Assessment of medical fitness for driving and firearms licenses: obligations of physicians

Professional and non-professional drivers and firearms license holders must meet certain health requirements set by law. General practitioners play a key role in assessing the medical fitness of these individuals. Below is an overview of the legislation and a clear summary of the obligations of doctors when assessing medical fitness to drive motor vehicles and possess firearms, including the obligation to report changes in a patient's health, the possible risks of failure to do so, and practical recommendations for everyday practice.

Author of the article: ​ARROWS (Mgr. Dita Zbožínková, LL.M., office@arws.cz, +420 245 007 740)

Overview of legislation

Act No. 361/2000 Coll., on road traffic:

Regulates the conditions for obtaining a driver's license, including the medical fitness of drivers. Applicants for a driver's license must submit a valid medical certificate of fitness (typically not older than 3 months) when enrolling in a driving school and applying for a driver's license. Ordinary (non-professional) drivers are required to undergo a regular medical examination at the age of 65, again at the age of 68, and then every 2 years.

A stricter regime applies to professional drivers and certain groups of driving licenses: they must undergo examinations more frequently – usually every 2 years up to the age of 50 and annually over the age of 50. Details of these intervals are set out in Section 87 of the Road Traffic Act.

Based on the results of a regular medical examination, the examining doctor may, in justified cases, particularly taking into account the current state of health, set a date for the next regular medical examination that is shorter than the periods specified in the previous paragraph.

The examining doctor may order a specialist examination.

The law also expressly stipulates the doctor's duty to report: if the doctor finds that the applicant or holder of a driving license is medically fit only under certain conditions or is not fit at all, he must immediately report this fact to the competent municipal authority with extended powers (according to the place of residence/study of the patient). This obligation is a breakthrough in standard medical confidentiality and is enshrined directly in law.

Decree No. 277/2004 Coll., on medical fitness to drive motor vehicles:

Implementing regulation to the Road Traffic Act. It defines in detail the health conditions for driving – it lists diseases, defects, and conditions that exclude medical fitness or make it conditional (e.g., the need to use compensatory aids or undergo a specialist examination).

The decree also specifies the scope of the medical examination (what tests the doctor must perform, including an orientation test of vision, hearing, neurological status, etc.) and the requirements for the medical report. The report must be unambiguous and without a diagnosis, containing only the information specified in the template and the final assessment. The decree also allows the doctor to specify a shorter validity period for the assessment than the standard interval – for example, in the case of progressive diseases, the doctor may indicate an earlier date for the next check-up on the assessment.

Act No. 119/2002 Coll., on firearms and ammunition:

Regulates the conditions for obtaining and holding a firearms license, including medical fitness. Medical fitness is one of the legal conditions for the issuance and possession of a firearms license. As with drivers, applicants for a firearms license must undergo a medical examination and submit a medical certificate, which must not be older than 3 months at the time of application for the professional competence test.

A firearms license is normally valid for 10 years, but may be limited to a shorter period by a doctor depending on the applicant's state of health. The law distinguishes between different categories of firearms licenses (A–E) according to their purpose; it is important for doctors to note that, for example, category D (carrying a weapon for professional purposes) and pyrotechnic investigation require ongoing monitoring of medical fitness even after the license has been issued.

Holders of group D licenses must undergo a periodic medical examination once every 30 months after the license is issued. The law also allows for extraordinary medical examinations if there is suspicion of loss of fitness due to a change in health status. As with drivers, a doctor's reporting obligation has been introduced: the examining doctor who finds a change in the health of a firearms license holder that excludes or limits their fitness must immediately send a new medical report to the relevant department of the Czech Police.

In addition, the law takes into account acute risks in relation to firearms licenses – every doctor (including specialists and psychiatrists) has the right to check with the police whether their patient holds a firearms license if they discover a serious illness or suspect one, and if this is confirmed, they must immediately pass this information on to the assessing doctor.

If the patient's condition poses a direct threat to life or health in connection with the handling of weapons, the doctor shall immediately report this fact not only to the assessing doctor but also directly to the police. The police will then invite the firearms license holder to undergo an extraordinary examination by their assessing physician (the license holder is obliged to undergo the examination within 10 working days of receiving the invitation) and, based on the new assessment, may decide to restrict or revoke the firearms license.

The examining doctor and the doctor specializing in the relevant field who provides further necessary specialist examinations are required to perform the medical examination and arrange for specialist examinations at a designated provider without undue delay after the gun license holder first visits the examining doctor. If the holder of a firearms license fails to appear for the medical examination or refuses to undergo it, the assessing physician shall notify the competent police department of this fact without undue delay.

Decree No. 493/2002 Coll., on the assessment of medical fitness for the issuance or validity of a firearms license:

Implementing regulation to the Weapons Act. It sets out specific requirements for the medical fitness of firearms holders and illnesses or conditions that are incompatible with the possession of a firearms license. Annex 1 to the decree lists diseases that exclude eligibility and diseases that limit eligibility and require an assessment after a specialist examination (e.g., certain mental disorders, neurological diseases, serious visual impairments, etc.).

The decree defines types of examinations: initial (before the issuance of a firearms license), periodic (groups D and F every 30 months), and extraordinary (if there is suspicion of a change in health status or if the previous assessment was issued with limited validity).

The decree describes in detail the content of the medical examination – in addition to medical history and physical examination, it also includes mandatory targeted sensory examinations (vision, hearing, balance) and any other specialist examinations, in particular clinical-psychological examinations or examinations by a sports doctor.

The decree also specifies the form of the medical assessment – it must not contain any diagnoses and must only explicitly state whether the person is "medically fit," "not medically fit," or "medically fit with the use of necessary medical aids or with an escort." It also requires the assessing doctor to clearly indicate in the patient's medical records that they are a holder (or applicant) of a firearms license and that this information be passed on to the new registering doctor when changing general practitioners.

Obligations of the general practitioner during assessments

The registering general practitioner (for adults, a general practitioner; for children and adolescents, a pediatrician) is usually the assessing physician for the purposes of driver's licenses and firearms licenses. Their main duties include:

• Conducting initial (one-off) examinations and issuing medical assessments: When issuing a driver's license, the GP is the one who examines the future driver and issues an assessment of their medical fitness to drive. Similarly, for a firearms license, the registered physician in the field of VPL assesses applicants for firearms licenses in groups A, B, C, E (or D, if they are not employees with a company doctor).
• The physician must responsibly assess the patient's current state of health based on their medical history, preventive examinations, and any specialist reports. If the patient is seeing a specialist (e.g., cardiologist, psychiatrist, neurologist), it is advisable to request a report or consultation – in many cases, this is directly required by law (e.g., if the patient is under the care of a specialist for a condition that may impair their fitness, the assessment will only be issued after the specialist's opinion has been obtained).
• Conducting regular periodic examinations: For senior drivers, the doctor may recommend a visit six months before reaching the age limit (65 or 68 years) so that the patient has the assessment in time. For holders of a firearms license, the doctor may set a shorter interval for check-ups depending on the individual condition of the patient. For example, if they find health problems that could worsen, they may issue an assessment valid for only one year or several months, after which the patient will need to be re-examined. This option is particularly important when the patient is not immediately disqualified, but more frequent check-ups are necessary (e.g., incipient eye disease, compensated diabetes with a risk of complications, etc.).
• Completing the medical assessment (forms): The medical assessment of fitness must comply with the requirements of the relevant regulations. The general practitioner should use the current form (for drivers, the template according to Decree 277/2004 Coll., for weapons, the template according to Decree 493/2002 Coll.). The assessment does not include diagnoses or sensitive details, only the conclusion: fit, or fit with conditions (including specifying what these are, e.g., "with glasses," "with automatic transmission"), or unfit. The assessment must be dated, signed, and include the name and identification details of the healthcare provider.

The assessment itself therefore contains only the minimum necessary information, while the supporting documents (e.g., examination results, specialist reports) are part of the medical records.

• One original copy of the assessment is given to the patient (for submission to the authorities, police, or driving school) and a second copy is kept in the doctor's medical records. The documentation shall include a record of its receipt by the person being assessed, confirmed by the signature of the assessing physician and the person being assessed, or a delivery note confirming receipt of the assessment by the person being assessed.
• Monitoring the patient's current state of health: General practitioners have the advantage of a long-term relationship with their patients and knowledge of their medical history. However, they must be vigilant if there is a significant change in the health of a patient who holds a driver's license or firearms license.
• As soon as routine care (e.g., during a preventive examination or when dealing with new problems) reveals that the patient suffers from a condition incompatible with safe driving or gun ownership, the doctor should immediately reassess their medical fitness. In practice, this may mean inviting the patient for an extraordinary assessment examination earlier than otherwise planned, or at least consulting a specialist. At the same time, however, it is helpful if the physician marks (i.e., flags) patients who are senior drivers or firearms license holders in the documentation. This will ensure that the doctor is aware that any new diagnoses (e.g., epilepsy, serious mental illness, visual impairment) may have an impact on the patient's fitness during every contact with the patient.

Duty to report changes in health status

One of the greatest responsibilities of a doctor in this area is the duty to report if a patient is no longer medically fit to drive a motor vehicle or possess a firearm. This reporting obligation is laid down by law and is not left to the discretion of the doctor – as soon as you discover a fact that excludes fitness, you must act, even if it is unpleasant for the patient.

• Driver's license (Road Traffic Act § 89a): If a doctor (general practitioner or other healthcare provider) finds that a driver is unfit to drive or fit only with conditions, they must immediately report this to the relevant municipal authority with extended powers. In practice, this means sending information about the assessment conclusion to the relevant authority (according to the patient's place of residence).

Important: In this notification, the doctor does not state specific diagnoses or details of the patient's state of health, but only communicates the result of the assessment (the person concerned has lost their medical fitness to drive/is medically fit with conditions). Based on this notification, the authority will initiate administrative proceedings – usually requesting the driver to surrender their driver's license or setting conditions (e.g., restrictions) in accordance with the medical assessment.

If the doctor has assessed the driver as unfit, the authority will decide to revoke the driver's license for health reasons and the person concerned must surrender their driver's license. This is an unpleasant step for doctors, but it is a necessary measure to protect both the patient and the public.

• Firearms license (Firearms Act § 20a): The mechanism is similar, with the only difference being that the competent authority is the Czech Police. If a doctor finds that a firearms license holder has undergone a change in health that excludes or significantly limits their ability to possess a firearm, they are required to report this fact without undue delay to the healthcare provider responsible for issuing the medical certificate, if known, and to notify the Czech Police.

In practice, the doctor then draws up an up-to-date medical assessment (this time probably with the verdict "not fit") and sends it to the relevant police department (usually the department for weapons and security material).

The law also covers cases where changes in health are noticed by a doctor who has no information about the patient's possession of a firearms license—for example, a psychiatrist may suspect that a patient with a serious mental disorder owns a weapon. In such a case, the psychiatrist has the right to check with the police whether the patient has a firearms license and, if so, inform the assessing doctor.

In the event of an immediate threat (e.g., the patient threatens to use a weapon and is clearly mentally unstable), the doctor informs the police directly. Again, the report/assessment should not include details of the diagnosis, only a statement of (in)competence. The protection of sensitive data in such cases is ensured by a legal exception to confidentiality.

After notification – what happens next:

The doctor should inform the patient that, due to their condition, they must report this fact to the authorities. This is often difficult news for patients, so it is advisable to communicate sensitively. After sending the notification or assessment, doctors are often not involved in the process any further – the administrative authority decides on the basis of the assessment. The patient has the option to appeal the decision of the authorities or disagree with the medical assessment.

In the event of disagreement with the assessment (for both firearms and driver's licenses), the patient may, within 10 working days of the demonstrable delivery, submit a request for review of the assessment in accordance with the Act on Specific Health Services. The review will be carried out by a higher administrative authority. The doctor who issued the assessment will have to defend their conclusions – this is another reason why it is important to have everything carefully documented.

In summary, if a doctor finds a person unfit, they must not hesitate to report it. It is their legal duty to prevent danger to health and life. At the same time, they should limit the information disclosed to the minimum necessary (assessment conclusion) so as not to breach confidentiality beyond what is required by law.

Risks for doctors in the event of a breach of duty

Failure to comply in this area can have serious legal and moral consequences for doctors. Issuing a medical assessment of fitness for work is a medical profession with elements of an administrative decision – doctors are responsible for it and must stand by it. If a doctor makes a mistake (e.g., negligently issues a positive opinion to a person who should not have received it, or fails to respond in time to a deterioration in a patient's health), various consequences may arise:

• Administrative or disciplinary sanctions: The Medical Chamber and state authorities may assess whether a doctor has complied with their legal obligations. The Czech Medical Chamber may initiate disciplinary proceedings in the event of serious misconduct (e.g., proven gross negligence in the provision of medical care). The regional authority, as the registration authority for healthcare providers, may also investigate complaints or suggestions.
• In addition, according to the Road Traffic Act and the Weapons Act, failure to cooperate may be considered a breach of duty—although the law does not specify a direct penalty for doctors for failure to report, doctors are bound by law and any inaction could be legally classified as a breach of legal duty.
• In extreme cases, if a doctor knowingly conceals a patient's medical condition (e.g., under pressure from the patient, issues a report that is contrary to the facts), they could also face criminal consequences (e.g., the offense of "forgery and issuance of a false medical report, opinion, or finding" under Section 350 of the Criminal Code).
• Loss of trust and professional prestige: In addition to the legal aspects, moral responsibility cannot be overlooked. A doctor who, through their approach, "lets an unfit driver on the road" or fails to take a weapon from a person in a mental crisis in time could endanger not only the public but also their own reputation and that of the entire medical profession. On the contrary, by following a consistent procedure, doctors protect their patients and those around them and strengthen public confidence in medicine.

It should be emphasized that the aim of these obligations is not to "punish" patients or doctors, but to prevent tragedies. In recent years, the Ministry of Transport and the police have drawn attention to cases where elderly or sick people behind the wheel have caused serious accidents and have appealed to doctors to assess the health of drivers in a truly responsible manner. Fortunately, most doctors are aware of this responsibility and assess drivers and gun owners carefully. If a doctor acts in accordance with the law, conscientiously, and in the interest of safety, they need not fear punishment—on the contrary, the law is on their side.

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Practical advice for doctors

1. Keeping records and documentation

Consistent documentation is essential. Record all relevant information – family and personal medical history, medications taken, results of tests performed (e.g., visual acuity, perimetry, audiometry, etc.), and recommendations from specialists. If you issue a restricted or negative assessment, include the reason in the documentation (e.g., “unfit to drive due to repeated hypoglycemia in DM1”).

Make a note that the patient has a driver’s license or health insurance (e.g., in the form of an alert or note in the medical record). This will help you to consider the impact of the patient's health on these licenses during routine examinations. Remember that the assessment form does not contain diagnoses – if the patient submits the assessment to a third party, that party should not know the details of their health. This makes it all the more important that you, as the physician, have all the relevant documentation on file in case of consultation or review.

2. Be proactive if you suspect unfitness

If you suspect that a patient's health no longer allows them to safely drive or possess a weapon (e.g., worsening dementia, increasing seizures, serious visual impairment, untreated psychosis), do not remain passive. There is no need to wait until the next scheduled periodic examination. Schedule the patient for an extraordinary examination or initiate a specialist examination.

In the case of weapons, you can also take advantage of the fact that the law allows other doctors to be involved in the process – do not be afraid to communicate with specialists. For example, if a neurologist informs you that your patient (driver) has started having epileptic seizures, act quickly – assess their condition in relation to driving (usually a driving ban applies for a certain period after a seizure) and, if necessary, temporarily prohibit driving until treatment is adjusted. Don't wait for "it to come out on its own" – a human life may be at stake.

3. Use restrictions and conditions instead of automatic "paper revocation"

The choice does not always have to be "let it be or take away the license." The law and implementing regulations allow for restrictions or conditions to be imposed to ensure safety while allowing the patient to continue the activity to a limited extent. For drivers, there is a system of harmonized codes – a doctor can restrict the conditions under which a patient is allowed to drive. For example: the obligation to wear glasses or a hearing aid or to use an automatic transmission instead of a manual one. These codes are then reflected on the driver's license and are checked by the police during inspections.

4. Communication with the patient

Informing a patient that they can no longer drive a car or that they must surrender their weapon is a sensitive matter. Approach this with empathy, but also with openness and firmness. A few tips:

• Explain the reason and emphasize safety: Speak clearly. For example: "Mr. Novák, unfortunately your eyesight has deteriorated to such an extent that it would be dangerous for you to continue driving. I am concerned that you could endanger yourself and others. Therefore, I cannot issue you a certificate of fitness." Emphasize that this is to prevent accidents or tragedies. Most patients understand deep down that you are acting in their best interest and in the public interest, even if they are upset at first.
• Reference to legislation and your duty: You can mention that you are required to do so by law – that this is not your personal decision on a whim, but a legal obligation of a doctor. For example: "The law requires me to report any serious illness that is incompatible with driving to the authorities. If I fail to do so, I am breaking the law." This will help the patient understand that you are not "against them," but are fulfilling your role.
• Offer solutions and support: Try to mitigate the impact—for example, provide information about alternatives to a senior citizen whose driver's license you are taking away: "I know you are used to driving to your cottage on your own. Let's talk about how to solve this. Maybe your family or neighbors could help..." In the case of weapons, you can recommend: "If you have a weapon, you will have to hand it in, but you could store it with the police until your condition improves—I can advise you on how to do this." Of course, the patient's condition will not always improve, but at least they can see a way forward.
• Allow space for questions and possible reactions: Patients may react emotionally – with denial, anger, or sometimes even an attempt to persuade the doctor. Be patient and let them vent their concerns ("What will I do without a car?", "I'll lose my job..."). Calmly repeat your reasons and offer to discuss the next steps together.
• Do not confront unnecessarily. If the patient disagrees with your conclusion, inform them in detail about the possibility of requesting a review of the assessment by another doctor or commission (within 10 days) – they have the right to do so. Sometimes, just knowing that there is a possibility of appeal reduces tension. In practice, however, it is rare for a review to completely overturn an assessment, especially if it is well-reasoned.
• Involve the family, if appropriate: It often helps seniors if you also talk to family members (with the patient's consent, of course, due to confidentiality). The family can be helpful – for example, they can arrange who will drive the senior or make sure that they actually stop driving. Sometimes the family itself appeals to the doctor to "take away the senior's license," while at other times they may be opposed—in which case it is necessary to stand your ground and explain the legal framework to them.

5. Don't go it alone—consult and educate yourself

Assessing medical fitness can be complicated, and dilemmas are not uncommon. Do not hesitate to consult colleagues, specialists, or even the legal department of the Czech Medical Chamber (ČLK) in unclear cases. The Czech Medical Chamber has published methodological materials (e.g., a brief guide for doctors on assessing medical fitness to hold a firearms license), and a sample notification form for fulfilling the reporting obligation under the Road Traffic Act is available on the ČLK website.

Keep an eye on legislative updates – for example, a change is being discussed in 2025 that would raise the mandatory age for driver examinations from 65 to 70 (effective possibly from 2026). Such changes may affect your practice. The better you know the rules, the more confidently and calmly you will apply them.

Conclusion

Assessing medical fitness for driving and firearms licenses is a demanding but extremely important task for general practitioners. The doctor finds himself in the role of a protector of public safety – his signature on the assessment can literally mean the difference between preventing an accident and a potential tragedy. It is therefore necessary to approach these assessments conscientiously, not to downplay symptoms, and not to accommodate the patient out of compassion if this could endanger him or those around him.

At the same time, however, empathic communication and an individual approach can help patients accept new restrictions. As doctors, you have a responsibility and the power to influence safety on the roads and in our community – use it wisely. By complying with the obligations described above, you will not only meet legal requirements, but also contribute to protecting health and life, which is the mission of the medical profession.