Get Fl Hsmv 72190 2018-2026

The Florida Highway Safety and Motor Vehicles Medical Referral Form, known as FL HSMV 72190, is essential for reporting medical conditions that may affect a person's ability to drive safely. This guide provides clear instructions to assist users in completing this form online with ease.

Follow the steps to accurately complete the FL HSMV 72190 online.

1. Press the ‘Get Form’ button to access the FL HSMV 72190 form online and open it for editing.
2. Begin by filling out the personal information section, including the individual's name, date of birth, address, city, zip code, and gender identity.
3. Enter the driver's license number and state associated with that license. Ensure accuracy for proper identification.
4. In the section labeled 'Physical or Mental Deficit or Disorder Noted', check all applicable conditions that may affect the individual's driving abilities.
5. Provide detailed explanations for each checked condition in the designated area to clarify the concerns regarding the individual's driving ability.
6. Indicate your relationship to the individual by describing how you know them, such as friend, family member, or patient.
7. If applicable, fill in the name of the law enforcement agency or health care provider and their corresponding identification numbers.
8. Complete your personal information, which includes your name, address, telephone number, and the date of the report.
9. Sign the form to verify that the information provided is complete and accurate.
10. After reviewing the completed form for any errors, save your changes, and download or print the form for submission.
11. Send the completed form to the Bureau of Motorist Compliance via mail as instructed on the form.

Begin the process now and complete your FL HSMV 72190 form online.