[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-296666-105":59,"doc-detail-296666-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","adaptive-driving-program-enrollment-packet-instructions","Adaptive Driving Program - Enrollment Packet - Instructions","","Adaptive Driving Program enrollment instructions for Helen Hayes Hospital outline a two-part driving evaluation: pre-driver evaluation and on-road evaluation conducted by an occupational therapist trained in driving rehabilitation. The packet specifies required documents, including a physician referral form, and provides mailing and fax submission details. It explains scheduling after all forms are received, arrival guidance, and key eligibility notes such as DMV vision minimums and the fee range plus payment method, with no refunds after service delivery.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/adaptive-driving-program-enrollment-packet-instructions/296666/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/adaptive-driving-program-enrollment-packet-instructions/296666.png","ImageObject",300,407,{"name":92,"@type":93},"Jordan Avery","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-18",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What are the two parts of the Adapted Driving Program driving evaluation?","Question",{"text":113,"@type":114},"The program consists of a pre-driver evaluation and an on-road evaluation.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which documents must be completed and submitted in the enrollment packet?",{"text":118,"@type":114},"The packet requires the Adapted Driving Program Fact sheet, the Adapted Driving Program Enrollment Form, and a Physician Referral Form completed by your physician for submission.",{"name":120,"@type":111,"acceptedAnswer":121},"How and when will the appointment be scheduled, and what should you bring?",{"text":122,"@type":114},"After all forms are received, Outpatient Scheduling will contact you for an appointment. Arrive 15 minutes early, bring your driver’s license, and do not drive yourself to the evaluation.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},296666,1789735224,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":130,"read_time":144},1099523882367,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Adaptive Driving Program  \nHelen Hayes Hospital, Route 9W, West Haverstraw, NY 10993  \nThank you for expressing interest in participating in the Adapted Driving Program at Helen Hayes Hospital. The Adapted Driving Program consists of two parts: the pre-driver evaluation and the on-road evaluation. (Refer to the attached Adapted Driving Program Fact sheet for details) .  \nThe Adapted Driving Program is offered by appointment with an OccupationalTherapist that is trained in Driving Rehabilitation.  \n1. Please read, ll out and sign all the documents enclosed in the Adapted Driving Program enrollment packet which includes:  \na. Adapted Driving Program Fact sheet  \nb. Adapted Driving Program Enrollment Form  \nc. Adapted Driving Program Physician Referral Form-Must be completed by your physician, who will then return it to you for submission with the enrollment packet forms.  \n2. Mail your completed enrollment and Physician Referral Forms to:  \nHelen Hayes Hospital  \n51-55 North Route 9W  \nWest Haverstraw, NY 10993  \nAttention: Eileen Szysh, OT Outpatient Neurology  \nOR FAX: 845-786-4031  \nThis packet is required for us to schedule your appointment. Please keep one copy of these forms for yourself.  \n3. You will be contacted by the Outpatient Scheduling Of ce for an appointment once all forms are received. If you are awaiting new glasses or having a pending surgery, please schedule your appointment after your glasses are received/surgery completed. DMV minimal requirement for driving is 20/40 .  \n4. The fee for the evaluation and report ranges from $250.00- $500.00 based on your needs. Any additional training sessions that are required will cost $250.00 per session.  \na. Payment will be required on the day of your appointment via check, Master Card or Visa. (Checks should be made payable to “Helen Hayes Hospital” with Adapted Driving Program in the memo section of the check. There is a $25.00 fee for a check returned due to insuf cient funds. )  \nb. There are no refunds of any payment once service is delivered  \n5. Please note: you will not receive a bill or a reminder phone call for your appointment.  \n6. Please arrive 15 minutes prior to your appointment and proceed to the registration of ce on the rst 􀀞oor. Please bring your driver’s license and do not drive yourself to the evaluation.  \n7. If there is inclement weather on the day of your appointment, we may contact you toreschedule.  \nWe look forward to having you participate in our Adapted Driving Program. If you have any questions, please contact the scheduling of ce at: (845) 786-4194.  \nAdapted Driving Program Enrollment Form  \nPlease read, complete, and sign this Adapted Driving Program Enrollment Form. It will provide key information for us to determine your needs  \nName:  Date of Birth/Age   \nAddress:   \nPhone:  Cell Phone:   \nEmergency Contact:  Relationship:  Phone:   \nDriving Questionnaire  \n1. What is your reason for requesting a driving evaluation?    \n2. Do you have a current driver’s license? Yes   No   State:   \n3. When was the last time you drove?    \n4. What type of car do you drive? SUV/Truck   Sedan   Standard   Automatic    \n5. When you last drove or if you are currently driving, what kind of driving do you do? Local roads  Highways   City   Nighttime   Inclement weather    \n6. Have you ever gotten lost while driving?    \n7. Have you had any accidents in the past year or near misses/unexplained dents scratches on vehicle? Yes   No    \nIf yes, please explain   \n8. Do you need any help getting into or out of a car? Yes  No   \n9. Have you had any falls in the past year? Yes   No   If yes, how many?   \n10. Are you experiencing any dif culty moving an arm or leg? Yes No    \nIf yes, please explain  11. Please list any equipment you use for mobility including: wheelchair (make/model/  \nyear), walker, cane, braces, etc:   \n12. Are you experiencing decreased sensation/sensory changes in your legs?Yes  No  If yes, please explain   \n13. Are you experiencing any dif cult","cbCaifXbyFEBzoSh","https://ap.wps.com/l/cbCaifXbyFEBzoSh","pdf",125827,"English","# Adaptive Driving Program\n## Program overview and process\n## Required documents and submission\n## Scheduling and appointment guidance\n## Fees and payment terms\n## Enrollment form details\n## Participant acknowledgements and signature\n## Driving questionnaire","[{\"question\":\"What are the two parts of the Adapted Driving Program driving evaluation?\",\"answer\":\"The program consists of a pre-driver evaluation and an on-road evaluation.\"},{\"question\":\"Which documents must be completed and submitted in the enrollment packet?\",\"answer\":\"The packet requires the Adapted Driving Program Fact sheet, the Adapted Driving Program Enrollment Form, and a Physician Referral Form completed by your physician for submission.\"},{\"question\":\"How and when will the appointment be scheduled, and what should you bring?\",\"answer\":\"After all forms are received, Outpatient Scheduling will contact you for an appointment. Arrive 15 minutes early, bring your driver’s license, and do not drive yourself to the evaluation.\"}]","Adaptive Driving Program - Enrollment Packet - Instructions | PDF",18]