P 142c form 2026

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The document is a Cardiology Medical Report from the Connecticut Department of Motor Vehicles, intended to assess a patient's ability to safely operate a motor vehicle based on their medical condition. It requires a licensed medical professional's examination and certification within 90 days, detailing the patient's health status, relevant conditions, medications, and any necessary follow-up evaluations or monitoring.

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Click ‘Get Form’ to open the p 142c form in the editor.
Begin by entering the driver's license number at the top of the form. This is essential for identification purposes.
Fill in the patient's name, date of birth, and contact information accurately. Ensure that all details are legible.
The medical professional must provide their examination details, including how long they have been treating the patient and the date of the last examination.
Document any relevant conditions affecting safe vehicle operation in the designated section, along with any technical reports that support your findings.
Complete the medication section by listing all medications relevant to motor vehicle operation, including dosages.
Answer all yes/no questions regarding the patient's understanding of their condition and ability to operate a vehicle safely.
Finally, ensure that the medical professional certifies and signs the report before submitting it to DMV.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (111 Votes)
2011	4.4 Satisfied (571 Votes)

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P 142c form 2026

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