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MED- II

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					DRAFT
                                                                                     Government of India
                                                                           Directorate General of Shipping
                                                                                                 Mumbai




________________________________________________________________________

                                                                        Guidelines to Appoint
                                                                  Approved Medical Examiners
___________________________________________




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                                                                  DRAFT

                           MERCHANT SHIPPING NOTICE NO. -------OF 2009


No. 7-NT (5)/2001-I                                                             Date: 06/03/2009.


Sub: - Appointment of Approved Medical Examiners under the provision of Section
98 of Merchant Shipping Act, 1958 and rule 4 of Merchant Shipping (Medical
Examination) Rules-2000- Regarding.

Notice to shipowners, ship managers, shipping agents, ship masters, seafarers &
their representatives(unions), DGS approved maritime training institutes, existing
empanelled medical examiners and new applicants aspiring to become medical
examiners and Principal Officers of MMD districts and other allied offices of the
Directorate.


                                                            Executive Summary

       These Guidelines prescribe the minimum criteria for the appointment of approved
medical examiners for the purpose of medical examination of seafarers serving merchant
ships. The procedures stated therein provide minimum standards for medical tests
required for existing and new entrant seafarers. It also recommends the requisite standard
for the facilities, infrastructure and competence standard of medical examiners,
associated medical doctors and other support staff involved in the medical examination
process. Fee structure for the inspection and examination of seafarers is also
standardized.



I            Scope of these Guidelines:-

             It is extended to the following categories:
                   New applicants of doctors seeking appointment to become approved
                      medical examiners.
                   Existing empanelled medical examiners with the Directorate General of
                      Shipping.
                   Ship owners /Ship Managers, Shipping agents,
                   Ship masters, apprentices and Seafarers
                   Other concerned Government and private organizations (maritime training
                      institutes, owner, managers and seafarers associations, etc) including the
                      Principal Officers, MMD districts/all allied offices of the Directorate
                      involved in the conduct of medical examination of masters, apprentices
                      and seafarers.


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II       Procedure for the appointment of approved medical examiner (new
         applicants) -

               The Directorate mindful of the various provisions of STCW code and
ILO/WHO requirements relating to medical fitness of sea-farers prescribes the following
guidelines with respect to the appointment of approved Medical Examiners:-

             1) All medical examiners aspiring to be on the panel of the Directorate General
                of Shipping as approved Medical Examiners of seafarers shall forward their
                application (in duplicate) in the prescribed format to DG Shipping. (use Form
                I of attachment- A copy of such form can be downloaded from DGS
                website:www.dgshipping.com). The applicant may submit more than one
                application for seeking approval if the facilities and the infrastructure
                prescribed in these guidelines are available within the municipal limits of the
                city.

             2) An applicant shall submit a sponsoring letter from any Indian Shipping
                Company or DGS approved maritime training institute or a corporate house
                engaged in Domestic, Home Trade, and International Sea Trade as the case
                may be. In addition to this, a recommendation letter from any of the shipping
                associations or Chamber of Commerce or Indian Maritime University (IMU)
                as the case may be.
             3) The above shipping company or DGS approved maritime training institute or
                a corporate house and the associations including the university shall verify the
                antecedents of the applicant and make a declaration that the applicant is
                known to them for a period of two years and express their views on the
                integrity and good standing of the applicant.
             4) The professional qualification and experience of the applicant(he or she)
                seeking Director General of Shipping approval for appointment shall meet the
                following conditions:-

                          a) shall be a Licensed Physician i.e. holding a degree of MBBS in
                             Allopathy recognized by Government of India..
                          b) shall have a minimum 5 years experience in general and occupational
                             medicine which includes at least 1 year of experience in maritime
                             occupational medicine.
                          c) shall be a member of both State and Indian Medical Council.
                          d) Experience as medical doctor on ships/oil rigs or associated activities
                             including occupational health and medicines and underwater diving
                             shall be given due weightage.
                          e) shall have adequate understanding of sea-faring profession, knowledge
                             of their living and working condition on board cargo or passenger
                             ships. Such experience or knowledge may be acquired either through
                             special instructions or through training programme. A copy of such
                             document may be attached with the application.



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                          f) shall have adequate understanding of International Regulations
                             formulated by WHO, IMO, ILO and National Rules framed by
                             Ministry of Shipping.
                          g) Shall have experience or knowledge of extending radio medical advice
                             or medical advice to ship-owners/ship managers in the event of any
                             shipping casualty or illness taking place that involves health and
                             welfare of the seafarers including master and apprentice on board ship.
                          h) Shall enjoy absolute professional independence from ship owners, ship
                             managers, seafarers and other associations/organizations.

             5) The Applicant in addition to above shall submit the following documents
                showing :-

                          a) The details on Clinical Infrastructure and Laboratory facilities.
                          b) Displaying infrastructure to accommodate Medical Officer, Medical
                             Staff and Provision for administrative activity.
                          c) The details of Junior Medical Officers, Managerial personnel, Para
                             Medical, Medical Consultants and Clerical Staff.
                          d) The details of the applicant’s good standing, integrity and goodwill
                             from his existing/previous clients (minimum 3 organizations for which
                             services has been rendered).
                          e) Prescribed fees in part X.

             6) The above mentioned documents (in Para 4 & 5) along with the application
                (in duplicate) shall be furnished to the Directorate directly in person or by
                post.

             The Nautical technical branch (NT) of the Directorate shall examine the
application and the supporting documents. If, all the requirements stated above are
fulfilled, then the applicant’s medical facilities shall be inspected by the nominated body
of the DGS. However, the medical examiners are to be personally interviewed by the
Nautical Adviser to the Govt.of India or any official nominated by him.

             Upon satisfactory completion of interview and fulfillment of other
requirements, the applicant shall be appointed to act as approved Medical Examiner
under the provision of Merchant Shipping Act and the rules framed there under for the
master, apprentices and sea-farers. A letter of appointment (Form II of attachment)
shall be issued in favor of the medical doctor who has submitted the application. The
name and other details of his clinic of the appointed medical examiner shall be hosted on
the DGS website at the earliest. This appointment shall be valid for a period of 5 years
subject to intermediate verification of compliance at interval of 2 years +/- six months of
the anniversary date (The day and month of each year which will correspond to the date
of expiry of the letter of appointment). The appointed medical examiner for one or more
facilities shall be the only authorized signatory to issue medical certificate and he shall be
responsible for such certification. Any infringement of these guidelines, if proven, he




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shall be held liable in accordance with the provision of Merchant Shipping Act and any
other laws applicable.

III The extension of these guidelines to the existing empanelled medical
     Examiners of D.G.Shipping.

         The existing empanelled medical examiners shall be required to comply with
these requirements within one year from the date of issue of this notification. The
facilities and infrastructure shall be inspected by the Inspecting body of the Directorate.
Based on their recommendation and fulfillment of all other requirement stated above, a
fresh letter of appointment as approved medical examiner superceding the earlier
approval, shall be issued to them having a validity of five years subject to intermediate
verification of compliance at interval of 2 years +/- six months of the anniversary date
(The day and month of each year which will correspond to the date of expiry of the letter
of appointment)..

IV       Guidelines to the inspecting bodies:-

             a) One copy of application along with the supporting documents shall be
                forwarded to the chairman of relevant academic council by the Directorate
                General of Shipping. Nomination of external member of the inspecting team
                shall be decided by the Nautical Adviser to the Govt. of India.
             b) Upon completion of examination by the chairman of the council an authorized
                official of the council shall conduct the inspection of the applicants’ medical
                facilities and infrastructure.
             c) The inspecting official shall submit the report along with the checklist as
                prescribed in Form III and supporting documentary evidences through the
                chairman of the Council with his recommendations/objections or rejections, if
                any, within one week of completion of inspection to the Directorate General
                of Shipping. The inspecting authorized official shall also give a copy of his
                report stating if the applicant is being recommended or otherwise.
             d) The Nautical Adviser to the Govt.of India shall issue a letter of appointment to
                the applicant to act as approved medical examiner (Form II of attachment)
                taking into account recommendations of the chairman of the council.

V            APPEAL/COMPLAINTS

             a) The applicant may directly appeal to the Director General of Shipping within
                45 days of completion of inspection against the decision of the authorized
                official or the chairman of the council or the Nautical Adviser to the Govt.of
                India. The decision of the Director General of Shipping shall be binding on
                the applicant.
             b) The Director General of Shipping shall also investigate the cases of adverse
                reporting or complaints relating to Medical Examination of Sea farers as soon
                as possible but not later than 45 days of the receipt of such report. Findings of
                such report and action taken may be communicated to the industry/public by



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                   issuing a DGS order/notice. Such orders/notices shall be hosted on DGS
                   website.

VI)   Verification during inspection by the authorized official of the chairman of
academic council:-

Qualification and Experience of the Applicant:-

1) Qualification – Medical Doctor desirous of being approved by DG should have a
minimum qualification in Allopathic (MBBS) as stated above. A post graduate
qualification in Occupational health or any other post graduate qualification is desirable.
2) Experience – Medical Doctor desirous of being appointed by DG should state the
experience as stated above, they have in dealing with seafarers which should not only
include Pre-Employment Medical examinations, but also treatment and evacuation
experiences of sick and injured seafarers.
3) Legal or Medico legal cases – Medical Doctor desirous of being appointed by DG
should state whether there are any legal or medico-legal cases pending against them and
if present should give a detailed explanation about the case and the status thereof.
4) Doctor should describe in details procedure for obtaining feedback from seafarers, and
whether they have acted on the information gained to improve practice.
5) Doctors should maintain written procedures, particularly concerning staff induction,
sharps injury or spillage of body fluids would be useful.
6) Doctor should state what specialist referral is available where necessary along with
detail of specialists available.
7) For female seafarers, examinations should be carried out by a female medical doctor,
preferably a gynecologist to ensure completeness of examination as well as to make
certain that the examinee is not uncomfortable. Conversely male seafarers should be
examined by male doctors so that conditions like hernia, fistula, hydrocoele, piles etc are
detected without making the examinee uncomfortable.
8) If there has been any untoward incidence involving general population, this should be
given in detail by concerned doctor stating what action has been taken to prevent such
recurrence in future.


VII)         INFRASTRUCTURE, FACILITIES AND SUPPORTING STAFF:-

a) Infrastructure:-
1) Location of clinic - Which part of the city along with landmarks. Mention accessibility
means available and all approaches to clinic.
2) Building - Condition of building (well or poorly maintained, etc), age of building,
outward appearances, clear signage, with appropriate security measures etc.
3) Interior of clinic - General layout of clinic with specifications of each area.
4) Appearance of clinic - ventilation, cleanliness, lighting, availability of wash rooms,
drinking water, etc. All areas should be clean and in good decorative order with waiting
area of appropriate size.
5) The clinic should be licensed locally wherever necessary.
6) Reception area - should be clean with adequate comfortable seating / waiting facilities.


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b) Facilities:-
1) Doctors examination room - Should be large enough to accommodate at least two
persons excluding the Doctor for examination with space for examination couch and desk
etc. It should be well equipped with scales, purpose designed height measure with a
hinged top, Sphygmomanometer, Stethoscope, otoscope, ophthalmoscope, near vision
test, Ishihara color plates, Snell en’s charts, torch, tape, etc.
2) Lavatory facilities should be available for sea farers and staff and be clean.
3) Wherever laboratory facilities are available the following should be implemented:-
         • written procedures for sharps injury
         • written procedures for waste disposal, including the disposal of sharps in
         appropriate containers in accordance with bio-medical waste regulation of local
         authority.
         • written procedures for dealing with spillage of blood and body fluids
         • written procedures for the performance of each test.
         • written procedures for specimen collection and storage
         • appropriate areas for handling and storage of specimens
         • Personal Protective Equipment is provided that is appropriate for infection
         control
         • All equipment should be maintained and calibrated according to the
         manufacturer’s instructions and applicable municipal laws.
         • Adequate secure storage space for kits and reagents
         • Tight procedures for drug and alcohol testing to avoid contamination of
         specimens.
         • Lab equipment should be maintained annually by the manufacturer, and
         calibrated daily in accordance with applicable local laws.

4) Wherever radiology facilities are available the following should be implemented:-
      • Local regulations governing the use of radiation should be followed whenever
      considered necessary.
      • An individual should be responsible for radiation protection
      • All staff involved in X-ray must wear radiation dosimeters, and regularly
      checked by Bhabha Atomic Research Centre (BARC)
      • Appropriate personal protective equipment should be available.
      • Signs should be displayed in the X-ray area warning of the danger of radiation
      during pregnancy
      • The X-ray machine should be checked every three months by the manufacturer,
      and is calibrated annually. The technician must be aware that the beam must be
      checked for scatter as per local laws requirement.
      • All staff performing X-ray examination should be suitably trained
      • X Ray area must be lined by lead wall sheets
      • Adequate dark room for development of X –rays
      • Proper record keeping and numbering and storage of X –ray plates to be done.

5) Wherever audiometry facilities are available the following should be implemented:-
      • audiometry room should be soundproofed for it fitness to use.



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             • Audiometer checks should be carried out by the manufacturer
             • the technician should check audiometer every day
             • An annual calibration should be carried out.

6) Wherever other diagnostic facilities like ECG, Spirometry, ultrasonography, etc are
available the same standards as above should be followed. Ultrasonography should be
registered with local authorities and certificate prominently displayed.

c) Technical Assistant and Supporting Staff:
        Lab technicians shall hold diplomas as medical laboratory technicians
           including Certificate of Medical Laboratory Technology(CMLT)-Diploma
           Medical Laboratory Technology(DMLT) or BSc.
        Certificates and qualifications of staff should be checked and a file with CVs,
           diplomas and hepatitis vaccination certificates maintained. References
           whenever available should be obtained All staff should have qualifications
           appropriate to the post held
        Provision for training and development of staff and other technical personals
        Provision for appraisal system for all staff and technical personals
        All staff should be aware of the importance of patient confidentiality

d) Record Keeping requirement:-
       • A single record should be held for each patient, and all documents within the
       record are firmly held together.
       • Electronic medical records if kept should be password protected
       • Records must contain full patient demographic information
       • All record entries should be dated, timed and signed
       • All record entries should be legible
       • Every consultation should be appropriately documented
       • Medical records should be stored in a way that ensures confidentiality is
       preserved
       • Provision for review of policies and procedures.

e) Clinical Governance:-
        • All examinees coming for medical examinations should furnish a photo identity
        document for proof of identity, and preferably a photograph should be attached
        and stamped on the examination form.
        • Practice should be monitored to ensure compliance with policies and
        procedures.
        • Safety and clinical risk assessments should be undertaken.
        • Procedures for response to fire or other emergency to be in place and fire
        extinguishers should be available.
        • All medications should be purchased from recognized suppliers
        • All drugs should be securely stored, and the keys should be held securely
        • Any hazardous materials should be stored appropriately
        • A refrigerator should be available for drugs/vaccines and the temperature should
        be regularly monitored and recorded.


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             • Stock level and expiry dates should be regularly monitored
             • Emergency drugs including adrenaline would be useful in case of an allergic
             reaction to a vaccine

VIII         Maintenance of condition during the validity of letter of appointment:-

      a) Medical Examiner shall communicate to the DGS of any modifications or
         changes to his organizational structure of facilities.
      b) Medical Examiner shall conduct the Medical examinations and issue Medical
         certificate in the prescribed format to the Medical Fit Sea farers at fee prescribed
         in the MS (Medical Examination) Rules and comply with other relevant
         provisions.
      c) Medical Examiner shall maintain relevant books and publication for reference at
         his clinic. The list is prescribed in inspection check list (form III).
      d) Medical Examiner shall endeavor to keep himself posted of all amendments
         relating to Medical Examinations issued by the Directorate General of Shipping.
      e) Medical Examiner shall maintain Medical records, logs and other documents
         relating to Medical examination for random inspection by the competent
         authorities.
      f) A copy of Letter of appointment shall be displayed at conspicuous location for the
         benefit of general public.
      g) Medical Examiner shall submit the periodical reports duly filled in at prescribed
         interval of six months to the DGS in the prescribed format Form IV-A and Form
         IV-B given in the MS (Medical Examination) Rules.

IX           Miscellaneous

      a) Cases of serious complaints or permanent medical unfitness shall be directly
          reported to the Director General of Shipping as soon as possible if deemed
          necessary otherwise submitted in periodical returns.
      b) The appointed medical examiners shall ensure that the prescribed format for
          medical examination certificate (Form VI) is dully filled in. The minimum
          number of tests, screening and vaccination are conducted as per the prescribed
          format (Form V). The validity shall be one years for the Sea farers age 40 years
          and above and two year for Seafarers age below 40 years. No other qualification
          shall be made on the certificate.
      c) It is the responsibility of the applicant seeking approval to bear the cost of
          inspection. This may include the payment of fees, transportation charges, lodging,
          boarding and overtime.
      NOTE: The letter of appointment shall be issued in favor of the applicant and he shall
      be the authorized signatory on the medical certificate.         In the event of any
      circumstances where he is unable to perform the functions of authorized signatory, he
      may submit the name of an alternate authorized signatory to the Directorate. The
      Directorate may consider the request based on the circumstances of the case.




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X             Fee structure
               for the inspection and issuance of letter of appointment including
                  periodical endorsement :-

                          a)           The applicant seeking appointment for the first time shall submit a
                                       demand draft of Rs. 25000/- drawn in favor of Directorate General
                                       of Shipping.
                          b)           The applicant seeking renewal of appointment shall submit a
                                       demand draft of Rs. 10000/- drawn in favor of Directorate General
                                       of Shipping.
                          c)           An applicant whose letter of appointment has been suspended for
                                       non compliance of procedures or adverse reports shall be treated as
                                       fresh approval after the completion of the suspensions period. He
                                       shall submit Rs. 25000/- as stated above.
                          d)           The applicant seeking for intermediate inspection and endorsement
                                       shall submit a demand draft of Rs. 5000/- drawn in favor of
                                       Directorate General of Shipping.
                          e)           Duplicate certificate Rs.1000/-

                     minimum fees for professional services (recommendatory)

                      a) Periodic medical examination – professional fees Rs.750/-
                      b) Pre-sea medical examination – professional fees Rs.1000/-
                      c) Yellow fever                 - as per Port Health Officers fee
                                                      Structure.
                      d) Appetites B/Typhoid       ()
                      e) Vaccination chicken pox   () As per the
                      f) Tetanus Toxoid            () prevailing
                      g) Oral polio vaccine        () practice.
                      h) Psychrometric evaluation ()


XI             Enforcement:-

        The Director General of Shipping has authority to carryout unscheduled
inspection of appointed medical examiners clinics or their facilities. The Chairman of the
academic council along with the representative of ship owner and seafarer associations
may carry out the inspection as directed by the Director General of Shipping. The
Director General of Shipping has the power to withdraw or suspend the Letter of
Approval upon recommendations from the chairman of the concerned academic council.




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XII This notice supercedes M.S.Notice 17 of 2002 dated 05.08.2002 and all other
circulars and notifications issued by the Directorate General of Shipping and comes into
force with effect from ---------------------.



(DG Shipping or Authorized Official)

Attachment:-
         a.           Application –Form I
         b.           Letter of Appointment-Form II
         c.           Check List-Form III
         d.           Returns of unfit seafarers– Form IV A
         e.           Returns of other category of seafarers – Form IV B
         f.           Minimum medical standards with respect to tests, screening and
                      vaccination.- Form V
                   g. Specimen medical certificate – Form VI (shall be attached later)




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                                                                                                            Form I
             Application For Appointment of Approved Medical Examiner Under M.S.Act, 1958 and
                       Merchant Shipping (Medical Examination) Rules 2000 as amended

                                                                                          Date: ______________
                                                                                          Place: ______________

To,
Directorate General of Shipping
Jahaz Bhavan,
Walahcnad.Hiranchand Marg,
Ballard Estate,
Mumbai-400 001.
                         [Kind Attn: Nautical Adviser to the Govt. of India].
    Subject:- Initial / intermediate / Renewal / Additional Approval for new applicants, existing approved
                                                medical examiners or others -Regarding.
Sir,
           I, Dr. __________________________________ wish to apply to for the appointment of approved
Medical examiner under the provision of M.S.Act, 1958 and Merchant Shipping (Medical Examination)
Rules 2000 as amended from time to time. The details of my Bio-data/self appraisal along with other
supporting documents pertaining to my academic and professional qualification, experience and Medical
facilities available are duly filled in the attached format as applicable.

         I am enclosing a Demand Draft of Rs.__________ as administrative fees drawn in favor of
Directorate General of Shipping, Mumbai for carrying out inspection and issuance of letter of approval to
me.

          You are therefore, requested to complete the inspection / interview formalities and issue an
appropriate letter of approval to perform the functions of approved Medical examiner under the provision
of the said Act and the relevant rules frame there under.


                                                                                                     Yours faithfully,


                                                                                        (Dr._____________________)
                                                                                           Name:__________________
                                                                  Medical Council of India Registration No.__________
                                                                                   Date of issue: __________________

Enclosures:
1.      Copy of Sponsoring shipping company letter
2.      Copy of Recommendation letter from associations such as INSA/ MASSA/ FOSMA or other
        organization approved by the DGShipping,
3.      Copy of Medical Council of India Registration Certificate.
4.      Copy of academic and professional qualifications, including experience on ships or adequate
        knowledge on living and working conditions (minimum 5 years experience in general and 1 year
        experience in sea farers medical examination).




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                                                                                                      Form II
                                                   LETTER OF APPOINTMENT
                                                   (No.DGS/Medical/_______/09)
No. 7-NT(5)/2001-Vol-III                                                             Date:- ___________
                                                                                     Place:- __________
To,
Dr Vallabh B. Dhaimodker,
Vidhya Diagnostics Pvt. Ltd.,
                                                                                    Pho
                                                                                      photographP




Dr. Dhasimodker's Occupational Health & Research Centre,
Dhavalimal, Ponda,
GOA-43 401.oooo
Sub: Letter of Appointment to Dr. Vallabh B. Dhaimodker, Medical Council of India Registration No. -
--      to conduct medical examination of seafarers in accordance with Section 98 of Merchant Shipping
       Act 1958.
           ------------------------------------------------------------------------------------------------
Sir,
       In response to your application No.__________ Nil dated 20th March 2006 and
subsequent satisfactory report of inspection from ____________ , the Directorate is
pleased to appoint you to perform the functions of approved medical examiner in
accordance with section 98 of Merchant Shipping Act,1958. Your name has been placed
on the panel of the Directorate and shall be displayed on the DGS Website at the earliest.
This approval is valid for a period of five years from the date of issue of this letter of
approval subject to intermediate endorsement and your compliance with the following
conditions:-
    1 The medical examination of seafarers shall be strictly conducted in accordance
       with provisions of Merchant Shipping (Medical Examination) Rules 2000, as
       amended and DGS Circulars / Notices issued from time to time.
       2     Periodical returns at an interval of six months shall be forwarded to the
             Directorate by 15th of January and 15th of July. (as per enclosed form V)

       3     You shall maintain the latest publications prescribed in form III of the notice at
             your clinic for reference purposes.

       4      Any change in place of clinic / laboratory or assistant doctors / staff shall be
             reported to the Directorate with supporting documents.

       5     The Directorate has the right to suspend or withdraw your approval and report
             such decision to the respective Medical Council of India.



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                                                                                           Yours faithfully,


                                                                     (Authorized Official of DG Shipping)


                                           Endorsement for intermediate inspection

This is to certify that intermediate inspection to demonstrate the extent of compliance to
continue with the approval in accordance with the provision of M.S.Act and rules framed
there under.



                                                    Signed           Authorized official
                                                                     Name:
                                                                     Designation:
                                                                     Place:
                                                                     Date:

Cc: All Principal Officers, MMD Districts for dissemination of information to all
   concerned including the examination centre.
   Chairmen, All Major Ports/Maritime Boards with a request to disseminate the
   Information to Port Health Officers.
      IMHA




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                                                                                                      FORM III
                                      SEAFARERS MEDICAL EXAMINATION
            CHECKLIST FOR APPROVED DOCTORS-INSPECTION REPORT
                                                                  PART I
                                                       Preliminary Information


APPLICANTS PERSONALS DETAILS
Name of the applicant-                                                           Date of Inspection
Address of his clinic-                                                           Name of Inspectors




Date of last inspection, if applicable

Educational/professional qualification with certified copies as attachment-
Medical Council of India registration number-


                                                                  PART II
CLINICAL ARRANGEMENTS
      1. Vision Testing
             Acuity
                     provision of Snellen chart
                     location
                     correct measured distance
                     measure marked
                     lighting
             Color Vision
                    provision of Ishihara plates
                    lighting


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                  knowledge of supplementary tests
                  provision of lantern tests
      2. Urine Testing
                  Suitability of arrangements
      3. Clinical arrangements
                  Ambience
                  Couch and cover
                  Equipment/servicing
                  Height/weight measures
                  Screening
                  Lighting
      4. Clinical Knowledge
                  General medical
                  Work related
                  Maritime
                  DG Shipping standards as per the M.S.Notice.

      5. Conduct of Medical Assessment
                  History
                  Examination
                  Clinical tests- As prescribed in Form V.
                  Health promotion


                                                                  PART III
                                                            ADMINISTRATION


Facilities/Administration
Points to consider

1. Facilities
     Premises
     Accessibility
     Waiting area


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            Washbasin in room

2. Record keeping/Document Control
     Secure storage facilities


      General Record Keeping
      Who maintains records?


3. List of publications maintained

                 i.       International Health Regulations, WHO Publication.
                ii.       Vaccination certificate requirements and health advice for International
                          travel, in accordance with International health regulations.
             iii.         M.S. Crew Accommodation Rules 1960 as amended.
              iv.         Merchant Shipping Act 1958.
               v.         Indian Port Health Rule 1955.
              vi.         Indian Ports Act 1908.
             vii.         Pocket Guide to cold water survival IMO, London
            viii.         Guidelines for drinking water quality Vol. I Recommendations, Geneva,
                          W.H.O.



3. IT Facilities
            Email address?
            Computerized records/


      Support staff
            What support staff are used?
            What aspects do they cover


      Fees
            Fees to be charged
            Who pays - seafarer or ship-owner or others


Overall impression




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Observations




      Recommendations




      Actions Required




Signature of Applicant                                            Signature Inspecting Team
Name                                                              Name
Date:                                                             Designation
                                                                  Date:
                                                                  Place:




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                                                                                            FORM V
                          DIRECTORATE GENERAL OF SHIPPING


MINIMUM MEDICAL STANDARDS: SCOPE OF TESTS (RECOMMENDATORY)


1. PERIODIC MEDICAL EXAMINATION
                                               Urine R/E
                                               Bl CBC
                                               Bl ESR
                                               RBS / FBS
                                               SGOT
                                               SGPT
                                               SGGT
                                               S Creatinine
                                               S Cholesterol
                                               S Triglycerides
                                               Blood group & Rh factor
                                               Test for Hepatitis B (HbsAg)
                                               Bl VDRL
                                               HIV I&II
                                               Audiometry
                                               X-ray chest (PA)
                                               ECG
                                               Ultrasound (USG) of the Abdomen & Pelvis
                                                    1
                                                     Drug & Alcohol Screening
                                               Physical Examination
                                               Psychometric evaluation on case to case basis
                                               Stress test (Optional)
                                               2D echo doppler study (for heart patient) (Optional)




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1
 Drug & Alcohol Screening:                                        Morphine, Barbiturates, Marijuana, Cocaine, Amphetamines,
Alcohol.(Optional)



             2. PRE-SEA MEDICAL EXAMINATION:
                                               Urine R/E
                                               Bl CBC
                                               Bl ESR
                                               RBS / FBS
                                               SGOT
                                               SGPT
                                               SGGT
                                               S Creatinine
                                               S Cholesterol
                                               S Triglycerides
                                               Blood group & Rh factor
                                               Test for Hepatitis B (HbsAg)
                                               Bl VDRL
                                               HIV I&II
                                               Audiometry
                                               X-ray chest (PA)
                                               ECG
                                                    1
                                                     Drug & Alcohol Screening
                                               Physical Examination
                                               Spirometry
                                               Ultrasound (USG) of the Abdomen & Pelvis
                                               Psychometric evaluation or psychological evaluation
                                                    should be encouraged.
                                               Stress test (Optional)
                                               2D echo doppler study (for heart patient) (Optional)




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1
 Drug & Alcohol Screening:                                        Barbiturates,   Amphetamines,   Marijuana,   Cannabinoids,
Benzodiazepine, Alcohol.(optional)




3. VACCINATION UNDER WHO OR OTHER COUNTRY’S REGULATIONS

(A) VACCINATION AT THE TIME OF PRE-SEA TRAINING

      1. YELLOW FEVER

             At a WHO designated Yellow Fever Centre only. Booster once every 10
             years.

      2. HEPATITIS B

             Recommended a primary course of three doses.
             Booster may be given once every 20 years. In cases of doubtful immunity,
             test for Anti HBS antibody titre shall be conducted to assess the suitability
             of administration of the vaccine.

      3. TYPHOID

             Recommended inject able vaccination. Once every three years.

      4. VARICELLA VACCINATION (AGAINST CHICKEN POX)

             Recommended primary course of two doses.

      5. TETANUS TOXOID

             Most of the pre-sea trainees would have received their tetanus pophylaxis
             during their childhood immunization. A tetanus toxoid injection shall be
             given at the time of entry to the pre-sea training programme. A booster
             injection every 5 years is recommended.

      6. ORAL POLIO VACCINE (OPV)

             One time, single booster dose of OPV, at the time of the entry to the pre-
             sea training course.



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(B) VACCINATION AT THE TIME OF PERIODIC MEDICAL EXAMINATION
(FOR REVALIDATION OF CDC, ETC)


THE DG   APPROVED MEDICAL EXAMINER SHALL CHECK THE IMMUNIZATION RECORD OF
THE SEAFARER. IN CASES WHERE THE IMMUNIZATION HAS NOT BEEN COMPLETED AS
GIVEN IN THE SCHEDULE ABOVE, THE SAME SHALL BE COMPLETED BY THE DG APPROVED
MEDICAL EXAMINER BEFORE HANDING OVER THE MEDICAL EXAMINATION REPORT.




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