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Click ‘Get Form’ to open the ds6 form in the editor.
Begin with Part 1, where you will enter the driver's identification details. Fill in the first name, last name, middle initial, date of birth (or approximate age), street address, city, state, zip code, make and color of the vehicle, and license plate number. Ensure all required fields marked with an asterisk are completed.
Move to Part 2 to describe the driver’s condition. Indicate whether you have treated this patient by selecting 'YES' or 'NO'. If 'YES', provide the date of the last examination and detail the condition being treated. Specify if medication is being administered and include type and dosage if applicable.
In this section, assess whether the patient's condition may affect their ability to drive safely. Choose one of the options provided regarding their driving privileges and add any necessary details in the space provided.
Finally, complete Part 3 by providing your professional information as a physician. Include your specialty, certificate or license number, full name, mailing address, contact number, signature, and date.
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Jan 25, 2020 This report was prepared under contract to the Department of Defense Strategic. Environmental Research and Development Program (SERDP).Read more
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