The California DMV DL 546 form is a health questionnaire designed for individuals applying for or renewing their driver's license. This form helps assess any medical conditions that may affect a person's ability to drive safely. To ensure compliance and maintain road safety, it is essential to fill out this form accurately every two years.
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When it comes to obtaining or renewing a driver's license in California, the DMV DL 546 form plays a crucial role in ensuring that drivers meet the necessary health standards. This health questionnaire is designed to assess any medical conditions that could potentially impact a person's ability to operate a vehicle safely. Applicants are required to answer a series of health-related questions, which cover a range of issues from vision and hearing impairments to chronic conditions like diabetes and cardiovascular diseases. Importantly, if an applicant answers "yes" to any of the questions, the DMV may need to consult with a physician to evaluate the individual's medical qualifications before issuing a license. Additionally, this form must be completed every two years, making it essential for drivers to stay informed about their health and its implications for driving. The DL 546 not only serves as a protective measure for public safety but also emphasizes the responsibility of drivers to disclose pertinent health information. Understanding the requirements and implications of this form is vital for anyone looking to maintain their driving privileges in California.
*DL546*
HEALTH QUESTIONNAIRE
546
DMV USE ONLY
Updated by
DO NOT use this form for Commercial Licensing Requirements. The applicant completes this form.
INSTRUCTIONS: Please check “Yes” or “No” to each question and explain any “Yes” answer(s) in the space provided on the bottom of the form, or on another piece of paper. If you are not sure how to answer a specific question, please contact your physician for assistance. “Yes” answers to any question may require DMV to contact your physician about your medical qualifications before DMV can issue you a license. You must submit a completed health questionnaire every two years.
SECTION 1 — PLEASE TELL US ABOUT YOURSELF
TRUE FULL NAME
DATE OF BIRTH
DRIVER LICENSE NUMBER
ADDRESS
CITY
STATE
ZIP CODE
DAYTIME PHONE
(
)
SECTION 2 — HEALTH QUESTIONS
YES NO
1.
Do you have difficulty recognizing the colors of red, green, and amber used in traffic signal lights and devices?
2.
Is your side (peripheral) vision less than 70° for either eye?
3.
Do you have difficulty perceiving a forced whispered voice in your better ear, with or without a hearing aid, at not less than
five (5) feet?
4.
Do you have a vision impairment in either eye that is not correctable to visual acuity of 20/40 or better?
5.
Do you:
a. Have a missing foot, leg, hand, finger or arm?
b. Have any impairment of a hand or finger?
c. Have any other impairment of an arm, foot, leg or any other limitation?
6.
Do you have diabetes requiring insulin?
a. Have you had a hypoglycemic episode in the last three (3) years?
b. Have you had any other adverse reaction related to diabetesin the last three (3) years?
7.
Have you had a heart attack, angina, coronary insufficiency, thrombosis, stroke, other heart problem, or cardiovascular
disease?
If “yes,” have you had labored breathing, fainting, collapse, congestive heart failure, or other symptoms in the last three (3)
years?
8.
Have you been diagnosed with a respiratory condition, such as emphysema, chronic asthma, or tuberculosis?
If “yes,” is your respiratory condition likely to interfere with your ability to drive a motor vehicle safely?
9.
Have you been diagnosed with high blood pressure?
If “yes,” is your blood pressure usually 140/90 or higher?
10.
Have you ever been diagnosed with rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease?
If “yes,” is the condition likely to interfere with patient’s ability to drive a motor vehicle safely?
11.
Have you been diagnosed with any mental, nervous, organic or functional disease, or psychiatric disorder?
12.
Have you been diagnosed with epilepsy or any other condition that may cause lapse of consciousness or loss of control?
If “yes,” have you had a lapse of consciousness or loss of control in the last three (3) years?
13.
Do you use a controlled substance, amphetamine, narcotic, or any other habit-forming drug?
a. If “yes,” did your doctor prescribe the drug?
b. Did your doctor advise you NOT to drive when taking the drug?
14.
Do you have a current clinical diagnosis of alcoholism?
If “yes,” when was your last drink of an alcoholic beverage?
EXPLAIN ANY “YES” ANSWERS HERE
PHYSICIAN’S NAME (PLEASE PRINT)
DATE OF LAST VISIT
PHYSICIAN’S OFFICE ADDRESS
PHYSICIAN’S PHONE NUMBER
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I hereby give consent to the release of medical information by the above named physician.
DRIVER’S SIGNATURE
DATE
X
EXAMINER’S SIGNATURE
ID NUMBER
OFFICE
DMV
USE
DL 546 (REV. 5/2016) WWW
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Filling out the California DMV DL 546 form is a straightforward process that requires careful attention to detail. After completing the form, it will be submitted to the DMV as part of your application or renewal process. Ensure all information is accurate and any necessary explanations are provided.
What is the purpose of the California DMV DL 546 form?
The California DMV DL 546 form is a health questionnaire that helps the Department of Motor Vehicles assess the medical qualifications of individuals applying for or renewing their driver’s license. It ensures that drivers are fit to operate a vehicle safely. This form must be completed every two years to maintain an active license.
Who needs to complete the DL 546 form?
Any individual applying for or renewing their driver’s license in California may need to complete the DL 546 form. However, this form is not required for commercial licensing. If you have any health conditions that could affect your driving ability, it’s crucial to fill out this questionnaire accurately.
What should I do if I answer "yes" to any health questions?
If you answer "yes" to any of the health questions on the DL 546 form, you may need to provide additional information. You should explain your "yes" answers in the space provided on the form or on a separate piece of paper. The DMV may contact your physician to discuss your medical qualifications before issuing your license.
How often do I need to submit the DL 546 form?
You are required to submit a completed DL 546 form every two years. This ensures that the DMV has up-to-date information regarding your health status and ability to drive safely. Be sure to keep track of when your next submission is due to avoid any issues with your driver’s license.
What happens if I do not submit the DL 546 form?
If you do not submit the DL 546 form when required, it may delay the processing of your driver’s license application or renewal. In some cases, your license could be suspended or revoked until the form is submitted and any necessary medical evaluations are completed. It is important to stay compliant with this requirement to maintain your driving privileges.
Filling out the California DMV DL 546 form can be straightforward, but many individuals make common mistakes that could delay their application process. One frequent error is not providing complete personal information. The form requires the applicant's true full name, address, date of birth, and driver license number. Omitting any of these details can lead to complications, as the DMV needs accurate information to process the application.
Another mistake involves the health questions section. Applicants often fail to understand the importance of answering each question accurately. A simple “yes” or “no” is required for each question, and if an applicant answers “yes,” they must provide an explanation. Neglecting to explain a “yes” answer can prompt the DMV to reach out to a physician for further clarification, which may delay the licensing process.
Additionally, some individuals overlook the requirement to submit a completed health questionnaire every two years. This is crucial for maintaining an active driver’s license. Failing to comply with this requirement could result in the suspension of driving privileges, as the DMV must ensure that all drivers meet health standards for safe driving.
People also tend to misinterpret the instructions regarding their physician's involvement. If there is uncertainty about how to answer a specific question, the form advises contacting a physician for assistance. Ignoring this guidance can lead to incorrect responses, which may necessitate further medical review by the DMV.
Lastly, applicants sometimes forget to sign and date the form. The certification statement at the end of the form is essential. Without a signature, the DMV cannot process the application, resulting in additional delays. Ensuring all sections are complete, accurate, and signed is vital for a smooth application process.
The California DMV DL 546 form is essential for assessing the health qualifications of individuals applying for or renewing their driver's licenses. Alongside this form, several other documents may be required or helpful in the process. Below is a list of forms and documents commonly associated with the DL 546.
Understanding these documents can streamline the application process and ensure compliance with DMV requirements. Being prepared with the necessary paperwork can help avoid delays and facilitate a smoother experience when applying for or renewing a driver's license.
The California DMV DL 546 form is a health questionnaire that helps assess an applicant's ability to drive safely. There are several other documents that serve similar purposes in evaluating health and fitness for driving. Below is a list of those documents:
Each of these documents plays a vital role in ensuring that drivers are healthy enough to operate a vehicle safely. It is essential to complete them accurately and honestly.
When filling out the California DMV DL 546 form, it is crucial to follow specific guidelines to ensure a smooth process. Below is a list of dos and don'ts to consider.
Here are eight common misconceptions about the California DMV DL 546 form, along with clarifications to help you better understand its purpose and requirements.
The California DMV DL 546 form is a health questionnaire that must be completed by all applicants seeking a driver's license.
Applicants must answer each health question with a “yes” or “no.” If “yes” is selected, further explanation is required.
This form must be submitted every two years to ensure that the DMV has up-to-date health information.
Failure to provide accurate information may lead to the DMV contacting your physician before issuing a license.