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ENT Surgery Solutions, LLC
Otolaryngology Ear, Nose & Throat Staffing Company
ENTlocums.com
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Time Sheet and Expenses
ENT Surgicalist Name
Date(s) of Assignment
# of Orientation Hours
Total number of patient care hours (not including orientation)
Total number of billable hours (e.g. # of hours in excess of included call hours)
Total amount due for assignment-not including expenses ($)
# of call days (# of 24 hour days plus additional call hours covered beyond 24 hour period; eg 2 days 10 hours)
Reimbursable expenses (please itemize below and email receipts to info@entlocums.com)
Total amount due for expenses ($)
Thanks for submitting...Please email copies of receipts for expenses to
info@entlocums.com
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