My current credential application to/with the Third Party authorized, to include only those boxes checked below. Taking this action is entirely voluntary; you are under no obligation to consent to the release of your information to any third party. PL E Act on my behalf in ALL MATTERS pertaining to the processing of my current U.S. Coast Guard credential application. Or, Matters Specifically Pertaining to Professional qualifications, certification records, or sea service time. Any medical i.
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How to fill out the Merchant Mariner Medical Certificate Application Third Party Authorization online
Filling out the Merchant Mariner Medical Certificate Application Third Party Authorization form online can streamline your credentials processing. This guide provides step-by-step instructions to help users navigate the form effectively and ensure all necessary information is included.
Follow the steps to complete the online form accurately.
- Click 'Get Form' button to obtain the form and open it in the editor.
- In the first section, print your full name clearly. This is necessary for identifying your application and authorizing the release of information.
- Review the authorization box options. Select your preferred option by checking the corresponding boxes to specify which matters you authorize for third-party disclosure.
- Fill out the Third Party Information section. Include the organization name (if applicable), authorized person’s mailing address, phone number, name, and optional email address.
- Sign the authorization agreement, confirming your consent to disclose information. Include the date of your signature, following the format MM/DD/YYYY.
- Provide your Mariner’s Reference Number or the last four digits of your social security number for identification purposes.
- After completing the form, save your changes. You may choose to download a copy of the completed form, print it for records, or share it as needed.
Complete your Merchant Mariner Medical Certificate Application Third Party Authorization online today.
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How do I submit my USCG medical certificate?
How do I submit an application? For a medical certificate only, the preferred way to submit your CG-719K or CG-719K/E (medical certificate applications) along with any supplemental medical information is via e-mail to MEDAIP@uscg.mil. Please include your full name in the subject line.
Who can perform a merchant marine physical?
The medical provider completing the required examination must be a physician, physician assistant, or nurse practitioner who is licensed in the U.S. or a U.S. territory. Use the following steps to apply. Step 2 - Complete the Application for Merchant Mariner Medical Certificate for Entry Level Ratings (CG-719K/E).
What are the medical disqualifications for merchant mariner credential?
Mariners may be disqualified due to multiple reasons, including but not limited to, the following: inadequately controlled diabetes with Hemoglobin A1c levels equal to or greater than 8.0%; episodes of hypoglycemia; documented non-compliance with treatment; significant diabetic retinopathy that causes the mariner not ...
How long does it take to get USCG medical certificate?
NPT is the total time the Coast Guard spends processing the application and does not include the time waiting for information from mariners. The NMC has set a NPT goal of 20 days. Medical Certificate throughput is a ratio of the total number of applications finished divided by the total number of applications received.
How much is a USCG medical certificate?
If you are applying for a Medical Certificate only, there is no fee.
How long is USCG medical certificate good for?
Those certificates will expire in either 1 or 2 years depending on the medical condition, condition status and the need for periodic medical evaluations. This 1- or 2-year expiration date will apply to all medical certificate categories (e.g., FCP, STCW, and National Certificates).
How do I check my USCG medical certificate status?
For the most current medical information available, please contact the National Maritime Center Medical Helpdesk, Marinermedical@uscg.mil, 1-888-IASKNMC (1-888-427-5662).
How long does it take to get a medical certificate from USCG?
NPT is the total time the Coast Guard spends processing the application and does not include the time waiting for information from mariners. The NMC has set a NPT goal of 20 days.
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