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National Casualty Company Home Office: One Nationwide Plaza Columbus, Ohio 43215 Adm. Office: 8877 North Gained Center Drive Scottsdale, Arizona 85258Scottsdale Indemnity Company Home Office: One
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Start by reading the form carefully and familiarizing yourself with the information it asks for.
02
Ensure that you have all the necessary medical records and documentation to provide accurate information.
03
Begin by filling out your personal information such as your name, address, date of birth, and contact details.
04
Provide details about your medical condition that may affect your ability to drive safely. Include any relevant diagnoses, medications, treatments, surgeries, or therapy you are undergoing.
05
Consult with your healthcare provider to help you accurately fill out the section regarding their statement. They may need to provide additional information or sign the form.
06
Review the completed form and make sure all the information is accurate and legible.
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Submit the filled out Physicians Statement of Driver form to the appropriate authority or organization, as instructed.

Who needs physicians statement of driver?

01
Physicians statement of driver may be required by individuals who have certain medical conditions or disabilities that may affect their ability to operate a motor vehicle safely.
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Common examples include individuals with epilepsy, heart conditions, vision impairments, certain psychiatric disorders, and neurological disorders.
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Additionally, individuals who have undergone major surgeries or are on certain medications that may impair their driving skills might also need to provide a physicians statement of driver.
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The physicians statement of driver is a form completed by a healthcare provider that assesses the medical fitness of a driver.
Commercial drivers or those with specific medical conditions may be required to file a physicians statement of driver.
The physicians statement of driver can be filled out by a licensed healthcare provider who has knowledge of the driver's medical history.
The purpose of the physicians statement of driver is to ensure that drivers are medically fit to operate a vehicle safely.
The physician must report the driver's medical history, current medications, and any medical conditions that may impact their ability to drive.
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