Form TC 94-176 Kentucky

Breath Alcohol Ignition Interlock Physician Statement

This document is a Kentucky Transportation Cabinet form, specifically for the Division of Driver Licensing's Ignition Interlock Program. The form consists of three sections: Section 1 gathers driver/patient information including name, contact details, and medical condition; Section 2 has the driver/patient authorize the release of their medical records to KYTC and District Court; and Section 3 requires a physician's assessment of the patient's ability to use an ignition interlock device based on their medical condition and results from a pulmonary function test. The physician must provide their name, title, phone number, mailing address, current diagnosis of the patient, and the type and date of the last pulmonary function test performed.

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Driving License Application Forms

In most countries, it's mandatory to have a driving license before you can hit the road. Getting a driving license is an important milestone for anyone who wants to drive a car.

Form TC 94-176 is one of Driving License Application forms that are documents used to gather information from people who want to apply for a driving license. It usually contains fields for the applicant's name, date of birth, ID number, contact information, as well as their driver's license history and experience.

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