MSC Form 6110/2 at a glance
What it is: MSC FORM 6110/2 (AUG-2026) is the MEDICAL SUMMARY of the Military Sealift Command Medical Department (Code: N02H).
Who signs: The MSC mariner enters the mariner's phone number, the mariner's email address, the mariner's signature and the date. Enter the MEDICAL / DENTAL PROVIDER SIGNATURE and the DATE SIGNED.
A filled-in MSC Form 6110/2 example: a mariner and a provider complete page 1
How to fill out MSC Form 6110/2, box by box
Date, mariner full name and DOD ID number
Enter the SUBMITTED DATE, the MARINER'S FULL NAME and the DOD ID NUMBER.
Medical specialty required
Leave MEDICAL SPECIALTY REQUIRED blank when there is no specific requirement.
Medical problems, history and diagnosis
Fill in 1. MEDICAL PROBLEMS TO BE ADDRESSED.
Fill in 2. Relevant history, physical findings, and/or testing results: (HPI, Vital signs, PE, Imaging, Testing, Labs).
Fill in 3. DIAGNOSIS/DIAGNOSES.
Treatment plan
Under 4. TREATMENT PLAN, list ALL medications (including over the counter and supplements), referrals, AND/OR other treatments.
Enter Treatment(s) Completed and Treatment(s) Planned/Undergoing.
For medications, please provide a 6-month supply.
Recommended work restrictions and follow up requirements
Fill in 5. RECOMMENDED WORK RESTRICTIONS/LIMITATIONS AND/OR FOLLOW UP REQUIREMENTS: (list specific limitations if applicable - see page 1).
If applicable, enter the estimated date of Maximum Medical Improvement and/or follow up dates.
MSC mariner, release of medical information and signature
MSC Medical has FINAL authority for MSC Mariner sea-duty medical status determination.
MSC MARINER: AUTHORITY TO RELEASE PRIVILEGED MEDICAL INFORMATION: I hereby authorize release to the Military Sealift Command Medical Department and the Department of Defense Medical Treatment Facilities, privileged medical correspondence and records in my case.
The MSC mariner enters the mariner's phone number, the mariner's email address, the mariner's signature and the date.
Medical or dental provider, facility and signature
Enter MEDICAL SPECIALTY and FACILITY PHONE NUMBER.
Enter FACILITY NAME AND ADDRESS and the MEDICAL / DENTAL PROVIDER'S NAME (Print or Stamp).
Enter the MEDICAL / DENTAL PROVIDER SIGNATURE and the DATE SIGNED.
More rules for MSC Form 6110/2
MSC vessels operate remotely from medical care for up to 180 days. The mariner must meet the following minimum standards to be fit for full duty (this listing is not complete, contact Force Medical if additional details are required).
On page 1: general medical requirements, but not limited to: Blood pressure below 179/119, HbA1c below 8%, and required follow-up care/visits should be every 6 months or longer.
Administrative action including, but not limited to, progressive discipline or termination may be applied to any MSC MARINER that fails to provide medical documentation in accordance with N02.2H.6110.2-Q, CIVMAR Medical and Physical Standards.
Failure to communicate may result in administrative or disciplinary action.
It is the Mariner's responsibility to keep Force Medical informed of the status of all medical conditions.
Please communicate with Force Medical early and often to keep your NFFD status current.
NFFD and leave
You are NFFD for multiple conditions
If you are NFFD for multiple conditions, you must keep Force Medical informed on all of them to remain in an unexpired NFFD status.
Leave
Force Medical DOES NOT approve or deny leave, that is handled by your Marine Placement Specialist (MPS).
Your MPS may require you to be in an unexpired NFFD status to grant your leave and may, at their discretion, mark you AWOL if your NFFD expires.
Where to get help with MSC Form 6110/2
Military Sealift Command Medical Department (Code: N02H), Building SP-64, 471 East C Street, Norfolk, VA 23511-2419, E-mail: msc_forcemedical@us.navy.mil, VOICE: 1-866-827-4955.
Sources
[1] MSC Form 6110/2 (AUG-2026), Medical Summary, Military Sealift Command (the Official source link on this page).