Get Ct P-142r 2011

Filling out the CT P-142R form online is a straightforward process that requires careful attention to detail. This guide will walk you through each step, ensuring that you provide the necessary information accurately and completely.

Follow the steps to fill out the CT P-142R form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by filling in the driver's license number and state of Connecticut. This information helps identify the individual for whom the form is being completed.
3. Input the patient's personal details including their name, date of birth, address, and telephone number. Ensure that this information is accurate and legibly typed.
4. Fill in the section regarding the duration of treatment. This helps to establish the medical professional's familiarity with the patient's medical history.
5. Indicate the date of the patient's last examination. This is crucial for determining the recency of the medical report.
6. In the section on respiratory abnormalities, check any relevant conditions such as asthma, COPD, or sleep apnea. Provide further explanations as required.
7. Answer the questions regarding the patient's ability to exhale 1000CC of air and their understanding of risks associated with their condition.
8. Indicate if the patient follows their prescribed medications and whether there are additional conditions that require evaluation from another specialist.
9. Assess the patient's capacity to safely operate a motor vehicle and indicate the necessity for periodic status reports concerning any changes in their condition.
10. Finally, the medical professional must complete the certification section, including their printed name, telephone number, office address, license number, specialty, signature, and the date of report completion.
11. After completing all fields, save your changes, and choose to download, print, or share the completed form as needed.

Start filling out your CT P-142R form online today!