How to Complete and Sign VA Form 10-0431a: Clinical Treatment Consent

VA Form 10-0431a is the Department of Veterans Affairs paper form that documents your voluntary agreement to a clinical treatment or procedure when electronic consent isn’t used. You sign it at the VA facility during or right after the informed consent discussion with your practitioner, and once signed it stays valid for 60 calendar days.¹

When You’ll See the Paper Form Instead of the Electronic Pad

The VA’s default consent tool is an electronic system with a signature pad at the point of care. The printed form comes out in four situations:²

You decline the electronic pad and prefer to sign on paper.
The electronic system is down.
You’re giving consent remotely by telephone, mail, or fax because you can’t appear in person before the procedure.
You’re in isolation precautions and the signature pad can’t be adequately disinfected.

Paper and electronic signatures carry the same legal weight. Only the recording method changes; the underlying consent conversation is the same either way.

Which VA Treatments Actually Require a Signed Form

Routine visits, blood draws, and standard outpatient check-ups usually proceed under the general consent you gave when you enrolled in VA health care. A signed form is required when the treatment meets at least one of these tests:¹

It requires sedation, anesthesia, or narcotic pain relief.
It’s expected to produce significant discomfort.
It carries a significant risk of complications.
It involves an injection into a joint space or body cavity.

Extended care services also run through the informed consent process: community living center stays (formerly VA nursing homes), adult day health care, respite care, hospice, and home-based primary care. If you’re entering one of these, expect to sign either the electronic consent or VA Form 10-0431a as part of enrollment.

What the Practitioner Must Explain Before You Sign

The conversation before you sign is the legal foundation of the consent, not a formality. Federal regulations require the practitioner to explain, in language you can understand:³

The nature of the treatment and what it involves.
The expected benefits.
Foreseeable risks and side effects.
Reasonable alternatives, including doing nothing.
What you can expect if you decline.

If the treatment is experimental or unorthodox, the practitioner must tell you that as well. You have the right to ask questions, and the practitioner cannot rush or pressure you. The discussion should happen in person when possible, but it can also take place by phone, video, or another VA-approved method if an in-person meeting isn’t practical.

What’s on the Form and How You Sign It

You don’t download and mail VA Form 10-0431a. It’s completed at the VA facility during or immediately after the consent discussion, with the practitioner or a delegated staff member handling most of the entries. The form documents:⁴

The practitioner’s assessment that you have decision-making capacity.
The name of every practitioner directly responsible for performing or supervising the treatment.
A brief written description of the recommended procedure or care plan.
Confirmation that the risks, benefits, and alternatives were explained and that you indicated you understood.
Confirmation that you had the chance to ask questions.
A statement that no pressure was applied.
The date and time of the consent discussion.
Your signature, or the signature of your authorized surrogate.
The practitioner’s signature and printed name.

Your part is simple. Read the treatment description on the form, check that it matches what you were told verbally, verify the date, and sign. If the written description doesn’t match the conversation, say so before you sign. Once signed, the form is valid for 60 calendar days.¹ If the procedure is delayed past that window, you’ll have to go through consent again.

Signing When You Can’t Be at the Facility

When you can’t come in before a scheduled treatment, the consent discussion can be held by telephone or video conference. Remote conversations must be audiotaped, videotaped, or witnessed by a second VA employee in place of a physically signed form.³ In some cases the paper form itself can be sent by mail or fax for your signature when an in-person visit isn’t possible before the procedure.¹

Signing When You Can’t Physically Write

If you can’t write your signature, you have options. You can place an “X,” a thumbprint, or a stamp in the signature block. When you do, two adult witnesses must be present to watch you make the mark and then sign the form themselves. The witnesses are attesting to the fact that they saw you sign, not endorsing the medical decision.³

You can also direct another person to sign for you. That person must sign in your presence and at your explicit direction.¹

When a Surrogate Signs on the Veteran’s Behalf

If a veteran lacks the capacity to consent, an authorized surrogate can consent instead. Not every family member qualifies. The VA follows a priority order:⁵

A health care agent named in a durable power of attorney for health care has first priority.
A court-appointed legal guardian is next.
Next of kin aged 18 or older follow, in this order: spouse, adult child, parent, sibling, grandparent, grandchild.
A close friend who has demonstrated care for the veteran and knows their values, health, and daily life comes last.

When a surrogate signs, the form must show the surrogate’s name, their relationship to the veteran, and the basis for their authority.¹

A diagnosis alone doesn’t strip capacity. Having dementia, mental illness, or a physical disability doesn’t automatically mean you can’t decide. Capacity is judged for the specific treatment at the specific time, and it can be temporary; someone delirious after surgery may recover full decision-making ability once the condition resolves.⁶ Refusing a recommended treatment is not, by itself, evidence you lack capacity. If you believe your capacity has been assessed incorrectly, you or a family member can ask another VA clinician for a second opinion.

Withdrawing or Changing Your Consent

You can withdraw your consent at any time, for any reason. The regulation states plainly that “the patient may withhold or revoke consent at any time.”³ A verbal statement to your physician or nurse is enough as long as the clinician records it in your medical record, though putting it in writing creates a cleaner record.

To change the treatment plan rather than stop, the existing form can’t be edited. A new consent discussion has to take place, and a new form must be signed reflecting the updated plan.¹

One Thing the Form Does Not Do

Signing VA Form 10-0431a for extended care doesn’t tell you what you’ll owe. Copayment amounts depend on the type of care and your financial situation and are handled separately through VA Form 10-10EC, the Application for Extended Care Services.⁷ If cost is a concern, ask to speak with a financial counselor at your VA facility before you sign.

1
U.S. Department of Veterans Affairs. VHA Directive 1004.01(3) – Informed Consent for Clinical Treatments and Procedures
2
U.S. Department of Veterans Affairs. VHA Handbook 1004.05 – iMedConsent
3
eCFR. 38 CFR 17.32 – Informed Consent and Advance Directives
4
Department of Veterans Affairs. VHA Handbook 1004.01 – Informed Consent Background Information
5
U.S. Department of Veterans Affairs. VA National Center for Ethics in Health Care – Surrogate Decision Making
6
U.S. Department of Veterans Affairs. Capacity 101
7
Veterans Affairs. Current VA Health Care Copay Rates