Form HSMV 77066. Ignition Interlock Medical Evaluation Form - Florida

The Form HSMV 77066, referred to as the Ignition Interlock Medical Evaluation Form, is used in Florida for individuals seeking to install an ignition interlock device in their vehicles due to a DUI conviction. Its purpose is to gather medical information and evaluations to ensure the safe use of the ignition interlock device.

This form typically consists of sections that require accurate completion, including personal information of the individual, details about their medical conditions or disabilities, disclosure of any medications being taken, and medical professional evaluations and recommendations. It may also include fields for additional information or documentation requirements, such as medical records or test results.

When filling out this form, it is important to provide accurate information about the individual's medical conditions, medications, and any relevant disabilities. The evaluations and recommendations provided by medical professionals should be comprehensive and based on the individual's ability to safely operate a vehicle with the ignition interlock device.

This form is used by individuals in Florida who have been convicted of a DUI and are required to install an ignition interlock device in their vehicles. By completing the Ignition Interlock Medical Evaluation Form, they undergo medical evaluations to determine their fitness for safe vehicle operation with the device installed.

An alternative form related to DUI-related requirements could be a DUI Program Enrollment Form, which is used to enroll in DUI programs mandated as part of DUI convictions. However, the Ignition Interlock Medical Evaluation form specifically focuses on gathering medical information and evaluations for installing an ignition interlock device.