Purpose Statement

This feature enables EMS field personnel to obtain appropriate signatures while completing electronic Patient Care Reports (ePCRs) in First Due. Patient signatures provide legal documentation of consent, refusal of care, or acknowledgment of treatment, ensuring compliance with EMS protocols and protecting both patients and providers. The digital signature capability streamlines the documentation process while maintaining the legal validity required for patient care records.

Background Information

Patient signatures are a critical component of EMS documentation, serving as legal verification of patient consent, treatment acknowledgment, or refusal of care. The electronic signature feature in First Due allows field crews to capture signatures directly on mobile devices during patient interactions, eliminating the need for paper forms and reducing documentation errors. This functionality supports various signature types including patient consent, refusal against medical advice (AMA), guardian consent for minors, and crew member attestations. The system stores signatures securely within the patient care record and maintains audit trails for compliance purposes. Proper signature collection is essential for legal protection, billing accuracy, and meeting state EMS reporting requirements.

Required Permissions

Field users must have the following permissions enabled in their First Due profile:

• Incident Documentation - Edit: Ability to modify and complete patient care reports
• Patient Care Records - Signatures: Permission to capture and manage digital signatures
• ePCR - Field Access: Access to electronic patient care report functions
• Mobile App - Signature Capture: Permission to use signature functionality on mobile devices

Contact your department administrator if any of these permissions are missing from your user profile.

Video

Step-by-Step Guide

Step 1: Navigate to the Signature Section

1. Open your current ePCR in First Due
2. Scroll to or navigate to the "Signature" section of the patient care report
3. Locate the signature blocks that need to be completed for your specific case

Step 2: Edit Existing Signature Block

1. Identify the signature block you need to complete
2. Click on the "Ellipsis" (three dots) menu next to the signature field
3. Select "Edit" to modify and add a signature to the existing block
4. The signature form will open for configuration

Step 3: Complete Signature Fields

1. Fill out the required information fields as appropriate for your situation:
   • Signature type (Patient, Guardian, Crew Member, etc.)
   • Print name of person signing
   • Relationship to patient (if applicable)
   • Date and time of signature
2. Review all fields for accuracy before proceeding
3. Ensure all required fields are completed per your department protocols

Step 4: Initiate the Signature Process

1. Click on the "Sign" button to display the signature form
2. The system will show relevant form language and legal disclaimers
3. Present the device to the individual who needs to sign
4. Explain the signature requirements and what they are acknowledging

Step 5: Capture the Digital Signature

1. Have the individual signing use their finger or stylus to trace their signature
2. Ensure the signature is captured within the designated signature space
3. Verify the signature is legible and complete
4. Allow the signer to redo the signature if necessary

Step 6: Save the Signature

1. Once the signature is satisfactory, click "Save" to store the signature
2. The system will attach the signature to the patient care record
3. Verify that the signature appears correctly in the signature block
4. Confirm the timestamp and signer information is accurate

Step 7: Document Refusal if No Signature Obtained

1. If a signature was not obtained, select the appropriate reason from the dropdown:
   • Patient refused to sign
   • Patient unable to sign (medical condition)
   • Guardian/family unavailable
   • Other circumstances (specify in notes)
2. Document the specific circumstances in the narrative section
3. Follow your department's protocols for unsigned reports

Step 8: Use Saved Crew Member Signatures

1. Agencies have the option to allow for crew members to used saved signatures when setting up signature configurations
2. If signing as a crew member and you have a saved signature in your profile settings
   
3. Click the "Fill" button to automatically populate your saved signature
4. Verify that your saved signature displays correctly
5. This option is only available for crew member attestations, not patient signatures

Step 9: Add Additional Signatures

1. Use the "Add" button to include extra signatures needed on a case-by-case basis
2. Common additional signatures include:
   • Multiple family members for pediatric patients
   • Witnesses for AMA situations
   • Multiple crew members for complex calls
3. Repeat the signature process for each additional signer
4. Ensure all signatures are properly labeled and documented

Best Practices

Do:

• Explain to patients what they are signing before obtaining signatures
• Ensure signatures are captured clearly and completely within the designated area
• Verify the correct person is signing (check ID when necessary)
• Document the circumstances if signatures cannot be obtained
• Use appropriate signature types for different situations (patient vs. guardian consent)
• Test signature functionality on your device before patient encounters

Don't:

• Rush patients through the signature process without explanation
• Accept illegible or incomplete signatures without having them redone
• Use crew member signatures for patient consent requirements
• Forget to save signatures before closing the ePCR
• Allow unauthorized individuals to sign on behalf of patients
• Skip signature requirements even in emergency situations when possible

Tips for Optimal Use:

• Keep your device screen clean for better signature capture
• Adjust screen brightness for optimal visibility during signature process
• Have patients use their finger rather than stylus for more natural signatures
• Explain that digital signatures have the same legal validity as paper signatures
• Save signatures immediately after capture to prevent data loss

Troubleshooting & FAQs

Q: The signature area isn't responding to touch. What should I do? A: Check that your device screen is clean and dry. Restart the First Due app if the touch response continues to be problematic. Ensure your device's touch sensitivity is properly calibrated.

Q: Can I delete a signature once it's been saved? A: Signature deletion capabilities depend on your department's configuration and protocols. Contact your supervisor or administrator for guidance on signature modifications after saving.

Q: What if the patient wants to read the entire form before signing? A: Allow patients adequate time to review all form language and disclaimers. You can scroll through the document with them and answer any questions about the content before proceeding with signature capture.

Q: My saved signature isn't appearing when I click "Fill." Why not? A: Check your profile settings to ensure you have a signature saved. Contact your administrator if you need assistance setting up or updating your saved signature in the system.

Q: Can family members sign for adult patients? A: Family member signature authority depends on your state's laws and department protocols. Generally, only legal guardians or those with power of attorney can sign for competent adults. Follow your local protocols and consult medical direction when uncertain.

Q: The signature looks distorted after saving. Is this normal? A: Some compression may occur when signatures are saved, but they should remain legible. If signatures are consistently distorted, report this issue to your IT department or First Due support.

Q: How many additional signatures can I add to one report? A: There's typically no strict limit, but add only signatures that are necessary and relevant to the patient care encounter. Excessive signatures can complicate the documentation process.

Related Articles

• EMS Setup - Signature Setup