Issues at a Glance: Signature Recognition

What is it?

Signature recognition refers to state laws that authorize nurse practitioners (NPs) to sign or otherwise complete forms related to patient care within their scope of practice.

As part of routine practice, NPs sign forms that document and facilitate patient care, including orders for treatment, referrals and the recognition of health status. Occasionally, some outdated policies get in the way of patient care and prevent schools, agencies or other health care providers from accepting forms with an NP’s signature. This unnecessary limitation creates inefficiency and costly delays for patients in need of disabled parking placards, health status documentation, sport participation physicals, emergency utility services and other important care documents.

To address these challenges and promote more efficient care delivery, states are taking steps to ensure that the signature of an NP is recognized. In some instances, legislation or agency rules are updated with language that includes NPs among the list of providers who are authorized to sign specific forms. In others, states are adopting statutes that authorize an NP to sign, attest, certify, stamp, verify, endorse or provide an affidavit for any form for patient care within the NP’s scope of practice.

This broader reform approach, commonly referred to as “global signature authority” or “global signature recognition,” has been successfully passed in a number of states over the past two decades. Essentially, these laws authorize NPs to “treat the paperwork” that reflects the treatment they are already authorized to provide for a patient. An example of one state’s signature recognition statute of NPs is below:

Global Signature Recognition of Certified Registered NPs

When any provision of the general or public law or regulation requires a signature, certification, stamp, verification, affidavit or endorsement by a physician, it shall be deemed to include a signature, certification, stamp, verification, affidavit or endorsement by a certified, registered NP; provided, however, that nothing in this section shall be construed to expand the scope of practice of NPs.

These signature recognition laws (1) promote transparency and accountability by allowing documentation to reflect the actual patient-provider relationship, (2) provide efficacy for patients as care delivery and form completion can be addressed in the same visit and (3) promote productive use of the health care workforce by eliminating the need for multiple health care providers to be involved in signing one patient’s care forms.

Where is it?

Sixteen states and the District of Columbia have broad-based, “global” signature authority laws. The 16 states include Colorado, Georgia, Hawaii, Idaho, Maine, Massachusetts, Montana, North Carolina, Nevada, New Hampshire, Rhode Island, Vermont, Virginia, Washington, West Virginia and Wyoming. Other states recognize NPs’ signatures on select forms.

How will it impact my patients and my practice?

NPs know the challenges and frustrations of bureaucratic paperwork delays. Recognizing NPs' signatures on forms reduces costs and promotes efficient, timely care and patient choice.

Some examples of important areas NP signature recognition would impact include:

• Certification of disability for patients to receive disabled parking placards.
• Sports physicals for student athletes.
• Pre-employment and health screening exams.
• Patient Orders for Life-Sustaining Treatment (POLST) and other end-of-life care documents.
• Vital statistics documents.
• Workers’ compensation forms for employees injured on the job.
• The provision of proof that a patient has a health need for emergency utilities.

Additional Information

• AANP members-only State Policy Fact Sheets — Highlights signature laws in each state.
• Are you a state leader? Contact the AANP State Government Affairs office for more details about State Policy Resource Guides.

Are you interested in learning more about signature recognition in your state? Contact the AANP State Government Affairs office at 703-740-2529 or via the AANP Help Center.

Download This Policy Brief

© American Association of Nurse Practitioners, Revised October 2023