The DMV Vision Test Illinois Form, known officially as the Vision Specialist Report, is a crucial document used by the Illinois Secretary of State to assess an individual's visual capability for holding a driver's license. This form is filled out by a vision specialist after a comprehensive eye examination of the applicant, detailing their visual acuity, peripheral vision, and any need for corrective measures, such as prescription telescopic lenses. For safe and lawful driving in Illinois, completing and submitting this form accurately is essential. Click the button below to start filling out your form.
In Illinois, obtaining or renewing a driver's license for individuals with vision challenges involves a critical process that includes the submission of a Vision Specialist Report to the Secretary of State. This form is a detailed document designed to assess an applicant's visual acuity and peripheral vision, ensuring they meet the state's criteria for safe driving. It begins with collecting basic applicant information, including name, address, and driver's license number, followed by instructions for the vision specialist conducting the examination. The form thoroughly evaluates visual acuity, both with and without corrective lenses, setting clear standards for unrestricted driving, daylight-only driving, and cases where driving is not advised. Additionally, it assesses peripheral vision, crucial for detecting vehicles and obstacles in a driver's side and peripheral view. For individuals using prescription mounted telescopic lenses, specific sections require completion, noting the lens's power and the wearer’s adaptation to them. The form also includes a section for the vision specialist's observations and recommendations, considering the stability or potential deterioration of the individual's visual condition. By facilitating a structured and comprehensive visual assessment, this form plays a pivotal role in the process, aiming to maintain road safety while accommodating the needs of drivers with visual impairments. Ultimately, the Vision Specialist Report is a testament to Illinois' commitment to ensuring all drivers possess the necessary visual capabilities to navigate its roadways safely.
Secretary of State
I. APPLICANT INFORMATION
State of Illinois
VISION SPECIALIST REPORT
Name
Last
First
Middle
Driver's License Number
Street Address
Birth Date
Sex
Month
Day
Year
❒ M
❒ F
City
County
ZIP Code
Driver Facility Control Number and Date:
II. INSTRUCTIONS TO VISION SPECIALIST
Applicants applying for an Illinois driver's license may be required to pass a vision screening. If the vision standards are not met, the applicant will be referred to a vision specialist. Driver Services employees do not recommend or suggest which registered vision specialist to contact.
Have the applicant sign and date this report in your presence. Place your signature and certificate number in Section VII. Comments may be entered in Section V. Sections VIII to XI (reverse side) must be completed for an applicant who desires to use a prescription mounted telescopic lens arrange- ment. READINGS WHICH INDICATE A PLUS (+) OR MINUS (–) ARE NOT ACCEPTABLE. (EXAMPLE: 20/40-1 OR 20/100+2)
If needed, a supplementary sheet, which has been signed and dated, may be attached to this report.
I authorize release of the report of this examination to the Secretary of State, Driver Services Department, Springfield, Illinois, for confidential use in my driver's record. This report shall remain valid for six months from the examination date shown below.
____________________________________________
_______________________________________________________
Applicant Signature
Telephone Number (Telescopic Lens Wearer Only)
III. ACUITY SECTION
Minimum Visual Screening Standards—Acuity
(For telescopic lens arrangements complete the report in Section VIII)
Vision Specialist Examination Certification
Acuity: –
No restrictions = 20/40 (without corrective lenses)
Acuity
Both
Right
Left
–
Daylight driving only = 20/41 to 20/70
With correction
20/
(with best correction binocular)
Failure = 20/71 or less (binocular)
Without correction
Left and right outside rearview mirror = to or greater than 20/100 (monocular)
IV. PERIPHERAL SECTION
Minimum Visual Screening Standards—Peripheral
Peripheral: –
Monocular = 70° temporal and 35° nasal
(105° total field)
Binocular = 140° total temporal field
Left Eye
Right Eye
Total Field of
Temporal Reading
Vision*
+
=
______________ °
(140° or greater – qualification with no
restrictions. If 139°
or less see below)
*If the total field of vision above equals less than 140° , the applicant may still be able to qualify for a driver's license with restrictions. Screen each eye individually by finding a temporal and a nasal reading. At least one of the eyes must have a minimum temporal reading of 70° and a minimum nasal reading of 35° for a total of 105° in order to qualify with a restriction of both a left and a right outside rearview mirror. If neither eye has at least 70° temporal and 35° nasal, the applicant is not qualified to be licensed to drive in Illinois.
Complete only if received less than 140° total field of vision above:
Temporal
Nasal
Total
_________ °
V.
The specialist will please check all applicable items:
1.
____
Applicant should drive in daylight only.
2.
Applicant would not accept correction.
3.
Corrective lens(es) were accepted, checked and approved.
Date: ___________________________
4. ____ Prescription spectacle mounted telescopic lens arrange-
ment. (See reverse.)
Comments:
VI.
Please check all applicable items:
Annual exam
Condition stable
Condition deteriorating (please explain)
4.
Condition warrants monitoring (please explain)
5. ____ Other (please explain)
If #3, 4 or 5 is marked, please indicate diagnosis and your recommen- dation for re-examination in ____ 6 months ____ 12 months
____ Other
VII.
I certify that I have personally examined the eyes of the above-named individual and that a true record of my examination appears hereon.
Signature __________________________________________________
Certificate No. ______________________________________
Business Address ___________________________________________
Telephone Number __________________________________
Date of Examination _________________________________________
City/ZIP Code _____________________________________
JESSE WHITE • Secretary of State
DSD X-20.10
This Side of Form to be Completed for Prescription Mounted Telescopic Lens Wearers ONLY
Sections I, II, V, VI, VII and the following sections must be completed for prescription spectacle mounted telescopic lens. Applicants who qualify to drive with the use of a Prescription Telescopic Lens Arrangement shall be restricted to driving during daylight hours only and shall be eligible for a Class "D" driver's license only.
VIII. ACUITY SECTION:
Prescription Spectacle Mounted Telescopic Lens(es)
Telescopic lens(es) may not exceed 3X wide angle, or 2.2X standard
Through carrier lenses
Central acuity through the telescopic lens must be 20/40 or better
Through telescopic lenses
Central acuity through the carrier must be 20/100 or better
–Left and right outside rearview mirror = to or greater than 20/100 (monocular vision through telescopic lenses)
IX. PERIPHERAL SECTION:
–Peripheral 140° binocular or monocular 70° temporal and 35° nasal with the prescription spectacle mounted telescopic lens(es) in place and without the use of field enhancers
(140° or greater – qualification with no restrictions.
If 139° or less see below)
X.
– Date the applicant received the telescopic lens arrangement
____________________
– Power of the telescopic lens arrangement
– Is the patient's condition stable?
❒Yes
❒ No
– In your professional opinion, is there any indication that the applicant
may not be capable of safely operating a motor vehicle?
– Indicate any additional comments or restrictions:
XI.
Has the patient successfully completed all the following requirements:
No❒
•The patient has been fitted for a prescription spectacle mounted telescopic lens arrangement and has had this arrangement in his/her possession for at least 60 days prior to the application date.
•The patient has clinically demonstrated the ability to locate stationary objects within the telescopic field by aligning the object directly below the telescopic lens and moving the head down and the eyes up simultaneously.
•The patient has clinically demonstrated the ability to locate a moving object in a large field of vision by anticipating future movement, so that by moving the head and eyes in a coordinated fashion, he/she is able to locate the moving object within the telescopic field.
•The patient has clinically demonstrated the ability to remember what has been observed after a brief exposure, with the duration of the exposure progressively diminished to simulate reduced observation time while driving.
•The patient has experienced levels of illumination which may be encountered during inclement weather or when driving from daylight into areas of shadow or artificial light and the patient has clinically demonstrated the ability to successfully adjust to such changes.
•The patient has experienced walking and riding as a passenger in a motor vehicle so that he/she has practical experience of motion while objects are changing position.
To ensure the Illinois DMV can process your Vision Test form accurately and promptly, please follow these detailed steps to fill it out correctly. This process is essential for applicants requiring a vision examination by a specialist, potentially due to a failure to meet the standard vision screening criteria at the DMV. Once filled, the form aids in determining your eligibility for driving or if any restrictions are necessary.
Upon completion, ensure all sections of the form have been accurately filled out and any necessary supplementary sheets are attached and signed. The completion of this form is crucial for assessing your driving capabilities and determining if any restrictions or additional requirements are necessary for your safety and the safety of others on the road.
What are the vision screening standards for obtaining a driver's license in Illinois?
To obtain a driver's license in Illinois, applicants must meet certain vision screening standards. Without corrective lenses, if both eyes together have an acuity of 20/40 or better, there are no restrictions. If the best corrected vision is between 20/41 to 20/70, driving is limited to daylight hours only. Failing the test means having vision that is 20/71 or worse with both eyes together. Additionally, for those with monocular vision, having a minimum of 20/100 in at least one eye with the use of left and right outside rearview mirrors may be acceptable. These standards ensure that drivers can see well enough to operate a vehicle safely.
Who selects the vision specialist for the DMV Vision Test?
The applicant must choose a registered vision specialist for the DMV Vision Test in Illinois, as the Driver Services employees do not recommend or suggest vision specialists. The selection of a qualified and registered vision specialist rests solely on the applicant, ensuring their freedom to consult with a practitioner of their choice.
Are there any specific requirements for the Vision Specialist Report?
Yes, there are specific requirements for completing the Vision Specialist Report. The applicant must sign and date the report in the presence of the vision specialist, who then must also sign the report, provide their certificate number, and the date of the examination. If the applicant is using a prescription-mounted telescopic lens arrangement, additional information is required, such as the acuity through the telescopic lenses and standard lenses, as well as the peripheral vision readings. Any readings indicating a plus (+) or minus (−) are not acceptable. Comments and supplementary sheets, if needed, must be signed and dated by the vision specialist.
What happens if an applicant fails to meet the minimum visual screening standards?
If an applicant fails to meet the minimum visual screening standards, they might not qualify for a driver's license. However, those with less than the required field of vision may still be eligible for a license with restrictions, such as the requirement to use left and right outside rearview mirrors. For those using telescopic lenses, there are specific criteria to meet, including a certain level of acuity through the lenses and a sufficient field of vision. If applicants cannot meet these standards, they may need to undergo further evaluation or consider alternative transportation options.
How long is the Vision Specialist Report valid?
The Vision Specialist Report is valid for six months from the date of the eye examination. This time frame allows for the processing of driver's license applications and ensures that the vision test results are current and accurately reflect the applicant's visual capabilities. If more than six months have passed since the examination, applicants may need to undergo another vision test to provide up-to-date information.
Filling out the DMV Vision Test Illinois form can be a straightforward process, but there are common errors that individuals often make. These mistakes can lead to unnecessary delays, or worse, the rejection of the form. Being aware of these common pitfalls can help ensure the process is done correctly and efficiently.
In summary, attention to detail and a thorough understanding of the requirements for the DMV Vision Test Illinois form are paramount. By avoiding these common mistakes, applicants and vision specialists can ensure a smoother process and optimize the outcomes for both safety and compliance.
When applying for or renewing a driver's license in Illinois, especially if there's a need for a vision specialist's report due to the DMV Vision Test Illinois form, several other forms and documents might also be required or prove to be useful throughout this process. Each document serves its specific purpose, ensuring that all aspects of a driver’s health, identity, and legal status are correctly represented and up-to-date. Here's a guide to some other forms and documents that are often used along with the DMV Vision Test Illinois form.
Together with the DMV Vision Test Illinois form, these documents ensure a comprehensive evaluation of an applicant's eligibility and capability to safely operate a vehicle under Illinois state law. It's advisable to prepare all necessary paperwork beforehand to streamline the application or renewal process, keeping in mind that specific requirements may vary based on the individual’s circumstances such as age, type of license, and medical conditions.
The DMV Vision Test Illinois form is similar to other health-related forms used by the Illinois Secretary of State, especially those that assess an individual's ability to safely operate a vehicle. Like medical examination forms for commercial driver’s license (CDL) applicants, the Vision Test Illinois form requires detailed information about the applicant’s vision capabilities. Both types of forms require applicants to provide personal information, include sections for professional certification by a specialist, and have strict standards that must be met for the applicant to qualify for the license they are seeking. However, while the CDLO medical form focuses broadly on overall physical and mental fitness to drive, the vision test zeroes in on specific vision standards, such as acuity and peripheral vision.
Additionally, the Vision Test Illinois form shares similarities with forms used for reporting the use of telescopically mounted lenses to the DMV. These forms both necessitate a detailed examination by a vision specialist, who must provide specific measurements of the applicant's vision, including acuity through both carrier and telescopic lenses, and field of vision tests. They also require the specialist's certification that the applicant meets the minimum standards for safe driving with such corrective lenses. Both documents serve to ensure that drivers with vision impairments are assessed rigorously to meet safety standards, but the Vision Test form is tailored specifically toward evaluating the capability to drive with specialized vision enhancement devices.
When time comes to fill out the DMV Vision Test Illinois form, accuracy and thoroughness are key. Navigating this document with care ensures not only compliance but also contributes to the safety of everyone on the road. Here are 6 essential dos and don'ts to consider:
Following these guidelines carefully will help ensure that your vision test form is completed accurately and submitted properly, paving the way for a smooth processing of your driver's license application or renewal. Remember, this is not just about fulfilling a legal requirement; it's also about ensuring the safety of you and other road users.
Many people hold misunderstandings about the vision test required by the Department of Motor Vehicles (DMV) in Illinois, particularly when it comes to the specific form known as the Illinois Vision Specialist Report. Here are ten common misconceptions and the facts that dispel them:
Everyone must take a vision test annually. This is not accurate. The requirement for a vision test is typically at the time of renewing your driver's license, not annually. However, if a vision specialist notes a condition that warrants monitoring, they may recommend a re-examination within a specific timeframe.
The vision test only measures clarity of vision. While acuity or clarity of vision is a significant component of the vision test, the form also requires assessments of peripheral vision, which is crucial for safe driving.
If you fail the vision test, you automatically lose your license. Failing the initial vision screening doesn't instantly mean your license is taken away. Individuals who don't meet the minimum standards will be referred to a vision specialist for a more detailed examination, and there may be corrective measures or devices that can help meet the DMV's requirements.
Wearing glasses or contact lenses will cause you to fail. This is a misconception. The form clearly accommodates results "with correction," meaning that as long as your vision meets the required standards with the aid of glasses or contact lenses, you can pass the vision test.
The form is only for people with poor vision. All applicants for an Illinois driver's license who are required to take a vision screening will have this form filled out, regardless of their vision quality. It assesses whether one's vision falls within or outside DMV standards.
Telescopic lenses are outright banned. The form and regulations provide provisions for individuals using prescription mounted telescopic lenses under specific conditions and with certain restrictions, such as daylight driving only, debunking the myth that telescopic lens users are categorically denied a license.
Field enhancers are allowed for passing the peripheral vision test. The instructions specify that the peripheral vision standards must be met without the use of field enhancers, highlighting the importance of natural, unaided peripheral vision capabilities for licensure.
There's no room for comments or explanations on the form. Section V and the reverse side of the form provide spaces where the vision specialist can include comments, diagnoses, and recommendations, allowing for a nuanced understanding of the applicant's visual abilities.
The form neglects the stability of the applicant's vision condition. There are sections specifically dedicated to the applicant's vision condition, whether it's stable, deteriorating, or requires monitoring, ensuring that the DMV has a comprehensive view of the applicant's visual health.
Plus or minus readings for vision acuity are acceptable. The form clearly states that readings which indicate a plus (+) or minus (–) are not acceptable, underscoring the need for precise and unambiguous, standardized vision measurements.
Understanding these aspects of the Illinois DMV Vision Test can alleviate some concerns and correct misconceptions, ensuring that applicants are better informed about the process and requirements.
Completing and understanding the DMV Vision Test Illinois form is crucial for individuals applying for or renewing their driver's license, especially those needing a prescription telescopic lens for driving. Here are six key takeaways from the form:
Understanding these key aspects of the DMV Vision Test Illinois form can help applicants navigate the process more effectively and ensure they meet all necessary requirements for driving in Illinois.
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