Form VTR-214 (rev. 05/14) Online Form at www.TxDMV.gov Page 2 of 2
DEFINITIONS
Transportation Code, Section 681.001(2) defines a disability as a condition in which a person has:
(a) mobility problems that substantially impair the person's ability to ambulate;
(b) visual acuity of 20/200 or less in the better eye with correcting lenses; or
(c) visual acuity of more than 20/200 but with a limited field of vision in which the widest diameter of the visual field subtends an
angle of 20 degrees or less.
Transportation Code, Section 681.001(5) defines a mobility problem as one that substantially impairs a person's ability to ambulate,
and the person:
(a) cannot walk 200 feet without stopping to rest;
(b) cannot walk without the use of or assistance from an assistance device, including a brace, cane, crutch, another person or a
prosthetic device;
(c) cannot ambulate without a wheelchair or similar device;
(d) is restricted by lung disease to the extent that the person's forced respiratory expiratory volume for one second, measured
by spirometry, is less than one liter, or the arterial oxygen tension is less than 60 millimeters of mercury on room air at rest;
(e) uses portable oxygen;
(f) has a cardiac condition to the extent that the person's functional limitations are classified in severity as Class III or Class IV
according to standards set by the American Heart Association;
(g) is severely limited in the ability to walk because of an arthritic, neurological, or orthopedic condition;
(h) has a disorder of the foot that, in the opinion of a physician licensed to practice medicine in this state or in a state adjacent
to this state, limits or impairs the person's ability to walk; or
(i) has another debilitating condition that, in the opinion of a physician licensed to practice medicine in this state or a state
adjacent to this state, or authorized by applicable law to practice medicine in a hospital or other health facility of the
Veterans Administration, limits or impairs the person's ability to walk.
DISABILITY STATEMENT - This section to be completed by a Licensed Medical Professional*
* Licensed Medical Professional is defined as a physician, podiatrist, optometrist, or qualifying physician's assistant or
advanced practice nurse as defined in Chapter 301, Occupations Code. At least one of the following conditions must be
met by the Licensed Medical Professional:
• Licensed in Texas, Arkansas, Louisiana, New Mexico, or Oklahoma; or
• Must practice medicine in a U.S. military installation based in Texas; or
• Must practice medicine in a hospital or health facility of the U.S. Department of Veterans Affairs.
I certify that has a
permanent, or temporary disability.
Printed Name of Person with a Disability
Printed Name of Licensed Medical Professional
Professional License Number Date
Signature of Licensed Medical Professional
Mailing Address City State
ZIP
Notary - This section to be completed by a Notary only if an original prescription is not submitted.
The signature of the Licensed Medical Professional must be notarized if an original prescription is not submitted.
On this date, the above named Licensed Medical Professional
appeared before me so I could witness his/her signature.
Date
Name
STAMP
HERE
Notary Public
My commission expires
Date
State of , County of
