Get Ga Dds-mr-274 2021-2025

Filling out the GA DDS-MR-274 form is essential for individuals needing a vision examination report completed by a licensed optometrist or ophthalmologist. This guide provides a straightforward approach to assist you in accurately filling out the form online.

Follow the steps to complete the GA DDS-MR-274 form.

1. Press the ‘Get Form’ button to obtain the form and access it in your document editor.
2. Begin by entering the patient information. Include the last name, first name, middle initial, date of birth, physical street address, city, state, driver's license number, zip code, phone number, and email address in the designated fields.
3. In the patient attestation section, specify the name of the licensed optometrist or ophthalmologist authorized to conduct the examination. Ensure that the driver/licensee signs and dates this section to validate the consent.
4. For the report on visual examination, record the best corrected visual acuity for each eye with and without corrective lenses. In addition, if applicable, disclose the measurements for bioptic telescope usage.
5. Input the results from horizontal perception testing by noting the degrees of vision for the right and left eyes, along with the total value.
6. Indicate whether the person has monocular vision, and if so, provide the nasal and temporal fields in degrees.
7. Fill out the vision report physician's statement, including the date of examination, responses related to double vision, evidence of eye disease, and an assessment of whether the individual can safely operate a vehicle.
8. The physician must sign and provide their details, including their full name, practice name, specialty, license number/state, address, and telephone number.
9. After completing all sections, ensure to save the changes. You can download, print, or share the form as required.

Complete your documents online for a smoother and more efficient process.