I have been searching high and low to find guidance for signature requirements for anesthesia procedure performed by CRNAs without medical direction. I'm trying to find out if an AN record for a procedure done by a solo CRNA has to have a supervising physician signature. In my experience, you would fail the MDA for medical direction if any of the attestations were missing, induction, emergence, & presence for key events, and bill to the CRNA. I do not recall having to look for physician signatures for procedures done by non medically directed CRNAs but did have to include information about a physician in a part of my keying. I'm learning a new facility and there are procedures at both an ASC and an office type setting that use MAC and am trying to find out if there's a signature requirement other than the CRNAs who are not medically directed in the state of TN. Thank you in advance.