Connecticut medical report 2026

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4.8 out of 5

79 votes

The document is a medical report required by the Connecticut Department of Motor Vehicles to assess a patient's ability to safely operate a motor vehicle. It includes sections for patient information, medication details, and physician evaluations regarding the patient's mental health and substance use. The physician must certify that they have examined the patient within 90 days and provide their professional opinion on the patient's fitness to drive.

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Click ‘Get Form’ to open the Connecticut Medical Report in our editor.
Begin by entering the patient's name, date of birth, and contact information in the designated fields. Ensure accuracy as this information is crucial for identification.
In the 'Medications' section, list any relevant medications the patient is currently taking. Include the name and dosage for each medication to provide a comprehensive overview.
Address questions regarding the patient's condition, such as whether they suffer from convulsive seizures or if they understand the risks associated with their condition. Select 'Yes' or 'No' as appropriate.
The physician must complete their certification at the end of the report, including their name, license number, and signature. This validates that they have examined the patient within 90 days.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (79 Votes)
2011	4.4 Satisfied (314 Votes)

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