The DMV Vision Test Illinois form is a critical document required for individuals applying for a driver's license in Illinois. This form facilitates a vision screening process to ensure that applicants meet necessary visual standards for safe driving. If an applicant does not meet these standards, they will be referred to a qualified vision specialist for further evaluation.
In Illinois, the DMV Vision Test form serves as a crucial tool for assessing an applicant's visual capabilities before they can obtain a driver's license. This form is primarily designed for individuals who may not meet standard vision requirements and need to consult a vision specialist. The form collects essential personal information, including the applicant's name, address, date of birth, and driver's license number. It outlines specific instructions for vision specialists, emphasizing the importance of accurate vision assessments. The form also details the minimum visual standards that applicants must meet, including acuity and peripheral vision requirements. For those who require prescription telescopic lenses, additional sections are included to ensure that their vision meets the necessary criteria for safe driving. The report must be signed by both the applicant and the vision specialist, affirming that a thorough examination has been conducted. This comprehensive approach ensures that all drivers on Illinois roads are equipped with the vision necessary to navigate safely and responsibly.
What is the purpose of the DMV Vision Test Illinois form?
The DMV Vision Test Illinois form is used to assess an applicant's vision capabilities when applying for a driver's license in Illinois. If an applicant does not meet the required vision standards during the initial screening, they will be referred to a vision specialist for further evaluation. This ensures that all drivers on the road meet the necessary visual acuity and peripheral vision requirements to drive safely.
Who needs to fill out this form?
Applicants who are applying for a driver's license in Illinois may need to complete this form if they do not pass the initial vision screening. Additionally, individuals who have specific vision conditions or use prescription telescopic lenses will also need to have this form filled out by a qualified vision specialist to determine their eligibility for a driver's license.
What are the minimum visual standards for passing the vision test?
The minimum visual standards for passing the vision test in Illinois are as follows: without corrective lenses, an applicant must have a visual acuity of 20/40 or better. If corrective lenses are used, the best corrected vision must also meet the same standard. For peripheral vision, monocular applicants need at least 70° temporal and 35° nasal vision, while binocular applicants must have a total field of 140° or more. If these standards are not met, restrictions may apply, or the applicant may not qualify to drive.
What should I do if I require a prescription telescopic lens?
If you require a prescription telescopic lens, you must have the vision specialist complete specific sections of the DMV Vision Test form. This includes documenting your acuity with and without the telescopic lenses and assessing your peripheral vision. It is important to note that those who qualify to drive with telescopic lenses will be restricted to daylight driving only and will be eligible for a Class "D" driver's license.
How long is the vision test report valid?
The vision test report remains valid for six months from the date of examination. It is essential to ensure that the report is submitted within this timeframe to avoid any delays in obtaining your driver's license.
Can I attach additional information to the form?
Yes, if necessary, you can attach a supplementary sheet to the DMV Vision Test form. This may be useful for providing additional comments or details regarding your vision assessment. Just ensure that any attached documents are signed and dated, as this helps maintain the integrity of your application.
Incomplete Personal Information: Many applicants fail to provide all required personal details, such as their full name, driver’s license number, or birth date. Omitting this information can delay processing.
Incorrect Acuity Readings: Some individuals mistakenly enter acuity readings that include plus (+) or minus (–) signs. This is not acceptable. Accurate entries are crucial for meeting vision standards.
Missing Signatures: Applicants often forget to sign and date the report. This oversight can lead to rejection of the application, as signatures are essential for validation.
Failure to Complete All Sections: Incomplete sections can be a significant issue. Each relevant section must be filled out fully, especially if the applicant uses a telescopic lens arrangement.
Ignoring Instructions: Many applicants overlook specific instructions for vision specialists. Not following these guidelines can result in incorrect evaluations and potential disqualification.
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.
When filling out the DMV Vision Test Illinois form, it is important to follow specific guidelines to ensure accuracy and compliance. Here are eight things you should and shouldn't do:
When applying for a driver's license in Illinois, various forms and documents may be required alongside the DMV Vision Test form. These documents help ensure that applicants meet the necessary standards for safe driving. Below is a list of commonly used forms that accompany the vision test.
These forms and documents work together to ensure that all applicants are properly assessed and qualified for driving in Illinois. Having the correct paperwork ready can streamline the application process and help avoid delays.
In Illinois, applicants for a driver's license may be required to pass a vision screening. If they do not meet the vision standards, they must see a vision specialist.
While applicants can choose a vision specialist, the Secretary of State does not recommend specific specialists. It's essential to find a registered professional.
The report from the vision test is only valid for six months from the examination date. Applicants need to be aware of this time frame.
While 20/40 is a minimum standard without corrective lenses, applicants can still qualify with different results under specific conditions, such as using corrective lenses.
Peripheral vision is crucial. Applicants must meet specific requirements for both monocular and binocular peripheral vision to qualify for a license.
The vision test assesses both acuity and peripheral vision. Both aspects are necessary for safe driving.
Applicants who do not meet the minimum standards may still qualify for a license with restrictions, such as only driving during daylight hours.
For those using prescription mounted telescopic lenses, specific guidelines apply. These lenses must meet certain standards to be acceptable.
Both the applicant and the vision specialist must sign the report. This ensures that the examination was conducted properly.
Different standards apply based on whether an applicant uses corrective lenses or has specific conditions. Each case is evaluated individually.
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