Get Medical Evaluation Form (cr-24) - Maine.gov - State Me

The Medical Evaluation Form (CR-24) is an essential document for individuals undergoing assessment for their driving capabilities. This guide will provide clear, step-by-step instructions to help you accurately complete the form and understand its various components.

Follow the steps to fill out the Medical Evaluation Form (CR-24) effectively.

1. Press the ‘Get Form’ button to access the Medical Evaluation Form (CR-24) and open it in the online editor.
2. Begin filling out your personal information in the designated fields. Provide your name, address, date of birth, and license/history number as required.
3. Complete the certificate of examination section by providing the necessary details for the reporting physician. This includes filling in their name, address, and the date the examination was conducted.
4. In the functional ability profile section, check only one box per diagnosis for the listed conditions, and provide additional information for any other conditions that may impact your ability to drive.
5. Include the date of your last examination and how long the physician has been treating you. Ensure this information is within the past year.
6. If applicable, state the date of any recent seizures, strokes, or loss of consciousness. Additionally, list any current prescribed medications and indicate how reliably you take them.
7. Answer whether the patient's medication has caused any side effects that could interfere with safe driving.
8. In the physician's comments section, provide a detailed description of any physical or cognitive deficits if necessary.
9. Authorize the release of medical information by signing the relevant section and having your physician certify their examination of the applicant.
10. Finally, review the form for accuracy and completeness. Once satisfied, you can save your changes, download, print, or share the completed form as needed.

Complete your Medical Evaluation Form (CR-24) online to ensure a smooth assessment process.