Section 441.258 - Consent form requirements(a)Content of consent form. The consent form must be a copy of the form appended to this subpart or another form approved by the Secretary.(b)Required signatures. The consent form must be signed and dated by- (1) The individual to be sterilized;(2) The interpreter, if one was provided;(3) The person who obtained the consent; and(4) The physician who performed the sterilization procedure.(c)Required certifications.(1) The person securing the consent must certify, by signing the consent form, that(i) Before the individual to be sterilized signed the consent form, he or she advised the individual to be sterilized that no Federal benefits may be withdrawn because of the decision not to be sterilized;(ii) He or she explained orally the requirements for informed consent as set forth on the consent form; and(iii) To the best of his or her knowledge and belief, the individual to be sterilized appeared mentally competent and knowingly and voluntarily consented to be sterilized.(2) The physician performing the sterilization must certify, by signing the consent form, that:(i) Shortly before the performance of sterilization, he or she advised the individual to be sterilized that no Federal benefits may be withdrawn because of the decision not to be sterilized;(ii) He or she explained orally the requirements for informed consent as set forth on the consent form; and(iii) To the best of his or her knowledge and belief, the individual appeared mentally competent and knowingly and voluntarily consented to be sterilized. Except in the case of premature delivery or emergency abdominal surgery, the physician must further certify that at least 30 days have passed between the date of the individual's signature on the consent form and the date upon which the sterilization was performed.
(3) In the case of premature delivery or emergency abdominal surgery performed within 30 days of consent, the physician must certify that the sterilization was performed less than 30 days, but not less than 72 hours after informed consent was obtained because of premature delivery or emergency abdominal surgery and- (i) In the case of premature delivery, must state the expected date of delivery; or(ii) In the case of abdominal surgery, must describe the emergency.(4) If an interpreter is provided, the interpreter must certify that he or she translated the information and advice presented orally and read the consent form and explained its contents to the individual to be sterilized and that, to the best of the interpreter's knowledge and belief, the individual understood what the interpreter told him or her.