Standards › Standard 18 › Forms
Form · PHY-FRM-004 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 18.6
Purpose
Records the written advice and home exercises given to each patient, and that the advice was explained and understood.
How to complete
- Give the written advice and exercises for the patient’s own condition.
- Explain them to the patient.
- Check understanding by teach-back and record it.
Checks
| Check | Entry |
|---|---|
| Patient (ID) and date | Yes |
| Written advice and exercises given (yes or no) | Yes |
| Advice explained to patient (yes or no) | Yes |
| Teach-back checked (yes or no) | Yes |
| Physiotherapist | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WCPT Descriptor of physical therapy (2019) and the WHO Rehabilitation in health systems guide (2019). |
| 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)