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BC Transit handyDART Medical Verification Form (H4)

BC Transit's custom transit systems, such as those in Victoria and Kamloops, use this form to learn about a handyDART applicant's physical or cognitive ability to use regular, low-floor buses. The practitioner describes the conditions, their effects and a detailed checklist of travel skills. The handyDART Clerk Registrar uses it with the application to assess eligibility, and submitting it does not guarantee approval.

Who completes it

A medical doctor, registered nurse, registered psychiatric nurse, occupational therapist, physical therapist, rehabilitation practitioner or social worker familiar with the applicant's mobility completes and signs every part. The applicant completes the separate handyDART application and acknowledges the privacy notice on this form.

Submitting and payment

How to submit it
Submit the form to the local handyDART office, with or after the community's handyDART application. Registration pages describe it as optional, though it helps staff understand the applicant's eligibility.
Who pays
Fees for completing the form are the applicant's responsibility.

Good to know

  • Question 3 asks whether the condition prevents, as opposed to makes difficult, the use of low-floor buses, answered yes, no or sometimes with an explanation.
  • An incomplete or unclear form is returned, so describe clearly what the applicant can and cannot do on the regular bus.
  • The checklist covers skills such as recognizing landmarks, telling time, crossing the street safely, walking up and down three steps with handrails and walking one to three blocks.
  • The form also asks whether a mandatory attendant is needed for behavioural or medical reasons and whether the applicant can be left alone at home or at a destination.

Get the official form

Download the current version from the source each time; forms change without notice.

Medical Verification of Eligibility Form

Official pagePDF

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Is the handyDART medical verification form required?

BC Transit's Kamloops and Victoria registration pages describe it as optional: applicants can include it with the handyDART application to help staff understand their eligibility. Some systems may ask for it after reviewing the application, and many also use an in-person assessment.

Who can complete BC Transit form H4?

A qualified health care or social services practitioner familiar with the applicant's mobility: a medical doctor, registered nurse, registered psychiatric nurse, occupational therapist, physical therapist, rehabilitation practitioner or social worker. The form records your qualifications, relationship to the applicant and how long you have been involved.

Does the practitioner need to assess the applicant specifically for this form?

Question 9 simply asks whether you completed any assessment or examination to determine the applicant's functional ability to take the regular bus, answered yes, no or partial. The form must be filled out by someone familiar with the applicant's mobility.