CG-719KApplication for Merchant Mariner Medical Certificate

Clinicians fill out · Employees complete · Submitted to regulator

When it’s used

Required at initial USCG credential issuance, renewal (every 5 years), and after any reportable change in medical condition (46 CFR 10.302).

Who fills it out

Examining licensed medical practitioner (MD, DO, NP, or PA authorized under state scope of practice). Mariner completes the personal-history section.

Who signs

Licensed physician, physician assistant, advanced practice registered nurse, or other practitioner authorized under 46 CFR 10.304 to perform mariner medical evaluations.

Where it goes

Submit to the USCG National Maritime Center with the mariner's credential application (online via the Merchant Mariner Licensing and Documentation system, by email to [email protected], or by mail).

Electronic submission

Supported — mariners and applicants may submit through the NMC online portal; emailed PDFs accepted.

Related forms

These forms are commonly filed alongside or in place of this one.

• Drug Testing

  CG-719P — Periodic Drug Testing Form

  CG-719P documents a negative chemical test for dangerous drugs as required for original issuance and renewal of mariner credentials.

  View form
• USCG Mariner

  CG-719K/E — Application for Medical Certificate — Entry-Level Ratings

  CG-719K/E is the abbreviated medical evaluation report for mariners applying only for entry-level ratings (such as ordinary seaman, wiper, or steward’s department). It is shorter than the full CG-719K; any application including an officer or STCW endorsement requires the full CG-719K instead.

  View form
• USCG Mariner

  Merchant Mariner Medical Waiver Request

  There is no numbered waiver form — a medical waiver request is a documentation package submitted with the CG-719K when a mariner does not meet the vision, hearing, or general physical standards. Under 46 CFR 10.303, the Coast Guard may grant a waiver when objective medical evidence shows the condition is sufficiently controlled, and may attach conditions such as more frequent monitoring or operational limitations on the medical certificate.

  View form
• USCG Mariner

  CG-719B — Application for Merchant Mariner Credential (MMC)

  CG-719B is the base application every mariner files with the National Maritime Center for a Merchant Mariner Credential — original issuance, renewal, raise of grade, new endorsement, or duplicate — and for a Medical Certificate when applying concurrently. The rest of the application packet (medical, drug test, sea service) attaches to this form.

  View form

Share an employee preparation guide so the visit goes smoothly. Each guide covers what to bring, how to prepare, and what to expect — bilingual EN/ES.

• Prep guide

  Mariner/USCG Physical Examination

  Coast Guard-required medical examination for merchant mariners seeking or renewing credentials.

  Open prep guide
• Prep guide

  Fitness for Duty Evaluation

  When an employee incident raises safety questions, you need a clear, defensible fitness-for-duty determination — not weeks of back-and-forth with a local clinic. Through BlueHive, employers can connect with board-certified occupational physicians who deliver ADA-compliant FFD evaluations in days, not weeks.

  Open prep guide