US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149 149.420(c)(2)-(3),(e)-(g): Obtain voluntary signed consent on the standard form, recording the notice and signature times, offer the documents in the 15 most common State languages, and give the patient a copy

Consent must be documented on the Secretary's form, signed before the items or services are furnished, voluntary and free of undue influence, fraud or duress, not revoked in writing before the service, and may be given by an authorized representative under State law who is not an affiliated provider or facility employee (unless a family member). The form must acknowledge receipt of the notice in the selected form, explain that payments might not count toward in-network deductibles or out-of-pocket maximums, state that the patient agrees to be treated and may be balance billed, and record the date and time the notice was received and the date and time the consent was signed. The documents must be offered in any of the 15 most common languages in the State (or the facility's region) and, where the patient's language is not among them and the patient cannot understand them, a qualified interpreter must assist or the criteria are not met. A copy of the signed notice and consent must be given in person, by mail or by email as the patient selects. The consent is not a contract for the estimated charges.