Cms signature log template 2025

1. Click ‘Get Form’ to open the cms signature log template in the editor.
2. Begin by entering the date this log was created and your group name at the top of the form.
3. In the 'Provider Full Name' column, type or print the full name of each licensed provider (MD, DO, NP, PA).
4. Next, each provider should enter their legal signature along with their full name and credential in the designated fields.
5. In the 'Actual Chart Signature Variations' column, indicate all possible ways you might sign medical records, including initials and electronic signatures.
6. Review your entries for accuracy and completeness before submitting. Ensure all variations of your signature are included.
7. Once completed, return this form via the Optum PAF Uploader or through secure fax as instructed.

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