Homepage Fillable Illinois Vision Specialist Report Template in PDF
Contents

The Illinois Vision Specialist Report form is a crucial document for individuals seeking to obtain or renew their driver's license in Illinois, particularly if they do not meet standard vision requirements. This form is designed to gather essential information about an applicant's vision capabilities, including acuity and peripheral vision. It includes sections for personal details, examination results, and recommendations from a certified vision specialist. The report must be completed in the presence of the applicant, who is required to sign and date it, thereby authorizing the release of the examination results to the Secretary of State. Specific criteria are outlined for both general vision standards and those applicable to individuals who use prescription telescopic lenses. The form also allows for comments and additional recommendations, ensuring that vision specialists can provide comprehensive feedback regarding the applicant's ability to drive safely. Importantly, the report remains valid for six months from the examination date, emphasizing the need for timely completion and submission. Understanding the requirements and implications of this form is essential for both applicants and vision specialists, as it directly impacts the ability to legally operate a vehicle in Illinois.

Things to Know About This Form

What is the Illinois Vision Specialist Report form?

The Illinois Vision Specialist Report form is a document that must be completed by a vision specialist for individuals who do not meet the vision standards required for obtaining a driver's license in Illinois. It is used to assess the applicant's visual acuity and peripheral vision, ensuring they can safely operate a motor vehicle.

Who needs to fill out this form?

Individuals applying for an Illinois driver's license who do not pass the initial vision screening may need this form. A vision specialist must complete it to certify the applicant's visual capabilities and any necessary restrictions.

What information is required on the form?

The form requires personal information such as the applicant's name, address, birth date, and driver's license number. The vision specialist must provide details about the applicant's visual acuity, peripheral vision, and any recommendations for driving restrictions. The specialist's signature and certificate number are also needed.

How long is the report valid?

The Illinois Vision Specialist Report remains valid for six months from the date of the examination. After this period, a new report may be required if the applicant has not yet obtained their driver's license.

What if the applicant requires a telescopic lens arrangement?

If the applicant uses a prescription spectacle mounted telescopic lens arrangement, additional sections of the form must be completed. This includes specific visual acuity and peripheral vision standards that must be met to qualify for a driver's license with restrictions.

What are the visual acuity standards for driving?

To qualify without restrictions, the applicant must have a visual acuity of 20/40 or better without corrective lenses. For daylight driving only, the acuity can be between 20/41 and 20/70. If the acuity is 20/71 or less, the applicant is not qualified to drive.

What should a vision specialist include in their comments?

The vision specialist can provide comments on the applicant's condition, such as whether it is stable, deteriorating, or warrants monitoring. They may also note any recommendations for re-examination or additional restrictions based on the applicant's visual capabilities.

Are there any restrictions for applicants with telescopic lenses?

Yes, applicants who qualify to drive with a telescopic lens arrangement will be restricted to driving during daylight hours only. They will also be eligible for a Class "D" driver's license only.

What happens if the applicant does not meet the vision standards?

If the applicant does not meet the required vision standards, they will not qualify for a driver's license. However, they may be able to qualify with restrictions, such as using outside rearview mirrors, depending on their individual vision assessment.

Key takeaways

  • The Illinois Vision Specialist Report is essential for applicants who do not meet the vision standards for a driver's license.

  • Vision specialists must ensure that the applicant signs and dates the report in their presence to validate the examination.

  • It is crucial to complete all relevant sections of the form, particularly if the applicant requires a prescription mounted telescopic lens arrangement.

  • Readings indicating a plus (+) or minus (–) are not acceptable; only whole numbers should be recorded.

  • The report remains valid for six months from the examination date, so timely submission is important.

  • For applicants using telescopic lenses, specific acuity and peripheral vision standards must be met to qualify for a driver's license.

  • Vision specialists should provide comments in Section V to clarify any additional observations regarding the applicant's condition.

  • Both eyes must be tested individually for peripheral vision, with minimum readings of 70° temporal and 35° nasal required for qualification.

  • Complete the additional sections for telescopic lens wearers, ensuring all requirements are met for safe operation of a vehicle.

Common mistakes

  1. Incomplete Personal Information: Applicants often forget to fill in all personal details, such as the last name, first name, middle name, or driver’s license number. Each section is crucial for accurate identification.

  2. Missing Signatures: It's common for applicants to neglect to sign and date the report in the presence of the vision specialist. This signature is essential for validating the report.

  3. Incorrect Acuity Readings: Applicants sometimes write acuity readings with a plus (+) or minus (–) sign, which is not acceptable. Only whole numbers or fractions should be used, as specified in the instructions.

  4. Failure to Complete Required Sections: Some people overlook sections VIII to XI, especially if the applicant requires a prescription mounted telescopic lens arrangement. Completing these sections is necessary for proper evaluation.

  5. Not Following Peripheral Vision Guidelines: Applicants may misinterpret the peripheral vision requirements. It's important to ensure that both temporal and nasal readings meet the minimum standards for qualification.

  6. Neglecting Additional Comments: When applicable, not providing comments in Section V can lead to misunderstandings about the applicant’s condition. Clear communication about any special circumstances or recommendations is vital.

How to Fill Out Illinois Vision Specialist Report

After completing the Illinois Vision Specialist Report form, it is important to ensure that all sections are filled out accurately. This form will be submitted to the Secretary of State's office for review. Follow the steps below to fill out the form correctly.

  1. Section I: Fill in the applicant's name, including last, first, and middle name. Include their driver's license number, street address, birth date, sex, city, county, and ZIP code.
  2. Section II: Ensure the applicant signs and dates the report in your presence. You will also need to place your signature and certificate number in this section.
  3. Section III: Complete the acuity section. Record the visual acuity readings for both eyes, both with and without correction. Ensure you note if the applicant meets the minimum visual screening standards.
  4. Section IV: Fill out the peripheral section. Document the temporal and nasal readings for each eye. Ensure the total field of vision is recorded accurately.
  5. Section V: Check all applicable items regarding the applicant's driving capabilities, including whether they should drive in daylight only or if corrective lenses were accepted.
  6. Section VI: Indicate the status of the applicant's condition. Check all applicable items and provide any necessary explanations.
  7. Section VII: Certify that you have personally examined the applicant's eyes. Include your signature, certificate number, business address, telephone number, and the date of examination.
  8. Section VIII: If the applicant is using prescription spectacle mounted telescopic lenses, fill out the acuity section for these lenses, noting the necessary standards.
  9. Section IX: Complete the peripheral section for the telescopic lens arrangement, recording the necessary readings for both eyes.
  10. Section X: Document the date the applicant received their telescopic lens arrangement and provide any additional comments or restrictions as needed.
  11. Section XI: Confirm whether the applicant has successfully completed all required assessments related to the telescopic lenses.