Fitness to Drive
The requirements for reporting Fitness to Drive changed on July 1, 2018.  As a result, the Ministry of Transportation’s Medical Condition Report form has been updated.
Fitness to Drive
The requirements for reporting Fitness to Drive changed on July 1, 2018.  As a result, the Ministry of Transportation’s Medical Condition Report form has been updated.

New Fitness to Drive Reporting Requirements

REMINDER: Please ensure both sides of the updated Medical Condition Report form are submitted. The Ministry cannot process incomplete forms.

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.  Correspondingly, the Ministry of Transportation’s (MTO) Medical Condition Report form was  updated on July 1, 2018 to reflect this additional level of detail.

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, in order to provide input on subsequent legislative changes and the corresponding new form. 

The updated reporting form works hand-in-hand with the new reporting regulations to include a list of the conditions and impairments that are mandatory to report, as well as a discretionary reporting section.



Each category includes a drop down list of frequently reported, high-risk conditions that warrant a license suspension.  Each category also includes a section for ‘Other’ for practitioners to report conditions that may not be included in the sample list.  

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 license
  • 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
Mandatory Reporting Requirements

For any impairment or condition listed below, report as follows in the chart below. 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 judgement 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 below 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 on the form:
  • Reporting the conditions listed under Mandatory Reporting will result in a driver's license suspension
  • It is important to accurately select the correct checkbox, as each one results in a corresponding follow up form that is sent to the patient.

Category Criteria Example
Cognitive Impairment

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

  • attention
  • judgement 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
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
Sudden Incapacitation

This patient has or appears to have a disorder that:

  • has a moderate or high risk of sudden incapacitation, OR
  • that has resulted in sudden incapacitation AND that has a moderate or high risk of recurrence  

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

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

Motor or Sensory Impairment

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

  • Coordination
  • Muscle strength and control
  • Flexibility
  • Motor planning
  • Touch
  • Positional sense
Patient has a diagnosis of multiple sclerosis, which is affecting her coordination and muscle control.
Visual Impairment

The patient has or appears to have any of:

  • 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.
Patient has glaucoma with a visual field that is measured at 100 continuous degrees along the horizontal median.
Substance Use Disorder

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
Patient has a diagnosis of alcohol use disorder and is non-compliant with the recommended residential treatment.
Psychiatric Illness

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

  • acute psychosis,
  • severe abnormalities of perception, or
  • has a suicidal plan involving a vehicle or an intent to use a vehicle to harm others
Patient has a diagnosis of schizophrenia that presents with psychotic episodes

Discretionary Reporting Requirements

As a result of the amendment, physicians now also now have discretion to report other medical conditions, functional and visual impairments that may make it dangerous for a patient to drive and which are not covered in the prescribed list for mandatory reporting.

It is important to note that discretionary reporting is not a duty – i.e., physicians are not required to make a discretionary report, but rather, have the authority to do so.

Liability

With the extensive mandatory list articulated in the regulation, it is likely there will be fewer circumstances in which physicians are unsure of whether or not to report. However, if a physician is unsure, but reasonably believes that a patient may present a danger behind the wheel, the physician should err on the side of caution and report the patient to the MTO. Physicians who use their discretion to report a patient will not be subject to liability. Whether or not a physician would be liable for failing to report a discretionary case is less clear, though, in light of the case law, there is the possibility of such a finding.


Key Questions: 

Is there a fee code for this form?
The current fee code (K035) and fee for completing a Medical Condition Report stays the same. 

Where can I get the new form?

To get copies of the Medical Condition Report form:

How do I submit the 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.

  • By fax: 416-235-3400 or 1-800-304-7889
  • By mail: Ministry of Transportation, Registrar of Motor Vehicles, Driver Improvement Office, Medical Review Section, 77 Wellesley St. W, Box 589, Toronto, Ontario M7A 1N3
Who do I talk to if I have feedback or suggestions for improvement on the form?

You may contact the Ministry of Transportation’s Driver Improvement Office directly (see contact information below), or provide your comments to the OMA to be passed on.


Contact Information:

For more information, please contact the following

Topic Organization Contact

For questions or feedback on the new reporting form

Ontario Ministry of Transportation

Ministry of Transportation, Driver Improvement Office, Medical Review Section
By phone: 416-235-1773 or 1-800-268-1481 (within Ontario)
By email: DriverImprovementOffice@ontario.ca

The amended Act and your legal responsibilities OMA Legal Services Legal.Affairs@oma.org  1.800.268.7215 or 416.599.2580 Ext: 3997


References
  1. Government of Ontario. Highway Traffic Act, R.S.O. 1990, c. H.8 Queen’s Printer for Ontario, Available from: https://www.ontario.ca/laws/statute/90h08 
  2. Government of Ontario. Highway Traffic Act, ONTARIO REGULATION 340/94, DRIVERS’ LICENCES  Queen’s Printer for Ontario, Available from:  https://www.ontario.ca/laws/regulation/940340

Updated: August 21, 2018