RHC Physician Supervision and Medical Direction Log

A log for documenting physician medical direction and supervision of advanced practice providers in a Rural Health Clinic (RHC) for certification and compliance tracking.

Log Entry Details

• Date of Log Entry
• Clinic Location
• Type of Supervision / Medical Direction
• If Other, describe the supervision type
• Supervision Period Covered
  Enter the date range or encounter period covered by this log entry.

Physician and Provider Information

• Supervising Physician Name
• Supervising Physician Credentials
• Advanced Practice Provider Name
• Provider Role
• If Other, specify provider role

Supervision Activities

• Supervision Activities Performed
• If Other, describe the activity
• Number of Cases or Charts Reviewed
• Summary of Medical Direction Provided

Issues, Follow-Up, and Compliance Notes

• Were any issues or gaps identified?
• Describe the issue(s) identified
• Is follow-up required?
• Follow-Up Owner
• Follow-Up Due Date

Attestation and Sign-Off

• Attestation
• Submitted By
• Submission Date
• Physician Signature
  Capture physician sign-off if required by your clinic's internal policy.