Minnesota Form PS31015 is the two-part medical report the Driver and Vehicle Services division uses to decide whether someone who has lost consciousness or voluntary control can keep driving. You complete the top section yourself, your physician completes the bottom section after examining you, and the whole form goes to the DVS Driver Evaluation Unit in St. Paul. The physician’s answers on diagnosis, treatment cooperation, and prognosis drive the outcome more than anything on your half.
Getting the Form
The PDF is on the Minnesota Department of Public Safety website under “Loss of Consciousness or Voluntary Control.” You can also request one by calling DVS at (651) 296-2025 or by visiting a DVS regional service center.1Minnesota Department of Public Safety. PS31015 – Loss of Consciousness or Voluntary Control Both halves have to be filled in and signed before you send it.
Your Section
The driver’s portion is short. You provide:
- Full legal name (last, middle, first) as it appears on your license
- Date of birth
- Minnesota driver’s license number
- Date of your most recent episode
The date of your most recent episode is the field DVS cares about most on your half. It starts the clock on the minimum waiting period before DVS can restore or maintain your privileges, and it needs to match your medical records. A mismatch gets flagged. Sign and date the bottom of your section before you hand the form to your doctor.1Minnesota Department of Public Safety. PS31015 – Loss of Consciousness or Voluntary Control
The Physician’s Statement
The lower half is where the evaluation actually happens. Your doctor completes it after examining you. The form itself notes that the physician’s report is advisory and DVS makes the final decision.1Minnesota Department of Public Safety. PS31015 – Loss of Consciousness or Voluntary Control The physician answers:
- How many times they’ve examined you, or how long you’ve been under their care
- Your diagnosis (epilepsy, cardiac syncope, diabetes-related hypoglycemia, and so on)
- Whether you’re cooperating with treatment (yes or no)
- Whether you’re medically qualified to exercise reasonable and proper control over a motor vehicle (yes or no)
- How often you should resubmit the form: every 6 months, 1 year, 2 years, 3 years, or 4 years
- Your long-term and short-term prognosis, written out
- The date of your first episode
Printed on the form is a rule the physician has to work within: a 6-month or 1-year review cycle is required until you have been episode-free for four years while on medication. If the physician leaves the review-frequency box blank, DVS defaults to a four-year cycle, but only if you’re otherwise eligible for that interval.1Minnesota Department of Public Safety. PS31015 – Loss of Consciousness or Voluntary Control The doctor signs and prints their name, address, and phone number so DVS can follow up.
Watch for contradictions between the checkbox answers and the written prognosis. If the doctor checks “yes” on fitness to drive but describes a short-term prognosis that reads as unfavorable, DVS reviewers will notice and request more documentation, which stalls your review. It’s worth reading the completed physician’s section before mailing it to make sure the narrative and the boxes line up.
Where to Mail It
Send both sections together as one package to:
Driver Evaluation Unit
Minnesota Department of Public Safety
445 Minnesota Street, Suite 170
St. Paul, MN 55101-51702Minnesota Department of Public Safety. Request for Examination of Driver
Don’t mail the driver’s section and the physician’s section separately; splitting them risks a fragmented file. Keep a photocopy of the whole form before it goes out. For submission questions, DVS is at (651) 296-2025.1Minnesota Department of Public Safety. PS31015 – Loss of Consciousness or Voluntary Control
The 30-Day Deadline
Minnesota requires you to report an episode of loss of consciousness or voluntary control in writing within 30 days. That window runs from the date of the episode, not the date you see your doctor, so call your doctor’s office as soon as you can and explain the time constraint. Missing the deadline doesn’t bar you from submitting, but it can complicate the review.
What DVS Does After It Reviews the Form
DVS mails a decision letter once the Driver Evaluation Unit processes your submission. Two broad outcomes are possible, and both come out of Minnesota Rules 7410.2500.
You Keep Driving on a Reporting Schedule
If the physician confirms treatment cooperation, medical fitness to drive, and a favorable prognosis, DVS lets you keep your license subject to periodic physician’s statements. The default cadence is annual, and it flexes with your situation:3Legal Information Institute. Minnesota Code 7410.2500 – Loss of Consciousness or Voluntary Control
- First episode, or one caused by a doctor-ordered medication change: physician’s statement every six months for one year, then the schedule may relax.
- Condition not well controlled: every six months, no automatic step-down.
- Episode-free for four years: every four years, unless your doctor recommends more often.
Your physician can always recommend a shorter interval than the default, and DVS will follow that recommendation.3Legal Information Institute. Minnesota Code 7410.2500 – Loss of Consciousness or Voluntary Control
Your License Is Canceled
If DVS has good cause to believe you have had a recent episode, or if the physician’s report shows an unfavorable prognosis, the commissioner cancels or denies driving privileges. The license stays canceled until both of these are true: at least three months have passed since the episode or diagnosis, and you submit a physician’s report showing a favorable prognosis, treatment cooperation, and medical fitness to drive.4Minnesota Office of the Revisor of Statutes. Minnesota Code 7410.2500 – Loss of Consciousness or Voluntary Control The three months is a floor. You still need the physician’s report to clear you. The commissioner’s underlying authority to examine any licensed driver and cancel the license of anyone believed unsafe to drive comes from Minnesota Statute 171.13.5Minnesota Office of the Revisor of Statutes. Minnesota Statutes Section 171.13
If You Disagree With the Decision
Call DVS first and find out the specific basis for the cancellation. Sometimes the problem is a missing signature, a blank field, or a physician’s statement DVS read differently than you expected, and a clarified or updated report from your doctor resolves it. For decisions you genuinely dispute, Minnesota law provides administrative and judicial review of licensing actions, with process and deadlines that vary by the type of cancellation. If a prolonged cancellation is on the table and driving is tied to your livelihood, talk to an attorney who handles driver’s license matters.
Two Boundaries Worth Knowing
A diabetes diagnosis by itself is not grounds for cancellation. Minnesota Statute 171.13 prohibits DVS from denying a license solely because a person has been diagnosed with diabetes mellitus; DVS can act only on an actual episode of lost consciousness or voluntary control, or on a physician’s report indicating the condition isn’t adequately controlled.5Minnesota Office of the Revisor of Statutes. Minnesota Statutes Section 171.13
If you hold a commercial driver’s license, PS31015 satisfies the state’s requirements but does not replace the separate federal medical certification process the Federal Motor Carrier Safety Administration runs for CDL holders with conditions like insulin-treated diabetes, seizure disorders, or cardiac issues.6Federal Motor Carrier Safety Administration. Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870 Expect to complete both processes.