REPUBLIC OF THE MARSHALL ISLANDS OFFICE OF THE MARITIME ADMINISTRATOR

TO:

Marine Guideline No. 7-47-1 12/09

ALL SHIPOWNERS, OPERATORS, MASTERS AND OFFICERS OF MERCHANT SHIPS, AND RECOGNIZED ORGANIZATIONS Guidance on Medical Exams and Certificates for Seafarers. (a) (b) (c) (d) (e) (f) (g) (h) Maritime Labour Convention, 2006 ILO/WHO Guidelines for Conducting Pre-sea and Periodic Medical Fitness Examinations for Seafarers Medical Examination (Seafarers) Convention 1946 (ILO No. 73) STCW Convention, Section B-I/9 Maritime Act, 1990, as amended (MI-107) 825 Maritime Regulations (MI-108) 7.47.4 Requirements for Merchant Marine Personnel Certification (MI-118) U.S. National Transportation Safety Board, Safety Recommendation (Obstructive Sleep Apnea), October 20, 2009

SUBJECT: References:

PURPOSE: This Guideline details suggested practices for conducting physical examinations of seafarers prior to beginning work on a Marshall Islands (MI) flag ship and periodically thereafter to ensure that they are medically fit to perform the duties they are to carry out at sea. This Guideline supplements requirements for merchant marine personnel certification contained in MI-108, 7.47.4 and in MI-118. Certified Recruitment Placement Services (RPSs) and seafarers are encouraged to provide a copy of this Guideline to their medical examiner prior to and for use during medical examinations. BACKGROUND: This Guideline is based on the International Labour Organization/World Health Organization document, Guidelines for Conducting Pre-Sea and Periodic Medical Fitness Examinations for Seafarers (ILO/WHO/D.2/1997). Consideration of this document is required by Section B-1/9 of the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1978, (STCW), as amended, and by Guideline B1.2.1 of the Maritime Labour Convention, 2006 (MLC, 2006).

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Inquiries concerning the subject of this Guideline should be directed to the Office of the Maritime Administrator, Republic of the Marshall Islands, c/o Marshall Islands Maritime and Corporate Administrators, Inc., 11495 Commerce Park Drive, Reston, VA 20191-1506 USA.
MI-03, 9/06

1.0 1.1

Qualifications of Medical Examiners A medical examiner used by a seafarer should: Be a licensed physician with independence from employers, workers and their representatives in exercising medical judgment with respect to examination procedures; Be experienced in general and occupational medicine or maritime occupational medicine; Have knowledge of the living and working conditions on board ships, gained either through special instruction or through personal experience of seafaring; and Be familiar with the IMO/WHO publication, International Medical Guide for Ships, upon which this MG-7-47-1 is based.

1.2

RPSs and seafarers may not utilize for the purpose of medical certification exams, medical examiners found to be incompetent, unethical or guilty of professional misconduct as a result of an appeals or complaints procedure. The Republic of the Marshall Islands Maritime Administrator (the Administrator) recognizes medical examiners approved by competent authorities of States that are party to the MLC, 2006, Medical Examination (Seafarers) Convention 1946 (ILO No. 73), or STCW. Guidance to Medical Examiners While nothing in these guidelines should preclude sound medical judgment, in conducting an examination, a medical examiner should bear in mind the following aspects of shipboard life: It is unadvisable and often unsafe to allow persons with certain medical conditions to become seafarers or return to seagoing employment due to the difficulty of transporting sick or injured seafarers ashore where they can receive adequate medical care. Contagious diseases may be a threat to other crew members and, when carried, passengers, due to the close living conditions.

1.3

2.0 2.1

3.0 3.1

Pre-Sea and Periodic Medical Exams The ILO/WHO guidelines differentiate between pre-sea and periodic medical examinations. Pre-sea examinations are those conducted before a person embarks upon a seafaring career. Periodic medical examinations are those conducted either before a seafarer reports to a ship or at periodic intervals during the seafarers career. Under MI regulations, seafarers must undergo a medical examination prior to employment aboard a vessel (not more than 12 months prior to the date of making application) and normally (unless a shorter time is specified for specific duties or required by STCW) every two (2) years thereafter (unless the seafarer is under the age of 18 where an annual exam is required) to obtain a valid medical certificate/report showing medical fitness for duty. The scope of the medical exam for both pre-sea and periodic assessments is identical.

3.2

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3.3

In addition, prior to or during employment on a MI flag vessel, seafarers must undergo, or provide proof by submitting a new MI-105M form, that they have undergone a medical exam, including mental health counseling, should they be subject to a situation involving robbery, hostage taking or piracy aboard a vessel. In urgent cases, a newly hired seafarer may work without a valid medical certificate until the next port of call where the seafarer can obtain a medical certificate from a qualified medical practitioner, provided that the period of work without a valid certificate does not exceed three (3) months and the seafarer concerned is in possession of a medical certificate that has expired within the past six (6) months. A model medical examination form is provided in Appendix 1. This form, although not mandatory, details the minimum requirements that a medical examiner should cover during an examination of a seafarer. Persons seeking to work aboard an MI flag vessel are encouraged to provide this form to their medical examiner to ensure all required aspects of the medical examination are covered. This form should not be confused with the Physical Examination Report/Certificate (form MI-105M, Appendix 2), which is a summary of the medical examination and is required to be filled out and signed by the medical examiner and then submitted to the Administrator to show fitness for duty. Determination of Fitness for Duty In conducting a medical exam and evaluating a seafarer for fitness for duty, the medical examiner should consider the following items.

3.4

3.5

4.0

4.1

Requirements of Job Medical issues may necessitate restrictions on an examinees work (e.g., fit for coastal or harbor service only) or disqualify a seafarer from service. Therefore, the examinees intended position on board ship and the physical and psychological requirements of this work should be considered as should the age and experience of the person, the nature of the duties to be performed and the type of shipping operations and cargo.

4.2

Occupational History Occupational history should be considered as it may illuminate potential occupational health hazards (e.g., risk of cancer from chemical cargoes, risk of hearing loss from work in engine room).

4.3

Previous Medical History Information should be collected directly from the examinee on his/her previous medical history, including details of previous diseases, injuries and mental health issues. The examinees previous medical records, where appropriate, should be reviewed.

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4.4

Counseling As appropriate, the medical examiner should counsel and provide printed health educational materials to the seafarer on: .1 Lifestyle, such as: limiting alcohol intake (see ILO publication, Drug and alcohol prevention programmes in the maritime industry, a manual for planners); stopping smoking; modifying diet; and losing weight.

.2 The dangers and methods of prevention of communicable diseases, such as: malaria; hepatitis; and HIV/AIDS (A seafarer should always be informed of positive results. An HIV positive test result should not automatically render the seafarer unfit for duty.).

.3 The dangers, symptoms and treatment for sleep disorders, such as: narcolepsy obstructive sleep apnea (OSA)

.4 Post trauma coping mechanisms, including short-and-long term mental health treatment necessitated by shipboard incidents of: 4.5 robbery; hostage taking; or piracy.

Hearing Hearing should be checked using a pure tone audiometer and recorded. Every seafarer on a MI flag vessel must have hearing unimpaired for normal sounds and be capable of hearing a whispered voice in the better ear at 15 feet (4.57m) and in the poorer ear at five (5) feet (1.52m).

4.6

Eyesight and Color Vision A licensed medical practitioner should examine a seafarer for visual fitness. Eyesight should be checked using appropriate equipment and recorded. .1 Eyes of seafarers should be free of disease. Any permanent or progressing dehabilitating pathology without recovery should be cause for determination of unfitness.

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.2 Eyesight must be in compliance with the minimum requirements established by the Administrator in accordance with the MLC, 2006 and STCW as provided below. Deck/Navigational Officer - A candidate must have (either with or without glasses) at least 20/20 (1.00)1 vision in one eye and at least 20/40 (0.50) in the other. If the candidate wears glasses, he/she must have vision without glasses of at least 20/160 (0.13) in both eyes. The candidate also must have normal color perception, and be capable of distinguishing the colors red, green, blue and yellow. Engineer or Radio Officer - A candidate must have (either with or without glasses) at least 20/30 (0.63) vision in one eye and at least 20/50 (0.40) in the other. If the candidate wears glasses, he must have vision without glasses of at least 20/200 (0.10) in both eyes. An engineer or radio officer candidate shall be examined only as to perception of the colors red, yellow and green.

.3 The maximum period of validity for a color vision certificate shall be six (6) years. 4.7 Vaccinations The examinees vaccination record should be examined. Seafarers should be vaccinated according to the requirements indicated in the WHO publication, International travel and health: Vaccination requirements and health advice. The medical examiner should give advice to the seafarer on immunizations. If new vaccinations are given, they should be recorded. It is recommended that all vaccinations be recorded on the International Certificate of Vaccination or Prophylaxis. 4.8 Communicable Diseases .1 The medical examiner should certify whether an applicant is free from communicable diseases. .2 Seafarers expected to be handling food (i.e., those in the stewards department) diagnosed with, suspected of, or exposed to any communicable disease that can be transmitted by food shall be restricted from working in any food or food-related areas or operations (including working with exposed food, equipment, utensils, table linens, single-service and single use articles or warewashing) until they are symptom-free for a minimum of 48 hours. .3 Communicable diseases that can be transmitted by food include, but are not limited to, typhoid (Salmonella typhi bacteria), shigellosis (Shigella spp. bacteria), cholera (Vibrio spp. bacteria), intestinal disease (Escherichia coli O157:H7 bacteria) and liver disease (hepatitis A virus). Other communicable diseases, as provided in section 4.9, below, may render an applicant unfit for duty. In any case of communicable disease, the medical examiner should provide counseling to the applicant as provided in section 4.4, above.
1

Numbers contained in parentheses are equivalents measured utilizing the decimal visual acuity scale.

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4.9

Medical Conditions There are medical conditions that if of a certain type or severity or if left untreated preclude service at sea permanently or temporarily or justify medical surveillance and/or restrictions on time, position, trade area and type of ships. These conditions are listed in Appendix 3. .1 When determining fitness for sea service of a person with the any of these conditions, a medical examiner should evaluate: The critical time needed for treatment/access to appropriate land-based care; The extent of the threat and danger caused by the medical problem to the patient, other persons on board and to the safety of the vessel or the environment; The current risk of occurrence of the medical problem; and Whether the condition is under control by medication, diet or another means and, if so, whether the person is under a physicians care on a regular basis for the condition.

.2 In any circumstance, a seafarer with the following medical conditions shall be considered unfit for duty: 4.9 epilepsy; insanity; senility; alcoholism; tuberculosis; acute venereal disease or neurosyphilis; AIDS; and/or the use of narcotics.

Determination of Fitness

4.9.1 If a person is found fit for the work to be performed, the medical examiner should fill out form MI-105M, Physical Examination Report/Certificate (Appendix 2) or on the official form of a country which is party to the MLC, 2006 or ILO Convention No. 73 on Medical Examination of Seafarers. Any such report shall specifically indicate that the candidate was examined as to hearing, vision and general physical and mental condition. This completed form constitutes the issuance of a Medical Certificate by the medical examiner and must be signed by both the medical examiner and examinee. 4.9.2 If the medical examiner imposes restrictions on work (i.e., the job the seafarer will perform, the trade area, time-limit, etc.), these restrictions should be reflected on the form. 4.9.3 If the examinee is found temporarily or permanently unfit for service, he or she should be given an explanation of the reasons and advised on the right and the procedures for making an appeal.

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4.9.4 If an examinee is found temporarily unfit, the medical examiner should give advice on the need to make additional tests, to obtain opinions from specialists, to complete dental or other treatment, rehabilitation and/or appropriate medical care. The examinee should be informed of when to return for another examination. 5.0 5.1 Appeals Procedures Any seafarer who, after medical examination, has been refused a certificate or has had a limitation imposed on their ability to work, may apply for a further examination by another independent medical practitioner or by an independent medical referee, as defined under section 1.0 above. Notwithstanding all of the Qualifications for Medical Examiners present in section 1.0 above, the independent medical practitioner or independent medical referee should: 5.3 Have higher or at least the same qualifications as the previous medical examiner; Be mutually acceptable to the Administrator and most of the representative organizations of shipowners and seafarers; and Have two (2) advisers acceptable to the Administrator and most of the representative organizations of shipowners and seafarers to provide practical guidance.

5.2

A shipowner/operator may require an additional examination by another medical examiner if there are valid grounds to believe that a seafarer seeking employment or already employed is unfit for sea service. All information of the appeals procedure shall remain confidential between involved parties and shall not be provided to any outside parties. Protected Health Information (PHI) Definition: PHI is any information which concerns health status, provision of health care, or payment for health care that can be linked to an individual, to include any part of an individuals medical record or payment history. Right of Privacy All persons concerned with the conduct of medical examinations, including those who come in contact with medical examination forms, laboratory results and other medical information, should ensure the right of privacy of the examinee. Medical records should only be used for determining the fitness of the seafarer for work and enhancing health care. The seafarer shall have the right of access to and receipt of a copy of his/her personal medical data.

5.5

6.0 6.1

6.2

6.3

Confidentiality In accordance with the local and national laws of the country in which any PHI is located, medical examination reports and records (whether electronic or hard copy form), including a copy of the medical certificate and all medical data collected from the examinee, should be

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clearly marked CONFIDENTIAL. Additionally, in accordance with the local and national laws of the country in which any PHI is located, PHI should be retained in the files of the medical establishment where the medical certificate was issued, should be kept confidential, used only to facilitate the treatment of the seafarer, and should be made available only to persons authorized with the informed consent of the examinee. Receipt of an examinees Physical Examination Report/Certificate (form MI-105M) by the Administrator will serve as the subject examinees informed consent to the Administrator to disclose the Physical Examination Report/Certificate (form MI-105M) in any regard relating to the examinees fitness for duty.

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APPENDIX 1 Model Medical Exam Form CONFIDENTIAL FORM Pre-sea Exam Periodic Exam Name (last, first, middle): Date of birth (day/month/year): Home address: / / Sex: male female

Passport No./Discharge Book No.: Type of ship (container, tanker, passenger, fishing): Trade area (e.g., coastal, tropical, worldwide): Examinees personal declaration (Assistance should be offered by medical staff) Have you ever had any of the following conditions: 1. 2. 3. 4. 5. 6. 7. 8. 9. Condition Eye/vision problem High blood pressure Heart/vascular disease Heart surgery Varicose veins Asthma/bronchitis Blood disorder Diabetes Thyroid problem Yes No Condition 18. Sleeping problems 19. Do you smoke? 20. Operation/surgery 21. Epilepsy/seizures 22. Dizziness/fainting 23. Loss of consciousness 24. Psychiatric problems 25. Depression 26. Attempted suicide 27. Loss of memory 28. Balance problem 29. Severe headaches 30. Ear/nose/throat problems 31. Restricted mobility 32. Back problems 33. Amputation 34. Fractures/dislocations Yes No

10. Digestive disorder 11. Kidney problem 12. Skin problem 13. Allergies 14. Infectious/contagious diseases 15. Hernia 16. Genital disorders 17. Pregnancy

If any of the above questions were answered yes, please give details.

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Additional questions Yes 35. Have you ever been signed off as sick or repatriated from a ship? 36. Have you ever been hospitalized? 37. Have you ever been declared unfit for sea duty? 38. Has your medical certificate ever been restricted or revoked? 39. Are you aware that you have any medical problems, diseases or illnesses? 40. Do you feel healthy and fit to perform the duties of your designated position/occupation? 41. Are you allergic to any medications? Comments. No

42. Are you taking any non-prescription or prescription medications? If yes, please list the medications taken and the purpose(s) and dosage(s).

I hereby certify that the personal declaration above is a true statement to the best of my knowledge. Signature of examinee: Date (day/month/year): Witnessed by: (Signature) Name: (Typed or printed) I hereby authorize the release of all my previous medical records from any health professionals, health institutions and public authorities to Dr. (the approved medical examiner). Signature of examinee: Date (day/month/year): Witnessed by: (Signature) Name: (Typed or printed) / / / /

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Medical examination Pre-sea Sight Unaided Right Left eye eye Distant Near Color vision: Hearing Pure tone and audio metry (threshold values in dB) 500 4,000 2,000 3,000 4,000 6,000 Hz Hz Hz Hz Hz Hz Right ear Left ear Height: Pulse rate: Blood pressure: Urinalysis: Head Sinuses, nose, throat Mouth/teeth Ears (general) Tympanic membrane Eyes Opthalmoscopy Pupils Eye movement Lungs and chest Breast examination Heart Chest X-ray: Results: Not performed Glucose: Normal Abnormal Skin Varicose veins Vascular (inc. pedal pulses) Abdomen and viscera Hernia Anus (not rectal exam.) G-U system Upper and lower extremities Spine (C/S, T/S and L/S) Neurologic (full brief) Psychiatric General appearance Performed on (day/month/year): / / Systolic: (cm) (/minute) Weight: Rhythm: (mm Hg) Diastolic: (mm Hg) Protein: Normal Abnormal Speech and whisper test (metres) Normal Whisper Right ear Left ear (kg) Not tested Normal Doubtful Defective Visual acuity Aided Binocular Right Left eye eye Visual fields Normal Defective Binocular Right eye Left eye Periodic Other

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Other diagnostic test(s) and result(s): Test Result

Medical examiners comments:

Vaccination status recorded:

Yes

No

Assessment of fitness for service at sea On the basis of the examinees personal declaration, my clinical examination and the diagnostic test results recorded above, I declare the examinee medically: Fit for look-out duty Deck service Fit Unfit Without restrictions With restrictions Engine service Not fit for look-out duty Catering service Other services

Describe restrictions (e.g., specific positions, type of ship, trade area)

Action taken by medical examiner (e.g., referral): Place of examination: Date of examination (day/month/year): / / / /

Medical certificates date of expiration (day/month/year): Official stamp: Signature of medical examiner: Name of medical examiner: (Typed or printed) Authorized by:

(competent authority)

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APPENDIX 2

PHYSICAL EXAMINATION REPORT/CERTIFICATE

OFFICE OF THE MARITIME ADMINISTRATOR
CONFIDENTIAL DOCUMENT

REPUBLIC OF THE MARSHALL ISLANDS

SURNAME DATE OF BIRTH MONTH DAY YEAR GIVEN NAME(S) PLACE OF BIRTH CITY COUNTRY SEX MALE FEMALE

EXAMINATION FOR DUTY AS:

MASTER DECK OFFICER ENGINEERING OFFICER RADIO OFF RATING

MAILING ADDRESS OF APPLICANT:

MEDICAL EXAMINATION (SEE REVERSE SIDE FOR MEDICAL REQUIREMENTS) STATE DETAILS ON REVERSE SIDE
HEIGHT WEIGHT BLOOD PRESSURE RIGHT EYE / / PULSE LEFT EYE RESPIRATION GENERAL APPEARANCE

VISION:
WITHOUT GLASSES WITH GLASSES

HEARING:
RT. EAR LEFT EAR

COLOR TEST TYPE: BOOK

LANTERN

CHECK IF COLOR TEST IS NORMAL - YELLOW

RED

GREEN

BLUE

ARE GLASSES OR CONTACT LENSES NECESSARY TO MEET THE REQUIRED VISION STANDARDS? YES NO HEAD AND NECK HEART (CARDIOVASCULAR) LUNGS EXTREMITIES:
UPPER LOWER

SPEECH (DECK/NAVIGATIONAL OFFICER AND RADIO OFFICER)

IS SPEECH UNIMPAIRED FOR NORMAL VOICE COMMUNICATION?

IS APPLICANT VACCINATED IN ACCORDANCE WITH WHO REQUIREMENTS? YES

NO

IS APPLICANT SUFFERING FROM ANY ILLNESS OR DISEASE LIKELY TO BE AGGRAVATED BY WORKING ABOARD A VESSEL, OR TO RENDER HIM/HER UNFIT FOR SERVICE AT SEA OR LIKELY TO ENDANGER THE HEALTH OF OTHER PERSONS ON BOARD? IS APPLICANT TAKING ANY NON-PRESCRIPTION OR PRESCRIPTION MEDICATIONS? YES NO

SIGNATURE OF APPLICANT

DATE

THIS IS TO CERTIFY THAT A PHYSICAL EXAMINATION WAS GIVEN TO:

NAME OF APPLICANT

THIS APPLICANT IS CERTIFIED FREE OF COMMUNICABLE DISEASE: YES NO CIRCLE APPROPRIATE CHOICE: (HE / SHE) IS FOUND TO BE (FIT / NOT FIT) FOR DUTY AS A (MASTER / DECK OFFICER / ENGINEERING OFFICER / RADIO OFFICER / RATING) (WITHOUT ANY / WITH THE FOLLOWING) RESTRICTIONS:
NAME AND DEGREE OF PHYSICIAN ADDRESS NAME OF PHYSICIAN'S CERTIFICATING AUTHORITY DATE OF ISSUE OF PHYSICIAN'S CERTIFICATE SIGNATURE OF PHYSICIAN
DATE

This certificate is issued by authority of the Maritime Administrator and in compliance with the requirements of the Medical Examination (Seafarers) Convention 1946 (ILO No. 73), as amended and the Maritime Labor Convention, 2006. Rev. 12/09 MI-105M

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MEDICAL REQUIREMENTS All applicants for an officer certificate, Seafarer's Identification and Record Book or certification of special qualifications shall be required to have a physical examination reported on this Medical Form completed by a certificated physician. The completed medical form must accompany the application for officer certificate, application for seafarer's identity document, or application for certification of special qualifications. This physical examination must be carried out not more than 12 months prior to the date of making application for an officer certificate, certification of special qualifications or a seafarer's book. The examination shall be conducted in accordance with the International Labor Organization World Health Organization, Guidelines for Conducting Pre-sea and Periodic Medical Fitness Examinations for Seafarers (ILO/WHO/D.2/1997) as provided in MI MG-7-47-1. Such proof of examination must establish that the applicant is in satisfactory physical and mental condition for the specific duty assignment undertaken and is generally in possession of all body faculties necessary in fulfilling the requirements of the seafaring profession. In conducting the examination, the certified physician should, where appropriate, examine the seafarers previous medical records (including vaccinations) and information on occupational history, noting any diseases, including alcohol or drug-related problems and/or injuries. In addition, the following minimum requirements shall apply: (a) Hearing All applicants must have hearing unimpaired for normal sounds and be capable of hearing a whispered voice in better ear at 15 feet (4.57 m) and in poorer ear at 5 feet (1.52 m).

(b) Eyesight Deck officer applicants must have (either with or without glasses) at least 20/20(1.00) vision in one eye and at least 20/40 (0.50)in the other. If the applicant wears glasses, he must have vision without glasses of at least 20/160 (0.13) in both eyes. Deck officer applicants must also have normal color perception and be capable of distinguishing the colors red, green, blue and yellow. Engineer and radio officer applicants must have (either with or without glasses) at least 20/30 (0.63) vision in one eye and at least 20/50 (0.40) in the other. If the applicant wears glasses, he must have vision without glasses of at least 20/200 (0.10) in both eyes. Engineer and radio officer applicants must also be able to perceive the colors red, yellow and green. (c) Dental Seafarers must be free from infections of the mouth cavity or gums.

(d) Blood Pressure An applicant's blood pressure must fall within an average range, taking age into consideration. (e) Voice Deck/Navigational officer applicants and Radio officer applicants must have speech which is unimpaired for normal voice communication. Vaccinations All applicants shall be vaccinated according to the requirements indicated in the WHO publication, International Travel and Health, Vaccination Requirements and Health Advice, and shall be given advice by the certified physician on immunizations. If new vaccinations are given, these shall be recorded. Diseases or Conditions Applicants afflicted with any of the following diseases or conditions shall be disqualified: epilepsy, insanity, senility, alcoholism, tuberculosis, acute venereal disease or neurosyphilis, AIDS, and/or the use of narcotics. Applicants diagnosed with, suspected of, or exposed to any communicable disease transmittable by food shall be restricted from working with food or in food related areas until symptom-free for at least 48 hours.

(f)

(g)

(h) Physical Requirements Applicants for able seaman, bosun, GP-1, ordinary seaman and junior ordinary seaman must meet the physical requirements for a deck/navigational officer's certificate. Applicants for fireman/watertender, oiler/motorman, pumpman, electrician, wiper, tankerman and survival craft/rescue boat crewman must meet the physical requirements for an engineer officer's certificate.

IMPORTANT NOTE:
A copy of the MI-105M must accompany the application. The applicant must retain the original of the MI-105M as evidence of physical qualification while serving on board a vessel. An applicant who has been refused a medical certificate or has had a limitation imposed on his/her ability to work, shall be given the opportunity to have an additional examination by another medical practitioner or medical referee who is independent of the shipowner or of any organization of shipowners or seafarers. Medical examination reports shall be marked as and remain confidential with the applicant having the fight of a copy to his/her report. The medical examination report shall be used only for determining the fitness of the seafarer for work and enhancing health care. DETAILS OF MEDICAL EXAMINATION (To be completed by examining physician; alternatively, the examining physician may attach a form similar or identical to the model provided in Appendix 1 of MI MG 7-47-1).)

Rev. 11/09

MI-105M

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APPENDIX 3 Medical Conditions That May Preclude Service 1. Infectious and parasitic diseases 2. Tuberculosis.1 Hepatitis. Malaria. Acquired Immunodeficiency Syndrome (AIDS). Enteritis. Sexually transmitted diseases. Any other infectious or parasitic disease in its communicable or carrier state which would present a health hazard to other crew members or passengers through casual contact.

Neoplasms Neoplasms of any type which could be considered to disqualify a seafarer from duty until evaluated. Exceptions may be appropriate for serving seafarers after treatment and without signs of recurrence.

3.

Endocrine, nutritional and metabolic conditions and immunity disorders Adrenal insufficiency, uncontrolled. Diabetes mellitus, all cases requiring insulin.2 Immunosuppressive therapy. Obesity, incapacitating function. Thyroid disease.

4.

Diseases of the blood and blood-forming organs There should be no diseases or abnormalities of the haemopoetic system or the circulating blood.

5.

Mental disorders Consumption of alcohol and use of psychotropic drugs which adversely affect the health of the seafarer or the safety of the ship. Psychosis. Psychoneurosis. Dementia. Personality disorder. State after mental disorder with tendency for recurrence.

The examining physician should take into account the advice of a chest physician, whether the lesion is fully healed and whether the patient has completed a full course of chemotherapy. Cases where either one or both lungs have been seriously affected are rarely suitable for re-employment. 2 All other cases should disqualify new candidates. For serving seafarers, cases controlled by food restrictions and/or oral hypoglycaemic agents should be evaluated and assessed individually. Exceptions may be made for serving seafarers if they do not require insulin.

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6.

Conditions of the nervous system Organic diseases of the nervous system or disorders due to metabolic disease causing disturbance of muscular function, balance, coordination or alertness. Epilepsy. Migraine, frequent attacks causing incapacity. Syncope and other disturbances of consciousness. Menieres disease. Post-concussion syndrome.

7.

Conditions of the cardiovascular system The cardiovascular system should be free from diseases causing disability: Heart diseases: o vascular disease; o ischaemic heart disease, angina pectoral history of coronary thrombosis or bypass grafting; o symptomatic abnormality of the rate of rhythm; o dependence on pacemaker. Hypertension: o Hypertension necessitating the use of antihypertensive drugs with side-effects which adversely affect seafarers fitness. Arterial disease: o history of intermittent claudication; o aortic aneurysm. Cerebrovascular disease: o history of cerebrovascular accident including transient ischaemic attack; o general cerebral arteriosclerosis including senility. Diseases of veins: o varicose veins, moderate to severe; o varicose ulcerations; o deep vein thrombosis or thrombophlebitis; o haemorrhoids, symptomatic; o varicocele, symptomatic.

8.

Conditions of the respiratory system Any condition of the respiratory system -- obstructive, restrictive or infectious -- causing significant disability, for example: Bronchial asthma.3 Pulmonary fibrosis. Gross deformity of the chest wall. Pneumothorax. Tumours.

Asthmatics who require systematic oral corticosteroids, or have been taking such mediation during the past year, should be re-evaluated for the likelihood of a recurrence of acute asthmatic attack. This disease disqualifies new candidates, but serving seafarers may be employed on board ships carrying a medical doctor.

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9.

Oral health Infections of the mouth cavity or gums. Severe dental defects that interfere with proper mastication. Seafarers must be dentally fit.

10.

Conditions of the digestive system Peptic ulcer. 4 History of gastro-intestinal bleeding/perforation. Recurrent appendicitis. Cholelithiasis, cholecystitis, cholangitis. Liver cirrhosis. Pancreatitis, recurrent. Intestinal stoma. Hepatitis. Perianal pathology.

11.

Conditions of the genitor-urinary system Genito-urinary tract infections, specific and non-specific. Renal failure. Urinary tract obstruction. Prostatism. Removal of one kidney. Renal transplantation. Urinary incontinence. Hydrocoele, large, symptomatic. Gynaecological condition likely to cause complications. Menstrual dysfunction.

12. 13.

Pregnancy Conditions of the skin Infections of the skin, until satisfactorily treated. Eczema. Dermatoses. Manifestations of systemic disease (e.g. lupus, allergy).

14.

Conditions of the musculoskeletal system Seafarers should have no defect of the musculoskeletal system that could interfere with their ability to discharge their duties (muscular power, balance, mobility and coordination should be unimpaired):

In the case of serving seafarers, those with proven ulceration should not return to seafaring until they are free of symptoms. There should be gastroscope evidence of healing and the seafarer should have been on an ordinary diet, without treatment, for at least six (6) months. Persons who have had gastro-intestinal bleeding, perforation, recurrent peptic ulceration (despite treatment) or complications after surgery should be classified as unfit for work on ships.

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 15.

Osteoarthritis. Recurrent dislocation of a major joint. Symptomatic flat foot or halux valgus. A limb prosthesis would not be acceptable.

Ears Infectious or inflammatory ear conditions. See section 4.5 of this Notice for minimum hearing requirements.

16.

Eyes Both eyes must be free from progressive pathological conditions. See section 4.6 of this Notice for minimum eyesight requirements.

17.

Sleep Disorders Narcolepsy. Obstructive Sleep Apnea (OSA). OSA has been determined by the United States National Transportation Safety Board (NTSB) to be the cause/probable cause of a number of serious accidents across all modes of transportation, including maritime. OSA is a condition in which individuals obstruct their own airways while sleeping. Although the condition is formally diagnosed through polysomnography -- extensive monitoring done as part of a sleep study -- there are certain symptoms and risk factors associated with this disorder. They include: daytime sleepiness hypoxia at night loud snoring non-restful sleep interruptions in breathing during sleep that last several seconds at a time obesity high blood pressure OSA can be effectively treated, usually through the use of a continuous positive airway pressure device or through surgery. Applicants diagnosed with OSA can routinely be approved for continued medical certification, provided they are effectively treated for their condition and it is controlled.

18.

Other Hernia. Severe speech impediment.

12/09

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The Republic of the Marshall Islands

MG-7-47-1