Take one signature and file the record.

The order of operations is the DLA's, and it is deliberate: verify the affirmations and that the text has not changed underneath the signer, render and store the PDF so a row can never point at a document that does not exist, then INSERT the append-only row. A failure at the PDF step leaves nothing signed.

SIGNING THE VERSION ALREADY SIGNED IS A 409, not an idempotent success. Two rows for one version is a question somebody has to answer later, and a physician who clicked twice needs to know the first click worked. Signing a NEWER version is the normal path and writes a new row beside the old one.