Standards › Standard 51 › Forms
Form · ONC-FRM-002 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 51.2
Purpose
Records the two independent checks of each chemotherapy dose before administration.
How to complete
- The first checker records their check of the patient, drug, dose, route and rate.
- The second checker records their own independent check.
- Record any mismatch and how it was resolved.
Checks
| Check | Entry |
|---|---|
| Patient identity confirmed | Yes |
| First check (drug, dose, route, rate) | Yes |
| Second independent check | Yes |
| Mismatch and resolution | Yes |
| Both checkers named and dated | Yes |
Evidence
| Reference | Note |
|---|---|
| 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)