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New York State Department of Motor Vehicles PHYSICIAN’S STATEMENT FOR MEDICAL REVIEW UNIT To Our Driver License Customer: Use this form to report medical, physical, mental or a combination of such conditions to the Me
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Document Date: 2014-07-31 04:29:34


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File Size: 142,67 KB

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City

State City / /

MedicalCondition

loss of consciousness / Mental disorder / neuromuscular disease / Dementia / disorder / unconsciousness / Epilepsy/convulsive disorder / Syncope/fainting/dizziness / Head trauma/tumor / Sleep disorder / Stroke / Diabetes / /

Organization

New York State Department / Department of Motor Vehicles / Medical Review Unit / /

Position

Driver / specialist / Dr. _ / care physician / psychiatrist /psychologist / physician assistant / physician /nurse / qualified specialist / Motor Vehicles PHYSICIAN / Neurologist / YOUR PHYSICIAN/NURSE PRACTITIONER Physician/Nurse / nurse / /

ProvinceOrState

New York / /

Technology

MRI / /

URL

www.dmv.ny.gov / /

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