Signing example
Medical consent e-signature
A medical consent e-signature has to prove three things: who consented, that they saw the risks, and that the file has not changed since. This two page consent for a day surgery arthroscopy at a fictional clinic covers all three, with an access code given at the pre-admission call, two required risk statements, a nurse signing a WITNESS block, and DocMDP certification sealing the result.
The document, with its fields
The pages as a signer sees them, with the signature, name, title and date fields placed where each party has to complete them.
Consent to Procedure
Procedure and clinician
| Patient | Gordon Ashworth, born 14 March 1961 |
|---|---|
| Procedure | Right knee arthroscopy with partial meniscectomy |
| Surgeon | Ms Farida Osei, orthopaedic surgeon |
| Scheduled | Tuesday 8 September 2026, admission 7:00am, fasting from midnight |
What the procedure involves
Two or three small incisions around the knee, a camera and instruments introduced to trim the torn portion of the meniscus, closure with adhesive strips, and discharge the same day once the recovery criteria are met. The expected theatre time is under an hour. You will need someone to drive you home and stay with you overnight.
Risks discussed
The material risks Ms Osei discussed at the consultation on 24 August 2026: infection needing antibiotics or rarely a washout, a blood clot in the leg or lung, bleeding into the joint, numbness near the incisions, ongoing pain despite the procedure, and the small chance that the tear is not repairable arthroscopically. The risks that matter specifically to you, given the blood thinner you take, were discussed and the plan for pausing it is in your pre-admission letter.
Anaesthesia
General anaesthesia, assessed and delivered by the anaesthetist, who will speak with you before the procedure. Anaesthetic risks including nausea, dental damage and, rarely, serious reactions were covered in the anaesthesia information sheet given to you at pre-admission.
On the day
Bring your medication list, wear loose clothing over the knee, and leave valuables at home. Admission is through the day surgery entrance on Lyndale Avenue. Expect to be at the facility for four to six hours in total, and expect a follow up call from the nursing staff the next morning.
Before you sign
Read the declaration below with the pre-admission letter beside you. If anything differs from what Ms Osei told you at the consultation, ring the pre-admission nurse before signing rather than signing and asking later; this form is witnessed on the spot and filed with your admission record the same day. Bring nothing to the appointment except your questions; the form itself, this page included, is completed on the facility's system, and you receive the signed copy with its certificate by email before you leave.
Patient declaration
Both statements are required; type a mark in each box before signing.
| The risks of this procedure were explained to me, including the risks specific to my medications. | |
| My questions were answered and I know I can withdraw this consent at any time before the anaesthetic is given. |
This consent covers the procedure named above and nothing further, except whatever is immediately necessary to deal with a life threatening complication found during it. Any other finding is treated as a separate decision for a separate day, discussed with me after I wake.
I consent to the procedure named above, performed by Ms Osei or, if unavoidable, another accredited surgeon of this facility who would speak with me first wherever possible.
Who signs what
- Gordon Ashworth, the patient, signs first
- Two risk statement boxes, required · Name, signature and stamped date · Access code given at the pre-admission call
- Imogen Vale, nursing staff, witnesses second
- Block headed WITNESS: Name, Title, Date · Email link
The signing journey
Step 1
The code travels by phone, not email
The clinic set an access code for the patient and read it out during the pre-admission call. His emailed link opens a Verify it is you card, and a forwarded email is useless without the spoken code. Five wrong attempts locks the link for fifteen minutes.
Step 2
Two statements before a signature
Gordon marks the two required boxes, that the risks including those specific to his medication were explained, and that his questions were answered. The portal refuses submission while either box is empty.
Step 3
The patient signs, the witness is invited
His drawn signature and stamped date complete page 2, and only then, because Sign in order is on, does the nurse receive her link. She types Registered Nurse into the Title line of the block headed WITNESS and signs beneath the declaration she is attesting.
Step 4
Certification seals the file
The listener stamps both signatures, writes the certificate, and certifies the PDF with a DocMDP signature that permits no further changes. The completion email delivers the certified consent to the patient, the nurse and the clinic.
What tamper proof means here
The completed consent is certified with a DocMDP permission level of no changes allowed. Open it in a PDF reader and the signature panel reports a certified document; alter so much as a byte and the reader reports that the document has been modified since certification. What certification does not do is timestamp the file against an external authority, and the missing suffix on the algorithm line says so honestly. The signing times you rely on are the ones in the certificate and the hash chained event log.
What the signed consent and certificate show
Page 2 shows two X marks against the printed statements, the patient's name and signature with the stamped date, and the witness block with WITNESS printed above the nurse's name, her typed title and her own stamped date. The certificate lists the patient verified by access code and the nurse by email link, over a twelve event log from Envelope created to her Signed.
How to adapt this envelope
An anaesthesia specific consent or an imaging consent swaps the document and keeps the skeleton: code for the patient, required statements, a witnessing staff member in order. For research consent with a fuller statement set and no witness, the consent form example walks the same trail with six boxes.
What makes this signing flow work
The code came by phone, so the mailbox is not the weak point
An emailed code proves control of a mailbox; an access code shared in a phone call proves the clinic spoke to this patient. The certificate prints Email link + access code beside his name, and the failed attempt lockout is logged if anyone guesses.
The witness is a signer with a heading
There is no witness role in the product and none is needed: the nurse is a full recipient whose block prints WITNESS above her name, title and stamped date, and whose own events sit in the trail. Her attestation is as auditable as the consent itself.
Certification is stated with its limits
The algorithm line reads PAdES-SHA256-DocMDP: the file is sealed so a reader flags any change, and there is no RFC 3161 timestamp in the current setup. The page says both halves, because tamper evidence you overstate is tamper evidence you lose.
Questions people ask
Is there a witness role in the product?
No, every recipient is a signer. A witness is simply a second signer whose signature block heading prints WITNESS, which puts the attestation on the face of the document while the trail records her invitation, viewing and signature like any signer's.
What does the access code protect against?
A forwarded or intercepted invitation. The link alone opens nothing but a challenge card, and the code exists only in the clinic's records and the phone call. Five wrong attempts locks the recipient for fifteen minutes, with the failures logged as events.
What happens if the file is edited after signing?
Any PDF reader that understands certification will flag it. The file carries a certifying signature with no changes permitted, so modification breaks the seal visibly. The reader's signature panel is the check, not a manual hash comparison.
Is the consent timestamped by an authority?
No. The certification algorithm line carries no RFC 3161 suffix because no timestamping authority is configured. The times that matter, consent acceptance and both signatures, are recorded to the second in the certificate and the hash chain.
Can the patient withdraw consent after signing?
Clinically, yes, at any time before the procedure, and this form says so above the signature. The envelope itself is not edited to reflect that; withdrawal of consent is recorded in the clinic's process, while the envelope remains the honest record of what was signed on the day.
Why does the nurse sign second rather than first?
Because a witness attests to a signature that has happened. Sign in order is on with the patient first, so the nurse's link is only generated once his signature exists, and the timestamps in the trail show the sequence a witness declaration implies.
Build your own in about a minute
The button below opens the generator with this use case already described. Change the wording to match your own, generate, then edit anything you like.
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Want the steps in the builder? Read Send a PDF for e-signature, then Send a document for signature. For everything this generator can do, see the signing flow maker.
Sources
Written and checked by the OneCraft team. Last checked .