Form 4318 - Military Application With Power Of Attorney (For Persons Mobilized And Deployed With The Us Armed Forces) Page 2

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New Applicants Only
Vision Examination Record (to be completed by eye doctor, physician, or vision examiner)
Both acuity and field vision readings are required.
Acuity — Your vision acuity reading must be recorded for each eye and then a combined acuity for both eyes, i.e., 20/20. The
minimum standard for a Missouri driver license is 20/40 in either or both eyes.
Field — The complete peripheral reading for each eye and a combined reading must be shown in degrees (numerics) i.e., 55°.
Do not record reading as “Full” or “Normal.” The minimum standard for a Missouri driver license is 55° in each eye or 85° in one
eye.
Remarks
Distant Vision Only
Right
Left
Both
Eye Doctor, Physician, or Vision Examiner Signature
Correction
20/
20/
20/
Registration Number (if applicable)
Without Correction
20/
20/
20/
Address
Horizontal Field in Degrees
°
°
°
City, State, Zip Code, Country
Note: Special restrictions can be added to license if required due to visual
condition. Specify in remarks area.
Phone
Date of Exam
(
)
HIGHWAY SIGN RECOGNITION TEST
Please print the correct name of each of the following signs on the line below it:
1.
2.
3.
4.
5.
6.
Form 4318 (Revised 8-2013)

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