Standards › Standard 24 › Forms
Form · MTR-FRM-001 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 24.1
Purpose
The written estimate, given before travel is booked, covering the procedure, the hospital stay and the common extras.
How to complete
- Write the estimate before travel is booked.
- Include the procedure, the stay and the commonly needed extras.
- Record the date given and that the patient accepted it.
Checks
| Check | Entry |
|---|---|
| Procedure and surgeon (or clinician) | Yes |
| Hospital stay and extras included | Yes |
| Total estimate and currency | Yes |
| Date given, before travel booked (yes or no) | Yes |
| Patient acceptance (date) | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Patient Safety Curriculum Guide (2011) and the NICE guidance on venous thromboembolic diseases (NG158, 2020). |
| 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)