Fillable P-142C REV - ct

CARDIOLOGY MEDICAL REPORT P-142C REV. 4-2011 STATE OF CONNECTICUT DEPARTMENT OF MOTOR VEHICLES DRIVER SERVICES DIVISION DRIVER'S LICENSE NUMBER MAIL TO: DMV, Driver Services Division, 60 State Street, Wethersfield, CT 06161-2510 The patient named below has been referred to the DMV Driver Services Division concerning their ability to safely operate a motor vehicle. This medical report must reflect the...
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