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Department of Transportation U.S. Coast Guard CG-719K (Rev 1/02) Merchant Mariner Physical Examination Report OMB-2115-0514 Page 1 Instructions If you are applying for: 1. ORIGINAL LICENSE AND/OR

How to fill out merchant mariner physical examination

Merchant mariner physical examination is required for individuals who wish to work in the maritime industry. This examination is necessary to obtain or renew a merchant mariner credential (MMC) and ensures that individuals are physically fit to perform the duties and responsibilities at sea.

To fill out the merchant mariner physical examination, follow these steps:

1. Start by obtaining the required forms: Contact the United States Coast Guard (USCG) or visit their website to obtain the necessary forms for the merchant mariner physical examination. These forms include the CG-719K Merchant Mariner Credential Medical Evaluation Report and other applicable medical forms.
2. Gather all relevant documents: Collect any documents and information that are usually needed for a physical examination. This may include your identification documents, medical history, immunization records, and any recent medical reports or prescriptions.
3. Schedule an appointment: Set up an appointment with a designated medical practitioner who is authorized to perform merchant mariner physical examinations. These practitioners are usually authorized by the USCG or approved by the National Maritime Center (NMC). You can search for a designated medical practitioner near you on the USCG or NMC website.
4. Complete the necessary forms: Fill out the CG-719K Merchant Mariner Credential Medical Evaluation Report and any other required medical forms. Provide accurate and complete information about your medical history, current medications, and any known medical conditions. Be honest and thorough to ensure an accurate evaluation.
5. Undergo the physical examination: Visit the designated medical practitioner at the scheduled appointment time. They will conduct a physical examination, which may include measuring your height and weight, checking your vital signs, performing a vision and hearing test, assessing your cardiovascular health, evaluating your musculoskeletal system, and conducting any other necessary tests or assessments as per USCG requirements.
6. Discuss any concerns or questions: If you have any specific concerns or questions during the examination, feel free to discuss them with the medical practitioner. They are trained to address maritime-specific health concerns and can provide guidance on any required follow-up actions or treatments.
7. Complete the evaluation forms: After the physical examination, the designated medical practitioner will complete the necessary evaluation forms. Ensure that all information is accurately recorded and that the forms are signed and dated by the medical practitioner.
8. Submit the forms: Once the physical examination and evaluation forms are completed, submit them to the USCG or NMC as per their instructions. This may involve mailing the forms, uploading them online, or visiting a local USCG office in person.

Remember, the merchant mariner physical examination is typically valid for a certain period, usually two years. You may need to undergo this examination periodically to maintain your merchant mariner credential or to update it as required by the USCG or NMC.

For pdfFiller’s FAQs

What is merchant mariner physical examination?

Merchant mariner physical examination is a comprehensive medical examination required for individuals who work in the maritime industry to ensure they meet the physical requirements for their job.

Who is required to file merchant mariner physical examination?

Merchant mariners who work in the maritime industry are required to file a physical examination.

How to fill out merchant mariner physical examination?

To fill out a merchant mariner physical examination, individuals must visit an approved medical examiner and provide all required medical information and documentation.

What is the purpose of merchant mariner physical examination?

The purpose of a merchant mariner physical examination is to assess the physical fitness of individuals working in the maritime industry to ensure they can safely perform their job responsibilities.

What information must be reported on merchant mariner physical examination?

Merchant mariner physical examination must include medical history, physical examination findings, laboratory results, and any necessary medical certifications.

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