What provides evidence of informed consent?

• A. Evidence of informed consent
• B. Physician signature only
• C. Diagnosis code
• D. Allergy list

Answer: (A)

Informed consent is evidenced by the signed consent document that records the patient’s understanding and voluntary agreement to the procedure. The process involves explaining the procedure, risks, benefits, and alternatives, and then the patient or their legal representative signs to indicate they understand and agree. The best evidence is the completed consent form showing what was explained and when the agreement was given, typically with the patient’s signature and date (and sometimes a witness or clinician signature). A physician’s signature alone does not prove that the patient understood or consented. Clinical data like a diagnosis code or an allergy list are important for care but do not establish that informed consent occurred.