The Department of Motor Vehicles offers different types of forms for individuals to use when conducting transactions with the department. Some of the most commonly used forms include Form DS-1, which is used to apply for a driver's license or identification card, and Form DS-11, which is used to apply for a United States passport. One other form that may be needed is Form DS-6, which is used to request a duplicate driver's license or identification card. The form can be downloaded from the DMV website or picked up at a local DMV office. Completed forms can be mailed in, faxed, or brought into an office. Instructions on how to fill out and submit the form are included on the document. There may be a fee associated with requesting a duplicate driver's license or identification card and this will vary depending on the state in which you reside.
| Question | Answer |
|---|---|
| Form Name | Dmv Form Ds 6 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | ds6 ds6 form |
NewYorkStateDepartmentofMotorVehicles |
PHYSICIAN’S REPORTING FORM
INSTRUCTIONS:
PleaseprovidealloftheinformationrequestedinParts 1 through 3below,andsignanddatetheform.
Thisformisprovidedforusebyaphysiciantoreportanindividualwhosedrivingabilitymaybeaffectedduetosomephysicalormental impairment.
Thisformmustbecompletedandsignedbyalicensedphysicianornursepractitioner.
Attachasheetofyourstationery(showingyourletterhead),oravoidedorblankprescriptionform,asadditionalverificationforthis statement,andmailthecompletedformwiththeattachedstationeryorprescriptionto:MedicalReviewUnit,NewYorkState DepartmentofMotorVehicles,6EmpireStatePlaza,Room337,Albany,NY12228.
PART 1 - DRIVER IDENTIFICATION (please print)
Last |
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M.I. |
DateofBirth(ifnotknown, |
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Name* |
Name* |
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Street |
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Address |
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City* |
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State |
Zip Code |
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Make of Vehicle the Person |
Color of |
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License Plate |
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Normally Drives |
Vehicle |
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* Required information |
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PART 2 - DESCRIPTION OF THE DRIVER’S CONDITION
Haveyoutreatedthispatient? o YES o NO
IFYES: DateofLastExamination?_______________________.
Pleasedescribetheconditionthatyouhavetreatedorarecurrentlytreating:
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Isthepatientreceivingmedicationforthiscondition? o YES o NO
IFYES: Pleasespecifythetypeanddosage:
__________________________________________________________________________________________________________
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Inmymedicalopinion,(pleasecheckone):
o thepatient’sconditionmayaffectthesafeoperationofamotorvehicle,andthepatientshouldbeevaluatedbytheDepartmentof MotorVehicles
o thepatient’sconditionpreventsthesafeoperationofamotorvehicleanddrivingprivilegesshouldbesuspended.
Pleaseprovidefurtherdetailinthespaceprovidedorinanattachedstatementonyourletterhead:
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__________________________________________________________________________________________________________
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PART 3 - IDENTIFICATION AND CERTIFICATION OF THE PHYSICIAN MAKING THIS REPORT
Your name |
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Certificate or Lic. No. |
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Specialty (Please specify) |
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(Print name in full) |
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Your Mailing Address |
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Your Signature |
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Date (Month/Day/Year) |
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(Sign name in full) |
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