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I'm interested in having physicians digitally sign pdf documents we create, in a HIPAA-compliant manner. Ideally, there would be an open-source solution, but I'm also willing to consider a digital signing service such as EchoSign.

Update: We've decided to use EchoSign as a digital signing service. It has a good front-end web interface and we can handle the backend via a SOAP-compliant web interface.

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The last place I worked we were in the in the process of using the Topaz signature pads. They have an SDK that allows you to grab the signature image off of the pad. From that point you could just embed it in your PDF (if you are creating them using something like iText to generate your PDF).

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With potentially hundreds of physicians were really looking for a web-based solution. EchoSign appears to be shaping up pretty well for this task. –  Jeff Bauer Mar 16 '12 at 19:08
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Looks promising. Does it use a signature pad w/stylus? If not, how would the end user sign? (without having to print, sign and fax it back) –  PantsOffNow Mar 21 '12 at 2:22
    
It appears from their demo that you can draw your signature with a mouse, or presumably with a stylus if you have one. You can also print/sign/fax. –  Lynn Mar 27 '12 at 15:15
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