Is an electronic signature valid?

Yes—electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted, provided intent, consent, attribution, and record retention requirements are met.

Do I need witnesses or notarization?

Requirements vary by state; many states accept either two witnesses or notarization. Check Minnesota statute or consult counsel to confirm local formalities.

Can I store the directive electronically?

Yes, if the electronic storage preserves the record, is reproducible, and meets HIPAA safeguards when PHI is involved (use encrypted storage and access controls).

What if my agent disagrees with treatment choices?

Agent authority is limited by the directive language. Disputes may require institutional review or court intervention if parties cannot reach agreement.

How do hospitals verify an electronic copy?

Hospitals rely on audit trails, identity proofing, witness/notary blocks, and EHR attachments; provide clinician-ready contact and authentication details for the agent.

Can I revoke the directive?

Yes—revocation should be in writing, signed, and dated; provide copies to the agent, clinicians, and any record holders to avoid reliance on the prior document.

Electronic Signature
Templates
Other
Minnesota Health Care Directive

Minnesota Health Care Directive

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

HEALTH CARE DIRECTIVE

(Minnesota Statutes 145C.16)

I, , understand this document allows me to do ONE OR BOTH of the following:

PART I: Name another person (called the health care agent) to make health care decisions for me if I am unable to decide or speak for myself. My health care agent must make health care decisions for me based on the instructions I provide in this document (Part II), if any, the wishes I have made known to him or her, or must act in my best interest if I have not made my health care wishes known.

AND/OR

PART II: Give health care instructions to guide others making health care decisions for me. If I have named a health care agent, these instructions are to be used by the agent. These instructions may also be used by my health care providers, others assisting with my health care and my family, in the event I cannot make decisions for myself.

PART I: APPOINTMENT OF HEALTH CARE AGENT

THIS IS WHO I WANT TO MAKE HEALTH CARE DECISIONS FOR ME IF I AM UNABLE TO DECIDE OR SPEAK FOR MYSELF

(I know I can change my agent or alternate agent at any time and I know I do not have to appoint an agent or an alternate agent)

NOTE: If you appoint an agent, you should discuss this health care directive with your agent and give your agent a copy. If you do not wish to appoint an agent, you may leave Part I blank and go to Part II.

When I am unable to decide or speak for myself, I trust and appoint to make health care decisions for me. This person is called my health care agent.

Relationship of my health care agent to me:

Telephone number of my health care agent:

Address of my health care agent:

(OPTIONAL) APPOINTMENT OF ALTERNATE HEALTH CARE AGENT: If my health care agent is not reasonably available, I trust and appoint to be my health care agent instead.

Relationship of my alternate health care agent to me:

Telephone number of my alternate health care agent:

Address of my alternate health care agent:

THIS IS WHAT I WANT MY HEALTH CARE AGENT TO BE ABLE TO DO IF I AM UNABLE TO DECIDE OR SPEAK FOR MYSELF

(I know I can change these choices)

My health care agent is automatically given the powers listed below in (A) through (D). My health care agent must follow my health care instructions in this document or any other instructions I have given to my agent. If I have not given health care instructions, then my agent must act in my best interest.

Whenever I am unable to decide or speak for myself, my health care agent has the power to:

(A) Make any health care decision for me. This includes the power to give, refuse, or withdraw consent to any care, treatment, service, or procedures. This includes deciding whether to stop or not start health care that is keeping me or might keep me alive, and deciding about intrusive mental health treatment.

(B) Choose my health care providers.

(C) Choose where I live and receive care and support when those choices relate to my health care needs.

(D) Review my medical records and have the same rights that I would have to give my medical records to other people.

If I DO NOT want my health care agent to have a power listed above in (A) through (D) OR if I want to LIMIT any power in (A) through (D), I MUST say that here:

My health care agent is NOT automatically given the powers listed below in (1) and (2). If I WANT my agent to have any of the powers in (1) and (2), I must INITIAL the line in front of the power; then my agent WILL HAVE that power.

(1) To decide whether to donate any parts of my body, including organs, tissues, and eyes, when I die.

(2) To decide what will happen with my body when I die (burial, cremation).

If I want to say anything more about my health care agent's powers or limits on the powers, I can say it here:

PART II: HEALTH CARE INSTRUCTIONS

NOTE: Complete this Part II if you wish to give health care instructions. If you appointed an agent in Part I, completing this Part II is optional but would be very helpful to your agent. However, if you chose not to appoint an agent in Part I, you MUST complete some or all of this Part II if you wish to make a valid health care directive.

These are instructions for my health care when I am unable to decide or speak for myself. These instructions must be followed (so long as they address my needs).

THESE ARE MY BELIEFS AND VALUES ABOUT MY HEALTH CARE

(I know I can change these choices or leave any of them blank)

My goals for my health care:

My fears about my health care:

My spiritual or religious beliefs and traditions:

My beliefs about when life would be no longer worth living:

My thoughts about how my medical condition might affect my family:

THIS IS WHAT I WANT AND DO NOT WANT FOR MY HEALTH CARE

(I know I can change these choices or leave any of them blank)

Many medical treatments may be used to try to improve my medical condition or to prolong my life. Examples include artificial breathing by a machine connected to a tube in the lungs, artificial feeding or fluids through tubes, attempts to start a stopped heart, surgeries, dialysis, antibiotics, and blood transfusions. Most medical treatments can be tried for a while and then stopped if they do not help.

I have these views about my health care in these situations:

(Note: You can discuss general feelings, specific treatments, or leave any of them blank)

If I had a reasonable chance of recovery, and were temporarily unable to decide or speak for myself, I would want:

If I were dying and unable to decide or speak for myself, I would want:

If I were permanently unconscious and unable to decide or speak for myself, I would want:

If I were completely dependent on others for my care and unable to decide or speak for myself, I would want:

In all circumstances, my doctors will try to keep me comfortable and reduce my pain. This is how I feel about pain relief if it would affect my alertness or if it could shorten my life:

There are other things that I want or do not want for my health care, if possible:

Who I would like to be my doctor:

Where I would like to live to receive health care:

Where I would like to die and other wishes I have about dying:

My wishes about donating parts of my body when I die:

My wishes about what happens to my body when I die (cremation, burial):

Any other things:

PART III: MAKING THE DOCUMENT LEGAL

This document must be signed by me. It also must either be verified by a notary public (Option 1) OR witnessed by two witnesses (Option 2). It must be dated when it is verified or witnessed.

I am thinking clearly, I agree with everything that is written in this document, and I have made this document willingly.

My Signature

Date signed:

Date of birth:

Address:

If I cannot sign my name, I can ask someone to sign this document for me.

Signature of the person who I asked to sign this document for me.

Printed name of the person who I asked to sign this document for me.

Option 1: Notary Public

In my presence on , acknowledged his/her signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf. I am not named as a health care agent or alternate health care agent in this document.

(Signature of Notary)

(Notary Stamp)

Option 2: Two Witnesses

Two witnesses must sign. Only one of the two witnesses can be a health care provider or an employee of a health care provider giving direct care to me on the day I sign this document.

Witness One:

(i) In my presence on , acknowledged his/her signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf.

(ii) I am at least 18 years of age.

(iii) I am not named as a health care agent or an alternate health care agent in this document.

(iv) If I am a health care provider or an employee of a health care provider giving direct care to the person listed above in (A), I must initial this box:

I certify that the information in (i) through (iv) is true and correct.

Signature of Witness One:

Address:

Witness Two:

(i) In my presence on , acknowledged his/her signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf.

(ii) I am at least 18 years of age.

(iii) I am not named as a health care agent or an alternate health care agent in this document.

(iv) If I am a health care provider or an employee of a health care provider giving direct care to the person listed above in (A), I must initial this box:

I certify that the information in (i) through (iv) is true and correct.

Signature of Witness Two:

Address:

REMINDER:

Keep this document with your personal papers in a safe place (not in a safe deposit box). Give signed copies to your doctors, family, close friends, health care agent, and alternate health care agent. Make sure your doctor is willing to follow your wishes. This document should be part of your medical record at your physician's office and at the hospital, home care agency, hospice, or nursing facility where you receive your care.

What the Minnesota Health Care Directive Is and why it matters

A Minnesota Health Care Directive is a written document that lets an adult designate a health care agent, state treatment preferences, and record other care-related instructions to be followed if the individual becomes unable to make or communicate medical decisions. It consolidates a durable power of attorney for health care and optional instructional directives into a single form recognized by care providers across Minnesota. While the directive documents personal choices about life-sustaining treatment, palliative care, and organ donation, it also describes who may access medical records and when the agent’s authority begins and ends.

Why completing a Minnesota Health Care Directive is important

A clear directive preserves your control over medical decisions, reduces uncertainty for family and clinicians, and documents consent and refusal choices in advance to guide care during incapacity.

Who typically prepares and relies on this directive

Typical users include adults planning for incapacity, caregivers coordinating long-term care, and health professionals verifying treatment authority.

Patients and older adults who want to name a trusted health care agent and specify treatment preferences.
Family members or designated agents who need legal authority to make decisions when a patient cannot communicate.
Clinicians, social workers, and hospital intake teams who must confirm decision-making authority and documented consent.

Completing a directive reduces disputes, speeds clinical decisions, and complements other legal tools such as a durable power of attorney or POLST where applicable.

Step-by-step: how to complete the form

Use this simple sequence to prepare a valid, clear Minnesota Health Care Directive and share it with relevant parties.

01

Gather information: Collect names, contact details, and medical history to inform choices.
02

Choose an agent: Select a trusted individual willing to act and list alternates.
03

Fill and date: Complete each field accurately using MM/DD/YYYY where required.
04

Authenticate: Sign, add witness or notary if state law requires, and retain copies.

How the directive is used in care settings

This overview shows common steps from completion to clinical use when capacity is lost.

Record creation: Declarant completes the directive and signs.
Verification: Clinical staff verify signature and witness/notary if present.
Activation: Agent steps in per directive when declarant lacks capacity.
Care decisions: Agent communicates with clinicians and consents or refuses treatments.

Configuring a digital workflow for completion and sharing

Set up these workflow elements to collect, verify, and distribute directives electronically while maintaining an audit trail.

Field	Configuration
Signer Identity	Email with SMS code or multi-factor for higher assurance
Witnessing	Add conditional witness fields that appear when witness required
Notarization	Support RON or prepare for in-person notarization where permitted
Distribution	Automate copies to agent, primary care provider, and emergency contact

Technical considerations for eCompletion and eSubmission

Ensure your platform supports secure signatures, access controls, and required authentication for healthcare records.

Document formats: PDF and DOCX are widely accepted for signed directives
Integrations: Connectors for EHRs and cloud storage simplify record sharing
Compliance: Support for HIPAA, audit trails, and optional 21 CFR Part 11 features

Use platforms that provide tamper-evident storage, audit logs, and appropriate authentication; confirm Business Associate Agreements (BAAs) when handling protected health information.

Essential information to include on the directive

Declarant identity: Full legal name

Agent details: Name, phone, relationship

Decision authority: Scope of agent powers

Treatment preferences: Yes/no on life support

Signature date: MM/DD/YYYY

Witness/notary: Names or notary acknowledgement

Common preparation errors to avoid

Leaving agent contacts incomplete, which delays hospital outreach and may hamper timely decisions.
Using ambiguous language about treatment wishes rather than specific, clinically meaningful choices.
Failing to sign, date, or include required witness information, which can render the directive invalid.
Not sharing copies with clinicians and the designated agent, leaving providers without immediate access during an emergency.

Consequences of an incorrect or invalid directive

Invalid document: May be unenforceable

Delayed care: Family disputes can postpone decisions

Legal challenges: Court intervention may be required

Unintended treatment: Default clinical choices may not reflect your wishes

Privacy risk: Improper sharing may violate HIPAA

Financial cost: Attorney or court fees may be incurred

Real-world examples of using directives with electronic tools

These case summaries illustrate how organizations applied digital signing and secure storage to support healthcare decisions.

Fertility Center Integration

A clinic standardized patient directives across intake forms to reduce paperwork delays.

They used an EHR-linked workflow for agent verification.
John Butler, Founder, Fertility Centers of Illinois, reports that the signNow team has been exceptional, responsive, and the API has been great, improving document turnaround and compliance.

Rural Hospital Adoption

A critical-access hospital implemented electronic directives to ensure agent access after hours.

Staff verified signatures with multi-factor authentication.
Tim Martin, Founder, Martin Properties, noted he can process and execute documents online with full compliance and secure mobile access.

Comparing eSignature vendors for executing health care directives

Costs and features vary; table highlights basic plan pricing, common features, and HIPAA considerations to inform platform selection for health care directives.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	Yes, 7-day free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes (Business Premium)	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes (BAA required)	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Envelope Cap	No envelope cap	100 envelopes/user/year limit	Varies by plan	Varies by plan	Varies by plan

Frequently asked questions about the Minnesota Health Care Directive

Answers to common questions about validity, signing, and electronic submission for health care directives.

Need help? Contact support

Is an electronic signature valid?
Yes—electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted, provided intent, consent, attribution, and record retention requirements are met.
Do I need witnesses or notarization?
Requirements vary by state; many states accept either two witnesses or notarization. Check Minnesota statute or consult counsel to confirm local formalities.
Can I store the directive electronically?
Yes, if the electronic storage preserves the record, is reproducible, and meets HIPAA safeguards when PHI is involved (use encrypted storage and access controls).
What if my agent disagrees with treatment choices?
Agent authority is limited by the directive language. Disputes may require institutional review or court intervention if parties cannot reach agreement.
How do hospitals verify an electronic copy?
Hospitals rely on audit trails, identity proofing, witness/notary blocks, and EHR attachments; provide clinician-ready contact and authentication details for the agent.
Can I revoke the directive?
Yes—revocation should be in writing, signed, and dated; provide copies to the agent, clinicians, and any record holders to avoid reliance on the prior document.

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