The procedures in §§B and C of this regulation apply to vision tests. A vision test shall be administered by a licensed optometrist or ophthalmologist. Statement by Optometrist or Ophthalmologist. A licensed optometrist or ophthalmologist shall submit a statement on a form furnished by the Administration. The statement is not acceptable if the date of the examination is more than 3 months before the date of submission of the statement to the Administration. The statement shall contain: A patient's full name, signature, address, date of birth, and sex; Whether the test results were obtained with or without corrective lenses; Date of the test; Signature and license number of the individual authorized to certify the statement; A statement as to whether the patient has a vision condition which is stable; Recommendations for the: Driving restrictions the ophthalmologist or optometrist wishes the Administration to consider, if any; and Administration's consideration relating to a vision reexamination on a 6-month or 12-month basis, if any; and A statement as to whether: The patient has been referred to an appropriate physician because of any underlying medical condition, The patient has been fitted for bioptic telescopic lenses which the patient has had in the patient's possession at least 60 days before the patient's original or renewal application for a Maryland driver's license; The patient has received instructions at least equal to the suggested instructions as set forth in Regulation .04 of this chapter; and In the opinion of the optometrist or ophthalmologist, the patient's vision condition would interfere with the safe operation of a vehicle upon the highways.