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6555 West Sunset Road Las Vegas, NV 89118 Ph: 702-579-1700 ? Fax: 469-621-5604 FreemanLasVegasES freemanco.com Name of Show: NAB Show April 11-14, 2011 / Las Vegas Convention Center COMPANY NAME:.

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In order to be considered valid for Medicare medical review purposes, an attestation statement must be signed and dated by the author of the medical record entry and must contain sufficient information to identify the beneficiary.

With eSignature, you can create documents for signatures and send signature requests in Google Docs. Signers can then easily fill in requested information to complete eSignature requests. Note that use of this feature is subject to the following terms and conditions.

Signature Logs The physician (provider) should sign his/her legal signature (full name, including credential). Under Actual Chart Signature, the provider should indicate all possible ways that he/she would sign the medical record (initials, first initial/last name, etc.).

The purpose of a physician's signature in a medical record or operative report is to clearly identify who ordered and provided supplies or services for the patient. It also serves as a testament that the services he or she provided were accurately and fully documented, reviewed, and authenticated.

Include the provider's printed name, handwritten signature(s), initials, credentials, license number and National Provider Identifier (NPI). If a provider has various signatures, all versions of the signature should be included on the signature log.

A signature log lists the typed or printed name of the author associated with initials or an illegible signature. The signature log might be included on the actual page where the initials or illegible signature are used or might be a separate document. The provider should also list his/her credentials in the log.

Attestation is a kind of testimony or confirmation. It is customary to sign a deed, make a will or sign other written documents in the presence of a witness who also signs the document to attest to its contents and the authenticity of the party's signature.

When claims are submitted electronically, the patient's signature indicator must be submitted in the appropriate record.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232