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NF 57-03-50, 51, 52 Report of Physical Examination

For NOAA Diver, Divemaster, and Diving Medical Technician Course Applicants:

This form documents the results of the prospective NOAA Diver candidate's initial diving physical exam, and is required to attend a NOAA Diving Program training class. This form must be completely filled out and signed by the applicant and the medical provider(s) administering the exam in order to be accepted. It is highly recommended that you begin the process to complete the diving medical physical exam as soon as possible to prevent delays in processing your application. 

All physical exam forms must be submitted and approved by the NOAA Diving Medical Officers before the prospective student will be allowed to begin training.

 

Submission for Training Applicants:

Completed Diving Physical Exam Report forms should be submitted DIRECTLY to the NOAA Diving Medical Officers (DMO) via a secured method of transfer, such as a password-protected PDF, Kiteworks, or other encrypted method.

Please note that the DMO's fax has been disconnected. Please do not use a fax machine to submit medical documents.

*These forms contain Personally Identifiable Information (PII) and are covered under the Health Insurance Portability and Accountability Act (HIPAA), therefore transmittal to the NOAA Diving Medical Officer (NDMO) should be done using a secure file transfer program, such as Accellion, or password-protected PDF. Please send these documents directly to the NDMO.

 

For Existing NOAA Divers:

Please see this page of the internal site for details about when and how you need to resubmit this form.

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Reviewed: December 8, 2021. Contact us with page issues.

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