Therapist Payroll Submission

Therapist Payroll Submission
Access Code*
Therapist Name*

First NameLast Name
Payroll Date*

MonthDayYear
Date
Payroll Date*
Overage of sessions (for 50% payroll, please input 0)*
Directions to run report for Oustanding Notes:

On PP, go to Reports> Tasks and Clinical> Document and Progress Note Status Report>adjust dates and select your name, set status to "Incomplete" then>Preview
I have run the PP report for outstanding notes and attest that all of my notes have been submitted.*

YESNO
I have submitted all reports on time (6 weeks before authorization ends), including discharge reports. I have an updated POC and report that is no more than 6 months old for all of my clients.*

YESNO
If no, please describe briefly.
I certify that I have read and understand Therapy West workplace harassment, HIPPA, Child Abuse policies and attest that if I experience workplace harassment, and/or am made aware of any HIPPA or Child Abuse issues and/or if I am injured while on the job, I will notify my supervisor or one of the owners immediately.*

YESNO
To the best of my knowledge, I certify that my billing is accurate and true.*

YesNo
By initialing this document,

I certify that all of this information is accurate and true.

AND

I certify that I have not been sexually or physically harassed by a TW employee during this pay period.
Initials*
Date*

MonthDayYear
Date
Should be Empty: