Get Penndot Reporting Form

Completing the Penndot Reporting Form online is essential for reporting medical conditions that may affect a person's ability to drive safely. This guide provides clear, step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the Penndot Reporting Form online

1. Click the ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Fill in Section A with the patient's information, including the driver’s license number, height, sex, last name, date of birth, first name, and contact details. Ensure all information is typed or printed in blue or black ink.
3. In Section B, check the appropriate boxes to indicate any diagnoses of disorders or disabilities. Provide specifics where required, such as the type of impairment or condition.
4. Continue in Section B by answering questions regarding seizure disorders, ensuring to check the appropriate boxes based on the patient’s history.
5. Moving on to Section C, indicate whether the individual has any history of alcohol or drug use by checking 'Yes' or 'No' for each query.
6. In Section D, enter the health care provider's information, including name, address, telephone number, specialty, and license number.
7. Finish by having the health care provider sign and date the form, confirming the information is accurate.
8. Finally, review the completed form and decide whether to save changes, download, print, or share it as needed.

Complete your Penndot Reporting Form online today to ensure timely processing of important medical information.