Standards › Standard 24 › Forms
Form · MTR-FRM-002 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 24.2
Purpose
The complete record of care sent to the patient’s home-country physician, in a usable format, with the patient’s consent.
How to complete
- Prepare the summary with the drugs and doses given.
- Record the patient’s consent to send it.
- Record the date and the physician it was sent to.
Checks
| Check | Entry |
|---|---|
| Diagnosis, procedure and outcome | Yes |
| Drugs and doses given | Yes |
| Follow-up needed | Yes |
| Patient consent to send (yes or no) | Yes |
| Sent to (physician) and date | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Patient Safety Curriculum Guide (2011) and the NICE guidance on venous thromboembolic diseases (NG158, 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
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)