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Form · GYN-FRM-002 · Version 1.0 · Approved by the ASF Expert Committee
Supports: Standard 12 (Obstetrics and Gynaecology), criterion 12.12
Purpose
Records the information given on contraception, the eligibility check and the woman’s choice.
How to complete
- Give the information before choice.
- Check eligibility.
- Record the choice or the decision not to choose.
Checks
| Check | Entry |
|---|---|
| Methods explained (date) | Yes |
| Risks and effectiveness explained | Yes |
| Eligibility checked against WHO criteria | Yes |
| Method chosen or decision not to choose | Yes |
| Signed by woman and clinician | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Medical eligibility criteria for contraceptive use (5th edition, 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)