CERTIFICATE OF VISION - oregon.gov

1 CERTIFICATE OF VISION . (ORS ). The medical information in this report is confidential and will be used by the Driver and Motor Vehicle Services (DMV). only to determine the qualifications of the person to operate motor vehicles. INSTRUCTIONS TO APPLICANT: 1. Take this CERTIFICATE to the licensed VISION specialist (optometrist or ophthalmologist) of your choice and have a VISION examination. 2. After the VISION specialist conducts the examination, dispenses new prescription lenses if necessary, and completes the CERTIFICATE : z Return completed form to a local DMV office, or z FAX (503) 945-5329 or mail completed form to DMV Driver Safety Unit, 1905 Lana Ave NE, Salem, OR 97314. z For Valid With Previous Photo License, return completed VISION form along with your application in the enclosed envelope.

2 NOTE X Failure to comply with this requirement may result in suspension of your driving privileges. T APPLICANT or DMV EXAMINER COMPLETE THIS SECTION T. LAST NAME (PLEASE PRINT) FIRST NAME MIDDLE NAME. OFFICE USE ONLY. TSR ID DATE STAMP. ODL / CUSTOMER NUMBER DATE OF BIRTH. T VISION SPECIALIST COMPLETE THIS SECTION T. Submission of this form may result in an immediate suspension of driving privileges if the applicant does not meet VISION standards. REPORT OF EXAMINATION BY VISION SPECIALIST. (Refer to VISION Standards on Page 2). Without With Best Possible Corrective Lenses Correction Right Eye 20 / 20 /. Left Eye 20 / 20 /. Both Eyes 20 / 20 /. Check all that apply: Applicant's VISION meets the eyesight standard stated in OAR 735-062-0050 (Refer to standards on Page 2): without corrective lenses with corrective lenses Driving should be restricted to daylight hours only.

3 Applicant has a progressive VISION impairment and DMV should require the applicant to submit updated VISION information in: 6 months 1 year Applicant's VISION does not meet the eyesight standard stated in OAR 735-062-0050. Does not meet standards for: acuity field of VISION Comments: Please include any VISION -related diagnoses that could affect the applicant's ability to drive safely or any other recommendations. VISION SPECIALIST'S NAME (PLEASE PRINT) SPECIALTY LICENSE or CERTIFICATE #. MAILING ADDRESS TELEPHONE # FAX #. CITY STATE ZIP CODE COUNTY. SIGNATURE OF VISION SPECIALIST DATE SIGNED DATE OF EXAMINATION (MUST be within last 6 months). X. 735-24 (7-17) Page 1 STK# 300007. STANDARD FOR VISION SPECIALISTS. (ophthalmologist or optometrist). OAR 735-062-0050. Eyesight Check Content and Standards (1) The Driver and Motor Vehicle Services Division of the Department of Transportation (DMV) will check the following items when testing the eyesight of applicants for a driver permit or driver license: (a) Acuity; and (b) Field of VISION .

4 (2) To qualify for driving privileges, a person must meet the following eyesight standards: (a) Acuity: The person must have a visual acuity level of 20/70 or better when looking through both eyes (or one eye if the person has usable VISION in only one eye). A person with usable VISION in both eyes will meet the standard if the visual acuity level in one eye is worse than 20/70 so long as the visual acuity level in the other eye is 20/70 or better;. (b) Field of VISION : The person must have a field of VISION of at least 110 degrees; and (c) Daylight driving only: DMV will restrict the person's driving privileges to daylight driving only if the person's best eye is worse than 20/40 and no worse than 20/70 unless, in the written opinion of a licensed VISION specialist (ophthalmologist or optometrist), the person's driving should not be restricted.

5 DMV will not restrict a person whose VISION is 20/40 or better to daylight driving only unless, in the written opinion of a licensed VISION specialist, such restriction is warranted. (3) A person may meet the eyesight standards with the use of a corrective lens or lenses. When a person must use a corrective lens or corrective lenses to meet the eyesight standards, DMV will restrict the person to driving only when wearing corrective lenses. (4) DMV may authorize a person to use a bioptic telescopic lens on a corrective lens, as defined in OAR. 735-062-0310(1) if, when looking through the carrier lens and not the telescopic device, the person meets the eyesight standards set forth in section (2) of this rule. ---Please see "Persons with Limited VISION " section below for additional Persons with Limited VISION - ORS - ORS oregon laws specify VISION qualification and licensing steps pertaining to persons with a Limited VISION Condition that are different than the standards under OAR 735-062-0050.

6 Limited VISION condition means visual acuity in the better eye with best lens correction that is no better than 20/80 and no worse than 20/200. The visual requirement is 120 degrees horizontally and 80 degrees vertically. (DMV form 735-24A required.). For additional information write to: For Official Use Only DMV. DMV DRIVER SAFETY UNIT Ref#: _____ Action: _____. 1905 LANA AVE NE. SALEM, OR 97314-4120 Date: _____ MV#: _____. OR CALL . (503) 945-5083. Telecommunication Device for the Hearing Impaired - Statewide relay: 7-1-1. Page 2.