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5 tips when notarizing for medical patients

Updated 12-19-23. Notaries asked to perform signings in health care facilities such as hospitals and nursing homes need to be prepared for unique circumstances, from family members and medical staff to the facility's own policies.

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
  2. Only notarize for an alert signer
  3. Know guidelines for alternatives to full signatures
  4. Understand the alternatives to ID documents
  5. Know the requirements of the facility

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. Only notarize for 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 is founder of and 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.

Related Articles:

Notary FAQs: Assessing a signer's mental capacity

A Notary's role in preventing elder financial exploitation

Additional Resources:

National Long-Term Care Ombudsman Resource Center

View All: Best Practices


Add your comment

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.


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.


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


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.


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.


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?


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.


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:


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.


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]).

Susan Cochran

07 Mar 2019

Does anyone know if there are specific rules for Indiana??

National Notary Association

11 Mar 2019

Hello. The Indiana Notary Public Guide published by the state ( has the following recommendations: “Special care must be taken when notarizing for the elderly or those in a medical care setting. Awareness may need to be established by someone in authority (i.e. doctor, nurse, attorney). Medications can alter the customer’s reasoning abilities. Consult with the signer’s doctor/nurse/attorney and write down their remarks in the notarial journal (and) have the authority sign your journal by their remarks as to the awareness of the client. Prior to notarizing, ask the client some questions about the document to be sure that they understand what they are signing and seem competent in their responses. Common sense, as well as reasonable care and caution, are the prime indicators on whether to proceed. When in doubt, do not notarize, but note why in the notarial journal and advise the client to seek legal advice.”

Mark Pears

13 Apr 2019

I fully appreciate the above comments. How would you approach a Hospice in Las Vegas to get a power of attorney notarized? Do I need permission or sign into the facility or do I also need a medical professional to be present at the signing of the document?

National Notary Association

17 Apr 2019

Hello. You would need to contact the facility in question to ask if they have specific rules for registering visitors or supervision of interactions with signers.


03 May 2019

I wanted to thank you for this article. I would, however, want to know what wording would I use to decline the notarization? I want to be sympathetic to the signer and the family but I don’t want to give my reasons for declining. Any suggestions? For those notaries that have experience on this matter, what wording did you use to decline?

Daisy Carlton

06 Aug 2019

I've never notarized a CA health care directive, client has a power of attorney, unable to physically sign the documents, am I able to notarize the directive?

National Notary Association

07 Aug 2019

Based on what you’ve described, we think it would be best if you contacted our Hotline team by phone and provided them with a more detailed description of the situation. The NNA Hotline: 1-888-876-0827 Mon – Fri: 5:00 a.m. – 7:00 p.m. (PT) Saturday: 5:00 a.m. – 5:00 p.m. (PT) If you’re not an NNA Member or Hotline Subscriber, they will provide you with a one-time courtesy call.

Jerry Lucas

17 Feb 2020

Beware of violations of HIPAA Privacy Rule 45 CFR 164.510 regarding protected personal health information and HIPAA Security Rule 45 CFR 164.302 regarding protected electronic personal health information.

Anthony Butler

05 Oct 2020

is there specialized training needed to work in the facilities?

National Notary Association

05 Oct 2020

Hello. Some facilities may require health safety procedures or other requirements. You should contact the individual facilities you wish to work with to check on any special requirements.


03 Jan 2021

Nice post Thank you

24 Jan 2022

# 1. Question. a Ombudsman needs to be present at EACH notarization that is made in a nursing home / health care facilities etc, OR only IF the signer has a sever medical conditions? # 2. If a ombudsman is need it Who is in charge to contact one ? and how?

National Notary Association

25 Jan 2022

Based on what you’ve described, we think it would be best if you contacted our Hotline team by phone and provided them with a more detailed description of the situation. The NNA Hotline: 1-888-876-0827 Mon – Fri: 5:00 a.m. – 7:00 p.m. (PT) Saturday: 5:00 a.m. – 5:00 p.m. (PT) If you’re not an NNA Member or Hotline Subscriber, they will provide you with a one-time courtesy call.

Aida Gonzalez

08 Feb 2022

Great article. I'm a signing agent and I had an experience in the past. I received an order of a refinancing home cashing out about $100k. The closing location was at rehab. center, where the couple was, There were seniors. I asked for the room and I met with the man first, he was very clear and I confirmed he was really alert and know what he was doing, when I asked for his wife, he told me that was in another room, the same floor. I told him, let me go and ask for a chair to bring for me, and I will come back. I went to the nurse station and asked for his wife's room and a person from the social security depart. came with me to meet her. She wasn't in her room, and she was seat in a wheelchair at the nurse station, I saw her, she was sleeping, drowsy, and I started asking her easy questions, about name, where was her husband, about documents need to sign, etc. Her answer was. Yes, my husband told me that I need to sign some papers, but don't know what they are. The social security person looked at me, and said, nobody at this center will serve or sign as a witness for this person's signature. I took the decision to leave the place, I went to see her husband first, and explained that I was leaving because I couldn't notarize her signature, he was very nervous, called his son and asked me to talk to him, the son started to scream on me over the phone saying that he will be coming to the place and sign as a witness for his mom, and I need to wait, I refused to wait for him, and explained that I was leaving. End of the story. I had the feeling that the money cashing out for the property was for his son. I felt very bad in that situation. We need to take care and be very careful about those situations.

Pati Kates

11 Mar 2022

I always carry hand sanitizer and wipes. I wipe off pens before and after clients use them. If it is more of a health risk (as far my journal is concerned) I also carry disposable gloves, or use the hospitals/facilities. The hospitals that I have gone to do not allow their staff to witness, so I always call the hospital myself to confirm the procedures of allowing witnesses in the room with me. I confirm with the client that no medication will be administered prior to my appointment that would effect their legal ability to sign. All of the hospitals that I have been to would not provided me with any confirmation of whether they had taken any medication or anything that would not allow a legal signature as this violates HIPAA laws. Finally, I ALWAYS speak with the signer PRIVATELY whenever a Will or a POA is being executed. I cover their "butt" by saying that I made an error on the document and would need to return to my office to make the change/correction if the signer provides any indication that they are being coerced.


27 May 2022

Thanks for sharing this wonderful information. Keep sharing

Any Hour Mobile Notary

30 May 2022

Nice blog . Keep sharing


23 Jan 2023

I always take a legal-size clipboard for signings at medical facilities. It makes it easier to secure the documents and for the patients to put them in a comfortable position for signing.

Loryn A

19 Aug 2023

I work at a hospital in Missouri. I was required to become a notary and am on an on-call rotation at the hospital to perform notaries for patients. It causes me extreme anxiety. When on call, we have to carry our pager our entire shift, including lunch breaks. If it takes you more than 2 minutes to call the paging number, they call your superior and complain. The ones who are in charge of the notary services seem to have very little understanding of everything. Policies says that medical staff cannot be witnesses. However, we have no choice but to use nurses since the families don't have anyone to witnesses and unless the patient is incapacitated, we cannot refuse to notarize or we get in trouble. They leave it up to the notary to track down witnesses which I do not feel is right. Try to say that the requester needs to find provide their own witnesses, and they will call to complain and you will be forced to do it anyway. Even in instances when we can and do refuse, we are still cussed at by the patients, their families, and the nursing staff! It is absolutely horrible. I dread every week that I am on call. To make it worse, they cannot longer force new people to become notaries. Whenever someone quits, the notary pool at work shrinks and we are stuck sharing this responsibility even more often. I know no on here can help, but just venting has made me feel better. Thank you for anyone who bothered to read this.

National Notary Association

21 Aug 2023

Hello. Notary duties can be extremely stressful under circumstances like the ones you face. We have an article with some tips to help cope with stress and anxiety on the job, we hope you may find it helpful:

Susan w

08 Jan 2024

From what I am readying, title co, hospitals, law offices. Almost any biz has a notary. Why do it then? In regards to hospitals and diseases. Carry hydrogen peroxide, spray and wipe. Kills cdiff which most will have in a long term facility or hospital. Look for the green top containers. Leave them your pen. Spray everything when you get out. Shoes too. Wish you all the best. You don’t make enough!

Justin S Haigh

08 Jan 2024

I just notarized a physicians certificate. A couple things to remember. The signer is the physician, not the client that hired you so it's the physician ID you'll need to record. Seems obvious but we so often think of the "client" as the one who signs and who's ID we'll need. Also, if it's a physician certificate that the doctor is signing to declare the person is "fit" or "capable of comprehending legal documents" this is often proceeded by an exam of your client. So the simple notarization act will be quick, but there's an exam of the client beforehand. I waited about an hour. Plan accordingly.

Kathy L O'Connor

08 Jan 2024

Colorado does not require a notarization or two witnesses for a medical power of attorney. Of course however it would be wise for the client to do so. When I go to hospitals I bring a clipboard, Reading glasses and a felt tip pen. This helps with people who cannot sit up. Lots of wipes after the notarization.

Nancy A. Johnson

09 Jan 2024

Thank you for this article. I have a pending notarization that involves a similar scenario. This article really helps me.


09 Jan 2024

Excellent and timely article. Between COVID and aging of the population, Notaries are an important first line source of documentation in medical situations. Knowing and following proper, legal steps to ensure validity and accuracy of the documents we notarize is essential. Thanks NNA for keeping us informed

Sandra June-Peterson

16 Jan 2024

In New Mexico can a person (who benefits from document) sign for for someone to sick to sign?

National Notary Association

19 Jan 2024

No, signatures by proxy are not permitted in New Mexico.

Mimi Simoncelli

06 Mar 2024

Can someone chime in to explain why Nevada requires Hospital Unit Clerks in the emergency department (ER) to have a Notary Stamp (be a Notary Public)? Please forgive me in advance if I am using improper nomenclature. I am a healthcare worker from out of state preparing to relocate to NV. It appears obtaining this credential is a move I need to make ASAP!

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