Medical Forms

The medical provider completing the required examination must be a physician, physician assistant, or nurse practitioner who is licensed in the United States or one of the U.S. territories.

719K Form (click to expand)

The Merchant Mariner Physical Exam (CG-719K) is required for Officers and Mariners with a qualified rating. The examination and form must be completed within 12 months of application date.

 

719K/E Entry Level Form (click to expand)

The Merchant Mariner Evaluation of Fitness for Entry Level Rating Form (CG-719KE) is required for entry level mariners. The examination and form must be completed within 12 months of application date.

Medical and Physical Evaluation Guidelines (click to expand)

The NVIC below provides guidance for evaluating the physical and medical conditions of applicants for merchant mariner documents (MMDs), licenses, certificates of registry and STCW endorsements, collectively referred to as “credentials.”