Transcription of UNIVERSAL MEDICAL EVALUATION/PROGRESS …
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UNIVERSAL MEDICAL EVALUATION/PROGRESS …
UNIVERSAL MEDICAL EVALUATION/PROGRESS Report Department of Motor Vehicles Agency of Transportation 120 State street Montpelier, Vermont 05603-0001 **THIS evaluation MUST BE COMPLETED IN FULL OR IT WILL BE RETURNED** ANY MEDICAL CHARGES INCURRED ARE THE RESPONSIBILITY OF THE PATIENT Indicate Reason for evaluation Complete Sections A, B, D & E if you are selecting one of the four reasons below . See front and back of form. Applying for a Vermont License/Permit School Bus Endorsement (Type II) Department Request New/Update MEDICAL Condition Complete ALL Sections if requesting a DISABLED PLACARD OR PLATES.
Indicate Reason for Evaluation Complete Sections A, B, D & E if you are selecting one of the four reasons below. See front and back of form.
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