LDSS-3239. Medical Evaluation (Operator)

Form Medical Evaluation (Operator) is a form used to evaluate a person's medical condition and ability to safely operate a motor vehicle in New York State.

The form consists of two sections: the first section is for medical providers to note any specific medical conditions that may impair a person's ability to safely operate a motor vehicle; the second section is for the operator to acknowledge that they have been evaluated by a medical provider and are aware of their medical condition.

Important fields in this form include the medical provider's name and signature, the operator's name and signature, the date of the medical evaluation, and a description of any medical conditions that would affect the operator's ability to safely operate a motor vehicle.

This form would be used in a situation where an operator is required to obtain a Medical Evaluation from a medical provider in order to obtain or renew their driver's license. Specific instructions for completing the form include providing full and accurate information regarding the operator's medical condition, and ensuring that both the medical provider and the operator sign and date the form. The purpose of using this form is to ensure the safety of the operator, as well as other drivers on the road, by ensuring that the operator has been medically evaluated and is capable of safely operating a motor vehicle.

Related forms or alternatives that may exist for similar transactions or purposes include the Medical Evaluation (Driver) form, which is used to evaluate a person's medical condition and ability to safely operate a motor vehicle in New York State. Additional documents that may need to be completed and submitted in order to complete the form include a copy of the operator's driver's license, medical records, or any other relevant documents related to the medical evaluation.