Form 1722 Medical Information Statement - New Hampshire

What Is Form 1722?

This is a legal form that was released by the New Hampshire Department of Health and Human Services - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 1722?
A: Form 1722 is the Medical Information Statement.

Q: Who needs to fill out Form 1722?
A: Form 1722 needs to be filled out by individuals applying for a driver's license in New Hampshire who have a medical condition that may affect their driving.

Q: What is the purpose of Form 1722?
A: The purpose of Form 1722 is to gather information about an individual's medical condition to determine if it may impact their ability to drive safely.

Q: What information is required on Form 1722?
A: Form 1722 requires personal information, details about the medical condition, medical provider information, and driver's license information.

Q: Do I need to submit any additional documents with Form 1722?
A: Depending on the medical condition, additional medical documentation may need to be submitted along with Form 1722.

Q: Is there a fee for submitting Form 1722?
A: No, there is no fee for submitting Form 1722.

Q: What happens after I submit Form 1722?
A: After submitting Form 1722, the DMV will review the information and may require further evaluation or medical documentation. They will then make a decision regarding the individual's driving privileges.