Page 60 - Policy-Communication-Report-Volume-67
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                                                                                       Ļ ÖćøđÿøĉöóúĆÜñĎšðśü÷ĒúąñĎšéĎĒúǰ(Empowerment)
                                                                                       ĻÖćøÿøšćÜÙüćöøĂïøĎšÿč×õćóéšćîÖćøĒóì÷ŤĒñîĕì÷ǰ(Literacy)
                                                                                                              Continuity of Care
                                                                                       ĻÖćøéĎĒúêŠĂđîČęĂÜĔîßčößîǰ(Community care)

                                                                                       Ļ ÖćøêĉéêćöĂćÖćøĀúĆÜÖćøøĆÖþćǰ(Follow up)
                                                                                       ĻÖćøüĉîĉÝÞĆ÷đóČęĂÿĉĚîÿčéÖćøøĆÖþćǰ(Finalized diagnosis)
                                                                                                          Discharge
                                                                                       Ļ ÖćøðøąđöĉîđóČęĂüćÜĒñîÝĞćĀîŠć÷ǰ(Discharge planning) øŠüöÖĆîÖĆïÿĀüĉßćßĊóǰ(Multidisciplinary team meeting)

                                                                                       Ļ ÖćøðøąđöĉîĒúąêĉéêćöÖćøøĆÖþćĒêŠúąüĆîǰ(Reassessment)
                                                                                       ĻÖćøøĆÖþćêćöĒîüìćÜðäĉïĆêĉđüßÖøøöĕì÷ǰ(TTM guideline)
                                                                                                            Care Delivery
                                                                                       Ļ ÖćøøĆÖþćêćööćêøåćîÖøöÖćøĒóì÷Ť/øćßüĉì÷ćúĆ÷ǰ(CPG)

                                                                                       ĻÖćøüćÜĒñîéĎĒúøĆÖþćøŠüöÖĆïÿĀüĉßćßĊóǰ(Multidisciplinary team planning)
                                                                                       ĻÖćøøĆÖþćêćöĒîüìćÜðäĉïĆêĉđüßÖøøöĕì÷ǰ(TTM guideline)
                                                                                                            Care Planning
                                                                                       Ļ ÖćøøĆÖþćêćööćêøåćîÖøöÖćøĒóì÷Ť/øćßüĉì÷ćúĆ÷ǰ(CPG)

                                                                                       ĻÖćøüĉîĉÝÞĆ÷ÝĞćĒîÖÙüćöøčîĒøÜǰ(Diagnosis & Classification)
                                                                                       Ļ ÖćøêøüÝøŠćÜÖć÷đóČęĂðøąđöĉîĂćÖćøǰ(Patient Assessment): Barthel index/Impairment
                                                                                                              Assessment & Dx
                                                                                       ĻÖćøàĆÖëćöðøąüĆêĉÖćøđÝĘïðśü÷ǰ(History taking)

                                                                                       ĻÖćøïĆîìċÖךĂöĎúÿŠüîïčÙÙúǰ(Personal data)
                                                                                       Ļ ÖćøúÜìąđïĊ÷î÷Čî÷ĆîêĆüêîđךćÿĎŠøąïïǰ(Identification)
                                                                                                            Access & Entry
                                                                                       ĻÖćøÙĆéÖøĂÜđïČĚĂÜêšîǰ(Screening): New case/Refer back/Walk in/Re-admit ìĊęđךćđÖèæŤǰIMC













                                                                                                              Continuity of Care





                                                                                                          Discharge

                                                                                    ĻñĎšðśü÷öĊõćüąêĉéđßČĚĂĀøČĂöĊēøÙêĉéêŠĂìĊęøčîĒøÜ
                                                                                    ĻñĎšðśü÷öĊõćüąđÿĊę÷ÜêŠĂđúČĂéĂĂÖÜŠć÷ǰđߊîǰñúÖćøêøüÝđúČĂéöĊÙŠćǰINR (International Normalized Ratio) öćÖÖüŠćǰ3 đðŨîêšî
                                                                                    øŠüöÖĆïĒóì÷ŤĒñîĕì÷ĒúąĒóì÷ŤìćÜđúČĂÖ
                                                                                                            Care Delivery
                                                                                    ĻñĎšðśü÷ĕéšøĆïÖćøøĆÖþćéšü÷÷ćĀøČĂüĉíĊÖćøĂČęîĂ÷ĎŠÖŠĂîǰĒúšüĂćÝÝąĕéšøĆïñúÖøąìïĀøČĂĂćÖćøĕöŠóċÜðøąÿÜÙŤëšćĀćÖĕéšøĆïÖćøøĆÖþć
                                                                                    Ēóì÷ŤìćÜđúČĂÖǰđߊîǰĒñúÞĊÖ×ćéǰĒñúôÖßĚĞćǰĒñúñŠćêĆéǰÖøąéĎÖĀĆÖǰöĊĂćÖćøĂĆÖđÿïǰđðŨîêšî
                                                                                    ĻñĎšðśü÷öĊĂćÖćøñĉéðøÖêĉìĊęĂćÖćø÷ĆÜĕöŠÙÜìĊęĀøČĂĂćÝÝąđÖĉéĂĆîêøć÷ÝćÖÖćøøĆÖþćĔîïøĉđüèìĊęÝąêšĂÜøĆÖþćēé÷Ēóì÷ŤĒñîĕì÷Ēúą
                                                                                        ĻךĂĀšćöìĊęĕöŠøĆïđךćøĆÖþćēé÷Ēóì÷ŤĒñîĕì÷ĒúąĒóì÷ŤìćÜđúČĂÖǰ(Contra-indication)
                                                                                                            Care Planning
                                                                                    ĻñĎšðśü÷ĕöŠöĊךĂĀšćöĔîÖćøøĆÖþćēé÷Ēóì÷ŤĒñîĕì÷ĒúąĒóì÷ŤìćÜđúČĂÖ
                                                                                    ĻñĎšðśü÷÷ĉîéĊìĊęÝąøĆïÖćøøĆÖþćēé÷Ēóì÷ŤĒñîĕì÷ĒúąĒóì÷ŤìćÜđúČĂÖ
                                                                                ĻĕöŠöĊĂćÖćøĒìøÖàšĂîìćÜøąïïðøąÿćìǰđߊîǰßĆÖǰàċöúÜǰÿĆïÿîǰĂćđÝĊ÷îóčŠÜǰđðŨîêšî
                                                                                ĻÙüćöéĆîēúĀĉêǰSBP 90-160 ĒúąǰDBP 60-100 öĉúúĉđöêøðøĂì
                                                                                                              Assessment & Dx
                                                                                ĻÿćöćøëĀć÷ĔÝĕéšéšü÷êîđĂÜǰĕöŠǰOn Oxygen ĕöŠöĊĂćÖćøĀć÷ĔÝĀĂïĀøČĂĀć÷ĔÝúĞćïćÖ
                                                                                ĻßĊóÝøđêšîÿöęĞćđÿöĂĒúąđêšîĂ÷ĎŠøąĀüŠćÜǰ60-100 ÙøĆĚÜ/îćìĊ
                                                                                ĻĂčèĀõĎöĉ×ĂÜøŠćÜÖć÷ǰ< 38 ĂÜýćđàúđàĊ÷ÿ
                                                                                    ĻñĎšðśü÷ìĊęĕéšøĆïÖćøüĉîĉÝÞĆ÷ĂĆöóùÖþŤĂĆöóćêĀúĆÜøą÷ąđÞĊ÷ïóúĆîìĊęöĊĂćÖćøÙÜìĊęǰéĆÜîĊĚ
                                                                                                            Access & Entry
                                                                                        ĻךĂïŠÜßĊĚĔîÖćøøĆïđךćøĆÖþćēé÷Ēóì÷ŤĒñîĕì÷ĒúąĒóì÷ŤìćÜđúČĂÖǰ(Indication)
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