Get Ny 619 2022-2025

The NY 619 form, also known as the Vision Test Report, is essential for users renewing their driver license. This guide provides clear instructions on how to complete the form accurately and effectively.

Follow the steps to complete the NY 619 form online

1. Press the ‘Get Form’ button to access the NY 619 form and open it in your preferred editor.
2. Enter the patient’s name exactly as it appears on their driver license. Include the last name, first name, and middle initial in the respective fields.
3. Fill in the date of birth of the patient in the MM/DD/YY format.
4. Provide the patient’s street address, including city, state, country, and zip code.
5. Record the date of the examination in the MM/DD/YY format.
6. Indicate if the patient achieved a Snellen Test score of 20/40 or better with one or both eyes by selecting ‘YES’ or ‘NO’.
7. Specify whether the patient wore corrective lenses during the test by selecting ‘YES’ or ‘NO.’ If 'NO,' you will need to complete form MV-80L instead.
8. Enter the name and title of the provider completing the form.
9. Provide the provider’s street address, including city, state, country, and zip code.
10. Select the validity period of the report, which can be for either 12 months or 6 months from the date of examination.
11. Sign the form in full, affirming the accuracy of the clinical findings reported.
12. Provide the professional license number of the provider.
13. Once all fields are completed, review the information for accuracy. Save any changes, and download, print, or share the form as necessary.

Complete and submit your documents online for convenience and efficiency.