For Patients, Use Of This Form Is Completely Voluntary
Use a For Patients, Use Of This Form Is Completely Voluntary 2015 template to make your document workflow more streamlined.
What this voluntary patient form means
For Patients, Use Of This Form Is Completely Voluntary is a patient acknowledgment stating that completing or participating in the related process is optional. It helps a healthcare organization document that the patient received clear information, understood the voluntary nature of the choice, and decided whether to proceed. The form should identify the patient, relevant service or program, and date, then capture the patient’s decision and signature when required. Because medical information may be involved, use controlled access and a HIPAA-compliant workflow when the organization is a covered entity or business associate.
Who uses this patient form
Healthcare providers
Clinics and hospitals can use the form for optional care programs, research-related participation, education, or other patient choices. The workflow should distinguish the patient’s voluntary decision from treatment authorization, financial consent, or legally required notices, and should route protected health information only to authorized recipients.
Patients and representatives
Patients, guardians, or authorized representatives may complete the form remotely when the organization permits electronic records. The signer should review the disclosure, indicate the decision requested by the form, sign the assigned field, and receive or access a completed copy.
Organizations that use voluntary patient forms
The right workflow depends on patient volume, the sensitivity of the information, and whether one person or a regulated organization administers the process.
A solo behavioral-health practitioner can send the voluntary participation form before an optional program, capture the patient’s decision remotely, and retain the signed record with an audit trail. A multi-location clinic can use a shared signNow template for consistent patient disclosures, assign signing fields to patients, and route completed forms to authorized administrative staff. A hospital or health system can connect patient-form workflows to Microsoft 365, Salesforce, or secure storage while applying HIPAA controls, role-based access, and documented retention policies.
These tasks are executed by both individual contributors and centralized administrators depending on organizational policy and required controls.
How this patient form works online
The signNow workflow moves this voluntary patient form from preparation to signed, reviewable evidence in four controlled stages.
Upload the form: Upload the voluntary patient form to signNow. Prepare fields: Review detected fields and add the patient decision and signature fields. Invite the patient: Send the assigned form by email or signing link. Store evidence: Save the signed form with its audit trail and access controls.
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How to prepare the patient form
Prepare the voluntary patient form in signNow by checking fields, assigning the signer, sending the request, and preserving the completed record.
Upload the form:
Upload the source PDF to signNow. Check patient fields:
Review auto-detected fields and add patient decision, date, and signature fields. Assign recipients:
Assign each field to the patient or authorized staff member. Send securely:
Send the voluntary form by email or signing link. Archive the record:
Store the completed form and audit trail in the approved repository.
Features that fit voluntary patient forms
signNow combines field preparation, patient routing, electronic signing, audit evidence, and controlled storage for this specific acknowledgment workflow.
Structured fields
Place patient decision, date, initials, and signature fields directly on the voluntary participation form, reducing manual field placement before sending.
Remote completion
Send the form by email or signing link so a patient can review and complete the voluntary decision without returning paper.
Audit evidence
Capture signer activity, timestamps, and document history in an audit trail that supports later review of the patient’s recorded decision.
Controlled templates
Use reusable templates to preserve the wording, field assignments, and routing sequence approved for a specific voluntary patient program.
HIPAA workflow
Apply HIPAA-compliant workflows with a BAA when protected health information is handled by a covered entity or business associate.
Record retention
Keep the completed form and supporting record available in a controlled signNow or connected repository for authorized retrieval.
Find and fill out the correct for patients use of this form is completely voluntary
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| IL IDPH Uniform Practitioner Orders for Life-Sustaining Treatment (POLST) Form 2017 | 4.8 Satisfied (1566 Votes) | |
| IL IDPH Uniform Practitioner Orders for Life-Sustaining Treatment (POLST) Form 2015 | 4.7 Satisfied (272 Votes) |
Recommended workflow configuration
Configure the patient form around identity, intent, audit evidence, retention, and protection of any health information.
| Setting | Recommendation |
|---|---|
| Patient authentication method | Email link with SMS verification when required |
| Patient signature type | Typed or drawn eSignature with recorded intent |
| Audit trail retention | Export with the completed patient record |
| Document retention period | Six years where HIPAA 45 CFR §164.530(j) applies |
| Encryption standard | TLS 1.2/1.3 in transit and AES-256 at rest |
Security controls for patient records
Protected health information:
Independent controls:
Information security:
Data at rest:
Data in transit:
Electronic signatures:
Record-keeping practices for this form
Retain the signed patient decision and its supporting audit evidence under a documented healthcare records policy.
Set retention against the applicable healthcare rule
Export the signed form and audit trail
Limit access to patient decisions
Document the retention and deletion process
Privacy pitfalls to address
Including diagnosis, treatment details, or identifiers beyond the voluntary decision increases exposure if the completed form is shared with unauthorized recipients. Failing to explain that participation is optional can undermine evidence that the patient understood and intended the recorded decision. Sending the form before assigning patient fields may route a signature or decision field to clinic staff instead of the patient. Using an unapproved shared link can expose the patient’s completed form outside the healthcare organization’s authorized access controls.
What the signNow audit trail records
The audit trail documents the technical history behind the patient’s voluntary decision, rather than merely showing that a signature field was completed.
Authenticate signer:
Capture timestamps:
Track document history:
Seal the record:
Preserve intent:
Export evidence:
Troubleshooting patient form completion
Use these checks to resolve signing, consent, privacy, and plan questions for this voluntary patient form.
Check that the patient’s email address is correct and resend the request from signNow. Business includes templates, audit trails, and legally binding eSignatures; HIPAA workflows require the appropriate BAA and administrative controls.
Confirm that every required patient field, decision field, date, and signature field is assigned to the correct signer. signNow’s auto-detection can identify fillable fields, but the sender should review each field before sending.
Use signNow’s audit trail to verify the signing event, timestamps, signer activity, and document history. Under ESIGN and UETA, preserve the completed record and make it reproducible for later review.
For patient-facing electronic records, provide the ESIGN consumer disclosure, explain the right to receive paper records, confirm electronic access, and explain consent withdrawal procedures under 15 U.S.C. §7001(c).
A HIPAA-covered organization should use signNow’s HIPAA-compliant configuration and execute a business associate agreement. Limit access to authorized personnel and avoid sending protected health information through unprotected channels.
Business Premium includes bulk send, while Business includes templates and audit trails at $8 per user per month when billed annually. Select the plan based on whether repeated patient invitations or bulk delivery is required.
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