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The MV-80L form, known as the Eye Test Report for the Medical Review Unit, plays a crucial role for individuals with specific vision impairments seeking to maintain their driving privileges in New York State. This form is primarily intended for those enrolled in the Low Vision Program, which caters to individuals who have corrected vision between 20/40 and 20/70, as well as wearers of telescopic lenses. It is essential to understand that the completion of this form is not merely a formality; failure to submit it can result in the inability to renew a driver's license or even lead to suspension. The form must be filled out by a qualified medical professional—either a physician, ophthalmologist, or optometrist—based on an examination conducted within the last 60 days. Additionally, the MV-80L includes specific requirements for visual acuity and field of vision, particularly for those using telescopic lenses. For instance, individuals must demonstrate a horizontal binocular field of vision of no less than 140 degrees. This form is not only a means of compliance but also a safeguard to ensure that drivers with visual limitations can operate vehicles safely. Understanding the requirements and implications of the MV-80L is vital for anyone affected by low vision or utilizing telescopic lenses, as it directly impacts their ability to drive legally and safely.
Mv 80L Example
EYE TEST REPORT FOR MEDICAL REVIEW UNIT
Medical Review Unit, Room 337
6 Empire State Plaza, Albany, NY 12228
dmv.ny.gov
LOW VISION PROGRAM - FOR PERSONS WITH CORRECTED VISION OF LESS THAN 20/40
BUT NOT LESS THAN 20/70, OR TELESCOPIC LENS WEARERS
INSTRUCTIONS:
1.If this completed form is not returned to the Medical Review Unit, you may not renew your license and you may be suspended. DO NOT GO INTO A DMV OFFICE UNTIL YOU HAVE SUBMITTED YOUR COMPLETED
THE MEDICAL REVIEW UNIT AT THE ADDRESS ABOVE AND HAVE RECEIVED A RESPONSE LETTER IN THE MAIL FROM THEM.
2.The
UNIT AT THE ABOVE ADDRESS OR FAX IT TO (518)
3.Please note, if you are currently in the Low Vision Program, you do not need to submit form
MINIMUM STANDARD FOR INDIVIDUALS WITH CORRECTED VISION OF LESS THAN 20/40, BUT NOT LESS THAN 20/70:
lHorizontal, binocular field of vision must be no less than 140 degrees.
MINIMUM STANDARD FOR TELESCOPIC LENS WEARERS:
lMust have been fitted with, trained to use, and used telescopic lenses for at least 60 days prior to filing this form.
For a
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lVisual acuity (Snellen Method) through telescopic portion in either or both eyes must be NO LESS THAN 20/40
lVisual acuity (Snellen Method) through carrier lens in either or both eyes must be NO LESS THAN 20/100
lTotal horizontal, binocular field of vision (no field expanders) must be NO LESS THAN 140 DEGREES
lMust pass road test if he/she has not taken a road test while wearing his/her telescopic lenses
lEligible for a Class D or DJ driver license only
lIneligible for a commercial driver license (CDL), a motorcycle license or a moped license.
PATIENT — COMPLETE THIS SECTION
Name
Address
New York State Client ID # |
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Date of Birth |
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□ Male □ Female |
Become an Organ Donor! Visit donatelife.ny.gov |
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2. If telescopic lenses are used, on what date did patient receive them?
PRACTITIONER — COMPLETE THIS SECTION
Patient’s Name |
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Date of Birth |
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(First) |
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(Month/Day/Year) |
Date of Examination |
(must be within 60 days) |
Check One: |
o Initial Evaluation o |
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(Month/Day/Year) |
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1. Visual Acuity (Snellen Method) NOTE: Please check the appropriate box to identify how visual acuity was achieved, then give the visual acuity.
o With corrective lenses o Without corrective lenses o With telescopic lenses only
Right eye 20/ |
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and/or left eye 20/ |
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Both 20/ |
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Through telescopic lenses right eye 20/ |
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and/or left eye 20/ |
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Through carrier lenses right eye 20/ |
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and/or left eye 20/ |
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Does the patient meet or exceed the minimum acceptable horizontal, binocular field of vision of 140 degrees? oYes |
o No |
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NOTE: The test object size for determining horizontal, binocular field of vision must be either a white 3 mm size test object at a |
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meter distance, or a white 6mm size test object at a one meter distance, or the equivalent angular size for any test distance. |
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If telescopic lenses, did the patient achieve his/her horizontal, binocular field of vision with the use of field expanders? oYes |
oNo |
5.What medical condition(s) caused the present loss of the patient’s visual acuity?
6. Patient should be
7. Is this condition stable at this time? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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6 Months oYear
Yes o No
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Check restriction(s) you recommend: o Day Driving Only |
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o No Limited Access Roads |
o None |
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In your opinion, would the patient’s condition interfere with the safe operation of a motor vehicle? |
o Yes |
o No |
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If “Yes”, please explain in the space provided, or attach an explanation on your letterhead |
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The above information is true, complete and best reflects my professional judgement.
X
(Practitioner’s Signature) |
(Date) |
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(Practitioner’s Name — please print) |
(Certificate or License Number) |
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(Address) |
(Telephone Number) |
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TELESCOPIC LENS WEARERS MUST COMPLETE THIS CERTIFICATION ONLY FOR A
I certify that I have successfully completed the minimum training requirements for telescopic lens wearers as outlined in Part 5 of the Commissioner’s Regulations, and that I received the training from:
X
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(Name of Trainer) |
(Telephone Number) |
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(Address of Trainer) |
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(Signature of Patient) |
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(Date Training Completed) |
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File Breakdown
| Fact Name | Description |
|---|---|
| Form Purpose | The MV-80L form is used for individuals with low vision who need to report their eye test results to the Medical Review Unit in New York State. |
| Submission Requirement | This form must be completed by a qualified medical professional and submitted to the Medical Review Unit to avoid suspension of your driver's license. |
| Vision Standards | For low vision individuals, the minimum standard is a corrected vision of less than 20/40 but not less than 20/70. For telescopic lens wearers, specific visual acuity standards apply. |
| Governing Law | The MV-80L form is governed by New York State Vehicle and Traffic Law, specifically related to the licensing of drivers with vision impairments. |
Guide to Using Mv 80L
Completing the MV-80L form is an essential step for individuals with low vision who need to submit an eye test report to the Medical Review Unit. This form must be filled out carefully and accurately to ensure that your application is processed smoothly. Once you have completed the form, you will need to send it to the designated address or fax it. After submission, wait for a response letter from the Medical Review Unit before proceeding to a DMV office.
- Obtain the MV-80L form, which can be downloaded from the DMV website or acquired from a medical professional.
- Fill out the Patient section with your personal information, including your name, address, New York State Client ID number, date of birth, and gender.
- If you use telescopic lenses, indicate the date you received them.
- Provide your Practitioner with the form for completion. They will need to fill out their section, including your name, date of birth, and the date of your eye examination.
- Your practitioner will check whether the evaluation is an initial evaluation or a re-evaluation.
- Your practitioner will measure your visual acuity using the Snellen method and indicate the results for each eye, both with and without corrective lenses, if applicable.
- If you wear telescopic lenses, your practitioner will provide visual acuity measurements through those lenses as well.
- Your practitioner will assess whether you meet the minimum acceptable horizontal, binocular field of vision of 140 degrees.
- They will also indicate if you achieved this vision with or without the use of field expanders, if applicable.
- Inquire about the medical condition(s) affecting your visual acuity and have your practitioner provide that information on the form.
- Your practitioner will recommend how often you should be re-evaluated and confirm whether your condition is stable.
- They will check any recommended driving restrictions that apply to you.
- Your practitioner will assess if your condition interferes with the safe operation of a motor vehicle and provide an explanation if necessary.
- Finally, your practitioner will sign the form, providing their name, license number, address, and telephone number.
- Ensure both pages of the completed form are returned to the Medical Review Unit at the specified address or faxed to the provided number.
Get Answers on Mv 80L
What is the MV-80L form?
The MV-80L form is an Eye Test Report required by the New York State Department of Motor Vehicles (DMV) for individuals with low vision. It is specifically for those who have corrected vision of less than 20/40 but not less than 20/70, as well as for wearers of telescopic lenses.
Who needs to complete the MV-80L form?
The form must be completed by individuals who have low vision and are looking to renew their driver's license. It is also required for those who wear telescopic lenses. If you are currently enrolled in the Low Vision Program, you do not need to submit this form.
How should the completed MV-80L form be submitted?
Once the form is completed by a qualified physician, ophthalmologist, or optometrist, it should be returned to the Medical Review Unit at the address provided on the form. You can either mail both pages of the completed form or fax it to (518) 402-2991.
What happens if I do not submit the MV-80L form?
If you fail to submit the completed MV-80L form, you may not be able to renew your driver's license. Additionally, your license could be suspended until the form is received and processed by the Medical Review Unit.
What is the time frame for the eye examination?
The eye examination must be performed within 60 days prior to submitting the MV-80L form. This ensures that the information is current and accurately reflects your visual capabilities.
Are there specific vision standards for telescopic lens wearers?
Yes, there are specific standards that must be met for individuals who wear telescopic lenses. These include:
- Visual acuity through telescopic lenses must be no less than 20/40.
- Visual acuity through carrier lenses must be no less than 20/100.
- The horizontal binocular field of vision must be no less than 140 degrees.
- Road testing may be required if you have not previously taken a road test while wearing telescopic lenses.
What if I have been using telescopic lenses for less than 60 days?
If you have not been fitted with and trained to use telescopic lenses for at least 60 days, you will need to wait until you meet this requirement before submitting the MV-80L form.
What information is required from the practitioner?
The practitioner must provide details such as the patient's visual acuity, whether the patient meets the minimum field of vision requirements, and any medical conditions affecting visual acuity. They must also indicate if the condition is stable and recommend any driving restrictions.
Can I drive with restrictions if I have low vision?
Yes, if your condition allows, the practitioner may recommend certain driving restrictions, such as day driving only or the use of a full-view mirror. These recommendations will be taken into consideration during the review process.
What should I do if I have further questions about the MV-80L form?
If you have additional questions or need clarification about the MV-80L form, it is advisable to contact the Medical Review Unit directly or visit the New York DMV website for more information.
Common mistakes
Filling out the MV-80L form is a crucial step for individuals seeking to renew their driver's license under the Low Vision Program. However, several common mistakes can hinder the process. One frequent error occurs when individuals fail to ensure that the form is completed by an appropriate medical professional. The instructions clearly state that only a physician, ophthalmologist, or optometrist can fill out this form, and it must be based on an examination performed within the last 60 days. Submitting a form signed by an unqualified person can lead to delays or outright denial of the renewal.
Another mistake often made is neglecting to provide the necessary visual acuity measurements. The form requires specific details about the patient’s vision, including visual acuity with and without corrective lenses, as well as through telescopic lenses if applicable. Failing to fill out these sections completely or accurately can result in the form being returned or the renewal process being stalled. It is essential to double-check that all required fields are filled in before submission.
Additionally, many applicants overlook the importance of submitting both pages of the MV-80L form. The instructions specify that both pages must be returned to the Medical Review Unit. Submitting only one page can lead to incomplete processing and potential issues with the renewal of the driver’s license. It is advisable to review the entire document to ensure that nothing is missing.
Lastly, individuals sometimes forget to check the box indicating whether they meet the minimum acceptable horizontal, binocular field of vision of 140 degrees. This is a critical component of the evaluation. If this information is omitted, it may raise questions about the applicant’s eligibility, leading to unnecessary complications. Ensuring that every section is thoroughly completed and accurately reflects the patient’s condition is vital for a smooth renewal process.
Documents used along the form
The MV-80L form is essential for individuals with low vision seeking to renew their driver's licenses in New York. Alongside this form, several other documents may be required to ensure a comprehensive review of the applicant's vision and driving capabilities. Here’s a brief overview of these accompanying documents.
- MV-80L.1 Form: This is the Medical Review Periodic Eye Test form sent to individuals already enrolled in the Low Vision Program. It serves as a reminder for regular eye evaluations and helps maintain up-to-date records of visual acuity.
- Driver License Application (MV-44): This application is necessary for anyone applying for or renewing a driver's license. It collects personal information, including identification and residency details, essential for the licensing process.
- Vision Test Report: This report may be required to document the results of a vision test conducted by a licensed eye care professional. It provides additional evidence of the applicant's visual capabilities.
- Medical Examination Report (MV-70): This form may be requested for individuals with specific medical conditions that could affect their ability to drive safely. It includes a thorough assessment from a healthcare provider regarding the applicant's overall health and fitness to drive.
- Patient History Form: This document collects information about the applicant's medical history, including previous eye conditions and treatments. It aids healthcare providers in understanding the patient's visual health background.
Submitting these forms and documents accurately and promptly is crucial for a smooth renewal process. Each piece of information plays a vital role in ensuring that individuals with low vision can safely operate a vehicle while complying with state regulations.
Similar forms
The MV-80L form is essential for individuals with low vision who need to renew their driver's license. Several other documents serve similar purposes, ensuring that individuals meet the necessary vision standards for safe driving. Here are eight documents that share similarities with the MV-80L form:
- MV-80 - This form is used for individuals applying for a vision test waiver. Like the MV-80L, it requires a medical professional's input regarding vision standards.
- MV-80.1 - This is a re-evaluation form for drivers previously assessed under the Low Vision Program. It parallels the MV-80L in that it addresses ongoing vision assessments.
- MV-80.2 - This document is for individuals who have undergone corrective surgery and need to report their vision status. Similar to the MV-80L, it necessitates a professional examination.
- MV-70 - The Vision Test Report is utilized for standard vision testing. It shares the requirement for a medical professional's evaluation, much like the MV-80L.
- DL-44 - This application form for a driver's license in California includes a vision test requirement. It aligns with the MV-80L in ensuring drivers meet vision standards.
- Form 4 - Used in some states for vision screening, this form requires a healthcare provider's verification, similar to the MV-80L.
- Vision Screening Report - Often required by schools or employers, this report assesses visual acuity and is comparable to the MV-80L in its focus on vision health.
- Medical Examination Report - This document may be required for commercial driving licenses. It shares the emphasis on medical evaluation found in the MV-80L.
Dos and Don'ts
When filling out the MV-80L form, it is important to follow certain guidelines to ensure a smooth process. Here are four key things to do and avoid:
- Do ensure that a qualified medical professional completes the form.
- Do return both pages of the completed form to the Medical Review Unit.
- Don't go to a DMV office until you have submitted the form and received a response.
- Don't use clip-on or hand-held telescopic lenses; they are not acceptable.
Misconceptions
- Misconception 1: The MV-80L form can be submitted at any DMV office.
- Misconception 2: Anyone can fill out the MV-80L form.
- Misconception 3: The MV-80L form is required for all drivers with low vision.
- Misconception 4: Telescopic lenses are optional for those who need them.
- Misconception 5: The visual acuity requirements are the same for all drivers.
- Misconception 6: Once the MV-80L form is submitted, there is no need for further evaluation.
- Misconception 7: The MV-80L form guarantees license renewal.
This is incorrect. The completed MV-80L form must be sent directly to the Medical Review Unit at the specified address. Submitting it at a DMV office will not suffice.
Only licensed professionals such as physicians, ophthalmologists, or optometrists are authorized to complete this form. Their examination must be conducted within the last 60 days.
This form is specifically for individuals with corrected vision between 20/40 and 20/70 or those using telescopic lenses. If you are already in the Low Vision Program, you do not need to submit this form.
For individuals who require telescopic lenses, they must have been fitted, trained, and using these lenses for at least 60 days prior to submitting the MV-80L form.
Different standards apply based on the type of vision correction. For telescopic lens wearers, specific visual acuity through both the telescopic and carrier lenses must meet established minimums.
Depending on the patient's condition, re-evaluations may be necessary. The form includes a section for the practitioner to recommend the frequency of these evaluations.
Submitting the form does not automatically ensure that a driver's license will be renewed. The Medical Review Unit must review the information and respond accordingly.
Key takeaways
Filling out the MV-80L form is a crucial step for individuals with low vision who wish to maintain their driving privileges. Here are some key takeaways to keep in mind:
- Submit on Time: Ensure the completed form reaches the Medical Review Unit. Failure to do so may result in license suspension.
- Who Can Complete It: Only a physician, ophthalmologist, or optometrist can fill out the MV-80L, based on an examination done within the last 60 days.
- Current Program Participants: If you’re already in the Low Vision Program, you don’t need to submit the MV-80L. Instead, you will receive the MV-80L.1 form periodically.
- Field of Vision Requirement: Individuals with corrected vision between 20/40 and 20/70 must have a horizontal binocular field of vision of at least 140 degrees.
- Telescopic Lens Users: Must have used telescopic lenses for at least 60 days prior to submitting the form. Clip-on lenses are not acceptable.
- Visual Acuity Standards: For those using telescopic lenses, visual acuity must be at least 20/40 through the telescopic lens and 20/100 through the carrier lens.
- Road Test Requirement: If you haven’t taken a road test while using telescopic lenses, you’ll need to pass one to qualify for a license.
- License Eligibility: This form is specifically for Class D or DJ licenses. Commercial driver licenses, motorcycle licenses, and moped licenses are not available for low vision drivers.
- Complete All Sections: Make sure all sections of the form are filled out accurately to avoid delays in processing.
Taking these steps seriously will help ensure a smoother process in maintaining your driving privileges while adhering to safety standards.