Who should sign the valproate risk acknowledgment form?

• A. One specialist
• B. Nurse and pharmacist
• C. Patient's GP
• D. Two specialists

Answer: (D)

Valproate carries a high risk to a baby, so before exposure in people who could become pregnant, there must be formal, documented counseling and confirmation of understanding. The risk acknowledgment form is designed to capture that informed consent, and it should be signed by two specialists who are involved in the patient’s care. Having two clinicians sign provides independent confirmation that the patient has been thoroughly counseled about the risks, the importance of contraception, and the alternatives, reducing the chance that important information is missed or inadequately conveyed. In practice, these specialists are typically clinicians responsible for the patient’s valproate management (for example, a neurologist/epilepsy specialist and another relevant specialist such as a psychiatrist or obstetric/gynaecology clinician), ensuring the message comes from more than one expert. A single clinician’s signature is not regarded as sufficient under this safety framework.