CDME Module 2: Vision, Hearing, Diabetes Mellitus-2-3: Vision Evaluation Report Form MCSA

2-3: Vision Evaluation Report Form MCSA

Pdf Summary

This document is a Vision Evaluation Report form from the U.S. Department of Transportation's Federal Motor Carrier Safety Administration (FMCSA). It is used for evaluating the vision of individuals who operate commercial motor vehicles. The report must be completed by an ophthalmologist or optometrist and contains information on the individual being evaluated, the test used to determine results, and the individual's visual acuity and field of vision. It also includes questions about the individual's ability to recognize traffic control signal colors, any progressive eye conditions or diseases, and the stability of their vision deficiency. The report requires the medical professional to provide their opinion on whether the individual's vision deficiency is stable, if a vision evaluation is required more often than annually, and if the individual has had sufficient time to adapt to their vision change. The medical professional must sign the report, attesting that the information provided is true and correct. The document includes a statement indicating that it contains sensitive information and should be handled and secured appropriately to prevent inadvertent disclosure.

Keywords

Vision Evaluation Report

FMCSA

commercial motor vehicles

ophthalmologist

optometrist

visual acuity

field of vision

traffic control signal colors

progressive eye conditions

vision deficiency