Form 412-NC at a glance
What it is: South Carolina Department of Motor Vehicles Form 412-NC (Rev. 05/18/24) is the Certificate of Vision Examination for Non-Commercial Beginner Permits or Driver's Licenses.
Who signs: Add the Patient's Signature and the Date. This form is void if there are any alterations or erasures. The section after the Patient's Signature Date is to be completed by a licensed eye care professional. Do not return this form to an individual requiring corrective lenses until new lenses are fitted. An individual must meet the minimum acceptable vision requirements, without the use of a telescopic lens or other attachment, to obtain and/or maintain a South Carolina non-commercial driver's license or beginner's permit. Add the Signature of Licensed Eye Care Professional, the Examination Date and the Telephone Number.
A filled-in Form 412-NC example: an optometrist certifies a vision exam
How to fill out Form 412-NC, box by box
Patient's Legal Name, Date of Birth, Address and Signature
Enter the Patient's Legal Name, Date of Birth and Driver's License Number.
Enter the Patient's Address, City, State and Zip Code.
Enter the Patient's Email Address and Cell Phone Number.
Distant Vision Only
The State of South Carolina's minimum visual acuity requirements to operate a non-commercial motor vehicle, with or without corrective lenses, are as follows. 20/70 or better in at least one eye; OR if an individual's weaker eye is worse than 20/200, the stronger eye must read 20/40 or better; OR worse than 20/70 in each eye but 20/70 or better with both eyes together.
Under Distant Vision Only, fill in the 20/ for Right, Left Eye and Both Eyes in Without Corrective Lens, With Corrective Lens and New Prescription.
Section A - Driving Restrictions
1. Is a corrective lens, such as a conventional type spectacle or a contact lens, needed to operate a motor vehicle? Mark Yes or No.
2. Is the individual's vision worse than 20/200 in one eye? Mark Yes or No.
3. Should the individual be restricted to daylight driving only? Mark Yes or No.
Section B - Permanent Sight Impairment
4. a) Does the individual have a permanent sight impairment? Mark Yes or No.
b) If yes, which eye? Mark Right or Left.
Section C - Recheck Visual Fitness
5. Is there any medical reason this individual's eyes should be rechecked within a period of time less than one year to determine visual fitness to operate a motor vehicle? Mark Yes or No, and add Comments.
Licensed Eye Care Professional certification
Enter the Printed Name of Licensed Eye Care Professional, the Professional No. and the License Type being licensed to practice, then the state after in the state of.
I have performed a vision examination of the eyes of the named individual. This is a true record of this examination and the individual met the visual acuity standards without the use of a telescopic lens or other attachment. I further certify that I have answered all of the questions and that he or she signed in my presence.
Add the Signature of Licensed Eye Care Professional, the Examination Date and the Telephone Number.
Enter the Business Address, City, State and Zip Code.
More rules for Form 412-NC
A licensed eye care professional must answer all questions based on the minimum visual acuity requirements. Do not complete the remainder of this form and do not sign the certification unless the individual's vision meets the standards to operate a motor vehicle.
Common questions about Form 412-NC
Is there a deadline?
This form is valid for 36 months from the date of vision examination.
When is this form not the right one?
Verify that the individual is not applying for a CDL. Complete SCDMV Form 412-CDL if applying for a CDL.
Sources
[1] Form 412-NC (Rev. 05/18/24), Certificate of Vision Examination for Non-Commercial Beginner Permits or Driver's Licenses, South Carolina Department of Motor Vehicles (the Official source link on this page).