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The MV-80L form, known as the Eye Test Report for the Medical Review Unit, plays a critical role in ensuring that drivers in New York State meet specific vision standards necessary for safe driving. This form is designed for individuals applying to the Low Vision Program, which serves persons with corrected vision ranging from less than 20/40 to not less than 20/70, as well as those who require telescopic lenses. It must be filled out by a qualified physician, ophthalmologist, or optometrist based on an examination conducted within the past 60 days. The completed MV-80L must be returned to the Medical Review Unit at the specified Albany address or faxed to their designated number. Failure to submit this form may result in the inability to renew a driver’s license or may lead to suspension. For participants already enrolled in the Low Vision Program, the requirements differ, as they receive periodic evaluations via the MV-80L.1 form. The form outlines minimum visual acuity standards, binocular field of vision requirements, and specific criteria for those using telescopic lenses. Key elements also include verifying the stability of the patient’s condition and determining if any driving restrictions are necessary. Understanding the nuances of the MV-80L form is essential for maintaining safety on the roads while supporting individuals with vision impairments.

Mv 80L Example

EYE TEST REPORT FOR MEDICAL REVIEW UNIT

Medical Review Unit, Room 337

6 Empire State Plaza, Albany, NY 12228

dmv.ny.gov

LOW VISION PROGRAM - FOR PERSONS WITH CORRECTED VISION OF LESS THAN 20/40

BUT NOT LESS THAN 20/70, OR TELESCOPIC LENS WEARERS

INSTRUCTIONS:

1.If this completed form is not returned to the Medical Review Unit, you may not renew your license and you may be suspended. DO NOT GO INTO A DMV OFFICE UNTIL YOU HAVE SUBMITTED YOUR COMPLETED MV-80L TO

THE MEDICAL REVIEW UNIT AT THE ADDRESS ABOVE AND HAVE RECEIVED A RESPONSE LETTER IN THE MAIL FROM THEM.

2.The MV-80L must be completed by a physician, ophthalmologist or optometrist, and must be based on an examination performed within 60 days. PLEASE RETURN BOTH PAGES OF THE COMPLETED FORM TO THE MEDICAL REVIEW

UNIT AT THE ABOVE ADDRESS OR FAX IT TO (518) 402-2991.

3.Please note, if you are currently in the Low Vision Program, you do not need to submit form MV-80L. The Medical Review Periodic Eye Test form MV-80L.1 will be mailed to you every six or twelve months based on your eye care provider’s recommendation. If there are no changes or your license is not due to expire within the next year, you have satisfied the requirements and will not receive anything in the mail from us.

MINIMUM STANDARD FOR INDIVIDUALS WITH CORRECTED VISION OF LESS THAN 20/40, BUT NOT LESS THAN 20/70:

lHorizontal, binocular field of vision must be no less than 140 degrees.

MINIMUM STANDARD FOR TELESCOPIC LENS WEARERS:

lMust have been fitted with, trained to use, and used telescopic lenses for at least 60 days prior to filing this form.

For a first-time evaluation, telescopic lens wearers must complete the certification at the bottom of Page 2.

lClip-on or hand-held telescopic lenses are not acceptable

lVisual acuity (Snellen Method) through telescopic portion in either or both eyes must be NO LESS THAN 20/40

lVisual acuity (Snellen Method) through carrier lens in either or both eyes must be NO LESS THAN 20/100

lTotal horizontal, binocular field of vision (no field expanders) must be NO LESS THAN 140 DEGREES

lMust pass road test if he/she has not taken a road test while wearing his/her telescopic lenses

lEligible for a Class D or DJ driver license only

lIneligible for a commercial driver license (CDL), a motorcycle license or a moped license.

PATIENT — COMPLETE THIS SECTION

Name

Address

New York State Client ID #

 

Date of Birth

 

Male Female

MV-80L (1/19)

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PAGE 1 OF 2

2. If telescopic lenses are used, on what date did patient receive them?

PRACTITIONER — COMPLETE THIS SECTION

Patient’s Name

 

 

 

Date of Birth

 

 

(Last)

 

(First)

 

 

(Month/Day/Year)

Date of Examination

(must be within 60 days)

Check One:

o Initial Evaluation o Re-evaluation

 

 

(Month/Day/Year)

 

 

 

 

 

1. Visual Acuity (Snellen Method) NOTE: Please check the appropriate box to identify how visual acuity was achieved, then give the visual acuity.

o With corrective lenses o Without corrective lenses o With telescopic lenses only

Right eye 20/

 

and/or left eye 20/

 

 

 

Both 20/

 

 

 

Through telescopic lenses right eye 20/

 

 

 

and/or left eye 20/

 

 

 

 

 

 

 

 

 

 

 

Through carrier lenses right eye 20/

 

and/or left eye 20/

 

 

/

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

Does the patient meet or exceed the minimum acceptable horizontal, binocular field of vision of 140 degrees? oYes

o No

 

NOTE: The test object size for determining horizontal, binocular field of vision must be either a white 3 mm size test object at a one-half

 

meter distance, or a white 6mm size test object at a one meter distance, or the equivalent angular size for any test distance.

4.

If telescopic lenses, did the patient achieve his/her horizontal, binocular field of vision with the use of field expanders? oYes

oNo

5.What medical condition(s) caused the present loss of the patient’s visual acuity?

6. Patient should be re-evaluated every . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Is this condition stable at this time? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o

o

6 Months oYear

Yes o No

8.

Check restriction(s) you recommend: o Day Driving Only

o Full-View Mirror

o No Limited Access Roads

o None

9.

In your opinion, would the patient’s condition interfere with the safe operation of a motor vehicle?

o Yes

o No

 

If “Yes”, please explain in the space provided, or attach an explanation on your letterhead

 

 

 

 

 

 

 

 

 

The above information is true, complete and best reflects my professional judgement.

X

(Practitioner’s Signature)

(Date)

 

 

 

 

 

(Practitioner’s Name — please print)

(Certificate or License Number)

(

)

 

 

 

 

(Address)

(Telephone Number)

TELESCOPIC LENS WEARERS MUST COMPLETE THIS CERTIFICATION ONLY FOR A FIRST-TIME EVALUATION

I certify that I have successfully completed the minimum training requirements for telescopic lens wearers as outlined in Part 5 of the Commissioner’s Regulations, and that I received the training from:

X

( )

(Name of Trainer)

(Telephone Number)

 

 

(Address of Trainer)

 

 

 

 

 

 

 

(Signature of Patient)

 

 

(Date Training Completed)

 

 

 

 

 

 

MV-80L (1/19)

 

 

PAGE 2 OF 2

Form Characteristics

Fact Description
Purpose The MV-80L form is used to report visual acuity for individuals applying for the Low Vision Program in New York State.
Submission Requirements This form must be completed by a physician, ophthalmologist, or optometrist within 60 days prior to submission. Failure to return the completed form may result in the inability to renew your driver's license.
Field of Vision Standards For individuals with corrected vision of less than 20/40 but not less than 20/70, a minimum horizontal binocular field of vision of 140 degrees is required.
Eligibility Limitations Those who wear telescopic lenses must meet specific visual acuity standards and are only eligible for a Class D or DJ driver license, excluding commercial driver licenses.

Guidelines on Utilizing Mv 80L

After obtaining the necessary information and ensuring you have access to the required resources, follow these steps to fill out the MV-80L form correctly. Completing this form is essential for individuals who meet certain vision requirements and are applying for a medical review related to their driving license.

  1. Collect your personal information, including your name, address, New York State Client ID number, date of birth, and gender.
  2. If you use telescopic lenses, note the date you received them.
  3. Provide the patient's name and date of birth in the practitioner section of the form.
  4. Fill in the date of the vision examination. This must have occurred within the last 60 days.
  5. Indicate whether this is an initial evaluation or a re-evaluation.
  6. Complete the visual acuity section. Specify whether the measurements were taken with or without corrective lenses and provide the visual acuity for both eyes. Include measurements with telescopic and carrier lenses if applicable.
  7. Answer whether the patient meets the minimum horizontal binocular field of vision standard, which must be at least 140 degrees.
  8. If the patient uses telescopic lenses, indicate whether the field of vision was achieved with field expanders.
  9. Detail the medical conditions that caused the patient's visual acuity loss.
  10. Indicate the recommended re-evaluation period, either 6 months or 1 year.
  11. Check if the patient's condition is currently stable.
  12. Choose any driving restrictions that apply from the provided options.
  13. Answer if the patient's condition would interfere with the safe operation of a vehicle. If yes, provide an explanation.
  14. Obtain the practitioner's signature, their printed name, license number, address, and phone number at the bottom of the form.
  15. If you are a first-time telescopic lens wearer, complete the certification on the second page by providing the trainer's name, contact information, and confirming the training completion with a patient signature.
  16. Review the completed form for accuracy before submission.
  17. Return both pages of the completed form to the Medical Review Unit by mail or fax it to the provided number.

What You Should Know About This Form

What is the purpose of the MV-80L form?

The MV-80L form is designed to report the results of an eye test for individuals with low vision and those who wear telescopic lenses. It is a requirement for anyone seeking to renew a driver's license under the Low Vision Program in New York State. The completed form must be submitted to the Medical Review Unit for evaluation. If not submitted, you may face license suspension.

Who is qualified to complete the MV-80L form?

Only a licensed physician, ophthalmologist, or optometrist can complete the MV-80L form. This ensures that the evaluation is conducted by a qualified professional who can accurately assess your visual acuity and overall eye health. The examination must occur within 60 days of submitting the form, guaranteeing that the most current information is available for review.

How should I submit the MV-80L form once completed?

You can submit the completed MV-80L form by either mailing it or faxing it to the Medical Review Unit at the specified address. The address is Medical Review Unit, Room 337, 6 Empire State Plaza, Albany, NY 12228. If you choose to fax it, use the fax number (518) 402-2991. Ensure that both pages are included in your submission.

What happens if I am currently enrolled in the Low Vision Program?

If you are enrolled in the Low Vision Program, you do not need to submit the MV-80L form. Instead, you will receive the Medical Review Periodic Eye Test form MV-80L.1 every six to twelve months based on your eye care provider's recommendation. If there are no changes in your condition and your license is not due to expire within the next year, you will not receive any additional paperwork.

What are the visual acuity requirements for telescopic lens wearers?

For individuals who wear telescopic lenses, strict visual acuity standards must be met. Visual acuity through the telescopic lens should be no less than 20/40 in either or both eyes. Additionally, visual acuity through the carrier lens must be at least 20/100. You must also have a horizontal, binocular field of vision of no less than 140 degrees, without the use of field expanders.

What should I do if I do not meet the visual standards?

If you do not meet the required visual standards outlined for low vision or telescopic lens wearers, it is crucial to discuss your situation with your eye care provider. They can advise you on potential corrective measures or alternative options. Keep in mind, failing to meet these standards may affect your ability to obtain or renew a driver's license.

Common mistakes

Completing the MV-80L form can be a straightforward process, but many people encounter obstacles that can delay their license renewal. One common mistake is failing to return the completed form to the appropriate address. This document must be submitted to the Medical Review Unit; neglecting this step can lead to the suspension of your license. Ensure you mail or fax both pages of the form to the provided contact information to avoid this unnecessary complication.

Another frequent error involves not having the form filled out by a qualified professional. The instructions clearly state that a physician, ophthalmologist, or optometrist must complete the MV-80L. Submitting a form that lacks the necessary signatures or was completed by an unqualified individual can jeopardize the entire application. Be certain to schedule an appointment with an appropriate eye care provider to ensure accurate completion.

Be mindful of the examination timeline outlined in the form. The eye examination must occur within 60 days prior to submitting the MV-80L. Some individuals mistakenly assume that an older evaluation is sufficient. Delaying the eye exam or using an outdated report could lead to rejection of your application.

Oftentimes, applicants overlook the specific vision criteria required for different situations, especially if they use telescopic lenses. Those lenses need to have been fitted and used for at least 60 days before submitting the form. Not following this requirement can make a person ineligible for their driver's license. Additionally, ensure that your visual acuity meets the standards for both carrier and telescopic lenses.

Another pitfall occurs when applicants fail to provide the correct medical condition information. The section requiring details about the conditions causing visual acuity loss is vital. Leaving this blank or providing incomplete information could hinder the review process. Clearly identify and provide any relevant conditions that may affect driving ability.

The section addressing the patient's horizontal, binocular field of vision can also lead to misunderstandings. It is crucial to provide accurate results from a proper vision test. Inaccuracies in measuring the field of vision or failing to note the test object size can result in an inaccurate assessment. Always double-check the measurements and ensure you are following the proper testing guidelines.

Furthermore, some applicants select their re-evaluation frequency without considering their personal situation. Specifying a timeframe that isn’t appropriate can affect future evaluations. Be realistic about how often you may need to be re-evaluated based on your condition and vision stability.

Finally, disregarding the implications of your answers regarding safe vehicle operation can lead to serious consequences. If there are concerns about the ability to operate a motor vehicle safely, providing this insight is essential. Avoiding this deliberation could not only prevent approval of the license but could also pose safety risks on the road.

Documents used along the form

When navigating the requirements for the MV-80L form, it is essential to understand that several accompanying documents may be necessary to ensure a smooth process. Each document plays a critical role in fulfilling state regulations regarding vision and medical evaluations for drivers. Below is a list of other forms and documents that are often used alongside the MV-80L.

  • MV-80L.1 - Medical Review Periodic Eye Test Form: This form is sent to individuals already enrolled in the Low Vision Program. It must be completed and returned at intervals determined by the eye care provider, typically every six months or annually.
  • MV-73 - Application for a Driver License or Renewal: This application is essential for obtaining or renewing a driver’s license. Applicants must provide personal information and confirm their eligibility through health-related disclosures.
  • MV-44 - Application for Permit, Driver License, or Non-Driver ID Card: Should be completed by individuals applying for a new license or ID card and includes basic identification details.
  • MV-262 - Certification of Vision Test: This is required for individuals renewing their licenses and serves as confirmation that the individual has met the minimum vision standards established by the DMV.
  • Physician's Report or Medical History: A detailed report from a physician highlighting any relevant medical conditions related to vision. This document may be requested for additional context regarding the patient's visual capability.
  • Visual Acuity Test Results: A formal record of the results from vision tests, providing specific measurements achieved through corrective lenses or other visual aids, which may be required alongside the MV-80L form.

Understanding these forms and documents is vital to comply with all requirements for maintaining a valid driver's license. Ensuring everything is in order can prevent potential delays or complications. Those needing assistance should not hesitate to reach out to their eye care providers or local DMV for clarification and support.

Similar forms

The MV-80L form is part of a larger framework of documents that serve specific purposes in the context of driving eligibility, health assessments, and regulatory compliance. Below are five documents that share similarities with the MV-80L form in terms of their intent, required information, and procedural context.

  • MV-80E - Medical Review Form: This form also requires completion by a healthcare professional and is used to evaluate an individual's medical fitness to operate a vehicle. Similar to the MV-80L, it focuses on specific health conditions affecting driving capabilities.
  • MV-78 - Vision Test Report: Like the MV-80L, this document is crucial for verifying an individual's vision status. It requires professional assessment and typically accompanies the application or renewal process for a driver's license.
  • BMV Form 600 - Vision Evaluation Report: Used in different states, this form is similar in that it involves a vision evaluation by a licensed eye care professional. It aims to establish that an individual meets the vision standards necessary for safe driving.
  • MV-85 - Medical Certification Submission: This document, like the MV-80L, is mandatory for certain classifications of drivers. It involves reporting any medical conditions that might impact the ability to drive safely, thereby ensuring regulatory compliance.
  • DL-50 - Driver License Application (Medical History Section): This section of the application requests specific health-related information. Much like the MV-80L, it requires candidates to provide details that will inform the state's decision about their driving privileges.

Each of these documents plays a vital role in maintaining road safety by ensuring that individuals who may have health concerns undergo necessary evaluations and meet established criteria before operating a vehicle.

Dos and Don'ts

Recommended Actions when Filling Out the MV-80L Form:

  • Ensure the form is completed by a licensed physician, ophthalmologist, or optometrist.
  • Submit your completed form to the Medical Review Unit within 60 days of the eye examination.
  • Return both pages of the MV-80L form to the Medical Review Unit, including any necessary signatures.
  • Double-check that the visual acuity measurements are clearly noted for each eye.
  • Indicate if the patient has been trained to use telescopic lenses, when applicable.

Actions to Avoid when Filling Out the MV-80L Form:

  • Do not submit the form in person at a DMV office; it must be mailed or faxed.
  • Avoid leaving sections of the form blank; all required fields must be completed.
  • Do not use clip-on or handheld telescopic lenses as they are not acceptable.
  • Refrain from submitting the form if the patient is already in the Low Vision Program.

Misconceptions

The MV-80L form is essential for individuals with vision impairments seeking to renew their driver’s licenses in New York State. However, various misconceptions surround this form. Here are ten common misconceptions, along with clarifications to enhance understanding.

  1. The MV-80L form is optional. Many believe completing the form is optional, but failure to submit it can lead to suspension of your driver’s license.
  2. Any eye care provider can complete the form. The MV-80L must only be filled out by a licensed physician, ophthalmologist, or optometrist.
  3. You can go directly to the DMV after completing the form. You should first submit the MV-80L to the Medical Review Unit and await a response before visiting a DMV office.
  4. Those already in the Low Vision Program need to submit the MV-80L. If you are in the Low Vision Program, you do not need to fill out this form; the Medical Review Unit will send you the necessary forms periodically.
  5. The visual acuity requirements are just guidelines. The standards for visual acuity and field of vision are strict requirements and must be met to avoid issues with your license.
  6. Field expanders can be used to meet vision requirements. The total horizontal, binocular field of vision must be obtained without the help of field expanders.
  7. If you have corrected vision, you don’t need to worry about the MV-80L. Even individuals with corrected vision must complete the form if their vision falls below specific thresholds.
  8. A road test is not necessary for telescopic lens wearers. A road test is required if you have never taken one while using telescopic lenses.
  9. Telescopic lens wearers can use clip-on lenses. Clip-on or hand-held telescopic lenses are not acceptable for meeting the requirements.
  10. The MV-80L form doesn't impact my driving status until my license is up for renewal. Submitting the form affects your ability to renew your license and maintain its validity; it cannot be postponed until renewal time.

Key takeaways

Understanding how to fill out the MV-80L form is crucial for individuals with low vision or those using telescopic lenses. Here are some important points to keep in mind:

  • Submission is mandatory. If you do not return the completed form to the Medical Review Unit, you risk suspension or inability to renew your license.
  • Complete the form promptly. The form must be filled out by a licensed eye care professional who performs the examination within the last 60 days.
  • Follow the specific submission instructions. Make sure to return both pages of the form or fax it to the provided contact number.
  • If you are currently enrolled in the Low Vision Program, you do not need to submit this form. Instead, you will receive the MV-80L.1 form periodically based on your eye care provider’s recommendation.
  • Visual acuity requirements vary. If you have corrected vision between 20/40 and 20/70, you must meet certain field of vision criteria.
  • Telescopic lens wearers have additional criteria. It's essential to have had training and usage for at least 60 days before submitting this form.
  • Do not use clip-on or hand-held telescopic lenses; only fitted lenses are acceptable.
  • Visual acuity through telescopic and carrier lenses must meet specified standards. Ensure you know these standards before your examination to avoid complications.
  • If you have not taken a road test with your telescopic lenses, you will need to do so.
  • Be prepared for possible restrictions on your driving privileges based on your eye care professional’s recommendations.

All these points emphasize the importance of clear communication with your eye care professional and strict adherence to the procedures outlined in the MV-80L form. They ensure that the process runs smoothly and that you remain eligible to drive safely.