Form BMV 5755. Health Care Provider Certification of Eligibility for Permanently Disabled ID Card

Form BMV 5755, titled "Health Care Provider Certification of Eligibility for Permanently Disabled ID Card," is used to certify an individual's eligibility for a permanently disabled ID card in Ohio. The main purpose of this form is to provide medical professionals, such as physicians or chiropractors, with a standardized format to verify an applicant's permanent disability status.

The form typically consists of sections where the health care provider can provide the applicant's personal information, details of the disabling condition, and their professional certification. The health care provider must indicate whether the disability is permanent or temporary and specify the type of disability. They also need to certify that the applicant meets the eligibility criteria for obtaining a permanently disabled ID card.

When filling out the form, it is essential for the health care provider to accurately assess and verify the applicant's disability status. The information provided by the health care provider plays a crucial role in determining the applicant's eligibility for a permanently disabled ID card.

An example scenario for using Form BMV 5755 is when an individual with a permanent disability seeks to obtain an Ohio ID card with disability accommodations. The individual would visit their health care provider, who would complete the form by verifying the disability and certifying the eligibility for the permanently disabled ID card. The completed form would then be submitted to the BMV along with the ID card application.

No additional documents are typically required to complete Form BMV 5755, as the form itself serves as a certification by the health care provider.

Related forms or alternatives may include similar health care provider certification forms for disability accommodations issued by other state DMVs or BMVs.