- Form DS-877 - Article 19-A Certified Examiner Application Form - New York
- Form DS-103 - Report of Passing Stopped School Bus - New York
- Form DS-879 - Article 19-A Carrier Application - New York
- Form IRP-5 - Schedule B Mileage Information (2013) - New York
- Form DS-875 - Article 19-A Biennial Behind the Wheel Road Test - New York
- Form DS-3.3 - Article 19-A Motor Carrier Annual Statistical Report - New York
Fillable Printable Form DS-703 - Article 19-A Bus Driver's Blood Pressure Follow-Up - New York
Fillable Printable Form DS-703 - Article 19-A Bus Driver's Blood Pressure Follow-Up - New York
Form DS-703 - Article 19-A Bus Driver's Blood Pressure Follow-Up - New York
ARTICLE 19-A BUS DRIVER’S BLOOD PRESSURE FOLLOW-UP
BY DRIVER’S HEALTH CARE PROVIDER
NYS DMV COMMISSIONER’S REGULATIONS PART 6.10
I, ________________________________________________________________, am acting as the above-
named bus driver’s health care provider. He/she is under my care, monitoring, and treatment (if necessary),
for high blood pressure. His/her condition is controlled by (indicate which):
www.dmv.ny.gov
DS-703 (6/15)
(Print Health Care Provider’s Name)
¨ Diet
¨ Medication (identify): ______________________________________________________________
¨ Other means (explain): ______________________________________________________________
Health Care Provider’s License or Certificate Number _______________________ Issuing State________
Health Care Provider’s Address: ____________________________________________________________
____________________________________________________________
Health Care Provider’s Phone:________________________
His/her blood pressure reading today is: Systolic: ______________
Diastolic: ______________
Health Care Provider’s Signature __________________________________________________________
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BUS DRIVER’S NAME: ________________________________________________________
DATE OF BIRTH: ________________________________________________________
CLIENT/LICENSE ID NUMBER (from Driver License): ____________________________________
(Must correspond to name on driver’s license)
NOTE: This form may be used in conjunction with the Examination to Determine Medical Condition of Driver
Under Article 19-A (DS-874), or with the federal medical form if it is being used in lieu of the DS-874.
Date ____________________
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