Background/Objectives Driving confers both risks and benefits to older adults, and physicians have been tasked with counseling them. We sought to estimate how many older patients discuss driving with a primary care provider during a calendar year, and to describe discussion triggers. Design Observational retrospective medical record review. Setting Three primary care clinics (geriatrics, hospital-based general internal medicine [GIM], and community-based GIM) affiliated with a tertiary care hospital. Participants Random sample of 240 older (≥65 years) patients with ≥1 visit in 2014 (January 1 to December 31). Measurements Standardized chart abstraction of patient demographics, medical diagnoses, and presence and context of discussions about driving. Provider factors (obtained from clinic administrators) included gender and average amount worked per week. Results Geriatric clinic patients were oldest, had more medical diagnoses, and had a median of 4 visits in 2014 (versus 3 visits in GIM clinics). Documented discussions about driving occurred with a greater proportion of patients in the geriatric (n=22; 28%, 95% CI 18-39%) and GIM hospital (n=15; 19%, 95%CI 11-29%) clinics than the GIM community clinic (n=6, 7.5%, 95%CI 2.8-16%). Medical diagnoses that might affect driving were prevalent but not associated with increased frequency of documented discussions. In multivariable analysis, patients were more likely to have ≥1 documented driving discussion in 2014 if they went to the geriatric clinic or had a primary care provider aged ≤45 years or who worked <6 half-day clinics per week. Conclusion Over one year, a minority of older patients had a documented discussion about driving with a primary care provider, with differences by clinic and provider characteristics. Strategies to support routine and preparatory conversations about driving should incorporate these findings.