Get Ds 874

The Ds 874 form is a crucial document required for medical examinations of drivers under Article 19-A in New York State. This guide provides a clear and comprehensive walkthrough for users to complete the form online, ensuring that all required information is accurately captured and submitted.

Follow the steps to fill out the Ds 874 online effectively.

1. Press the ‘Get Form’ button to access the form and open it in your online editor.
2. Enter the driver and carrier information in Section 1. Include the driver's first and last name, middle initial, date of birth, address, client/license ID number, state, and carrier/doing business as (DBA) name.
3. Complete Section 2 regarding health history. Indicate 'Yes' or 'No' for each medical condition listed and provide additional comments where necessary.
4. Certify the accuracy of the health information provided by signing and dating where indicated.
5. Move to Section 3 and record vision test results, including uncorrected and corrected visual acuity for each eye.
6. In Section 4, input blood pressure and pulse rate readings, ensuring to record both systolic and diastolic measurements.
7. Provide hearing test results in Section 5, indicating whether a hearing aid was used and recording the distance at which whispered voice can be heard.
8. Complete Section 6 by documenting the results of the required urinalysis and any additional tests that were conducted.
9. In Section 7, conduct and note findings from the physical examination. Check yes or no for abnormalities in body systems.
10. Finally, in Section 8, the medical examiner should certify the examination results, indicating the driver's qualification status along with any restrictions.
11. After all sections are completed, save changes, download, print, or share the form as needed.

Complete your Ds 874 form online today for a smooth medical examination process.