Impaired Driver Consent Form IDSM-3

Providers must obtain consent from the motorist in order to access their records in the Impaired Driver System.

Consent to allow for the referring entity and OASAS provider, IDP Program, and relevant state agencies to receive and disclose information regarding the impaired driver offender.

Consent to allow for the referring entity and OASAS provider, IDP Program, and relevant state agencies to receive and disclose information regarding the impaired driver offender.

Consent to allow for the referring entity and OASAS provider, IDP Program, and relevant state agencies to receive and disclose information regarding the impaired driver offender.

Consent to allow for the referring entity and OASAS provider, IDP Program, and relevant state agencies to receive and disclose information regarding the impaired driver offender.

Consent to allow for the referring entity and OASAS provider, IDP Program, and relevant state agencies to receive and disclose information regarding the impaired driver offender.

Consent to allow for the referring entity and OASAS provider, IDP Program, and relevant state agencies to receive and disclose information regarding the impaired driver offender.

Consent to allow for the referring entity and OASAS provider, IDP Program, and relevant state agencies to receive and disclose information regarding the impaired driver offender.

Providers must obtain consent from the motorist in order to access their records in the Impaired Driver System,