INSTRUCTIONS: CONNECTICUT PSYCHIATRIC/SUBSTANCE ABUSE MEDICAL REPORT (Form P-142P/S)

When the Connecticut Department of Motor Vehicles receives a report that a driver may be unable to safely operate a vehicle due to abuse of medication, they will be required to receive an evaluation from a physician. The results of this evaluation will be documented and submitted on a form P-142P/S, which can be found on the website of the government of the state of Connecticut.

Connecticut Psychiatric/Substance Abuse Medical Report P-142P/S Step 1: Enter the date of the incident being addressed where indicated.

Connecticut Psychiatric/Substance Abuse Medical Report P-142P/S Step 2: The patient should enter their signature and the date in the first two blank boxes, then turn the form over to the medical professional conducting the evaluation, who will complete the rest of the form.

Connecticut Psychiatric/Substance Abuse Medical Report P-142P/S Step 3: Enter the patient's name in the first blank box, their date of birth in the second blank box, and their telephone number in the third blank box.

Connecticut Psychiatric/Substance Abuse Medical Report P-142P/S Step 4: Enter the patient's address in the fourth blank box.

Connecticut Psychiatric/Substance Abuse Medical Report P-142P/S Step 5: Enter the date of the last patient examination in the fifth blank box.

Connecticut Psychiatric/Substance Abuse Medical Report P-142P/S Step 6: In the next section, indicate the type of medication the patient is taking by placing a check mark next to the applicable medications.

Connecticut Psychiatric/Substance Abuse Medical Report P-142P/S Step 7: In the next section, document up to three medications being taken that are relevant to motor vehicle operation. Enter the name of the medication in the column on the left and the dose taken in the column on the right.

Connecticut Psychiatric/Substance Abuse Medical Report P-142P/S Step 8: Indicate with a check mark whether the patient currently suffers from convulsive seizures. If yes, give the date of their last seizure.

Connecticut Psychiatric/Substance Abuse Medical Report P-142P/S Step 9: Indicate with a check mark whether you believe the patient understands the risk posed by their condition that can affect their operation of a motor vehicle.

Connecticut Psychiatric/Substance Abuse Medical Report P-142P/S Step 10: Complete the rest of the form as instructed.