Dmv Form Dld 7 PDF Details

The DMV DLD 7 form, recognized as the Confidential Physician’s Report, plays a vital role in the assessment of an individual's medical fitness to operate a motor vehicle safely within Nevada. This form serves as a structured method for healthcare professionals to communicate their patient's medical condition(s) and its potential impact on driving abilities directly to the Nevada Department of Motor Vehicles (DMV). It requires detailed inputs on diagnosis, the effect of the condition on driving, medications prescribed, and recommendations for any driving restrictions, among other aspects. Physicians must submit this comprehensive evaluation within 30 days of the patient's examination, adhering to the stipulations set by the Nevada Administrative Code 483.310. Furthermore, individuals have the option to request an indicator on their driver’s license or identification card, highlighting specific medical conditions to inform police and medical personnel promptly during emergencies. The process and considerations encapsulated in the form underscore the balance between maintaining road safety and respecting an individual's right to mobility, demonstrating an organized approach to navigating the complexities of health-related driving assessments.

QuestionAnswer
Form NameDmv Form Dld 7
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesreport, physician's, dld7, physician reporting to dmv

Form Preview Example

555 Wright Way Carson City, NV 89711 Reno/Sparks/Carson City (775) 684-4DMV (4368) Las Vegas Area (702) 486-4DMV (4368)

Rural Nevada or Outside Nevada (877) 368-7828 Fax: (775) 684-4829 Website: www.dmvnv.com

CONFIDENTIAL PHYSICIAN’S REPORT

PLEASE NOTE: According to the Nevada Administrative Code 483.310, the Department of Motor Vehicles MUST receive this report within 30 DAYS after the date of the examination. All questions must be answered.

Driver’s License No.

Date of Birth (MM/DD/YYYY)

 

 

 

 

 

 

Patient’s Name

 

 

 

 

Last

First

Middle

1.Diagnosis:

2.In your opinion, will this medical condition affect the patient’s ability to drive a vehicle safely?

Yes*

No

Uncertain*

*If Yes or Uncertain, please explain:

 

 

 

 

 

 

 

 

3.Status of Patient’s Medical Condition(s)*:

Improving

Stable

Worsening or Deteriorating

*If multiple conditions exist, please describe status and prognosis.

Subject to Change

4.How long has this person been your patient?

Years

 

Months

Date of Last Examination:

5.Is your patient under a controlled medical program? *If Yes, how long has control been maintained?

6.Is the patient adhering to the medical regimen?

*If No, please explain:

Yes*

Years

Yes

No

Months

No*

7.Is the patient knowledgeable about the medical condition?

8.Medications prescribed (please list type and dosage):

Yes

No

9.Will these medications affect the patient’s ability to operate a motor vehicle safely?

Yes*

No

*If Yes, please explain:

 

 

 

 

 

 

Please complete BOTH SIDES of this form.

DLD-7 (Revised 9/2012)

10.Does the nature of the condition indicate loss/lapse of consciousness, seizure activity, fainting or dizzy

spells?

Yes*

No

*If Yes, please indicate the date (MM/DD/YYYY) of the last occurrence:

10a.Was the seizure or loss of consciousness an isolated incident?

Yes

No

10b.Are additional seizures likely to occur?

Yes

No

11.Please recommend any restrictions you feel are necessary for this patient to safely drive a vehicle:

12.Physician’s Comments:

________________________________________________________________________________________________________

_________________________________________________________________________________________________________

Date of Examination

 

Signature of Attending Physician

Physician Number

 

 

 

 

Physician’s Office Phone Number

 

Please PRINT Name of Physician

 

 

 

 

 

Office Address of Physician

 

City

State and Zip Code

I hereby authorize any physician, surgeon, medical practitioner or other person, and/or any clinic, or hospital, including the Department of Veterans Affairs or government hospital, to release any and all acquired medical information that specifically addresses the information on this form and may relate to, or affect my ability to operate a motor vehicle safely.

_______________________________________________________

___________________________

Patient’s Signature

Date

You have the option of having an indicator of a medical condition imprinted on your driver’s license or identification card to alert police and medical personnel. Your physician must state on this form that you suffer from any of the medical conditions listed below.

□ 250.3

Diabetes with other coma

□ 496.0

Chronic Airway Obstruction

□ 345.9

Epilepsy

□ E934.2 Anticoagulants (adverse effect)

□ 369.00

Blindness and low vision

□ 995.6

Food Allergies

□ 389.1

Deafness

□ 995.86

Malignant Hyperthermia

□ 414.0

Coronary Atherosclerosis

□ 719.7

Difficulty in walking

You must present this form in person to the DMV if you wish to have one of these medical conditions imprinted on your driver’s license or identification. If mailed, your medical indicator cannot be processed. There is a $3 fee to have this added.

PLEASE NOTE:

According to the Nevada Administrative Code, the Department of Motor Vehicles

MUST receive this report within 30 DAYS after the date of the examination.

DLD-7 (Revised 9/2012)

How to Edit Dmv Form Dld 7 Online for Free

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1. Fill out your dmv physician reporting form with a selection of necessary fields. Gather all the necessary information and make certain not a single thing neglected!

Stage number 1 in filling in dld7

2. Your next part is to complete the following blank fields: Is your patient under a controlled, Yes, If Yes how long has control been, Is the patient adhering to the, If No please explain, Yes, Is the patient knowledgeable about, Yes, Medications prescribed please list, Will these medications affect the, Yes, No If Yes please explain, Please complete BOTH SIDES of this, and DLD Revised.

The best way to complete dld7 portion 2

3. The following portion is about Does the nature of the condition, Yes, If Yes please indicate the date, aWas the seizure or loss of, Yes, bAre additional seizures likely to, Yes, Please recommend any restrictions, and Physicians Comments - fill out all these blank fields.

How one can complete dld7 part 3

4. Your next part requires your involvement in the following parts: Date of Examination, Physicians Office Phone Number, Office Address of Physician, Signature of Attending Physician, Please PRINT Name of Physician, City, State and Zip Code, and I hereby authorize any physician. Be sure to provide all required info to move further.

dld7 conclusion process clarified (part 4)

Regarding Office Address of Physician and Signature of Attending Physician, be sure you do everything right in this section. These two are thought to be the most important ones in the file.

5. This pdf has to be finalized by going through this segment. Further there can be found a detailed list of form fields that need appropriate information to allow your document submission to be faultless: I hereby authorize any physician, Chronic Airway Obstruction E, Diabetes with other coma, According to the Nevada, MUST receive this report within, PLEASE NOTE, and DLD Revised.

Part no. 5 in submitting dld7

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