Get Part A - Medical Certification - Public Passenger Chauffeur License

Filling out the Part A - Medical Certification for a Public Passenger Chauffeur License can seem daunting, but this guide is designed to assist you through the process with clarity and support. By following these step-by-step instructions, you will be able to complete the form accurately and with confidence.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the Part A - Medical Certification form and open it in your preferred editing tool.
2. Provide the examinee's name in the designated field. This information identifies the individual undergoing the medical certification.
3. Fill in the age and date of birth of the examinee. Ensure that these details are accurate, as they will be used for identification purposes.
4. Indicate the sex of the examinee. This section helps in demographic data collection and may be necessary for the medical examination process.
5. If the examinee chooses to disclose their Social Security number, enter it in the specified field. Remember, providing this information is voluntary.
6. Write the complete address of the examinee, including the street address, city, state, and ZIP code. This will facilitate correspondence related to the application.
7. In the history section, answer the questions listed by selecting 'Yes' or 'No' for each item. It is important to be honest and thorough, as this information informs the physician's assessment.
8. If you answer 'Yes' to any of the history questions, provide additional detail in the space provided. This will help the physician understand any medical concerns.
9. The examinee must sign and date the form at the bottom of this section, indicating their acknowledgment of the information provided.
10. Once the examinee's section is completed, the physician will fill out the physical examination part, detailing pertinent medical assessments such as height, weight, and any tests performed.
11. After the physician completes their section, ensure that they also sign and date the form. Their signature confirms that the examination has taken place.
12. Review the completed form for accuracy and completeness. Once verified, you can save changes, download, print, or share the form as needed.

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