Dmv Form Mv 346 – Fill Out and Use This PDF

The DMV MV-346 form, provided by the State of Delaware Department of Transportation Division of Motor Vehicles Driver Improvement Unit, is a crucial document for assessing an individual's medical fitness to operate a motor vehicle. It requires thorough documentation by a physician of the applicant's medical conditions, any limitations, and an evaluation of their capabilities to safely drive. To ensure road safety and compliance with medical standards for driving, individuals may need to complete and submit this form, with its comprehensive review of medical history, conditions, and the physician's attestation to driving safety.

For those needing to submit a DMV MV-346 form, click the button below to get started.

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Dmv Form Mv 346 PDF Details

In the realm of ensuring public safety and the responsible operation of motor vehicles, the Delaware Department of Transportation's Division of Motor Vehicles employs a rigorous process for evaluating the medical fitness of drivers. The Medical Report of Physician's Findings, distinguished by its form number MV-346, stands as a testament to this comprehensive approach. This document is pivotal, serving as a conduit through which medical professionals relay critical information regarding an individual's capability to drive safely. It encompasses a broad spectrum of health assessments, spanning orthopedic, neuromuscular, cardiovascular, and psychological evaluations, among others. Additionally, the form delves into specifics such as the presence of conditions like diabetes, potential hearing impairments, and even the influence of drugs or alcohol. Notably, the form requires the physician to make a decisive judgment about the patient's driving capability, factoring in whether any prescribed medications could impair their ability to operate a vehicle. Crucially, this delineation extends to individuals with diseases of the central nervous system, where the physician must attest to the patient's condition being sufficiently managed or resolved, ensuring they can drive without posing a risk. By mandating a physician’s signature, the form underscores the gravity of such assessments. Submitted confidentially to the Driver Improvement Unit's Medical Records Section, the MV-346 form epitomizes the intersection of healthcare and vehicular law enforcement, highlighting an essential step in maintaining road safety through a meticulous evaluation of drivers’ health.

Question	Answer
Form Name	Dmv Form Mv 346
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	medical report findings form online, MV-346, habituation, delaware physician form

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STATE OF DELAWARE	DEPARTMENT OF TRANSPORTATION
DIVISION OF MOTOR VEHICLES
DRIVER IMPROVEMENT UNIT MEDICAL RECORDS SECTION
PO BOX 698	DOVER, DE 199030698

MEDICAL REPORT OF PHYSICIAN’S FINDINGS

Name: _____________________________________ DOB ___/___/___ License Number: ________________

Address: ___________________________________________________________________________________

I hereby authorize Doctor ___________________________________ to perform any medical examination

necessary for the purpose of determining my fitness to operate a motor vehicle. Also I understand that this authorization includes permission for the Director of Motor Vehicles and/or their designee to have this information reviewed by a Medical Board of unidentified physicians for the purpose of giving him/her a medical opinion on my case for a guidance in determining my medical capabilities to operate a motor vehicle safely. The information contained in this report is confidential and will be used solely for the purpose of drivers license considerations.

_____________________________________	____________________________________________________
Date	Signature of Applicant (Required)
(Legibility is a must)
Mental level for reading (check one) Inadequate	Marginal	Adequate Height: _________ Weight __________

(A)ORTHOPEDIC AND NEUROMUSCULAR: (Please check as appropriate)

Spastic, Amputations or Ankylosed Joints YES

NO Joint Ataxia, Paralysis, or Weakness

YES

Prosthetic Devices used for Driving

YES

NO Other Deformities or Abnormalities

YES

If YES to any of the above, please describe: _______________________________________________________

___________________________________________________________________________________________

(B)CARDIOVASCULAR: (Please check as appropriate)

Strokes Adams Syndrome	YES	NO	Syncope	YES	NO	Vertigos	YES	NO
Angina Pectoris	YES	NO	Arteriosclerosis	YES	NO	Arrhythmia	YES	NO
Cardiac Decompensation	YES	NO	Dyspnea	YES	NO	Blood Pressure	____________

If YES to any of the above, please describe: _______________________________________________________

___________________________________________________________________________________________

(C)DIABETES: (Please check as appropriate)

Is he/she a known diabetic?	YES	NO	Status of Control ______________________________________
Duration: ____________________________			Diabetic Acidosis	YES	NO ________________________

If YES to any of the above, please describe: _______________________________________________________

___________________________________________________________________________________________

(D)HEARING: Normal?

YES

NO If NO, please describe: _________________________________

___________________________________________________________________________________________

(E)DRUGS AND/OR ALCOHOL: (Please check as appropriate)

Any objective evidence or personal knowledge of addiction, habituation, or alcoholism? YES NO

If YES, please explain: ________________________________________________________________________

___________________________________________________________________________________________

Page (2) Patient Name: __________________________________________________ DOB ___/___/___

(F)PSYCHOLOGICAL ASSESSMENT: (Please check as appropriate)

Is there any evidence of emotional instability?			YES	NO	Is further examination suggested?		YES	NO
Does he/she have or has he/she had any episodes of conditions listed below?
Mental Clouding	YES	NO	Blackouts		YES	NO Dizziness	YES	NO
Unconsciousness	YES	NO	Convulsions		YES	NO

If YES to any of the above, please explain nature and date of last episode:________________________________

___________________________________________________________________________________________

Diagnosis: __________________________________________________________________________________

___________________________________________________________________________________________

(G)Does he/she have any other condition or diseases which would decrease ability to safely operate a motor

vehicle? (Please check as appropriate)

YES

If YES, please explain: ________________________________________________________________________

___________________________________________________________________________________________

(H)What type(s) and quantities of drugs are being prescribed for the patient? _________________________

___________________________________________________________________________________________

(I)

Do any of the above medications affect driving ability? (Please check as appropriate)

YES

If YES, please explain: ________________________________________________________________________

___________________________________________________________________________________________

(J)

From a medical standpoint, do you feel he/she is capable of operating a vehicle safely?

YES

If NO, please explain: _______________________________________________________________________

___________________________________________________________________________________________

If YES, the treating physician must attest to one of the two below listed statements, as may be applicable, for any person who is subject to loss of consciousness due to disease of the central nervous system.

I hereby certify that I am the treating physician duly, licensed to practice medicine and surgery, for the above named individual and that I have been the treating physician for him/her for a period of at least three months, that I am aware of his/her medical history, including his/her history with respect to diseases of the central nervous system, and that such person’s infirmity is under sufficient control to permit him/her to operate a motor vehicle with safety to person and property.

I hereby certify that I am the treating physician, duly licensed to practice medicine and surgery, for the above named individual and that I have been the treating physician for him/her for a period of at least three months, that I am aware of his/her medical history, including his/her history with respect to diseases of the central nervous system, and that such person’s disease no longer requires treatment and that such person can reasonably expect to suffer no further losses of consciousness on account of such disease.

(K)How long have you been treating this patient? ________________ Date of last examination: ___/___/___

(L)Additional comments: ___________________________________________________________________

___________________________________________________________________________________________

_____________________________________________________	_______________________________________________________
Physician’s Name (Printed or typed)	Physician’s Signature
_____________________________________________________	_______________________________________________________
Address	Phone Number
_____________________________________________________	Date: __________________________________________________

Please mail form to: MEDICAL RECORDS SECTION DRIVER IMPROVEMENT UNIT PO Box 698 Dover, DE 199030698

The form may be transmitted by facsimile to: (302) 7395667 ATTN.: MEDICAL RECORDS SECTION

FORM: MV346 – Revised 6/24/2003

Document No. 4507930301

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2. After filling out the previous step, go on to the next step and fill out the essential particulars in these blank fields - YES YES YES, CARDIOVASCULAR Please check as, NO Syncope NO Arteriosclerosis NO, Mental level for reading check one, DRUGS ANDOR ALCOHOL Please check, DIABETES Please check as, NO If NO please describe, Status of Control Diabetic, YES, HEARING Normal, YES YES YES, YES YES, NO NO, YES, and YES.

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3. Completing YES, YES, YES, NO Is further examination suggested, YES YES, YES YES, NO NO, NO Dizziness NO, Blackouts Convulsions, PSYCHOLOGICAL ASSESSMENT Please, Patient Name DOB, Does heshe have any other, Page F Is there any evidence of, What types and quantities of drugs, and Do any of the above medications is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

4. The subsequent paragraph requires your input in the following areas: Page F Is there any evidence of, From a medical standpoint do you, YES, I hereby certify that I am the, I hereby certify that I am the, How long have you been treating, and K L Physicians Name Printed or. Make sure that you fill out all needed details to move forward.

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Dmv Form Mv 346 – Fill Out and Use This PDF

Dmv Form Mv 346 PDF Details

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