SCDMV Form VS-004C. Ignition Interlock Medical Exemption Certification

SCDMV Form VS-004C is used by individuals who have been ordered to install an ignition interlock device in their vehicle but have a medical condition that prevents them from using the device. The purpose of this form is to request a medical exemption from installing the device.

The form consists of sections for personal information of the individual, details of their medical condition, a section for a medical provider to complete and sign, and a declaration of truthfulness. It may also require supporting documentation such as medical records or statements from healthcare professionals.

It is important to consider that the exemption is subject to approval by the South Carolina Department of Motor Vehicles (SCDMV) and that false statements or failure to provide required documentation may result in denial or revocation of the exemption.

An example of when this form is used is when an individual has a medical condition that makes it physically impossible or dangerous for them to use an ignition interlock device, such as a severe respiratory condition. By completing this form and obtaining the necessary medical documentation, they can request an exemption from the device.

An alternative form that is similar to this one is SCDMV Form VS-100, which is used for individuals seeking a sworn statement for the release of an immobilized motor vehicle.