Michigan DA-4P Physician’s Statement of Examination: Filing and Deadlines

The Michigan DA-4P form is a Physician’s Statement of Examination that the Michigan Department of State uses to decide whether you are medically fit to drive. If it arrived in your mail, the Driver Assessment Section has a concern about your physical, mental, or visual ability to operate a vehicle safely and needs a qualified provider to evaluate you. You complete part of the form, your provider completes the clinical portion, and the whole thing has to be back with the state within three months of the physician’s signature.

Why You Received a DA-4P

The Department of State can order a medical evaluation for several reasons. The most common is a reported concern about your ability to meet Michigan’s physical, mental, and vision standards for driving. A DA-4P can also follow a fatal crash, three or more at-fault crashes within two years, traffic convictions while on probation, or violations of existing license restrictions.¹

The medical conditions that most often prompt the form include episodes of lost consciousness, seizures, fainting, blackouts, and any impairment of driving judgment or vision.² Along with the DA-4P itself, the state may send supplemental addendums tied to the specific condition under review.¹

Who Can Sign the Form

Despite the name, the Physician’s Statement of Examination doesn’t have to be signed by a physician. Any of the following providers can certify it:

A physician (MD or DO), including a psychiatrist.
A physician’s assistant, with no countersignature required.
A psychologist, with no countersignature required.
A nurse practitioner, with the supervising physician’s countersignature.¹

If you already have a treating provider who knows your history, that’s usually the person to see. They will evaluate you against Michigan’s Physical and Mental Standards for Drivers (R 257.851–R 257.857) and, where relevant, the Visual Standards for Motor Vehicle Drivers’ Licenses (R 257.1–257.5).³

Filling Out Your Sections

The DA-4P has seven sections. The first four are yours.

Section 1 collects your identifying information.
Section 2 asks about your medical history.
Section 3 covers current health as it relates to driving.
Section 4 is your signed certification that everything you wrote is truthful.⁴

Fill these in before your appointment. Your provider needs to read your answers alongside their own clinical findings, and handing over a blank form slows everything down. If you no longer have the copy the state sent, you can download a fresh one from the Michigan Department of State website.⁴

What Your Provider Completes

Sections 5 through 7 belong to the certifying provider. Section 5 covers general medical questions from the clinician’s perspective. Section 6 is the clinical core: primary, secondary, and tertiary diagnoses, all current medications, the treatment plan, and a prognosis. Section 7 is the provider’s signature confirming that a qualifying examination took place.⁴

The assessment should speak directly to how your conditions affect safe driving, not just your general health. If the completed statement says you cannot safely operate a vehicle, the Department may deny or restrict your license on that recommendation alone.³

Deadlines and How to Return the Form

Two three-month clocks govern the DA-4P, and missing either one can lead to a license suspension:

The medical examination has to happen within three months of the date the physician signs the certification.
The completed form has to reach the Department of State within three months after the physician signs it.⁴

Schedule the appointment promptly. Both windows effectively start on the exam date, so waiting to book is the fastest way to run out of time.

Send the completed DA-4P to the Driver Assessment Section by any of these methods:

Mail: Michigan Department of State, P.O. Box 30810, Lansing, MI 48909-9832
Fax: 517-335-2189
Email: MedicalForms@Michigan.gov¹

Fax and email create an immediate record of when you sent the form. That matters if a dispute ever comes up about whether you met the three-month deadline.

What Happens After You Submit

The Driver Assessment Section reviews your DA-4P against the state’s medical standards. If the form alone resolves the concern, for instance where your provider confirms a condition is well-controlled, the review can end there. In many cases, though, the state schedules an in-person reexamination.

If a reexamination is required, you’ll get a Notice to Appear by mail with the date, time, and location. The Department sets the schedule; you cannot pick your own date, and you have to appear in person. A Driver Assessment analyst will discuss the medical concerns, review your Michigan Driving Record and the DA-4P, and evaluate your driving behavior and risk to traffic safety.¹

Depending on the reason for the reexamination, you may also be tested on-site. Testing can include a vision screening, a general knowledge test, and an on-road driving test. If an on-road test is required, you must bring a properly registered and insured vehicle. The state does not provide one.¹

Possible Outcomes

At the end of the reexamination, the analyst prepares an Order of Action summarizing the results and any licensing changes. Three outcomes are possible:

Restrictions. You keep your license with conditions noted on the license and your driving record, such as corrective lenses, daylight-only driving, or adaptive equipment.
Suspension. Your driving privileges are removed for a set period ranging from days to months. An indefinite suspension can also be imposed, lasting until you provide evidence that you meet the state’s medical standards and can drive safely.
Revocation. Your license is taken away entirely, and you must wait one to five years before you can even apply for re-licensure.

If later medical evidence shows your condition has improved or no longer exists, the Department will reassess the licensing action. The state can also require periodic physician statements as a condition of keeping your license.³

When You Need a DA-4P for a Reinstatement Hearing

The DA-4P is not only used during an active medical review. If you’re applying for a license reinstatement hearing and you take any medication to treat addiction, pain, or a physical or mental health condition that could affect driving, a completed DA-4P has to go in your hearing packet alongside the Hearing Request Application, a substance use evaluation where applicable, and other supporting documents.⁵

For a reinstatement hearing, submit the DA-4P through the Driver Appeal Integrated System (DAIS) online portal, or by mail or fax to the Office of Hearings and Administrative Oversight at P.O. Box 30196, Lansing, MI 48909 (fax: 517-335-2190). This is a different address and fax number than the Driver Assessment Section uses for standard medical reviews, so check which process applies to you before sending the form.⁵

1
Michigan Department of State. Driver Assessment
2
Michigan Legislature. Michigan Compiled Laws MCL 333.5139
3
Michigan Department of Licensing and Regulatory Affairs. Physical and Mental Standards for Drivers R 257.853
4
Michigan Department of State. Physician’s Statement of Examination DA-4P
5
Michigan Department of State. Request a Hearing