Medical Forms

MSC Medical Summary Form

USCG 719-K
Medical Forms


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

MSC Force Medical Requirements

  • USCG Medical Certificate - we require you use the USCG 719K
  • Medical Surveillance Program Exams
  • Entry / Periodic MSC SQ
  • Keep MSC updated as to their medical conditions. Any change in dental or medical status, diagnosis, or treatment plan is required to be reported to MSC.
  • Immunizations and tuberculosis screening
  • Supporting medical documentation as required.

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

  • CIVMARs diagnosed with chronic medical conditions are highly encouraged to follow up regularly with their primary medical/dental teams and adhere to the medical/dental management plan.
  • Every 6 or 12 month proof of medical follow up for chronic medical conditions is no longer required.
  • CIVMARs are required to keep MSC updated as to their medical conditions. Any change in dental or medical status, diagnosis, or treatment plan is required to be reported to MSC using the MSC MSF or submitting the clinical evaluation note.
  • However, if a CIVMAR diagnosed with a chronic medical condition is unable to maintain a normal work schedule or is repatriated more than once in a 12 month period for the same/similar condition, or meets criteria outlined in Human Resources Advisory 2022-01, his/her fitness for MSC sea duty will be reevaluated,
  • 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 personal provider’s letterhead, narrative summary form, or clinical evaluation note as long as it contains the information requested on the MSC Medical Summary Form, particularly listing diagnosis, treatment plan, all current medications, any limitations or recommended work restrictions, 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 (six-month supply from the moment of shipboard check-in). 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

  • MSC no longer requires a periodic MSC Physical Examination (MSC PE), what used to be documented on 2807/2808/Appendix S forms. The EKG, labs and audiogram associated with the periodic MSC PE are also no longer required.
  • The periodic MSC PE has been replaced with periodic screening which consists of the completion of a MSC Standardized Medical Questionnaire (MSC SQ) and a review of the CIVMAR’s valid unexpired USCG Medical Certificate.
  • The requirement of MSC CIVMARs occupational health medical surveillance program (MSP) exams remains. The MSP numbered exams include 503 hearing conservation, 702 waste water and sewage, 704 weight handling equipment, 710 forklift operator, 716 respirator certification, 719 healthcare worker, and 721 explosive handler operator. If you are notified that you are due for a physical or occupational medical surveillance program (MSP)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).
  • If you are notified that you are due for a periodic MSC Standardized Medical Questionnaire (MSC SQ), download the MSC SQ from your ship’s server or this website, complete the form and email it to:
  • The submitted MSC SQ will be reviewed and upon review further requirements may be communicated from MSC Force Medical.

Not Fit for Duty (NFFD) Procedures

CIVMARs are to submit medical updates with a completed MSF from their visit with their healthcare provider, or the clinical encounter note from their visit with their healthcare provider to:

Medical documentation submitted to MSC Force Medical will be reviewed for acceptability. If the documentation is acceptable, it will be reviewed to update the CIVMAR’s medical duty status. Medical documentation can be submitted to:

The Force Medical Officer is the final authority on fitness for duty determination. DO NOT assume that because your personal medical provider has recommended “Fit for Duty” (FFD) that you will be cleared by MSC medical as being FFD.

DO NOT assume that because your personal medical provider has recommended “Not Fit for Duty” (NFFD) that you will be placed into a NFFD medical duty status.

MSC Force 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 continue to not meet MSC Medical Standards.

Important Points

  • MSC Medical only determines medical fitness for MSC sea duty status not for leave status. You must request leave through your ashore supervisor 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.
  • 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 medical duty status with your ashore supervisor.
  • 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.
  • With the approval of MSC’s Medical Procedures Manual Interim Change Notice (ICN) 04, MSC Force Medical no longer accepts appointment slips as supporting documentation to initiate, change or to extend a NFFD status. To pursue sick leave for the date(s) of a scheduled medical or dental appointment, please contact your afloat supervisor or ashore MSC Placement Officer (supervisor) for approval. Direct any questions regarding this change to your supervisor.
  • Repeated repatriation for failure to meet your responsibilities such as having enough medication or prescription eyewear to complete a deployment may 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 (underway / OCONUS) Medical Notice for CIVMARs

The Medical Services Officer (MSO) or Medical Department Representative (MDR) is responsible for ensuring each mariner is medically screened when reporting onboard and before departing the ship to identify what agency required occupational examinations, if any, are needed. Your medical surveillance program occupational examination(s) may be scheduled before departing the ship and the MSO/MDR can assist you with scheduling or you can call the CIVMAR Support Center at 877-CIVMAR-1.

The out-port occupational medical examination process enables you to obtain your required MSC occupational examinations at 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).

While attending the occupational 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. The MSO and MDR is the point of contact for questions from shipboard personnel regarding out-port required occupational medical exams. CIVMARs ashore may contact the MSC Force Medical Office at 757-443-5760.