PLS-FRM-001: Suitability assessment record

Standards › Standard 55 › Forms

Form · PLS-FRM-001 · Version 1.0 · Approved by the ASF Expert Committee

Supports: 55.1

Purpose

Records the pre-operative suitability assessment, the risk factors found, and the surgeon’s decision.

How to complete

• Record the medical history, medicines and smoking status.
• Record body weight, the expectations stated and whether they are realistic.
• Record the decision and the surgeon’s signature.

Checks

Check	Entry
Medical conditions and medicines	Yes
Smoking and body weight	Yes
Expectations realistic (yes or no)	Yes
Decision (suitable or not)	Yes
Surgeon signature and date	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

• Plastic & Cosmetic Surgery Safety Endorsement (AMB-19)

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)