Medical Forms

MSC Medical Summary Form

MSC is committed to a safe and healthy environment for all CIVMARs; therefore, we offer medical services to all full-time employees. Read below for additional information on medical services and processes.

Personal Medical Conditions

CIVMARs are responsible for arranging treatment for routine and chronic conditions and non-work related injuries with their primary care provider or other civilian provider in their current location. The Medical Services Officer (MSO) aboard ship is available for urgent medical needs and arranging Occupational Health examinations based on your position, but they do not serve as your primary care provider. They do not treat or provide medications for any chronic medical condition.

All CIVMARs are strongly encouraged to have health insurance. You are encouraged to verify that your coverage includes overseas medical coverage and covers emergency expenses. Although MSC will ensure that medical expenses for work related injuries are paid overseas, if you need to be seen overseas for a non-work related medical problem or emergency, you could incur great expense or even risk not being seen if you do not have overseas insurance coverage. You have 60 days from your start of employment to enroll in the Federal Employee Health Benefits program. Coverage will start on the first pay period after the enrollment form is submitted. See the FEHB advisor for more information.

Important Points

  • Any chronic conditions such as high blood pressure, diabetes, thyroid disorders, cholesterol disorders, cardiac conditions, and cancer, are the CIVMAR’s responsibility and should be controlled well enough to not require follow-up evaluation more frequently than every six months. Conditions that require a follow-up evaluation more frequently (less than six months) may result in extended periods of being Not Fit for Duty (NFFD). To ensure that chronic conditions remain controlled, CIVMARs must submit a Medical Summary Form completed by your medical provider approximately every six months to one year, depending on the condition. Medical Summary Form may be obtained from your MSO, the MSC medical offices via fax, or downloaded. The required information may also be on your own provider’s letterhead or narrative summary form, as long as it contains the information requested on the MSC Medical Summary Form, especially listing all current medications, any lab or other test results, and follow-up requirements.
  • Anyone required to take a prescription medication should have at least a six-month supply of the medication prior to sailing. Medications should be in carry-on bags, if flying overseas to a ship. DO NOT pack your medications in your checked luggage in case it gets lost. Relying on refills via mail is not recommended. MSC Medical may provide a letter which you can give to your doctor, pharmacy, or insurance company to try and help you obtain extra refills of medications needed for deployment.
  • If you use a CPAP, it is strongly encouraged that you have extra face pieces and hoses to last the duration of your overseas assignment, as it will be difficult to obtain additional parts for your machine while sailing.
  • If eyeglasses or contacts are needed for vision correction, you should ideally have two pairs of glasses or extra contacts with you and a current written prescription. You can request prescription safety glasses through the Safety Department IAW SMS 2.1-012-ALL procedure.

MSC Medical Examinations

If you are notified that you are due for a physical or occupational health exam, these examinations will be paid for by MSC. Exams can be scheduled by the ship Medical Services Officer (MSO) or by calling the CIVMAR Support Center (CSC). You must bring your supplemental health record with you to the examination. If the periodicities align, MSC Medical examinations may be submitted to the USCG National Maritime Center (NMC) for renewal of USCG mariner credentials in lieu of completing the USCG 719K examination forms at your own expense. NMC may still require additional documentation at their discretion. If additional information is requested, it is the CIVMAR’s responsibility to provide it.

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Not Fit for Duty (NFFD) Procedures

If a medical condition occurs which requires you to be placed in a Not Fit for Duty (NFFD) status, you must submit supporting documentation to MSC Medical via fax or email. The preferred method of submission is via email. The fax number and email address are located at the top of the Medical Summary Form and on the Medical Points of Contact page. Follow-up Medical Summary Forms should be provided to MSC Medical on a regular basis (preferably at least monthly) to update your fitness for duty status. Based on the documentation provided by your health care provider, MSC Medical will determine if you are fit to return to duty. DO NOT assume that because your personal medical provider has marked “Fit for Duty” (FFD) that you will be cleared by MSC medical as being FFD. MSC Medical will determine if you meet MSC medical standards or whether more information may be needed from your provider. You do not want to have needlessly traveled to the CSU pool at your own expense only to find out you were not cleared by MSC Medical, and that more information was required or that you do not meet MSC Medical Standards.

Important Points

  • MSC Medical only determines fitness for duty status not for leave status. You must request leave through your placement officer (sick leave, annual leave, LWOP, etc.) If documentation indicates that an extension of the NFFD status is warranted, you still must contact your Marine Placement Specialist (MPS) regarding your leave status.
  • If a chronic condition follow-up requirement lapses while you are NFFD for another reason such as an injury, although you may get medically cleared for the original reason you were NFFD, you will not be cleared as FFD until you have provided an update on the lapsed chronic condition.
  • Once you have been cleared FFD by MSC Medical, you should contact your MPS regarding orders or reporting to the pool.
  • Please do not make any travel arrangements to report back to the pool until you have verified your duty status with Medical.
  • CIVMARs in a leave status who have medical issues arise which can affect their duty status, such as scheduling of routine tests, elective surgery, and prolonged dental work, should keep their MSO (if assigned to a ship) and the MSC Medical Office informed of their status and submit appropriate supporting documentation.
  • Recurrent medical repatriations for the same problem can be grounds for being made permanently NFFD. Repatriation for failure to meet your responsibilities such as having enough medication or prescription eyewear to complete a deployment can result in disciplinary action.
  • If you have been medically repatriated off a ship due to a work related injury, you must keep MSC Medical updated as well as the MSC Office of Workers Compensation Program (OWCP) staff. The OWCP representative is assigned based on first letter of the mariner’s last name.
  • The OWCP contact numbers are:
    Alpha A-F: 757-341-6478
    Alpha G-M: 757-341-6475
    Alpha N-Z: 757-341-6474
    Supervisor: 757-341-6473

Out-port Medical Notice for CIVMARs

The out-port medical examination process enables you to obtain your required MSC examinations occupational at Navy Medical Treatment Facilities (MTF) or contracted Occupational Health clinics while at home on leave. The intent is to allow maximum flexibility in obtaining required medical examinations closer to your residence and allowing you to spend more time in a personal leave status. You have the option to complete your exam either while on leave or when you return to the CIVMAR Support Unit (CSU).

The Medical Services Officer (MSO) is responsible for ensuring each mariner is medically screened when reporting onboard and before departing the ship to identify what examinations, if any, are needed. Your physical examination may be scheduled before departing the ship and the MSO can assist you with scheduling or you can call the CIVMAR Support Center, 757-341-4610 or 757-341-4611.

If you have any supporting documentation from your own physician on any new health concern or existing chronic medical condition, please bring a copy to your appointment and have it forwarded with your physical examination to the MSC medical office. The CSU East Medical Office and West Medical Office are the centralized points of review for the physical examinations and making duty determinations.

There are certain aspects of the occupational medical examination which may not be done at contracted clinics. If you require an asbestos medical surveillance examination or an audiogram (hearing test) as part of the hearing conservation program, these examinations must be done at a MTF and not a contracted facility. A hearing test may be done at a contracted facility, as part of a routine physical examination, but may not be valid as part of the hearing conservation program.

Before departing the ship, the Master, Purser and/or your Department Head will remind you of your obligation to remain in contact with your Marine Placement Specialist (MPS). At the time you leave the vessel, you will be required to provide updated contact information (such as home address, telephone number, email address, cellular number, and/or fax number) to the purser for relaying to your MPS.

It is the CIVMAR’s responsibility to keep possession of their supplemental medical record while traveling, especially when leaving a ship or transferring to another ship.

Many physical examinations done for MSC include lab tests requiring fasting specimens. When scheduling an appointment for a physical, ask if you will have blood drawn. Fasting requires that you eat no food for a minimum of eight hours, but preferably up to 12 hours, prior to having your blood drawn. You should drink no liquids (other than water) during this time but should continue to take all required prescription medication. Smoking and heavy exercise may affect your results as well so avoid them during your fasting period.

While attending the medical examination, you are placed in a full duty status with pay. The time you take to set up the examination and to make arrangements is not paid. Time and attendance will be maintained by your MPS and can be accomplished by phone, fax, or other specified means. Compensation and transportation costs to and from the nearest medical facility will be in accordance with existing joint travel regulations entitlements. Mariners who miss appointments or make untimely cancellations will reflect negatively upon you and the Command.

The MSO is the point of contact for questions from shipboard personnel regarding out-port physicals. CIVMARs ashore may contact the respective MSC Force Medical Offices:
East: 757-443-5760
West: 619-524- 9990 or 9987