Sample private duty nurse receipt image

Sample private duty nurse receipt image

  1. Nurse's name, degree and address 
  2. Registration number 
  3. Hours worked and dates of service 
  4. Location of services (home or hospital) 
  5. Name of patient receiving care 
  6. Attending physician name and degree 

You need to include a Certification Statement with this type of receipt. Please see your benefit information for more details.