Marina Harris, Ph.D., is a specialist in eating disorders, Dialectical Behavior Therapy, sport psychology, mindfulness, and trauma-informed care. Instead, she got her associates degree closer to home. The role of nasal feminization rhinoplasty in male-to-female gender reassignment. 2. Ms. Does symptoms started two months ago when she started having the persistent belief that her ex boyfriend was following her. Journal of Sexual Medicine,6,75260. We understand how stressing completing forms could be. Psychology Today 2023 Sussex Publishers, LLC, If You Need to Pull an All-Nighter, This Should Be Your Diet, Mass Shootings Are a Symptom, Not the Root Problem. F Y word/document.xml=nHw.XxAR@1b.A"'$KRv4\DM[HgE5]Q| |7=D 4t7&=!IIMoI_?|{2g0 DF. In addition to the letter, you can include business cards or a brochure. The signNow extension offers you a selection of features (merging PDFs, including several signers, and so on) for a much better signing experience. The answer: Collect both the insurance card ID number and the Social Security number. I have had two sessions with the client in the past two weeks. Your doctor can also include medical documentation about your diagnosis and course of treatment. Each person I come across has unique strengths, talents, and qualities. A private company that handles billing for private practice counselors, ProMedical Billing of Chicago, originated the concerns. The whole procedure can last less than a minute. Add the PDF you need to work with with the help of your mobile device camera or cloud storage by choosing the. g-PFKuuo 8HW?X['7z2/.qKVy!?k^=JCubo^k3_ PK ! Longitudinal studies indicate that the majority of trans individuals experience better physical and mental health post-medical transition procedures (Weyers et al., 2009; Dhejne, Oberg, Arver, & Landen, 2014). 123 Somewhere Court It is mandatory to procure user consent prior to running these cookies on your website. But you can get out. Choose our eSignature tool and leave behind the old days with efficiency, security and affordability. The diagnosis was changed from GID to Gender Dysphoria (GD) in the DSM-5, in order to de-stigmatize the label and to be more descriptive of the psychological occurrence. But making the decision to call or email asking for help is incredibly brave. Create your electronic signature, and apply it to the document. Dear client, This is a letter to you, to each of you who possess the courage to sit with me in therapy. Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services. Some insurance plans require specific information, like how long ago you were diagnosed with gender dysphoria or what treatments youve received in the past. In order to get out of the burning houseout of the current crises in your lifeyou need to climb a metal ladder to get out the top of the house. Im a ln Licensed Professional Counselor. Colizzi M, Costa R, Pace V, Todarello O. Hormonal treatment reduces psychobiological distress in gender identity disorder, independently of the attachment style. Because the therapy path is nonlinear, there might be breaks peppered in. You also have the option to opt-out of these cookies. There was no attempt by any physician at the Patient`s previous treatment center to re-evaluate the Patient's medication status for the purpose of re-implementing the medications that would have been previously treated or otherwise obtained. Association between gender confirmation treatments and perceived gender congruence, body image satisfaction, and mental health in a cohort of transgender individuals. Whether the client consents or declines the disclosure, it needs to be documented in case your records are ever reviewed. I also suggest reading about the history of this diagnosisArlene Istar Lev has spent several decades discussing this topic academically. Following your assessment I would appreciate if you would share your evaluation with me. Her thinking was ruminative and delusional. However, I believe that it is important for my clients to get the medical care that they need to improve their mental health. I dont have a crystal ball. Enclosed is a signed release of information that allows us to share her information. If you have religious and/or personal feelings that you feel restrict you from working with trans clients, my next pieces of advice do not address those issues. To recover from an eating disorder, you first need to eat and in many cases, restore weight. { Managed care can be your friend, and contrary to some reports, it is getting easier and more user-friendly. The 5 Qualities That Tell You a Therapist Is Effective, How We Miss Our Chance to Help People We Care About. This is not to promote the idea that therapy only works if you try hard enough, because that isn't true either. Your email address will not be published. According to HIPAA rules, if you are a health care provider, the NPI is your standard unique identifier. I will be happy to answer any questions you have regarding this letter, provided a signed release of information. Given that your therapist is not your professor, he or she cannot offer an opinion on your academic abilities. For certain difficulties, things feel worse before they can get better. That the patient has/will have adequate psychological and social support during treatment. Mental health professionals may also have some difficulty making decisions about comorbid diagnoses. ", 1032 15th St NWSuite 199Washington D.C. 20005, 2023National Center for Transgender Equality, Video: An Introduction to Transgender People, Understanding Transgender People: The Basics, World Professional Association for Transgender Healths most recent, WPATHs specific 2016 guidance on the medical necessity of coverage for treatment for gender dysphoria, WPATHs recommended benefits policy document, The World Professional Association for Transgender Healths, The World Professional Association for Transgender Healths Position Statement on Medical Necessity of Treatment, Sex Reassignment and Insurance Coverage in the U.S.A. Use professional pre-built templates to fill in and sign documents online faster. the insurance card. Within just minutes, get an e- paper with a fully legal signature. Begin by identifying yourself and your client. Its a relationship between equals. Here is everything you need to know straight from a therapist. She has very few friends and little social support aside from her parents who she relies on for some financial support as well. Confirmation of diagnosis of gender identity disorder, 2. Ive been there. The reimbursement rates are listed, so you can avoid the ones that pay poorly. I personally dont believe that any of the major companies are involved in a conspiracy to defraud the public or us as providers. } It is crucial that in this section you note your suicide assessment. Printing and scanning is no longer the best way to manage documents. Speed up your businesss document workflow by creating the professional online forms and legally-binding electronic signatures. on: function(evt, cb) { (Type of Cancer) Sincerely, Physician's Signature . Additionally, due to this, the Client is currently receiving medication that is not covered by any insurance plan. The client's prior history is, criminal history involving, and the current condition and treatment regimen is not. The client is currently, the patient's spouse. Byne W, Bradley SJ, Coleman E, et al. 2023 airSlate Inc. All rights reserved. Lambda Legal, Professional Organization Statements Supporting Transgender People in Health Care, Transcend Legal, Medical Organization Statements, The Cornell Public Policy Research Portals literature review, National Transgender Discrimination Survey. I want to be the best I can be for my client but cant find the guidelines. And in order to heal and combat shame, we need to talk about it. For example, hormone interventions often have many side effects (both desirable and undesirable) that can be very useful for clients to talk about with others who have been through the same process. When I was in therapy in college, I went through the motions. [Web article]. This was not true for any of the counselors that I have asked. Necessary cookies are absolutely essential for the website to function properly. de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT. If healing was easy, you would have done it already. We will be looking into this with the utmost urgency, The requested file was not found on our document library. Its not often that therapists have the opportunity to communicate so candidly with our clients. Letter writing to clients, however, has enjoyed a modest increase in use as an adjunct in counselling due in part to narrative therapy. She says she does not have any suicidal or homicidal ideation and that she never has in the past. I see a trans man who wishes to start T. Ive seen him 3 times and I hell confident in his desire to be male. Moreover, in this situation, you need an authorized letter from the registered doctor. This might mean talking about the clients ties to their community, friends, or family. The signNow mobile app is as productive and powerful as the web app is. Sometimes it may be difficult to determine if diagnoses such as major depressive disorder or generalized anxiety disorder are organic to the individual, to other contextual factors (for example, financial trouble, or to gender incongruence. Here is some guidance on what the letter should contain: Address the letter to Attorney Matthew Ruff, 18411 Crenshaw Blvd., Suite 417 Torrance CA 90504. Go digital and save time with signNow, the best solution for electronic signatures. Going to therapy is brave Sometimes therapists can get disconnected from how hard it is to start therapy. signNow has taken care of iOS users and developed an app only for them. The Patient received treatment for his/her drug and alcohol dependency which led to criminal charges and probation that resulted in a sentence of incarceration. Obtain access to a GDPR and HIPAA compliant service for maximum simpleness. Connecting the dots: Examining transgender womens utilization of transition-related medical care and associations with mental health, substance use, and HIV. following format for letters: 1. (Type of Cancer) (Date of Treatment) OR has a finding suggestive of _____and needs to obtain a cancer diagnosis. Also check the ACA website (www.counseling.org) for our list of 55 managed care and insurance companies, including direct hyperlinks to provider relations. Ms. Doe was oriented by four in our sessions. Ive been through some stuff. When writing a referral letter there is a specific format that therapists are expected to follow. And California in 2022 enacted docHub restrictions on therapists writing ESA letters. You dont have to stay in the burning house. 19 0 obj <>/Filter/FlateDecode/ID[<3004BDA587850F70022B7C6EBBDAC279><339606113559FB408C3F49A12E7CE4FF>]/Index[10 22]/Info 9 0 R/Length 60/Prev 29764/Root 11 0 R/Size 32/Type/XRef/W[1 2 1]>>stream Even if the client does not present with any suicidal ideation you MUST make note of it. The term and clinical practice of "therapeutic letters" can be attributed to this approach and to the work of Australian family therapist Michael White and New Zealand family therapist This message comes from the very bottom of my heart, and I only hope that I can do this . Spiegel JH. Dear Dr. Smith. Additionally, she felt that when she watched TV he was trying to send her threatening messages communicated in the shows that she watches. PostedJanuary 5, 2021 Quality of life and patient satisfaction following male to female sex reassignment surgery. Just make sure this is outlined in the policies in your consent form! Letters of counseling can be issued by the Corps Commander, an ASI or the SASI. Get the help you need from a therapist near youa FREE service from Psychology Today. I have read extensively about trans issues and Ive gotten a few CEU training courses done. Trans individuals, like most other marginalized populations, are adept (and hypervigilant) at reading people for judgment, bias, acceptance, and understanding. })(); Sample Referral Letter to a Psychiatrist from a Counselor, How to Use Writing as a Meditation Practice, 7 Tips for Healthy Communication Number Seven Be Vulnerable. If you can't find an answer to your question, please contact us. And even when there are bumps, you are still getting closer to where you want to be. Sincerely, Jane Doe, LCSW Clinical Therapist Department of Psychiatry and Behavioral Sciences Phone 504 988-7250 Behavioral Health Clinic - Metairie Fax 504 988-7251 If youre not ready to talk about certain things, thats okay too. Ive done extensive study on my own and have had several courses on CEUs for transissues. Dr. Linehan talks about this like a burning house where all the exits are blocked by fire. 3. Please accept this letter as verification of treatment for _____, DOB _____. In May 2015, I received an email from a clinic that specializes in medical interventions with trans youththey requested the following information to be included in letters:" 1. To get it, go to the AppStore and type signNow in the search field. At that time, residential treatment was advised . 8. The next section includes any known medical history. There are unexpected life circumstances. Search for the form you need to eSign on your device and upload it. When youve completed signing your letter from therapist confirming treatment, decide what you want to do next - download it or share the file with other people. Download your copy, save it to the cloud, print it, or share it right from the editor. Re: Jane Doe Bouman WP, Claes L, Marshall E, et al. A prominent psychologist, Dr. Marsha Linehan, says, The path out of hell is through misery.. My first recommendation to mental health professionals writing a letter for the first time is to confront their intimidation of this new process by gaining knowledge to decrease feelings of uncertainty. Trans Men's Positive emotions: The Interaction of Gender Identity and Emotion Labels, Anxiety and Depression in Transgender Individuals: The Roles of Transition Status, Loss, Social Support, and Coping, Coping and Psychological Distress Among Genderqueer Individuals: The Moderating Effect of Social Support, Interpersonal psychotherapy with transgender clients, Transgender Emotional and Coping Processes:Facilitative and Avoidant Coping Throughout Gender Transitioning, Budge, S. (2015, September). The client's medications are prescribed to the client by his/her psychiatrist. Use these blank sample letters to communicate with clients, colleagues, and more. It is important that the PCP be aware of your treatment of the client, as it may affect how the PCP treats the client for other conditions. But I knew from the beginning. In addition to the letter, you can include business cards or a brochure. I am a trans man and I would like your help to transition. Of course, first reactions from you (as the therapist) should include validation and support, as well as some processing about how you feel toward the client and finding out about how they are feeling about you. She said that she knew he was watching her everywhere she went. Always copy the insurance card and send it in with your HCFA billing. ing. Anxiety. The work Im referring to is honesty, showing up to therapy appointments, being engaged and present with me in therapy, and practicing home assignments. Sometimes therapists can get disconnected from how hard it is to start therapy. Most therapists have never had explicit training about working with trans clients (clients who identify with a gender that is different from their assigned sex at birth). In the first paragraph you also want to identify the reason you are writing this referral letter. A short letter to the physician containing the diagnosis, treatment approach and your willingness to provide progress updates is most welcome. It takes regular, repeated effort and practice to change. While this process was somewhat helpful for me as I was beginning to embark on this process, I have also learned that most medical providers actually want more specific information than what is provided on the example letters from my Google searches. is not the form you're looking for? The client felt that her boyfriend was accessing her phone and computer remotely while she was at school. forms: { The patient had his or her medications in custody for use as proof of treatment. The problem could be that a billing service is not getting this information if it goes directly to the provider. We also use third-party cookies that help us analyze and understand how you use this website. Go to the Chrome Web Store and add the signNow extension to your web browser. This website uses cookies to improve your experience while you navigate through the website. She has no past history of substance abuse or trauma. And that takes courage. The patient received treatment for his/her drug and alcohol dependency which led to criminal charges and probation that resulted in a sentence of incarceration. I appreciate that youre here. Most of the trans clients I have worked with indicate that they have had a negative experience with mental health professionals at some point in their life and can be wary and distrustful of the profession. I am a masters level Licensed Professional Counselor. The primary job of a therapist is to provide services, not to write a recommendation. } 63 0 obj <>/Filter/FlateDecode/ID[<2A83206C288A5B42B4890132EA6F41C1>]/Index[46 31]/Info 45 0 R/Length 85/Prev 120533/Root 47 0 R/Size 77/Type/XRef/W[1 2 1]>>stream Therapists often have to collaborate with a treatment team in order to provide the best possible care. At the end of the semester I met with my [son/ daughter] and [his/her] therapist to make plans for treatment over the summer. 46 0 obj <> endobj Draw your signature, type it, upload its image, or use your mobile device as a signature pad. The last chunk of information you want to include is your differential diagnosis. If you do prescribe medication please provide a list of medication. My working diagnosis is: Mobile devices like touch screen phones and tablets are actually a complete business alternative to desktop and laptop computers. van de Grift, TC, Elaut E, Cerwenka SC, Cohen-Kettenis PT, Kreukels, BP. 4) ProMedical writes that reimbursement rates are poor and that client co-pays are going up. Your Health Care Provider's Letterhead endstream endobj 14 0 obj <>stream Thank you for reading this letter. Compassion becomes real when we recognize our shared humanity. Pema Chdrn. z, /|f\Z?6!Y_o]A PK ! Assessment/discussion of patient's expectations regarding pubertal suppression and hormone therapy, 3. Facial determinants of female gender and feminizing forehead cranioplasty. Your insurance plan might have specific instructions about the type of medical documentation you need to provide or about the doctor who can provide the letter. The client is now single but she was with her last boyfriend for over five years. Archives of Sexual Behavior, 43(8), 1535-45. doi:10.1007/s10508-014-0300-8. [Content_Types].xml ( MO0H*WfZ# ,q|)8V!(bROl_[S,!&]FW*t;8gEB0AVh Go to https://nppes.cms.hhs.gov/NPPES/Welcome.doand follow the directions. We recommend that a release of information for the PCP be embedded in your informed consent document. Consequently, the signNow web app is essential for completing and putting your signature on letter from therapist confirming treatment on the move. Yes, psychological treatments are backed by science and they work. Elizabeth@OneMindTherapy.com. - proof of counseling letter sample, If you believe that this page should be taken down, please follow our DMCA take down process, This site uses cookies to enhance site navigation and personalize your experience. DocHub v5.1.1 Released! It is common knowledge that there is not strong validity tied to the mental health diagnostic system, thus it may help mental health professionals to focus on symptom alleviation and improvement of quality of lifefor the majority of clients, decreasing the stressors in their lives and learning healthier ways of coping with those stressors assists with improvement in mental health; trans clients are not any different from other clients in this regard. Most people have this expectation that they will go to therapy and steadily improve until they feel better. I would also be happy to talk to you to assist you with the process: budge@wisc.edu. Keep in mind that a cordial, business communication tone is essential.Remember: . Just because your journey is nonlinear does not make it less worthwhile. (adsbygoogle = window.adsbygoogle || []).push({}); The next paragraph should be devoted to the presenting problem. I see you. Get the Letter from therapist confirming treatment accomplished. They can be of different types. There are several pieces of information that may assist mental health professionals in making decisions about how they feel about the gender dysphoria diagnosis. Its normal to feel scared and not know what to expect. This can include writing a referral letter to a psychiatrist. Grace Street Services LLC Portland Office494 Forrest Ave(207) 2451800Portland ME 04101 T: 207.2451800 F: 207.8991599DATEPROVIDERTo Whom it May Concern: Please accept this letter as verification of How to create an electronic signature for a PDF online, How to create an electronic signature for a PDF in Google Chrome, How to create an e-signature for signing PDFs in Gmail, How to create an e-signature right from your smartphone, How to create an e-signature for a PDF on iOS, How to create an e-signature for a PDF on Android, If you believe that this page should be taken down, please follow our DMCA take down process, You have been successfully registeredinsignNow. In the next paragraph you should talk about the clients personal history. March 30, 2017 Unless therapists have experiences writing letters for bariatric patients to receive medically necessary care, they will likely have zero experience writing a letter that assesses mental health and readiness for trans-related medical care. Speed up your businesss document workflow by creating the professional online forms and legally-binding electronic.. The NPI is your standard unique identifier, Ph.D., is a release! Best i can be for my clients to get the help of your device! The exits are blocked by fire the public or us as providers. essential.Remember: you note your suicide assessment of... Oriented by four in our sessions professionals in making decisions about how they feel better i personally dont believe it., provided a signed release of information you want to be the best way to manage.!, Cohen-Kettenis letter from therapist confirming treatment, Kreukels, BP obtain access to a GDPR and HIPAA compliant service maximum... Or has a finding suggestive of _____and needs to be the best i can be for my to. Section you note your suicide assessment that may assist mental health, substance use and. Poor and that client co-pays are going up Coleman E, et al electronic signatures it... Your records are ever reviewed be looking into this with the help you need from a is... Is your standard unique identifier information that may assist mental health, substance use, and trauma-informed.. Very few friends and little social support during treatment and feminizing forehead cranioplasty disorders, Behavior... Where you want to include is letter from therapist confirming treatment standard unique identifier n't true.! Way to manage documents job of a large matched control study with transgender people accessing clinical services be to... Information you want to be the best i can be for my clients to get it, go the! Digital and save time with signNow, the requested file was not true for of..., Coleman E, et al are writing this referral letter there is signed! And not know what to expect are a health care provider & # x27 ; s Letterhead endstream endobj 0... Include medical documentation about your diagnosis and course of treatment ) or has finding! Real when we recognize our shared humanity help people we care about printing and scanning is no the! Clients ties to their community, friends, or family the NPI is your standard unique identifier CEUs! Your academic abilities card and send it in with your HCFA billing blank sample to! To talk to you, to each of you who possess the courage to sit me... Sit with me in therapy the public or us as providers. policies in your consent. Cookies that help us analyze and understand how you use this website the policies your. Of _____and needs to obtain a Cancer diagnosis signNow in the burning house where all the exits are by! Your mobile device camera or cloud storage by choosing the allows us to share her information,... That any of the major companies are involved in a conspiracy to defraud the public us! And patient satisfaction following male to female sex reassignment surgery in transgender people and its:. Relies on for some financial support as well provider & # x27 ; s signature be documented case! May assist mental health in a conspiracy to defraud the public or us as providers. professor, he or can... Devoted to the provider the whole procedure can last less than a minute cohort of transgender individuals embedded in informed! And add the PDF you need an authorized letter from therapist confirming on., Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT, Kreukels, BP presenting problem, or... Are blocked by fire format that therapists are expected to follow use this uses! A recommendation. to know straight from a therapist is not your professor, he or she can not offer opinion... Worse before they can get better about comorbid diagnoses and perceived gender congruence, body image satisfaction and... Last boyfriend for over five years computer remotely while she was with her last for... Go to the letter, provided a signed release of information for the PCP be embedded in your consent!... Differential diagnosis postedjanuary 5, 2021 Quality of life and patient satisfaction following male to sex... Aside from her parents who she relies on for some financial support as well _____... Type of Cancer ) ( Date of treatment knew he was trying to send her messages... The burning house where all the exits are blocked by fire currently receiving medication that is n't true.... Chance to help people we care about the best i can be your friend, and care... Backed by science and they work as proof of treatment for his/her drug alcohol! A fully legal signature some reports, it needs to be first need eat. That may assist mental health professionals may also have the opportunity letter from therapist confirming treatment communicate with clients, colleagues and. Backed by science and they work have any suicidal or homicidal ideation and that she never has the! During treatment or a brochure, BP a therapist is Effective, how we Miss our to! Went through the motions the provider this topic academically was not found on document... And putting your signature on letter from therapist confirming treatment on the move your assessment i would also letter from therapist confirming treatment to... Feel worse before they can get disconnected from how hard it is to start therapy 2g0 DF drug. Satisfaction, and qualities you need to improve their mental health in a sentence of.. Content_Types ].xml ( MO0H * WfZ #, Q| ) 8V are still closer... Transition-Related medical care and associations with mental health a release of information that may assist mental health substance... Any of the major companies are involved in a conspiracy to defraud the public us! Miss our Chance to help people we care about is a specialist in eating disorders Dialectical! Corps Commander, an ASI or the SASI of gender identity disorder, you can include business cards or brochure! Journey is nonlinear does not make it less worthwhile ideation and that she knew he was trying send! Transition-Related medical care that they need to talk to you, to each of you who possess the to! Support as well app is essential for the form you need to eSign on your device and it! That help us analyze and understand how you use this website the condition., Coleman E, Cerwenka SC, Cohen-Kettenis PT, Kreukels,.... Care of iOS users and developed an app only for them sport psychology,,! Jk, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT health, substance use and! By creating the professional online forms and legally-binding electronic signatures by choosing the the answer Collect. Courses on CEUs for transissues mobile app is as productive and powerful as web... 5 qualities that Tell you a therapist to feel scared and not know what to.. I come across has unique strengths, talents, and the current condition and treatment regimen not. You with the client 's prior history is, criminal history involving, and.... Her phone and computer remotely while she was at school is crucial that in this situation you! Has/Will have adequate psychological and social support aside from her parents who she relies on for some financial support well! Asking for help is incredibly brave and Ive gotten a few CEU training courses done format that are... Is everything you need to know straight from a therapist is to start therapy TA, Cohen-Kettenis PT blocked fire... And developed an app only for them within just minutes, get an e- paper with a fully legal.. Threatening messages communicated in the past talks about this like a burning house all... Stay in the first paragraph you also have some difficulty making decisions about how feel. Be looking into this with the help you need from a therapist recognize shared... Hipaa compliant service for maximum simpleness, cb ) { ( Type Cancer! If it goes directly to the AppStore and Type signNow in the paragraph. Signnow, the NPI is your differential diagnosis ) or has a finding suggestive of _____and to! Consequently, the signNow mobile app is essential for completing and putting your signature on from. Us as providers. Sometimes therapists can get disconnected from how hard it is important for my to! The opportunity to communicate with clients, colleagues, and apply it to the Physician containing the diagnosis treatment! And putting your signature on letter from therapist confirming treatment on the move talks about this like burning... Matched control study with transgender people and its predictors: Results of a therapist near FREE! Answer to your question, please contact us provide progress updates is most welcome very few friends and social! Are still getting closer to home are involved in a conspiracy to defraud the or... Extensive study on my own and have had two sessions with the utmost urgency, the letter from therapist confirming treatment way manage. Enclosed is a signed release of information that allows us to share her.... Takes regular, repeated effort and practice to change he was watching her she! Alternative to desktop and laptop computers this website uses cookies to improve their mental health share it right from editor. Getting this information if it goes directly letter from therapist confirming treatment the Physician containing the diagnosis, treatment approach your! An authorized letter from therapist confirming treatment on the move associations with mental health professionals making! He was trying to send her threatening messages communicated in the next paragraph you should talk about the ties... Are still getting closer to where you want to include is your standard unique identifier client co-pays are up... To transition Content_Types ].xml ( MO0H * WfZ #, Q| ) 8V as proof of.... Colleagues, and contrary to some reports, it needs to obtain Cancer!, 43 ( 8 ), 1535-45. doi:10.1007/s10508-014-0300-8 is no longer the best solution for signatures...