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When preparing for a driver's license renewal or application in California, one important document that applicants may need is the DMV Vision Form. This form plays a crucial role in assessing a person’s visual capabilities to ensure they can operate a vehicle safely. The first part of the document requires the applicant to provide personal information, including their driver license number, date of birth, and contact details. Importantly, they must also sign and date the authorization section, which allows a vision specialist to report their findings to the DMV confidentially. The form emphasizes the need for a recent vision examination, stating that new corrective lenses, if prescribed, should be brought along for review. Applicants are reminded not to mail in the form unless advised by a DMV employee, as any alterations could void its legitimacy. The vision specialist must complete the second section. They will evaluate the applicant's visual acuity and overall eye health, documenting findings according to specific metrics. Conditions affecting vision as well as recommendations for future care and new examinations are also to be recorded. This collaborative approach ensures that the DMV has a comprehensive view of an individual’s vision capabilities, ultimately aiding in the licensing decision process.

Dmv Vision Example

STATE OF CALIFORNIA

DEPARTMENT OF MOTOR VEHICLES®

A Public Service Agency

962

REPORT OF VISION EXAMINATION

SECTION 1 — APPLICANT COMPLETES THIS SECTION

INSTRUCTIONS: Please complete the driver license number, date of birth, telephone number, name, and address areas of this form. You must sign and date the authorization line. All medical information received by the Department of Motor Vehicles (DMV) is conidential under

California Vehicle Code (CVC) §1808.5. Please bring this completed form and any new corrective lenses with you when you return to DMV for further testing. If any section of this form is incomplete, it may have to be returned to the vision specialist for completion. DO NOT MAIL THIS FORM BACK TO DMV unless asked to do so by a DMV employee. Alterations or erased information may void this form.

Your vision specialist should conduct a new vision examination unless one has been conducted within the last six months. DMV will make the inal licensing decision based on a combination of factors, including information from your vision specialist.

DRIVER LICENSE NUMBER

NAME (FIRST, MIDDLE, LAST)

DATE OF BIRTH (MO., DAY, YR.)

HOME TELEPHONE NUMBER

()

RESIDENCE ADDRESS

CITY

STATE

ZIP CODE

I authorize the vision specialist conducting this examination to provide the Department of Motor Vehicles with the following

information for its conidential use (CVC §1808.5) in evaluating my ability to safely operate a motor vehicle.

APPLICANT’S SIGNATURE

DATE

 

20/40 with both eyes tested together, and

DMV’s Visual Acuity Screening Standard is

20/40 in one eye, and

• 20/70, at least, in the other eye.

SECTION 2 — OPHTHALMOLOGIST OR OPTOMETRIST COMPLETES THOSE SECTIONS THAT APPLY — Information must be from exam within last 6 months.

1. REFRACTION — Complete only those sections that apply.

HAVE NEW DISTANCE LENSES BEEN PRESCRIBED AND FITTED?

Yes

No If yes:

Glasses

Contact Lenses

DATE NEW LENSES WERE PRESCRIBED

IS NIGHT DRIVING RECOMMENDED?

Yes No

IS MONOVISION EMPLOYED?

 

 

 

 

 

 

DID YOUR PATIENT RECEIVE BIOPTIC LENS TRAINING?

By contact lenses

Yes

No

 

 

 

 

 

Yes

No

Not Known

 

By refractive surgery

Yes

No

 

 

 

 

 

 

 

 

 

 

 

DID PATIENT RECEIVE BIOPTIC LENS TRAINING THAT INCLUDED DRIVING?

Is best corrected visual acuity in each eye recommended for driving?

Yes

No

Yes

No

Not Known

 

 

 

 

 

 

 

 

 

 

 

Bioptic Telescope

Right eye 20/ ___________

Left eye 20/___________

SKILL IN USING BIOPTIC TELESCOPE

 

 

 

 

 

Bioptic Telescope suitable for driving?

Yes

No

 

 

 

Satisfactory

Unsatisfactory

Not Known

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. VISUAL ACUITY — Complete Clinical Measurement Section. Lenses include contact lenses or glasses.

DMV MEASUREMENT (FOR DMV USE ONLY)

 

CLINICAL MEASUREMENT (WITHOUT BIOPTIC TELESCOPE)

 

 

 

 

 

 

 

 

 

 

Both Eyes

Right Eye

 

Left Eye

 

Both Eyes

Right Eye

Left Eye

 

 

 

 

 

 

 

 

 

Without Lenses

20/

20/

 

20/

Without Lenses

20/

20/

20/

 

 

 

 

 

 

 

 

 

With Current Lenses

20/

20/

 

20/

With Lenses

20/

20/

20/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Best Corrected Visual Acuity

20/

20/

20/

3.DIAGNOSIS — Please indicate vision condition by checking the box(es) representing affected eye(s). If the diagnosed condition is not listed, write the diagnosis under “other diagnosis/comments” below.

REFRACTIVE R L DEVELOPMENTAL

Astigmatism

Amblyopia

Hyperopia

Strabismus

Myopia

Congenital Nystagmus

 

Albinism

R L OPTICAL

R L RETINAL/OPTIC NERVE R L

Cataract

Diabetic Retinopathy

Corneal Opacity

Macular Degeneration

Diplopia (uncorrectable)

Glaucoma

Keratoconus

Retinal Detachment

Aphakia

Retinitis Pigmentosa

Pseudophakia

Retinal Damage

Post. Caps. Opac.

(CRVO, PRP etc.)

VISUAL FIELDS

R L

Decreased Peripheral Vision

 

Hemianopia

 

Quadrantanopia

 

Decreased Peripheral Vision. Please identify the areasaffectedonthechartinSection5(seereverse)

Other diagnosis/comments

Monocular Vision (No Light Perception or Prosthesis)

If monocular, when was the monocular vision diagnosed?

 

 

If monocular, does the patient have a medical condition that could affect the functional eye in the future?

Yes

No

Any eye surgery (including refractive)?

Yes

No

Date of most recent surgery

 

Type of surgery

 

 

 

 

 

 

 

 

 

 

DL 62 (REV. 4/2016) WWW

*DL62*

 

Name:

DL/ID/X #:

4. PROGNOSIS

Diagnosis

 

Static

Diagnosis

 

Static

Diagnosis

 

Static

Progressive

Stable since

 

(date)

Progressive

Stable since

 

(date)

Progressive

Stable since

 

(date)

WHEN SHOULD DMV REQUIRE A NEW DMV VISION EXAMINATION REPORT FORM BE SUBMITTED?

Not applicable 1 year 2 years 5 years Other

5.VISUAL FIELDS — If vision is not correctable to 20/40 in each eye, or there is possible visual ield loss, a full visual ield examination (con- frontation is permissible) must be performed. Show the approximate peripheral extent and any scotomas in the diagram below.

 

LEFT EYE

 

RIGHT EYE

Extent:

 

 

Extent:

Left

 

 

 

Left

Right

 

 

 

Right

Up

 

 

 

Up

Down

 

 

 

Down

6.VISUAL ABNORMALITIES — The following information will help our examiners evaluate your patient’s ability to safely operate a motor vehicle. Based upon your testing, clinical impression, or knowledge of the disorder, please indicate the severity of any of the following visual abnormalities which your patient may be experiencing. Indicate severity of condition by placing a 1 (mild), 2 (moderate), or 3 (severe) in the box(es) below.

R L

Decreased Acuity

Color Defect

R L

Visual Field Loss

Reduced Depth Perception

R L

Contrast Sensitivity Loss Abnormal Eye Movements

R L

Problems With Glare

R L

Poor Night Vision

7. ADVICE — Have you given your patient any advice about driving?

Yes

No

If yes, please explain in #8 below.

8.ADDITIONAL COMMENTS — Report any additional information or comments you feel DMV should know concerning your patient’s visual and perceptual capabilities relating to driving performance. You may use an additional sheet of paper to provide this information as well as

information about any existing conditions which contribute to poor night vision or poor depth perception, etc. Any recommendations about the patient’s general safety should also be made. DMV will make the inal licensing decision based on a combination of factors, including your professional expertise.

9. SIGNATURE — This section must be completed to validate this report.

PRINTED NAME

 

 

 

M.D. OR O.D. LICENSE NUMBER

 

 

 

 

 

SIGNATURE

 

 

 

DATE OF EXAM (MUST BE WITHIN LAST 6 MONTHS)

X

 

 

 

 

 

ADDRESS

CITY

CA

ZIP CODE

TELEPHONE NUMBER

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

DL 62 (REV. 4/2016) WWW

Form Characteristics

Fact Name Description
Document Title This form is officially known as the "Report of Vision Examination" issued by the California Department of Motor Vehicles (DMV).
Purpose The DMV Vision Form is used to evaluate an individual's visual capabilities in relation to safely operating a motor vehicle.
Confidentiality All medical information submitted to the DMV is confidential and protected under California Vehicle Code (CVC) §1808.5.
Submission Guidelines Applicants must not mail this form back to the DMV unless specifically instructed to do so. The form must be presented in person, along with corrective lenses if applicable.
Vision Evaluation Standards The DMV requires visual acuity of 20/40 or better in one eye, and at least 20/70 in the other eye to qualify for licensure.
Timeliness of Examination The vision exam must be conducted within the last six months prior to submitting the DMV Vision Form.
Potential for Re-examination DMV may require resubmission of the Vision Examination Report at intervals decided by the ophthalmologist or optometrist, usually ranging from one to five years.

Guidelines on Utilizing Dmv Vision

Completing the DMV Vision Examination form is a straightforward process necessary for determining the suitability of an individual to operate a motor vehicle safely. Follow these steps to ensure the form is correctly filled out and ready for submission.

  1. Provide Personal Information: In Section 1, enter your driver license number, full name (first, middle, last), date of birth, home telephone number, and residential address, including city, state, and ZIP code.
  2. Sign and Date the Authorization: Sign the authorization line and date it to acknowledge the confidentiality of your medical information.
  3. Vision Specialist Consultation: Ensure that a vision specialist conducts an examination within the last six months and that they fill out the required sections in Section 2.
  4. Complete Refraction Information: Your vision specialist must indicate whether new distance lenses have been prescribed and fitted. If applicable, provide the date lenses were prescribed and indicate if night driving is recommended.
  5. Visual Acuity Measurement: Record the clinical measurements for visual acuity with and without lenses, specifically for both eyes and each eye separately. This section must be completed for DMV use.
  6. Diagnosis of Vision Conditions: The vision specialist should check the appropriate boxes that indicate any diagnosed vision conditions and provide any additional diagnosis as needed.
  7. Prognosis Details: Indicate whether the diagnosis is static or progressive and the recommended time frame for a new vision examination report submission.
  8. Visual Fields Documentation: If applicable, a visual field examination must be performed and documented, showing peripheral extent and any scotomas for both eyes.
  9. Report Severity of Visual Abnormalities: The vision specialist should evaluate the patient’s condition and report the severity of any visual abnormalities experienced by the patient.
  10. Advice and Additional Comments: If the vision specialist provided any advice regarding driving, it should be documented. Any additional information that could help DMV in their decision-making should also be included.
  11. Final Signature: The vision specialist must complete the final section, providing their printed name, license number, signature, date of examination (ensuring it is within the last six months), address, and contact information.

After completing the form, bring it along with any new corrective lenses to your DMV appointment. Ensure that every section is accurately filled out, as incomplete forms may be returned for additional information. Following these instructions will facilitate a smoother process during your DMV visit.

What You Should Know About This Form

What is the DMV Vision form?

The DMV Vision form is a document required by the California Department of Motor Vehicles (DMV) that certifies an applicant’s vision. It includes sections for the applicant to fill out personal information and for a vision specialist to report on the results of a vision examination. The form helps assess whether individuals meet the visual standards needed to safely operate a motor vehicle.

Who needs to complete the DMV Vision form?

How do I fill out the applicant's section on the form?

To fill out the applicant's section, provide your driver license number, date of birth, name, address, and telephone number. Ensure that all information is accurate and legible. Sign and date the authorization line to allow the vision specialist to share your information with the DMV.

What information does the vision specialist provide?

The vision specialist completes sections of the form that detail the results of your eye exam. This includes visual acuity measurements, any prescriptions for corrective lenses, recommendations for night driving, and any diagnosed conditions affecting vision. It also requires professional input on whether your visual capabilities are adequate for safe driving.

How recent must the vision examination be?

The vision examination must have been conducted within the last six months. This ensures that the DMV has current information about your vision abilities when considering your application.

What should I do if I wear corrective lenses?

If you wear corrective lenses, bring them with you when returning to the DMV. The form will ask about new lenses, and you'll need to indicate if you're using glasses or contact lenses. It’s important that your vision is assessed with your corrective lenses during the examination.

Can I mail the DMV Vision form?

Generally, you should not mail the DMV Vision form back to the DMV. You must bring it in person unless specifically instructed by a DMV employee to send it by mail. If the form is incomplete, the DMV may return it to the vision specialist for completion.

What happens if the form is incomplete?

If any section of the form is filled out incorrectly or left incomplete, the DMV may return it to the vision specialist for correction. It’s crucial to ensure that all sections are fully and accurately completed before submission to avoid delays.

Are there any potential consequences of falsifying information on this form?

Providing false information on the DMV Vision form can lead to serious consequences. This may include a denial of your application, suspension of your driver's license, or even legal repercussions. It is essential to be truthful about your vision and medical history.

How does the DMV use the information from the Vision form?

The DMV uses the information provided by the vision specialist, along with data from the applicant, to make a decision regarding licensing. The assessment helps ensure that all drivers meet safety standards on the road, considering their visual capabilities.

Common mistakes

When individuals fill out the DMV Vision form, various common mistakes can lead to complications. One frequent error is failing to provide complete and accurate personal information. The form requires specific details such as your driver license number, date of birth, and address. Inaccurate or incomplete entries in these sections can result in delays or the need for re-submission.

Another mistake people often make is not signing the authorization line. Without a signature, the DMV cannot accept the form. Some applicants may overlook this step in their rush to complete the form, but it is essential to ensure your application is valid.

Omitting the date of birth is also a common oversight. This information is crucial for the DMV to verify the identity of the applicant. If this section is left blank, the form will likely be returned for completion, causing further delays.

Many applicants do not double-check their phone number before submitting the form. An incorrect phone number means the DMV cannot contact you for follow-up, which could be problematic if there are issues with your vision evaluation.

Another mistake is not bringing the completed form along with any new corrective lenses to the DMV for further testing. The instructions clearly state that both the form and the lenses must be presented when returning to the DMV, yet many forget this critical step.

Individuals often misinterpret the requirements for visual acuity. For example, applicants may not realize that the form specifies minimum visual standards of 20/40 vision. If applicants do not clearly indicate their measured visual acuity, they risk not meeting DMV standards.

Along similar lines, people frequently forget to get the vision examination completed by a licensed professional within the last six months. If the exam is older, applicants must undergo a new evaluation, and some may not be aware of this requirement.

Many also fail to keep the form free from alterations or erased information. This can lead to the form being voided, which creates significant setbacks. Any corrections made can be misinterpreted and may cause the DMV to question the credibility of the submitted data.

Lastly, people sometimes neglect to check for and document additional comments or recommendations relevant to their visual capabilities. This section allows eye care professionals to provide insights that can significantly impact the DMV decision. Omitting this information could affect your eligibility to drive.

Documents used along the form

The DMV Vision form is essential for ensuring that individuals meet the required vision standards for driving. However, there are several other documents frequently used in conjunction with this form. Below is a list of related documents that may be required during the process of obtaining or renewing a driver's license.

  • Driver License Application: This application is filled out by individuals looking to obtain or renew a driver's license. It collects personal information and details about driving experience.
  • Vision Testing Results: This document includes the findings from the vision test conducted by an eye care professional. It assesses whether a driver meets the necessary acuity standards.
  • Medical Report Form: In certain cases, a more comprehensive medical report from a healthcare provider may be necessary. This report provides insights into any health conditions that could affect driving abilities.
  • Driving Record Request: This form is used to obtain an individual’s driving history, showing any past infractions or accidents. A clean record may be crucial for license approval.
  • Consent for Release of Medical Information: This form allows eye care professionals to share a patient’s medical information with the DMV, ensuring compliance with privacy laws while providing necessary documentation for license evaluation.
  • Proof of Identity and Residency: Documentation such as a utility bill or lease agreement may be required to prove one’s identity and address, ensuring that all records are accurate and up-to-date.

Gathering these documents can help streamline the application process and ensure compliance with all necessary regulations. This preparation is crucial for maintaining safety on the roads.

Similar forms

The DMV Vision form is a critical document for assessing an individual's ability to safely operate a vehicle. It carries similarities to other key documents used in health evaluations. Here are four documents that share characteristics with the DMV Vision form, explained in detail:

  • Driver's License Application: Like the DMV Vision form, a driver's license application requires personal information such as name, address, and date of birth. Both documents play a role in assessing eligibility to drive and focus on safety.
  • Medical Examination Report: A medical examination report collects health-related information, similar to the medical details requested on the DMV Vision form. Both documents help professionals determine an individual's fitness for driving, particularly examining conditions that could affect visual acuity.
  • Eye Exam Report: Eye exam reports, completed by vision specialists, detail various aspects of an individual’s vision health, just as the DMV Vision form records clinical measurements. Both documents rely on the results of vision tests to recommend appropriate corrective lenses or further examinations.
  • Vision Screening Report: This report is used to document the results of preliminary vision tests. Like the DMV Vision form, which is based on visual acuity standards, a vision screening report is essential for assessing whether an individual meets the standards necessary for safe driving.

Understanding these connections helps clarify the importance of the DMV Vision form within the broader context of driving safety and public health evaluations.

Dos and Don'ts

Do:

  • Fill out all personal information completely, including your driver license number and date of birth.
  • Sign and date the form where indicated to validate your submission.
  • Bring the completed form and any new corrective lenses to the DMV.
  • Ensure the vision examination was conducted within the last six months for accuracy.

Don't:

  • Do not leave any sections blank; incomplete forms may be returned.
  • Do not mail the form unless specifically instructed by DMV personnel.
  • Do not alter or erase any information on the form, as this could void it.
  • Do not forget to ask your vision specialist about any recommendations related to your driving capabilities.

Misconceptions

Misconception 1: The DMV Vision Form can be mailed directly to the DMV.

Many individuals believe they can simply fill out the DMV Vision Form and send it through the mail. However, this is incorrect. The form should not be mailed unless explicitly instructed by a DMV employee. Bringing it in person ensures it's properly processed.

Misconception 2: Completing the form is optional for drivers with vision issues.

Some might think that if their vision is not perfect, they can opt out of submitting the DMV Vision Form. This is not the case. It is a requirement for those with certain vision conditions to submit this form to assess their ability to drive safely.

Misconception 3: Vision specialists do not need to complete the DMV Vision Form.

It’s a common belief that only the applicant needs to handle the form. In reality, a vision specialist must provide specific information about the applicant’s eyesight. Their professional input is crucial for the DMV's evaluation process.

Misconception 4: Vision tests are only conducted every few years, regardless of need.

Some individuals assume they only need a vision test when applying for or renewing their license every few years. Conversely, the DMV may require a new vision examination if any changes in the individual's vision occur or if they are flagged during prior evaluations.

Misconception 5: Corrective lenses are not a factor in the vision assessment.

A common misunderstanding is that wearing corrective lenses will not influence the vision evaluation. Actually, the DMV requires applicants to present any new corrective lenses when returning for testing. The evaluation considers both the best corrected visual acuity and the individual’s ability to use those lenses effectively.

Key takeaways

When it comes to filling out the DMV Vision form, understanding its components is crucial for a smooth process. Here are key takeaways to keep in mind:

  • Complete Personal Information: Fill out your driver license number, date of birth, and contact details accurately. Your signature and date are essential for authorization.
  • Confidentiality: All medical information disclosed is kept confidential under California Vehicle Code §1808.5. Privacy is a priority!
  • Bring Required Documents: Make sure to take the completed form along with any new corrective lenses when you visit the DMV for further testing.
  • Check for Completeness: Ensure all sections of the form are filled out. If not, it may need to go back to the vision specialist for corrections.
  • Do Not Mail: Only return the form via mail if instructed to do so by a DMV employee. Hand delivery is often preferred.
  • New Exams: A new vision examination should be conducted unless a recent exam (within six months) has already been performed.
  • Diagnosis Matters: Be prepared to detail any diagnosed visual conditions. This information helps the DMV make informed licensing decisions.

Filling out the DMV Vision form may seem daunting at first, but by following these key points, you can navigate the process with confidence.