By Laura Biewer on April 1, 2015
Updated 1-26-21. 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
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 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.