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Administrative Instructions:
Document and Data Control
Confidentiality
All medical information is considered to be of a personal nature and should
be given due protection except when requested by authorised individuals in the
course of their duties.
Combined Form - Application for Medical Examination
and Certificate ^
The combined form for application for medical examination and the medical
certificate is established by the Minister for use in accordance with the Crewing
Regulations as form number 82-0662. This form is amended from time to time
as required to meet changing administrative and regulatory requirements, and the
most recent version of the form is titled "Marine Medical Examination
Report".
Responsibility for completion of the sections of the form, and the
destination of the parts of the form, is as follows. This form is a
multiple-part form (currently two parts).
Applicants for a medical examination must complete the section expressly
described as "To be completed by the Applicant", and the form thus
completed is then given to the examining physician.
On completion of the medical examination to the standards outlined in
this Guide, the examining physician issues the "Applicant" copy of
the medical certificate to the applicant. The examining physician then
ensures that the original Marine Safety copy of the medical certificate is
mailed to:
Marine Medical Certification (AARG/M)
Transport Canada
Place de Ville,
Tower ‘C’, 6th Floor
330 Sparks Street
Ottawa, Ontario
K1A 0N8
It is recommended that the examining physician make a copy of the
Marine Safety copy for the physician’s record-keeping purposes.
When the examining physician has made the assessment of
"Unfit" (for duty) or placed limitations on a medical
certificate, that physician shall forward all medical documents
pertinent to the certification to the Director, Marine Medical Branch,
Marine Safety, Tower C, 330 Sparks Street, Ottawa, Ontario, K1A 0N8. The
documents should be marked "Medical Confidential - Protected
B".
Supply of Forms ^
The form used in connection with the medical examination program is
Transport Canada form number 82-0662, titled "Marine Medical
Examination Report". Examining physicians purchase copies of this
form from DataMark Systems, 1680 Woodward Drive, Suite 201, Ottawa, Ontario,
K2C 3R7, telephone: (613) 228-2576, fax (613) 228-9976.
Fees ^
Fees for medical examinations and associated tests are the responsibility
of the examinee, which may be payable or reimbursable by company or
provincial health insurance programs.
In the case of re-examination as per Division 8 of the Crewing
Regulations, the cost shall be borne by the requesting party.
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