How the consent engine works

Informed consent is a conversation, but what survives it is a piece of paper. In most clinics those two things drift apart: the conversation is thorough and the document is a template, or the document is thorough and nobody can show what was actually said. Med’s consent engine exists to close that gap. It records the conversation, checks it against the subjects the law requires you to cover, drafts the paperwork from what was actually said, and keeps the conversation next to the signed document afterwards.

This page explains the mechanism. For the steps at the chair side, read Running a consent session.

Two different consents

The most common misunderstanding is that Med collects one consent. It collects two, for two different things, and they are not interchangeable:

Consent to audio-record the consultation. A separate document, signed before any recording starts. The wizard states the purpose plainly: the consultation may be recorded “solely to assist in preparing medical documentation”, the recording is processed with EU data residency and encrypted, it “does not replace the physician’s judgment”, and the patient “has the right to refuse without affecting medical care”.
Consent to the procedure itself. The informed-consent paperwork: the agreement, the pathology annex where one applies, and the self-declaration.

A patient may refuse the recording and still consent to the procedure. That is a supported path, not a dead end — see Without a recording. A patient may equally agree to the recording and then decline the procedure; see When a patient declines.

The visit is the unit

Everything hangs off a visit: one patient, one procedure, one date, optionally tied to one appointment. The visit is what the paperwork belongs to, and it is what “once per visit” means when Med refuses to produce a second copy of a document that has already been signed.

Choosing the procedure matters more than it looks. It decides which annex applies, which of your clinic’s approved wording is available, and what the conversation is checked against. Procedures are organised as type of medicine → discipline → procedure; if what you are doing is not in the list you can type a name for it, at the cost of the annex and the approved wording that a catalogued procedure brings with it.

The conversation, and what happens to it

If the patient agreed to the recording, you record the consent discussion in the Hub. Med then:

Transcribes it. Transcription is automatic and usually takes about a minute. The transcript is text only — it does not label who was speaking.
Adds the transcript to your clinic’s clinical knowledge library, marked as patient data, so it is searchable alongside the rest of the visit’s record and stays inside your clinic.
Checks the conversation against the required subjects (below).

You can add a follow-up recording to the same visit later — for example after going back to the patient to cover something. It is transcribed and folded into the same check, rather than starting a second visit.

The conversation is kept. When you finish a consultation, the transcript, the audio and the check all stay on the visit page next to the signed documents, because the conversation is the record of what the patient was told. They are removed only when someone deletes the visit, which deletes the audio, the transcript and the documents together and cannot be undone.

The conversation check

Med checks the conversation against four subjects, which are the ones Romanian law requires for valid informed consent (Legea 95/2006, art. 660(3)):

Subject	What counts as covering it
Nature and purpose of the proposed procedure	What the procedure is, briefly how it is done, what it is meant to achieve for this patient; anaesthesia type, duration and team where relevant.
Risks and consequences of the proposed procedure	The common risks, the serious or procedure-specific ones even if rare, anaesthesia risks where applicable, and major possible consequences.
Viable alternatives and their risks	The main alternatives including conservative treatment or watchful waiting, their principal risks or limits, and briefly why you recommend this procedure.
Prognosis without treatment	What is likely to happen if the patient declines or postpones, and the main complications of not treating or delaying.

A fifth item, patient questions and the answers you gave, is extracted but not scored: it records what happened, including “the patient asked nothing”, and it is used to fill the questions section of the annex.

Each of the four scored subjects gets its own coverage reading, shown as Discussed, Partially or Not discussed, with the underlying percentage and the passages behind it available under Coverage details. The panel is headed Conversation check and summarises as “N of 4 topics covered”.

The gate is per subject, not an average: every one of the four must clear your clinic’s coverage threshold before Med will generate documents without asking you a question first. This is deliberate — an average lets one uncovered subject hide behind three well-covered ones.

If a subject falls short, Med does not block you. It asks How do you want to continue? and offers, in plain language:

Continue the conversation — record a short follow-up with the patient; it joins the same check.
Generate and fill in by hand — the documents are generated and you type what is missing in the editor.
Complete from the clinic’s standard content — the gaps are filled from your clinic’s approved wording for that pathology, and each field shows where its text came from. Offered only when approved content exists for the procedure.
Leave it as it is — you confirm the coverage is sufficient for this case. The decision is timestamped and stored with the visit.

Where the clinic has approved content, the check also compares what you said against it, and flags both elements from the standard content that were not discussed and possible contradictions between the conversation and the approved text. Both are advisory: they never stop you printing or signing, and you can record that you reviewed them.

Signals the check also reports

Besides coverage, the check reports what it heard about the patient:

The patient’s voiced decision — accepted, refused, undecided, or not determinable, with the verbatim quotes it relied on. A detected refusal shows a red banner and offers to move the visit onto the refusal track. It only ever suggests; switching is your decision.
Abusive language toward staff, with quotes, shown to clinic staff only. Med states what this is for: it may support a documented decision to refuse care, except in emergencies.
Uncertain attribution. Because the transcript is not speaker-labelled, attributing a sentence to the patient is inference. When the check is not confident, it says so and tells you to verify against the recording. Treat a quote as a pointer to the audio, not as proof of who spoke.

Without a recording

If the patient refuses the recording, the session continues on a without recording path. Instead of a transcript, you complete the procedure’s intake checklist yourself — the same subjects, typed rather than spoken. The wizard is blunt about the trade-off: “Write as much as you can here — without a recording, these fields are the document’s main source; the standard content only completes what you leave empty.”

On this path there is no conversation check to pass: the panel says the check is not required and you can generate documents once the required intake fields are complete.

Where the words in a document come from

Every value on a generated document carries a caption saying where it came from, and those captions survive into the audit trail:

Caption	Meaning
from the conversation	Taken from what was said during the recorded discussion.
from the intake you filled in	Taken from what you typed on the without-recording path.
from the standard content / from the clinic library	Taken from your clinic’s approved wording for that pathology, or from the protocols you uploaded.
from the patient record	Taken from the patient’s profile (names, CNP, ID document, representative).
from the patient’s history	Taken from this patient’s earlier visits.
edited by the doctor	You typed or corrected it.

This is what makes the document defensible later: it shows not only what the patient was told but on what basis each sentence was written.

The document set

For a general clinic, a consent visit produces:

Informed patient agreement — the main consent document, filled from the visit.
Pathology consent annex — the pathology-specific part (risk tiers, the description of the act, alternatives, investigations, anaesthesia, and the manoeuvres table). It appears when the procedure calls for it, and it renders your clinic’s approved wording for that pathology exactly, pinned to the version in force when it was signed.
Self-declaration, annex to the agreement — completed by hand.

A hospital gets the hospital versions of the admission, discharge and refusal paperwork; the facility type you set once decides which. On the refusal track, the set also includes the treatment refusal declaration.

Clinic paperwork around the visit — the document-handover receipt at check-in, the return receipt at discharge, the refusal minutes — is described in Clinic forms and documents.

How a document becomes signed

A document moves through four states, shown as a badge:

Generating → Draft → Unsigned → Signed

Generating — Med is filling it from the visit.
Draft — filled, but no printable document exists yet. This is the review gate: Med tells you “Check the fields before the document is created” and lists anything the conversation did not supply. You correct what needs correcting and confirm with The fields are correct — create the document. Only then is the printable document rendered. Documents with nothing to confirm are marked as checked instead.
Unsigned — rendered, printable, and of no legal effect. The label is deliberately “Unsigned” rather than “Final”, because a finished-looking document that nobody signed is exactly the thing a clinic must not mistake for done.
Signed — signed, sealed and downloadable.

Signing happens one of two ways, chosen per document under How will this document be signed?:

On screen — the patient (or their legal representative) signs on the display; Med burns the signature into the document and seals it electronically. You confirm, by ticking a box, that everyone named is signing in person.
On paper — Med gives you the document to print with a reference ID and a QR code on the sheet. The patient signs by hand, you photograph or scan every page, and Med binds the capture to the record. It checks the page count and the reference ID before accepting, and refuses a scan of a sheet that no longer matches the current version of the document. The scan then is the signed document.

Where a visit produces several documents, Med walks you through them one at a time and tells you how far you are: “Document signed (2 of 3). Next up: …”.

Language and translations

The signed document is always in Romanian — that is the legal act. When you start a session you may additionally declare English, Hungarian or German. Med then produces an informative translation annex in each declared language.

An annex is never the act. It is not signed, is not reviewed as part of the consent flow, and never blocks anything. The panel says so: “Informative translation only — the signed Romanian document is the legally binding version.” The one exception to “translations are separate” is the audio-recording consent, where the patient’s single signature is applied to the Romanian act and to each declared-language copy, so the patient can be handed a version they read.

When a patient declines

Declining is a normal outcome with its own paperwork, not an error state.

If the check detects a refusal, Med leads with it and offers Generate the refusal documents. That is a deliberate action, never automatic, and it takes the visit onto the refusal track: Med produces the refusal declaration — filled from the visit, with the diagnosis, the procedure and the consequences of declining, each carrying its provenance — and you walk the same review and signing steps as a consent visit. The declaration is the visit’s outcome.

Two things worth knowing:

A false positive is recoverable. The refusal banner carries Not a refusal? Continue with consent, and the coverage options stay available.
Some refusal paperwork cannot be generated from a conversation and stays hand-filled — in particular the refusal minutes, which record that the patient refused to sign, and which are signed by the staff member and two witnesses whose identities no analysis can supply.

Before signing, a document can be edited, regenerated, or deleted and produced again. Deleting one loses the corrections you typed into it.
After signing, a document is final for its visit. Asking for the same form again returns the signed copy rather than making a second one.
A new visit is a new consent. A different appointment counts as a different visit, so a patient consenting again — for a repeat procedure, after a change of plan, or because circumstances changed — goes through a new session and gets a new signed document. Nothing overwrites what was signed before, and the earlier documents stay on the patient’s record.
If a patient consents at the same visit after initially declining, the visit does not dead-end: once consent documents exist, Med resumes the normal review and signing flow so the visit can be completed.

What is kept, and where

Artefact	Kept	Removed when
Consultation audio, including follow-ups	Yes	The visit is deleted
Transcript	Yes, on the visit page	The visit is deleted
Conversation check	Yes	The visit is deleted
Signed documents and captured scans	Yes	The visit is deleted
Signed audio-recording consent	Yes	The visit is deleted

All of it lives inside your clinic’s own space. Staff at another clinic cannot see it — a record from another organization is simply not found. Data is stored in the European Union, encrypted, and never used to train AI models without your explicit consent. The platform documentation covers the tenanted model, roles and knowledge bases that Med builds on.

The audit trail

For each signed document Med retains: the version history of its content, the provenance of every field, any attestations you recorded (that you reviewed the standard-content coverage, or the flagged contradictions), the signatures collected and when they were collected, the document’s reference ID, and — for a paper signature — the capture events including a checksum of the scan that was bound. The transcript and the conversation check sit alongside, so you can show not only what was signed but what was said.