familiar with their health history, then complete and sign Sections 1–3. The driver should print legibly and explain any “YES” answers in the health history section.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What must the medical professional complete on this form?",{"text":68,"@type":64},"The medical professional completes Sections 5–13 on pages 2 through 5. They must answer all questions and indicate “N/A” when a question does not apply, and may include a narrative report with pertinent information.",{"name":70,"@type":61,"acceptedAnswer":71},"How does the form address confidentiality and DMV access to medical information?",{"text":72,"@type":64},"It states that medical information is confidential under California Vehicle Code §1808.5 and describes how records relating to physical or mental condition are handled. It also includes authorization for the medical professional and DMV to exchange information to determine safe operation of a motor vehicle.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},438880,1791072198,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":97,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145,"preview_page_count":4},2336474466412,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","A Public Service Agency  \n*DS326*  \nDRIVER MEDICAL EVALUATION  \n(Medical information is CONFIDENTIAL under California Vehicle Code §1808 .5 CVC)  \nINSTRUCTIONS 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.  \nINSTRUCTIONS 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:  \n\n| PHYSICIAN RETURN FORM TO: | RETURN BY: |\n| --- | --- |\n|  |  |\n\nSECTION 1—DRIVER INFORMATION  \n\n| NAME (LAST, FIRST, MIDDLE) | DRIVER LICENSE NO. | BIRTH DATE | FIELD FILE |\n| --- | --- | --- | --- |\n| STREET ADDRESS CITY | ZIP | PATIENT’S DAYTIME OR HOME PHONE NO.( ) |  |\n\nDRIVER MUST COMPLETE HEALTH HISTORY BELOW. (Please explain any “YES”answers)  \n\n| YES | NO |  | YES | NO |  |\n| --- | --- | --- | --- | --- | --- |\n|  |  | Head, neck, spinal injury, disorders or illnesses |  |  | Kidney disease, stones, blood in urine, or dialysis |\n|  |  | Seizure, convulsions, or epilepsy |  |  | Muscular disease |\n|  |  | Dizziness, fainting, or frequent headaches |  |  | Any permanent impairment |\n|  |  | Eye problem (except corrective lenses) |  |  | Nervous or psychiatric disorder |\n|  |  | Cardiovascular (heart or blood vessel) disease |  |  | Regular or frequent alcohol use |\n|  |  | Heart attack, stroke, or paralysis |  |  | Problems with the use of alcohol or drugs |\n|  |  | Lung disease (include tuberculosis, asthma or emphysema) |  |  | Other disorders or diseases |\n|  |  | Nervous stomach, ulcer, or digestive problems |  |  | Any major illness, injury, or operations in last 5 years |\n|  |  | Diabetes or high blood sugar |  |  | Currently taking medications |\n\nEXPLANATION: (Include onset date, diagnosis, medication, doctor’s name and address and any current condition or limitation. Attach additional sheet, if needed).  \n\n| 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. |  |\n| --- | --- |\n| DATE | DRIVER’S SIGNATURE\u003Cbr>X |\n| SECTION 2—DRIVER’S ADVISORY STATEMENT |  |\n| 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.\u003Cbr>All records ofthe 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. |  |\n| SECTION 3—MEDICAL INFORMATION AUTHORIZATION |  |\n\nMEDICAL PROFESSIONAL, HOSPITAL, OR MEDICAL FACILITY (NAME AND ADDRESS)  \n\n| DATE | MEDICAL RECORD/PATIENT FILE NO. |\n| --- | --- |\n\nI 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.  \nI 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.  \nNOTE: You may wish to make a copy of the completed Drive","cbCaiu26drxtjiIf","https://ap.wps.com/l/cbCaiu26drxtjiIf","pdf",598765,"English","# SECTION 1—DRIVER INFORMATION\n# Driver Health History\n## Certification and signature\n# SECTION 2—DRIVER’S ADVISORY STATEMENT\n# SECTION 3—MEDICAL INFORMATION AUTHORIZATION\n# SECTION 4—MEDICAL PROFESSIONAL’S MEDICAL EVALUATION INSTRUCTIONS\n## Vision (SECTION 5)\n## Treatment by other medical professionals (SECTION 6)","[{\"question\":\"What are the driver’s responsibilities on the DS326 Driver Medical Evaluation form?\",\"answer\":\"The driver must take the form to the medical professional most familiar with their health history, then complete and sign Sections 1–3. The driver should print legibly and explain any “YES” answers in the health history section.\"},{\"question\":\"What must the medical professional complete on this form?\",\"answer\":\"The medical professional completes Sections 5–13 on pages 2 through 5. They must answer all questions and indicate “N/A” when a question does not apply, and may include a narrative report with pertinent information.\"},{\"question\":\"How does the form address confidentiality and DMV access to medical information?\",\"answer\":\"It states that medical information is confidential under California Vehicle Code §1808.5 and describes how records relating to physical or mental condition are handled. It also includes authorization for the medical professional and DMV to exchange information to determine safe operation of a motor vehicle.\"}]","DRIVER MEDICAL EVALUATION - DS326 - Public Service Agency | PDF",1790686667,13]