Signature Log Template
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1Signature Log
Legible Name
Credentials
Legal Signature with
Any Signature
( Print / Type )
Credentials
Variations
Unacceptable Physician Signatures and Credentials
Unacceptable unless…
1. The provider authenticated typed name.
2. Non-physician or non-physician extender cc-signed by acceptable physician.
3. Provider of services’ signature without credentials name linked to provider
credentials or name on physical stationary.
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Parent category: Miscellaneous