2010 BC Guide in Determining Fitness to Drive

EXAMINING OPTOMETRIST’S NAME AND ADDRESS(Use Rubber Stamp or Print)EXAMINATION DATE(YYYY/MM/DD)SIGNATURE OF EXAMINING OPTOMETRISTTELEPHONE NUMBER:To the Driver:Under section 29 of the Motor Vehicle Act the Superintendent of Motor Vehicles requires you to have this form completedfor one of the following reasons: you failed a vision test at an ICBC Driver Services Centre your recently reported visual status did not provide all the information we require it is time to review the status of your previously reported visual condition.This form must be completed and returned by the examining optometrist to the Office of the Superintendent of MotorVehicles within 30 days. If approval is needed prior to obtaining a driver’s licence, you will be unable to obtain that licenceuntil the completed form is submitted and approved. If this examination is required for a class of licence you already have,your driver’s licence may be cancelled if you fail to have the form completed and submitted to the Superintendent by youroptometrist within 30 days. If your driver’s licence is cancelled, you will not be able to drive until the form is submittedand you are issued a new driver’s licence.If your driver’s licence is presently cancelled due to a visual condition, this report must be completed and returned by youroptometrist before your driving privilege can be considered for reinstatement.If you have a visual condition that may deteriorate, you may need future visual examinations.The Office of the Superintendent of Motor Vehicles is billed through the Medical Services Plan (MSP) for completing thisform and reimburses optometrists as follows: Examination of Visual Functions only: $ 70 Examination of Visual Functions and Visual Field Test at the same appointment: $102Should you have questions please contact the Driver Fitness Unit, Office of the Superintendent of Motor Vehicles, Victoriaat (250) 387-7747.To the optometrist:This Examination of Visual Functions is paid by the Office of the Superintendent of Motor Vehicles and is billedthrough the Medical Services Plan Billing System. If a computer-assisted visual field test is required it is also billablethrough MSP. Please refer to the MSP Fee Codes located at the top right corner of the first page of this document.282