Medical Department

Medical Hearings / Disability Forms (Diabetic, Hearing Impaired, and Medical)

DE-26 Vision form The DE-26 form has multiple purposes. The form is used when an applicant wishes to be issued a blind disability ID. It is also utilized if the driver wishes to remove Restriction (B) from their driver’s license. All applicants who fail the initial eye exam and do not currently wear eyeglasses are also given the form. Lastly, the DE-26 form is used by the Medical Hearing Officers to determine if a driver still has the ability to safely operate a motor vehicle.

DR-11 Medical Form The DSB Record's Division issues a DR-11 Form to a motorist whose driving skills have been assessed to be inadequate. In Mississippi, the following criteria are used to identify incompetent or medically unsafe drivers:

  1. Any citizen who has knowledge of improper or inadequate driving skills may notify the Driver Records Division Medical department in writing.  This notification must be signed and notarized.
  2. Notification may be by a physician attesting to the physical or mental incompetence of an individual to safely operate a motor vehicle.
  3. Any accident report filed with the department that includes a notation by the investigating officer that a driver needs to be re-examined will be provided to the Medical Hearing Officer.  Notifications from the public or physician are confidential and are not subject to inspection under the Public Records Law.
  4. Any driver’s license examiner who reasonably believes that an applicant for a driver’s license or renewal of a driver’s license is in such a condition that the applicant is incapable of safely operating a motor vehicle will refer the applicant for re-examination

The driver must have the appropriate form, DR-11 or DE-26 form filled out by their physician before they are afforded a Medical Hearing. Completed DR-11 and DE-26 forms must be mailed or emailed by a physician only to 


Medical Administrator Contact

(601) 987-1226


Driver Records Division/Medical 

P.O. Box 1459

Canton, MS 39046


Driver Records Division/Medical 

1900 E. Woodrow Wilson Dr. 

Jackson, MS 39216