Standards › Standard 11 › Forms
Form · PRO-FRM-001 · Version 1.0 · Approved by the ASF Expert Committee
Supports: Standard 11 (Procedure Units), criterion 11.1
Purpose
Records the suitability assessment before each procedure.
How to complete
- Complete before the procedure starts.
- Record each contraindication and its resolution.
- Sign before the procedure.
Checks
| Check | Entry |
|---|---|
| Medical history reviewed | Yes |
| Current medicines, including anticoagulants and supplements | Yes |
| Allergies recorded | Yes |
| Pregnancy status checked | Yes |
| Contraindication found and resolved (or none) | Yes |
| Signed by practitioner, date and time | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the ASF Expert Committee consensus and the WHO Guidelines for Safe Surgical Care and Safe Procedures (2009). |
| 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)