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Assessing Fitness to Drive

Table of Contents

5. Assessment and reporting process – step by step

Assessing fitness to drive is based on the decision-making process outlined in Figure 3. Medical decision-making process for assessing fitness to drive. The nature and extent of the examination will depend on the circumstances and the reasons for the examination. Details of the process and administrative requirements are described in this section and are further illustrated in Figure 4 and Figure 5. Note also the further considerations outlined in section 3. Roles and responsibilities.

Figure 3: Medical decision-making process for assessing fitness to drive

Figure 4: Conducting an examination at the request of a driver licensing authority (DLA)

The image is a decision tree for medical professionals about conducting an examination at the request of a driver licensing authority. The DLA can request a report on the patient’s fitness to drive. The DLA provides the driver with the appropriate forms (medical report form) which may identify the licence type and reason for examination. The medical professional conducts examination using commercial and/or private standards. If the health professional assesses that the patient meets the unconditional licence requirements, then the health professional: completes the medical report in accordance with the findings, provides the original medical report to the patient to return to the DLA, and advises and counsels the patient. Then, the patient returns the medical report to the driver licensing authority. If the health professional assesses that the patient’s condition and circumstances do not meet unconditional requirements but may meet conditional requirements, then the health professional completes the medical report in accordance with the findings. The health professional notes: the relevant details of the patient’s condition, the medical requirements that are not met, the recommended conditions of the licence, the requirements for ongoing monitoring and periodic review, and the recommended rehabilitation if appropriate. Then the health professional: provides the original medical report to the patient to return to the DLA, advises and counsels the patient accordingly, retains a copy of the medical report for the medical file, and shares their report with the patient’s GP to support effective long-term management. The patient then returns the medical report to the driver licensing authority. If the health professional assesses that the patient does not meet medical requirements for an unconditional or conditional licence, then the health professional completes the medical report in accordance with the findings, noting the: relevant details of the patient’s condition, medical requirements that are not met, recommended conditions of the licence, requirements for ongoing monitoring and periodic review, and the recommended rehabilitation if appropriate. Then the health professional provides the original medical report to the patient to return to the DLA, advises and counsels the patient accordingly, retains a copy of the medical report for the medical file, and shares their report with the patient’s GP to support effective long-term management. The patient then returns the medical report to the driver licensing authority. If the health professional assesses the patient and is in doubt about the patient’s fitness to drive, then the health professional: may need to advise and counsel the patient not to drive until decision is made by the DLA, refer the patient to a specialist if required, may recommend or refer the patient for a practical driver assessment, completes the medical report in accordance with findings which will note the reasons for doubt in assessing the patient and recommendations for further assessment, provides original medical report to the patient to return to the DLA, and retains a copy of the medical report for the medical file, and shares their report with the patient’s GP to support effective long-term management. The patient returns the medical report to the driver licensing authority. The driver licensing authority may require a specialist opinion or suggest a practical driver assessment. After the patient returns the medical report to the driver licensing authority, the authority will consider the medical report, practical driver assessment (if conducted), driving record, any relevant options for rehabilitation and retraining, and other required information. If the driver licensing authority grants the licence with or without conditions, then the authority will inform the driver and provide information about any restrictions or licence conditions. If the driver licensing authority does not grant, cancels, or suspends the licence, then the authority will inform the driver and advise of the driver’s right of appeal.

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Figure 5: Assessing and reporting on fitness to drive in the course of patient treatment

The image is a decision tree for medical professionals about conducting an assessment if a condition is diagnosed or a patient is subject to a procedure. When a condition is diagnosed or the patient is subject to a procedure, the health professional should establish whether the patient is a driver, motorbike, or motor trike rider and establish the licence type held. The health professional should conduct the examination according to relevant standards (commercial and/or private standards). If the health professional assesses the condition to temporarily affect driving ability, then they advise the patient to abstain from driving for an appropriate period. No report needs to be submitted to the driver licensing authority. If the health professional assesses that the patient meets requirements for an unconditional licence, then no report needs to be submitted to the driver licensing authority. If the condition is progressive, then the health professional: continues monitoring in relation to fitness to drive during normal treatment, advises and counsels the patient accordingly, seeks patient family support where appropriate, and maintains appropriate records of examination. No report needs to be submitted to the driver licensing authority. If the health professional assesses that the patient’s condition and circumstances do not meet unconditional requirements but may meet conditional requirements, then the health professional: advises and counsels the patient about the impact of their condition and the need to restrict driving as appropriate, completes the Medical condition notification form for the patient (Appendix 2.2) including details of requirements not met, recommends conditional licence and driving restrictions if appropriate, meets requirements for ongoing monitoring and periodic review, recommends rehabilitation, provides a report to the patient and advises them to notify the DLA, advises the patient of their legal obligations and implication of failure to comply, and seeks family support for the patient if appropriate, retains copy of the report and other forms for medical file, and shares their report with the patient’s GP to support effective long-term management. The patient provides the medical report to the driver licensing authority. However, if the patient is unable to appreciate the impact of their condition or to take notice of the health professional’s recommendations due to cognitive impairment or if driving continues despite above measures and is likely to endanger the public, then the health professional can consider reporting directly to the driver licensing authority while informing the patient. If the health professional assesses that the patient does not meet medical requirements for an unconditional or conditional licence, then the health professional: advises and counsels the patient about the impact of their condition and the need to restrict driving as appropriate, completes the Medical condition notification form for the patient (Appendix 2.2) including details of requirements not met, recommends rehabilitation, provides a report to the patient and advises them to notify the DLA, advises the patient of their legal obligations and implication of failure to comply, seeks family support for the patient if appropriate, retains copy of the report and other forms for medical file, and shares their report with the patient’s GP to support effective long-term management. The patient returns the medical report to the driver licensing authority. However, if the patient is unable to appreciate the impact of their condition or to take notice of the health professional’s recommendations due to cognitive impairment or if driving continues despite above measures and is likely to endanger the public, the health professional can consider reporting directly to the driver licensing authority while informing the patient. If the health professional is unclear on the diagnosis or the impact on driving, then the health professional: counsels the patient and advises not to drive until diagnosis and impact on driving is clear, seeks specialist or second opinion, considers referral for practical driver assessment, advises the patient to notify the DLA, provides a report to the patient to advise the DLA, and maintains appropriate records of examination. The patient notifies the driver licensing authority. The driver licensing authority may seek independent advice. After the patient returns the medical report to the driver licensing authority, the authority will consider the medical report, practical driver assessment (if conducted), driving record, any relevant options for rehabilitation and retraining, and other required information. The driver licensing authority will inform the driver of their licence status and advise them of their right of appeal as applicable.

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