Standards › Standard 16 › Forms
Form · PED-FRM-006 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 16.11
Purpose
Records the weight used for each weight-based dose, its source, the dose calculated and the second-person check.
How to complete
- Measure or confirm the weight, and record its date and source.
- Record the dose calculated.
- Record the second-person check before the dose is given.
Checks
| Check | Entry |
|---|---|
| Weight measured or confirmed (kg) and date | Yes |
| Source of weight (measured today, confirmed, carried forward) | Yes |
| Dose calculated (medicine, dose, unit) | Yes |
| Second person checked (name) | Yes |
| Recorded by | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Pocket book of hospital care for children (2013) and the UN Convention on the Rights of the Child (1989). |
| 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 |
E-learning for this document
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)