Medical Review Process

Fitness for Medical Certification

Seafarers work in a multitude of environments and conditions that can impact their physical condition and may prevent them from obtaining timely medical care. Remote locations with minimal, if any, medical resources is common and the loss of a functioning mariner on a vessel can significantly impact the rest of the crew, both in regards to routine and emergency duties.

Medical conditions that preclude performance of these duties increase the risk to remaining crew, property and public safety.

Recommendations for issuing a Medical Certificate by treating practitioners are taken into consideration by the National Maritime Center (NMC) personnel evaluating the medical condition of the mariner. It should be noted, however, that treating practitioners often make recommendations without fully understanding fitness for certification guidelines and the marine transportation system (MTS) safety needs. Final determination will be made in accordance with the overriding safety needs of the MTS.

The determination of whether or not a mariner is fit for certification is based on a medical evaluation of the physical examination form and supporting documentation submitted by the applicant. The medical evaluation is a three-step process; however, not all applicants are subject to all three steps:

1) Medical Screening: Certified medical assistant (CMA) or Registered Medical Assistant (RMA) review every physical examination arriving at the NMC. The CMAs/RMAs have a limited ability and clear approximately 70 percent of the files without any further review required.

2) Initial Medical Review: Any medical condition deemed outside of the scope of the CMA or RMA is then reviewed by a mid-level medical provider, a physician assistant (PA). The PAs review all application files which require a more comprehensive assessment. These evaluators have the ability to grant waivers, request additional information and are authorized to speak with the applicant’s physician when there are questions with regards to fitness for certification requirements or requested information.

3) MD Review: If a physical examination has been evaluated and determined that the mariner may not be fit for certification, the file is then submitted to our senior evaluation staff for final determination.

Supporting Medical Documentation

Frequently a mariner’s medical examination will indicate treatment for an illness, injury or prescription medication which requires further clarification in order to make a fitness for medical certification determination. Awaiting information (AI) refers to additional information requested by the medical evaluation staff to complete the medical evaluation.