Driving_Rules_In_Texas - Medical Advisory Board Medical Form - Authorization to Release Medical Information

Sep 18, 2026

Upload by Grenda

Document explains Texas Department of Public Safety (DPS) authority in licensing decisions for drivers and the role of the Medical Advisory Board (MAB) under the Department of State Health Services for medical conditions. It states that DPS is responsible for licensing actions, while providing legal liability boundaries for MAB and attending physicians. Includes appeal guidance for medical denials or revocations and provides a detailed driver license medical history questionnaire with categories and physician authorization.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages23

Reading Time58 min

AccessFree to download

Who regulates driving licensing medically

Medical Advisory Board (MAB) and DPS responsibilities

Authorization and legal limits

Authorization to release medical information

Appeal for medical denials or revocations

Medical history questionnaire

Cardiovascular

Neurological

Metabolic

Mental

Musculoskeletal

Vision

Physician information and reporting

Who regulates this for the state? ▶DPS is responsible for issuing all driving licenses-(and hasthe final say) ▶ The Medical Advisory Board ▶ under the directorship of the Department of State HealthServices EMS Certification and Licensing advises DPSregarding medical conditions and driving ▶DPS is the licensing agency for driving for Texas ▶DPS is solely responsible for all actions taken or initiatedwith licensing. ▶"Neither the MAB nor the attending physician arelegally liable for the decisions or actions taken by DPSin the licensing or un-licensing of drivers.” ▶ If a license is denied or revoked for medical reasons,thedecision may be appealed to the courts for finaldetermination. A.Cardiovasecular Texas Department of State Health Services The Texs Department ofPublie Safety has rejuestet than the Medical AdvisoryHealth ana SaSety Cedie,Tile 2,SubtiteA.Bourd assist them in the evaluationofChaptir 12,Subehapler Hthe case ofMedikeal Advhory BuardSe.1.098 LubilityFIRSTNAMEMID_NAME+LASTNAMEo 1.Has the patient been hospitalzed within the past two years for problems related to thisevaluation? Page40f7 Bn D 1121 DPS Physiclan to return this oraginal form to the Medical Advisory Board withAuthorization to Release Medical Information Medcal Аdуiогу Воагд | APPLICANTLICENSEE-S MEDICAL HISTORY
То Ье сотрББй БуаЙсєпхй рЙуяТап | | --- | s it pertains to hisbe license to operatea motor vehicele.This evaluntionmbon4,craphyskclen wto pports to the redadvsoy bodo apanel urd Secio 12.096 is notconcens a possible medical limitationliele forapcfesoral spinien rconnerdcim,orwhich could adversely afict hisherability to operne a motor vehicledyAc5195,74地L呢，1865.8Authority to perfom thisreview is inSept 1,1995acordance with the TranspoetatiomCode,Chapter 521,Section 321,theHealth and Safety Code,Chagter 12, Sections 091-098,and the implementing rules adbopted by the Texas Depatmest of State Hcalth Services. | ГиП Маше оЕцрйсшиЛсепеє «ЕТВбТсМАМЕ» «МП МАМЕ» «ЬАбТМАМЕ»
Drivrs License Nunber DL._NLM
Ргоуйде зрестБс тбоппмоп опЮе ЁПомпр тесйса соєвШоес чМЕО РВОВЕЕМо | | --- | PATIENT'S MEDICALHISTORY A.When? _Where? Why? Physician B.Whem?_ Where? Why? Physician OCASENBRn THURSDAY_DATE Dslla torerntiifrm 0 Ie Medleal MNisryBand wltArtartrahions IL Please Bote the presence of abaormalities in the following applicable categories,I04 口Does not apply to this paticm | Т. Вюой ргєззигё
узрпел
Апцтпа
2.Pacemaker —
Dree Installed—
3. 5упсоре—
Ртедиеосу —
Date__
А, ЕипспосаГ Сароспу
5.Pulse_ Defibrillaor_
б. АНА ГипеПооаГСирасйущ
□k
只Chn⁴Ccrpleclimiain plosilstiy
chm R Serfon ofaiy
e porla hold le darrioe by teCedn Culirar Ssiey
idhanfiknby the New Yonk HentAueciufindlasifkalion
只C Aee
2Arrna wihmedaleei
Chaer卖Argira withmldoxrtin
2.Clirbhr l fe nn rEpa
□ Can4:Mngi y bod ofrydca esalie | Diagnosis
Неягє ЕзВмгс
□ChmI(ril Noliriuiw ofrokal
Bsdu frpelaian r dyne
□
hiclathityrsuibsi ffge,pdpiatio
□C lc mabalirii
pysiealstihay.Cenkrabe n ret buaka
鲁n ondrary ey 6Ues ftarigaz
did | | | --- | --- | --- | | ЕРавюнуую ниринеп
B.Neurological | | | | 1.Dateoflast seizure
2.Seizure frequensy_
З,Агеуош оопсегпешЕпшНе єрПєрзу огШвапЕюоаушбппв аге
interfering wih cogitive abilities or processing speed
Yes No口
4.Stroke′TIA or functianal irpaimment _
5. Весштеп ПАУЕисБопл аросйу
7 Dementia?Yes□ No□
В Мпи Соршпче ШшрзшешРУеяШ МоШ
9.Was a DPS writen &diving test recommecnded?Yes□No□
То ВаскоиР ..Хез ЕЛ МоШ
Rerscon frBlakout._
Date of Blackout: | | Diagnosis | FukimrthcnNnalAd Aiterbn C.Metahbolie ШГоегп дррУДю ЄярШещ Daznosis Т оноПаАъу шойсаюа ШОхаШп

FAQs

What role does the Medical Advisory Board (MAB) play in Texas driving licensing?

The MAB advises DPS about medical conditions that may affect driving licensing decisions, under the direction of the Department of State Health Services EMS Certification and Licensing.

Who is legally responsible for licensing actions in Texas?

DPS is solely responsible for actions taken or initiated with licensing, while the document states neither the MAB nor the attending physician is legally liable for DPS decisions or actions.

If a driving license is denied or revoked for medical reasons, what can the applicant do?

The decision may be appealed to the courts for final determination.

Sep 18, 2026

Upload by Grenda