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STATE OF CONNECTICUT DEPARTMENT OF MOTOR VEHICLES 60 STATE STREET, WETHERSFIELD, CT 061611013 DRIVER SERVICES DIVISION ct.gov/dmvMEDICAL FORM P142M Rev. 718Department of Rehabilitation Services/ Driver.

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How to fill out the CT DMV P-142M online

The CT DMV P-142M is a medical form used to assess an individual's ability to safely operate a motor vehicle. This guide will provide clear, step-by-step instructions on how to complete this form online, ensuring that users can easily navigate through each section, regardless of their experience level.

Follow the steps to complete the CT DMV P-142M form effectively.

  1. Click ‘Get Form’ button to obtain the CT DMV P-142M and open it in the editor.
  2. In Section (A), fill in your personal information, including your full name, mailing address, date of birth, and phone number. Ensure all details are accurate to avoid processing delays.
  3. Continue in Section (A) by providing your operator's license number. Sign and date the authorization statement to allow your medical examiner to conduct the examination and share relevant medical records.
  4. In Section (B), your medical examiner will complete the clinical information section. They should indicate if they are your primary care provider and document any conditions that could impact your ability to drive safely.
  5. Your medical examiner will also complete additional subsections in Section (C), listing any specific health conditions and relevant medication that may affect your driving capabilities.
  6. Once all sections have been filled out, review the form for any errors or missing information. Ensure all required signatures, including that of your medical examiner, are provided.
  7. Finally, after confirming that the form is complete and accurate, you can save your changes, download the document, print it for submission, or share it as necessary.

Complete your CT DMV P-142M form online today for a hassle-free experience!

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Related content

DMV Medical Form P-142M - CT.gov
P-142M Rev. 7-18. This patient has been referred to the DMV concerning his or her ability...
Learn more

Related links form

Yankton Commission Meeting Minutes 2013-14 STUDENT REGISTRATION FORM COMMON SCHOLARSHIP APPLICATION Yankton City Commission Meeting Minutes

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CT DMV P-142M
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