Driver Evaluation and Training Program
Requirements and Instructions for Participation
Dear Candidate,
Thank you for your interest in the Driver Evaluation and Training
Program at Rancho Los Amigos National Rehabilitation Center. Please
complete and submit all required forms (below). Download the
PDF Reader to
open all linked forms.
The following are required for your participation:
- A valid driver license or permit if you wish to be scheduled for an on-road Driving Evaluation.
- Driving candidates must be medically stable.
- Consultation request signed by your physician (Enter or click to select.) This form can be substituted with your own physician's prescription for Occupational Therapy Driver Evaluation and Training. Print the physician's full name, medical license number and mailing address.
- History and physical form completed by your physician (Enter or click to select.) This form can be substituted with a recent summary from your physician or recent evaluation from your occupational or physical therapist.
- Completed patient information form (Enter or click to select.)
- Department of Motor Vehicles (DMV) Driver Medical Evaluation Form (5 pages) completed and signed by you and your physician. The DMV requires this if your license has been suspended or if you have a medical condition that might interfere with driving. Visit the DMV Web site for a copy of the form.
- Vision Examination Form completed by your eye specialist or a
copy of your last eye exam if you have any visual impairments other
than corrective lens.
- DMV Printout of your driver license status (typically costs $5.00).
Return forms by mail or fax to:
Rancho Los Amigos National Rehabilitation Center
Occupational Therapy Department
Driver Evaluation and Training Program
7601 East Imperial Highway, Building 900, Room 91
Downey, CA 90242
Fax all pages to: (562) 401-6167
You will be contacted when all necessary forms have been received. If you have any questions regarding your medical insurance coverage or payment, please call Patient Financial Services at (562) 401-7320. For additional questions, call (562) 401-7081.
Frequently Asked Questions (Click or enter to select.)
Thank you for your interest.
Sincerely,
Sandra Okada, MSG, OTR/L, CDRS
Ken Reynolds, Driving Instructor, CDRS
Driver Evaluation and Training Program
Tel: (562) 401-7081 / Fax: (562) 401-6167
E-mail: DriverTraining@rancho.org