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Get Ds6 Form

E the form. This form is provided for use by a physician to report an individual whose driving ability may be affected due to some physical or mental impairment. This form must be completed and signed by a licensed physician or nurse practitioner. Attach a sheet of your stationery (showing your letterhead), or a voided or blank prescription form, as additional verification for this statement, and mail the completed form with the attached stationery or prescription to: Medical Review Unit, New Yo.

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