Customer Medical Report Form Instructions
This file provides guidance on completing the Customer Medical Report required by the Virginia DMV. It includes instructions for patients and medical providers on necessary medical information submissions. Important details about deadlines and requirements are also specified.
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How do I fill this out?
Filling out this form requires careful attention to detail. Begin by reviewing all DMV correspondence regarding your driving ability. Ensure you provide complete and accurate medical information to your healthcare provider.
How to fill out the Customer Medical Report Form Instructions?
1
Review all DMV correspondence regarding your medical report.
2
Complete the Customer Information and Information Release Approval sections.
3
Deliver the MED 2 form and DMV letter to your physician.
4
Ensure your physician completes the required sections and returns the form.
5
Submit the form to DMV before the specified deadline.
Who needs the Customer Medical Report Form Instructions?
1
Individuals facing medical reviews by DMV for driving privileges.
2
Commercial drivers seeking disability waivers or variances.
3
Patients with recent medical episodes affecting driving ability.
4
Physicians and medical providers assisting patients with DMV reports.
5
Anyone receiving DMV suspension notices requiring medical documentation.
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Make changes directly within the PDF editor.
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What are the instructions for submitting this form?
To submit this form, fax the completed MED 2 to DMV Medical Review Services at (804) 367-1604. You can also mail it to the Virginia Department of Motor Vehicles, Post Office Box 27412, Richmond, Virginia 23269-0001. For any inquiries, you can contact DMV Medical Review Services via phone at 1-804-367-6203.
What are the important dates for this form in 2024 and 2025?
Important dates for submitting the Customer Medical Report form include deadlines following suspension notices. Ensure the report is completed at least 5-7 days before your suspension deadline. Stay updated on DMV processing timelines to avoid complications.
What is the purpose of this form?
The purpose of the Customer Medical Report form is to gather critical medical information regarding an individual's ability to operate a vehicle safely. It is necessary when concerns arise about a driver's medical fitness related to their driving privileges. By completing this form, both the driver and their healthcare provider contribute to ensuring public safety on the roads.
Tell me about this form and its components and fields line-by-line.
- 1. Customer Information: Includes personal details such as name, address, phone number, and date of birth.
- 2. Medical History: Inquires about existing medical conditions, medications, and any recent episodes of concern.
- 3. Information Release Approval: A section for the customer to authorize their medical provider to share relevant information with DMV.
- 4. Physician's Evaluation: Part F, to be completed by a licensed medical provider, assessing the patient’s capability to drive.
What happens if I fail to submit this form?
Failure to submit the Customer Medical Report form can result in the suspension of driving privileges. Not providing the necessary medical documentation can lead to delays in reinstating a driver’s license. Always meet all deadlines specified in correspondence from DMV to avoid adverse outcomes.
- Suspended Driving Privileges: Failure to submit may result in the DMV suspending your driving privileges.
- Delayed License Reinstatement: Incomplete submissions can delay the process of reinstating your driver's license.
- Legal Consequences: Not complying with DMV requests may lead to potential legal issues.
- Inaccurate Medical Evaluation: Late submission could result in an inaccurate assessment of your driving ability.
- Public Safety Risks: Without proper evaluation, risks to public safety by allowing unfit drivers remain.
How do I know when to use this form?
- 1. DMV Suspension Notice: When you receive a notice regarding potential suspension or medical review.
- 2. Medical Conditions Evaluation: If your medical provider identifies potential issues affecting your ability to drive.
- 3. Commercial License Applications: When applying for a disability waiver in relation to commercial driving.
- 4. Post-Crash Assessment: If involved in an accident and medical evaluation is required.
- 5. Periodic Medical Review: As part of the DMV’s periodic review process for maintaining driving privileges.
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What should I include in the form?
Ensure all personal and medical information is filled out completely.
How do I submit this form?
You need to follow submission guidelines mentioned in the form.
What if I have questions about the form?
You can contact DMV Medical Review Services for assistance.
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