Form DE-26 template
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Vision Form
This document is a request form for releasing visual condition information to the Driver Services Bureau of the Department of Public Safety in Mississippi. The form must be type-written or printed and signed by the driver. It includes sections for the driver to provide their personal information, date of birth, and signature. The ophthalmologist or optometrist completing the form provides information about the patient's eyesight, including visual acuity with and without corrective lenses, field of vision, total angle, prognosis, and any necessary comments. The form is valid for one year from the date of issuance.
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