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Forms - DMV - PG&E - Social Security
You may find it helpful to download and complete your portion of any forms you may need your provider to sign before your next visit to Kaiser. Please remember that ALL forms must be left with Medical Secretaries for proper and timely completion.
DMV Reporting
California Law (California Health and Safety Code Section 103900) requires physicians to report patients with conditions which result in lapses of conciousness, episodes of confusion or dementia. Please be advised that your neurologist does not have the authority to grant you driving privileges, nor to hasten the review process: only DMV has that authority. After you have been reported, the DMV will send paperwork to you that must be completed by your physician. You may also download a copy here - Driver Medical Evaluation Form. Please remember ALL forms must be left with Medical Secretaries for prompt and accurate completion.
Please allow at least one week for your physician to complete this paperwork. If you would like a copy please indicate that on the forms. Please remember to sign the release on the back page.
All inquiries regarding driver's license status, reinstatement of driving privileges, hearings, appeals, etc, should be directed to:
Department of Motor Vehicles
Licensing Operations Division
Driver Safety Branch
303 Hegenberger Road, Suite 400
Oakland, CA 94621
(510) 563-8900
Lapses of Consciousness
Additional information can be obtained at the DMV website: Lapses of Consciousness Disorders
Visual Field Loss (Hemianopsia)
Additional information can be obtained at the DMV website: Visual Field Loss
Disabled Person Placard
You may be eligible for disabled person license plates and/or a parking placard if you are permanently disabled. Temporary parking placards valid for up to 6 months are available to individuals with temporary disabilities.
To apply for a permanent or temporary placard:
- Complete an Application for Disabled Person Parking Placard or Plates.
- The doctor's statement certifying your disability must be completed on the form.
- Include a check or money order if requesting a temporary disabled person parking placard. There is no fee for a permanent placard or plates.
- Mail the application to the address on the form.
- You will receive your placard approximately 2 weeks after the completed form and fees are submitted.
- NOTE: You can also make an appointment and take the completed Application for Disabled Person Placard or Plates to a DMV office near you.
PG&E Information and Forms
Social Security and State Disability
STATE DISABILITY INSURANCE (SDI)
To initiate a claim for State Disability benefits, obtain a State Disability Claim form (available from the Business Office at each healthcare facility or download here Employment Disability), complete your portion of the form, and return it to the Business Office. The Business Office will have the Doctor’s Certificate portion completed by your physician, and then forward it to the State.
Disability checks are issued every two weeks, commencing approximately ten working days from the date the claim is received. Benefits begin on the 8th day following the date you first became disabled. In the event of hospitalization or outpatient surgery, benefits will commence on the first day hospitalized or the date of the outpatient surgery. You are entitled to draw state disability benefits for 12 months from date first disabled.
For further information, your may call their statewide toll-free number at 1-800-480-3287. You may also visit their Web Site or contact your local Office.
SOCIAL SECURITY DISABILITY
You are eligible to apply for Social Security disability as soon as you become disabled. Your local Social Security Office can advise you on the application process (this can be lengthy and we recommend you initiate your claim as soon as possible), as well as the amount of your monthly benefit.
For further information:
The Social Security Administration Web site offers extensive information regarding the entire Social Security disability process.
You may also use their toll-free number: (800)772-1213 or TTY (800)352-0778.
Or apply in person at one of their local offices. To find the office nearest you, use their Online Office Locator Web site or call their toll-free number listed above.
STATE DEPARTMENT OF REHABILITATION
The State Department of Rehabilitation offers retraining for patients who are permanently disabled from their usual occupation, but who wish to receive training for employment in a new field. Patients will continue to receive State Disability Insurance (SDI) benefits while participating in a retraining program.
General information regarding retraining programs can be obtained from the Department of Rehabilitation Web site or by contacting your local office.
You may wish to contact your employer or Human Resources Department to inquire about possible disability benefits to which you may be entitled. If you are covered by a collective bargaining agreement, you may also wish to contact your local union representative regarding possible benefits through your union.
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