Get Medical Report - Mvd Express

Filling out the MEDICAL REPORT - MVD Express is a crucial step for individuals seeking to maintain their New Mexico driver’s license. This comprehensive guide provides you with step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the MEDICAL REPORT.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by typing or printing all required patient information in the designated fields. This includes the patient’s name, date of birth, driver license number, social security number, and address.
3. Select the type of disease or condition the patient is being treated for by marking the appropriate checkboxes. Options include neurological, psychological, cardiovascular, epilepsy, hypoglycemia, diabetes, lapses of consciousness, and orthopedic.
4. Provide details regarding how long the physician has been treating the patient, the frequency of office visits, and the date of the last examination.
5. Describe the nature, extent, and frequency of any signs or symptoms exhibited by the patient that may affect their ability to safely operate a motor vehicle.
6. State the physician's diagnosis and the method of treatment being administered.
7. If applicable, input the dates of relevant tests such as EKG or EEG, along with the name of the physician who performed these tests and their results.
8. Record the date of the last blood pressure test and its results.
9. List any medications the patient is taking, including the kind, quantity, and frequency of intake.
10. Indicate whether the medication impairs the patient's ability to safely operate a motor vehicle, and if so, provide a brief explanation of the effects.
11. Mention any abnormal personality traits, addictions, or complications if applicable.
12. Assess whether the physician considers the patient's condition controlled and whether the patient is capable of safe driving by selecting yes or no.
13. Finally, fill in the next recommended interval for medical report review, specifying in years and/or months.
14. Have the physician print or type their name, sign the form, and provide their office address and phone number, as well as the date of completion.
15. Once all fields are completed, save your changes, download the document, and print or share the form as needed.

Complete the MEDICAL REPORT - MVD Express online today!