Fitness to drive

Fitness to drive reporting requirements

After problems with the initial reporting requirements were highlighted in the early 1990s, the Ontario Medical Association worked closely with the MTO, in consultation with an expert physician working group, to provide input on subsequent legislative changes and the corresponding new form. Access the Medical Condition Report form.

As a result of over 20 years of advocacy, the Highway Traffic Act was amended to provide more specifics around the types of medical conditions and impairments that are considered mandatory to report when assessing and reporting a patient’s fitness to drive.

The new mandatory and discretionary reporting requirements came into effect on July 1, 2018. Correspondingly, the MTO’s Medical Condition Report form was updated to reflect this additional level of detail. The reporting form works hand-in-hand with the reporting regulations to include a list of the conditions and impairments that are mandatory to report, as well as a discretionary reporting section. Both sides of the updated Medical Condition Report form must be submitted, the ministry cannot process incomplete forms.

The amended regulation also expands the types of clinicians who may report on fitness to drive. Now, nurse practitioners are subject to the same mandatory/discretionary reporting requirements as physicians and optometrists, and occupational therapists have the authority to make discretionary reports.

General guidance for reporting

  • The law applies to any patient, age 16 or older regardless of whether they hold a driver’s licence
  • Conditions that are, in the opinion of the physician, transient or non-recurrent are not required to be reported
  • Additionally, modest or incremental changes in ability that are, in the opinion of the physician, attributable to a process of natural aging, are not required to be reported unless the cumulative effect of the changes constitutes a condition or impairment prescribed in the mandatory list for reporting
  • If there is a condition or impairment that is not covered in the prescribed list for mandatory reporting, but that in your medical opinion may impair the individual’s ability to drive safely, you may report it in the discretionary section
Physician resources
Medical Condition Report form (MTO)
Reporting a driver for medical review (MTO)
Physician primer - Fitness to Drive (OMA)
Determining medical fitness to operate motor vehicles (CMA)
Medical standards for drivers (CCMTA)
Patient resources
Driving and dementia roadmap

Contact information

Questions about the reporting form: Email the MTO, driver improvement office, or call 1-800-268-1481. 

Questions about the Highway Act or your legal responsibilities: Email OMA Legal Services or call 1-800-268-7215. 

Mandatory reporting requirements

For any impairment or condition listed, report as follows, in the mandatory conditions to report section. Do not report transient or non-recurrent conditions, or modest or incremental changes attributable to natural aging where overall, the individual is still fit to drive.

Liability 

Physicians must use their judgment to decide when to report. Physicians who comply with the regulations, and report a patient unfit to drive for one of the mandatory conditions listed, will not be subject to liability. Conversely, failing to report a patient whose condition falls under the mandatory reporting category may leave the physician open to liability.

Notes about the form

  • Reporting the conditions listed under “Mandatory conditions to report” will result in a driver’s licence suspension
  • It is important to accurately select the correct checkbox (where applicable), as each one results in a corresponding followup form that is sent to the patient

Mandatory conditions to report

Criteria

The patient has or appears to have a disorder resulting in cognitive impairment that affects (one or more of the following):

  • Attention
  • Judgment and problem solving
  • Planning and sequencing
  • Memory
  • Insight
  • Reaction time
  • Visuospatial perception

    AND
  • Results in substantial limitation of the person’s ability to perform activities of daily living

Example 

The patient has a diagnosis of dementia, which is affecting his judgement and reaction time and has resulted in a substantial limitation in his ability to perform the activities of daily living.

Criteria

The patient has or appears to have a disorder that:

  • Has a moderate or high risk of sudden incapacitation

    OR
  • Has resulted in sudden incapacitation and that has a moderate or high risk of recurrence 

Examples

The patient was diagnosed with an aortic aneurysm, which is at the stage of imminent rupture.

The patient had a seizure and was diagnosed with epilepsy. His seizures are likely to recur.

 

 

Criteria

The patient has or appears to have a condition or disorder resulting in severe motor impairment that affects any of the following:

  • Co-ordination
  • Muscle strength and control
  • Flexibility
  • Motor planning
  • Touch
  • Positional sense

Example

Patient has a diagnosis of multiple sclerosis, which is affecting her co-ordination and muscle control.

Criteria

The patient has or appears to have any of the following:

  • Best-corrected visual acuity below 20/50 with both eyes open and examined together
  • A visual field that is less than 120 continuous degrees along the horizontal meridian, or less than 15 continuous degrees above and below fixation, or less than 60 degrees to either side of the vertical meridian, including hemianopia
  • Diplopia that is within 40 degrees of fixation point (in all directions) of primary position, that cannot be corrected using prism lenses or patching

Example

The patient has glaucoma with a visual field that is measured at 100 continuous degrees along the horizontal median.

Criteria

This patient has or appears to have:

  • A diagnosis of an uncontrolled substance use disorder, excluding caffeine and nicotine

AND

  • Is non-compliant with treatment recommendations

Example

The patient has a diagnosis of alcohol use disorder and is non-compliant with the recommended residential treatment.

Criteria

This patient has or appears to have a condition or disorder currently involving any of the following:

  • Acute psychosis
  • Severe abnormalities of perception such as those present in schizophrenia or in other psychotic disorders, bipolar disorders, trauma or stressor-related disorders, dissociative disorders or neurocognitive disorders
  • Has a suicidal plan involving a vehicle or an intent to use a vehicle to harm others

Example

The patient has a diagnosis of schizophrenia that presents with psychotic episodes.

Questions

The current fee code (K035) and fee for completing a Medical Condition Report are the same. 

To get copies of the Medical Condition Report form:

You can submit the completed form via mail or fax. Please be sure to submit both pages of the completed form, and make sure to keep a copy for your records.

  • Fax: 416-235-3400 or 1-800-304-7889
  • Mail: Ministry of Transportation, Driver Medical Review, 77 Wellesley St. W., Box 589, Toronto, Ont., M7A 1N3

You may email the Ministry of Transportation’s Driver Improvement Office, or email your comments to the OMA to be passed on.