Any user can be set up as someone who must or may have his or her encounter notes co-signed by another provider. This can be useful to allow a physician's assistant, nurse, or nurse practitioner, for example, to complete and sign notes that are then placed in a queue for review and co-signing by a supervising doctor (setting up co-signing requirements can be done through the Admin > Manage > Users panel).


Co-signature can be set up in one of several ways for a particular provider:

  • Co-signature options never appear when the provider signs a note.
  • Co-signature options always appear when that provider signs a note, but co-signature is always optional, at the option of the provider making the request for co-signature.
  • Co-signature options always appear when that provider signs a note, and co-signature is required for some notesthat contain designated charge types (CPT codes that you have specified), e.g., for particularly complex encounters.
  • Co-signature options always appear when that provider signs a note, and co-signature is always required.



Where co-signature options appear, the provider requesting co-signature will generally have the option to submit the request to any other provider with the power to co-sign. These are doctors (or more experienced providers of any type) that we have set up as available co-signers at your request. A single provider may also be designated as the default or required co-signer for another user.


When co-signature is requested, the note appears signed with a "Pending Co-Signature" label, and the co-signature request appears in the designated co-signer's task list, or in the task list of each provider who is authorized to co-sign if "Request Co-Signature From: Any Authorized Provider" is selected. When the note is co-signed, it will show in the top right-hand corner both the signed date and user and the co-signed date and user.


Co-signing cannot be undone. But if the note is unsigned, both the signature and co-signature will be cleared.


If you're interested in the work-flow from the perspective of the supervising physician, we've provided a short video below: