Overall Impression
1. This guide is a useful and effective physician education tool.
2. This guide has raised my awareness of older driver safety as a public health issue.
3. I have a better understanding of the medical conditions and medications that may impair my patients’ ability to drive safely.
4. I will probably use at least one of the guide’s tools in my clinical practice.
5. I have a better understanding of driver rehabilitation options and alternatives to driving.
6. I have a better understanding of my state’s reporting requirements regarding patients who may not be safe to operate a motor vehicle.
Please rank the usefulness of the following guide materials by circling a number on a scale of 1 to 5.
| 7. Physician’s Plan for Older Drivers’ Safety (PPODS) | Very useful | 1 | 2 | 3 | 4 | 5 | Not useful at all | |
| 8. Red Flags for Medically Impaired Driving | Very useful | 1 | 2 | 3 | 4 | 5 | Not useful at all | |
| 9. Assessment of Driving-Related Skills (ADReS) | Very useful | 1 | 2 | 3 | 4 | 5 | Not useful at all | |
| 10. State Licensing Requirements and Reporting Laws (Chapter 8) | Very useful | 1 | 2 | 3 | 4 | 5 | Not useful at all | |
| 11. Medical Conditions and Medications That May Impair Driving (Chapter 9) | Very useful | 1 | 2 | 3 | 4 | 5 | Not useful at all | |
| 12. Patient education materials (Appendix) | Very useful | 1 | 2 | 3 | 4 | 5 | Not useful at all |
If you have any additional comments, please write them in the space below.
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Please fax/mail the completed form to:
Catherine Kosinski
American Medical Association
515 N. State Street
Chicago, IL 60610
312 464-5842 fax