Arizona Driver Vision Examination Report - ADOT MVD
This is a vision examination report required by the Arizona Department of Transportation Motor Vehicle Division (ADOT MVD). It includes a standard vision report, a comprehensive medical eye report, and instructions for both physicians and drivers. This form is necessary for drivers to meet the vision requirements for a driver's license.
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How do I fill this out?
To fill out this form, you will need to provide your personal information and have a licensed physician or optometrist complete the vision test results. Ensure all sections are fully completed and signed where indicated. Follow the specific instructions provided for physicians and drivers on the form.
How to fill out the Arizona Driver Vision Examination Report - ADOT MVD?
1
Fill in your personal information such as name, date of birth, and address.
2
Sign the Medical Information Release section before giving the form to the physician.
3
Have a licensed physician or optometrist complete the vision test results.
4
Ensure the physician or optometrist signs and includes their medical license number.
5
Submit the completed form to the MVD for processing.
Who needs the Arizona Driver Vision Examination Report - ADOT MVD?
1
Drivers with a medical condition affecting their vision need this form to ensure they meet vision standards.
2
Commercial drivers requiring vision assessment to distinguish colors of traffic signals.
3
Drivers using corrective lenses, bioptic telescopic lenses, or experiencing night vision issues.
4
New residents of Arizona applying for a driver’s license and needing vision verification.
5
Physicians and optometrists who need to provide medical information about a patient's vision to the MVD.
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What are the instructions for submitting this form?
To submit this form, ensure all sections are fully completed and signed by both the driver and the physician/optometrist. Send the completed form to the Arizona Motor Vehicle Division (MVD) via mail at Medical Review Program, PO Box 2100, Phoenix AZ 85001-2100. You may also submit the form in person at an MVD office. For additional information or questions, contact the MVD at their provided phone number.
What are the important dates for this form in 2024 and 2025?
Important dates for this form in 2024 and 2025 include submission deadlines based on licensing renewal periods. Typically, this form needs to be submitted within a specified timeframe before the expiration of the current license. Check with the MVD for specific deadlines and ensure timely submission to avoid any disruptions in your driving privileges.
What is the purpose of this form?
The purpose of this form is to ensure that drivers in Arizona meet the required vision standards to safely operate a motor vehicle. This form must be completed by a licensed physician or optometrist who will provide detailed vision test results and recommendations. The Arizona Motor Vehicle Division (MVD) uses this information to make licensing decisions and ensure that drivers are capable of performing the functional skills required for safe driving.
Tell me about this form and its components and fields line-by-line.
- 1. Driver Information: Includes fields for driver’s name, date of birth, street address, and contact information.
- 2. Medical Information Release: A section for the patient to authorize the release of medical information to the MVD.
- 3. Vision Exam Results: Fields for the physician to record uncorrected and corrected vision test results, as well as visual acuity and field measurements.
- 4. Bioptic Telescopic Lens System: Section to indicate whether a bioptic telescopic lens system was used for the test.
- 5. Physician/Optometrist Certification: Fields for the examining physician’s name, signature, medical license number, and contact information.
- 6. Comprehensive Medical Eye Report: Additional section for detailed vision diagnosis, recommendations, and monitoring schedule.
- 7. Instructions: Detailed instructions for both the driver and the physician/optometrist on how to complete and submit the form.
What happens if I fail to submit this form?
Failure to submit this form may result in the inability to obtain or renew a driver’s license. This can lead to legal and practical issues for the driver.
- License Suspension: Your driver’s license may be suspended if the MVD does not receive the completed form.
- Driving Restrictions: Without a valid vision assessment, you may face driving restrictions or be deemed unfit to drive.
- Legal Consequences: Operating a vehicle without a valid license may result in fines or legal penalties.
How do I know when to use this form?
- 1. License Renewal: When renewing your driver’s license and a vision test is required.
- 2. Commercial Driving: To verify that you meet the vision standards for commercial driving.
- 3. Medical Condition: If you have a medical condition affecting your vision that needs to be reported.
- 4. New Residents: New residents applying for an Arizona driver’s license.
- 5. Corrective Lenses: If you use corrective lenses or bioptic telescopic lenses and need to report your vision results.
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