Updated Merchant Mariner Medical Eval Forms
The Coast Guard is releasing a new version of the CG-719 K (Merchant Mariner Credential Medical Evaluation Report) and CG-719 K/E (Merchant Mariner Evaluation of Fitness for Entry Level Ratings) forms to facilitate obtaining objective medical information which will enable the Coast Guard to make accurate and timely fit for duty determinations which will reduce risk to maritime safety. These forms more clearly align the Merchant Mariner Credentialing process with the policies set forth by Navigation and Vessel Inspection Circular 04-08, “Medical and physical evaluation guidelines for merchant mariner credentials.” These new forms are designed to be used in conjunction with the NVIC, particularly enclosure 3, to facilitate obtaining objective medical evidence of an applicant’s physical condition as it relates to their ability to perform duties as a merchant mariner. Mariners and physicians are highly encouraged to use the NVIC in conjunction with the new forms to provide as much documentation of an applicant’s physical condition as possible. If these forms are properly and completely filled out and additional information mandated/requested by the NVIC/Instructions is provided, mariners, even those with medical conditions, should expect to see reduced processing times for their applications.
These forms will be available via the NMC website (www.uscg.mil/nmc/) for familiarization purposes on or before September 1, 2009. The Coast Guard is working to create both a printable user guide and to embed instructions in the electronic version of the form in order to assist both the mariner and physicians in completing the forms.
The forms will be available for use on October 1, 2009. The previous version of the forms 719K, Rev (01/02), and K/E, Rev (10/02), will no longer be available from the Coast Guard after that date.
Physical Exams completed on or after January 1, 2010 must be on the new form, Rev (01/09). Physicals completed and signed prior to January 1, 2010 will continue to be accepted with applications submitted after that date (must be dated within one year of application).
The CG-719 K/E should be used only by mariners seeking an entry level credential. This form is limited to applicants for the following rating endorsements: Ordinary Seaman, Wiper, or Steward’s Department (food handler).
The CG-719K should be used for all other endorsement applications.