Standards › Standard 27 › Forms
Form · TEL-FRM-001 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 27.1
Purpose
Records whether the patient can connect to the telemedicine service and, where they cannot, the alternative route taken.
How to complete
- Check the patient’s device, connection and digital ability at booking.
- Record the outcome of any failed connection.
- Record the alternative route and the date it was completed.
Checks
| Check | Entry |
|---|---|
| Device and connection available (yes or no) | Yes |
| Digital ability (adequate or needs support) | Yes |
| Connection failed (yes or no) and time | Yes |
| Alternative route (referral, call-back, in person) | Yes |
| Completed and by whom | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO Recommendations on digital interventions for health system strengthening (2019) and the WHO Ethics and governance of artificial intelligence for health (2021). |
| 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)