Scribe Graphic Signature Request Form

Scribe Graphic Signature Request Form

For the Scribe Local Administrator: Print this form and provide one to each dictating user in your group for whom you wish to set up a digital signature.

Please print your credentials below, exactly as you would like them to appear in your electronic signature. Any format may be used, but an example format is supplied below:

Example: Full Name, M.D.

         Assistant Professor of (speciality)        

         Section of (section name)        

_____________________________________________________________________________________________________________

Please write your signature in black pen in the box below exactly as you wish it to appear in your electronic signature.  Please leave at least a 1/2” space between your signature and the boundaries of the box.  Also ensure that your signature is aligned parallel with the bottom and top line of the box.

When you have finished, please scan and email this page to your Scribe System Administrator.