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Informed vs implied consent, and who obtains it

Consent questions look like communication questions and are graded like law questions. The exam puts you alone in the room with a form and a patient who does not understand the procedure, or with a relative who says she can sign, and the answer turns on one fact: informed consent belongs to the provider, and everything the medical assistant does around it is witnessing, verifying and documenting.

Who must obtain itThe provider performing the procedure. The MA may witness the signature and confirm the form is complete — never supply the disclosure that makes it informed
What makes it informedNature of the procedure, risks, benefits, alternatives, and what happens if the patient declines — with a real chance to ask questions before signing
Implied consentInferred from the patient's conduct for routine, low-risk care: rolling up a sleeve for a blood pressure, holding out an arm for a routine venipuncture, tilting the head for an ear check
Express / written consentAnything carrying material risk — excisions, surgery, anesthesia, sedation, and whatever the practice's policy lists
Emergency implied consentA separate doctrine, and narrow: it applies only when the patient cannot consent and delay would cause harm. It does not cover routine care
MinorsParent, legal guardian, or an adult holding documented authority such as a court order or a signed caregiver authorization. A grandparent, a stepparent, or "the adult who brought him" is not enough, and relayed telephone permission from a third party is not consent
RefusalA competent adult may refuse anything, including a test his employer wants. Treating anyway is battery — intentional contact without consent. Document the refusal and notify the provider
Vaccine Information StatementFederal law (42 U.S.C. 300aa-26) requires the current VIS before the dose is given, every single time, even for a patient who has had that vaccine and that VIS before
Living will vs proxy vs POLST/MOLSTA living will states the patient's wishes; a durable power of attorney for health care names the decision-maker; a POLST or MOLST is a signed medical order EMS can act on immediately and it travels with the patient
Notice of Privacy Practices acknowledgmentA receipt, not a consent. Refusing to sign does not block treatment — document the good-faith effort and the refusal (45 CFR 164.520(c)(2))

Where the point is lost: Two swaps decide most of these items. First, battery is the completed touch, assault is putting someone in apprehension of a touch, and negligence needs a breached standard of care plus harm — injecting a patient who has refused is battery every time, no matter how it was justified. Second, a signature is not consent if the conversation never happened: when the patient says "I still don't know what they're going to do," the answer is always to stop and get the provider, never to explain it yourself and never to have him sign now and ask later.

Informed vs implied consent, and who obtains it

9 questions on informed consent medical assistant, each with an explanation and statute citation.

9 questions

Pass line: 78%, same as the real exam

Questions and answers, explained

All 9 questions above, with the correct answer and why it is correct. Everything here is on informed vs implied consent, and who obtains it.

  1. A new patient reads the practice's Notice of Privacy Practices at registration but refuses to sign the acknowledgment. How should the medical assistant proceed?

    • AExplain that treatment cannot be provided until the acknowledgment is signed.
    • BDocument the good-faith effort and her refusal, then continue with the visit.Correct
    • CSign the form herself as a witness that the notice was handed to the patient.
    • DSkip the form entirely, since the notice is posted in the waiting room already.

    Why: A provider with a direct treatment relationship must make a good-faith effort to obtain written acknowledgment that the patient received the notice, no later than the first date of service, and when that acknowledgment is not obtained must document the effort and the reason. The acknowledgment is a receipt, not a consent: refusing to sign it does not block care and does not stop the practice from using protected health information for treatment, payment, and operations. Staff never sign in the patient's place, and posting the notice does not replace the acknowledgment step.

    Reference HIPAA Privacy Rule 45 CFR 164.520(c)(2)(ii) (notice acknowledgment and documentation of good-faith effort); NHA CCMA Detailed Test Plan Domain 5, k175

  2. A patient is scheduled for an in-office excision. The medical assistant brings in the consent form and the patient says, "I still don't know what they're going to remove or what could go wrong." What should the medical assistant do?

    • AExplain the procedure and all of its risks yourself so that the patient can then sign
    • BStop and notify the provider — informed consent requires the provider to explainCorrect
    • CHave the patient sign now and ask the provider to explain afterward
    • DDocument that the patient refused the procedure and reschedule

    Why: Informed consent is the provider's legal responsibility: the provider must disclose the nature of the procedure, its risks and benefits, and the alternatives, and the patient must have the opportunity to ask questions before signing. Option A is a scope-of-practice violation — the medical assistant may witness the signature and confirm the form is complete but cannot supply the disclosure that makes the consent informed.

    Reference Domain 7, task 7B, k216 (informed and implied consent)

  3. When must the Vaccine Information Statement (VIS) be provided to the patient, parent, or guardian?

    • AAt checkout, after the vaccine has been given
    • BBefore the vaccine is administered, every time a dose is givenCorrect
    • COnly if the patient specifically asks for written information
    • DOnly the first time a patient receives that vaccine

    Why: CDC states that federal law requires the VIS be given before the vaccine is administered, regardless of the patient's age, and every time a dose is given even if the patient has received the same vaccine and VIS before. Giving it afterward (A) defeats the purpose of informed decision-making, and limiting it to the first dose (D) contradicts the every-dose requirement.

    Reference Domain 3B; k66 immunization requirements and documentation; CDC Pink Book ch. 6, Vaccine Information Statements

  4. Which document allows a competent adult to name another person to make health care decisions on their behalf if they later become unable to do so?

    • ALiving will, which states treatment wishes in advance
    • BInformed consent form for a specific procedure
    • CDurable power of attorney for health careCorrect
    • DNotice of privacy practices given at intake

    Why: A durable power of attorney for health care (also called a health care proxy or medical power of attorney) designates an agent to make medical decisions once the patient loses decision-making capacity. A living will, the closest distractor, records the patient's own treatment wishes in writing but does not appoint anyone to speak for the patient.

    Reference Domain 7, task 7D, k217, k218; Patient Self-Determination Act (1990)

  5. A patient with a valid do-not-resuscitate order documented in the chart collapses in the waiting room and is unresponsive with no pulse. Family members present begin shouting for staff to "do everything." What should the medical assistant do?

    • ABegin chest compressions immediately because the family members requested resuscitation
    • BNotify the provider, follow the emergency plan, and do not start CPR against the DNRCorrect
    • CAsk the family to sign a form revoking the DNR order before acting
    • DWait for emergency medical services to arrive before telling the provider

    Why: A valid DNR is a physician order that reflects the patient's own advance directive, and family members cannot override it in the moment; the medical assistant honors the order while immediately alerting the provider and following the office emergency action plan. Option D is wrong because delaying provider notification withholds the clinical response and comfort care the office is still obligated to provide.

    Reference Domain 7, task 7D, k217 (DNR/DNI); Domain 3B, k82 (emergency action plans)

  6. A grandmother brings her 6-year-old grandson in for scheduled immunizations. The chart lists the child's mother as legal guardian, and nothing on file gives the grandmother authority to consent. What should the medical assistant do?

    • AGive the vaccines, since a grandparent counts as an immediate family member
    • BHold the vaccines and have the provider verify who may legally consentCorrect
    • CHave the grandmother sign the consent form as the adult accompanying him
    • DAsk the grandmother to phone the mother and relay her verbal permission

    Why: Consent for a minor must come from a parent, a legal guardian, or an adult holding documented authority such as a court order or a signed caregiver authorization; being a relative does not by itself create that authority. Immunizing without valid consent can constitute battery, so the medical assistant stops and lets the provider verify. Option D is the closest miss: many practices do accept a guardian's telephone consent, but only when the provider obtains it directly and it is witnessed and documented, not when a third party relays it second-hand.

    Reference Domain 7, task 7B, k216 (consent, including consideration for minors), k218 (power of attorney and legal guardianship)

  7. The medical assistant says she is going to check the patient's blood pressure. The patient sits down, pushes up his sleeve, and holds out his arm without saying anything. This is an example of:

    • AImplied consent, shown by the patient's cooperative conductCorrect
    • BInformed consent, which the patient gave by acting voluntarily
    • CExpress written consent, satisfied here without a signature
    • DEmergency implied consent, which covers all routine care

    Why: Implied consent is inferred from a patient's actions for routine, low-risk procedures such as taking vital signs, a routine venipuncture, or an ear check. Injections are a mixed case: cooperating with the touch implies consent to it, but vaccines still require the current Vaccine Information Statement before every dose, and any procedure carrying material risk requires the provider's informed consent process. Informed consent, the near-miss in option B, is a documented process in which the provider discloses the nature, risks, benefits, and alternatives of a procedure and the patient then agrees; cooperating with a blood pressure cuff is not that process. Emergency implied consent is a separate doctrine that applies only when a patient cannot consent and delay would cause harm.

    Reference Domain 7, task 7B, k216 (informed [verbal or written] and implied consent); 42 USC 300aa-26 (Vaccine Information Statement required before each dose); CDC, Vaccine Information Statements: Instructions for Use

  8. A competent adult states clearly that he does not want the tuberculin skin test. The medical assistant tells him it is required for his job paperwork and injects him anyway. The injection itself is best classified as:

    • AAssault, because he was misled about the test being required
    • BNegligence, because the standard of care was not followed
    • CInvasion of privacy, because his refusal was disregarded
    • DBattery, because he was touched without giving consentCorrect

    Why: Battery is intentional harmful or offensive contact with another person without consent, and injecting a patient who has refused meets that definition; a competent adult's right to refuse any treatment is part of the Patient's Bill of Rights. Assault is a different tort: it is conduct that puts someone in reasonable apprehension of imminent harmful contact and requires no touching at all. Misstating that the test was a job requirement is a misrepresentation, not an apprehension of contact, so option A names the wrong tort for the wrong reason, and once the needle enters the skin the completed tort is battery. Negligence would require a breach of the standard of care that caused harm, not an intentional act. The correct response is to document the refusal and notify the provider.

    Reference Domain 7, k221 (criminal and civil acts; medical malpractice), k215 (Patient's Bill of Rights); NIH/StatPearls, assault and battery in health care; Restatement (Second) of Torts secs. 13, 21

  9. A seriously ill patient arrives with a completed MOLST (Medical Orders for Life-Sustaining Treatment) form signed by her physician. How does this form differ from the living will already in her chart?

    • AIt replaces her health care proxy by naming who decides for her
    • BIt takes effect only after two physicians certify she is terminally ill
    • CIt is a signed medical order that EMS can act on immediatelyCorrect
    • DIt is valid only inside the facility where it was originally signed

    Why: A MOLST or POLST form is an actionable medical order signed by a physician, nurse practitioner, or physician assistant that converts a seriously ill patient's goals of care into orders every setting can follow immediately, and it travels with the patient between home, EMS, clinic, and hospital. A living will is an advance directive written by the patient: it states wishes, generally takes effect only once the patient lacks capacity, and usually requires interpretation by the provider and the surrogate, so EMS cannot act on it at the bedside. The MOLST does not replace the health care proxy, the near-miss in option A; the documents work together. The medical assistant's role is to obtain the form, scan it into the chart, and flag it for the provider.

    Reference Domain 7, task 7D, k217 (advance directives; DNR/DNI; MOLST); National POLST form standards and "POLST vs. Advance Directives"; Patient Self-Determination Act of 1990 (facility duty to ask about and document advance directives — background only; it does not govern portable medical orders)

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