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Outline

The DMV Vision Test Illinois form is an essential document for individuals applying for a driver's license in the state of Illinois, particularly for those who may need to meet specific vision standards. This form collects important applicant information, including the individual’s name, address, and driver’s license number, alongside details about their vision specialist. The process begins with a vision screening, and if the applicant does not meet the required standards, they are referred to a vision specialist for further evaluation. The vision specialist must complete various sections of the form, documenting the applicant's visual acuity and peripheral vision. For those who require prescription telescopic lenses, additional sections must be filled out to ensure compliance with specific visual requirements. Importantly, the form outlines that readings indicating a plus or minus are not acceptable, emphasizing the need for precise measurement. The applicant must also authorize the release of their examination results to the Secretary of State, ensuring that their driving record reflects their vision status. This form remains valid for six months from the examination date, making timely submission crucial for those looking to obtain or renew their driver's license.

Sample - Dmv Vision Test Illinois Form

VISION SPECIALIST REPORT
Month Day Year
M F
Name Last First Middle Driver's License Number
Street Address Birth Date Sex
City County ZIP Code Driver Facility Control Number and Date:
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)
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
)
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:
Please check all applicable items:
1. ____ Annual exam
2. ____ Condition stable
3. ____ Condition deteriorating (please explain)
4. ____ Condition warrants monitoring (please explain)
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 _____________________________________
Secretary of State
I. APPLICANT INFORMATION State of Illinois
JESSE WHITE • Secretary of State
DSD X-20.10
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.
VI.
IV. PERIPHERAL SECTION
III. ACUITY SECTION
II. INSTRUCTIONS TO VISION SPECIALIST
V.
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.
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.
Date the applicant received the telescopic lens arrangement ____________________
Power of the telescopic lens arrangement ____________________
Is the patient's condition stable? Ye s No
In your professional opinion, is there any indication that the applicant
may not be capable of safely operating a motor vehicle? Ye s No
Indicate any additional comments or restrictions:
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)
VIII. ACUITY 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)
* 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
+= +=
_________ ° _________ ° _________ ° _________ ° _________ ° _________ °
IX. PERIPHERAL SECTION:
X.
XI.

Form Information

Fact Name Description
Applicant Information The form collects essential details such as the applicant's name, address, birth date, and driver's license number.
Vision Screening Requirement Applicants may need to pass a vision screening. If they do not meet the standards, they will be referred to a vision specialist.
Minimum Visual Standards To qualify, applicants must achieve a minimum acuity of 20/40 without corrective lenses or 20/70 with correction.
Peripheral Vision Standards Applicants must have a minimum temporal field of 70° and a nasal field of 35° for a total of 105° to qualify for a driver's license.
Governing Law This form is governed by the Illinois Vehicle Code, specifically related to driver licensing and vision requirements.

Detailed Guide for Filling Out Dmv Vision Test Illinois

Completing the DMV Vision Test form in Illinois is an essential step for individuals applying for a driver's license, especially if a vision screening is required. This form helps document the results of the vision examination and provides necessary information to the Secretary of State's office. Follow the steps below to accurately fill out the form.

  1. Begin by entering your personal information in Section I. This includes your name (last, first, and middle), driver’s license number, street address, birth date, sex, city, county, and ZIP code.
  2. In Section II, ensure that the vision specialist signs and dates the report in your presence. This section also includes a note about the release of the examination report to the Secretary of State.
  3. Move to Section III to provide acuity readings. Fill in the visual acuity results for both eyes, with and without corrective lenses. If you have a telescopic lens arrangement, complete the additional details required.
  4. Proceed to Section IV to document the peripheral vision readings. Ensure to provide the necessary measurements for both eyes and total field of vision.
  5. In Section V, the vision specialist will check applicable items regarding your driving capabilities, such as whether you should drive only in daylight or if corrective lenses were accepted.
  6. Section VI requires the vision specialist to check items related to your condition, such as whether it is stable or deteriorating. They should also provide any recommendations for re-examination.
  7. Section VII is where the vision specialist certifies the examination. They need to sign, provide their certificate number, business address, telephone number, and date of examination.
  8. If you are a telescopic lens wearer, complete Sections VIII through XI. These sections will require additional acuity and peripheral vision readings specific to the telescopic lenses.
  9. Finally, review the entire form for completeness and accuracy before submitting it to the appropriate DMV office.

Obtain Answers on Dmv Vision Test Illinois

  1. What is the purpose of the DMV Vision Test Illinois form?

    The DMV Vision Test Illinois form is utilized to assess the visual acuity and peripheral vision of individuals applying for a driver's license in Illinois. If an applicant does not meet the minimum vision standards during the initial screening, they are referred to a vision specialist. This form serves as a record of that examination and includes critical information about the applicant's vision capabilities.

  2. Who needs to complete the vision test?

    Individuals applying for a driver's license in Illinois may be required to undergo a vision screening. If they do not meet the necessary vision standards, they must have the vision specialist complete the DMV Vision Test form. This requirement applies to both new applicants and those renewing their licenses if their vision has changed.

  3. What are the minimum visual screening standards?

    The minimum visual screening standards vary based on whether the applicant has corrective lenses. For those without corrective lenses, a visual acuity of 20/40 is required for unrestricted driving. If an applicant's vision is between 20/41 and 20/70, they may be limited to daylight driving only. A visual acuity of 20/71 or less indicates a failure to meet the necessary standards. Additionally, peripheral vision requirements mandate a minimum of 70° temporal and 35° nasal vision for monocular applicants.

  4. What should a vision specialist include in their report?

    The vision specialist must complete several sections of the form, including the acuity and peripheral sections. They should also provide their signature and certificate number to certify the examination. Comments regarding the applicant's vision condition and recommendations for re-examination should be included if necessary. It is important for the specialist to indicate whether the applicant's condition is stable or deteriorating.

  5. How long is the vision test report valid?

    The DMV Vision Test report remains valid for six months from the date of the examination. This time frame allows applicants to submit their results in a timely manner when applying for or renewing their driver's license.

  6. What if an applicant requires a telescopic lens arrangement?

    Applicants who qualify to drive with a prescription spectacle mounted telescopic lens arrangement must have specific visual standards met, including a central acuity of 20/40 or better through the telescopic lens. They will be restricted to driving during daylight hours only. The vision specialist must complete additional sections of the form specifically addressing the requirements for telescopic lens wearers.

Common mistakes

Completing the DMV Vision Test form in Illinois can be straightforward, but many applicants make common mistakes that can delay their application process. One frequent error is not signing the form in the presence of the vision specialist. The applicant must sign and date the report while the specialist is present. If this step is overlooked, it could lead to rejection of the form.

Another mistake involves incorrect completion of the acuity section. Applicants often fail to provide the correct visual acuity readings. For instance, using a plus (+) or minus (–) sign in the readings is not acceptable. This can lead to confusion and the need for a resubmission. Ensure that the readings are clearly noted without any symbols.

Additionally, some applicants neglect to complete the peripheral vision section properly. Each eye must be assessed individually, and the total field of vision must be calculated accurately. If the readings do not meet the minimum requirements, the applicant may not qualify for a driver's license. It’s essential to double-check these measurements before submission.

Another common oversight is failing to include necessary comments in Section V. If there are any specific conditions or observations that need to be noted, they should be included. Leaving this section blank could result in additional questions or complications later in the process.

Moreover, applicants sometimes forget to check all applicable items in the specialist's certification sections. It’s crucial to mark all relevant conditions, such as whether the applicant should drive only during daylight hours. Missing these details can lead to misunderstandings regarding driving privileges.

Finally, not providing a valid contact number can be a significant mistake. This information is important for any follow-up or clarification needed by the DMV. Ensure that all contact details are accurate and up-to-date to avoid unnecessary delays.

Documents used along the form

When preparing to take the DMV Vision Test in Illinois, several other forms and documents may be required or beneficial. These documents can help ensure a smooth process and provide the necessary information for your application. Below is a list of these forms, along with a brief description of each.

  • Driver's License Application: This form is essential for anyone applying for a driver's license in Illinois. It collects personal information and details about the applicant's driving history.
  • Vision Specialist Report: This report is completed by a certified vision specialist if the applicant does not meet the vision standards. It details the results of the vision examination and any recommendations.
  • Medical Evaluation Form: This document may be required for applicants with certain medical conditions that could affect their ability to drive safely. It provides a comprehensive overview of the applicant's health status.
  • Proof of Identity: Applicants must provide documents that verify their identity, such as a birth certificate or passport. This helps confirm that the person applying for the license is who they claim to be.
  • Proof of Residency: This document, such as a utility bill or lease agreement, shows the applicant's current address. It is necessary to establish residency in Illinois.
  • Social Security Number Verification: Applicants may need to provide their Social Security number or a document verifying it. This is used to confirm identity and eligibility.
  • Vision Screening Results: If the applicant has undergone a vision screening at a location other than a DMV, they may need to present the results. This document confirms whether they meet the required vision standards.
  • Temporary Visitor Driver's License (TVDL) Application: For individuals who are not U.S. citizens, this application allows them to obtain a driver's license in Illinois. It includes additional requirements specific to non-citizens.
  • Application for a Restricted License: If an applicant is seeking a restricted license due to medical or vision issues, this form outlines the specific restrictions and conditions under which they can drive.
  • Parent or Guardian Consent Form: For applicants under the age of 18, this form must be signed by a parent or guardian, giving permission for the minor to obtain a driver's license.

Having these documents ready can streamline the process of applying for a driver's license in Illinois. Each form plays a vital role in ensuring that applicants meet the necessary requirements to drive safely and legally.

Similar forms

The DMV Vision Test Illinois form is essential for applicants seeking a driver's license in Illinois. Several other documents serve similar purposes in assessing an individual's vision capabilities for driving. Here are five documents that share similarities with the DMV Vision Test Illinois form:

  • Vision Screening Certificate: This document verifies that an individual has undergone a vision screening, often required for various licenses or permits. Like the DMV form, it includes the applicant's information and the results of the vision test.
  • Eye Examination Report: An eye examination report details the findings from a comprehensive eye exam conducted by an eye care professional. Similar to the DMV form, it includes visual acuity measurements and may recommend corrective lenses if necessary.
  • Driver's License Application: The application for a driver's license typically includes sections that require information about the applicant's vision. Both documents aim to ensure that individuals meet the necessary vision standards for safe driving.
  • Medical Evaluation Form: This form is often used to assess an individual's overall health and fitness to drive, including vision. It parallels the DMV Vision Test by requiring a professional's assessment and may include recommendations for corrective measures.
  • Vision Specialist Referral Form: This document is used when an applicant is referred to a vision specialist for further evaluation. Similar to the DMV Vision Test, it records the findings of the specialist and the recommendations for the applicant's driving capabilities.

Dos and Don'ts

When filling out the DMV Vision Test form in Illinois, there are important guidelines to follow. Here’s a list of things you should and shouldn’t do:

  • Do ensure all personal information is accurate, including your name and address.
  • Do sign and date the report in the presence of the vision specialist.
  • Do provide your driver's license number and contact information.
  • Do have your vision tested by a certified specialist if required.
  • Do ensure that the vision readings meet the specified standards.
  • Don't leave any sections of the form incomplete; fill out all required parts.
  • Don't use readings that indicate a plus (+) or minus (–); they are not acceptable.
  • Don't forget to check if you need to attach a supplementary sheet for additional information.
  • Don't ignore any instructions regarding the use of telescopic lenses if applicable.
  • Don't hesitate to ask the vision specialist if you have any questions about the process.

By following these guidelines, you can ensure a smoother experience while completing the DMV Vision Test form.

Misconceptions

There are several misconceptions surrounding the DMV Vision Test in Illinois that can create confusion for applicants. Here are seven of the most common misunderstandings:

  • Anyone can take the vision test at any location. Many believe they can take the vision test at any eye care facility. However, the test must be conducted by a registered vision specialist approved by the state.
  • A passing score is the same for everyone. Some think that the vision standards are uniform for all applicants. In reality, the requirements vary based on whether the applicant is using corrective lenses, has monocular vision, or is applying for a specific type of license.
  • Vision tests are only for new drivers. There is a misconception that only new applicants need to undergo the vision test. In fact, anyone renewing their license may also be required to complete a vision screening.
  • Results are valid indefinitely. Many assume that once they pass the vision test, the results are valid forever. However, the report is only valid for six months from the examination date.
  • Only eye doctors can conduct the vision test. Some people believe that only optometrists or ophthalmologists can perform the vision screening. While these professionals can conduct the test, any registered vision specialist can also administer it.
  • Having a prescription for glasses means you automatically pass. There is a belief that simply having corrective lenses ensures a passing score. However, applicants must still meet specific visual acuity standards, even with correction.
  • There are no restrictions for passing applicants. Finally, some think that passing the vision test means they can drive without restrictions. This is not always true, especially for those who qualify with specific conditions, such as needing to drive only during daylight hours.

Understanding these misconceptions can help applicants prepare more effectively for the DMV Vision Test in Illinois. Being informed ensures that you meet all necessary requirements and can proceed smoothly through the licensing process.

Key takeaways

  • When applying for an Illinois driver's license, a vision screening is often required. If the applicant does not meet the vision standards, they must see a vision specialist.

  • It’s essential to have the applicant sign and date the vision test report in the presence of the vision specialist. This ensures the authenticity of the document.

  • Readings that include plus (+) or minus (–) signs are not acceptable. For example, formats like 20/40-1 or 20/100+2 will not be recognized.

  • The report remains valid for six months from the examination date. Make sure to submit it within this timeframe to avoid any issues.

  • If the applicant uses a prescription telescopic lens, additional sections of the form must be completed. This includes specific acuity and peripheral vision standards.