Little attention has been paid to the possibility of cognitive deficits in patients with major organs   failure   such as  the  liver,  kidney,  or  heart.  Hemodialysis     patients    are   at high   risk   for   cognitive dysfunction,     psychometric     deficits   and metabolic    alternations    than   chronic   kidney disease    alone   that   can   affect   the   quality   of hand   writing    and   impair   its proper recognition. Aim  of  the  study  it aims to : Structurally  analyze changes in handwriting characteristics  among some  hemodialysis  Egyptian   patients and to assess their medico-legal  implications of the handwriting . Thirty seven stable hemodialysis patients were included in this study. All the patients were asked to write a sample.  Typing tool, writing surface, writing mode and time for filling the form were standardized for all the patients. Qualitative data were presented as frequencies and percentages. Results:  Handwriting   analysis  showed,  There was a statistically  significant  difference  (P<  0.001)  regarding Writing   speed  (slow speed (81.1%), medium (13.5%), and very slow speed (5.4%),  Pen  pressure   grades  (light pressure (62.2%),heavy  pressure  (24.3%) and medium pressure (13.5%»,  word  size (large word size (46%), medium word size (40.5%) and small word size   (13.5%), Interrupted stroke (97.3%), Curved (zigzag) stroke   (100%), Extra stroke (100%)  and      Stiff  stroke(100%), dirtiness(78.4%), spacing represented (97.3%)over-Writing (73%) defined as number of over-writings done by each subject / total number of words written by each subject x  100. Conclusion: hemodialysis patients had a characteristic impairment in handwriting skills which may indicate cognitive deficit that cannot be elicited by clinical examination and investigations. These changes may carry great medico legal implications, and should be considered when analyzing their hand writings.