Standards › Standard 16 › Forms
Form · PED-FRM-001 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 16.1
Purpose
Records the age, weight and equipment choice for each child, and the second-person check of the dose.
How to complete
- Record the age and the measured weight.
- Record the equipment size chosen.
- Record the dose and the second-person check.
Checks
| Check | Entry |
|---|---|
| Child’s age group and weight (date measured) | Yes |
| Equipment size chosen | Yes |
| Medicine and dose calculated | Yes |
| Second person checked (name) | Yes |
| Recorded by and date | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Pocket book of hospital care for children (2013) and the UN Convention on the Rights of the Child (1989). |
| 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
- Pediatric Ambulatory Care (AMB-23)
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)