Oklahoma Handicapped Form PDF Details

If you are a resident of Oklahoma, you may already be aware of the various forms and regulations in place to protect the rights of individuals who has been declared disabled. However, for those who aren't familiar with the process it can seem daunting navigating all the paperwork needed to secure what is deserved by law. The goal of this blog post is to explain how Oklahoma Handicapped Form works and provide insight into which forms are necessary for filing or securing benefits for those facing limitations due to disability.

QuestionAnswer
Form NameOklahoma Handicapped Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameshandicap parking application, how do you apply for handicap parking permit, handicap parking permit oklahoma, renew handicap placard online

Form Preview Example

HANDICAPPED PARKING PLACARD APPLICATION

The Department of Public Safety requires approximately 10 business days after receipt to process the application.

NOTICE: The inform ation subm itted on this form may cause a review of your ability to operate a motor vehicle

as provided in 47 O .S. Section 6-119, pursuant to the standards prescribed by the driver license medical

advisory com m ittee as created in 47 O .S. 6-118.

THIS FORM MUST BE FULLY COMPLETED BY APPLICANT AND PHYSICIAN BEFORE A HANDICAP PLACARD CAN BE ISSUED.

THERE IS A $1.00 PROCESSING FEE FOR EACH PLACARD ISSUED. MAKE CHECK PAYABLE TO: DEPARTMENT OF PUBLIC SAFETY

PLEASE DO NOT SEND CASH.

I hereby make application to the Oklahoma Department of Public Safety for a handicapped parking placard. I understand I must display the official placard on the rearview mirror of my vehicle. I further understand this item may only be displayed in motor vehicles either operated by me, or in which I am a passenger. I further understand that any person who knowingly makes false application for or unauthorized use of a handicapped placard is guilty of a misdemeanor and upon conviction thereof shall be punished by a fine of not more than $500.00.

P LE AS E P R IN T O R TYP E

APPLICANT’S (PATIENT) NAM E:

 

 

 

DATE OF BIRTH:

 

 

 

 

 

 

(FIRST)

(MIDDLE)

(LAST)

 

 

 

 

M AILING ADDRESS:

 

 

 

 

 

 

 

 

(STREET OR P.O. BOX)

(CITY)

 

 

(STATE)

(ZIP)

 

 

DRIVER LICENSE NUM BER:

 

PHONE:

 

 

 

 

 

 

 

 

 

(HOME)

 

 

 

SIGNATURE:

 

 

 

 

 

 

 

TH E FO LLO W ING MUST BE C O MPLETED B Y A PERSO N LICENSED TO A PR ACTICE MEDICINE, SUR G ERY,

O STEO PAT HIC, CH IRO PRA CTIC O R PEDIATR IC MEDICINE, O R O PTO METRY . THE ABOVE NAM ED APPLICANT (PATIENT):

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A.CANNOT WALK TWO HUNDRED (200) FEET WITHOUT STOPPING TO REST, OR

C.IS RESTRICTED TO SUCH AN EXTENT THAT THE PERSON’S FORCED

(RESPIRATORY) EXPIRATORY VOLUME FOR ONE (1) SECOND, WHEN MEASURED BY SPIROMETRY, IS LESS THAN SIXTY (60) MM/HG ON ROOM AIR AT REST, OR

E.HAS FUNCTIONAL LIMITATIONS WHICH ARE CLASSIFIED IN SEVERITY AS CLASS

III OR CLASS IV ACCORDING TO STANDARDS SET BY THE AMERICAN HEART ASSOCIATION, OR

G.IS CERTIFIED LEGALLY BLIND, OR

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B.CANNOT WALK WITHOUT THE USE OF OR ASSISTANCE FROM A BRACE, CANE,

CRUTCH, ANOTHER PERSON, PROSTHETIC DEVICE, WHEELCHAIR OR OTHER ASSISTANT DEVICE, OR

D.MUST USE PORTABLE OXYGEN, OR

F.IS SEVERELY LIMITED IN HIS OR HER ABILITY TO WALK DUE TO AN ARTHRITIC, NEUROLOGICAL, OR ORTHOPEDIC CONDITION, OR

H.IS MISSING ONE OR MORE LIMBS WHICH IMPAIRS MOBILITY.

IN YOUR PROFESSIONAL OPINION WOULD THIS CONDITION AFFECT THIS PERSON’S ABILITY TO SAFELY OPERATE A MOTOR VEHICLE UNDER NORMAL OR ADVERSE DRIVING CONDITIONS?

οNO

οYES DIAGNOSIS:

TYPE OF PLACARD REQUESTED:

TEMPORARY ISSUED

FOR UP TO 6 MONTHS

5 YR. PLACARD

TEMPORARY PLACARD

EXPIRATION DATE:

I certify that the applicant’s physical disability described above is accurate and the care and treatment is within the authorized scope of my practice.

DATE:

PHYSICIAN’S NAME:

 

 

 

 

 

PHYSICIAN’S LICENSE NO.

 

 

 

 

 

 

 

 

 

PLEASE PRINT OR TYPE

 

 

 

 

 

 

 

 

ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(STREET OR P.O. BOX)

 

 

(CITY)

 

 

 

(STATE)

PHONE:

 

 

 

 

 

PHYSICIAN’S SIGNATURE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FO R D PS O FFICE O N LY

 

 

 

 

 

 

 

 

Expiration D ate:

 

 

 

 

D ate issued:

 

Placard N umber:

 

 

 

 

 

 

 

 

 

M ail t h is co m p le t ed ap p licat io n w it h o n e d o llar ch e ck t o :

 

 

 

 

 

If you have any questions, please call (405)/425-2290

O klahom a D epartm ent of P ublic S afety

 

 

 

 

 

 

 

 

 

 

 

D river License Services D ivision

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P .O . B ox 11415

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O klahom a C ity, O K 73136 -0415

 

 

 

 

 

 

 

 

 

DPS: DLS0791-94 4 REV. 3 04

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Step # 1 for filling in oklahoma handicapped parking application

2. After filling out this section, go on to the next stage and fill in the essential details in these fields - IN YOUR PROFESSIONAL OPINION WOULD, o NO o YES DIAGNOSIS TYPE OF, YR PLACARD TEMPORARY PLACARD, TEMPORARY ISSUED FOR UP TO MONTHS, I certify that the applicants, DATE PHYSICIANS NAME PHYSICIANS, ADDRESS, STREET OR PO BOX, CITY, STATE, PHONE PHYSICIANS SIGNATURE, PLEASE PRINT OR TYPE, Expiration D ate D ate issued, FOR D PS OFFICE ON LY, and M ail t h is co m plet ed applicat.

M ail t h is co m plet ed applicat, TEMPORARY ISSUED FOR UP TO MONTHS, and STATE in oklahoma handicapped parking application

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