Get Tx Medical Advisory Board (mab) Physician Referral Form 2021-2025

The TX Medical Advisory Board (MAB) Physician Referral Form is a crucial document for reporting medical conditions that may impact a person's driving ability. This guide will walk you through each section of the form, ensuring you understand how to accurately complete it online.

Follow the steps to fill out the physician referral form with ease.

1. Click the ‘Get Form’ button to access the form and open it in your document editor.
2. Begin by filling out the patient information section. Enter the patient's last name, first name, and middle initial in the appropriate fields.
3. Next, provide the patient's complete address, including city, state, and ZIP code.
4. Fill in the patient's date of birth to confirm their age.
5. If available, include the patient's driver license number to facilitate identification.
6. In the section labeled 'Explain any specific medical limitations to driving for this patient,' provide a detailed description of any driving impairments. Be clear and thorough to ensure accurate assessment.
7. The physician must then sign the form in the designated area, ensuring that it is dated.
8. Include the printed name of the physician, their Texas physician license number, address, and telephone number.
9. Lastly, confirm the city and state along with the ZIP code of the physician's practice.
10. Once the form is completed, users can save changes, download, print, or share the form as needed.

Take the next step and complete your MAB Physician Referral Form online today.