NOTE You may wish to make a copy of the completed Driver Medical Evaluation for your records. SIGNED DS 326 REV. O. Box 934345 MS J-234 Sacramento CA 95818 A Public Service Agency DRIVER MEDICAL EVALUATION Medical information is CONFIDENTIAL under Section 1808. With your assistance the department hopes to resolve the matter with a minimum of inconvenience to all concerned. The Health History and Medical Information Authorization sections on page 1 must be completed and signed by the patient before you complete this Driver Medical Evaluation form. Your experience and knowledge of the patient s condition results of medical examinations and treatment plans will be of great value in assisting the department to determine a proper licensing decision. PLEASE ANSWER ALL QUESTIONS on this form. If questions do not apply indicate N/A. 5 CVC INSTRUCTIONS TO THE DRIVER Please take this form to the medical professional most familiar with your health history and current medical condition. Before giv....
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How to fill out the CA DS 326 online
Filling out the CA DS 326, a driver medical evaluation form, can be straightforward if approached step by step. This guide aims to assist users in completing the form accurately online, ensuring that necessary medical information is properly documented.
Follow the steps to accurately complete the DS 326 form online.
- Click the ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by completing Section 1, which focuses on driver information. Fill in your full name, street address, driver license number, birth date, city, and ZIP code. Ensure that your daytime or home phone number is also entered here.
- In Section 1, answer the health history questions by checking 'YES' or 'NO' for each medical condition listed. Provide explanations for any 'YES' answers in the space provided.
- Sign and date Section 1 to certify that the information you provided is accurate. This declaration is vital as it is a legal statement.
- Proceed to Section 2, where you will read the advisory statement regarding the confidentiality of your medical information and the implications of not providing requested information.
- In Section 3, fill out the medical information authorization. Input the name and address of your medical professional or hospital, along with the date and your medical record number.
- Once Section 1 through 3 are completed, forward the completed form to your medical professional. They will need to fill out Sections 5 through 13 based on their evaluation.
- Wait for your medical professional to complete their sections. Ensure they check all relevant medical evaluations and provide detailed comments where necessary, especially if any impairments affect driving.
- After all sections are filled, review the completed form for accuracy. You may wish to save it for your records.
- Finally, submit the completed form as instructed, which may include faxing it or delivering it directly, depending on the directions provided by your medical professional.
Complete your CA DS 326 form online today to ensure your driving privileges are maintained.
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