Get Ma Mab118 2018-2026

The MA MAB118 form is essential for evaluating a person’s capacity to operate a vehicle safely concerning their psychiatric health. This comprehensive guide will assist users in accurately completing the form online with clarity and confidence.

Follow the steps to fill out the MA MAB118 form online.

1. To obtain the form, click the ‘Get Form’ button to access it and open it in your preferred editor for online completion.
2. Begin by filling out the patient information section. This includes entering the last name, first name, middle name, suffix, date of birth, license number, and reported condition.
3. For the section regarding the psychiatric condition, provide a description using the DSM-V or ICD-10 diagnosis to outline the patient’s specific psychiatric issues.
4. Describe the extent, frequency, and control of the patient’s symptoms that may affect their ability to operate a motor vehicle. Include details on their orientation and any dissociative episodes.
5. Indicate whether the patient's psychiatric condition is likely to impair their driving ability by selecting ‘Yes’ or ‘No’.
6. If the condition involves seizures or loss of consciousness, specify the type and date of the last episode.
7. Answer whether the patient is currently on any medication by selecting ‘Yes’ or ‘No’. If yes, list the medications and their dosages.
8. Assess if the medications could interfere with the patient's ability to drive safely and select ‘Yes’ or ‘No’.
9. Check one of the options confirming the patient’s qualification to operate a motor vehicle safely and provide your professional opinion.
10. Indicate if you have read the attached police report by checking ‘Yes’, ‘No’, or ‘N/A’.
11. If necessary, include any additional comments that may support your evaluation.
12. Complete the physician certification section by providing the physician's or RN's name, Massachusetts Board of Registration number, phone number, and address.
13. Finally, ensure to sign and date the form to certify that all information provided is true and correct.
14. Once all sections are filled, save your changes, and choose to download, print, or share the completed form as needed.

Complete the MA MAB118 form online today to ensure timely processing.