In some cases more than one Physician will need to sign-off on a transcription. The most common case of needing an additional signature is a Resident physician needing a signature from an Attending physician. If an additional signature from a particular physician will always be needed, it can be implemented through the InCommand Client Maintenance to request that signature automatically. This tutorial will step through all the steps in setting up automatic additional authenticators so that none are missed.

1. Log into InCommand and enter Client Maintenance. In the workflow, select the Document Types Folder as shown below.

2. You can individually specify which document types will require additional signatures. For documents that will need an additional signature from some physicians:

• Select the document type that will need additional signatures and click on the "Edit {Document Type}" link.
• In the "Workflow Options" make sure that the checkbox "Require Additional Signatures" is checked as shown below:

3. Go back to the workflow. If you have User Groups set up and the additional signature option should be turned on for all or most users in that group, then click on the "User Groups" folder as shown below. If you do not have User Groups or it is easier to enable the additional signature option for individual users, skip to step 7.

4. Select the appropriate user group and then click "Edit selected user group".

5. In the "Dictating Clinician Options" make sure that the checkbox for "Require Additional Signature" is checked as shown below. This will cause all users in this group to require an additional signature. If there are some users in this group that will not need this option enabled, it can be turned off on a per user basis in the User Settings. Make sure to click "Save" at the bottom of the screen.

6. Repeat steps 4 and 5 for all User Groups that will need additional signatures. It is a good idea to make sure that User Groups which will not need additional signatures have the option in step 5 unchecked. If there are no exceptions for individual physicians to these group rules for additional signatures then you can skip to step 11.

7. Go back to the workflow. If you have individual Users that need to be set up for the additional signature separate from User Group Settings then click the "Users" folder as shown below:

8. Select the appropriate User and click Edit {User Name}.

9. In the "Dictating Clinician Options" tab to the right, make sure that the checkbox for "Require Additional Signature" is checked as shown below. This will cause this particular user to require an additional signature. If you have a Physician who will not require additional signatures, but he/she is in a User Group with the option turned on, make sure that this setting has a red "x" by clicking in the box again. Make sure to click "Save" at the bottom of the screen.

10. Make sure you save any changes, and repeat steps 8 and 9 for all users needing additional signatures enabled.

11. If you are not already in the User Settings folder in the Workflow, follow step 7 to enter it.

12. The final step in this process is to assign the physician who requires an additional signature the appropriate authenticator. If the additional authenticator will not be the same person for each transcription then you are done and can skip the rest of this process. Click on the physician who will need an additional authenticator(s) assigned and click the "Additional Signatures for {User Name}" link as shown below.

13. The next screen has two boxes with some buttons between. Select the correct additional authenticator (i.e. Attending Physician) from the right box and click the "add" button as shown below. If you have an incorrect name in the "Signing Users" (the left) box then select that name(s) and click the "remove" button. Make sure to click "Save" at the bottom of the screen after making changes.

14. Repeat steps 12 and 13 for each physician that will need a specific additional authenticator.

By following this procedure, all the settings for automatically requiring additional signatures for a physician will be set. If you are having problems with Physicians requiring signatures when not needed, requiring the wrong additional signature, or not being prompted for additional signatures when needed, make sure to verify all the settings as laid out in this topic.