{"id":"signed-documents-workflow","slug":"signed-documents-workflow","title":"Signed Documents and Clinical Agreement Workflows","description":"Paper signatures still sit in the middle of many high-trust ambulance and citizen workflows: patient consent, refusal of care, non-conveyance acknowledgement, hospital handover, and formally issued agreements. When those","category":"modules","tags":["modules"],"lastModified":"2026-04-22","source_ref":"content/modules/signed-documents-workflow.md","url":"/developers/signed-documents-workflow","htmlPath":"/developers/signed-documents-workflow","jsonPath":"/api/docs/modules/signed-documents-workflow","markdownPath":"/api/docs/modules/signed-documents-workflow?format=markdown","checksum":"e4a4328f477eef62e551438b67b9acb09162b5020ae38aba7034c257e7e022f4","headings":[{"id":"overview","text":"Overview","level":2},{"id":"key-features","text":"Key Features","level":2},{"id":"use-cases","text":"Use Cases","level":2},{"id":"integration","text":"Integration","level":2},{"id":"open-standards","text":"Open Standards","level":2}],"markdown":"# Signed Documents and Clinical Agreement Workflows\n\n## Overview\n\nPaper signatures still sit in the middle of many high-trust ambulance and citizen workflows: patient consent, refusal of care, non-conveyance acknowledgement, hospital handover, and formally issued agreements. When those signatures are captured outside the operational system, services end up reconciling PDFs, photos, emails, and paper scans after the fact.\n\nThe Signed Documents and Clinical Agreement Workflows module keeps that process inside the platform. Staff can create a document instance from a controlled template, capture handwritten signatures on the responder device, complete and verify the document, and make the resulting artifact available to staff, citizens, or public-link recipients as appropriate. The goal is not just signature capture, but a governed document workflow that produces a defensible final record.\n\n```mermaid\nflowchart TD\n    A[Template Selected] --> B[Document Instance Created]\n    B --> C[Staff or Citizen Reviews Content]\n    C --> D[Hand Signature Captured]\n    D --> E[Document Completed]\n    E --> F[Verified Artifact Produced]\n    F --> G[Staff Access]\n    F --> H[Citizen Portal Delivery]\n    F --> I[Audit and Download History]\n```\n\n**Last Reviewed:** 2026-04-22\n**Last Updated:** 2026-04-22\n\n## Key Features\n\n- **Template-Driven Workflow**: Use controlled document templates for handover, consent, refusal, non-conveyance, and related agreement flows.\n- **Staff, Citizen, and Public Delivery Paths**: Support operational staff views, authenticated citizen views, and controlled public-link access where appropriate.\n- **Handwritten Signature Capture**: Record handwritten signatures on the responder device with signer role, timing, and capture metadata.\n- **Offline-Tolerant Workflow**: Support field capture patterns that can survive poor connectivity and still reconcile into a single signed record.\n- **Artifact Generation**: Produce the final document package in a format suitable for archive, download, and downstream handoff.\n- **Verification View**: Let services verify the resulting document state rather than trusting a screenshot or email attachment.\n- **Portal Branding**: Apply organisation-specific branding so citizen-facing documents look like official service communications.\n- **Delivery and Download Audit**: Record resend and download events so the service can show how the document was distributed.\n\n## Use Cases\n\n- **Patient Consent**: A crew captures informed consent for treatment or a downstream workflow while the patient is still present.\n- **Refusal of Care**: A refusal document is completed and signed on scene so the operational record and the signed acknowledgment stay together.\n- **Non-Conveyance Record**: A treat-and-leave pathway produces a signed patient-facing document without separate paper handling.\n- **Hospital Handover**: A formal handover or receiving-signature workflow is completed as part of the transfer of care.\n- **Citizen Agreement Delivery**: A citizen receives a completed, signed artifact through a secure portal or controlled delivery link.\n\n## Integration\n\n- **Electronic Patient Care Report Clinical Workspace**: Signed documents can be created directly from encounter and patient context.\n- **Citizen Portal and Public-Link Workflows**: Completed documents can be surfaced to the person who needs them without a separate document store.\n- **PDF Export and Archive Services**: Final artifacts can feed wider reporting, archive, and evidence-style workflows.\n- **Signature Verification Chains**: Signed output can align with adjacent verification and integrity workflows elsewhere in the platform.\n- **Notification Services**: Delivery and resend flows can trigger email or SMS notifications where the deployment requires them.\n\n## Open Standards\n\n- **PDF/A-3**: completed artifacts can be stored in an archive-friendly document format designed for long-term preservation.\n- **ISO 32000 PDF**: the final output aligns with the common portable-document standard used across healthcare, legal, and citizen-service workflows.\n- **PAdES / ETSI EN 319 142**: embedded signing workflows can align with the standard advanced electronic signature model for PDFs.\n- **eIDAS**: citizen- and staff-signing journeys can align with the European framework for electronic signatures and trust services.\n- **W3C PROV-DM**: signature capture, completion, delivery, and download actions can be represented as a provenance trail.\n- **ISO 8601**: signature and completion timestamps use a standard date-time format.\n"}