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Form D4 Minnesota

  1. Language English
  2. Country USA
  3. Activity Driver's License
  4. State Minnesota
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Form D4 Minnesota

Ophthalmologist Examination Report

An individual named (Patient's name) is seeking a waiver from Minnesota Department of Public Safety for intrastate school bus driving, following an ophthalmologist examination. The report requests information on the patient's diabetic condition's impact on visual health. The examining ophthalmologist should answer the following questions regarding the patient's: unstable proliferative diabetic retinopathy status, Snellen distant visual acuity (Left: 20/ Right: 20/), Horizontal Fields in Degree for each eye (Left Eye: _____ Right Eye: _____ BothEyes: _________), whether the patient reads with or without corrective lenses, and if their visual acuity is stable. The ophthalmologist should also provide their name, office/clinic name, telephone number, sign the report, and ensure that it has been examined within the preceding six months.

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ABOUT

Driving License Application Forms

Form D4 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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