USCG CG-719K 2002 free printable template
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Department of Transportation U.S. Coast Guard CG-719K (Rev 1/02) Merchant Mariner Physical Examination Report Instructions If you are applying for: OMB-2115-0514 Page 1 1. ORIGINAL LICENSE AND/OR
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How to fill out USCG CG-719K
01
Obtain the USCG CG-719K form from the official US Coast Guard website or local office.
02
Start by filling out your personal information in Section I, including your name, address, date of birth, and social security number.
03
Complete Section II regarding your medical history. Be honest and thorough about any medical conditions or medications.
04
Move to Section III and answer the questions regarding your physical and mental condition, ensuring to check all relevant boxes.
05
In Section IV, provide information about any medical evaluations or treatments you have undergone.
06
Fill out Section V, where you will indicate your signature and date affirming that the information is accurate to the best of your knowledge.
07
If required, have the form reviewed and signed by a qualified medical professional as indicated in the instructions.
08
Submit the form to the appropriate Coast Guard office or online via their submission system as instructed.
Who needs USCG CG-719K?
01
Individuals who are applying for a U.S. Coast Guard merchant mariner credential.
02
Those who are required to demonstrate physical and mental competency to operate vessels.
03
Applicants for certain positions on commercial vessels, including captains, mates, and engineers.
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0:34 10:27 Application for Merchant Medical Certificate (Form CG-719K) YouTube Start of suggested clip End of suggested clip And now we start getting to where you fill the form out so we have your last name here again yourMoreAnd now we start getting to where you fill the form out so we have your last name here again your first name your middle initial.
Where do I send my CG-719K form?
The CG-719K and CG-719 K/E forms can be sent directly to the NMC via e-mail at MEDAIP@uscg.mil. Electronic submission requirements can be found on the NMC website.
How long is a CG 719K good for?
This means the certificate is really only good for 18 months. For those of you required by your company to get an annual physical, make sure the medical provider fills out the Coast Guard medical form (CG-719K), and make sure to submit it annually.
How long is a CG-719K good for?
This means the certificate is really only good for 18 months. For those of you required by your company to get an annual physical, make sure the medical provider fills out the Coast Guard medical form (CG-719K), and make sure to submit it annually.
How do I submit CG 719K?
How do I submit an application? For a medical certificate only, the preferred way to submit your CG-719K or CG-719K/E (medical certificate applications) along with any supplemental medical information is via e-mail to MEDAIP@uscg.mil. Please include your full name in the subject line.
What is CG-719K form?
The Application for Merchant Mariner Medical Certificate for Entry Level Ratings (CG-719K/E) is required for entry level mariners. The examination and form must be completed within 12 months of application date.
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What is USCG CG-719K?
USCG CG-719K is a medical certificate form used by the United States Coast Guard to assess the medical fitness of individuals applying for or holding a merchant mariner credential.
Who is required to file USCG CG-719K?
Individuals applying for a merchant mariner credential, as well as those renewing their credentials, are required to file the USCG CG-719K.
How to fill out USCG CG-719K?
To fill out USCG CG-719K, an applicant must complete the form by providing personal information, medical history, and details about their medical examinations, along with the signature of a qualified medical professional.
What is the purpose of USCG CG-719K?
The purpose of USCG CG-719K is to ensure that individuals applying for or holding merchant mariner credentials meet the necessary medical standards for safety and fitness to operate vessels.
What information must be reported on USCG CG-719K?
The information that must be reported on USCG CG-719K includes personal identification details, medical history, current medications, and any medical conditions that may affect an individual's ability to safely operate a vessel.
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