Get Ct P-142c 2011-2025

The CT P-142C form is a cardiology medical report required by the Connecticut Department of Motor Vehicles to assess a person's ability to safely operate a motor vehicle. This guide provides comprehensive, step-by-step instructions to assist users in completing the form accurately online.

Follow the steps to fill out the CT P-142C accurately.

1. Click ‘Get Form’ button to obtain the CT P-142C form and open it in the editor.
2. Begin filling in the patient's information at the top of the form, including the driver's license number, patient's name (last, first, and initial), date of birth, and telephone number.
3. Complete the patient's address section, providing the street, city, state, and zip code.
4. Indicate how long the medical professional has been treating the patient and the date of the last examination.
5. In the relevant conditions section, describe any medical conditions that may impact the patient's ability to operate a vehicle safely.
6. List any technical reports (such as Echo, Scan, Holter) relevant to motor vehicle operation, along with their findings, dates, and results.
7. Complete the medication section by entering the names and dosages of any medications that may affect driving ability.
8. Address questions regarding the patient's understanding of their condition, adherence to medication, and potential substance abuse. Choose 'Yes' or 'No' where applicable.
9. Provide a professional assessment regarding the patient's ability to operate a vehicle safely and whether periodic status reporting is necessary.
10. Fill out the medical professional certification section, including the name, telephone number, license number, specialty, and signature of the medical professional.
11. Once all fields are completed, review the entire document for accuracy and completeness. Save changes, then download, print, or share the form as needed.

Complete your CT P-142C online today to ensure prompt processing of your application.