Report of Visual Status template
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This document is a report of visual status by an optometrist or ophthalmologist for an applicant seeking to renew or obtain a Delaware driver's license. The report includes the applicant's name, date of birth, current DL number, address, and date of examination. The document also lists the applicant's visual acuity with and without corrective lenses in both eyes (left eye and right eye), and indicates if there is any evidence of eye disease or defect that could affect visual performance now or in the future. The report may include restrictions on the license based on safety considerations, such as daylight driving only or denial of the license. Additionally, the document asks about the applicant's use of corrective lenses and their field deficit if applicable, and how often they should have their vision checked.
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