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Form · PRO-FRM-003 · Version 1.0 · Approved by the ASF Expert Committee
Supports: Standard 11 (Procedure Units), criterion 11.4, 11.12
Purpose
Records the information given for a procedure, the risks and complications covered, and the time given to reconsider.
How to complete
- Give the information before the procedure.
- Record the time given to reconsider for elective procedures.
- Record the questions asked and the answers.
Checks
| Check | Entry |
|---|---|
| Expected outcome explained realistically | Yes |
| Risks and complications explained, with their treatment | Yes |
| Alternatives explained | Yes |
| Reconsideration time given (date and time) for elective procedures | Yes or N/A |
| Questions and answers | Yes |
| Signed by patient and practitioner, date | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the ASF Expert Committee consensus and the WHO Guidelines for Safe Surgical Care and Safe Procedures (2009). |
| 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)