Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out Section A, which requires the name of the person with a disability, their driver’s license or identification, or Social Security number, along with their address details including street, city, and zip code.
3. Next, complete the signature field where either the person with a disability, next of kin, or care provider must sign and provide a telephone number and date signed.
4. Proceed to Section B to indicate the type of placard requested. Choose from options such as new, replacement, or renewal. If applicable, specify reasons for replacement like damaged, lost, or stolen.
5. If applying for an additional placard, provide a clear reason for its necessity. You may also opt to make a donation by indicating the amount next to the opportunities for Ohioans with disabilities.
6. For the prescription part, in Section C, ensure that the health care provider fills in their name, license number, address, expected duration of disability or placard end date, and their daytime phone number. A proper signature and date from the health care provider is essential.
7. After completing all necessary sections, review the form for accuracy and completeness before saving any changes. Users can then download, print, or share the form as needed.

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