Standards › Standard 26 › Forms
Form · DIA-FRM-003 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 26.5
Purpose
Records each patient’s written dialysis prescription, the adequacy measured for each treatment against the target, and any change.
How to complete
- Record the written prescription and the target set.
- Measure adequacy for each treatment and record it.
- Record any change in the prescription and why.
Checks
| Check | Entry |
|---|---|
| Prescription (written, date) | Yes |
| Adequacy target set by clinician | Yes |
| Adequacy measured (per treatment) | Yes |
| Change in prescription and reason | Yes |
| Clinician | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on ISO 23500:2019 (fluids for haemodialysis) and the KDIGO Clinical Practice Guideline for Hemodialysis Adequacy (2015 update). |
| 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
- Dialysis & Renal Replacement Therapy (AMB-12)
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)