Recommended Evaluation Data Excerpt From Nvic 04-08
ADVERTISEMENT
1Recommended Evaluation Data Excerpt from NVIC 04-08
Purpose: This document is an excerpt from the Medical and Physical Evaluations
Guidelines for Merchant Mariner Credentials, contained in enclosure 3 of NVIC 04-08. It
addresses evaluation data for specific conditions that may be requested upon evaluation
of the physical examination report (CG-719K).
No.
MEDICAL CONDITION
RECOMMENDED EVALUATION DATA
BLOOD AND BLOOD-FORMING TISSUE DISEASE
189
Anemia with hemoglobin
Submit an internal medicine or hematology consultation with
< 10.0 grams per deciliter
clinical history of the condition and medications, including
diagnosis and course. Include a CBC with reticulocyte count,
electrophoresis in cases of thalassemia and hemoglobinopathies. (In
the case of sickle cell trait, the electrophoresis should document
hemoglobin A > hemoglobin S) Hemoglobin A2 quantification in
cases of beta-thalassemia trait, serum iron, TIBC, and serum ferritin
in cases of thalassemia trait.
190
Hemophilia
Submit an internal medicine or hematology consultation with
clinical history of the condition, including diagnosis and course.
Include a CBC with reticulocyte count.
191
Other disease of the blood or blood-
Submit an internal medicine or hematology consultation with
forming tissues
clinical history of the condition, including diagnosis and course.
causing significant functional impairment
Include a CBC with reticulocyte count, electrophoresis in cases of
thalassemia and hemoglobinopathies. (In the case of sickle cell trait,
the electrophoresis should document hemoglobin A > hemoglobin
S) Hemoglobin A2 quantification in cases of beta-thalassemia trait,
serum iron, TIBC, and serum ferritin in cases of thalassemia trait.
192
Polycythemia
Submit an internal medicine or hematology consultation with
clinical history of the condition, including diagnosis and course.
Condition #
Comments:
Applicant Name:_____________________________
Date of Birth:____________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical