DMV medical review, school entrance, TB screening, sports, workers' comp, Medicaid, end-of-life and reporting forms from Virginia agencies, with who completes each.
Virginia's clinician forms come mostly from the DMV and the Virginia Department of Health (VDH). DMV Medical Review sends drivers in with the Customer Medical Report (MED 2) or the Customer Vision Report (MED 4), and the MED 10 covers disabled parking placards and plates. VDH issues the School Entrance Health Form (MCH 213G) and the Report of Tuberculosis Screening that schools, employers and child care programs ask for. This hub lists 29 forms, including the VHSL physical and the Workers' Compensation Commission's Form 6.
On the MED 2, Part F is always completed and the other parts only where the condition applies. The MED 10 front must be filled in before the clinician signs. The MCH 213G physical must be within 12 months of school entry. Deaths are certified online in EDRS within VVESTS. Fee-for-service Medicaid authorizations (DMAS-351, DMAS-363) go through the Acentra Health Atrezzo portal. 2 forms here have a Spanish version. Vero Documents fills PDF forms from the visit note and the chart, and the clinician reviews and signs.
Treating physician's report of the injury account, findings, diagnosis and causation, treatment, disability periods (light duty/regular work), permanent defect and MMI.
Treating physician marks the exact point of amputation of the hand/fingers/metacarpals or foot/toes/metatarsals with a straight line to support a scheduled-loss claim.
VRS-6BPhysician or other medical professional describes the functional limitations, diagnoses, treatment and permanence of the condition(s) on which a VRS member's disability retirement application is based, for the VRS Medical Board.
Multi-part report (neurological/musculoskeletal, cardiovascular, diabetes, psychiatric, etc.) the driver takes to their clinician when DMV Medical Review requests medical information; Part F is the clinician's overall assessment.
Eye doctor reports acuity, visual field and ocular conditions for a driver who failed the DMV vision test, is on vision review, wants their own doctor's test, or seeks a CDL waiver.
Clinician describes a missing or impaired limb, functional limitations (sensory/motor, reaction time, strength, range of motion) and recommended restrictions for a non-commercial driver.
Medical provider certifies a condition requiring additional window sun-shading so DMV can issue a sun-shading medical authorization for listed vehicles.
Specialists certify an intrastate CDL driver's disability (limb, diabetes/metabolic, seizure, vision under 49 CFR 391.41 categories) for a Virginia-only waiver or hazmat variance.
Eye doctor reports vision and bioptic telescopic lens details (make, power, date received, diagnosis, prognosis) for an applicant wishing to drive with bioptics.
Eye doctor certifies the applicant has been fitted with and used a prescription bioptic telescopic lens for at least 60 days and demonstrated required abilities.
Clinician certifies a temporary or permanent walking limitation or safety condition for a disabled parking placard or disabled parking license plates.
Requests fee-for-service Virginia Medicaid service authorization for procedures and devices (including DME).
Requests fee-for-service Virginia Medicaid service authorization for outpatient services such as rehabilitation therapy, home health and imaging.
Mancomunidad de Virginia Formulario de Salud Para El Ingreso Escolar
Required school-entry health form: Part II certification of immunization and Part III comprehensive physical examination report for children entering Virginia public kindergarten or first grade, or entering from out of state.
VDOE model form: parent authorization and physician certification that a medication must be given in a licensed child day center.
Annual athletic participation consent and pre-participation physical examination required for VHSL athletics.
'To whom it may concern' TB clearance documenting risk assessment, symptom screen, TST/IGRA results and chest x-ray conclusions, used for school employment, child care, college and other screening requirements.
State TB risk assessment for persons over age six (separate tool for children under 6) used to decide on TB testing before issuing a TB screening report.
Medical documentation required by 7 CFR 246.10(d) for WIC to issue exempt infant formula, WIC-eligible nutritionals or non-contract formula, and to modify WIC foods, for a participant with a qualifying medical condition.
Online death registration module of the Virginia Vital Events and Screening Tracking System (VVESTS) where physicians and medical certifiers complete the medical certification of attended deaths and fetal deaths.
Physician's (or authorized NP/PA) written order under Va. Code 54.1-2987.1 to withhold CPR, honored by EMS and all qualified health care personnel in any setting.
Physician-signed portable medical order for CPR and treatment intensity; Virginia adopted the National POLST form, which is honored as a Durable DNR (12VAC5-66).
Practitioner certifies that the patient has a condition or disease that will benefit from cannabis products; the digital certification (with QR code) lets the patient buy at a licensed pharmaceutical processor/dispensary.
Mandated report of suspected child abuse or neglect to Child Protective Services.
Physician or facility report of a suspected or confirmed reportable disease or condition to the local health department.
Mandated report of suspected abuse, neglect or exploitation of an adult aged 60+ or an incapacitated adult 18+.
Physician certifies that a customer or household member has a serious medical condition (with any powered equipment, refrigeration or HVAC needs) so regulated electric and water utilities limit disconnection under 20VAC5-330.
Physician's certification of a permanent physical disability (Code of Virginia §29.1-528.2) exempting a hunter from a county requirement to hunt from an elevated treestand.
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 and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
A physician, physician assistant or nurse practitioner. The Customer Medical Report has parts for neurological and musculoskeletal, cardiovascular, diabetes, psychiatric and other conditions; complete only the parts relevant to the patient, and always Part F, the overall assessment. DMV Medical Review sends the 9-page form with a letter, and it goes back by fax or mail. Charges for completing it are the customer's responsibility.
A TB risk assessment, symptom screen, TST or IGRA results and chest x-ray conclusions, with the evaluator's signature, in sections I to V. The clinician, facility or health department that did the evaluation completes it and gives it to the person for the employer, school or program. It is a fillable PDF, with Spanish, Arabic, Chinese and Korean versions. VDH's TB Screening and Risk Assessment Tool helps decide who needs testing.
The Commonwealth of Virginia School Entrance Health Form (MCH 213G). A physician, NP, PA or health department official completes Part II, the certification of immunization, and Part III, the comprehensive physical examination report; the parent completes Part I. It applies to children entering public kindergarten or first grade, or entering from out of state, and the physical must be within 12 months of entry. The fillable PDF has an electronic signature checkbox.
Yes. Virginia adopted the National POLST form, which is honored as a Durable DNR. A physician, NP or PA completes Sections A to C and signs after an advance care planning discussion, and the patient keeps the form. VDH's Office of EMS hosts the fillable version. The Authorized Durable Do Not Resuscitate Order is a separate VDH form whose original stays with the patient. The legacy Virginia POST is still valid.