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  • Physician Attestation Form Final-jl20150803

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Physician Attestation of Consumer Capacity The following client is interested in participating in Consumer Directed Attendant Support Services (CDASS). The client will select, train, and direct attendants.

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The teaching physician “attestation” refers to documentation in the medical record that supports the teaching physician's presence and level of participation in the services provided to the patient.

When you apply for health coverage through the Marketplace, you're required to agree (or "attest") to the truth of the information provided by signing the application.

Physicians often use the term "attestation" to refer to any kind of statement they insert into a progress note for an encounter involving work by a resident, non-physician practitioner (NPP), or scribe.

In order to be considered valid for Medicare medical review purposes, your attestation statement must include the following elements: The printed full name of the physician or practitioner. Sufficient information to identify the beneficiary. Date of service. Signature and date by the author of the medical record entry.

“I _(print full name of the physician/practitioner)___ , hereby attest that the medical record entry for ___(date of service)__accurately reflects signature/notations that I made in my capacity as ___(insert provider credentials, e.g. M.D.)__ when I treated /diagnosed the above listed Medicare beneficiary.

Signature Attestations Statement. Page 1. Medicare requires that services be authenticated by the persons responsible for the care of the beneficiary. The treating physician's/non-physician practitioner's (NPP's) signature on a note indicates that the physician/NPP affirms the note adequately documents the care ...

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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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:
1-877-389-0141
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