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Pilot signed wrong line on medical certificate.
| Attributes | |
| ACN | 521219 |
| Time | |
| Date | 200108 |
| Day | Fri |
| Local Time Of Day | 1201 To 1800 |
| Place | |
| Altitude | agl single value : 0 |
| Aircraft 1 | |
| Controlling Facilities | artcc : zlc.artcc |
| Person 1 | |
| Qualification | pilot : private |
| ASRS Report | 521219 |
| Person 2 | |
| Qualification | other other : med examiner |
| Events | |
| Independent Detector | other other : 1 |
| Resolutory Action | other |
| Supplementary | |
| Problem Areas | Flight Crew Human Performance |
| Primary Problem | Flight Crew Human Performance |
Narrative:
When finished with my medical examination (3RD class) and waiting for the office clerk to finish my 3RD class medical paperwork, I was distracted several times. I was given the medical certificate to sign and was distracted by another clerk, doing my billing. I turned back to sign my medical certificate and mistakenly signed in the space reserved for the doctor. The clerk took the medical forms and certificate to the doctor in an examination room. He lined out my name and signed his in the remaining space. I then signed my name in the appropriate space. The clerk assured me the doctor said this error would invalidate my medical certificate. Errors do occur on the ground.
Original NASA ASRS Text
Title: PLT SIGNED WRONG LINE ON MEDICAL CERTIFICATE.
Narrative: WHEN FINISHED WITH MY MEDICAL EXAM (3RD CLASS) AND WAITING FOR THE OFFICE CLERK TO FINISH MY 3RD CLASS MEDICAL PAPERWORK, I WAS DISTRACTED SEVERAL TIMES. I WAS GIVEN THE MEDICAL CERTIFICATE TO SIGN AND WAS DISTRACTED BY ANOTHER CLERK, DOING MY BILLING. I TURNED BACK TO SIGN MY MEDICAL CERTIFICATE AND MISTAKENLY SIGNED IN THE SPACE RESERVED FOR THE DOCTOR. THE CLERK TOOK THE MEDICAL FORMS AND CERTIFICATE TO THE DOCTOR IN AN EXAMINATION ROOM. HE LINED OUT MY NAME AND SIGNED HIS IN THE REMAINING SPACE. I THEN SIGNED MY NAME IN THE APPROPRIATE SPACE. THE CLERK ASSURED ME THE DOCTOR SAID THIS ERROR WOULD INVALIDATE MY MEDICAL CERTIFICATE. ERRORS DO OCCUR ON THE GND.
Data retrieved from NASA's ASRS site as of July 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.