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Form TC 94-176 Kentucky

  1. Country USA
  2. Language English
  3. Activity Driver's License
  4. State Kentucky
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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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ABOUT

Driving License Application Forms

Form TC 94-176 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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