Form 5839 is the official Missouri Physician’s Statement and Authorization required when you want a medical alert notation placed on a driver’s license or non‑driver ID. The form must be completed by a licensed health‑care provider and presented at the time of application.
This form is used under Section 302.205, RSMo to certify medical conditions that affect driving ability. It is typically needed by individuals with conditions such as epilepsy, diabetes, vision impairments, or any health issue that the Missouri Department of Revenue deems relevant for a medical alert.
Instead of downloading the PDF and editing it manually, simply click the "Fill out this form" button on this page. The Formize PDF Filler app will load, allowing you to complete every field directly in your browser. Once finished, you can save or print the completed form.
After filling out Form 5839, bring the printed copy (or a saved electronic version) to your local Missouri Department of Revenue office when applying for or renewing a driver’s license or ID. The office will verify the medical information before adding the alert notation.
Below are answers to the most common questions about this form. For more details, refer to the downloadable PDF linked at the bottom of the page.
Only a licensed physician, osteopathic doctor, or other qualified health‑care professional can sign the form.
Yes, but the scan must be clear and legible. Using the online Formize filler ensures a high‑quality PDF.
Generally no, unless the Department of Revenue specifically requests supporting documentation.
The alert remains until the physician provides a new statement indicating the condition has resolved.
No separate fee is charged for the medical statement; any standard licensing fees still apply.
The form will be rejected. Contact the physician to obtain a proper signature before submission.
Enamikus riikides on enne teele asumist kohustuslik omada juhiluba. Juhiloa saamine on oluline verstapost kõigile, kes soovivad autot juhtida.
Form 5839 on üks juhiloa taotlusvormidest, mis on dokumendid, mida kasutatakse teabe kogumiseks inimestelt, kes soovivad juhiluba taotleda. Tavaliselt sisaldab see väljasid taotleja nime, sünnikuupäeva, ID-numbri, kontaktteabe, samuti tema juhiloa ajaloo ja kogemuste kohta.
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