Minnesota uses this one-page report when a driver with diabetes applies for a waiver from the medical standards for intrastate school bus drivers. The ophthalmologist answers whether diabetes has affected the patient's eye health, starting with whether there is unstable proliferative diabetic retinopathy, and records acuity, fields and stability.
An ophthalmologist completes and signs the whole form, including the patient's name in the letter at the top and the office or clinic details.
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Ophthalmologist Examination Report
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An ophthalmologist. The form is addressed to the ophthalmologist and asks for findings on how the applicant's diabetes has affected eye health, for a waiver from the intrastate school bus driver medical standards. The ophthalmologist prints their name and clinic, then signs and dates the exam.
The form states the patient must have been examined within the preceding six months, and the date of examination is entered next to the ophthalmologist's signature. Acuity is recorded with the Snellen chart, with a note of whether the reading was with or without corrective lenses.