Form 1528-2026

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4.8 out of 5

130 votes

The document is a Physician's Statement form (Form 1528) from the Missouri Department of Revenue, intended for evaluating a patient's fitness to operate a motor vehicle. It includes sections for patient information, medical history, and physician assessments regarding various health conditions that may affect driving ability. The form requires the physician to determine if the patient is capable of driving safely and responsibly, with options for recommendations or restrictions based on their evaluation.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the patient’s name, social security number, and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill out the patient’s mailing address, including city, state, and zip code. This ensures that any correspondence reaches the correct location.
In the Driver and Patient section, respond to all questions regarding driving habits and medical history. This includes how many trips are made weekly and any incidents involving law enforcement.
Proceed to the Physician section where you will enter examination details. Ensure that all relevant medical conditions are checked accurately based on your assessment.
Finally, review all entries for completeness and accuracy before signing. Once satisfied, save your document for submission.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (130 Votes)
2012	4.4 Satisfied (288 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is considered a hardship for the USPS?

Hardship or Medical Problems is defined as an illness or handicap which would present a physical challenge for an individual to retrieve mail.

What is an example of a hardship letter for the post office?

Dear Sir: I request hardship delivery of my mail at XXXXXXXXX. The mail is currently delivered to a cluster box which I believe is not ADA compliant. I use a wheelchair and am not able to get to the current cluster mail box from either my wheelchair or the drivers seat of my van.

How do I get my mailbox moved for the elderly?

Contact your local postmaster. This is the immediate first step you should make. There are no national laws mandating relocation of mailboxes by USPS. Instead, local postmasters decide what is best for their geographic location and mail service. Make a quick call or visit your local post office.

What is the hardship form number for USPS?

On the website of the U. S. Post Office, there is a form titled Request for Exception to Current/Proposed Delivery Mode Due to Physical Hardship, PS Form 1528. You should download this form and follow the directions on the form.

What is a PS form 1528?

To request door delivery, you need to submit PS Form 1528, Request For Exception To Current/Proposed Delivery Mode Due To Physical Hardship and the required documentation, including a statement from a doctor. The doctors statement should indicate you are unable to collect your mail from a curb or centralized mailbox.

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What is a PS form?

Postal Service forms may be preceded by PS Form, which simply stands for Postal Service Form. For example: 3541, Form 3541, and PS Form 3541 all refer to the Periodicals postage statement.

What is a PS form 1723 used for?

The PS Form 1723, which shows the times and dates of the 204b detail, is the controlling document for determining whether an employee is in a 204b status. A separate PS Form 1723 is used for each detail.