Is an electronic values list legally valid?

Yes. Electronic records and signatures are legally effective under the federal ESIGN Act (15 U.S.C. §7001) and state UETA statutes where adopted, provided the transaction meets intent, consent, attribution, and retention requirements.

Do healthcare values lists require notarization or witnesses?

Typically no; internal governance documents rarely need notarization. If the list is bundled with a legal instrument that requires notarization (state-specific), follow that instrument's notarization or witness rules.

Can patients be asked to sign a values acknowledgement?

Yes, but for patient-facing acknowledgements include consumer-disclosure steps and obtain consent where required. For consumer-facing records, ESIGN requires notice of the right to paper and an ability-to-access confirmation.

How do we update an approved values list?

Use a documented amendment workflow: draft changes, obtain the same approval level as the original, publish a new effective date, and retain prior versions with audit trails.

What authentication level is appropriate for approvals?

Low-risk approvals may use email verification; governance or legal sign-offs benefit from stronger authentication (SMS code, MFA, or organization SSO) and an audit trail.

How long must we retain signed versions?

Follow retention rules tied to related records: at least 3 years for financial evidence (IRC §6501(a)) and 6 years for HIPAA-related documentation (45 CFR §164.530(j)); check state law for longer requirements.

Electronic Signature
Templates
Healthcare
Healthcare Values List

Healthcare Values List

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HEALTHCARE VALUES LIST

Purpose: This Healthcare Values List is an explicit statement by the patient of personal values, priorities, and general preferences to guide clinical decision-making when the patient is unable to communicate. This document is intended to inform treating clinicians and surrogate decision-makers. It is not a replacement for legally executed advance directives unless otherwise specified by state law.

Patient Information

Patient Name

Date of Birth: Gender:

Address Primary Phone Emergency Contact

Insurance & Medical Record

Insurance Provider

Policy Number

Group Number

Subscriber Name (if different)

Medical History (Brief)

Current Medications Allergies (drug, food, environmental) Prior Surgeries / Significant Procedures Chronic Conditions

Core Health Values & Priorities

Select values and priorities that most reflect what matters to you when making healthcare decisions.

Values (check all that apply) Maintain independence and ability to perform daily activities Prioritize comfort and relief of pain Prolong life as long as reasonable interventions exist Preserve cognitive function and awareness Maintain dignity and privacy Prefer care at home when feasible Follow religious or cultural care preferences Minimize burden on family and caregivers

Top three values or priorities (ranked) Persons most important in making decisions or in providing support

Acceptable and Unacceptable Health States & Interventions

Health states I would find acceptable (brief) Interventions I would NOT want or find unacceptable (check all that apply)

Long-term mechanical ventilation Long-term artificial nutrition/hydration (feeding tube) Cardiopulmonary resuscitation if unlikely to restore acceptable quality of life Chronic dialysis to prolong life in advanced multi-organ disease Major invasive surgery with low likelihood of meaningful recovery Repeated hospitalizations for progressive terminal illness Other (please describe below)

If Other or additional explanation

Decision-Making Preferences

I prefer to: Make my own decisions as long as able Share decision-making with family/clinicians Rely on a designated surrogate if I am unable

Designated Surrogate Decision-Maker (if any)

Spiritual, Cultural, and Personal Considerations

Religious / Spiritual Beliefs Cultural or Language Needs

Organ and Tissue Donation

I consent to organ and tissue donation I do not consent to organ and tissue donation

Additional organ donation instructions (if any)

Privacy & Authorization

I acknowledge that the information in this Healthcare Values List will be placed in my medical record and treated as confidential in accordance with applicable privacy laws. I authorize my healthcare providers to share this information with my designated surrogate and other clinicians involved in my care as necessary to carry out my preferences.

I acknowledge and consent to the placement of this information in my medical record and to the sharing described above. Authorization Expiration Date (optional)

Right to Revoke: I understand I may revoke or amend this Healthcare Values List at any time by providing written notice to my treating clinician or by completing a new Healthcare Values List. The most recent documented list will supersede prior statements.

Additional Notes

Other instructions or clarifications

Acknowledgment and Signature

By signing below, I affirm that I have read and understand the contents of this Healthcare Values List, that the statements reflect my values and preferences at this time, and that I may update this document as my preferences change.

Patient Name:

Signature:

Date:

If signed by a guardian or legal representative, indicate relationship:

What a Healthcare Values List Is and Why It Matters

A Healthcare Values List is a formal document that records an organization’s core principles, behavioral expectations, and service priorities as they relate to patient care, safety, and staff conduct. It typically names each value, describes observable behaviors tied to that value, and assigns accountability for implementation and monitoring. Organizations use the list to align training, policy language, patient communications, and quality programs. Maintaining a written values list helps make decisions consistent, informs accreditation reviewers, and provides a single reference during audits or internal investigations.

Why a Clear Values List Improves Clinical Consistency

A documented Healthcare Values List reduces ambiguity about expected conduct, supports consistent clinical decision-making, reinforces patient-centered care, and helps demonstrate organizational governance during audits and accreditation reviews.

Who Typically Creates and Maintains a Healthcare Values List

Clinical leadership, compliance officers, human resources, quality improvement teams, and patient experience staff commonly lead development and maintenance of the values list.

Hospitals and health systems — enterprise alignment across departments and care settings with formal approval workflows.
Clinics and private practices — concise lists support onboarding, patient-facing communications, and team huddles.
Health plans and administrators — values used to guide vendor selection, member communications, and quality measures.

Use the list as a governance tool: circulate drafts to stakeholders, document approvals, and publish the approved version to staff and patients.

Essential Components of a Professional Healthcare Values List

A practical values list combines clear statements, behavioral examples, responsibilities, governance, and review mechanisms so values become operational rather than aspirational.

Core Values

Short, plain-language statements such as Respect, Safety, Transparency, and Equity that define organizational priorities and guide everyday decisions and interactions.

Behavioral Examples

Concrete examples and acceptable actions for each value so staff understand how to translate principles into observable clinical and administrative behaviors.

Responsibilities

Designated departments or roles responsible for implementing, measuring, and reporting on each value, including escalation paths for breaches.

Integration Points

How values connect to policies, training modules, consent materials, and patient-facing documents so the list aligns with operational processes.

Review Cycle

A defined schedule and approval workflow for periodic updates to ensure the list stays current with regulatory, clinical, and community expectations.

Measurement

Key performance indicators or qualitative metrics used to track whether stated values are being met in patient care and staff interactions.

Stepwise Process to Draft, Approve, and Publish the List

Follow these sequential steps to draft, obtain approval, and make the Healthcare Values List available to staff and patients.

01

Draft: Assemble stakeholders and create initial value statements and behaviors.
02

Review: Circulate to clinical, legal, and patient-experience teams for feedback.
03

Approve: Obtain sign-off from designated leadership and record the approval date.
04

Publish: Distribute internally, post on the intranet, and include in patient materials.

Configuring an Online Approval and Distribution Workflow

Configure digital workflows to capture approvals, keep version history, and notify stakeholders automatically.

Field	Configuration
Signing order	Sequential by role; clinical leadership then compliance then CEO
Authentication	Email link plus optional SMS code for sensitive approvals
Template retention	Retain completed versions with audit trail and version ID
Notifications	Automated email to approvers and publishing list on approval

Where Completed Lists Are Sent and How They Are Archived

A finalized Healthcare Values List should be routed to operational owners, HR, and secure archives with clear access rules.

Policy Repository: Store the final document in the centralized policy management system.
Human Resources: HR keeps version for onboarding and training records.
Legal/Compliance: Legal retains a copy for audit and regulatory review.
Patient Materials: Publish an approved patient-facing summary on the website or brochures.

Technical Considerations for Digital Completion and Signing

Choose a platform that supports secure storage, audit trails, and the file formats you use for governance documents.

File formats: PDF, DOCX supported
Integrations: Connect to HR and document management systems
Authentication: Email, SMS, or stronger MFA

Key Deadlines and Review Timelines to Track

Track adoption dates, review cycles, and training deadlines so the values list remains current and actionable.

Adoption Effective Date:

Date the approved list becomes active and applies to staff obligations.

Annual Review Deadline:

Complete a formal review once every 12 months to address clinical or regulatory changes.

Training Completion Window:

Set a 60–90 day window post-publication for staff to complete required training.

Interim Update Period:

Allow ad hoc updates for urgent regulatory or safety changes with documented approvals.

Retention Trigger:

Retention period begins from the effective date of each approved version.

Common Pitfalls When Preparing a Healthcare Values List

Vague language that lacks observable behaviors, which makes enforcement and training inconsistent across teams and locations.
Failure to assign ownership so that updates, monitoring, and accountability responsibilities are unclear or never completed.
Publishing without stakeholder review, causing clinical, legal, or community concerns that require retractions or revisions.
Not documenting version history and approvals, which complicates audits and undermines trust during regulatory inspections.

Risks of an Incomplete or Incorrect Values List

Regulatory noncompliance: Increased audit findings

HIPAA exposure: Potential privacy incidents

Accreditation risk: Negative survey outcomes

Patient trust loss: Reputation damage

Operational inconsistency: Variable care delivery

Legal liability: Increased litigation risk

Practical Examples of Values Lists in Use

These brief scenarios show how organizations convert values into practice and governance steps.

Community Clinic

A small clinic convened a cross-functional team to write five concise values emphasizing respect and access.

They included clear behavioral examples for front-desk and clinical staff.
After approval, the clinic integrated the list into new-hire training and displayed a patient-facing summary, reducing confusion about appointment prioritization and improving patient satisfaction scores within six months.

Behavioral Health Center

A behavioral health provider drafted values focused on dignity and trauma-informed care.

The list tied each value to documentation standards and consent practices.
Leadership used the list to update intake scripts and staff debriefing protocols, resulting in more consistent safety reporting and clearer expectations across multidisciplinary teams.

Who Typically Signs and Owns the Values List

Medical Director

The Medical Director commonly reviews clinical content and signs to confirm alignment with clinical standards; this signature indicates clinical endorsement and responsibility for clinician-facing behaviors.

HR Manager

The HR Manager signs to confirm integration with onboarding, training, and performance management processes and to accept responsibility for operational rollout and recordkeeping.

Frequently Asked Questions About the Healthcare Values List

Answers to common operational and legal questions when creating, approving, or storing a Healthcare Values List.

Need help? Contact support

Is an electronic values list legally valid?
Yes. Electronic records and signatures are legally effective under the federal ESIGN Act (15 U.S.C. §7001) and state UETA statutes where adopted, provided the transaction meets intent, consent, attribution, and retention requirements.
Do healthcare values lists require notarization or witnesses?
Typically no; internal governance documents rarely need notarization. If the list is bundled with a legal instrument that requires notarization (state-specific), follow that instrument's notarization or witness rules.
Can patients be asked to sign a values acknowledgement?
Yes, but for patient-facing acknowledgements include consumer-disclosure steps and obtain consent where required. For consumer-facing records, ESIGN requires notice of the right to paper and an ability-to-access confirmation.
How do we update an approved values list?
Use a documented amendment workflow: draft changes, obtain the same approval level as the original, publish a new effective date, and retain prior versions with audit trails.
What authentication level is appropriate for approvals?
Low-risk approvals may use email verification; governance or legal sign-offs benefit from stronger authentication (SMS code, MFA, or organization SSO) and an audit trail.
How long must we retain signed versions?
Follow retention rules tied to related records: at least 3 years for financial evidence (IRC §6501(a)) and 6 years for HIPAA-related documentation (45 CFR §164.530(j)); check state law for longer requirements.

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