19. severIIIa Delay cannot be tolerated if delayed ER or admission suspected Complicated cases. Rare cases. Need to know the lap result ASAP. Risk with continuation on the same plan without follow up. Red flags. ------------------------------------ Must be Seen by consultants. SMS and call reminder. Their lap should take the first priority. Priority in the appointments. Make their appointments at the beginning of the day If it’s a chronic case with potential of >4 visit have to spend time with one of the administration staff or prepare paper clarify the hospital way in arrangement the appointments. ID card show the patient case and possible red flag for admission. 1 st Priorities in the pharmacy. 1 st Priority in the radiology. b if delay in the appointment happened the case will complicate. c Sever stable case with complication need to be regularly followed up (end stage complication)

20. moderateIIaCases most likely to present as sever case if delayed or get worse. Cases don’t meet any of the sever criteria. Cases need to be seen >1 and <3 months. Cases that the lap needs longer time to get the result. Cases that continuing with same dose or stopping the drugs will not harm the patient. Cases with complication that its semi- controlled or will not get complicated. ------------------------------------- Seen by a senior resident. SMS reminder of the patient and the lap. bCases downgraded from sever after management or cases upgraded from mild that got complicated

21. mildIaRemission after treatment or need follow up after >6 month. Cases were treated. Follow up after >6 months. No complications. Need laps after 6 months or more. staple patient. ------------------------------ Seen by a resident, bRemission no further visit needed. cstaple patient need to do regular chick up for genetic or high risk in family.

22. 2 nd visit 1 st visit First comer and referral Sever:- -Get the investigation - seen by specialist seen by the consultant Moderate:- -seen by the resident Not getting well or complicated -upgrade to sever Improvement -downgrade Mild:- Seen by the resident Seen by general clinic

23. 2 nd visit -based on previous visit grading 1 st visit -considered (IIa) -investigation should be done Determine the progress After ER or previous admission Complicated or no improvement - upgrade Sever -investigation should be done Determine the severity and progression Moderate -determine the severity and improvement Improvement -downgrade mild

24. Considered (Ia) Patient for follow up after >6 month Determine the severity