Form MED 40. Vision Examination Form for Wearers of Bioptic Telescopic Lens - Virginia

Form MED 40 - Vision Examination Form for Wearers of Bioptic Telescopic Lens is used by eye-care practitioners to provide the Virginia Department of Motor Vehicles (DMV) with an applicant's vision information when the applicant wears a bioptic telescopic lens. The primary purpose of this form is to assess the visual acuity of individuals using bioptic telescopic lenses to determine their eligibility for a driver's license.

The parties involved in this form include the eye-care practitioner (ophthalmologist or optometrist) conducting the vision examination and the applicant for a driver's license who uses a bioptic telescopic lens. The form consists of sections where the eye-care practitioner must record the visual acuity test results and provide any relevant comments or recommendations.

Important fields in this form include the applicant's personal information, the visual acuity test results, and any comments or recommendations from the eye-care practitioner. The accuracy and legitimacy of the recorded vision information are crucial for determining the applicant's eligibility for a driver's license with the use of a bioptic telescopic lens.

An example scenario for using this form would be an individual with low vision who uses a bioptic telescopic lens to improve their visual acuity. The individual would visit an eye-care practitioner to undergo a vision examination. The eye-care practitioner would complete Form MED 40, providing the DMV with the applicant's visual acuity test results and any necessary comments or recommendations. Based on this information, the DMV would determine the individual's eligibility for a driver's license with the use of a bioptic telescopic lens.

When completing this form, the eye-care practitioner must conduct a thorough and accurate vision examination, following the proper guidelines for assessing visual acuity when using a bioptic telescopic lens. The information provided must be comprehensive and precise to ensure a fair and accurate evaluation by the DMV.

Related forms or alternatives for similar purposes may include vision examination forms used in other states or jurisdictions. However, each jurisdiction may have specific guidelines and requirements for assessing visual acuity for individuals using bioptic telescopic lenses for driving.