Connecticut DMV uses this 2-page report when a patient has been referred over their ability to drive safely and vision is part of the question. The eye care professional records uncorrected and corrected acuity, monocular vision, blind spots, horizontal fields, hemianopsia and color vision, then gives clinical findings and safety recommendations; page 2 reprints Connecticut's vision regulations.
The patient completes Section A. A licensed physician, optometrist or ophthalmologist completes Sections B, C and D, the eye findings, clinical information and the signed examiner's certification.
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Eye Care Professional's Medical Report
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A licensed physician, optometrist or ophthalmologist completes Sections B, C and D based on a personal examination within 90 days. Reporting is authorized by Section 14-46 of the General Statutes, and no civil action can be brought against anyone who reports in good faith.
Section B says that if telescopic lenses are required for driving, complete form P-142B as well. Connecticut regulation 14-45a-4 allows a license for drivers who wear bioptic lenses if they otherwise meet the vision standards reprinted on page 2.