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Form P142ER Connecticut

  1. Language English
  2. Country USA
  3. Activity Driver's License
  4. State Connecticut
Form P142ER Connecticut

Hospital ER physician's impaired driver report

This document is a Hospital Physician's Impaired Driver Report from the Connecticut Department of Motor Vehicles. The report allows any physician to submit, in writing, the name, age, address, date of birth, and diagnosis of patients who have chronic health problems significantly impacting their ability to safely operate a motor vehicle or experiencing recurrent periods of unconsciousness uncontrolled by medical treatment. The reports are for informational purposes only, helping the commissioner enforce state motor vehicle laws in determining eligibility to operate a motor vehicle. Required fields include patient's name, address, date of examination, type and other impairment or medical condition, physician's comments and certification, physician's name, signature, hospital name, telephone number, report date, physician's specialty, license number, state of issue, CDL/PS status, and driver's license number.

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ABOUT

Driving License Application Forms

Form P142ER is one of Driver's license forms that are documents used to apply for a driver's license or to request various services related to driver's licenses. These forms are typically provided by the department or agency responsible for issuing driver's licenses in a specific jurisdiction, such as the Department of Motor Vehicles (DMV) in the United States.

Common driver's license forms include:

Driver's License Application: This form is used to apply for a new driver's license or to renew an existing one. It typically requires personal information such as name, address, date of birth, and Social Security number.

Identification Documents: Some jurisdictions require specific identification documents to verify the applicant's identity and residency. These may include forms such as a birth certificate, passport, or social security card.

Vision Examination: Many driver's license applications require a vision examination form, where an authorized medical professional or eye care specialist certifies that the applicant meets the minimum vision requirements for driving.

Driver's Education Forms: In some cases, individuals may need to provide proof of completing a driver's education course, such as a driver's education completion certificate or a form signed by an instructor.

Medical Evaluation: Certain medical conditions may require additional forms to be completed by a healthcare professional. These forms verify the applicant's physical and mental fitness to drive.

Address Change Form: If a driver's license holder moves to a new address, they may need to fill out an address change form to update their driver's license information.

Driver's license forms can be obtained from the local DMV office or downloaded from their website. It is important to carefully complete and submit the required forms along with any supporting documents to ensure a smooth application or service process.

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