Healthcare Notaries must use extra care when determining if a patient seems fit to sign a document. Below are three situations where the Notary should refuse the notarization, and what steps to take afterward. Situation One: Physical Disability If a patient is alert and willing to sign a document, they must also be physically able to write. If they cannot physically sign, and if state law permits, you may perform a signature by mark notarization if the patient can make an “X” or similar mark in the presence of witnesses. However, if the signer is completely unable to write, the notarization cannot proceed unless state law authorizes other special provisions, such as in Florida. Florida permits a physically disabled signer to direct a Notary to sign a document on the disabled person’s behalf in the presence of the signer and two impartial witnesses. Situation Two: Medication Medication can affect a patient’s awareness, understanding and mental capacity. You must make a professional judgment as to whether a patient signing a document is impaired by medication. If the patient seems drowsy, confused, or unresponsive, you should halt the notarization and reschedule for a time when the patient is more alert. Situation Three: Lack of ID Many patients in hospitals or long-term care facilities may not have access to ID such as a driver’s license. If the signer lacks ID, the notarization cannot proceed unless the signer can produce credible identifying witnesses who can serve to identify the signer at the notarization. Otherwise, you should reschedule to allow the signer time to obtain satisfactory ID. If a notarization is scheduled in advance at a healthcare facility, it’s a good idea to ask if someone can make sure the signer has satisfactory ID ready for the appointment.