Medical report format: Fill out & sign online

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01. Edit your medical report format online

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Click ‘Get Form’ to open the medical report 2013 form in the editor.
Begin with SECTION I, where you will enter your personal information. Fill in your name, driver's license number, address, date of birth, and gender. Ensure all fields are completed accurately.
Sign the Agreement/Release of Information section to authorize your physician to share necessary medical details with the Secretary of State.
Move to SECTION II for the medical professional's input. This section must be filled out by an MD/DO or qualified medical professional. They will assess your fitness to drive and complete various health condition questions.
In SECTION III, if applicable, the medical professional will evaluate any mental health disorders and provide necessary details regarding medications and conditions.
Complete any additional information in SECTION IV as required by your healthcare provider.
Finally, ensure that the medical provider signs and dates the form in SECTION V before submitting it.

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