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Click ‘Get Form’ to open the connecticut p 142op in the editor.
Begin with Section (A) where the patient must fill in their personal information, including name, mailing address, operator's license number, date of birth, and phone number. Ensure all fields are completed accurately.
In Section (B), the eye care professional should provide clinical information. They need to indicate if they are the regular eye care provider and detail any present eye conditions affecting driving ability.
Section (C) requires specific eye-care information. The examiner must assess visual acuity and whether corrective lenses are needed for driving. Any blind spots or additional conditions should also be noted here.
Finally, in Section (D), the medical examiner certifies that they have examined the patient within the last 90 days. They must sign and provide their details including name, signature, telephone number, and specialty.

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