
Nse Number Street Address Birth Date Month City County Gender Day Year M F ZIP Code Telescopic Readings On Reverse I authorize release of the report of this examination to the Secretary of State, Driver Services Department, Springfield, IL, for confidential use on my driving record. This report is valid for six (6) months from the examination date below.
Loading
Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save
How to fill out the IL DSD X 20.14 online
The IL DSD X 20.14 is an essential form used for documenting vision examinations for individuals seeking to maintain or obtain a driver's license in Illinois. This guide provides clear and supportive steps to assist users in filling out the form accurately and efficiently online.
Follow the steps to fill out the IL DSD X 20.14 online.
- Press the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
- Begin by filling out the applicant information section. Include your last name, first name, and middle name as requested. Provide your driver's facility control number, driver's license number, street address, birth date, city, county, gender, and ZIP code.
- Provide your telephone number as necessary, and indicate your approval for the report’s release to the Secretary of State.
- In the acuity section, complete the readings for both eyes with and without correction, ensuring to follow the guidelines for acceptable vision readings.
- Move on to the peripheral section and fill in the necessary readings for both eyes as specified. If total peripheral vision is less than 140°, record the additional readings as instructed.
- In the follow-up requirements section, check the applicable items regarding your visual health and provide your opinion if required.
- Complete the medical provider section, which includes the date of examination, the provider's signature, and their professional license information.
- If you are a prescription-mounted telescopic lens wearer, ensure to fill out sections VI through IX as required, providing specific readings and assessments.
- Review all entries for accuracy and completeness before finalizing the form.
- Once completed, you can save changes, download, print, or share the filled form as needed.
Complete your documents online today to ensure a smooth filing process.
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Related content
Appendix B-2. 2014 Illinois Water Quality Maps ... 18 Lower Illinois/Macoupin Creek...
I . 4 • 2 Data Processing Plan For HE&~-B - This GSFC doc~nt (X-565-78-2, Feb....
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down process here.