Standards › Standard 2D › Forms
Form · AI-FRM-003 · Version 1.1 · Approved by the ASF Expert Committee
Supports: 2D.8
Purpose
Plain-language notice telling patients when an AI system supported their care, and what that means.
How to complete
- Name the AI system in plain words and what it was used for.
- State that a clinician made the final decision.
- Give a contact for questions and any non-AI option.
Checks
| Check | Entry |
|---|---|
| Plain words, no technical terms | Yes [EC] |
| States that a clinician made the final decision | Yes [EC] |
| Says what the system was used for | Yes [EC] |
| Contact for questions given | Yes [EC] |
| Available in the patient languages used | Yes [EC] |
Evidence
| Reference | Note |
|---|---|
| E-011 | WHO (2021), Ethics and governance of artificial intelligence for health. Used as the basis for AI governance. Link and wording to verify before publication. |
| E-009 | ASF Expert Committee consensus. Notice wording to be agreed. |
Change history
| Version | Date | What changed | Approval |
|---|---|---|---|
| 1.0 | the date of approval | First version | Approved by the ASF Expert Committee |
| 1.1 | the date of approval | Internal quality review: corrected cross-references, status wording and document control | Approved by the ASF Expert Committee |
E-learning for this document
References
- World Health Organization (2021). Ethics and governance of artificial intelligence for health: WHO guidance. Geneva: WHO. Open source (E-011)
- Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 1. (E-009)