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How to use or fill out Form MV-80L 'Eye Test Report for Medical Review Unit'
- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the 'Patient' section. Enter your name, address, New York State Client ID number, date of birth, and select your gender.
- In the 'Practitioner' section, your physician will need to complete their details including the patient's name, date of examination, and visual acuity results. Ensure they check the appropriate boxes for how visual acuity was achieved.
- If telescopic lenses are used, provide the date they were received and confirm if the patient meets the minimum horizontal field of vision requirement.
- The practitioner must also indicate if the condition is stable and recommend any driving restrictions. Finally, ensure they sign and date the form.
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