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FAX TO 6048772136 BCT PHYSICAL ASSESSMENT TO BE COMPLETED BY HOSPITAL STAFF (MD or RN) Assessment Performed by: Print Name and Title MD or RN / / / Signature D Evidence of: Nonmedical injection of
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What is print name and title?
Print name and title refers to the full name and official job title of the person signing the document or form.
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Any individual who is authorized to sign a document or form is required to provide their print name and title.
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To fill out print name and title, simply write your full name followed by your official job title in the designated space on the document or form.
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The purpose of print name and title is to provide clarity and transparency regarding the identity and authority of the person signing the document or form.
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The information that must be reported on print name and title includes the individual's full name and official job title.
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