Welcome to the National Maritime Center's instructional video on completing the US Coast Guard 719 series of applications. Form CG 719K is the application for the Merchant Mariner Medical Certificate. The first three pages provide detailed instructions on filling out the form. The table on page two provides details of the requirements for a demonstration of physical ability. Each section listed in the instruction corresponds with a specific section of the form. Also, throughout the form, there are instructions following each section heading which indicate whether the applicant or the medical practitioner should complete each section. Please read these instructions carefully prior to filling out the application. In section 1, please fill in each block with appropriate contact information or write "n/a" if not applicable. For section 2a, you will need to mark all "yes" or "no" responses with the appropriate answer. Both of these sections should be reviewed by your medical practitioner. Also, please remember to fill in the applicant name and date of birth blocks at the bottom of each page of the form. Section 2b should be completed by a medical practitioner for any conditions marked "yes" in section 2a. The practitioner should list the corresponding number of the condition from section 2a and list the condition and diagnosis date of onset or date of diagnosis, any treatment required or received, the current status of the condition, and any limitations you may have due to the condition, as applicable. Your medical practitioner may attach supporting documentation. Please make sure any additional sheets include your name and date of birth. In section 3, please list all prescription medications prescribed, filled, refilled, or taken within 30 days prior to the date you sign this form. Also, list any non-prescription over-the-counter medications, including dietary supplements or vitamins, used for a period of 30...
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