Mass RMV - Psychiatric Evaluation Form

Form Psychiatric Evaluation Form serves as a means to confirm the safe operation of a vehicle when the RMV has requested it. It must be completed by a licensed medical doctor or psychiatric nurse practitioner.

If the RMV requires confirmation of a person's ability to safely operate a vehicle due to medical or psychiatric reasons, this form must be completed by a qualified medical professional.

Form Structure

This form involves individuals who need to provide a medical or psychiatric evaluation to confirm their ability to operate a vehicle safely. It consists of sections for personal information, medical or psychiatric evaluation details, and the medical professional's certification.

How to Fill Out and submit the Form

When completing this form, ensure that a licensed medical doctor or psychiatric nurse practitioner fully completes the medical or psychiatric evaluation. The completed form should be submitted to the RMV to satisfy their requirements for confirming the safe operation of a vehicle.

While completing the form, remember that it must be fully completed by a qualified medical professional and include accurate evaluation details.

Alternative form: Medical Affairs Unit Medical Evaluation Form (form T21075)