WTG-FRM-003: Teach-back record for key decisions

Standards › Standard 45 › Forms

Form · WTG-FRM-003 · Version 1.0 · Approved by the ASF Expert Committee

Supports: 45.5

Purpose

Records the teach-back check for each key decision, and whether the patient understood it.

How to complete

• Ask the patient to say in their own words what was decided.
• Correct and repeat the explanation where the patient is unsure.
• Record the result and any interpreter used.

Checks

Check	Entry
Decision (diagnosis, treatment, medicine or discharge)	Yes
Patient explained the decision in their own words	Yes
Gaps found and corrected	Yes
Interpreter used	Yes
Clinician name and date	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

• Reception & Information: The First Ten Minutes (H-02)

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)