| Mandatory Reporting |
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| How to Report to DMV |
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Reports must be submitted on the Mandatory Impairment Referral Form, which may be downloaded from this web site or ordered by fax:
To download the form (read all downloading instructions below before accessing the form):
- Click here to access an electronic version of the form;
- Once you have accessed the form, you may print it on your local printer using your browser's "Print" option; or
- Once you have accessed the form, you may save a copy to your computing device using your browser's Save As option.
To order the form by fax:
- Write a request on your agency’s or organization's letterhead;
- Include the form number #735-7230 in your request; and
- Fax the request to the ODOT Storeroom at (503) 986-2801.
Forms are provided free of charge.
 In order for DMV to process the report, the form must be filled out completely. You will be contacted by DMV if your form has not been filled out completely.
Click here to view an example of a completed form.
List the underlying medical diagnosis or condition in the space provided on the form, and specify any other factors that may interfere with the safe operation of a motor vehicle, including drug and/or alcohol abuse, medications and pertinent test results.
Completed forms 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
Note: You do not need to mail a form if you have already faxed it or vice versa.
Once a report is submitted to DMV, the person’s driver license will usually be suspended. The medical information you provide will allow DMV's Medical Determination Officer to decide under what conditions driving privileges may be reinstated.
You will be notified if the patient is not suspended or if driving privileges are reinstated (e.g., the individual passes DMV tests, DMV's Medical Determination Officer decides the person’s driving privileges should be reinstated or privileges are reinstated based on the outcome of a hearing).
Click here for more information about what happens after reporting.
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| Related Information |
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Additional information that may be relevant includes:
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