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Form · HSP-FRM-005 · Version 1.0 · Approved by the ASF Expert Committee
Supports: Standard 10 (Hospice and Palliative Care), criterion 10.6
Purpose
Records the dying care plan, the comfort measures, the family present and each review.
How to complete
- Write the plan when the patient is recognised as dying.
- Record each comfort measure and dose.
- Record each review.
Checks
| Check | Entry |
|---|---|
| Date recognised as dying | Yes |
| Comfort measures and pain control | Yes |
| Family present and supported | Yes |
| Preferences recorded (HSP-FRM-002) | Yes |
| Reviews (date and change) | Yes |
| Signed by clinician and date | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Palliative Care fact sheet and the Lancet Commission on the Global Access to Palliative Care and Pain Relief (2017). |
| 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)