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Form · HSP-FRM-003 · Version 1.0 · Approved by the ASF Expert Committee
Supports: Standard 10 (Hospice and Palliative Care), criterion 10.4, 10.8
Purpose
Records the information given to families, the carer support offered, and the bereavement follow-up offer.
How to complete
- Record the information given and the family’s understanding.
- Record the carer support offered.
- Record the bereavement follow-up offer and the answer.
Checks
| Check | Entry |
|---|---|
| Information given to family (date) | Yes |
| Named contact given | Yes |
| Carer support offered and answer | Yes |
| Bereavement follow-up offered (date of death) | Yes or N/A |
| Answer to bereavement offer | Yes or N/A |
| Recorded by and date | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Palliative Care fact sheet and the Lancet Commission on the Global Access to Palliative Care and Pain Relief (2017). |
| 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)