Cg 719k 2002 form-2026

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The document is a Merchant Mariner Physical Examination Report issued by the U.S. Coast Guard, outlining the requirements for physical examinations of applicants seeking original licenses, renewals, or upgrades in maritime qualifications. It details the responsibilities of physicians in assessing the physical fitness of mariners, lists potential disqualifying medical conditions, and provides guidelines for conducting the examination. The report also includes sections for personal information, vision and hearing tests, medication history, and certification of physical impairment.

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Click ‘Get Form’ to open the CG-719K form in the editor.
Begin by filling out Section I, which requires your personal information such as name, date of birth, and social security number.
Proceed to Section II to provide your physical information including eye color, hair color, weight, height, blood pressure, and pulse.
In Section III, detail your vision. Ensure you include both uncorrected and corrected vision measurements for each eye.
Complete Section IV regarding color vision. Indicate whether you passed or failed the tests listed.
Fill out Section V on hearing capabilities. Record results from any audiometer tests if applicable.
In Section VI, list all current medications along with dosages and potential side effects.
Finally, complete Section VII by answering questions about any medical conditions and providing necessary test results.

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