Standards › Standard 27 › Forms
Form · TEL-FRM-005 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 27.14
Purpose
Records that the patient was told the limits of remote care, including when an in-person examination is needed, and consented before the consultation.
How to complete
- Explain the limits of remote care and when an in-person examination is needed.
- Record the patient’s consent to remote care before the consultation starts.
- Record the in-person advice given, where it applies.
Checks
| Check | Entry |
|---|---|
| Limits of remote care explained (yes or no) | Yes |
| In-person examination advice given (yes or no) | Yes |
| Consent to remote care before consultation | Yes |
| Clinician and date | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Recommendations on digital interventions for health system strengthening (2019) and the WHO Ethics and governance of artificial intelligence for health (2021). |
| 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)