Mv 619 2026

1. Click ‘Get Form’ to open the mv 619 in the editor.
2. 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.
3. Input the patient's date of birth in the MM/DD/YY format to ensure accurate identification.
4. Fill in the patient's street address, including city, state, country, and zip code for complete contact information.
5. Record the date of examination using the MM/DD/YY format to document when the vision test was conducted.
6. Indicate whether the patient achieved a Snellen Test score of 20/40 or better with one or both eyes by selecting 'YES' or 'NO'.
7. Specify if corrective lenses were worn during the test by selecting 'YES' or 'NO'. If 'NO', remember to complete form MV-80L.
8. Enter your name and title as the provider, along with your street address and city/state/country details.
9. Select how long this report is valid for (12 months or 6 months) from the date of examination.
10. Finally, sign your name in full as a confirmation of accuracy and provide your professional license number.

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