Notaries in healthcare environments often encounter signers with physical issues, making it difficult for them to pen their signature on a document. But this issue is generally not a cause to refuse the notarization. In some states the physically impaired can sign a document using what’s known as a “signature by mark,” in which the signer makes an “x” or similar mark on the document in the presence of witnesses. In California, two witnesses must be present. One witness writes the principal signer’s name near the mark, and both witnesses must sign their own names to the document. It’s important to check your state statutes for any special requirements or procedures before notarizing a signature by mark. If the principal signer is unable to write at all, some states allow the signer to direct the Notary to sign the document on their behalf, including Florida, Hawaii, Michigan, Massachusetts, Texas and Washington. Texas and Hawaii require a single witness with no interest in the document to be present when the Notary signs, and in Florida and Massachusetts, two impartial witnesses are required during the signing. Florida also requires the use of special certificate wording when a Notary signs on behalf of a disabled signer. It is not appropriate for a third party to attempt to physically move a signer’s arm in order to complete a signature if the signer is unable to write, and Notaries should immediately halt any notarization where a third party attempts to physically control a signer’s actions.