How can a practice send consent and financial policy documents for signature before a visit?

A practice builds the documents as templates in GoHighLevel Documents and Contracts, sends each patient a link, the patient signs on a phone, and the signed copy is filed in the chart. The bottom line: electronic signatures are valid for most patient documents, and the work is deciding which documents can be signed this way, what each must contain, and where the signed copy lives.

Is an e signature valid for patient documents

The ESIGN Act gives electronic signatures the same legal effect as handwritten ones when the signer intends to sign and consents to doing business electronically, and the Uniform Electronic Transactions Act, adopted in 49 states according to a vendor review, complements it. A compliance vendor reports that HIPAA permits electronic signatures on authorizations as long as all required elements are present and the signature is valid under applicable law. Some documents are different: state law may require witnesses, notarization, or a handwritten signature for certain documents, and rules differ for minors and for sensitive records. A UCSF research advisory notes that an electronic signature on a consent form can be valid when it meets state law and the signature can be shown to be legitimate. Patients also cannot be forced to sign electronically, so the practice needs a paper alternative.

Which documents to send

Build it in GoHighLevel

GoHighLevel's help pages describe Documents and Contracts, under Payments, for creating and sending contracts, proposals, and estimates with a signature field, and a workflow trigger for statuses such as sent, viewed, and signed. A changelog entry says customers can accept and sign proposals on mobile browsers and download a PDF of the signed document. Confirm in your account what the signed document records about the signing, and whether it is covered under your HIPAA configuration.

GoHighLevel's help portal says accounts are not HIPAA compliant by default, and that HIPAA Compliance is a paid upgrade, $297 a month as an account wide add on, that must be enabled for the agency and then configured for the sub accounts that need it. Third party guides add that the add on provides a business associate agreement, encryption, audit logging, and multi factor authentication, that the practice also needs its own agreement with the agency, and that GoHighLevel itself recommends avoiding protected health information in SMS and email even with the add on. Whether the AI features are covered by the agreement is a question to put to HighLevel in writing before any patient data reaches them.

1. Build each document as a template with the practice's approved text, reviewed by counsel and the privacy officer.
2. Add a short statement that the patient agrees to sign electronically and may ask for paper.
3. Build a workflow with the Customer Booked Appointment trigger that sends the documents for the visit type.
4. Build a workflow with the Documents and Contracts trigger set to signed that tags the contact Documents signed and creates a task to file the PDF in the chart.
5. Send a reminder 48 hours before the visit for unsigned documents, and a task for the front desk to hand a paper copy at check in.
6. Keep the signed documents for the retention period set by state law, which may be longer than the HIPAA baseline.

Worked example

For example, if a practice sees 300 patients a month and each needs 3 documents, that is 900 signatures a month (300 times 3). If 60 percent are signed before the visit, that is 540 fewer documents to hand over at check in (900 times 0.6).

Mistakes to avoid

• Treating a signature as informed consent. For procedures, the clinician discussion is the consent.
• Skipping the paper fallback. Patients may decline electronic signing.
• Assuming every document can be signed electronically. State law may require witnesses.
• Not filing the signed copy. The chart is the record.

How this was handled before

Patients signed paper forms at check in, and the front desk scanned them. E signature laws made electronic forms valid, and a signing link moves the step to before the visit, with a paper fallback.

What to measure after launch

Track documents sent, signed before the visit, paper fallbacks, and signed copies filed in the chart. Audit a sample of charts for filed signed documents.

Check before you switch it on

US text messages sent from a standard 10 digit number need A2P 10DLC registration. The HighLevel support portal says registration is required for texts to US recipients from 10 digit long code numbers and that toll free numbers do not require it. HighLevel's opt in guidelines also say a person cannot be forced to agree to text messages in order to submit a form, so keep the consent box optional. One compliance guide separates informational texts, which need documented consent, from marketing texts, which need prior express written consent. Ask your attorney which category your reminders fall into. Have counsel confirm which documents your state allows to be signed electronically, and keep a record of each signature. This is general information, not legal advice.

Questions people ask

Are electronic signatures valid in healthcare?

ESIGN and UETA give them legal effect, with some state specific exceptions, according to compliance summaries.

Can a HIPAA authorization be signed electronically?

A compliance vendor says yes, if all required elements are present and the signature is valid under applicable law.

Can a procedure consent be sent by link alone?

The information can be, but the clinician should discuss it. The signature records the conversation.

Ready to try it yourself? Start a GoHighLevel account here.

You can also see this in action in our GoHighLevel capabilities demo.