Attestation
Formal Definition
A supervising physician's countersignature and co-signature on a trainee's note confirming that they have reviewed the patient, agree with or amend the assessment and plan, and accept medical and billing responsibility for the encounter.
How It's Used on the Ward
"Needs attending attestation" or "the attending has to attest" — the supervisory sign-off that makes a student or resident's note billable and legally complete.
Example
""Third-year wrote a thorough note but it can't be billed until attending attestation. Attending added: 'I personally saw and evaluated this patient. I agree with the student's assessment and plan as written.'""
Clinical Context
Attestation has legal and billing weight. CMS teaching physician rules require the attending to personally see the patient (or be present during the key portion of the exam) for a note to be billable under their name. A blanket "reviewed and agree" without evidence of personal involvement is a compliance violation — audit bait. Attendings who sign without seeing the patient are billing fraudulently, not just cutting corners.