Standards › Standard 9 › Forms
Form · FLD-FRM-006 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 9.13
Purpose
Records the clinical response to a report of sexual violence, with the patient’s consent.
How to complete
- Record consent before any evidence is kept.
- Record each treatment and its time.
- Record each referral.
Checks
| Check | Entry |
|---|---|
| Time of report and time seen | Yes |
| Consent to evidence collection (yes or no) | Yes |
| Emergency contraception offered and time | Yes |
| Post-exposure prophylaxis offered and time | Yes |
| Referral to support and protection (date) | Yes |
| Record held securely | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Clinical management of rape survivors (2004) and IASC Guidelines on Gender-Based Violence Interventions in Humanitarian Settings (2015). |
| 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 |
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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)