Part 2 (continued) to be completed by Medical Practitioner
2.Special licence requirements including exception cases for epilepsy
a)Epilepsy: If this does not apply mark - Not Applicable
If your patient has had an epileptic seizure within the last 12 months,
have they been declared fi t to drive a group 1 vehicle (See below for vehicle categories)
by a consultant neurologist under the exceptional case criteria for epilepsy shown below: Yes No
Exceptional case criteria include: First seizure; provoked seizure only in preceding year; seizure not affecting consciousness
or driving ability; seizure in preceding year only on medically supervised withdrawal of antiepileptic medication; or seizure
exclusively while asleep and the fi rst such sleep seizure was a minimum of 12 months previous
b) Restricted licence recommendation If this does not apply mark - Not Applicable
limited to day-time driving (one hour after sunrise and one hour before sunset) Yes No
limited to journeys within a radius of 30 km from holder’s place of residence. Yes No
limited to journeys with a speed not greater than 80 km/h Yes No
Signature of Medical Practitioner ____________________________ Date: _____ / _____ / ______
Note:
This form must be submitted to the NDLS within one month of this date
Driving Licence Medical Report Form
EXPLANATORY NOTES
1. To complete your medical examination you must go to
your doctor, have your medical examination and sign
this form in the presence of the doctor. When the form
is completed by your doctor you must submit it to the
National Driver Licence Service with your learner
permit/driving licence application within one month
of the date of the medical examination.
2. For medical fi tness standards, vehicles are classed as being
in Group 1 or Group 2. This table describes which vehicles
are in Group 1 and in Group 2. Further information on each
licence category can be found online at ndls.ie and on the
licence application form. A higher standard of medical
fi tness is required of those drivers who hold licences for
Group 2 vehicles. Please note that Group standards apply
to all categories of vehicles within that Group. Individual
categories should not be marked on the table above.
3. A person driving a Group 2 category vehicle must be
certifi ed as medically fi t at least every fi ve years.
4. Applicants over 75 years of age can only be certifi ed
as being fi t to drive for either one or three years.
5. Where appropriate the doctor may engage the services
of other medical and driving professionals (e.g.
consultant, occupational therapist, optometrist,
on-road driving assessor) to inform their completion
of this form.
6. Please have your Doctor initial any alteration or change
made in completing this form. This is important in
assessing the validity of the document presented.
7. For more information on medical fi tness standards
see Medical Fitness to Drive Guidelines on www.ndls.ie.
Vehicles are classed as Group 1 and Group 2. If you are applying for a
vehicle in both Groups, please tick Group 1 and 2. Where an applicant
meets the medical criteria for Group 2 vehicles, they will automatically
meet the criteria for Group 1 vehicles
Making an application for a learner permit or driving
licence? Apply online now at ndls.ie
There is no need for you to complete paper forms, make
appointments or visit an NDLS centre in person. All you need is
your Public Service Card and your verifi ed MyGovID for secure
access to an online application at ndls.ie
Your medical report form can be uploaded when you apply online
or can be posted after you make your application.