Form Mv3030V PDF Details

Driving privileges are not only a cornerstone of personal independence but also a responsibility that requires certain physical capabilities, including adequate vision. In Wisconsin, individuals who seek to obtain or renew their driver's license might encounter the MV3030V form, a pivotal document designed under the auspices of the Wisconsin Department of Transportation Medical Review. This Certificate of Vision Examination, necessitated by chapter 343 of the Wisconsin Statutes and Trans. 112 Administrative Code, serves as a crucial assessment tool. It ensures that drivers meet the necessary visual standards to safely operate a motor vehicle. This form is filled out by a qualified vision specialist who evaluates the applicant's visual acuity both with and without corrective lenses, alongside their field of vision. It delves into whether the applicant has progressive eye conditions, their ability to distinguish traffic signal colors, and suggests any restrictions to their driving privileges that might be warranted based on their visual capabilities. Recommendations can range from limiting driving to daylight hours to suggesting further medical evaluation. This thorough evaluation process underscores the commitment to road safety and the individual's right to fair assessment. As it circulates between the applicant, medical professionals, and the Department of Transportation, the MV3030V form embodies a critical interface of healthcare and vehicular law, demonstrating the nuanced balance between ensuring public safety and facilitating personal mobility.

QuestionAnswer
Form NameForm Mv3030V
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmv3030v no download needed form, yy, wisconsin dmv vision form, WisDOT

Form Preview Example

CERTIFICATE OF VISION EXAMINATION BY COMPETENT AUTHORITY

MV3030V

7/2014

Ch. 343 Wis. Stats. and Trans. 112 Admin. Code

APPLICANT: You may be required to ile vision reports on a regular basis.

We will send you the forms at the time they are required.

Incomplete forms will be returned for completion.

Wisconsin Department of Transportation

Medical Review

PO Box 7918, Madison, WI 53707-7918

Telephone: (608) 266-2327

FAX: (608) 267-0518

Email: dmvmedical@dot.wi.gov

Applicant Name – First, Middle Initial

 

 

 

Driver License Number

 

 

 

 

 

 

 

Applicant Name – Last

 

 

 

Birth Date (m/d/yyyy)

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

(Area Code) Telephone Number

 

 

 

 

 

 

 

City, State, ZIP Code

 

 

 

Email Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Internal WisDOT Use ONLY

 

Yes

No

MV3141 Driver Condition or Behavior Report is enclosed

Issued by:

Date:

 

 

 

 

 

 

License Applied For

 

 

 

 

 

Class D

 

Class M

CDL

School Bus

Passenger

 

 

 

 

 

 

 

 

 

Minimum Standards see:

www.dot.state.wi.us/drivers/drivers/apply/vision.htm

VISION SPECIALIST: The Secretary of the Department of Transportation is, by statute, responsible for the decision of driver licensing. Your report will be advisory in determining eligibility.

Indicate Snellen Chart Figures

Visual

Without RX

With RX

Temporal Field of

Acuity

Vision In Degrees

 

 

Right Eye

20/

20/

 

 

 

 

 

Left Eye

20/

20/

 

 

 

 

 

This report must be completed based on an examination conducted within the past 90 days or since:

YES NO

1. Does applicant have progressive eye condition(s)? If yes, what?

2. Is applicant able to distinguish trafic signal colors of red, amber and green?

3. Would you recommend:

Driving evaluation with DMV (knowledge, signs and road test)

No highway driving

Limited radius driving. Miles from home:

Daylight driving ONLY

Other:

4. Do you feel the patient is safe to operate the following: (any recommendations are strictly advisory) Non-Commercial Vehicle

Commercial Vehicle

School and/or Passenger Bus

5. If applicable, I reviewed the attached Driver Condition or Behavior Report

6. Do you recommend any additional medical evaluation

Comments:

Specialist – Print Name

Check One: MD

DO

Medical License Number

 

 

 

OD

PA-C

APNP

 

Ofice Address, City, State, ZIP Code

 

 

 

(Area Code) Ofice Telephone Number

 

 

 

 

 

 

 

 

 

Patient Exam Date (m/d/yyyy)

X

 

 

 

 

(Specialist – Signature)

 

(Date – m/d/yyyy)

 

 

 

 

 

 

Pursuant to s.448.01 and s.449.01 Wis. Statutes and Trans Ch. 112.02 Wis. Admin. Code, this form must be signed by an MD, DO, OD, PA-C or APNP.

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This form will involve specific details; to guarantee accuracy and reliability, you should consider the subsequent tips:

1. The wisconsin dmv vision form needs certain information to be inserted. Make certain the next fields are finalized:

Step # 1 of filling in wisconsin dot mv3030v

2. Once your current task is complete, take the next step – fill out all of these fields - Does applicant have progressive, Corrective lenses, No freeway or interstate highway, Limited radius driving Miles from, Daylight driving ONLY, Other, Would you recommend a driving, Do you feel the patient is safe to, NonCommercial Vehicle, Commercial Vehicle, School andor Passenger Bus, If applicable I reviewed the, Do you recommend any additional, YES NO, and Comments with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

wisconsin dot mv3030v completion process shown (portion 2)

Always be very attentive while filling in School andor Passenger Bus and Do you recommend any additional, since this is where a lot of people make errors.

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