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How to use or fill out merchant mariner medical certificate application third party authorization

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name in the designated field to authorize the U.S. Coast Guard National Maritime Center (NMC) to disclose information regarding your credential application.
Select the appropriate boxes that indicate what matters you are authorizing the third party to act on, such as professional qualifications or medical information.
Fill in the Third Party Information section with the organization name (if applicable), authorized person's mailing address, phone number, and email address.
Sign and date the form at the bottom, ensuring that you include your reference number or last four digits of your Social Security Number for identification.
Choose one of the four methods provided to send your completed authorization to the NMC.

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Who can perform Coast Guard physicals?

APPLICATION FOR MERCHANT MARINER CREDENTIAL (FORM CG-719B) ------ Instructions ------ 1. . Applicants seeking a Merchant Mariner Credential (MMC), whether original, renewal, duplicate, raise of grade, or a new endorsement on a previously issued MMC and applicants requesting a Medical Certificate.

What are the medical disqualifications for merchant mariner credentials?

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.

What medical conditions disqualify you from merchant marines?

For renewal of all licenses or Merchant Mariners Credentials with qualified ratings other than Lifeboatman, you must not have blood pressure higher than 160/100 if under the age 50 or higher than 175/100 if over 50, regardless of treatment or medication.

What disqualifies you from being a merchant marine?

Diabetes:Any elevated fasting blood glucose level on a new applicant exam will require a follow-up evaluation to include an HbA1C test. The minimum acceptable HbA1C level is less than 8.0% or less. Diabetes requiring for control cannot be considered for waiver.

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