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DEMO Page 6 Instructions

The Organ & Tissue Donation/Medical History Verification page will display the questions and your answers from the previous page. Review your answers and click Confirm to continue.

Click on or hover over the green demo tip icon below to view the demo tips

This website is a demonstration only, completing the following form will not process your request.

Organ & Tissue Donation/Medical History

Voter Registration is not an option during the online process. A link will be provided on the Confirmation page with more information.
Does not pertain to individuals who are under 18.
Veterans Designation:

Do you wish to have the word "VETERAN" displayed on the front of your operator's license or state identification card to show that you served in the armed forces of the United States of America? (To be eligible you must register with the Nebraska Department of Veterans' Affairs registry.)

Answer: N/A

Organ & Tissue Donation:

Do you wish to be an organ and tissue donor?

Answer: N/A

Do you wish to receive any additional specific information regarding organ and tissue donation?

Answer: N/A

Do you wish to donate $1 to promote the Organ and Tissue Donor Awareness and Education Fund?

Answer: N/A

Medical History:
Have you within the last three (3) months:
(e.g. due to diabetes, epilepsy, mental illness, head injury, stroke, heart condition, neurological disease, etc)

Lost voluntary control or consciousness

Answer: No

Experienced vertigo or multiple episodes of dizziness or fainting

Answer: No

Disorientation

Answer: No

Seizures

Answer: No

Impairment of memory, memory loss

Answer: No

Since the issuance of your last permit/license have you experienced any condition which affects your ability to operate a motor vehicle due to loss or impairment of:

Foot/Leg

Answer: No

Upper Body Strength

Answer: No

Range of Motion/Mobility

Answer: No

Hand/Arm

Answer: No

Neurological/Neuromuscular Disease

Answer: No

Since the issuance of your last driver permit/license, have you suffered a medical condition that has adversely affected your ability to drive?

Answer: No

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Nebraska Department of Motor Vehicles
DMV Information: www.dmv.ne.gov
Online Services: www.clickDMV.ne.gov
Phone: 402.471.3861
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