TIME LOG MEDICAL STAFF FOR MONTH ENDING: ________________ First Week Second Week Third Week Fourth Week Total Hours of the of the Month of the Month of the Month Month Meeting with CEO/Designee MEC Meeting Preparation/ Attendance/Minutes - Preparation and Review Other Medical Staff Meeting attendance and/or preparation, including meetings with other leaders (circle) Credentials Peer Review Other (specify) Board meeting Preparation/Attendance Collegial Intervention/Peer Review/Counseling Preparation and Participation Education (e.g., seminars) Miscellaneous Activities HOURS I certify that the above information is true and complete. ___________________________________ ______________________________ ________________, M.D. Date ___________________________________ ______________________________ Approved By Date
TIME LOG MEDICAL STAFF FOR MONTH ENDING: ________________ First Week of the Month Second Week of the Month Third Week of the Month Fourth Week of the Month Total Hours Meeting with CEO/Designee MEC Meeting Preparation/ Attendance/Minutes - Preparation and Review Other Medical Staff Meeting attendance and/or preparation, including meetings with other leaders (circle) Credentials Peer Review Other (specify) Board meeting Preparation/Attendance Collegial Intervention/Peer Review/Counseling Preparation and Participation Education (e.g., seminars) Miscellaneous Activities HOURS I certify that the above information is true and complete. ___________________________________ ______________________________ ________________, M.D. Date ___________________________________ ______________________________ Approved By Date
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