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HIPAAsign

HIPAAsign lets you send documents out for signatures when signers are not in the same place. It notifies each signer by email (and optionally SMS), authenticates them before they can view the document, and moves through signers one at a time in the order you set. You can track the status of each envelope as it makes its way through the signing chain.

HIPAAsign works with both PDF documents and HIPAAtizer forms.

tip

If only one person needs to sign, or everyone is signing on the same device, use the Signature component instead. For a full comparison, see HIPAAsign vs. Signature Component.

What you can do with this feature​

  • Send a PDF out for sequential signatures from multiple parties
  • Build a from-scratch signing form using HIPAAtizer's full component library
  • Define the exact order in which signers receive the document
  • Control which fields each participant can see and which fields are shared across the workflow
  • Generate a public link that lets the first participant start a new signing workflow on demand
  • Customize the email each participant receives at their turn

Requirements​

  • Available for Covered Entity accounts on Gold Plus and Platinum plans
  • Each completed signing workflow uses one envelope from your monthly allotment
  • Sending envelopes via SMS requires an active Twilio integration configured on your account. Without it, participants can still be notified by email.

For current envelope limits and pricing, see the pricing page.

How envelopes work​

HIPAAsign works through envelopes. An envelope holds a document and defines who signs it and in what order. Each signer is a participant, and the order you define determines who gets the document first, second, and so on. The next participant is only notified once the previous one finishes their part.

Configure​

Step 1: Create a HIPAAsign form​

Go to the HIPAAsign menu in your dashboard and click Create Form. You'll see three options:

  • Create a new Form with AI: use AI to generate a HIPAAsign form
  • Create from scratch: build a HIPAAsign form using HIPAAtizer's full component library
  • Sign the Existing PDF: upload a PDF and add signature blocks on top of it

Pick the option that matches what you're starting with.

Step 2 (PDF path): Upload your PDF​

If you chose Sign the Existing PDF, the system prompts you to upload the file.

PDF compatibility

HIPAAsign works best with flattened, plain PDFs. Files with macros, dynamic fields, or embedded scripts can interfere with placing signature blocks: the signature box may not appear on the document, or the rendered PDF can come out blank with only the signature visible.

If your PDF was generated from Word or another editor with form fields baked in, re-export it as a plain PDF before uploading. The maximum file size is 20 MB.

Step 3: Define your participants​

Participants are the different people who must sign or add data to the envelope. When creating participants, you set the order in which the system sends the document. For example, a Patient/Witness workflow would have Patient as participant 1 and Witness as participant 2.

You can reorder participants later from the form settings.

Step 4: Add fields to the document​

On a PDF, drag fields from the left sidebar onto the document:

  • Signature
  • Initials
  • Input Field
  • Checkbox
  • Select
  • Date Signed: renders the date the participant signs the document

If you chose Create from scratch, the builder looks like the standard HIPAAtizer Form Builder, and you have access to every component available there.

Step 5: Assign each field to a participant​

HIPAAsign fields have most of the same settings as regular form components, plus two important additions:

  • Assign to: a dropdown listing every participant you defined. The selected participant is the only person whose input is expected for that field.
  • Display for other participants: a toggle controlling who else can see the field.
    • On: the field appears for every participant in the workflow, but for anyone other than the assigned participant it is shown as a disabled (read-only) field. If the assigned participant has already filled it in, downstream participants will see the data they entered.
    • Off: the field is hidden from everyone except the assigned participant.

Use Display for other participants to keep each participant's view focused on what's relevant to them. For example, a clinician's internal notes don't help a patient who's just signing a consent, so you can hide that field while the patient fills in their part. This is about reducing clutter during signing, not about privacy.

Completed-envelope PDFs include everything

The visibility toggle only controls what each participant sees while filling out the envelope. If a participant opts in to receive a copy of the completed envelope, the PDF they receive contains all data and fields completed by every participant, including fields that were hidden from them during signing.

Reuse an existing form

If you've already built a HIPAAtizer form and want to use it in HIPAAsign:

  1. Open the form in the Form Builder and click Export JSON.
  2. Create a blank HIPAAsign form using Create from scratch.
  3. Click Import JSON and select the file you exported.

You'll still need to assign each field to a participant once the form is imported.

Step 6: Publish the envelope​

Once all fields are placed and assigned, click Publish. From here you have two ways to start the signing workflow: create a public link, or start the envelope directly from your dashboard.

When you create the public link, the system prompts you for:

  • Your Message to Participants: the message that appears to participants when they open the envelope
  • Preset emails of second and other participants: fill these in if you already know who the downstream signers are, or leave them blank to let the first participant enter the addresses themselves

The first participant can either start a new envelope by entering their own email and the next participants' emails, or use the values you preset.

Click Generate Link, copy the URL, and send it to your client (email, SMS, embed in your site, whatever works for your workflow).

Option B: Start the envelope from the HIPAAtizer dashboard​

If you'd rather not share a public link, you can start the envelope yourself from within HIPAAtizer. Open the HIPAAsign form, enter the contact information for all participants, and create the envelope. The system automatically emails the first participant with their signing link, and the workflow advances from there exactly the same way as with a public link.

This is the better choice when you already know every signer up front (for example, a recurring patient-and-clinician workflow) and don't need a reusable link.

Step 7: Customize the email each participant receives​

Each time a participant finishes their part, HIPAAsign automatically emails the next participant in line. To customize what those emails say, open the HIPAAsign form's settings and go to User Email Notifications.

What participants see​

Before signing, each participant is asked whether they'd like a copy of the signed document. If they say yes, they enter their email address and a password. That password is what they'll use to open the PDF when the signed copy arrives in their inbox, keeping the document protected if their email account isn't on a HIPAA-compliant service.

After signing and submitting their part, the workflow advances to the next participant automatically. Once the final participant signs, the envelope is complete and the signed document is ready for download.

Use cases​

See step-by-step instructions

Goal: Collect a patient signature and a witness signature on the same consent form, with the witness signing after the patient.

  1. Go to HIPAAsign → Create Form and choose Sign the Existing PDF.
  2. Upload the consent PDF (flattened, under 20 MB).
  3. Create two participants: Patient (order 1) and Witness (order 2).
  4. Drag a Signature field onto the patient signature line and assign it to Patient. Add a Date Signed field next to it.
  5. Drag a second Signature field onto the witness line and assign it to Witness. Add another Date Signed field.
  6. Make sure Display for other participants is on for the patient's signature so the witness can see what was signed.
  7. Click Publish and generate a public link.
  8. Send the link to the patient.

Result: The patient signs first; once they submit, the witness automatically receives an email with a link to sign their portion. When both are done, the final signed PDF is available for download.

Convert an existing HIPAAtizer intake form into a sign-in-order workflow​

See step-by-step instructions

Goal: Turn an existing patient intake form into a HIPAAsign workflow where the patient signs first and the clinician adds notes and signs second.

  1. Open the existing intake form in the Form Builder and click Export JSON.
  2. Go to HIPAAsign → Create Form and choose Create from scratch.
  3. Click Import JSON and pick the file you just exported.
  4. Add a second participant for the clinician.
  5. For each field, set Assign to to either the patient or the clinician. Use Display for other participants to control visibility of clinical notes.
  6. Publish and generate a public link.

Result: A two-step workflow that uses your existing intake form's layout and logic, with sequential signing and per-participant field visibility.

Troubleshooting​

Signature box doesn't appear on the PDF​

Cause: The uploaded PDF contains macros, dynamic fields, embedded scripts, or other interactive elements that interfere with HIPAAsign's overlay.

Fix: Re-export the document as a flattened, plain PDF (most editors have a "Print to PDF" or "Save as PDF (flattened)" option). As a workaround, place the HIPAAsign Signature block above the existing signature field on the PDF, then drag it into position.

Uploaded PDF is too large​

Cause: The file exceeds the 20 MB maximum.

Fix: Compress the PDF (most editors and online tools can downsample images and remove unused resources) and re-upload.

A participant didn't receive their signing email​

Cause: The email may have been routed to spam, the previous participant hasn't actually completed their step yet, or there's a typo in the participant's email address.

Fix: Open the envelope in HIPAAsign to confirm which participant is currently active. Resend the link from the envelope details, or correct the email address and re-publish. If SMS notifications are enabled, you can also copy the signing link and send it manually.

The signed PDF prints blank with only the signature visible​

Cause: This typically happens when the original PDF used an unusual format or contained dynamic content that didn't flatten correctly during signing.

Fix: Re-upload a flattened version of the source PDF and resend the envelope for signature. If you continue to see the issue with a known-good PDF, contact support and share the file so the team can investigate.

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