Kansas's Division of Vehicles uses this one-page vision form when a driver is referred to its Medical/Vision Unit. The vision professional records distance acuity with and without correction, bioptic readings, horizontal fields, diagnosis and prognosis, then answers whether the driver needs adaptive equipment, a drive test, a medical exam or a Kansas Medical Advisory Board review, and recommends restrictions.
The patient, or a guardian if under 18, completes the general information and signs the release. An optometrist or ophthalmologist completes Section I, the vision report, and signs with specialty and exam date.
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Kansas Division of Vehicles Vision Form
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A vision professional, an optometrist or ophthalmologist, completes Section I under K.S.A. 8-295 and 8-255c and K.A.R. 92-52-12. The patient fills in general information and signs the release; a minor may sign their own form or a guardian may sign for them.
Yes. To remove a restriction previously requested by a vision professional, check that restriction box and write R beside it. You can also add up to six restrictions, such as daylight hours only or no interstate driving, and recommend an annual vision report.