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Cosign notes, orders and verbal orders

When a resident or an advanced practice provider (NP, PA, APP) signs a note or order, or a nurse enters a verbal or telephone order you gave, it waits in your Cosign queue until you review and sign it. This is the teaching-physician and order-authentication step: the work is not final for billing or the record until you cosign.

Before you start​

You need an attending-level role with cosign rights. In the left navigation, under Clinical, click Cosign. The badge shows how many items are waiting and how many are overdue.

Steps​

  1. Open Cosign. Use the filters at the top to narrow the list: All, Resident, APP, or Verbal orders.
  2. Select an item. You see who wrote or took it, when, and how long you have left (verbal and telephone orders must be authenticated within 48 hours).
  3. Review the work:
    • Click Review in chart to read the full note or order in context.
    • If the note needs changes, edit it in the chart first, then come back and cosign.
  4. Check the Attestation text. It is pre-filled with the standard statement for the type of work (for example, that you saw the patient with the resident and agree with the findings). Adjust it if your involvement was different.
  5. Click Cosign for notes and orders, or Authenticate order for a verbal or telephone order. The item leaves the queue.

What happens next​

  • Billing: a charge proposed from a resident's or APP's note is held until you cosign. When you cosign, the hold is released; for residents the GC modifier (service performed in part by a resident under the direction of a teaching physician) is added automatically. See Review and approve charges.
  • Taken by: if someone else on your team cosigns an item first, it shows as taken by them and drops off your list.

Tips / Troubleshooting​

  • Nothing waiting for your cosign means your queue is clear. Items appear only for notes and orders where you are the supervising or ordering physician.
  • Overdue items are flagged; verbal orders past 48 hours are a compliance finding, so clear those first.
  • If Cosign is not in your navigation, your selected role does not include cosign rights (residents, students and scribes never see it).