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Signatures

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Enter information for the Signatures section of the Child Adolescent Diagnostic Assessment Part 2.

  1. In the Provider and Provider Date fields, enter the provider's name and the date for the provider's signature.

  2. For the 'Provider Rendering Diagnosis, if different than Above' and Provider Rendering Diagnosis Date fields, if the rendering provider is different from the provider listed above, enter the rendering provider's name and the date for the rendering diagnosis.

  3. In the Physician and Physician Date fields, enter the physician's name and the date for the physician's signature.

  4. If the physician has a supervisor, in the Supervisor and Supervisor Date fields, enter the supervisor's name and the date for the supervisor's signature.

  5. Record the following service information for up to two services.

  • Date of Service
  • Staff ID Number- This field defaults to the user logged in if the user is associated with a staff ID.
  • Procedure Code
  • Start Time
  • Stop Time
  • Total Time (minutes)- This value is calculated by subtracting the Start Time from the Stop Time.