Get Az Adot 32-4005 2013-2025

The AZ ADOT 32-4005 form, known as the Medical Examination Report, is vital for individuals needing to report medical conditions that may affect their ability to drive. This guide will provide you with clear and concise instructions on how to complete the form online.

Follow the steps to successfully complete the AZ ADOT 32-4005 form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the driver’s name, including first, middle, last, and suffix, along with their date of birth and street address. Ensure that the customer number, city, state, and zip code are also accurately provided.
3. Report any symptoms and/or medical conditions that have been communicated to the Motor Vehicle Division (MVD). It is essential to remember that this information is confidential.
4. The patient must complete the medical information release section. This includes providing their name or the name of their legal guardian, signing the form, and dating it.
5. The physician must complete their section of the form, including the examination date, diagnosis, symptoms, and whether the symptoms are present at all times.
6. The physician should indicate if they recommend MVD to monitor the patient's condition and specify how often if applicable.
7. Include any current medications the patient is taking and whether the physician recommends continuation of driving privileges.
8. For patients with episodes of altered consciousness, describe the type of episode, aftereffects, and whether those episodes are under control.
9. The physician must indicate if the patient is compliant with the required medical treatment, and provide an explanation where necessary.
10. Complete the final areas of the form by providing the physician's printed name, signature, medical license number, street address, city, state, phone number, and zip code.
11. After filling out the form, review all sections for accuracy. Save changes, download, print, or share the completed document as needed.

Complete your documents online now for a more efficient process.