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If you live in an area with a material commercial mariner population, you should find there is a local hospital that has a program specializing in completing this paperwork. My renewal is due, and I secured an appointment from the right local hospital within 10 ten days, at a cost of $80 out of pocket.....You need a good, and patient doc to trudge through the Physical exam form with you. I make two physical exam appointments: the first for the exam, the second to fill out the form.