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Get Az Dot 96-0668 2016-2026
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How to fill out the AZ DoT 96-0668 online
The Arizona Department of Transportation (ADOT) form 96-0668, also known as the Physician Examination Report, is designed to evaluate how medical conditions may affect a person's ability to drive safely. This guide will provide clear, step-by-step instructions for filling out the form online, making the process as straightforward as possible.
Follow the steps to effectively fill out the AZ DoT 96-0668 online.
- Press the ‘Get Form’ button to access the form and open it in your chosen editor.
- Begin by entering the driver's full name, including the first name, middle name (if applicable), last name, and any suffix (e.g., Jr., Sr.).
- Fill in the driver's date of birth in the appropriate format.
- Provide the driver's complete street address, including city, state, and zip code.
- Input the driver's license number accurately to ensure proper identification.
- Document the date of the examination clearly.
- Provide a diagnosis that describes the medical condition pertinent to the individual's driving capability.
- Indicate the recommended actions by selecting the appropriate checkboxes that pertain to the driver's condition, such as suggesting a suspension, revocation, or specific tests.
- If applicable, outline any recommended restrictions by selecting the corresponding boxes and filling in necessary details, such as mileage restrictions.
- Print the physician's name clearly and include the medical license number along with the clinic or office address.
- Conclude by obtaining the physician's signature and noting their professional designation (physician, psychologist, or nurse practitioner).
- Finally, ensure that all provided information is accurate before saving the changes. You can then download, print, or share the completed form as needed.
Complete your AZ DoT 96-0668 online today for a seamless submission process.
Yes, in Arizona, DMV and MVD refer to the same entity, but technically, MVD is the correct term. The Motor Vehicle Division operates under the Arizona Department of Transportation. Whether you see DMV or MVD, both terms relate to transportation services, including those surrounding the AZ DoT 96-0668.
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