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5 Tips When Notarizing For Medical Patients

resized hospital

Updated 7-13-18. Because patients in health care facilities can be very ill, heavily medicated or otherwise impaired, notarizing for them requires extra time, compassion and skill. 

Often, patients who need to sign documents have issues with alertness, positive identification, signing ability and other challenges you won't find covered in your Notary handbook. 

In this setting, clients are at their most vulnerable. They’re often stuck in a room with equipment connected to them that beeps or buzzes; arm bands or leg stockings that squeeze their limbs; and IV bags hanging on poles, etc. They may be lying down, draped in a gown and thin blanket, and not physically or mentally at their finest.

In this situation, they may need significant documents notarized, such as powers of attorney, which gives another person temporary or long-term power to make their medical or financial decisions. Here are tips for notarizing documents for clients in hospitals, hospices and other health care facilities:

1. Schedule Extra Time For Hospital Notarizations
 

Consider total time versus uninterrupted time. After you find parking, which is usually not near the entrance of the facility, you may walk through a maze of hallways and elevators. There will likely be staff interruptions for taking vitals, making notes and conducting medical procedures, such as X-rays and changing IVs. Book a realistic amount of time for the appointment so that you won’t rush the client or be tempted to take shortcuts.

2. Speak To An Alert Signer
 

You should always make sure your signer is alert and aware of what’s going on before completing the notarization. Engaging your client in everyday conversation, as well as asking casual questions about the document, should help you decide if it is appropriate to proceed. If you are unsure, look to a nurse or social worker to see if there’s anything prohibiting them from signing. Follow the best practice of noting your client’s behavior and awareness in your journal.

If the signer’s family or other visitors are causing any kind of commotion, you might ask them to step out momentarily to ensure the signer is not being pressured or directed.

3. Know Guidelines For Alternatives To Full Signatures
 

Your client’s medical condition may make signing the document difficult. Make sure you’re familiar with your state’s guidelines regarding alternatives to a full signature. If witnesses are present and available, you may be able to have the patient sign with a mark, such as an “X” or even a thumbprint. If your signer is unable to sign, some states may allow the patient to direct another person to sign his or her name.

4. Understand The Alternatives To ID Documents
 

Many patients do not have their ID with them at the hospital, making the task of verifying your signer’s identity challenging. Again, you need to know what your state’s rules and guidelines say about what is acceptable ID — especially what is an acceptable alternative to an identity document. For example, does your state make provisions for the use of credible witnesses to identify a patient? If so, what are the requirements? If not, what other alternatives are there? When in doubt, call the NNA Hotline for assistance.

Taking assignments at medical facilities requires a little extra flexibility. Being fully prepared — down to bringing extra tools such as a clipboard and special pens for patients with arthritic or damaged hands — will go a long way toward making these types of appointments as streamlined and flawless as if performed in an office setting.

5. Know The Requirements Of The Facility
 

Apart from the Notary-related requirements, it also is helpful to ask about any non-notarial rules so you do not encounter any unexpected obstacles or legal issues that impact the acceptance of the document.

For example, if you go to a nursing home or long-term care facility in California to notarize an Advance Health Care directive, the signing must be witnessed by a patient advocate called an ombudsman. This person ensures that the patient understands what they are signing, is alert and agrees with the health care decisions detailed in the document. Without this special witness, the directive will not be honored at the facility and could be challenged at another facility.

Most other states have similar requirements. So it’s advisable to find out what type of document you’re expected to notarize ahead of time because ombudsmen are not employed by the facility and generally only work by appointment.

Psychiatric and behavioral centers also may have special requirements. Some facilities have policies barring patients from signing documents because they may be in an altered state or taking psychotropic medications. Either of these situations would impair their ability to make informed decisions. Some facilities will not allow you beyond the front desk.

For these assignments, check with the facility directly about their policies. The person hiring you may not be aware of them or may have inaccurate information.

If policy is not an issue, take extra care screening the signer for willingness and awareness, and make sure to document the steps you take in this environment. I ask for a doctor’s verification that the patient can sign for themselves before proceeding.

Laura Biewer owns At Your Service Mobile Notary in Modesto, California. She also teaches seminars for the National Notary Association and is a regular presenter at the NNA’s annual Conferences.

 

22 Comments

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Russ Nichols

06 Apr 2015

I had an appointment last week, the Borrower has MS and is confined to a Hospital bed. He cannot use his right hand.. My assignment was to have to him sign with an X with two witnesses besides myself. The title company ask for a letter stating I witnessed this. I sent an APA with the DOCS. They wanted a written statement. To top this off it was a 70 mile drive each way at 9 AM.

Wanda Williams

06 Apr 2015

Thank you for this article. We have several new Notaries in our hospital and this information while geared toward mobile Notaries still applies to those of us who provide services to patients in the facility we are employed. It is very important for staff and notaries to realize the specific constraints required when notarizing for patients. Thank you for sharing!

Robert sikes

07 Apr 2015

I did a reverse mortgage for a couple at a rehab facility. The wife was a few days out of open heart surgery. Having had a triple bypass myself, I know how she felt. The mortgage company lied as to the amount of documents. A very trying experience for all but with patience I got it done.

Monica Voloshin

07 Apr 2015

I also bring pens with me that specially made for people with limited power or flexibility in their hands. It makes singing easier for the patient.

Terri

13 Jun 2016

In our state there is a law that states if a person is residing in a hospital or facility the notary must see a letter of competency from the doctor attached to the Power of Attorney prior to executing the document. I did not see this listed anywhere in the article regarding Nevada.

Laura

13 Jun 2016

@Terri What a great observation. Some states may have restrictions, such as yours. In CA for Power of Atty Medical, an Ombudsman or patient advocate is required on the document is not valid. This is why it is imperative that every notary be familiar with their specific state laws to ensure compliance in their state. Thank you for pointing out yours so other notaries in Nevada are aware. Is this requirement for any POA or just health care? I will add it to my list of requirements when I am asked about Nevada. At your service, Laura Biewer

Cheri

25 Jul 2016

Thanks for your article. I work in a hospital and provide notary services free for our customers. I make it a point to ask all of my questions from the nurse of case management before going to the patient's room, but have still had to refuse because of patients being given certain medications before I get there. One thing I have always wondered is - how does everyone work it if a patient is on contact isolation precautions? Do you just wipe off your journal after the patient touches it for signing? Either the book is held by the patient, or lying on top of their bed or bedside table - and I have never seen any requirements to assure it is sterile for the next signer. Does anyone know if Maryland requires a competency from the doctor for Power of Attorney or other documents?

Susanne Pellicano

25 Jul 2016

I would like to know the answer to the question presented above by Cheri on July 25, 2016 regarding sterile conditions.

Laura Biewer

26 Jul 2016

I suit up with the garb provided by hospital, I do not use my own pens, I keep older thumbprinters for this purpose and once used by the Patient I throw it out. I hold the journal for the patient on the table. I can use a wipe for the cover of the journal, but nothing for the page, but I can skip the remainder of the spaces on that page and start the next. Not exactly sterile, but this is the best I can do to protect my tools. I am in CA so I do not know MD requirements for POAs. In CA we are not required.

Teresa Villanueva

27 Jul 2016

I would like to work at a hospital, but how much are we allowed to charge for services?

National Notary Association

27 Jul 2016

Hello. Notary fees are regulated by state law, so you would be able to charge up to the maximum allowed in your state, regardless of the location the notarization takes place at.

Barb

27 Jul 2016

I am a chaplain for hospice and also the company's notary. I do almost all out-of -hospital DNRs and Medical and Durable power of attorney papers for our patients. I use a yellow marker to indicate where they are to sign and bring a clipboard for a hard surface to write on. I talk slowly and clearly and make sure they understand the meaning of a DNR (Texas has 2 types: in hospital and out of hospital). I make them repeat to me what their wishes are since they are terminally ill. I have never contracted anything from them but I constantly wash my hands. People are most grateful that you have come to them. They feel vulnerable and out of control. I try to give that back to them with respect and listening.

Julie Brickley

31 Aug 2016

Knowing your documents and asking questions during the intake phone call also helps. In Colorado, Medical Powers of Attorney, Wills, and Living Wills must be signed in front of two witnesses, and generally, most medical/care facilities do not allow their employees to act in that capacity due to conflicts of interest. We make sure the person scheduling the appointment knows this and arranges for witnesses in advance. I have put together a form/checklist for my team and admin that asks all the important questions during the initial phone call. That way we are best prepared for the appointment. One of these does include what medical condition are we dealing with/walking into. Not everything is a terminal illness and the ER can be quite a shocking experience. One person met me in the hall with a picture of the patient (on their phone). So glad they did. Better to leave the shock/gasp/gag reflex in the hallway and greet the signer professionally.

Matt

29 Jul 2017

Julie, went on my first long term care facility today and it was a learning experience. First off, the staff was all over me and long story short I had to end the signing before it started because the signers son didn't have his witnesses lined up and the staff was unwilling. he then became very argumentative with the patient counselor and administrator and they were forced to call the police on him. I'd like to still take these types of assignments but would like to be a whole lot more prepared next time. Would you be willing to share your precheck list?

Elsa

21 Aug 2017

I needed a notary to meet me at the hospital. A hospital social worker was contacted by nursing personal that I was expecting a notary to arrive. She claimed that she could save me the $100 fee and that the power of attorney that was signed right months ago would be retro active and no need on spending $100. She than went on to ask my partner if he knew his birthday. My partner stated October 18 1954. (Correct response) she than claimed he was incoherent and unable to sign any documents because he was in and out of consciousness. My partner had been talking to me earlier and now was sedated. Does the hospital decide or the notary decides if a patient is coherent and able to sign legal documents. The next day my partner passed away with out a will. I felt intimidated and just accepted her decision and now I'm at war with his family.

Cheryl

24 Jul 2018

Thanks for the information above. I am in CA and have never heard the information you stated above re: an Ombudsman: "For example, if you go to a nursing home or long-term care facility in California to notarize an Advance Health Care directive, the signing must be witnessed by a patient advocate called an ombudsman. This person ensures that the patient understands what they are signing, is alert and agrees with the health care decisions detailed in the document. Without this special witness, the directive will not be honored at the facility and could be challenged at another facility." Can you please direct me to where you found this law/rule so I can check it out? Thanks much.

National Notary Association

25 Jul 2018

Hello. Here's a link to a document with more information on California's ombudsman requirements from the National Long-Term Ombudsman Resource Center: http://ltcombudsman.org/uploads/files/support/Chapter_4_Witnessing.pdf

Scott

28 Jul 2018

Do the names of the grantee in the body of a quit claim deed have to match verbatim as the send to portion of the deed. Or did the notory make those changes on her own.

National Notary Association

30 Jul 2018

Hello. We're sorry but we can't answer questions regarding requirements to prepare a quitclaim deed, or whether or not a deed was prepared correctly. You would need to contact a qualified attorney for assistance.

Jessica

09 Aug 2018

In regards to the Ombudsman; I have not had 1 person in any of the healthcare facilities come and verify, whether it was a hospital or a nursing facility. They usually run out of the room once I get there. So this is news to me. I used to be a hospice CNA and in the 10 years I have been in the field I have not ever met an ombudsman. I will be asking for some more information on this. I recently had a healthcare program contact me for mobile services for their immobile clients and they said nothing to me in regards to having an ombudsman present.

Mary Joyce

25 Oct 2018

I am a Notary in Michigan where Hospital workers are not generally permitted to serve as witnesses to documents (at least in the hospitals I work in). A friend of mine in FL is in a Probate dispute with her brother regarding undue influence with her father. And somehow they got a document notarized the day after major surgery (in the recovery room no less) with a notary from the hospital and a nurse as a witness. So my question is- in FL is it legal for a notary to work in a hospital and notarize personal documents for patients and can hospital employees serve as witnesses to said documents?

National Notary Association

25 Oct 2018

Hello Mary. We're sorry, but we cannot provide legal advice or opinions regarding the details of your friend's document dispute. Your friend would need to consult with a qualified attorney familiar with Florida law to answer any legal concerns about the validity of a specific healthcare document or Florida laws governing hospital employees. Florida Notary statutes provide the following general information regarding disqualifying interest for Notary employees: “A notary public may not notarize a signature on a document if the notary public has a financial interest in or is a party to the underlying transaction; however, a notary public who is an employee may notarize a signature for his or her employer, and this employment does not constitute a financial interest in the transaction nor make the notary a party to the transaction under this subsection as long as he or she does not receive a benefit other than his or her salary and the fee for services as a notary public authorized by law” (FS 117.107[12]).

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