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The Department of Veterans Affairs (VA) proposes to amend its regulation regarding informed consent and advance directives. The primary purpose of the proposed rule is to ensure that VA practice remains consistent with contemporary standards of health care delivery. We propose to amend the regulation by reorganizing it, and amending language where necessary to enhance clarity. We would amend the definition of practitioner to expand the types of health care professionals authorized to obtain informed consent from a patient, and would define the scope of information that must be provided as part of the informed consent discussion. We would establish the type of documentation required when a patient consents to a low risk treatment or procedure, and for a treatment or procedure necessitating signature consent. We propose to expand the approved means of communication that may be used by VA when an in-person discussion with a patient or surrogate regarding a proposed treatment or procedure is impracticable. We would remove the special process related to consent for unusual or extremely hazardous treatments or procedures as VA no longer performs such treatments or procedures. We would add definitions of advance directives that VA recognizes, including the Department of Defense Advance Medical Directive, and Mental Health (or Psychiatric) Advance Directive. We propose to add a definition of State-Authorized Portable Orders to reflect VA’s recognition of these specialized forms or identifiers authorized by state law or the state medical board or association, that translate a patient’s preferences with regard to specific life-sustaining treatment decisions into portable medical orders. We propose to allow family members who are VA employees to serve as witness to the signing of a VA Advance Directive. Finally, we would add a mechanism to allow a patient unable to execute a signature on a VA Advance Directive due to a physical impairment by authorizing a patient or a third-party at the direction and in the presence of the patient, to sign an X on the form.