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Applicants seeking a Medical Certificate are required to complete this form and submit all 10 pages, including instructions, to the U.S. Coast Guard. Guidance for completion of this form can be found at https://www.uscg.mil/hq/cg5/nvic/pdf/2008/NVIC_04-08.pdf.
Applicants seeking a Medical Certificate are required to complete this form and submit all 10 pages, including instructions, to the U.S. Coast Guard. Guidance for completion of this form can be...
CG 719K. The Application for Mariner Medical Certificate (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.
All other applicants for a Medical Certificate must use the Application for Medical Certificate, Form CG-719K. All exams, tests and demonstrations must be performed, witnessed or reviewed by a physician, physician assistant, or nurse practitioner licensed by a state in the U.S., a U.S. possession, or a U.S. territory.
All other applicants for a Medical Certificate must use the Application for Medical Certificate, Form CG-719K. All exams, tests and demonstrations must be performed, witnessed or reviewed by...
Applicants seeking a Medical Certificate are required to complete this form and submit it to the U.S. Coast Guard. Applicants seeking a raise-in-grade are required to submit this form if a previous medical evaluation report has not been submitted within the last 3 years.
Coast Guard (CG) Official Forms (Internet Releasable Only) Washington, DC. Tips: 1. If you see "Please wait..." when you try to open the form, click on the disc icon to save the form to a location of your choice. Open the form from the saved location. 2. If you still see "Please wait..."
After your exam, email the completed CG-719K form directly to MEDAIP@uscg.mil. Your form will need to be a .pdf so we recommend using a .pdf scanner on your phone or converting it to .pdf on your computer.
U.S. Coast Guard OMB-2115-0514 CG-719K (Rev 1/02) Merchant Mariner Physical Examination Report Page 1 Instructions If you are applying for: 1. ORIGINAL LICENSE AND/OR QUALIFIED RATING DOCUMENT (i.e., First Rating of Able Seaman, Qualified Member of the Engine Department, and Tankerman) – Submit this report, completed by your physician. 2.
Completed Merchant Mariner Credential applications (Form CG719B and supporting documentation) should be emailed to MMCApplications@uscg.mil. Medical Certificate ONLY Applications (719K or 719K/E) are processed separately and should be sent via email to MEDAIP@uscg.mil.