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Rx Med Staff, LLC 502 Granberry Humble, Texas 77338 Office: (832) 527-0771 Fax: (281) 596-2714 7214 www.rxmedstaff.com Hospital/Client’s name Employee’s name Social Security # Area date

Dept# time start

time end

break

reg hrs

over time

client approved

Sun

Mon

Tue

Wed

Thu Fri Sa

Total hours to nearest ¼ hrs

I certify that the hours shown above are correct and performed satisfactorily. Employee signature:

date:

I certify that the hours shown above are the accurate hours worked and verified by client or by an authorized representative.

Signatue of authorized personnel of Facility ONLY

date:


Time Sheet