dmv medical examination report form

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0 0 8.523 8.571 re (4) Tj endstream endobj 590 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream ET Improve customer satisfaction with state services, Improve government efficiency and employee engagement, Help keep people safe in their communities and on Pennsylvania's roads. W 0 0 Td HdA VA^ChY%PClqiw(BymbZ}F;OkG 5M! W W endstream endobj 645 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream The DMV is unable to guarantee the accuracy of any translation provided by Google Translate and is therefore not liable for any inaccurate information or changes in the formatting of the pages resulting from the use of the translation application tool. School bus drivers that have a history of coronary artery disease, previous myocardial infarction, congenital heart defects, cardiomyopathy, pericarditis, myocarditis, chronic atrial flutter/fibrillation or valvular heart disease, and individuals who have undergone corrective surgery for congenital heart defects, coronary angioplasty, valve repair/replacement, coronary artery bypass graft surgery, or ablative surgery for paroxysmal supraventricular arrhythmias, may be qualified to drive if the individual annually meets established waiver criteria. Commercial Vehicle Pre-Trip Inspection Checklist. If the Medical Examiner determines that the driver examined is physically qualified to drive a commercial motor vehicle in accordance with the physical qualification standards, the Medical Examiner will complete and provide the driver with a Medical Examiner's Certificate (MEC), Form MCSA-5876. PD)M}eMFXMB_`5aT,wg(+a}a@}xD$kjEK'LL3| q* AND MOTOR VEHICLES . n Proudly founded in 1681 as a place of tolerance and freedom. A Medical Examiner's Certificate is valid for no more than two years. while the individual was under the treating health care providers care, during or concurrent with a nonrecurring transient illness, or. H31. 1 1 6.523 6.571 re W This webpage contains information and instructions to become compliant with these regulations. Application For Approval To Drive With Bioptic Lenses (DLD 98) For licensed vision specialists who dispense bioptic devices. 864 0 obj <>stream If your medical examination report does not indicate your medical examination was performed by an MD, DO, Physician Assistant, Advanced Practice Registered Nurse or a Chiropractor listed on the most current National Registry of Certi!ed Medical Examiners; DMV will not process your certi!cate application or accept your medical examination report . How to submit a Medical Certificate to the Medical Certification UnitEmail: dmv.sm.cdlmedcertunit@dmv.ny.gov Put your first and last name in the subject line. A person who requires a hearing aid to meet the requirements of this paragraph shall also have a speech reception threshold of 40 decibels H. L. or better in the better ear with a hearing aid; achieve a score of 60% or better in a speech discrimination test of phonetically balanced words. 71.3(b)(10) states that a driver is qualified to drive a school bus providing theyhaveno established medical history or clinical diagnosis of seizure disorders or another condition likely to cause loss or impairment of consciousness or loss of ability to drive a school bus safely. Make an appointment with your chosen doctor. Your doctor must use Form MCSA-5876 to fill out your medical examination. Locate contact information for NCDOT employees, local offices, and more. n endstream endobj 627 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 596 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Notice of Transfer and Release of Liability, Special Interest and Personalized License Plates Orders, Preparacin para el examen terico y de manejo, Solicitud de licencia de manejar/tarjeta de identidad, Vehicle & Occupational Licensing Industry News Memos, Vehicle Industry Services Resources & Links, Industry Business Center Case Status Request, Occupational Licensing Status Information System, The History of the Department of Motor Vehicles, Department of Motor Vehicles Strategic Plan: 2021-2026, Small Business and Disabled Veteran Business Enterprise Program, Department of Motor Vehicles Field Office Wait Times Reports, Department of Motor Vehicles Performance Reports, Privacy Policy Statement (Privacy/Security), install the Google Toolbar (opens in new window). Submit this completed medical fitness exam to the DMV when you apply for a NV commercial driver's license. License Plate Application for Mayors, Former Members of the General Assembly or US Congress, Municipal and County Council, and County Coroner. The Department of Motor Vehicles (DMV) website uses Google Translate to provide automatic translation of its web pages. The medical examination form must have all sections that apply to the driver's condition completed in its entirety and address the medical concern (s) for which it was required. If more information is needed on the medical condition, the DMV may require a medical report form completed by their . PLEASE PRINT LEGIBLY. The driving record is analyzed for potential problems that may be related to the physical or mental condition (violations, accidents, suspension . Vehicle or Driver's Records Requests. In addition, 83.4(b) allows a physician to request a waiver if the individual has a strictly nocturnal pattern of seizures or a pattern of seizures occurring only immediately upon awakening and has been established over a period of at least 2 years immediately preceding, with or without medication; a specific prolonged aura accompanied by sufficient warning has been established over a period of at least 2 years immediately preceding, with or without medication; the individual previously had been free from seizure for a 6-month period and the subsequent seizure or seizures occurred as a result of a prescribed change in or removal from medication while under the supervision of a licensed physician. A copy of the report is retained by the physician, the - -. 3 0 0 Td Medical/Vision Examination Form (DPSMV 2015) This form provides medical information concerning an applicant's ability to safely operate a motor vehicle. %%EOF X6ga /Tx BMC Examination Report (to be filled out by the medical examiner) 49 CFR . 2674 0 obj <> endobj Learn the laws and rules of the road in preparation for your drive and knowledge tests. Any discrepancies or differences created in the translation are not binding and have no legal effect for compliance or enforcement purposes. B1ui"7E@C endstream endobj 608 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream f Based upon the information provided, MVD will make a licensing decision. A waiver may be granted providing there has been no more than a single, nonrecurring episode of altered consciousness or loss of bodily control, occurring at least 2 years preceding application, which did not require treatment; or if a seizure disorder has been diagnosed, but the person has been episode-free for at least 5 years preceding application and has not required treatment for at least 5 years preceding application. endstream endobj 586 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream 83.3 outlines the minimum vision standards for driving a vehicle and 71.3(b)(1) outlines the minimum vision standards for school bus drivers. 112 Admin. 9\zffp9k!d%$0!P!hiv@ D 7.704 TL The journey time between Dortmund Airport (DTM) and North Rhine-Westphalia is around 1h 41m and covers a distance of around 96 km. endstream endobj 632 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream A person will not be disqualified if the person has experienced only auras during that period. DC regulations state you must be seizure-free for at least 12 months prior to obtaining a DC DMV driver license. endstream endobj 593 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream These reports are reviewed to determine if the driver requires a re-examination of driving skills or written testing, or medical or psychological evaluation. Driver's Signature: Date: SECTION 2. Before giving this form to your medical professional, complete and sign Sections 1-3. H4 HdO Apply for a license or ID card (including REAL ID). Medical Examination Report Forms collected by FMCSA will be stored in FMCSA's automated National Registry of Certified Medical Examiners System and will be used to monitor the performance of medi- cal examiners listed on the National Registry. If you are a health care provider and would like to request these credentials, please click here toregister. f If any questions arise related to the information contained in the translated website, please refer to the English version. 83.4(a) states that a person who has a seizure disorder will not be qualified to drive unless a licensed physician reports that the person has been free from seizure for at least 6 months immediately preceding, with or without medication. The tested shall use C.I.D. f endstream endobj 642 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream P-MswVLg#v&`!/|(VZ*([f0x}b{n1gE*Pg71'| Once received, DC DMV will review the Medical/Eye Report Form. 83.5(a)(3) states that a person who has periodic episodes of loss of consciousness which are of unknown etiology or not otherwise categorized, unless the person has been free from episode for the year immediately preceding will not be qualified to drive. Get Form 3 @~bJm6v6`hB|cU4AzFc]OE5t Uc>P7_`S3 ^o REPORT OF VISION EXAMINATION SECTION 1 APPLICANT COMPLETES THIS SECTION INSTRUCTIONS: Please complete the driver license number, date of birth, telephone number, name, and address areas of this form. 9\zffp9k!d%$0!P!hiv@ D 0 0 Td Arizona Department of Transportation . endstream endobj 599 0 obj <>/Subtype/Form/Type/XObject>>stream Attachment (s): Medical/Eye Report (English) - 48.8 KB (pdf) Medical/Eye Report (Spanish - Espaol) - 96.0 KB (pdf) P-9K.iCB&`!>TZTDc+0cW8xc\aZ4jw:k}#)qW > /ZaDb 4.6839 Tf ET 7.704 TL Eye Examination Certificate (DP 18) For visual examinations completed by a physician. %PDF-1.7 % q Requesting Removal from Medical Review Program, North Carolina Division of Motor Vehicles, Authority to Release Confidential Medical Report & Release of Claim. 773 0 obj <>/Filter/FlateDecode/ID[]/Index[565 300]/Info 564 0 R/Length 307/Prev 438572/Root 566 0 R/Size 865/Type/XRef/W[1 3 1]>>stream 2126-0006. 1 1 6.522 6.571 re W-22 word lists and masking noise consisting of speech spectrum noise or white noise, which shall be presented in monaural indirect mode45 Azimuth for left ear and 315 Azimuth for right ear; wear the aid and keep it operational at all times when driving the school bus; keep a good spare battery source on their person whenever driving the school bus; and present, at the time of the hearing test, an electroacoustic analysis test report of the hearing aid which indicates that the aid meets manufacturers specifications. endstream endobj 592 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Based on the results of these tests you may be called . H235045VH2T0Tz For DMV questions, call us at Form must be completed by a doctor. Sign the form where indicated. Once the results of 2 consecutive HbA1C tests are 8% or less, the individual may discontinue the additional examination reporting requirements. 2.2802 2.7001 Td ;^=rueY#P(Z9a DqH cXM:{/C0 b :sP-{#UyQu#u pF_B.0 F:!l=*$yPYBX}BHf$s q ;HHD/lQ(k !Ed5,PP;q/X,AAvK[<>>7 * g="2P w@3*P B#CG-k`b?SrY!+=4X>;3&0WA{|u{7kxFU^-3@wh)1,a}v~!G2e. 7.704 TL ), licensed physician's assistant (P.A. 71.3(b)(14) states that a driver is qualified to drive a school bus providing theydonot have a type of tuberculosis in a transmittable stage and has taken the tuberculin test every 2 years as required by section 1418(b) of the Public School Code (24 P. S. 14-1418(b)). /ZaDb 4.6839 Tf You will be notified of the status of your online submission via the email address you provided on the Medical Eye Report . 4.5106 TL As a commercial driver, you may be required to submit a copy of your medical examiner's certificate (MEC) (also called medical or DOT card).. Beginning January 1, 2012 - All CDL applicants engaged in interstate or intrastate commerce and subject to Part 391 must provide an original or copy of their medical examiner's certificate to DMV prior to issuance of a CDL . 71.3(b)(8) states that a person is qualified to drive a school bus providing they haveno established medical history or clinical diagnosis of a respiratory dysfunction likely to impair the ability to drive a school bus safely. In addition, 71.3(b)(6) states that a person who has no established medical history or clinical diagnosis of other cardiovascular disease resulting in syncope, dyspnea, loss or impairment of consciousness, collapse, or congestive cardiac failure is qualified to drive a school bus. q INSTRUCTIONS TO THE DRIVER: Please take this form to the physician most familiar with your medical . ET w\2'b#&3X7h E,ZHsu+{NDjW& um`3!i BT Q endstream endobj 631 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream 83.5(b)(5) and (8) states that a provider can disqualify someone from driving if the provider feels the individual has a mental disorder manifested by the symptoms of inattentiveness to the task of driving because of, for example, preoccupation, hallucination or delusion; contemplation of suicide, as may be present in acute or chronic depression or in other disorders; excessive aggressiveness or disregard for the safety of self or others or both, presenting a clear and present danger, regardless of cause or any other condition that could impair a person's ability to drive safely. Please note that the only change to the forms is the . If the particular medical condition no longer exists, you must submit a final Medical Report Form completed by your physician indicating the condition no longer exists, in order to be removed from the follow-up program with this office. Get Form Disability Forms ITD 3392 Disability License Plates For further assistance, call us at 71.3(b)(2) states that a driver is qualified to drive a school bus providing theyhaveno loss of a foot, a leg, a hand, or an arm; or has been granted a waiver by the Department after competency has been demonstrated through a driving examination administered in accordance with 71.4(b)(2)(ii) and (iii) (relating to drivers examination). P-MswVLg#v&`!/|(VZ*([f0x}b{n1gE1 un{)qG The web pages currently in English on the DMV website are the official and accurate source for the program information and services the DMV provides. 9\zffp9k!d%$0!P!hiv@ D JavaScript Required JavaScript must be enabled to use some features of this site. 1.4036 2.113 Td endstream endobj 640 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream In addition, 71.3(b)(9) states that a driver is qualified to drive a school bus providing he/she has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease likely to impair the ability to drive a school bus safely. DL 51, Medical Examination Report fo commercial Driver Fitness Determination. It looks like your browser does not have JavaScript enabled. P-MsVLg#v&`!/|(VZz.P*GQap+3^`^w&"f2 un{)qG O H4 Q endstream endobj 638 0 obj <>/Subtype/Form/Type/XObject>>stream 0.749023 g 0 0 Td @ /Tx BMC endstream endobj 605 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream 7.704 TL If there are any cognitive deficits noted above, please provide the results of a Mini Mental State Exam (MMSE) or a Montreal Cognitive Assessment (MoCA):_____ . MV-73. We will send you the forms at the time they are required. n endstream endobj 598 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream EMC endstream endobj 595 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream HdA VA^ChY%PClqiw(BymbZ}F;OkG 5M! Hd11$m*MSGGNz #`f7Hc}06%=*y4|od[q1 nZvp2bX1a]I(RR,'E reports on a regular basis. 2.2798 2.6995 Td Requests for Medical Evaluations. W (The medical examiner must review and discuss with the driver any "yes" answers and potential hazards of medications, including over-the-counter medications, while driving. endstream endobj 607 0 obj <>/Subtype/Form/Type/XObject>>stream 0 0 Td Chapter 83 - Medical Regulations for Drivers, other than School Bus Drivers, Reporting Drivers with Diabetes Mellitus Frequently Asked Questions, Chapter 71 - School Bus Driver Medical Regulations. Bill of sale (PDF 193K) (Not to be used as an assignment of ownership for a Titled vehicle). Department of Motor Vehicles Performance Reports. H4 0 0 Td 0 0 Td Code APPLICANT . Purpose: Medical Examination Report. The specialist may ask additional questions, require a physician's statement, or require you to take a driving, written, and vision test. ET endstream endobj 615 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Our mailing address is 3101 Mail Service Center, Raleigh NC 27699-3101. HdA VA^ChY%PClqiw(BymbZ}F;OkG 5M! endstream endobj 636 0 obj <>/Subtype/Form/Type/XObject>>stream 83.4(c) also requires providers who treat a person who has experienced a single seizure to also report that individual to the Department. H4 Resources: Language Assistance Services (PDF) Keeping Active When I can No Longer Drive (PDF) Medical Reporting and PennDOT Review Process (PDF) Medical Reporting FAQ. H4 endstream endobj 603 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream H235045VH2T0Tz& Google Translate is a free third-party service, which is not controlled by the DMV. (4) Tj Report of Vision Examination (DL 62) California 6 hours ago REPORT OF VISION EXAMINATION SECTION 1 APPLICANT COMPLETES THIS SECTION INSTRUCTIONS: Please complete the driver license number, date of birth, telephone number, name, and address areas of this form. 5050. Refer to the below links to Chapters 83 & 71 for a comprehensive list of the minimum vision standards. 83.5(b)(1), (2), and (3) states that a provider can disqualify someone from driving if the provider feels the individual has a loss of a joint or extremity as a functional defect or limitation; an impairment of the use of a joint or extremity as a functional defect or limitation, if the condition has lasted or is expected to last longer than 90 days; rheumatic, arthritic, orthopedic, muscular, vascular or neuromuscular disease, if the condition has lasted or is expected to last longer than 90 days. f 0 0 8.522 8.57 re endstream endobj 580 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Presented at 50 decibels H. L. + 12 decibels S/NAverage sound levels plus background noise. 1 1 7.5751 7.041 re In recording distance vision, use 20 feet as normal. Loss of Attention, Awareness, or Consciousness of Unknown Etiology. 7.704 TL If the report satisfies our concerns, this may be all that is required. (4) Tj W Q The Federal Motor Carrier Safety Administration requires that interstate commercial motor vehicle drivers maintain a current Medical Examiner's Certificate (MEC), Form MCSA-5876 to drive. Must be completed by a medical professional. (4) Tj 2.2797 2.7 Td 2.2802 2.7 Td endstream endobj 569 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream q ADOT. HD)MmVLg#,v&`!/\RQ96rR}aW|_ptoYj;}55DZOd)I+=' T Wisconsin Department of Transportation Medical Review PO Box 7918, Madison, WI 53707-7918 Telephone: (608) 266-2327 FAX: (608) 267-0518 Email: dmvmedical@dot.wi.gov Please send notification in writing to: Secretary of State Medical Review Unit 2701 S. Dirksen Pkwy. 649-F Medical Examination Report for Commercial Driver Fitness Determination Medical exam form you must provide to the Office of Motor Vehicles when applying for a LA commercial driver's license. endstream endobj 609 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream @~bKX"_xi1JZJe9p`trs_];n%/0FL %^_o . 343 Wis. Stats. install the Google Toolbar (opens in new window) . 0 0 Td W n ET B1ui"7E@C You must sign and date the authorization line. BT Law enforcement officers who have observed drivers . HdO endstream endobj 594 0 obj <>/Subtype/Form/Type/XObject>>stream Medical Advisory Board. X6ga 3 4.5106 TL %%EOF Q ET B1ui"7E@C endstream endobj 578 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Get Form Open the form. A person who is required to wear a hearing aid to meet the standards of this paragraph shall be tested by an audiologist or a licensed physicianM.D. If you should lose the wallet-sized Medical . Many drivers who file a Medical Examination Report MV3644 or Certificate of Vision Examination by Competent Authority MV3030V are found to meet medical standards for licensing. /Tx BMC Renewal Processing Times. 1 1 6.522 6.57 re 4.5106 TL DMV may require a driver to provide a Medical Examination Report MV3644 or a Certificate of Vision Examination by Competent Authority MV3030V , take the signs, knowledge and/or skills tests, or any combination of these. 71.3(b)(12) states that a driver is qualified to drive a school bus providing theyhaveno hearing loss greater than 40 decibels in the better ear, without a hearing aid, at frequencies of 500, 1,000, and 2,000 Hz. /ZaDb 4.6839 Tf 0.749023 g endstream endobj 643 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 604 0 obj <>/Subtype/Form/Type/XObject>>stream BT Loss of Consciousness of Unknown Etiology. 71.3(b)(4) states that a person who has no established medical history or clinical diagnosis of diabetes mellitus currently requiring use of insulin or other hypoglycemic medication is qualified to drive. 71.3(b)(5) states that a person who has no established medical history or clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency or pacemaker insertion is qualified to drive a school bus without applying for the School Bus Driver Cardiovascular Waiver. endstream endobj 613 0 obj <>/Subtype/Form/Type/XObject>>stream Research Studies & Reports. 2824 0 obj <>stream 9\zffp9k!d%$0!P!hiv@ D In addition, a driver is qualified providing he/she has no impairment of a hand or finger likely to impair prehension or power grasping, or has been granted a waiver by the Department after competency has been demonstrated through a driving examination administered in accordance with 71.4(b)(2)(ii) and (iii). endstream endobj 628 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC Medical Examination Report Medical examination form required by the AZ Motor Vehicle Division when applying for your CDL. Box 173350 Denver, CO 80217-3350 FAX: (303) 205-8301 Confidential Medical Examination Report Driver/Patient Section Patient Last Name First Name Middle Initial Street Address City State ZIP . Medical Card Requirement. BT 649-F Medical exam form Idaho commercial driver's license applicants must submit to the DMV. EMC Operated by Dortmunder Stadtwerke Bus, DSW21-Dortmunder Stadtwerke AG and National Express . Hd ^8@ D$YF8sh(P`Z~}*~2\jEea(:|\3qN(7mqWBW]+G!&s HA{bM~?O=S{_~v;/UFS f;V'7kw$q^7Zz!W:;"lk'y^ON=:]d"wK!h[^v;`h`x(*/n4b}V3'raBtp0Z94RF.0B9viDdTMSjtt&gGX8S :Pcne8Y3BAL&/MHNoNKvLRMl6fsSm[w*9bG iC^'KOX4$"XXgZ15#q&-ld+l+G*xlbu%"gjjQ'W7d7yr3hSCQ}oz;yGzE6tuOHUB}mEvvyw2M(Iwguc)L5Q&s;x9js_o]A"VeXXeLAAK(_ }Us1VO = Once your doctor fills out the paperwork, you need to upload your medical certification through Connecticut's Online Medical Certification System. 3 endstream endobj 574 0 obj <>/Subtype/Form/Type/XObject>>stream This translation application tool is provided for purposes of information and convenience only. 1 1 7.5751 7.642 re _53# MVD Services. B1ui"7E@C Report visual acuity as a ration with 20 as numerator and the 0 0 Td %PDF-1.5 % Our online ordering system makes it easy. 1 1 6.523 6.571 re FMCSA Form MCSA-5871 (Vision Evaluation Form) . those items which require follow-up information and/or evaluation from a prior examination. ^rp "Ot ta8R.1(|Cyf5{W%:Oom>[6,u *)L69WD Reporting of Medical Conditions Affecting Driver Safety (PDF) Talking with Older Drivers (PDF) Q (Form is valid for 180 days from date of exam) Are you the primary care provider for this patient Yes No endstream endobj 572 0 obj <>/Subtype/Form/Type/XObject>>stream Refer to the above link to Chapter 71 for more information. (919) 715-7000, 3101 Mail Service Center @ 9\zffp9k!d%$0!P!hiv@ D EMC (4) Tj endstream endobj startxref Search form. DMV can only accept a Medical Examiner's Certificate (MEC), MCSA - 5876, also known as a "medical card" or "DOT card". 4.5106 TL State of California Department of Motor Vehicles. [x 0 #e/ It is the responsibility of the driver to report to MVD any medical condition that may affect the ability to operate a motor vehicle safely. To translate this page, please endstream endobj 616 0 obj <>/Subtype/Form/Type/XObject>>stream [x 0 #e/ 0.749023 g 1 1 7.5751 7.641 re BT endstream endobj 581 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Search . OMB No. 83.5(b)(6) states that a provider can disqualify someone from driving if the provider feels the individual has periodic episodes of loss of attention or awareness, which are of unknown etiology or not otherwise categorized, unless the person has been free from episode for the year immediately preceding, as reported by a licensed physician.
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