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Medical Record Signature Attestation Statement NOTE: This form provides a suggested format for a signature attestation statement. Submission of a signature attestation statement and use of this form.

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  5. Include the date to the document with the Date tool.
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  8. Select Done in the top right corne to save or send the document. There are several alternatives for receiving the doc. As an instant download, an attachment in an email or through the mail as a hard copy.

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