/PS YES NO MAIL TO: DMV, Driver Services Division, 60 State Street, Wethersfield, CT 06161-2510 INSTRUCTIONS: Under the provisions of Section 14-46 of the Connecticut General Statutes, any physician may report to the DMV, in writing, the name, age and address of any person diagnosed by him to have any chronic health problem which in the physician's judgment will significantly affect the person's ability to safely operate a motor vehicle, or to have recurrent periods of unconsciousness uncontr.
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How to fill out the CT P-142ER online
The CT P-142ER is an essential document for physicians reporting patients who may be impaired drivers. Filling out this form accurately ensures critical information is communicated effectively to the Department of Motor Vehicles in Connecticut.
Follow the steps to accurately complete the CT P-142ER online.
- Click ‘Get Form’ button to access the CT P-142ER online and open it for editing.
- Begin by entering the patient's driver's license number. This information is crucial to correctly identify the individual being reported.
- Provide the patient's name in the designated fields. Make sure to include the last name, first name, and middle initial, if applicable.
- Fill in the patient's complete address. Ensure accuracy for future correspondence regarding the report.
- Enter the patient's date of birth. This information helps verify the identity of the individual and assess eligibility.
- Input the date of examination. This should reflect when you conducted the medical assessment of the patient.
- Select the type of impairment from the list provided. You may choose more than one if necessary, and if applicable, describe any other impairments or medical conditions in the designated space.
- Provide your comments as the physician. This section allows you to include additional insights that may help in the evaluation of the patient's ability to operate a motor vehicle.
- Certify the report by entering the physician's name, hospital name, telephone number, and the date of the report. Your signature is required to validate the information provided.
- Enter your specialty, physician's license number, and state of issue to provide additional context to your qualifications.
- Once all sections are completed, review the information for accuracy. Save the changes, then download, print, or share the form as necessary.
Ensure patient safety by completing the CT P-142ER online today.
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Can you refuse a breathalyzer in Connecticut?
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