Mv 619: Fill out & sign online

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Click ‘Get Form’ to open the mv 619 in the editor.
Begin by entering the patient's name exactly as it appears on their driver license in the designated fields for Last, First, and Middle Initial.
Fill in the patient's date of birth using the MM/DD/YY format, followed by their sex selection.
Complete the patient's street address, including city, state, country, and zip code.
Input the date of examination in MM/DD/YY format.
Indicate whether the patient achieved a Snellen Test score of 20/40 or better with one or both eyes by selecting 'YES' or 'NO'.
Specify if corrective lenses were worn during the test by selecting 'YES' or 'NO'. If 'NO', note that form MV-80L must be completed.
Enter the name and title of the provider completing this report along with their street address and city/state/country details.
Select how long this report is valid for: either 12 months or 6 months from the examination date.
Finally, ensure that the provider signs in full and includes their professional license number before saving your document.

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