GME Staff Attestation Statements of Supervision

[comment memo="GME Attestation Statements"]
[checkbox memo="Indirect Supervision" name="IndirectSupervision" value=""][conditional field="IndirectSupervision" condition="(IndirectSupervision).is('')"]
I provided indirect supervision with direct supervision immediately available. I was immediately available to assist the resident in the care of the patient, and have reviewed the resident's documentation and agree with the resident’s findings and plan of care [checkbox value="with the following exception(s):|with the following clarification(s):"][textarea][/conditional][checkbox memo="Direct Supervision" name="DirectSupervision" value=""][conditional field="DirectSupervision" condition="(DirectSupervision).is('')"]I saw the patient with the resident and discussed the plan. I reviewed the resident's documentation and agree with the resident’s findings and plan [checkbox value="with the following exception(s):|with the following clarification(s):"][textarea][/conditional][checkbox memo="Indirect Observation (oversight of non-privileged staff)" name="IndirectObservation" value=""][conditional field="IndirectObservation" condition="(IndirectObservation).is('')"]I reviewed the documentation of care provided by the resident and agreed with the resident’s findings and plan of care. [checkbox value="with the following exception(s):|with the following clarification(s):"][textarea][/conditional][checkbox memo="Procedures Direct Supervision" name="ProceduresDirectSupervision" value=""][conditional field="ProceduresDirectSupervision" condition="(ProceduresDirectSupervision).is('')"]I saw the patient with the resident and was present during the procedure. I discussed the case with the resident and reviewed the resident's documentation and agree with the resident’s findings and plan [checkbox value="with the following exception(s):|with the following clarification(s):"][textarea][/conditional][checkbox memo="Procedures Indirect Supervision" name="ProceduresIndirectSupervision" value=""][conditional field="ProceduresIndirectSupervision" condition="(ProceduresIndirectSupervision).is('')"]I verified the resident was approved for indirect supervision of this procedure. I discussed the case with the resident. I provided indirect supervision with direct supervision immediately available during the procedure. I reviewed the resident's documentation and agree with the resident’s findings and plan [checkbox value="with the following exception(s):|with the following clarification(s):"][textarea][/conditional][checkbox memo="Medical or PA Student Written Note" name="MedStud" value=""][conditional field="MedStud" condition="(MedStud).is('')"]The Medical/IPAP student assisted in the gathering and inputting of information about the patient. This information was verified by me with the patient. The exam documented was performed by both the student and repeated by myself. I take full responsibility for the documentation in this encounter.
[/conditional][checkbox memo="Inpatient Supervision" name="InpatientSUpervision" value=""][conditional field="InpatientSUpervision" condition="(InpatientSUpervision).is('')"]The above resident(s) discussed this case with me. [checkbox value="I have examined the patient. "][checkbox value="I agree with the above documentation and plan of care. "][checkbox name="InpatientSUpervisionaddl" memo="Additional clarification" memo_size="small" memo_color="yellow" value=""][/conditional][conditional field="InpatientSUpervisionaddl" condition="(InpatientSUpervisionaddl).is('')"][text size="3"]yo [select name="AD1" value="|active duty |retired |dependent "][select value="|M|F"] with [textarea rows="6"][/conditional]