Supplement 18-2 TITLE 17 TRANSPORTATION CHAPTER 5 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Driver Identifying Information, including the applicant's name, address, and date of birth. Ensure accuracy as this information is crucial for identification.
3. In section 1, check the appropriate box to indicate if you are board certified or eligible in endocrinology. If neither applies, do not proceed with the assessment.
4. Fill in your office telephone and fax numbers in section 2. This information is essential for communication regarding the applicant's evaluation.
5. Continue through each question methodically, providing detailed responses where required. For example, confirm whether you have reviewed the patient’s glucose logs and driving log as per sections 4 and 5.
6. Complete all certification statements in sections 6 to 16 by checking 'YES' or 'NO' based on your medical opinion about the applicant's diabetes management and ability to operate a CMV safely.
7. Finally, ensure that you print your name, sign, and provide your license number along with today's date before submitting the form as instructed at the end.

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