Medical Certificate for Motor Vehicle Driver

Medical Certicate for Motor Vehicle Driver

Transport Operations (Passenger Transport) Act 1994, Tow Truck Act 1973

Transport Operation (Road Use Management) Act 1995

The following information is provided to guide you through the process of when you

have a permanent, or long-term medical condition and a medical assessment is required

to determine whether you meet the medical criteria for the class of driver licence you

currently hold, or the class of driver licence you are applying for.

Your treating doctor will undertake your medical assessment in accordance with the

nationally consistent medical standards set out in the Austroads Assessing tness to

drive for commercial and private vehicle drivers (AFTD) publication.

Notifying the Department of Transport and Main Roads (TMR)

If you are applying for a licence you must notify TMR about any mental or

physical incapacity that is likely to adversely aect your ability to drive safely.

If you hold a Queensland or a non-Queensland licence, you also have a legal obligation

to notify TMR of any new, permanent, or long-term medical condition, or any increase

in that condition that is likely to adversely aect your ability to drive safely. This must

be done before you continue to drive.

TMR can legally require you to give medical evidence (i.e. a current Medical

Certicate for Motor Vehicle Driver (form F3712) completed by your treating doctor)

about whether you meet the medical criteria for the class of driver licence you hold, or

the class of driver licence you are applying for.

Getting your completed Medical Certicate for Motor Vehicle Driver (form F3712)

• Make an appointment with your treating doctor to determine if you have a

permanent, or long-term medical condition that is likely to adversely aect your

ability to drive safely. When making your appointment, advise the receptionist

why you are making the appointment as this kind of medical assessment may take

longer than a standard consultation. You are responsible for payment of any fees

that are charged by health professionals for their services.

• To assist your treating doctor with your medical assessment, complete the

health questionnaire on page 1 of the Private and Commercial Vehicle Driver’s

Health Assessment (form F3195) prior to your appointment and give it to your

treating doctor. Your treating doctor will complete page 2 as part of their medical

assessment and will generally retain the completed form for their records. This

form is not compulsory. However, it may assist your doctor in making a medical

assessment. For a copy of the form, go to tmr.qld.gov.au/Find-a-form and search

‘F3195’.

• You will also need to complete Part 1 of this form prior to your appointment and

give it to your treating doctor at the commencement of your medical assessment.

• If the medical assessment has been requested for a particular reason e.g. you have

been issued a show cause notice on medical grounds by TMR, you need to advise

your treating doctor of this reason. If you need to wear glasses or contact lenses

when driving, make sure you take these with you to your appointment.

• If you drive, or intend to drive a vehicle for commercial reasons (e.g. a class

MR, HR, HC or MC vehicle, drive a bus or a personalised transport service etc.),

you must tell your treating doctor so that you are assessed correctly under the

commercial standards in the AFTD.

• If your treating doctor thinks it is necessary, or the AFTD requires it, you may be

required to be assessed by an appropriate specialist before your treating doctor is

able to provide TMR with an opinion about whether you meet the medical criteria

for a driver licence.

• If your treating doctor has referred you to an optometrist or ophthalmologist, Part

3 of this form must be completed by your treating optometrist or ophthalmologist.

If you need to wear glasses or contact lenses when driving, take these with you to

your appointment.

• Any reports from your specialist, physiotherapist, occupational therapist,

optometrist or ophthalmologist must be given to your treating doctor before they

can complete Part 2 of this form and provide an opinion regarding your medical

tness to drive.

If there is a delay in seeing your specialist

If there is a delay before you can see a specialist, talk to your treating doctor about

whether you meet the criteria to hold a conditional licence. If so, your doctor may

issue you with an interim Medical Certicate for Motor Vehicle Driver (form F3712)

to cover this period on the provision that you have an appointment booked and your

medical condition is not likely to lead to an acute incapacity, or loss of concentration

before you see the specialist.

Your completed Medical Certicate for Motor Vehicle Driver (form F3712)

You can present this completed form at your nearest TMR customer service centre,

or you can send it via:

Email:

mcr@tmr.qld.gov.au

Mail: Department of Transport and Main Roads

Locked Bag 2000

Red Hill Rockhampton Qld 4701

TMR will consider the opinion of your treating doctor and any recommended

conditions/restrictions and make a decision about whether you are eligible for the

class of driver licence you currently hold, or the class of driver licence that you are

applying for.

Indemnity for health professionals

The Transport Operations (Road Use Management) Act 1995 provides indemnity

against liability, both civilly or under an administrative process, for health

professionals who give information in good faith to TMR about a person’s

medical fitness to hold, or to continue to hold a driver licence.

For more information

For more information about medical conditions and driving, please visit

www.qld.gov.au/transport/licensing/update/medical or call 13 23 80*.

*Check with your service provider for call costs.

Privacy Statement: TMR collects this information under the provisions of the Acts

nominated on this form so that you may conrm your medical tness to drive a

motor vehicle safely. TMR may disclose this information to interstate authorities

that issue driver licences, pilot or escort vehicle driver accreditations, driver or rider

training accreditations, trac controller accreditations, dangerous goods vehicle

licences, tow truck licences and driver authorisations, and the Queensland Police

Service (QPS). Your information will not be disclosed to any other third parties

without your consent, unless required or authorised by law.

Page 1 of 4 TRB Forms Area F3712 V01 Nov 2022

Department of Transport and Main Roads - Medical Certicate for Motor Vehicle Driver Department of Transport and Main Roads - Medical Certicate for Motor Vehicle Driver Department of Transport and Main Roads - Medical Certicate for Motor Vehicle Driver

Medical Certicate

for Motor Vehicle Driver

(To be completed by the treating doctor if the driver is 75 years or older

or question 5B of Part 2 has been completed)

Name of driver (please print)

Licence number (if known)

TRB Forms Area

F3712

V01 Nov 2022

This ‘tear-o’ medical certicate must be carried when driving.

Medical Certicate issue date

Review/expiry date

(provide details from question 5)

Licence class/es (provide details from question 6)

Licence Conditions/Restrictions (provide details from question 5B)

Doctor’s details

Name (please print)

Address and contact telephone number (oce stamp)

Signature

fold here

Medical Certicate for Motor Vehicle Driver

Transport Operations (Passenger Transport) Act 1994, Tow Truck Act 1973

Transport Operation (Road Use Management) Act 1995

This form has been provided so that your treating doctor, optometrist or ophthalmologist (if required) may provide their opinion about whether you meet the medical and/or

visual standards for a driver licence for the class/es of licence you currently hold, or the class of driver licence you are applying for.

Part 1 of this form should be completed by you before giving the form to your treating doctor.

Part 2 should be completed by your treating doctor after considering any report from a specialist, optometrist or ophthalmologist (if required).

Part 3 should be completed by your treating optometrist/ophthalmologist if your vision or eye disorder is not rectied by wearing glasses or contact lenses.

This medical assessment should be conducted in accordance with the national medical standards in the Austroads Assessing tness to drive for commercial and private vehicle

drivers (AFTD) publication. This publication is available from the Austroads website www.austroads.com.au. For more information about medical tness to drive, please visit

www.qld.gov.au/transport/licensing/update/medical.

Important: Parts 1 and 2 of this form must be completed in

full or it will not be accepted by TMR.

Part 1 - Personal Details (to be completed by the driver)

1. Personal details

Family name

Given name/s

Date of birth (dd/mm/yyyy) Contact number

/ / ( )

Residential address

Postal address (if same as residential address, write ‘as above’)

Postcode

Email address

Licence number (if known) State/Territory/Country of issue

2. What class/es of licence are you applying for or currently hold?

Motorbike

(RE or R)

Car (C)

Light Rigid (LR)

Medium Rigid (MR)

Heavy Rigid (HR)

Heavy Combination (HC)

Multi-Combination (MC)

Specially Constructed Vehicle (UD)

3. Do you drive, or intend to drive–

• a vehicle with a GVM of more than 8t (class MR, HR, HC, MC, UD)?

• a public passenger vehicle (e.g. a bus or a personalised transport vehicle)?

• a vehicle transporting dangerous goods in a receptacle

with a capacity of more than 500L or 500kgs?

*Note: To assist your treating doctor with your medical assessment,

please complete page 1 of the Private and Commercial Vehicle Driver’s

Health Assessment (form F3195) prior to attending your appointment. You

will be assessed against the commercial standard in the AFTD.

No Yes see note*

Yes see note*

4. Do you need to wear glasses or contact lenses for driving?

Yes

No Yes

6. Do you agree to the amendment of your Queensland

driver licence for the purpose of adding/removing a

condition or class?

Yes

If your driver licence requires amendment you

will need to complete a separate Driver Licence

Amendment (form F4358), which may delay the

reissue of your driver licence.

7. Driver’s declaration:

I declare that the information I have provided on this form and to my

treating doctor is true and complete.

I understand that the TMR may contact my treating doctor for further

information about my medical tness to drive, or to clarify the information

that has been provided in this form. I authorise TMR to contact my relevant

health professional as it relates to my suitability to apply for, or hold a

drivers licence. I further understand that action may be taken to amend,

suspend, or cancel my driver licence or authority to drive in Queensland if

it is proven the driver licence was obtained on the basis of information that I

knew was false or misleading, and that I may be prosecuted as a result.

Driver’s signature Date

/ /

Page 2 of 4 TRB Forms Area F3712 V01 Nov 2022

/ /

5. Has your most recent driver licence been cancelled, or

downgraded on medical grounds, or have you been

given a notice proposing the cancellation, or downgrade

of your driver licence on medical grounds by any driver

licensing authority, or police ocer?

1. Were you familiar with this person’s medical history

prior to this assessment?

Part 2 - Medical Assessment (to be completed by the treating doctor)

Yes How long has this person been treated at

this medical practice?

weeks/months/years

Page 3 of 4 TRB Forms Area F3712 V01 Nov 2022

2. What is your assessment of the person’s visual acuity?

R 6/ L 6/ Binocular 6/

2.1 Visual elds (confrontation to each eye)

Normal

Abnormal

Do not complete if Part 3 has been completed by an optometrist or

ophthalmologist.

3. Does this person need to wear glasses or contact

lenses for driving?

Do not complete if Part 3 has been completed by an optometrist or

ophthalmologist.

No Yes Code S will be shown on the licence.

4. Does this person have any other vision or eye

disorders?

Part 3 may be required to be completed if the disorder is not rectied by

wearing glasses or contact lenses.

No Yes Code M may be shown on the licence.

See Question 5 on Part 1 of this form. If you are not familiar with the

person’s medical history, or you haven’t been involved in any previous

assessment of the person’s medical tness to drive, this assessment

should generally be more thorough than a normal consultation. Particularly

where the person has had their driver licence suspended, cancelled, or

downgraded on medical grounds.

5. Please choose one recommendation (A, B or C)

regarding the person’s medical tness to drive.

Meets the medical criteria for an unconditional

licence. Please mark one of the following boxes to

indicate the reason why.

person does not have a permanent or long-term

medical condition

person has a permanent or long-term medical

condition and the AFTD provides the person is t to

hold an unconditional licence

person’s medical condition has improved. The person

no longer needs a conditional licence and requires no

further medical review (M condition will be removed)

person has a non-progressive medical condition,

which does not require a further medical review and

they do not need to drive a modied vehicle, or a

vehicle that has an automatic transmission

B. Meets the medical criteria for a conditional licence.

Please mark one or more of the following boxes to

indicate the conditions.

person has a permanent or long-term medical

condition, which is not likely to adversely aect their

ability to drive safely and requires a further medical

review (M condition will be added)*

What is the medical certicate expiry date?

(the expiry date must not be longer than the review period

stated in the AFTD, or if the person is 75 years or older the

maximum period is 13 months from date of issue)

vehicle must be tted with an automatic transmission

(A condition will be added)

vehicle must be tted with a synchromesh gearbox

(B condition will be added)

vehicle must be modied to suit the person’s physical

disability (V condition will be added)

Please specify the type of vehicle modication/s

other condition/s and/or restriction/s

(M condition will be added)*

Please specify the type of condition/s and/or restriction/s

C. Does not meet the medical criteria for a driver licence.

(Refer to AFTD - Conditional licences for more information.)

6. What medical standard did you refer to in the AFTD for

this medical assessment?

Commercial

A class MR (medium rigid), HR (heavy

rigid), HC (heavy combination), MC (multi-

combination) driver licence, a person who

is authorised or apply for authorisation to

carry public passengers (for hire or reward)

or dangerous goods.

Private

A class C (car), RE or R (motorcycle),

LR (light rigid) driver licence, unless

the person is authorised, or applying for

authorisation to carry public passengers

(for hire or reward) or dangerous goods

(refer to commercial standard).

person is 75 years or older and has no permanent or

long-term medical condition

What is the medical certicate expiry date?

(maximum period is 13 months from date of issue)

*You must complete the tear o Medical Certicate for

Motor Vehicle Driver located at the bottom of page 2.

Important Information

• Your medical assessment must be conducted in accordance with the medical

standards in Austroads Assessing tness to drive for private and commercial

motor vehicle drivers (AFTD) publication, which is available at

www.austroads.com.au.

• You must assess the person against the commercial standards if they are:

- applying for, or currently hold a class MR, HR, HC or MC driver licence

- driving, or intending to drive a public passenger vehicle (e.g. a bus or a

personalised transport service etc.), or a vehicle to transport dangerous goods in

a receptacle with a capacity of more than 500L or 500kg.

• If the AFTD states that assessment by a specialist is required, then you must refer

the person to the relevant specialist.

• If you are uncertain about the impact of the person’s medical condition on their

ability to drive safely, you can refer the person to a specialist, physiotherapist,

occupational therapist, optometrist or ophthalmologist for an opinion.

• Do not complete Part 2 Medical Assessment until you have received all of the

necessary reports back from the person’s specialist, physiotherapist, occupational

therapist, optometrist or ophthalmologist.

• All driver licensing decisions are the responsibility of TMR and your

recommendation regarding the person’s medical tness to drive, is considered as

part of the decision making process.

• For more information on medical conditions and driving please visit

www.qld.gov.au/transport/licensing/update/medical or call 13 23 80.

Doctor’s details (please print)

Name

Email address

Contact number

( )

Address (oce stamp)

Signature Date

/ /

What is the medical certicate expiry date?

/ /

In your opinion, the person meets the above medical

standard to hold what class/es of licence?

/ /

1. What medical standards did you refer to in the AFTD to assess this person’s eyesight?

Part 3 - Eyesight Assessment (to be completed by the treating optometrist or ophthalmologist) - if required

Private Standards Commercial Standards

2. In my opinion, the person named in this report:

Meets the visual criteria for an unconditional licence

Meets the visual criteria for an unconditional

licence as visual condition has improved and no

longer needs a conditional licence and requires

no further review.

Code M may be removed from the licence once the

treating doctor has completed Part 2 and considers

there are no other conditions/restrictions. Provide

details opposite.

Meets the visual criteria for a conditional licence and

requires further review (code M will be shown on the

licence).

Other recommended conditions/restrictions

(Refer to AFTD - Conditional licences for more information).

Provide details opposite.

Does not meet the visual criteria as set out in the AFTD.

Recommended conditions/restrictions

4. Does this person need to wear glasses or contact lenses for driving?

Yes Code S will be shown on the licence.

3. What is your assessment of the person’s visual acuity?

R 6/ L 6/ Binocular 6/

5. Visual elds

Visual elds tested by confrontation

or automated perimetry

Normal

Abnormal

Optometrist’s/ophthalmologist’s details (please print)

Name Contact number

( )

Address (oce stamp)

Postcode

Signature Date

/ /

Page 4 of 4 TRB Forms Area F3712 V01 Nov 2022

This assessment should be conducted in accordance with the standards provided in the Austroads Assessing tness to drive for private and commercial vehicle drivers (AFTD)

publication, which is available at the Austroads website www.austroads.com.au.

The purpose of this eyesight assessment is so that an optometrist, or ophthalmologist may provide an opinion to the treating doctor about whether a person meets the visual

criteria for a driver licence and any recommended conditions/restrictions. An eyesight assessment is not a holistic assessment of a person’s medical tness to drive, and

therefore, should not be used as a standalone assessment.

The completed assessment must be returned to the treating doctor who will consider it in conjunction with Parts 1 and 2 of the Medical Certicate for Motor Vehicle Driver

form. TMR will not accept Part 3 without the completion of Parts 1 and 2 of the Medical Certicate for Motor Vehicle Driver form.