CG-719KApplication for Merchant Mariner Medical Certificate
Issued by U.S. Coast Guard – National Maritime Center
CG-719K is the medical evaluation form a licensed practitioner completes for any mariner applying for or renewing a Merchant Mariner Credential (MMC) or Medical Certificate. The National Maritime Center reviews submissions and issues the certificate.
Also known as: Merchant Mariner Medical Certificate · USCG 719K · Mariner physical form
Key facts
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.
Sources & citations
Every form we publish traces to an authoritative government source. We cite the issuing agency, the underlying statute, and the operative regulation so you can verify scope and signing authority for your own records.
Issuing agency
USCG National Maritime Center — Forms
Last verified 2026-05-12
VerifiedOpenRegulation
46 CFR Part 10 — Merchant Mariner Credential
Last verified 2026-05-12
VerifiedOpen
Attribution. Form authored and maintained by the U.S. Coast Guard National Maritime Center. BlueHive links to the official USCG source; do not rely on cached copies for active applications. BlueHive does not modify the underlying government PDF; the file you download is the agency original.
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