Standards › Standard 53 › Forms
Form · ALR-FRM-004 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 53.5
Purpose
Gives the patient a written plan for avoiding their allergens and for treating a reaction in an emergency.
How to complete
- List the agents to avoid and the safe alternatives.
- Write the emergency steps and the medicine to use.
- Give a copy to the patient and the referrer, and record the date.
Checks
| Check | Entry |
|---|---|
| Agents to avoid | Yes |
| Safe alternatives | Yes |
| Emergency steps and medicine | Yes |
| Copy given to patient and referrer | Yes |
Evidence
| Reference | Note |
|---|---|
| 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)