Get Physician's Statement Of Examination Michigan 2020-2025

Filling out the Physician's Statement of Examination in Michigan is a crucial step for individuals applying for a medical waiver. This guide will provide clear steps to help you navigate the form successfully and ensure accurate completion.

Follow the steps to competently complete the Physician's Statement of Examination

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the Release of Information section. This includes entering the applicant's name, address, date of birth, driver license number, and daytime phone. Ensure that the applicant or their representative provides a signature and date.
3. Proceed to the Instructions for Physician section. The physician must fill in relevant information regarding the applicant's medical condition as it relates to their ability to operate a commercial motor vehicle.
4. Complete Section A regarding neurological or neuromuscular diseases. The physician should describe any relevant medical history and current medications for conditions like epilepsy, narcolepsy, and other neurological disorders.
5. Fill out Section B, which involves other medical disorders and general medical conditions. This includes diabetes management, heart disease, and any other relevant conditions that may affect the applicant's driving abilities.
6. In Section C, provide information regarding any history of drug or alcohol use. Indicate whether the applicant has received treatment, and detail the nature and frequency of any substance-related issues.
7. Complete Section D, the psychological evaluation. The physician should assess any psychiatric conditions and their impact on the applicant’s ability to operate a vehicle safely.
8. Use Section E for comments. The physician should detail the duration of treatment, compliance with medical recommendations, and provide any additional pertinent information about the applicant’s ability to drive safely.
9. Finally, in Section F, the physician must provide their certification. This section requires the physician's signature, professional license number, and contact information to confirm that the statements are truthful.
10. Review the completed form for accuracy. Once satisfied, save the changes, and utilize available options to download, print, or share the completed form as required.

Ensure your medical waiver process runs smoothly by completing the Physician's Statement of Examination online today.