CTR-FRM-001: Contrast media pre-screen and consent record

Standards › Standard 50 › Forms

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

Supports: 50.4

Purpose

Records the allergy and renal function pre-screen and the informed consent before contrast media is given.

How to complete

• Ask about allergies and past reactions.
• Check the renal function result and record it.
• Record informed consent and the emergency plan explained.

Checks

Check	Entry
Allergy and past reactions	Yes
Renal function result	Yes
Informed consent (yes or no)	Yes
Emergency plan explained (yes or no)	Yes
Radiographer name 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

• Diagnostic Imaging Safety and Quality Standards (AMB-16)

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)