Dds mr 274 2026

1. Click ‘Get Form’ to open the dds mr 274 in the editor.
2. Begin by filling out the Patient Information section. Enter the patient's last name, first name, middle initial, date of birth, physical address, city, state, driver’s license number, and zip code.
3. In the Patient Attestation section, authorize a licensed optometrist or ophthalmologist to complete the examination by writing their name in the designated space. Ensure that the driver/licensee signs and dates this section.
4. Proceed to the Report on Visual Examination. Fill in visual acuity measurements for both eyes under various conditions (without glasses, with existing prescription, etc.).
5. Complete the Monocular Vision section if applicable. Indicate whether the patient has monocular vision and provide details on nasal and temporal fields.
6. Finally, have the physician complete their statement by answering questions regarding double vision and eye injuries. The physician must sign and provide their details at the end of the form.

Start using our platform today to easily fill out your dds mr 274 form online for free!