Form TC94-176 Breath Alcohol Ignition Interlock Physician Statememt - Kentucky

What Is Form TC94-176?

This is a legal form that was released by the Kentucky Transportation Cabinet - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is TC94-176 Breath Alcohol Ignition Interlock Physician Statement?A: TC94-176 Breath Alcohol Ignition Interlock Physician Statement is a form used in Kentucky for medical professionals to provide a statement regarding a person's eligibility for a breath alcohol ignition interlock device.

Q: Who needs to fill out the TC94-176 form?A: The TC94-176 form needs to be filled out by a licensed medical professional, such as a physician.

Q: What is the purpose of TC94-176 form?A: The purpose of the TC94-176 form is to determine whether an individual is medically eligible to have a breath alcohol ignition interlock device installed in their vehicle.

Q: What information is required on the TC94-176 form?A: The TC94-176 form requires information about the individual's medical condition, treatment history, and any medications that may affect their ability to provide a breath sample.