Yes! You can use AI to fill out U.S. Coast Guard Form CG-719K, Application for Medical Certificate
CG-719K is the U.S. Coast Guard’s official application and medical evaluation form for issuing a Merchant Mariner Medical Certificate. It collects the mariner’s identifying information, medical conditions and medications, and the results of a physical exam, vision and hearing testing, and (when required) a demonstration of physical ability. A licensed medical practitioner must review and complete key sections and attest to the accuracy of the examination and findings. The Coast Guard uses the completed form to determine whether the applicant meets medical standards for safe maritime service and credentialing.
CG-719K is part of the
Coast Guard forms, Medi-Cal forms, medical certificate forms, medical forms and VA medical forms categories on Instafill.
Form Complexity Index
Very Complex
89 / 100
| Fillable fields | 460 |
| Pages | 10 |
| Fields per page | 46 |
| Sections | 118 |
| Conditional rules | 169 |
| Tables & lists | 5 |
| Instruction pages | — |
| OMB Control No. | 1625-0040 |
| Instafill Form ID | IF-DEPARTMENT-OF-HOMELAND-SECURITY-US-COAST-GUARD-APPLICATION-FOR-MEDICAL-CERTIFICATE |
CG-719K has a very complex Form Complexity Index of 89/100 — 460 fillable fields across 10 pages. Instafill’s AI completes it accurately in under a minute.
Form specifications
| Form name: | U.S. Coast Guard Form CG-719K, Application for Medical Certificate |
| Number of fields: | 460 |
| Number of pages: | 10 |
| FCI: | Very Complex (89/100) |
| Field instructions: | CG-719K Instructions |
| Filled form examples: | CG-719K Examples |
| Language: | English |
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How to Fill Out CG-719K Online for Free in 2026
Are you looking to fill out a CG-719K form online quickly and accurately? Instafill.ai offers the #1 AI-powered PDF filling software of 2026, allowing you to complete your CG-719K form in just 37 seconds or less.
Follow these steps to fill out your CG-719K form online using Instafill.ai:
- 1 Confirm you are applying for a Coast Guard Medical Certificate and gather prerequisites (Mariner Reference Number or MMC/SSN, government photo ID, and any relevant medical records/waivers).
- 2 Complete Section I (Applicant Information), including contact details and selecting all applicable endorsements held or sought (e.g., Deck, Engine, STCW, Food Handler, Pilotage, entry-level).
- 3 Fill out Section III(a) (Medical Conditions) by answering each condition Yes/No and marking Previously Reported (PR) and/or Medical Waiver (MW) where applicable; prepare supporting documentation for any “Yes” items.
- 4 Complete Section IV (Medications) by listing all required prescription/nonprescription medications, supplements, and vitamins per the form’s lookback periods, including dose, frequency, and condition treated.
- 5 Schedule an exam with an eligible Medical Practitioner (physician/PA/NP; MD required for U.S. Registered Pilots) and bring your completed sections, photo ID, and supporting records for the practitioner to review and complete Sections II and V–IX (food handler certification if applicable, physical exam, vision, hearing, physical ability if required, and summary).
- 6 Review the completed application for completeness (initials/dates where required, attachments noted, signatures present), then sign Section X (Applicant Certification) and optionally complete Section XI (Applicant Consent/third-party authorizations).
- 7 Submit all 10 pages (including instructions) and any attachments to the U.S. Coast Guard/National Maritime Center as required, ensuring the application includes your reference number or MMC so it will be accepted.
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Frequently Asked Questions About CG-719K
CG-719K has a Form Complexity Index of 89 out of 100, placing it in the very complex complexity tier. This score is calculated deterministically from the form’s own structure using Instafill’s published Form Complexity Index methodology, so it can be reproduced and independently verified — it is not a subjective estimate.
For CG-719K specifically, the score reflects 460 fillable fields across 10 pages, grouped into 118 sections, and 169 conditional fields that only apply depending on earlier answers, 5 tables or repeating lists. The number of fields is the largest factor in the base score (weighted 36%), followed by how difficult those fields are to complete based on their type, where free-text and signature fields count for more than simple checkboxes (26%). The number of pages that actually contain fields (15%), the amount of conditional “fill-only-if” logic (16%), and how many sections the form is divided into (7%) account for the rest of the base. On top of that base, the index adds points for tables and repeating lists, bundled instruction pages, and dense page layouts — capturing difficulty the base alone can miss.
In practical terms, a very complex score means the form is exceptionally demanding — a very large number of fields, often combined with tables, dense pages or extensive conditional logic. Instafill removes that effort entirely: our AI reads your information, maps each value to the correct field — including the conditional ones — and completes CG-719K accurately in under a minute, with every field available for you to review before you download. See exactly how the Form Complexity Index is calculated.
CG-719K is the U.S. Coast Guard Application for Medical Certificate. It is used to determine whether you meet medical standards for issuance of a merchant mariner medical certificate (and related MMC medical qualification decisions).
Applicants seeking a Coast Guard Medical Certificate must complete the form and submit all 10 pages (including instructions) to the U.S. Coast Guard. Certain entry-level mariners requesting an MLC-compliant certificate may have reduced section requirements (see the entry-level/MLC question).
Yes. The instructions state you must submit all 10 pages, including the instruction pages, with your application.
No. The Coast Guard will not accept an application for a medical certificate without a reference number or a Merchant Mariner Credential (MMC). If you previously held a Coast Guard credential, use your reference number; otherwise follow NMC guidance for obtaining one.
Your Home Address must be your principal place of residence and cannot be a PO Box. A PO Box is acceptable for the Delivery/Mailing Address if it is different from your home address.
Your application will be rejected. The form states that if nothing is selected, the Coast Guard will not accept the application.
If you are under 18, you must attach a notarized statement signed by a parent or guardian authorizing the Coast Guard to issue a Medical Certificate.
Exams, tests, and demonstrations must be performed, witnessed, or reviewed by a physician, physician assistant, or nurse practitioner licensed by a U.S. state/territory/possession. For U.S. Registered Pilots, the medical examination must be conducted by a licensed medical doctor (MD).
Not always. Entry-level mariners on non-STCW vessels who request an MLC-compliant medical certificate and want to be qualified for lookout duties do not have to complete Sections III (Medical Conditions), IV (Medications), and V (Physical Examination); the resulting medical certificate will be restricted to entry-level only.
You must present one current, valid government-issued photo ID to the Medical Practitioner. Examples include an unexpired passport, driver’s license, military ID, MMC, or TWIC.
Check “YES” if you have ever been diagnosed with, treated for, are currently under treatment/observation for, or currently have the condition (even if untreated). If a condition was previously reported, mark “PR,” and if you have a medical waiver, mark “MW” and provide a copy to the Medical Practitioner.
For each “YES,” the Medical Practitioner must document the condition, date of onset/diagnosis, treatment, current status, limitations, and any needed supporting information, and indicate if attachments are included. For “PR,” they generally only need to address interval history and current status.
You must report all prescription and nonprescription medications, dietary supplements, and vitamins that you took or refilled within 30 days before you sign the form, and any that you used for 30 or more days within the last 90 days before signing. The Medical Practitioner must review and comment on duration of use and side effects.
No. Vision and hearing exams may be performed by qualified office staff or referred to other qualified practitioners (such as optometrists or audiologists), but the Medical Practitioner must review the results.
Section XI is optional and lets you authorize (a) your Medical Practitioner to release information to the Coast Guard, (b) the Coast Guard to release information to a third party, and/or (c) a third party to act on your behalf. You are not required to sign these, but not authorizing release to the Coast Guard may delay a timely determination.
Compliance CG-719K
Validation Checks by Instafill.ai
1
Ensures all 10 pages of CG-719K are submitted (including instructions pages)
Validate that the submission includes all pages required by the Coast Guard (the form explicitly states all 10 pages must be submitted, including instructions). This prevents incomplete packets that cannot be processed or reviewed by the Medical Practitioner (MP) and NMC. If any page is missing, the application should be rejected as incomplete and the applicant prompted to resubmit the full packet.
2
Validates Applicant Legal Name completeness and format (Last, First, MI, Suffix)
Check that Last Name and First Name are present and contain only valid name characters (letters, spaces, hyphens, apostrophes), and that Middle Name/Initial and Suffix (if provided) follow expected formats. This is critical for identity matching across Coast Guard systems and for ensuring additional sheets can be correctly attributed to the applicant. If invalid or missing, flag the submission for correction before acceptance.
3
Validates Date of Birth format and age-related requirements
Ensure Date of Birth is provided and matches MM/DD/YYYY, represents a real calendar date, and is not in the future. If the applicant is under 18, require an attached notarized parent/guardian authorization as stated in the instructions. If DOB is invalid or the under-18 attachment is missing, the submission should fail validation and be returned for completion.
4
Requires Mariner Reference Number or SSN and validates its format
Enforce that either a Mariner Reference Number or a Social Security Number is provided, since the form states the Coast Guard will not accept an application without a reference number or MMC. If SSN is used, validate it is 9 digits (optionally formatted as XXX-XX-XXXX) and not an obviously invalid pattern (e.g., all zeros). If neither identifier is present or the identifier format is invalid, reject the application as non-acceptable.
5
Validates Sex selection is present and within allowed values
Confirm that Sex is selected and is one of the allowed options shown on the form (Male/Female). This supports consistent medical evaluation and record matching. If missing or outside allowed values, the submission should be flagged for correction.
6
Validates Home Address is a physical address (no PO Box) and is complete
Check that Home Address includes street address, city, state, and ZIP, and that the street address does not contain PO Box indicators (e.g., 'PO Box', 'P.O. Box'), as explicitly prohibited. This ensures the principal place of residence is captured correctly for official records. If a PO Box is detected or required components are missing, fail validation and request a corrected physical address.
7
Validates Delivery/Mailing Address logic and completeness (defaults to Home Address if blank)
If Delivery/Mailing Address is provided, validate it includes street, city, state, and ZIP; PO Boxes are allowed here. If it is blank, ensure the system will route correspondence to the Home Address as the form specifies. If a partial mailing address is provided (e.g., missing ZIP), fail validation to prevent misdelivery of certificates and correspondence.
8
Validates contact information: primary phone required; phone/email formats
Require a Primary Phone Number and validate it matches an acceptable phone format (e.g., 10 digits with optional country code and separators). Alternate phone and email are optional, but if provided, validate email syntax and phone formatting to ensure the NMC can contact the applicant. If the primary phone is missing or any provided contact field is malformed, flag for correction before acceptance.
9
Ensures at least one Endorsement Held or Sought is selected
Validate that at least one endorsement checkbox is selected (Deck, STCW, Engine, Food Handler, U.S. Registered Pilot, First-Class Pilot/Serving as Pilot, Entry-level with lookout duties, or Other with explanation), because the form states the Coast Guard will not accept the application if nothing is selected. This drives which sections are required and how the medical assessment is interpreted. If none are selected, reject the submission as non-acceptable.
10
Validates 'Other' endorsement explanation is provided when selected
If the applicant selects 'Other (Please explain)', require a non-empty explanation field with sufficient detail (not just 'N/A' or a single character). This prevents ambiguous endorsement intent and ensures the correct evaluation pathway is applied. If missing, fail validation and request clarification.
11
Food Handler Certification dependency check (Section I vs Section II)
If 'Food Handler' is checked in Section I, require Section II to be completed by the Medical Practitioner with exactly one of Yes/No/N/A selected for 'Is the applicant free from communicable disease?'. This is necessary because the Food Handler certification is conditional and must be explicitly attested by the MP. If Food Handler is selected but Section II is blank or has multiple selections, fail validation and return for MP completion.
12
Medical Conditions Section III(a) completeness and single-response enforcement per item
For each condition item (1–34), validate that exactly one of Yes/No is marked, and that PR and MW are only marked when Yes is marked (since PR/MW are qualifiers of a positive history). This prevents contradictory reporting (e.g., No + PR) and ensures the MP knows which conditions require follow-up. If any item is unanswered or has conflicting selections, fail validation and require correction.
13
Section III(b) required follow-up for every YES condition in III(a)
For every item marked YES in Section III(a), require a corresponding entry in Section III(b) including condition name, date of onset/diagnosis (mm/dd/yyyy), treatment, status, and limitations; also require the 'Item #' to match the III(a) item number. This ensures the MP’s discussion meets the minimum required content and supports Coast Guard review. If any YES item lacks a matching III(b) block or required details, the submission should be rejected as incomplete.
14
Medical Waiver (MW) attachment requirement and consistency
If any condition is marked MW in Section III(a), require an uploaded copy of the waiver letter and any waiver reporting requirements as instructed. This is critical because waiver terms can impose specific documentation and follow-up obligations. If MW is checked but no waiver documentation is attached, fail validation and request the missing waiver materials.
15
Medications section logic: 'Do you currently use any medication?' vs medication table completion
If the applicant answers 'Yes' to current medication use, require at least one medication row with medication name, dose, frequency, and condition; if 'No' is selected, ensure the medication table is empty (or explicitly marked none) to avoid contradictions. This supports accurate risk assessment and MP verification obligations described on the form. If the answer conflicts with the table contents or required fields are missing, flag for correction.
16
Medical Practitioner credentials and attestation completeness (Section IX.e)
Require the MP to provide name, credential type (MD/PA/NP), state of licensure, license number, office address, phone number, signature, and date in MM/DD/YYYY. This confirms the exam was conducted/reviewed by an authorized practitioner and provides traceability for audits and follow-up. If any credential/attestation element is missing or the date/signature is absent, fail validation because the form is not legally attested.
Common Mistakes in Completing CG-719K
Applicants often upload only the signature pages or the exam pages and omit “instruction” pages because they assume they aren’t required. The CG-719K instructions explicitly state all 10 pages must be submitted, and missing pages commonly trigger a rejection or delay at the National Maritime Center. Avoid this by scanning and submitting the entire packet in order (pages 1–10), even if some pages are “N/A” for your situation.
People frequently enter only a Social Security Number when they already have a Mariner Reference Number, or they leave the field blank entirely. The form states the Coast Guard will not accept an application without a reference number or an MMC, so this can cause an immediate non-acceptance. Use your Mariner Reference Number if you have ever held a Coast Guard credential; otherwise provide the SSN as allowed and ensure it matches your identity documents.
Applicants often put a PO Box in the Home Address because it’s their preferred mailing address, but the form clearly says PO Box is not acceptable for the Home Address (principal place of residence). This can lead to follow-up requests, processing delays, or returned correspondence if addresses don’t align. Enter a physical residential street address for Home Address, and use the Delivery/Mailing Address field for a PO Box if needed.
A very common oversight is leaving “Endorsement Held or Sought” blank because applicants think it’s only for current credential holders. The form states that if nothing is selected, the Coast Guard will not accept the application, resulting in a preventable rejection. Check all that apply (e.g., Deck, STCW, Engine, Food Handler, Pilot, Entry-level with lookout duties) and add an explanation in “Other” when necessary.
Applicants and medical practitioners frequently mix formats (DD/MM vs MM/DD), omit leading zeros, or sign with a date that doesn’t match the exam date or medication reporting window. Inconsistent or unclear dates can trigger clarification requests and can undermine the 30/90-day medication reporting requirements tied to the applicant’s signature date. Always use MM/DD/YYYY everywhere, and ensure signature dates align logically with the exam and the medication history timeframe.
People often answer “No” because a condition is controlled, “in the past,” or they think it’s not relevant (e.g., prior surgery, sleep apnea, mental health treatment, repatriation, or hospitalizations). The instructions require “Yes” if there was diagnosis/treatment, current observation, or the condition is present regardless of treatment, and omissions can lead to delays, requests for records, or potential enforcement issues due to the 18 USC § 1001 attestation. Avoid this by answering broadly and honestly, then letting the Medical Practitioner document status, limitations, and treatment in Section III(b).
Even when applicants correctly check “Yes,” the follow-up narrative is often missing key elements like diagnosis date, current status, treatment, limitations, and whether documentation is attached. The form requires the Medical Practitioner to discuss each “Yes” item and to attach recommended evaluation data for conditions subject to further review, and missing details commonly result in “Needs Further Review” and additional evidence requests. Ensure each “Yes” item number is addressed in III(b) with dates and specifics, and check the “Attached” box when you include extra pages or test results.
Applicants frequently mark PR or MW incorrectly—either checking PR without having previously reported it to the Coast Guard, or checking MW without providing the waiver letter and required follow-up documentation. This creates confusion for reviewers and can delay processing while the Coast Guard verifies prior records or requests missing waiver materials. Only mark PR if it was previously reported to the Coast Guard, mark MW only if you have an active waiver, and provide a copy of the waiver letter plus any waiver reporting requirements.
Many applicants list only prescriptions and forget over-the-counter meds, vitamins, dietary supplements, or “as needed” drugs, and they often omit dose, frequency, or the condition being treated. The form requires reporting medications taken within 30 days before signing and those used 30+ days within the last 90 days, and incomplete lists can trigger follow-up or raise concerns if conditions imply medications that aren’t listed. Use the exact reporting windows, include all substances (Rx/OTC/supplements), and provide dose, frequency, and purpose; the Medical Practitioner should add duration and side effects in comments.
A common error is writing “passed” without documenting the test method, number of errors, or corrected vs uncorrected acuity, or allowing color-enhancing lenses despite the stated prohibition. Missing the test type and error count can invalidate the color vision section and lead to retesting requests. Ensure distance vision is recorded for each eye (uncorrected and correctable-to if applicable), select the exact color vision test used, and record the number of errors and pass/fail per the listed standards.
Applicants and clinics often perform an audiogram but fail to record aided/unaided values, averages, or the functional speech discrimination test when thresholds require it, or they leave the “normal/abnormal/hearing aid required” selection unclear. The instructions specify when additional testing is required (e.g., unaided threshold > 30dB in the better ear) and incomplete data can cause delays or a request for repeat testing. Follow the flow: document whether hearing is normal by forced whisper >5 feet; if abnormal, complete the appropriate audiogram fields and add speech discrimination at 65dB when required, including aided and unaided results.
This form is frequently rejected because the Medical Practitioner doesn’t initial/date each page where indicated, doesn’t sign the attestation in Section IX, omits license number/state/credential (MD/PA/NP), or the applicant forgets to sign Section X and date it. Since both parties attest under 18 USC § 1001, unsigned or partially signed forms are treated as incomplete and can’t be processed. Before submission, do a final checklist: MP initials/dates on each required page, MP signature and license details in Section IX (with office stamp/address), and applicant signature/date in Section X (and Section XI only if authorizing consents).
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