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Form R-323 Examination to Determine Physical Condition

Form R-323 Examination to Determine Physical Condition

 

INSTRUCTIONS: CONNECTICUT EXAMINATION TO DETERMINE PHYSICAL CONDITION OF DRIVER (Form R-323)

 

 

In order to receive a license to operate as a commercial vehicle operator in Connecticut, you must be certified as in shape to do so. This examination is documented using a form R-323, which can be obtained from the website of the government of Connecticut.

 

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 1: The first section concerns the driver and should be completed by them. In the first three blank boxes, enter your name, Social Security number and birthdate.

 

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 2: Indicate your sex with a check mark in the fourth blank box.

 

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 3: Indicate whether you are applying for a new certification, a recertification or a follow-up with a check mark in the fifth blank box.

 

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 4: Enter the date of the exam in the sixth blank box.

 

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 5: Enter your street address, city or town, state and zip code in the seventh blank box.

 

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 6: Enter your work telephone number in the eighth blank box and your home telephone number in the ninth blank box.

 

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 7: Enter your driver's license number in the tenth blank box. Indicate your license cass with a check mark in the eleventh blank box.

 

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 8: Enter the state that issued your driver's license in the twelfth blank box.

 

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 9: Section 2 documents the driver's health history. For each condition, indicate whether it is in your history by checking "Yes" or "No" as applicable. For all conditions to which you answered "Yes," provide the onset date, diagnosis, the treating physician's name and address, any current limitations and all medications used recently or currently.

 

Connecticut Examination To Determine Physical Condition Of Driver R-323 Step 10: Sections 3 through 7 will be completed by the medical examiner, who will sign and date the bottom of the second page.

 

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