Rred to the DMV Driver Services Division concerning their ability to operate a motor vehicle safely. This medical report must reflect the results of the licensed physician's personal examination of the patient performed within 90 days of this report being filed. It must be signed by the patient authorizing the physician to release this report and any attachments to DMV. I hereby authorize the licensed physician completing and signing this medical report to release such report to DMV along with.
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How to fill out the CT P-142C online
The CT P-142C is a cardiology medical report required by the Connecticut Department of Motor Vehicles. This guide will provide clear, step-by-step instructions for completing the form online to ensure it meets all necessary criteria.
Follow the steps to properly complete the CT P-142C form.
- Click ‘Get Form’ button to access the CT P-142C and open it in your online document editor.
- Begin by entering the patient's driver's license number at the top of the form. This identifies the individual who is the subject of the medical report.
- The patient must sign the authorization statement, confirming that they allow the physician to release the medical report to the DMV.
- List any conditions relevant to the safe operation of a motor vehicle. Be specific about medical issues that may affect the patient's driving ability.
- State if the patient has experienced any altered circulatory stability and any medications that are relevant to their ability to operate a vehicle, including doses.
- The physician must answer questions about the patient's understanding of their condition, adherence to medication, and any concerns regarding substance abuse.
- Complete any additional comments or notes that may be relevant to the patient's condition or driving ability.
- The physician must certify the report by signing, printing their name, and providing their license number and specialty. Include the date the report is completed.
Complete your CT P-142C online today to ensure a smooth reporting process.
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