Price:$29.00
Medical Director Engagement File, Physician Supervision Log, Exit Record (PDF)
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Full name, credentials (MD, DO, NP, PA) and license number. Orders without it are refunded.
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Highlights
For licensed physicians, NPs, and PAs evaluating or holding a medical director role. This is your personal record, kept separate from any practice. It is not legal advice. Have your attorney and your professional liability carrier review any agreement before you sign.
For the prescriber asked to be a medical director for an aesthetic or IV practice. Your license can be held accountable for how services under your authority were delegated and supervised. This file helps you decide whether to take that on, and keeps the record of what you agreed to, what you saw, and what you raised.
Inside:
- Before you sign: the practice, services and devices, people and supervision, and your own exposure (coverage, tail, supplier accounts under your license, your name in their marketing)
- Time commitment worksheet
- Engagement decision record
- Practices supervised register
- Site visit log
- Protocol sign-off register
- Concerns and escalation log
- Exit record
Print-and-fill PDF, US Letter, 14 pages. Single-prescriber license.
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