Physician Examination Report Form 2016-2023

Use a form 96 0668 2016 template to make your document workflow more streamlined.

Indicate to MVD how this person s medical condition affects his or her ability to safely perform the functional skills necessary for driving. Please submit the completed report by mail fax or by email to the appropriate address listed above. Arizona law provides immunity from personal liability to physicians supplying medical information* State law makes MVD responsible for the licensing decision on individuals. Arizona Revised Statutes 28-3005 28-3314 Arizona Administrative Code R17-4-502...

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