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Form · HSP-FRM-004 · Version 1.0 · Approved by the ASF Expert Committee
Supports: Standard 10 (Hospice and Palliative Care), criterion 10.5
Purpose
Records each patient’s spiritual, cultural and psychological needs and the action taken.
How to complete
- Ask at each review.
- Record the need and the action.
- Record the chaplain or leader connected.
Checks
| Check | Entry |
|---|---|
| Spiritual need (yes or no) and detail | Yes |
| Cultural need or practice (yes or no) and detail | Yes |
| Psychological need (yes or no) and detail | Yes |
| Chaplain or leader connected (name, date) | Yes or N/A |
| Reason if no action possible | Yes or N/A |
| Recorded by and date | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Palliative Care guidance and the WHO Package of Essential Noncommunicable Disease interventions (2020). |
| 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
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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)