Signing a medical/legal document for a patient is a major offense and exposes the hospital and the nurse to liability, even if the patient agrees with the signature. Unless the family member has durable power of attorney rights to intervene on the patient’s behalf and make decisions for the patient in the event of their incapacity to do so, a family member’s signature may not be substituted for the patients. While it is generally a good idea to consult with Risk Management/legal administrators in cases of confusion, the circumstance presented in this question does not require consultation as a simple “X” or any other personal mark suffices once the patient has understood and agreed to the informed consent. While this is acceptable for a patient to consent to treatment, there is no substitute for thoroughly discussing the procedures, possible outcomes, side effects, recovery period and other details of any procedure a patient is undergoing.