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Psychiatric Practice and Managed Care
Published Online: 21 May 2010

Model Attestation Statement

Publication: Psychiatric News
Volume 45, Number 10
https://doi.org/10.1176/pn.45.10.psychnews_45_10_023
I, (full name of psychiatrist), hereby attest that the medical record entry for my patient (beneficiary name) on (date of service) accurately reflects the notations I made in my capacity as psychiatrist when I treated/diagnosed (him/her, choose one). I hereby attest that this information is true, accurate, and complete to the best of my knowledge.
(Psychiatrist's Signature)
(Date of Attestation)

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Psychiatric News
Volume 45 • Number 10 • May 21, 2010
Pages: 19

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Published online: 21 May 2010
Published in print: May 21, 2010

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