Licensing agencies in all states accept reevaluation referrals for drivers of any age. Each state has a process for reporting a potentially unsafe driver to its licensing office or department of motor vehicles. Law enforcement officers and physicians represent the majority of those submitting reports, but concerned family members and citizens can also submit reports.
Medical professionals are in an excellent position to assess if changes in their patients’ physical or cognitive abilities may increase their crash risk. In addition, clinicians, such as pharmacists, nurses, occupational or physical therapists, and social workers or case managers, can assess for physical, cognitive, or functional limitations. These limitations might warrant further evaluation, counseling, or referral to the licensing agency, if appropriate.
As of 2016, six states require physicians to report patients who have specific medical conditions, such as epilepsy or dementia. Other states require physicians to report “unsafe” drivers, with varying guidelines for defining “unsafe.” In all 50 states and the District of Columbia, physicians are permitted to report medically at-risk drivers. Physicians must balance their legal and ethical responsibilities to protect their patient’s health and confidentiality with their duty to protect the general public from unsafe drivers. Consider that physicians have been held liable for damages from crashes involving patients because they failed to report the patient to the licensing agency.
Licensing decisions based on drivers’ medical fitness to drive can be established through review by a medical advisory board (MAB) and/or with one or more medical professionals performing reviews of the referrals. Having medical professionals or a MAB perform case reviews provides certain advantages, including legal immunity to physicians voluntarily referring at-risk drivers.4 NHTSA conducted a study of MAB structures, referrals, and outcomes in six states, and found that physician referrals resulted in changes in license status in 90 percent of cases studied. In fact, physician referrals were most likely to result in changes to driver license statuses. Therefore, an MAB may serve to promote physician referrals. See Lococo, Stutts et al., 2017 for a summary of the medical review structures and referral processes in all states.
 Graham, L., Darrah, J.R. & Thomas, F.D. (2020). Older Driver Licensing Policies and Practices Database Update (Technical Report). AAA Foundation for Traffic Safety. Retrieved March 27, 2023 from https://aaafoundation.org/older-driver-licensing-policies-and-practices-database-update/
 American Geriatrics Society & A. Pomidor, Ed. (2016, January). Clinician’s guide to assessing and counseling older drivers, 3rd edition. (Report No. DOT HS 812 228). Washington, DC: National Highway Traffic Safety Administration. https://www.nhtsa.gov/sites/nhtsa.gov/files/812228_cliniciansguidetoolderdrivers.pdf
 National Highway Traffic Safety Administration. (2014). Older driver safety (Highway Safety Program Guideline No. 13, Older Driver Safety, DOT HS 812 007D). https://icsw.nhtsa.gov/nhtsa/whatsup/tea21/tea21programs/pages/812007D-HSPG13-OlderDriverSafety.pdf
 Lococo, K. H., Stutts, J., & Staplin, L. (2016, October). Medical review practices for driver licensing, Volume 1: A case study of guidelines and processes in seven U.S. States (Report No. DOT HS 812 331). National Highway Traffic Safety Administration. https://rosap.ntl.bts.gov/view/dot/1974
 Lococo, K. H., Stutts, J., Sifrit, K. J., & Staplin, L. (2017, April). Medical review practices for driver licensing, Volume 3: Guidelines and processes in the United States (Report No. DOT HS 812 402). National Highway Traffic Safety Administration. https://www.nhtsa.gov/sites/nhtsa.gov/files/documents/812402_medicalreviewdriverlicense.pdf
 Venkatraman, V., Richard, C. M., Magee, K., & Johnson, K. (2021, July). Countermeasures that work: A highway safety countermeasures guide for State Highway Safety Offices, 10th edition, 2020 (Report No. DOT HS 813 097). National Highway Traffic Safety Administration.