
Ecretary of State State of Illinois Birth Date Month ZIP Code Day Year Gender M F Telescopic Readings On Reverse I authorize release of the report of this examination to the Secretary of State, Driver Services Department, Springfield, IL, for confidential use on my driving record. This report is valid for six (6) months from the examination date below. App.
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How to fill out the IL DSD X 20.14 online
Filling out the IL DSD X 20.14 form is an important step for individuals seeking to have their vision evaluated for driving purposes in Illinois. This guide provides clear, step-by-step instructions to help users complete the form accurately and effectively.
Follow the steps to fill out the IL DSD X 20.14 form online.
- Click the ‘Get Form’ button to access the IL DSD X 20.14 form online and open it in your preferred editor.
- In Section I, fill in your personal information, including your name, driver facility control number, driver's license number, address, date of birth, gender, and telephone number. Make sure to print the information clearly.
- For the acuity section, provide your visual acuity readings for both eyes, both with and without correction. Ensure to follow the acceptable formats for reporting your readings.
- Proceed to the peripheral section to record your temporal readings for both eyes. Ensure that your total field of vision is recorded, and check if you meet the minimum visual screening standards.
- In the follow-up requirements section, indicate whether the applicant is visually fit to operate a motor vehicle and check all applicable items. Provide any necessary details about corrective lenses or monitoring needs.
- Section V is for the medical provider to certify the examination. Make sure the provider completes this section with their signature, professional license number, and any additional notes.
- If applicable, complete the telescopic acuity and peripheral sections, including the specific requirements for prescription spectacle-mounted telescopic lens wearers.
- Finally, review all completed sections for accuracy before saving the changes, downloading, printing, or sharing the form as needed.
Complete your IL DSD X 20.14 form online today to ensure your vision assessment is processed smoothly.
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