Register Signature Attestation For Free

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

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.

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.

I attest that, to the best of my knowledge and belief, all information in the above referenced data reported is accurate and complete. I have personal knowledge that some of the information in the above referenced data reported is not accurate or not complete.

?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.

'Signed in my presence by ........ (name of person) ..... and I hereby certify that the contents of this document were read over and explained to the said ..... (name person again) ......... who, to the best of my belief, understood the nature and effect thereof.

?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.

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.