1. (1) If the department has reason to believe that an applicant has a physical or mental disability which affects his or her ability to safely operate a motor vehicle, the department shall not process the application until a statement of physical or mental history has been received and reviewed.
2. (2) The application shall be denied if, upon review, the statement indicates the person cannot safely operate a motor vehicle.
3. (3) If the department has reason to believe that a licensee has a physical or mental disability which affects his or her ability to safely operate a motor vehicle, the department shall require the licensee to submit a statement of physical or mental history at or before a reexamination of the licensee. A license or indorsement may be restricted, suspended, or revoked if that action is ordered at a reexamination conducted by the department or if the person who completed the statement recommends no driving privileges or otherwise indicates the licensee lacks the physical or mental ability to safely operate a motor vehicle.

4. (4) The statement of physical or mental history shall include all of the following information with respect to the person completing the examination:

   1. (a) Name, address, title, and signature.
   2. (b) Area or specialty of practice, if any.
   3. (c) The person's professional license number, if any, and telephone number.

5. (5) The statement of physical or mental history shall include all of the following information pertaining to the applicant or licensee:

   1. (a) The person's full name, address, and date of birth.
   2. (b) The date of the report.
   3. (c) The date of examination.

6. (6) The statement of physical or mental history shall contain the following information as it pertains to the current ability of the applicant or licensee to safely operate a motor vehicle:

   1. (a) The diagnosis, age of onset, prognosis, and prescribed treatment or plan of therapy.
   2. (b) Prescribed medications.
   3. (c) The person's compliance with and response to treatment, therapy, or medication.
   4. (d) Any adverse or other reaction to treatment, therapy, or medication.
   5. (e) The results of the examination.
   6. (f) The signature of the applicant or licensee on a release or waiver authorizing the use of the information by the department only for the purpose of assisting in evaluating the person's ability to safely operate a motor vehicle.
   7. (g) Any other information required by these rules.
7. (7) A statement of physical or mental history may include an evaluation of the effect of the condition and treatment, therapy, or medication upon the person's ability to operate a motor vehicle and a recommendation for licensure restrictions or special limitations.
8. (8) If the statement is completed by a psychologist or neuropsychologist and the applicant or licensee is taking prescribed medication for the treatment of his or her condition or for any other reason or condition known to the psychologist or neuropsychologist, the statement shall also be signed by the physician who prescribed the medication.
9. (9) The department may request the applicant or licensee to provide additional information concerning his or her current ability to safely operate a motor vehicle, including additional medical information when appropriate.
10. (10) The department may require, as a condition for or a restriction upon a license, that a licensee submit statements of physical or mental history periodically during the duration of a license or indorsement or upon submission of an application for an operator's or chauffeur's license or indorsement.
11. (11) A licensing action taken by the department on the basis of a physical or mental condition or disability will be reassessed by the department upon receipt of new medical evidence and documentation that the condition or disability has changed or abated or no longer exists.
12. (12) All records and information received or secured pursuant to these rules shall be kept confidential and shall be used only for the purpose of assisting in evaluating a person's ability to safely operate a motor vehicle.
13. (13) Disclosure of the contents of any document or other information received pursuant to these rules by any employee of the department for any reason other than assisting in the evaluation of a person's ability to safely operate a motor vehicle may be grounds for disciplinary action.

History: 1988 AACS.