Use a backup signer where supported
Sign another doctor's note as the Owner's backup, or as their cover, with a reason.
Purpose
Sometimes a note needs signing and the doctor who ran the consultation can't sign it. Two people can stand in: an Owner with prescribing rights, as Principal backup, or a doctor that colleague chose to cover them. Either way, Keel asks for a reason and records who signed, for whom and why.
Before you start
you need prescribing rights
(Understand clinical signing authority).
if you aren't an Owner, the doctor must have added you as their delegate, with dates that
include today
(Set up and end sign-off delegation).
Steps
Step 1: Open the other doctor's note
Doon the patient's appointment page, select Open note in the Consultation card.
You'll seethe draft, with Sign off in the top bar.
review it as you would your own (Review a generated note).
Step 2: Start the sign-off
Doselect Sign off.
You'll seea dialog titled Sign off as Principal backup if you're the Owner, or Sign off for the doctor's
name if you're covering for them.
Step 3: Give a reason
Dopick a quick reason (On leave, Sick, After hours or Patient asked), or type your own under
Reason.
You'll seehow many characters you've used out of 500, for example 8 of 500 characters for On leave.
the dialog's Sign off key stays greyed out until there's a reason.
Step 4: Sign it
Doselect Sign off in the dialog.
You'll seeSigning…, then Note signed at and the time.
Sothe note is signed, and your reason is kept with the signature.
Result
You'll seethe note can't be edited any more, and the appointment's Consultation card shows Signed.
If it doesn't work
- If you see: Sign off is greyed out: This is the doctor's note. Ask them to sign it, or your clinic owner can.You aren't their cover today. Ask them to add you, or ask an Owner with prescribing rights.
- If you see: Sign-off permission changed — refreshing.The cover ended or prescribing rights changed. Check the button again once the page reloads.
- If you see: Not signed · 1 medicine needs youFix the marked medicine first (Resolve medicine review blockers)
- Working: Note signed at and the timeDone
Limits
when no consulting doctor is on record, only an Owner with prescribing rights can sign. A
covering doctor can't.
an Owner always signs another doctor's note as Principal backup, even if they're also that
doctor's delegate.
backup signing isn't available in the Keel phone app.
Checked against the Keel product source and in the live product on 2026-10-11. No step on this page was observed. Opening another doctor's note, the backup sign-off dialog, its reasons and signing were not exercised.