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In the interest of public safety and ensuring that all drivers maintain the necessary visual acuity to navigate Tennessee’s roads safely, the Tennessee Department of Safety and Homeland Security has instituted a meticulous process for evaluating and certifying drivers' vision. The Vision Examination Form plays a pivotal role in this process, providing a structured method for eye care professionals to document the visual capabilities of driver applicants. This form, which must be completed by either a licensed Doctor of Optometry or Doctor of Ophthalmology, captures critical information about the driver's visual acuity, field of vision, and any need for corrective lenses. It also delves into other visual irregularities that could impair driving, such as double vision or poor night vision, and evaluates whether glasses or other treatments can rectify such conditions. Importantly, the process respects the autonomy of applicants in selecting their eye care provider, as Driver License Examiners are strictly prohibited from making recommendations. Once completed, this form, along with any prescribed eyewear, must be presented to the Driver Service Center, signifying a crucial step toward obtaining or maintaining a Tennessee driver's license. Through this careful approach, the state endeavors to ensure that all drivers can meet the vision standards required for safe driving, thus protecting all who share the road.

Example - Tennessee Drivers License Form

TENNESSEE DEPARTMENT OF SAFETY

AND HOMELAND SECURITY

VISION EXAMINATION FORM

Important information for Driver Applicant

The vision screening by a Driver License Examiner indicates there is a possible vision impairment that would affect your ability to safely operate a motor vehicle. You are being asked to have your vision checked by a licensed eye care Doctor of Optometry or Doctor of Ophthalmology to determine whether your vision can be improved by eye glasses or eye treatment.

If you have any questions about how well you must be able to see to drive on the streets and highways of Tennessee, the Driver’s License Examiner will be glad to assist you.

Driver License Examiners are prohibited from referring you to or recommending the name of an eye specialist.

When you return to the Driver Service Center after your eye examination, you must bring this completed form by your eye doctor, along with any new eye glasses or corrective lenses.

FOR DOCTOR OF OPTOMETRY OR OPHTHALMOLOGY ONLY

Important information for the Eye Care Provider

All applicants for a driver license as well as drivers whose record cast doubt on their ability to drive safely, are given vision screenings by the Driver License Examiners. When this screening indicates that a vision examination is needed by an eye care professional, the person is asked to visit a vision specialist.

Upon completion of your eye examination of the driver applicant, please completely fill out this form and certification. Please have patient sign this form in your presence.

No recommendations or suggestions are given by the Tennessee Department of Safety and Homeland Security Driver License Examiners as to which eye specialist to visit. This report can only be accepted from a licensed Doctor of Optometry or Doctor of Ophthalmology.

Full Name of Person Examined: _________________________________________________________________________________________

FirstMiddleLast Name

Street Address: __________________________________________________________ City ______________________________________________ State ___________ Zip Code ___________

ACUITY

RIGHT EYE

LEFT EYE

BOTH EYES

FIELD OF VISON

 

 

 

 

 

 

 

 

 

 

WITH PRESENT

 

 

 

TO RIGHT OF POINT OF

20/

20/

20/

FIXATION

GLASSES (IF ANY)

 

 

 

 

 

 

 

 

 

 

20/

20/

20/

TO LEFT OF POINT OF FIXATION

WITHOUT GLASSES

 

 

 

 

 

 

WITH BEST

 

 

 

TOTAL ANGLE

POSSIBLE

20/

20/

20/

 

CORRECTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLOR TEST

 

 

 

 

 

 

 

 

 

SF-0257 (Rev. 1/12)

(OVER)

- 1 -

RDA 1348

TENNESSEE DEPARTMENT OF SAFETY

VISION EXAMINATION FORM

1.Are glasses needed for distant vision? ___________________ Are they being prescribed or fitted?________________

2.Describe any irregularities such as : Double vision, poor night vision, eye injury, eye disease, poor near vision, etc:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

3.Will eye glasses improve conditions described in Question 2 above?_______________________________________

4.Will other treatments improve above-described conditions for the eyes? ____________________________________

__________________________________________________________________________________________________

5.Is the person named in this report currently undergoing the recommend treatment to improve vision? ______________

6.Additional Comments:

__________________________________________________________________________________________________

CERTIFICATION OF OPHTHAMOLOGIST OR OPTOMETRIST

I, _____________________________________________________________, being licensed to practice in the

specialty of eye care, in the State of ___________________________________, certify I have personally

examined the eyes of the above named. A true record of this examination appears on this report and he or she signed below in my presence.

Signature of Examining Doctor ______________________________________ DATE _________________

Medical License Number ________________________________________ STATE _________________

Office Address ________________________________________________City _________________________

STATE _____________ ZIP CODE _____________Office Telephone Number ________________________

Signature of Person ____________________________________________ DATE _____________________

Receiving Eye Examination

SF-0257 (Rev. 1/12)

- 2 -

RDA 1348

Form Breakdown

Fact Name Fact Detail
Form Purpose The Tennessee Driver License Vision Examination Form is utilized to verify whether an individual's vision impairment affects their ability to safely operate a motor vehicle and if it can be improved with eyewear or treatment.
Professional Requirement Only a licensed Doctor of Optometry or Doctor of Ophthalmology can complete and sign off on the vision examination form, ensuring the examination is conducted by professionals qualified to assess vision health.
Vision Screening Applicants for a Tennessee driver's license and those whose records suggest a doubt about their ability to drive safely must undergo vision screenings conducted by Driver License Examiners.
Examination Content The form evaluates various aspects of the applicant's vision, including acuity for both eyes individually and together, field of vision, and color vision, with sections detailing the need for eyeglasses and other treatments.
Form Accessibility Upon completion of an eye examination, applicants must return to the Driver Service Center with the completed vision examination form along with any new eyeglasses or corrective lenses prescribed by the eye care provider.

Detailed Instructions for Filling Out Tennessee Drivers License

Filling out the Tennessee Drivers License vision examination form is a critical step for individuals who have been informed by a Driver License Examiner that their initial vision screening indicated a possible impairment. This form must be completed by a licensed eye care professional—either a Doctor of Optometry or Doctor of Ophthalmology—after conducting a thorough eye examination. The aim is to determine if the applicant's vision can be corrected or improved, thereby ensuring they can safely operate a motor vehicle on Tennessee roads. To make this process as smooth as possible, here are step-by-step instructions for completing the form.

  1. Full Name of Person Examined: The eye care professional should begin by writing the patient's full name, including the first, middle, and last names in the space provided.
  2. Street Address, City, State, Zip Code: Next, the address where the patient resides should be filled out. This includes the street address, city, state, and zip code in their designated spots.
  3. Acuity Right Eye, Left Eye, Both Eyes: This section requires documentation of the patient's vision acuity. The eye doctor must note the acuity values for the right eye, left eye, and both eyes with present glasses (if any), without glasses, and with the best correction possible.
  4. Field of Vision: Record the total angle of the field of vision for each eye to the right and left of the point of fixation — with any current glasses and without — as well as the best total angle possible after correction.
  5. Color Test: Indicate the results of the color vision test in the space provided. This is crucial as color perception is a key component of safe driving.
  6. Questions 1-6: There are specific questions on the form that need to be answered. These include whether glasses are needed for distant vision, any irregularities like double vision or poor night vision, if glasses will improve the conditions described, whether other treatments will improve the conditions, if the person is currently undergoing recommended treatment, and any additional comments on the patient's vision condition.
  7. Certification of Ophthalmologist or Optometrist: The examining eye doctor must fill out their name, their state of licensure, medical license number, office address, office telephone number, and then sign and date the form to certify the examination results.
  8. Signature of Person Receiving Eye Examination: Finally, the patient must sign and date the form in the presence of the examining eye doctor to acknowledge the eye examination.

Once the Tennessee Drivers License vision examination form is properly filled out and signed by both the eye care professional and the patient, it, along with any new eyeglasses or corrective lenses, should be brought to the Driver Service Center. This documentation is essential for determining the patient’s eligibility to safely operate a motor vehicle in Tennessee. Ensuring that this form is filled out accurately and in its entirety is a key step in maintaining the safety of all drivers on the road.

More About Tennessee Drivers License

What is the purpose of the vision examination form?

The vision examination form is designed to determine if an individual has a vision impairment that could affect their ability to safely operate a motor vehicle in Tennessee. If a Driver License Examiner's screening suggests a possible impairment, the applicant is asked to have their vision checked by a licensed eye care professional. This helps ensure the safety of the driver and others on the road by confirming that all drivers meet the required vision standards.

Who should complete the vision examination form?

This form must be completed by a licensed Doctor of Optometry or Doctor of Ophthalmology only. These professionals have the qualifications needed to accurately assess an individual's vision and provide the necessary treatment or correction, if needed.

What information does the eye care provider need to provide?

The eye care provider is required to fill out the form completely, which includes information about the patient's acuity (clarity of vision) for both eyes separately and together, field of vision, and any need for glasses or other corrective measures. The provider must also report on any irregularities such as double vision, poor night vision, eye injury or disease, and whether glasses or other treatments can improve these conditions.

Can a Driver License Examiner recommend an eye specialist?

No, Driver License Examiners are prohibited from referring or recommending any eye specialists. Applicants need to select an eye care professional of their own choosing that meets the licensing requirements as set by the state.

What happens after the eye examination?

Once the eye examination is complete, and the form has been filled out by the eye care professional, the applicant must return to the Driver Service Center. They need to bring the completed form and any new eye glasses or corrective lenses that have been prescribed as a result of the examination.

Is it necessary to wear glasses if they were prescribed?

If glasses are prescribed by the eye care provider to improve distant vision or to address any other issues identified during the examination, it is necessary for the applicant to wear them while driving. Adhering to this requirement ensures the driver's vision meets the safety standards required for operating a vehicle on Tennessee roads.

What if the applicant is currently undergoing treatment for a vision problem?

The eye care provider must indicate on the form whether the applicant is currently undergoing any recommended treatment to improve their vision. It's important for assessing the applicant’s ability to safely operate a vehicle at the present time and whether any further evaluation might be needed in the future.

What is the significance of the certification by the eye care provider?

The certification by the eye care provider serves as an official attestation that they have personally examined the eyes of the individual named in the report. It confirms that all the information provided on the form is accurate and based on a professional examination, reinforcing the reliability of the assessment for the Department of Safety and Homeland Security.

Common mistakes

Filling out the Tennessee Driver's License vision examination form is a critical step in ensuring the safety of drivers and pedestrians alike. However, individuals often make several common mistakes during this process, which can impede their ability to secure a driver's license. Identifying and avoiding these errors can streamline the application process and facilitate better outcomes.

One widespread mistake is the incomplete filling out of personal information. Applicants sometimes leave crucial fields blank, such as the full name, address, or contact details, leading to processing delays. Ensuring every section is accurately completed is crucial for the timely processing of the application.

Another error involves inaccuracies in the vision acuity sections for the right eye, left eye, and both eyes. It's essential to report vision acuity precisely, as inaccuracies can lead to inappropriate decisions regarding the applicant's ability to drive. The field of vision section is also commonly misconstrued. Applicants or eye care providers sometimes misunderstand the instructions, leading to incomplete or inaccurate information regarding the applicant's peripheral vision capabilities.

Failure to specify the need for glasses or corrective lenses for distant vision is yet another mistake. The form explicitly asks whether glasses are needed and if they are being prescribed or fitted. Providing clear answers here is vital, as it directly relates to the applicant's eligibility for a driver's license. Additionally, individuals often neglect to thoroughly describe any vision irregularities, such as double vision or night vision challenges, which are crucial for assessing fitness to drive.

Moreover, the sections inquiring about improvements through glasses or other treatments can be a source of confusion. It's essential to explicitly state whether vision conditions described earlier in the form can be improved and, if so, how. This information is critical in determining whether an individual's vision meets the legal standards for driving.

Ensuring the current status of recommended treatments is another area where mistakes are made. The form asks if the person is undergoing recommended treatments to improve vision, which is a detail that cannot be overlooked. Confirmation of ongoing treatment or its necessity is important for establishing the applicant's commitment to safe driving.

In addition to these specific errors, applicants and eye care providers must also ensure that the certification section at the end of the form is duly signed and dated. This certification verifies the accuracy of the information provided and is a mandatory step in the application process.

In conclusion, when filling out the Tennessee Driver's License vision examination form, it is imperative to:

  1. Complete all personal information accurately.
  2. Report vision acuity and field of vision accurately and completely.
  3. Specify the necessity and prescription status of glasses or corrective lenses.
  4. Provide detailed descriptions of any vision irregularities.
  5. Clarify improvements achievable through glasses or other treatments.
  6. Confirm the current status of recommended treatments for vision improvement.
  7. Ensure the certification section is signed and dated by the examining eye care professional.

By avoiding these common mistakes, applicants can contribute to road safety and expedite the process of obtaining or renewing their driver's license in Tennessee.

Documents used along the form

In the process of obtaining or renewing a Tennessee Driver's License, applicants might need to provide additional documentation alongside the Tennessee Department of Safety and Homeland Security Vision Examination Form. These documents are crucial for verifying personal information, confirming eligibility, and ensuring the applicant meets all state requirements for holding a driver's license. It's beneficial to be aware of these documents to ensure a smooth application process.

  1. Proof of Identity and Age: This can include a birth certificate or passport. These documents are used to verify the applicant's identity and confirm they meet the minimum age requirement.
  2. Proof of Social Security Number: A Social Security card or a document issued by the Social Security Administration (SSA) with the full number is required. This confirms the applicant's Social Security number for identity verification purposes.
  3. Proof of U.S. Citizenship or Legal Presence: Non-citizens must provide documents such as a Permanent Resident Card to prove they are legally allowed to reside in the United States.
  4. Proof of Tennessee Residency: Applicants need to provide two documents with their current residential address, such as utility bills or bank statements, to verify they reside in Tennessee.
  5. Proof of Name Change (if applicable): Individuals who have changed their name due to marriage, divorce, adoption, or other reasons must provide documentation of the name change, like a marriage certificate or court decree.
  6. Real ID Documentation: For a Real ID-compliant driver's license, additional documentation may be required, including proof of identity, proof of Social Security number, proof of U.S. citizenship or legal presence, and two proofs of Tennessee residence.

Having the necessary forms and documents ready can expedite the process of applying for or renewing a Tennessee Driver's License. Applicants are encouraged to carefully review the requirements and prepare all required documents before visiting a Driver Service Center. This proactive approach helps in avoiding delays and ensures compliance with Tennessee's Department of Safety and Homeland Security guidelines.

Similar forms

The Tennessee Driver's License vision examination form bears a resemblance to the medical examination report for commercial driver license (CDL). Both forms are designed to assess whether an individual meets the required health standards to operate a vehicle safely. In the case of the CDL medical examination, the focus is broader, considering not just vision but also cardiovascular health, neurological conditions, and overall physical ability. However, both documents serve a similar purpose: ensuring that drivers possess the necessary physical capabilities for their respective driving responsibilities.

Similarly, the passport application form also shares certain similarities with the Tennessee Driver's License vision examination form. Although the passport form is used for identity verification and international travel authorization, it also requires applicants to provide detailed personal information, much like the vision examination form requests specific details about the examinee's vision and eye health. Both documents are critical for accessing certain privileges—driving for the latter and international travel for the former—and necessitate accurate and comprehensive personal data.

The school physical examination forms, required for students to participate in sports or to enroll in certain schools, also resemble the vision examination form in their function of assessing eligibility based on physical health criteria. While school physicals may cover a broader range of health assessments, including vaccination history and general physical fitness, the principle of using a health standard to determine eligibility parallels the vision examination's aim to ensure safe driving through adequate vision.

The job application forms that include health questionnaires for positions involving physical labor or the operation of heavy machinery share a goal with the Tennessee vision examination form: ensuring individuals are physically capable of safely performing their duties. Though the job-related forms might assess a wider spectrum of physical abilities and health conditions, both document types are preventative measures designed to avoid accidents and ensure safety in potentially hazardous activities.

Professional licensing forms for careers that require specific physical abilities or health conditions, such as pilots or maritime workers, also compare to the vision examination form. These forms evaluate if candidates meet the health standards essential for safe operation within their professional fields. The vision exam form, similarly, ascertains that individuals have the requisite vision capacity for safe driving, underscoring the importance of physical standards across various professions.

The firearms licensing application process in various jurisdictions, which often includes a vision test, mirrors the Tennessee vision examination form's purpose. Both are regulatory measures to ensure individuals can safely operate potentially dangerous equipment, whether it's a vehicle or a firearm, emphasizing the role of vision and overall health in public safety.

Disability benefits application forms also share common ground with the vision examination form, despite serving different purposes. Both require thorough and accurate documentation of an individual's physical condition. However, while disability forms typically assess how an individual's condition affects their daily life and ability to work, the vision examination focuses on the specific aspect of vision as it relates to safe driving.

Lastly, insurance claim forms that require a detailed account of an individual’s health condition for processing claims bear a resemblance to the vision examination form. These insurance forms might be used after an incident to assess health status and determine eligibility for benefits, akin to how the vision examination form assesses vision health to determine driving eligibility. Both necessitate rigorous documentation of an individual's health status for official review and decision-making.

Dos and Don'ts

When filling out the Tennessee Drivers License form, especially the portion pertaining to the vision examination, it's crucial to ensure the process is done correctly to avoid any potential delays or issues with your license. Here are some essential dos and don'ts to consider:

  • Do read the entire form carefully before filling it out to ensure you understand all the requirements.
  • Do ensure that your eye care provider is licensed in the state of Tennessee as either a Doctor of Optometry or Doctor of Ophthalmology.
  • Do bring your current eyeglasses or corrective lenses to the eye examination, as they must be evaluated.
  • Do make sure the eye care provider signs and dates the form in your presence, as this is a mandatory step.
  • Do double-check all entered information for accuracy before submitting the form, especially your full name and address.
  • Don't leave any required fields on the form blank. If a question does not apply to you, write "N/A" to indicate this.
  • Don't forget to bring the completed form back to the Driver Service Center along with any new eyeglasses or corrective lenses prescribed.
  • Don't attempt to falsify any information on the form, as doing so can result in serious repercussions.
  • Don't hesitate to ask the Driver’s License Examiner questions if you're unsure about any part of the process.
  • Don't ignore the importance of this form and the eye examination, as they are crucial for determining your ability to safely operate a motor vehicle.

Following these guidelines can help streamline the process of completing the Tennessee Drivers License form and ensure that your driving privileges are granted without unnecessary delays.

Misconceptions

Understanding the intricacies of the Tennessee Drivers License form, particularly the Vision Examination Form, requires dispelling some common misconceptions. Here are six notable misunderstandings:

  • Misconception 1: Only individuals with previously identified vision impairments need to complete the vision examination form.
  • This is incorrect. The form is also required for new applicants and existing drivers whose records suggest a reevaluation of their ability to drive safely due to potential vision concerns.

  • Misconception 2: Driver License Examiners can recommend specific eye doctors for the vision examination.
  • Driver License Examiners are expressly prohibited from recommending any eye care specialists. This ensures impartiality in the examination process and leaves the choice of eye care provider to the applicant.

  • Misconception 3: Any healthcare professional can complete the vision examination form.
  • In fact, only licensed Doctors of Optometry or Ophthalmology are authorized to conduct the examination and complete the form. This requirement ensures that vision evaluations are conducted by specialists.

  • Misconception 4: If you wear glasses, you automatically fail the vision screening.
  • Wearing glasses does not mean an automatic failure. The screening assesses whether your vision, with or without corrective lenses, meets the state’s criteria for safe driving.

  • Misconception 5: The vision examination form is only concerned with acuity, or sharpness of vision.
  • While visual acuity is a critical component, the form also evaluates other aspects of vision such as field of vision and color vision, all of which play a role in safe driving.

  • Misconception 6: Once the vision examination form is completed, no further action is required.
  • After the examination, it’s the applicant's responsibility to return the completed form to the Driver Service Center, along with any prescribed corrective lenses or glasses. This step is crucial for the final determination of driving eligibility.

Clearing up these misconceptions is vital for all drivers and applicants in Tennessee. Understanding the true requirements and procedures ensures a smoother process for maintaining or obtaining a driver's license, particularly when it comes to vision health and safety on the roads.

Key takeaways

When applying for or renewing a driver's license in Tennessee, individuals may be required to undergo a vision examination if a Driver License Examiner identifies a potential vision impairment that could impact safe driving abilities. Here are key takeaways to consider regarding the Tennessee Department of Safety and Homeland Security Vision Examination Form:

  • The vision screening performed at the Driver Service Center might indicate a need for a further examination by a professional eye care provider, either a Doctor of Optometropy or a Doctor of Ophthalmology.
  • Applicants are required to visit a licensed eye specialist for a comprehensive vision exam if the initial screening suggests it's necessary. This ensures that their vision meets the state's safe driving standards.
  • Driver License Examiners are not allowed to recommend specific eye doctors. The responsibility to choose an eye care provider rests with the applicant.
  • The eye examination form must be completely filled out by the examining eye doctor. It is essential for the accurate assessment of an applicant's vision capabilities and needs.
  • Upon completion of the eye examination, applicants must return to the Driver Service Center with the completed form, along with any new eyeglasses or corrective lenses prescribed by the eye care professional.
  • The form asks for detailed information, including whether eyeglasses are needed for distant vision, the presence of any vision irregularities (e.g., double vision, poor night vision), and if eyeglasses or other treatments can improve these conditions.
  • The eye care professional's certification section at the bottom of the form must be signed by the optometrist or ophthalmologist, indicating that a thorough vision exam has been conducted.

Understanding these steps and requirements ensures that individuals seeking a driver's license in Tennessee are well-informed about the vision examination process and what to expect. It is a crucial component to maintaining safe driving standards for everyone on the road.

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