Get the free PLEASE NOTE: Use this form for reporting lapses of consciousness, Alzheimer's diseas...
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If this report is based upon episodic lapses of consciousness when was the most recent episode mm/dd/yyyy 2. Are additional lapses of consciousness likely to occur 5. If the patient has had episodes of nocturnal seizures is there likelihood of lapses of consciousness occurring while he/she is awake 6. Does this patient s condition represent a permanent driving disability 9. Would you recommend a driving evaluation by DMV Remarks CDPH 110c 07/16 for reporting conditions reportable to DMV Page...
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