Standards › Standard 21 › Forms
Form · URG-FRM-003 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 21.5
Purpose
Records the written advice each patient leaves with, including when to return and the follow-up needed.
How to complete
- Give the written advice on leaving.
- Record when to return and the follow-up needed.
- Record that the patient understood the advice.
Checks
| Check | Entry |
|---|---|
| Written advice given (yes or no) | Yes |
| When to return (stated) | Yes |
| Follow-up needed and booked | Yes |
| Understanding checked (yes or no) | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Emergency triage, assessment and treatment (ETAT) manual (2005) and the WHO Emergency care systems for universal health coverage (2016). |
| 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)