Get CT P-40 2012-2021
DMV, Driver Services Division, 60 State Street, Wethersfield, CT 06161-2510 The patient named below has been referred to the DMV Driver Services Division concerning their ability to safely operate a motor vehicle. This medical report must reflect the results of the medical professional's (licensed physician, PA or APRN) personal examination of the patient performed within 90 days of this report being filed. It must be signed by the patient authorizing the medical professional to release this r.
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