INSTRUCTIONS: CONNECTICUT EYE CARE PROFESSIONAL'S MEDICAL REPORT (Form P-142OP)

In order to receive a Connecticut license to operate a public service motor vehicle or service bus, you must have your vision examined by an eye care professional. Your examination is documented using a form P-142OP, which can be found on the website of the government of the state of Connecticut.

Connecticut Eye Care Professional's Medical Report P-142OP Step 1: Enter the date of the incident being addressed in the top right-hand corner.

Connecticut Eye Care Professional's Medical Report P-142OP Step 2: The patient should enter their signature in the first blank box and the date in the second blank box. The form should then be given to the medical professional for completion.

Connecticut Eye Care Professional's Medical Report P-142OP Step 3: Enter the patient's name in the third blank box.

Connecticut Eye Care Professional's Medical Report P-142OP Step 4: Enter the patient's date of birth in the fourth blank box.

Connecticut Eye Care Professional's Medical Report P-142OP Step 5: Enter the patient's telephone number in the fifth blank box.

Connecticut Eye Care Professional's Medical Report P-142OP Step 6: Enter the patient's street address, city, state and zip code in the sixth blank box.

Connecticut Eye Care Professional's Medical Report P-142OP Step 7: Enter the date of the last examination in the seventh blank box.

Connecticut Eye Care Professional's Medical Report P-142OP Step 8: Enter the patient's visual acuity information for both eyes where indicated.

Connecticut Eye Care Professional's Medical Report P-142OP Step 9: Indicate with a check mark whether the patient requires corrective lenses for driving.

Connecticut Eye Care Professional's Medical Report P-142OP Step 10: If both eyes are present, enter the uninterrupted binocular peripheral visual field in the horizontal median where indicated.

Connecticut Eye Care Professional's Medical Report P-142OP Step 11: If only one eye is present, enter the uninterrupted monocular peripheral visual field in the horizontal median where indicated.

Connecticut Eye Care Professional's Medical Report P-142OP Step 12: If the patient's best corrected vision is 20/70 or worse, give a written explanation of the cause where indicated.

Connecticut Eye Care Professional's Medical Report P-142OP Step 13: Answer all remaining questions on the form as instructed.

Connecticut Eye Care Professional's Medical Report P-142OP Step 14: Sign and date the bottom of the form, as well as providing your telephone number and your medical professional license number.