Get Commission For The Blind Mandatory Report Of Legal Blindness Form

The Commission For The Blind Mandatory Report Of Legal Blindness Form is an essential document used for reporting cases of legal blindness in Massachusetts. This guide will provide comprehensive, step-by-step instructions on how to complete this form online.

Follow the steps to fill out the form accurately and efficiently.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by filling in the patient information section. Enter the patient's first, middle, and last name along with their sex, address, social security number, date of birth, and age at onset of legal blindness.
3. Continue with the visual acuity section. Record the best corrected distant vision for each eye using Snellen notations (e.g., 20/200) for both the right eye (R.E.) and left eye (L.E.).
4. If there is a restriction in the field of vision, indicate it in the appropriate section and record any test results on the reverse side of the form.
5. Document the cause of blindness, specifying any injury, disease, or poisoning if applicable. Include the diagnosis and etiology for both eyes.
6. Check if there is a secondary disability and specify. Additionally, note whether a low vision aid evaluation is recommended.
7. Fill out the prognosis field, providing any recommendations or remarks from the examiner.
8. Finally, include the date of examination, signature, and the discipline of the examiner, as well as the date of the report. Print the name of the examiner.
9. Once all the sections are completed, review the form for accuracy and completeness before saving changes, downloading, printing, or sharing as needed.

Start completing your Commission For The Blind Mandatory Report Of Legal Blindness Form online today!