Todos

A signature makes a clinical document part of the patient's record. Once a document is signed, its content can never change; corrections are made as addenda.

Who signs#

The provider named on a document signs it. When an administrator or another provider started the draft for you, you sign it; the person who started it cannot sign it for you.

Sign a document#

1. Open the draft from the patient's Documentation tab, the Documentation page or the Todos page.
2. Click Sign at the bottom of the document. NeatPractice saves your latest typing first.
3. Read the attestation and check I agree to this attestation.
4. If your clinic requires a code to sign, NeatPractice asks for a Verification code: open your authenticator app and type or paste its current six-digit code into the six boxes. One code covers the next few minutes (15 unless your clinic chose otherwise), so signing several notes in a row needs only one code. Tick Remember this device for 30 days to sign from this browser without a code until then (remembered devices). Clinics that do not require a code sign with the attestation alone.
5. Click Sign.

Every required field must be filled in before you can sign, and the note must pass the clinic's checks before signing. A note written for a visit also needs the visit to be Ready to sign: its treatment lines and diagnoses complete. For Medicare patients, a daily note on treatment day 11 since the last progress report waits for that report; see Progress reports and discharge summaries. On a Medicare co-treatment, neither provider can sign while their timed minutes for the patient add up to more than the session: split the minutes on the visits first.

Expired licenses#

You cannot sign a document when your license for the service state has expired by the document's date of service. The service state is where the visit happened: the patient's service address for a home or community visit, the patient's home address for telehealth, and otherwise the visit's location (or, without a visit, the patient's home location). The same goes for a credential the service state requires, such as a technician registration, when you do not hold it for that state on that date. NeatPractice names the credential type and the state. Update your provider's Credentials tab in Setup, then sign again, or ask an admin for a license override covering the date. Having no ordinary license on file for that state does not stop signing.

Users who can override documentation gates, such as clinic admins, see a Reason to sign past the credential check field instead. Enter the reason and click Sign again; the reason is kept with the document for review. The same rule applies to co-signing: a supervisor whose license has expired cannot co-sign without that override.

If the signing window says signing could not be prepared, Sign stays off. Click Try Again once your connection is back. When a Verification code or a reason is asked for, it must be filled in before you can sign. A number outside the range its field allows (a percentile above 100, for example) is refused when the note saves and must be corrected before you can sign.

What signing does#

• The content is locked. NeatPractice keeps the document exactly as you signed it, with the template version it used, the goal results it recorded and, for a visit note, the treatment lines and diagnoses billed for the visit.
• The signature is recorded with your name and credentials, the attestation, the time the server received it, how you confirmed it was you (a verification code, a code on a remembered device, a recent sign-in, or your signed-in session and the attestation), the network address and browser you signed from, and a fingerprint (a SHA-256 hash) of the locked content. Each signature on the signed copy ends with a small line naming who signed, how and when (in UTC). Your signature image from your provider profile appears on the signed copy when you have one. The document's Signatures card, and the signed copy when you have no image, show your name in a handwritten signature style above your printed name.
• A signed copy is saved. Choose Print or Send > Print on a signed document to open the PDF. It lists the goals you addressed with their results. When the template has a goals, services or signature block, the goals, the visit's treatment lines and the signatures print inside that block, once, and the same blocks on screen show them instead of template guidance. After a co-signature, the signed copy shows both signatures, and every addendum follows the original. To print or send it, see Print and send documents.
• The visit moves on. A signed visit note finalizes the visit and sends it to billing, or holds it at Awaiting co-sign, with its charges held, when a supervising provider must co-sign. The patient's appointment shows Completed.
• Late entries are flagged. A document signed more than seven days after its date (or the number of days your clinic set), or after its signing deadline, shows Late entry.
• A discharge summary closes the episode of care, with the summary's date and discharge reason.

Co-signing#

A note waits for a co-signature when the author's supervision assignment in Setup asks for one, or when the visit's payer pays for the author's credential only with the supervisor rendering. The supervising provider on the visit (or on the supervision assignment) co-signs it.

To co-sign:

1. Open the note from Awaiting my co-sign on the Todos page.
2. Click Co-sign, check the attestation and, when asked, enter your verification code. Your license must cover the date of service, as when signing.
3. Add a Comment if you want one; it is kept with your co-signature.
4. Click Co-sign. The visit is finalized.

To send a note back instead, click Return, say what needs correcting and click Return. The note stays signed; it moves to the author's Returned to me list with your reason. The author corrects it with an addendum, and the note comes back to Awaiting my co-sign for you.

The Todos page#

Click Todos, just below Dashboard in the main menu, to open your signing work. Its menu lists one page per list; My unsigned notes opens first:

Each note shows how long it has waited: Under 24 hours, Over 24 hours or Over 72 hours, counted from the end of the visit, from the author's signature or from the return. Click the document type to open the note, or the patient's name to open the chart, and click Filter to narrow a list by document type or discipline. Pick patients or providers in the panel on the left to see only their notes; a supervisor can pick one supervisee to work through their co-signatures. Sent to me always lists everything sent to you. Each page has its own address, so a bookmark or a notification opens it directly, and keeps its own page, sort and filters.

The same lists, with the visits that still need a note and the reports coming due, can sit on your dashboard; see Your dashboard.

Permissions#

A user who can co-sign for every patient can co-sign a note in place of the supervisor named on it.