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Click ‘Get Form’ to open the functional ability evaluation medical report in the editor.
Begin by filling out the top portion of the form. Enter your last name, first name, middle or maiden name, date of birth, and driver license or DPC number. Ensure all information is accurate.
Sign the authorization section to allow healthcare professionals to disclose relevant health information regarding your ability to operate a motor vehicle safely.
Next, move to the bottom portion for completion by a healthcare professional. They will assess safety levels and mark appropriate categories based on your health conditions.
Ensure that your healthcare professional provides their printed name, degree, signature, state license number, and contact details before submitting the form.

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What is a functional abilities evaluation?

A functional abilities evaluation (FAE) or functional capacity evaluation (FCE) is a comprehensive evaluation of your physical and functional abilities, using objective and measurable tests. The FAE can be general or specific to your job and related duties.

What to expect when my medical condition has been reported to PennDOT?

PennDOT will review the information it has received and may contact you to obtain further information. Based on all the information submitted, PennDOT makes the decision to place restrictions on the persons driving, recall the license, ask the person to complete a drivers examination or no action may be taken.

What is a functional ability evaluation medical report?

A functional capacity evaluation (FCE) is a set of tests that are used to identify a persons physical skills, functional capabilities, activity endurance, and work tolerances. The FCE is a 6-to-8-hour evaluation that is administered over two days by an occupational therapist or physical therapist.

What do you have to do to renew your license in Utah?

What you need to do Fill out online application make appointment. REQUIRED: Online application. SAVE TIME: Make appointment. Gather your documents - must bring to appointment. Bring your current Utah driver license. Address change? At your appointment. Have your confirmation number ready to check-in. Have photo taken.

What does an FCE test consist of?

A FCE is a series of tests that help evaluate your physical abilities. The tests have you pull, push, lift and complete other tasks that relate to your job duties. Your physical therapist observes your performance as you complete these tests and records this data in a report.

functional ability evaluation medical report utah

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