MEDICAL CERTIFICATE - - PDF by warwar123

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									                                   TOWN POLICE CLAUSES ACT 1847

                                   LOCAL GOVERNMENT (MISCELLANEOUS
                                   PROVISIONS) ACT 1976




                             MEDICAL CERTIFICATE


This certificate is the method by which the Licensing Authority becomes satisfied that
the applicant is medically fit to drive hackney carriages/private hire vehicles.
Applicants must be examined and certified as being medically fit by their own
General Practitioner or another General Practitioner in the practice with which they
are registered and must take into account previous medical history.

In normal circumstances, the Council will only accept this certificate, without prior
approval, no other medical certificate will be accepted. New applicants are advised
not to obtain a medical certificate, until the Council has determined their application.

This certificate is not one which must be issued free of charge as part of the National
Health Service. The Council accepts no liability to pay for it. Unless any other
arrangements have been made for the payment of the fee, the applicant is to pay.

In completing this certificate, Medical Practitioners are asked to have regard to the
recommendations by the Medical Commission for Accident Prevention in their
booklet “Medical Aspect of Fitness to Drive” and/or the Notes for the Guidance of
Doctors conducting these examinations prepared by the British Medical Association.




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MERTHYR TYDFIL COUNTY BOROUGH COUNCIL

MEDICAL CERTIFICATE ASSOCIATED WITH APPLICATION FOR A
LICENCE TO DRIVE A HACKNEY CARRIAGE/PRIVATE HIRE VEHICLE




 FULL Name of Applicant ……………………………………………………………..

 FULL Address ………………………………………………………………………….

 …………………………………………………………………………………………..

 Date of Birth …………………………………………………………………………….

 Signature of Applicant………………………………………………………………….
 (to be signed in the presence of the Medical Practitioner signing this Certificate)

                     IMPORTANT NOTE FOR MEDICAL PRACTITIONERS

 THIS MEDICAL CERTIFICATE SHOULD BE COMPLETED IN ACCORDANCE WITH GROUP II
 ENTITLEMENT CONTAINED IN THE DOCUMENT ‘MEDICAL ASPECTS OF FITNESS TO DRIVE’ ISSUED
                      .
 BY THE MEDICAL COMMISSION FOR ACCIDENT PREVENTION


 PLEASE READ THE ABOVE NOTE PRIOR                                   REPLY TO BE WRITTEN IN THIS COLUMN
 COMPLETING THIS FORM
 1. Is the applicant to the best of your judgement subject to
 epilepsy, vertigo, sudden attacks of disability giddiness or
 fainting or any mental disorder or defect likely to affect
 his/her efficiency as a driver of a hackney/private hire
 vehicle?
 2. Does he/she suffer from any heart or lung disorder or
 defect which might interfere with the efficient performance
 of his/her duties as a hackney carriage/private hire vehicle
 driver?
 3. Are the blood pressure readings – both systolic and
 diastolic – normal, having regard to the applicants age? If
 not, do you consider that the abnormal blood pressure
 would be likely to affect his/her competence as a hackney
 carriage/private hire vehicle driver?
 4. (a) Is there any defect of vision? If so, please give details

    (b) If the reply to (a) is in the affirmative give acuity of    (b) R.E.___________ L.E._____________
 vision by Snellens Test type with and without glasses and                     without glasses
 answer the following:
                                                                           R.E____________ L.E______________
                                                                                  With glasses

 (i) was the test conducted with the applicant’s                    (i)
 own glasses, or

 (ii) have suitable glasses been prescribed?                        (ii)

 (iii) do you consider that the applicant should wear glasses
 when driving?                                                      (iii)




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(iii) do you consider that the applicant should wear glasses            (iii)
when driving?

(iv) is the applicant’s field of vision by hand test                    (iv)
satisfactory?

(v) is the colour vision normal?                                        (v)

(vi) does the applicant suffer from a squint or any defect
which could affect his/her fitness to drive a motor vehicle?            (vii


5. Is there any defect of hearing? If so, do consider that it
would interfere with the efficient performance of the
applicant’s duties as a hackney carriage/private hire vehicle
driver?


6. Has the applicant any deformity or loss of limbs? If so,
could it interfere with the efficient performance of his/her
duties as a hackney carriage/private hire vehicle driver?


7. Is the applicant sufficiently active for the performance of
his/her duties.

8. Does the applicant show any evidence of being addicted
to the excessive use of alcohol, tobacco or drugs?

9. Is the applicant in your opinion generally fits as regards
(a) bodily health and (b) temperament for the duties of a
hackney carriage/private hire vehicle driver?

10 Is there any abnormality present that is not included in
the above questions?

11. Do you consider further examination necessary? If so,
in what period of time?




I Certify that I have this day examined (NAME OF APPLICANT) .......................................................................................


The answers to the foregoing questions are correct to the best of my knowledge and belief. The applicant
has satisfied the requirements in accordance with Group II entitlement contained in the document
‘Medical aspects of Fitness to drive’ issued by the Medical Commission for Accident Prevention. I
therefore consider the applicant * FIT/UNFIT to act as a driver of a hackney carriage/private hire vehicle.


Signature of qualified Registered Medical Practitioner ………………………………………………………..

                                                         Address …………………………………………………………….

                                                                     …………………………………………………………….

                                                         Date ………………………………………………………………..




* Delete as applicable
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