How to complete the certificate of disability on Florida HSMV 83039
HSMV 83039 is Florida's application for a disabled person parking permit. Section 2 is the certificate of disability, completed by a physician or other certifying practitioner. This guide walks through Section 2 in the form's order.
- Form
- Application for Disabled Person Parking Permit, Certificate of Disability (Florida HSMV 83039)
- Issued by
- Florida Department of Highway Safety and Motor Vehicles
- Revision
- HSMV 83039 (Rev. 10/26)
- Checked against the source
- November 5, 2026
What it is and when it is used
A person applies for a Florida disabled parking permit, new or renewal, with HSMV 83039. The application needs the certificate of disability in Section 2, completed by a certifying authority.
The form lists who may certify: a physician licensed under Florida Statutes chapters 458, 459 or 460 or similarly licensed in another state (with extra documentation the form describes), an osteopathic or podiatric physician, a chiropractor, an optometrist, an advanced practice registered nurse under a physician's protocol, or a physician assistant.
Some renewals of a permanent permit do not need a new certificate. The form explains which ones.
Who completes which part
| Part | Completed by | What it covers |
|---|---|---|
| Section 1 | Applicant (the patient), or an organization | Name, date of birth, contact details, address and Florida driver license or ID number, and the applicant's signature. An organization that transports disabled people has its own block. |
| Section 2 | Physician or certifying practitioner | The certificate of disability: temporary or permanent, the criterion that applies, your license details and signature. |
| Section 3 | Tax collector or license plate agency | Office use only. |
The provider's part, section by section
Section 2 is the certificate of disability. Check either the temporary permit or the permanent permit, check the disability that applies, then complete the license and signature lines.
Temporary permit
For a temporary disability, six months or less, that limits or impairs the ability to walk, or a temporary sight impairment. The form ties it to the specific disability you check in the list below. It says a temporary permit is issued for the period you specify, up to six months.
The disability criteria
For a permanent permit, check the permanent permit box and each criterion that applies. In the form's order:
- 1. Legally blind, or a permanent disability that limits or impairs the ability to walk 200 feet without stopping to rest. Name the specific disability.
- 2. Cannot walk without a brace, cane, crutch, prosthetic or other assistive device, or without help from another person. The form says a person whose device restores walking without severe limitation does not qualify under this item.
- 3. Needs to use a wheelchair permanently.
- 4. Lung disease to the degree the form sets: FEV1 below one liter on spirometry, or arterial oxygen below 60 mm Hg on room air at rest.
- 5. Uses portable oxygen.
- 6. A cardiac condition with functional limitation classified as Class III or Class IV under American Heart Association standards.
- 7. Severe limitation in walking from an arthritic, neurological or orthopedic condition.
- 8. Legally blind.
- 9. Permanent dismemberment or amputation. The form says a lifetime permit is issued for this criterion.
License, address and signature
Your certification or license number (the form marks it required), the state that issued it, your business address and phone, your printed name, signature and the date signed.
Special exception
Check this box only when a severely disabled applicant for a permanent permit cannot obtain a Florida driver license or ID card. A disability above must also be checked, and you sign and date the exception separately.
Deadlines the form states
- The form says it is not valid for more than 12 months from the date of the certifying authority's signature.
Where it goes
The form says the applicant submits the original or a copy in person at the local tax collector office or license plate agency, or the certifying authority faxes it directly to that office.
Official source
HSMV 83039 (Rev. 10/26). Checked against the issuer's copy on November 5, 2026. This guide paraphrases the form's own instructions; the form and Florida Department of Highway Safety and Motor Vehicles are the authority.
How Scribeable fills it
Scribeable fills the official HSMV 83039 from your visit note. It writes an answer only when the note states it.
Anything the note does not say stays blank for you to complete. Scribeable checks a criterion only when the note states the finding it needs. Section 1 is left for the applicant, and your license number is yours to add if the note does not carry it. Your signature and the date you sign are always yours to add.
Each filled answer shows the sentence in the note it came from, so you can check it before you sign.
You review every field, then download or print the form, sign it, and give it to the patient.
Other forms
- FMLA, employee (WH-380-E)U.S. Department of Labor, Wage and Hour Division
- FMLA, family member (WH-380-F)U.S. Department of Labor, Wage and Hour Division
- NY disability benefits (DB-450)New York State Workers' Compensation Board
- NY workers' comp narrative (CMS-1500 template)New York State Workers' Compensation Board
- CA workers' comp progress report (PR-2)California Division of Workers' Compensation
- CA SDI Part B answers (DE 2501)California Employment Development Department
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