Get Dmv Vision Test Illinois Form

The DMV Vision Test Illinois form is a crucial document for individuals applying for a driver's license in Illinois. This form is used to report the results of a vision screening, ensuring that applicants meet the necessary visual standards for safe driving. If you need to fill out this form, click the button below to get started.

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The DMV Vision Test Illinois form is a crucial document for individuals seeking to obtain or renew a driver's license in Illinois. This form is designed to assess the visual acuity and peripheral vision of applicants, ensuring they meet the necessary standards for safe driving. It includes sections for applicant information, instructions for vision specialists, and detailed visual acuity and peripheral vision requirements. Vision specialists play a key role in this process, as they are responsible for conducting the examination and certifying the results. The form outlines minimum visual standards, such as acuity measurements and peripheral field requirements, which must be met for both binocular and monocular vision. Additionally, the form addresses specific provisions for applicants using prescription telescopic lenses, detailing the unique standards applicable to them. The completion of this form is essential not only for the applicant's eligibility but also for the safety of all road users. It must be signed by both the applicant and the vision specialist, and is valid for six months from the date of examination. Understanding the requirements and processes outlined in the DMV Vision Test Illinois form is vital for anyone navigating the driver's licensing process in the state.

Document Breakdown

Fact Name	Description
Purpose of the Form	This form is used to assess the vision of applicants seeking an Illinois driver's license. It ensures that individuals meet the necessary vision standards for safe driving.
Vision Standards	Applicants must achieve a minimum visual acuity of 20/40 without corrective lenses. For those using telescopic lenses, specific acuity and peripheral vision standards apply.
Validity Period	The vision report remains valid for six months from the date of examination. This ensures that the information reflects the applicant's current vision status.
Governing Law	The vision screening requirements are governed by Illinois law, specifically under the Illinois Vehicle Code, which outlines the necessary standards for safe driving.

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Misconceptions

Misconceptions about the DMV Vision Test in Illinois can lead to confusion for applicants. Here are seven common misunderstandings:

1. Everyone must take the vision test. Not all applicants are required to take the vision test. It depends on individual circumstances, such as age or previous eye conditions.
2. A perfect score is necessary to pass. While meeting certain visual standards is important, not every applicant needs to have perfect vision. There are acceptable ranges for different conditions.
3. The test can be taken anywhere. The vision test must be conducted by a registered vision specialist, not just any eye doctor or facility.
4. If you fail, you cannot drive at all. Failing the vision test does not mean you cannot drive. Some applicants may qualify for a restricted license based on their specific vision capabilities.
5. The test results are only valid for a short time. The results of the vision test remain valid for six months from the date of examination, allowing some flexibility for applicants.
6. Telescopic lenses are not allowed. Prescription telescopic lenses can be used, but there are specific requirements that must be met, including restrictions on driving hours.
7. You do not need to bring anything to the test. Applicants should bring necessary documentation, including their driver's license number and any previous vision reports, to the vision specialist.

Understanding these misconceptions can help applicants prepare better for the vision test process in Illinois.

Example - Dmv Vision Test Illinois Form

						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
								❒ 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/	20/	20/
	(with best correction binocular)
–	Failure = 20/71 or less (binocular)		Without correction		20/	20/	20/
–	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	(For telescopic lens arrangements complete the report in Section VIII)
	(105° total field)	Vision Specialist Examination Certification
–	Binocular = 140° total temporal field	Left Eye		Right Eye		Total Field of
	Temporal Reading			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:

	Left Eye			Right Eye
Temporal	Nasal	Total	Temporal	Nasal	Total
_________ °	+	=	_________ °	+	=
_________ °	_________ °	_________ °	_________ °	_________ °	_________ °

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:

1.	____	Annual exam
2.	____	Condition stable
3.	____	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:
	Minimum Visual Screening Standards—Acuity	Vision Specialist Examination Certification
	Prescription Spectacle Mounted Telescopic Lens(es)
		Acuity	Both	Right	Left
–	Telescopic lens(es) may not exceed 3X wide angle, or 2.2X standard	Through carrier lenses	20/	20/	20/
–	Central acuity through the telescopic lens must be 20/40 or better	Through telescopic lenses	20/	20/	20/
–	Central acuity through the carrier must be 20/100 or better	Without correction	20/	20/	20/

–Left and right outside rearview mirror = to or greater than 20/100 (monocular vision through telescopic lenses)

IX. PERIPHERAL SECTION:

Minimum Visual Screening Standards—Peripheral

Prescription Spectacle Mounted Telescopic Lens(es)

–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

Vision Specialist Examination Certification

Left Eye	Right Eye	Total Field of
Temporal Reading	Temporal Reading	Vision*
	+	=
______________ °	______________ °	______________ °
		(140° or greater – qualification with no restrictions.
		If 139° or less see below)

Complete only if received less than 140° total field of vision above:
	Left Eye			Right Eye
Temporal	Nasal	Total	Temporal	Nasal		Total
_________ °	+	=	_________ °	+		=
_________ °	_________ °	_________ °	_________ °	_________ °		_________ °

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			❒Yes	❒ No
may not be capable of safely operating a motor vehicle?			❒Yes	❒ No
– Indicate any additional comments or restrictions:

XI.
Has the patient successfully completed all the following requirements:				❒Yes	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.

Dos and Don'ts

When filling out the DMV Vision Test Illinois form, consider the following guidelines:

Do ensure all personal information is accurate and complete.
Do have a vision specialist sign and date the report in your presence.
Do use clear and legible handwriting when filling out the form.
Do check the vision standards carefully before submission.
Don't leave any sections blank; all relevant sections must be completed.
Don't use plus (+) or minus (–) indicators for vision readings; they are not acceptable.
Don't forget to attach any supplementary sheets if necessary.
Don't submit the form without ensuring that the vision specialist has completed their certification.

Dmv Vision Test Illinois: Usage Instruction

Filling out the DMV Vision Test form for Illinois is an important step in the process of obtaining or renewing a driver's license. This form must be completed accurately to ensure that all necessary information is provided. Here are the steps to fill out the form correctly.

Start by entering your name in the designated fields: Last, First, and Middle.
Fill in your Driver's License Number.
Provide your street address, including the city, county, and ZIP code.
Enter your birth date in the format of Month, Day, Year.
Select your sex by marking either M or F.
If applicable, include the Driver Facility Control Number and Date.
Have the applicant sign and date the report in your presence.
As the vision specialist, place your signature and certificate number in Section VII.
Complete the Acuity Section by providing the necessary visual acuity readings for both eyes.
In the Peripheral Section, record the total field of vision for each eye.
Check all applicable items in Section V and Section VI regarding the applicant's vision and any recommendations.
Fill out the date of examination and your business address and telephone number in Section VII.
If the applicant uses a prescription telescopic lens, complete Sections VIII to XI as required.

After completing the form, review it to ensure all information is accurate and legible. Once everything is confirmed, submit the form as instructed by the DMV or relevant authority.