A COVID-era policy gave Cityblock 60 days to collect written consent after care began. That rule was ending in two and a half months. I redesigned consent in Commons, our care management platform, so staff could text forms to members or collect them in person.
Role
Duration
Team
Written consent collected before first visit, not up to 60 days later
About 10 hours of medical assistant time saved each day
One Docusign envelope used per member instead of four
I shadowed and interviewed six frontline staff in three roles: outreach specialists, medical assistants, and EMTs.
Members signed paper forms at visits. Medical assistants scanned and uploaded them at the end of the day, and were often a day or two behind. Some forms got lost and had to be signed again. Some were uploaded to the wrong member.
The documents page listed every possible form for every member, even child-only forms on an adult's profile. Nothing showed which forms were required or which were done.
Outreach staff told me many members feared a scam when a stranger called to offer free care. Long legal forms made that worse. How could we build trust with new members if we were asking them to sign legal forms before we helped them?
I proposed short plain-language summaries with one tap to agree. Legal turned it down because of audit risk, and Engineering could not build and maintain our own signing pages before the deadline.
It was disappointing to pivot, but Cityblock already used Docusign internally, which helped us hit the deadline. I still had opportunities to improve the member experience. Docusign forms were pre-filled with the member's name and the date. Members signed once, and that signature was reused on each form.
Once a member signs, the form saves to their profile by itself, with nothing to scan or upload later on.
The page shows only forms a member has been sent or has signed, with required forms on top. When staff select forms, the main button changes from "Upload document" to "Sign documents." They then choose to text a link or sign in person.
Status tags like Sent, Opened, and Signed tell staff what’s happened. If a document is uploaded incorrectly, staff can remove it themselves, and the reason is logged for audits. This saved engineering time and helped users solve their own problems quickly.
Bulk send shipped two weeks after launch, so members got one link instead of four.
Before
After
I tested with six staff. All six sent multiple forms without errors.
But a PDF preview embedded on the detail page made them think unsigned forms were already signed. I replaced it with a plain status message and moved the preview action into a menu.
Before: Staff saw a preview embed and assumed it was signed
After: Clearer state and copy. Embed shown once signed
Medical assistants worked down the backlog of paper consent forms and eventually stopped spending the end of the day on uploads. Outreach managers reported shorter calls once bulk send shipped. Later that year, the same flow powered a staff-free onboarding process.
Consent rates also fell. Signing by text asked more of members than agreeing over a phone call. I raised this concern early, and it was the reason behind my one-tap consent idea. Operations brought verbal consent back alongside the new flow, which complicated documentation and outcome tracking.
Here’s what I do differently now: when a new flow adds steps for users, I get the team to agree up front on which metric we'll watch after launch and what we'll do if it drops below a certain level.