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At-Risk Driver Forms, Brochures & Training Materials

Overview

Image of people attending a training session
This page provides forms, brochures and training materials for the Oregon DMV Medically At-Risk Driver Program
 
You may use the links below to go directly to any section:
Forms
Available Forms
DMV provides two forms for reporting drivers under the Medically At-Risk Driver Program:
Form Name: Mandatory Impairment Referral
Form Number: 735-7230
Stock Number: 300457
Example: Sample of Completed Form
Use: Physicians and other health care providers MUST use this form to submit their reports as part of the mandatory reporting component of the program.
 
Form Name: Driver Evaluation Request
Form Number: 735-6066
Stock Number: 300230
Use: Family members, friends, health care providers, social service providers, law enforcement officials and others MAY use this form to report an unsafe driver as part of the voluntary reporting component of the program.  They may also submit a letter on their agency/organization letterhead so long as it contains the same information.
Viewing Forms
To view forms, click on the form names above.

Downloading/Printing Forms
Forms may be downloaded and printed directly from the Internet, using your browser's "Save As" and "Print" options while viewing them.  For best results, be sure to print them on plain white paper.  For helpful information, see DMV forms and publications.
 
Ordering Forms
Forms may be ordered in bulk from the ODOT Storeroom.  To do so, fax a request on your agency/organization letterhead directly to the storeroom at (503) 986-2801.  Be sure to include the following in your request:
  • Form Name
  • Form Number
  • Stock Number 
  • Your contact and mailing information, if different than your letterhead
Submitting Forms
Completed forms and letters may be faxed to DMV's Driver Safety Unit at (503) 945-5329, or mailed to:
DMV Driver Safety Unit
1905 Lana Ave., NE
Salem, OR 97314-4120
Brochures
Available Brochures: DMV provides a series of brochures that can be used in talking to patients about safe driving, and planning for a time when they may want to consider “retiring” from driving:
 
  Form Name: How's My Driving? Staying Safe Behind the Wheel
Form Number: 735-7242
Stock Number: 300239

  Form Name: Retiring From Driving: When Someone You Know Should Give Up Driving
Form Number: 735-7240
Stock Number: 300046

  Form Name: Caring for the Medically At-Risk Driver: Resources for Health Care Professionals
Form Number: 735-7241
Stock Number: 300061

   Form Name: Transportation Resources When You Cannot Drive
Form Number: 735-7243
Stock Number: 300433
 
Viewing Brochures
To view color copies of brochures, click on the images or form names above.

Downloading/Printing Brochures
Brochures may be downloaded and printed directly from the Internet, using your browser's "Save As" and "Print" options when viewing them.  For helpful information, see DMV forms and publications.
 
Note: The brochures are in a two-sided, tri-fold format.  This means that they are designed to be printed on both sides of a single page and then folded in thirds.  This requires duplex printing capabilities, or each side may be printed on a separate page and then converted by a photocopier with 1 to 2 side conversion capabilities.
 
Ordering Brochures
Black and white copies of brochures can be ordered in quantities of 50 from the ODOT Storeroom.  To do so, fax a request on your agency/organization letterhead directly to the storeroom at (503) 986-2801.  Be sure to include the following in your request:
  • Form Name
  • Form Number
  • Stock Number
  • Your contact and mailing information, if different than your letterhead.
Training Video
DMV provides an 18 minute training video on the Medically At-Risk Driver Program. It is available in both VHS and DVD formats and will be mailed within five business days. Click here to request a copy of the video.
 
Please note: This video is intended for physicians and vision specialists who are mandatory reporters in the Medically At-Risk Driver Program.

Need More Information or Have Questions?
If you have questions or need more information about the materials provided on this page or the program, you may contact us by phone at (503) 945-5295 or submit an online inquiry.

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