Standards › Standard 3 › Forms
Form · MNP-FRM-001 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 3.2
Purpose
Records the reason for an opioid, the alternatives considered, the dose, the review and the stop date.
How to complete
- Complete when an opioid is first prescribed.
- Complete at each review date.
- Record the stop or review date.
Checks
| Check | Entry |
|---|---|
| Reason for opioid recorded | Yes |
| Non-opioid alternatives considered | Yes |
| Lowest effective dose and duration | Yes |
| Stop or review date set | Yes |
| Review outcome at each review | Yes |
| Prescriber and date | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022). |
| E-006 | ASF Policy Framework v1.2. Adapted. |
| E-009 | ASF Expert Committee consensus. |
Change history
| Version | Date | What changed | Approval |
|---|---|---|---|
| 1.0 | the date of approval | First version | set Expert Committee approval |
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References
- Accréditation Sans Frontières (2026). ASF Policy Framework v1.2. (E-006)
- Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 1. (E-009)