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LD.1. Qualified program director effectively manages the diabetes center.
LD.1.1. The center director must be Endocrinologist and has the knowledge and experience and management qualification to provide administrative leadership and clinical guidance to the program.
LD.1.2. The center director has a written job description and his/her qualifications match the requirements in the job description.
LD.1.3. The diabetes center director guides the center in meeting the mission, goals, and objectives.
LD.1.4. The center identifies members of its leadership team.
LD.1.5. The diabetes center defines the accountability of its director.
LD.1.6. The diabetes center director identifies, in writing, the composition of the interdisciplinary team.
LD.2. The Diabetes center director ensures availability of qualified and competent staff for the delivery of reliable timely and safe care.
LD.2.1. The Diabetes center director ensure that the staff have education, qualification consistent with the center scope of service based on the level of care.
LD.2.2. The program director ensures the credentials of required staff to match patient needs. Refer to appendix (1) SNDC standards of services and quality measures in diabetes centers and unit. Table 1.
Specific requirement staffing in tertiary health care
• At least one Endocrinology
• Health educator specialist /Health coach.
• Clinical dietician specialist / Health coach.
• Nurse
• Ophthalmology technician /Optometrists /Trained Nurse
• Lab technician / Trained Nurse.
• Podiatrist/orthopedics/ Vascular/ General surgery specialty
• Qualified specialist + Lab technician
• Pharmacist.
• social worker specialist
• Coordinator.
• Accessible medical service (in-hospital referral): Neurology, Nephrology, Cardiology, Retina specialist, Dentist and psychiatry
• Insulin Pump service: Endocrinologist/ diabetologist, Diabetic educator specialist and Clinical dietician specialist.
LD.2.3. The program director assures DC staff have relevant and current licensure. competencies, experience, orientation, training, and education.
LD.3. The Diabetes center steering committee ensure the provision of reliable, timely and safe service.
LD.3.1. The diabetes center director forms and leads a steering committee.
LD.3.2 The steering committee meets periodically at least every 3 months.
LD.3.3. The steering committee integrates all organizational services involved in the management of diabetes patients.
LD.3.4. The steering committee ensures that protocols, clinical practice guidelines, standards are shared as part of diabetes centers network cooperated alliances.
LD.3.5. The diabetes center steering committee receives, and resolves, patient and non-patient related ethical dilemmas, within identified timeframe.
LD.3.6. Discussions, decisions, and actions taken are documented in a formal meeting minute.
LD.3.7. Diabetes center director summarizes the ongoing discussions to the hospital director.
LD.4. The Diabetes center optimizes patients flow throughout the hospital from the time they arrive until they leave.
LD.4.1. The Diabetes center director works collaboratively with hospital leadership to develop a map addresses all parts of patient's journey.
LD.4.2. The Diabetes center director selects representatives from relevant clinical services as liaison officers to facilitate diabetic patients' journey.
LD.4.3. The Diabetes center identifies and overcomes all obstacles, in the patients' journey.
LD.4.4. The Diabetes center matches capacity in line with demand and responds dynamically to changes in demand.
LD.4.5. The Diabetes center director works collaboratively with hospital leadership to reduces waiting time, backlogs, avoidable admissions, length of stay, improves the net response time, as well as the patient planning process for transfer or discharge.
LD.5. The Diabetes center manages the supply chain in a cost-effective manner.
LD.5.1 The center works collaboratively with hospital leadership to effectively manage the supply chain, to achieve timelines and efficiency of inputs, warehousing, and distribution.
LD.5.2. The center ensures optimal use of the supply within the program by handling over, under and misuses.
LD.6. The Diabetes center enhances social and community participation in DIABETES healthcare services.
LD. 6.1. The diabetes center considers the perspective of the community as partners in healthcare decision-making processes.
LD. 6.2. The diabetes center with relevant stakeholders ensure a range of services is available locally for people to choose from as possible as they can.
LD.6.3. The diabetes center coordinates with the community key stakeholders to improve the public awareness of the diabetes risk factors and early symptoms of diabetes.
LD.6.4. The diabetes center evaluates and utilizes stakeholders' inputs to guide decision making and the provision of health services.
LD.7. The Diabetes center provides the community with information on its services and its accessibility.
LD.7.1. The diabetes center provides the community through different means with an appropriate format and understandable information on its scope of services and when and how to access.
LD.7.2. Patients and their families/caregivers and the general community have a user-friendly access to information about health and healthcare services using different communication means.
LD.8. The Diabetes center provides on going community education to improve the public awareness of the risk factors, early symptoms and complications of diabetes.
LD.8.1. The diabetes center provides the Primary Health Centers (PHCs) with the educational materials according to the best evidenced based practice.
LD.8.2. The diabetes center empowers the PHC's personnel with the right tools in education by training and couching them.
LD.8.3 The diabetes center involves other amenities like universities and education facilities in the area in the process of development and training the PCH's personnel
LD.8.4 The diabetes center provides awareness and education to the people with diabetes in regards the burden and complications of the disease and how to reach better control
LD.8.5 The diabetes center ensures the implementation of the education process provided to the public by measurable indicators.
LD.9. The Diabetes center develops an effective policy and procedure to guide the management of patients and families /service users' complaints, concerns, and suggestions.
LD.9.1. Diabetic Center must have a process for receiving complaints, concerns and suggestions and making them publicly available.
LD.9.2. The diabetes center assigns a specific unit or person responsible for receiving, recording and managing complaints, concerns, and suggestions.
LD.9.3. Patients /service users receive feedback about their complaints concerns and suggestions within a defined timeframe.
LD.10. The Diabetes center seeks feedback from patients and service users regarding the services provided.
LD.10.1 The diabetes center conducts direct patients/service users interviews at the provision point, focus group, telephone calls and the appropriated social media.
LD10.2. The diabetes centers conduct patients/service user's satisfaction survey periodically to improve patient experience.
LD.10.3. The diabetes center evaluates the patient satisfaction report through departmental meetings to improve the patient journey and their experience.
LD.11. The Diabetes center director obtains participation of qualified quality staff to support the quality of provided services.
LD.11.1. The quality staff support implementation of relevant quality management and patient safety plan, including risk management program.
LD.11.2. The quality staff assist the diabetes centers in integrated data collection, aggregation, validation, analysis, and interpretation of data.
LD.11.3. The quality staff support the diabetes centers in performance improvement activities including projects.
LD.12. A multidisciplinary quality and risk management committee to oversees the quality of service.
LD.12.1. The center director assigns a quality and risk management committee with periodic meetings and annual reports to be submitted to the director of the center.
LD.12.2. The committee chairman is one of the center consultants knowledgeable in quality and risk management tools by education and training.
LD.12.3. The committee provides oversight, monitoring and assessment of key organizational processes, outcomes, and reports; makes recommendations concerning physician credentialing and educational activities; and recommends appropriate policies.
LD.12.4. The committee is responsible to monitor the implementation of the quality improvement plans.
LD.12.5. Discussions, and actions taken are documented in a meeting minute.
LD.12.6. The committee chairman report to the center 's director discussions, decisions and actions taken.
LD.13. The Diabetes center quality team designs and monitors the implementation of risk management program, in line with hospital risk management program.
LD.13.1. The diabetes center risk management program has a plan that details the following:
Identify Risk, Quantify & Prioritize Risk, Investigate & Report Sentinel Events, Perform Compliance, Reporting and Capture & Learn from Near Misses & Good Catches
LD.13.2. Reducing medical errors must be set as a goal and one of the main concerns of the strategic plan of the center.
LD.14. The Diabetes center manages safety incidents, adverse events and near misses that affect or may affect patients/service users, staff, and facility and in line with hospital policy and procedures.
LD.14.1. The diabetes center develops a policy that outlines the types of safety incidents, adverse events and near misses to be reported internally and externally to relevant regulatory authorities with the time frame and mechanism for reporting.
LD.14.2. The center utilizes a risk scoring matrix to categorize the severity of incidences.
LD.14.3. Incidents involving patients/service users are documented in the medical record.
LD.14.4. The diabetes center quick fixes the situation, mitigates consequences of safety incident as needed.
LD.14.5. The diabetes center performs an intensive root cause analysis for all severe adverse events and high potential near misses.
LD.14.6. Staff are aware of the incidents in their working areas and educated on the notification and reporting mechanism.
LD.14.7. The diabetes center follows the hospital plan for managing sentinel events.
LD.15. The Diabetes center prioritizes and selects a set of indicators that focus on the essential structures, processes and outcomes of the services provided.
LD.15.1. The diabetes center develops a set of indicators cover the essential structures, processes and outcomes of the services provided.
LD.15.2. Diabetes centers should comply with SNDC key performance indicator.
(for more details Refer to appendix (1) SNDC standards of services and quality measures in diabetes centers and unit. table 2)
LD.15.3. The indicators' results are discussed with staff and reported monthly to hospital leadership along with action plans taken for improvement.
LD.16. The Diabetes center implements and monitors a comprehensive quality management and patient safety program in line with hospital quality and patient safety program.
LD.16.1. The diabetes center leaders develop quality management and patient safety program collaboratively and allocate responsibilities and resources.
LD.16.2. The diabetes center covers all services provided and focuses on essential safety requirements.
LD.16.3. The diabetes center utilizes key performance indicators, surveys, safety incidence, complaints, and suggestions for prioritizing quality improvement projects.
LD.16.4. The diabetes center utilizes an evidence-based quality improvement methods and tools.
LD.16.5. Quality and patient safety information is readily accessible in a timely manner to those responsible for the delivery of the services and is utilized for making improvements and supporting the leaders' decision making.
LD.17. The DIABETES center provides secure tele-DIABETES services to other hospitals in its network to ensure integrated DIABETES care, whenever the need arises.
LD.17.1. Diabetes center have virtual clinics distributing among pediatric endocrinologist, adult endocrinologist, clinical dietitian, and educator.
LD.17.2. Every specialty should have at least 1 virtual clinic per month and 10-12 clinics per year.
LD.17.3. The diabetes center develops a process for secure storage of data and information.
LD.17.4. The diabetes center monitors information security, confidentiality and integrity and takes actions on the areas of improvement.
LD.18. The center has continuing education and training program for all categories of staff
LD.18.1. the center has scheduled educational and training program based on needs/ scope of service include but not limited to: patient safety, risk management and infection control.
LD.18.2. Center has clinical evidence-based practice educational plan.
LD.18.3. There is a policy and procedure contain a list of required competency assessment in each staff category.
LD.18.4. All staff are evaluated annually for required competencies.
LD.18.5. Participate in post-graduate training program.
LD.18.6. Participate in research proposal/ publication.
LD.19. The DIABETES center participates in a registry for its population and services provided.
LD.19.1. The diabetes center registers all cases especially the new cases.
LD.19.2. The diabetes centers maintain a registry for its population and services provided.
LD.19.3. The register follows SNDC diabetes registry, electronic statistical system for diabetes centers
LD.19.4. Ensure assigning a personal to fulfill the requirements
PC.1. The DIABETES services are accessible and obtainable in equity manner, to all patients whose medical needs can be met within the capability of the DIABETES program.
PC.1.1. The diabetes center informs patients about how to access care, treatment, and services.
PC.1.2. Timely access to and appropriateness of care and treatment are available to all patient out of any discrimination.
PC.1.3. The diabetes center ensures that all relevant services for its targeted population are available.
PC.1.4. Acuity of the patient's condition determines the resources allocated to meet the patient's needs.
PC.2. The hospital's layout, structure and function facilitate the delivery of reliable, timely and safe care to patients.
PC.2.1. The hospital's layout optimizes flow of inpatients between all needed units.
PC.2.2. The laboratory tests and other required investigations are ease accessible and obtainable in identifiable time, whenever the need arises.
PC.3. The Diabetes center uses clinical pathways and protocols to guide the process of providing effective emergency care to DIABETES patients through:
PC.3.1. The diabetes center program implements a standardized emergency care protocol for diabetes patients
PC.3.2. The diabetes center monitors the implementation of the protocol
PC.3.3. Educate staff and spreading the materials to make sure staff following the standard of care in emergency management.
PC.4. The clinical laboratory is fully equipped for a spectrum of tested procedures and has qualified and competent staff to meet the patients' needs.
PC.4.1. The clinical laboratory department is available and accredited
PC.4.2. Qualified and competent staff perform and report the tests.
PC.5. Multidisciplinary team involved in the management of DIABETES patients, develops a policy and procedure for the assessment / reassessment of patients.
PC.5.1. The policy defines the scope, content of the assessment, frequency of the reassessment process to all diabetic patients.
PC.5.2. The team utilizes assessment sheet which contain at least diabetes classification, lab finding, social/family history, allergy, comorbidities, physical examination, diabetes education, foot exam and plan.
PC.5.3. The assessment sheet for pediatric includes national growth chart.
PC.5.4. The assessment identifies the patient discharge or referral planning based on the patient's needs.
PC.5.5. The assessment identifies the risk stratification of patients.
PC.6. The DIABETES team develops a comprehensive multidisciplinary plan of care, based on assessment findings, and directed by clinical practice guidelines
PC.6.1. The center's programs are collaboratively designed, implemented, and evaluated.
PC.6.2. The center's program develops a plan of care that is based on the patient's assessed needs
PC.6.3. The center develops a standardized process originating in SNDC Saudi Diabetes Mellitus Clinical Practice Guidelines first addition 2021 to deliver or facilitate the delivery of clinical care.
PC.6.4 Patients' needs are reassessed when indicated and care plan is revised and modified accordingly.
PC.6.5. The most responsible physician ensures the relevance and integration of other healthcare givers' plans.
PC.6.6. Care plan is documented for each patient.
PC.6.7. the center emphasizes PHCs to implement SNDC screening program.
PC.7. The center involves patients in making decisions about managing their disease or condition.
PC.7.1. The center involves patients in decisions about their care, treatment, and services.
PC.7.2. The center assesses the patient's readiness, willingness, and ability to engage in self-management activities.
PC.7.3. The center assesses the family and/or caregiver's readiness, willingness, and ability to provide or support self-management activities when needed.
PC.7.4. The center utilizes the assessment of the patient and family and/or caregiver to guide the development of a self-management plan.
PC.7.5. Patients and practitioners mutually agree upon goals.
PC.8. The Diabetes centre addresses the patient's self-management plan and supports patients to pursue an independent healthy lifestyle.
PC.8.1. The center promotes lifestyle changes that support self-management activities.
PC.8.2. The center evaluates barriers to lifestyle changes.
PC.8.3. The center engages family and community support structures in the patient's self-management plan, as directed by the patient.
PC.8.4. The center assesses and documents the patient's response to recommended lifestyle changes.
PC.8.5. The center refers the patient if needed to Psychology/psychiatry or adolescent medicine specialist depending on the age.
PC.8.6. The center refers the patients to diabetes educator and Clinical dietitian if needed
PC.8.7. The center prescribes glucose monitoring machine and equipment as needed
PC.9. Skilled multidisciplinary team guides the provision of comprehensive education services.
PC.9.1. The center education materials comply with recommended elements of care, treatment, and services, which are supported by literature, clinical practice guidelines and evidence-based practice.
PC.9.2. The center presents content in an understandable manner according to the patient's level of literacy.
PC.9.3. The center presents content in a manner that is culturally sensitive.
PC.9.4. The center addresses the education needs of the patient regarding his or her disease or condition and care, treatment, and services.
PC.10. The Diabetes center conduct periodically, minimum every 3 months and as needed, mortality and morbidity meetings.
PC.10.1. The center has a mortality and morbidity committee assigned in diabetes center
PC.10.2. All mortality and morbidity cases are reviewed on ongoing basis to highlight avoidable cases.
PC.10.3. The center documents the interventions taken by the meeting minutes.
PC.10.4. Shared cases between departments are referred to the medical director to decide on presenting it to the hospital morbidity and mortality committee.
PC.11. Referral pathway guides patient referral process within the DIABETES network, based on the patient's health needs according to SNDC.
PC.11.1. The pathway highlights the patient's acceptance criteria.
PC.11.2. The pathway identifies the required essential information communicated and care needed during transfer.
PC.11.3. The pathway defines the operation times of the communication channels to facilitate immediate transfer.
PC.11.4. The pathway determines staff accountability on both ends of the transfer process.
PC.11.5. The pathway addresses the infection prevention and control measures to be followed.
PC.11.6. The referral center has availability of access to care for new patient with one of the team within 2 to 4 weeks and follow up visit for follow up patient within 3 months.
PC.11.7. The referral center has availability visit with educator, clinical dietitian, and retina exam within 3 months from the first visit and encouraging to be seen by all in the first visit (ONE stop).
PC.12. The diabetes center initiates discharge planning and facilitates arrangements for subsequent care, treatment, and services to achieve mutually agreed upon patient goals
PC.12.1. Diabetes center team discusses and plans with the patient and family the care, treatment, and services that are needed to achieve the mutually agreed upon self-management plan and goals.
PC.12.2. Diabetes center team member collaborates with patients to arrange a follow-up appointment within one month of discharge with the patient's primary care provider, endocrinologist, or diabetes educator.
PC.12.3. In preparation for discharge, the program communicates the patient's needs and goals to other practitioners who will continue to support the patient in achieving the desired outcomes.
PC.12.4 Patients and families could identify and discuss their post- discharge needs.
PC.12.5. All medications and support services necessary for a safe discharge should be organized and documented in the discharge summary.
PC.13. Diabetes center has specific requirement for the initial visit
PC.13.1. All DM referrals must be screened within 1 week of referral date.
PC.13.2. Patient who is accepted must do laboratory tests (CBC, LIPID, A1C, LFT, RENAL, ACR) one week before his appointment in the clinic.
PC.13.3. Diabetes center has acceptant criteria to accept patients with diabetes.
PC.13.4. Five parties (stations) is preferred to be done in one visit, if not possible it has to be completed within 2 weeks from 1st visit. The five parties include (Physician: covered by the assistant and consultant on call for DM, Diabetes educator, Retinal examination, Clinical dietitian and Foot examination.
PC.13.5. All patients with diabetes, at the end of first visit, receive the needed medication, medical supply and needed education.
PC.13.6. All patients with diabetes receive follow up appointment in 3 months or according to patient needs.
PC.14. Diabetes center has a policy for high risk patients with diabetes.
PC.14.1. DC has a policy to identify high risk patient including but not limited to the following: severe hyperglycemia, severe and/or frequent hypoglycemia, hypoglycemia unawareness and frequent DKA.
PC.14.2. High risk Patients have 2 to 3 visits per month.
PC.14.3. High risk patients are seen by three parties: Physician: covered by the consultant endocrinologist/diabetologist, Diabetes educator and Clinical dietitian.
PC.15. Diabetes Center has insulin pump services
PC.15.1. Insulin pump service is supervised by endocrinology consultant.
PC.15.2. Diabetes center has eligibility criteria for insulin pump
PC.15.3. Pump clinic run by the following: Physician: Endocrinology/diabetology Consultant, Diabetes educator with special training on insulin pump and clinical dietitian
PC.16. the diabetes center has a process for management of children and adolescents with Type 1 Diabetes
PC.16.1 The MRP is pediatric endocrinologist.
PC.16.2. Individualized medical nutrition therapy is recommended for children and adolescents with type 1 diabetes as an essential component of the overall treatment plan.
PC.16.3. Clinical dietitian is monitoring carbohydrate intake by carbohydrate counting.
PC.16.4. Diabetes center follow the international Physical Activity and Exercise recommendations.
PC.16.5. Psychosocial services are available for pediatric patients and their families.
PC.16.6. All type 1 patient with diabetes are screened for autoimmune disease. (Table 3)
PC.16.7. All type 1 patient with diabetes are screened for long-term complications. (Table 4)
PC.17. Diabetes center has diabetes in pregnancy service
PC.17.1. DC has specific Eligibility criteria:
• Pregnant women followed by hospital or Obs/Gyn clinic within attachment area who has type 1 or 2 DM
• Pregnant women followed by hospital Obs/Gyn or clinic within the attachment area has GDM with poor control (FBS > 100 or 2hPPS > 120, or HbA1C >6.5)
PC.17.2. Diabetes Center provides institute with SNDC clinical practice guidelines to manage pregnant patients with diabetes throughout intrapartum management.
PC.17.3. Diabetes Center educate pregnant patients with diabetes to follow up with family physician after delivery.
MOI.1. The DC has a policy that defines what information is shared with staff (internal) and with other governmental and non-governmental entities (external).
MOI.1.1. The policy defines how patient demographics and medical information is shared among medical and administrative staff (paper format, electronic, or a combination).
MOI.1.2. The policy identifies how information is dispersed from staff to leaders and conversely from the leadership to staff.
MOI.1.3. The policy define what information is required to be reported to the Ministry of Health and the frequency of reporting.
MOI.1.4. The policy defines what patient information, personal and medical, that is required to be referred to a higher center.
MOI.1.5. The policy identifies the staff security levels for accessing patient information.
MOI.1.6. The policy identifies how all types of information are secured and safely stored.
MOI.1.7. The policy highlights how long the DC is required to store the various types of information (records retention) as consistent with the MOH rules and regulations.
MOI.2. The DC uses standardized diagnosis codes, procedure codes, symbols and minimizes abbreviations.
MOI.2.1. The DC uses diagnosis and procedure codes consistent with the MOH requirements.
MOI.2.2. The DC has a limited list of abbreviations and symbols distributed in all patient care areas for reference.
MOI.3. All patients seen in the DC have unique medical record files.
MOI.3.1. The contents of the medical record are arranged according to a standardized process.
MOI.3.2. Medical record files contain the required patient demographics, including National identification, contact information, emergency contacts, and insurance information.
MOI.3.3. Medical/ record files contain sufficient updated medical information to safely manage the patient (history and physical examination, plan of care, investigations, consultations, observations, consents, procedure/surgery reports, and medications) and promote continuity of care.
MOI.3.4. Medical records contain information related to adverse events and unanticipated incidents.
MOI.3.5. Patient allergies, prior adverse reactions, anticoagulation medications, and chronic infections are confidentially documented and consistently displayed in a specified area of the patient's record.
MOI.4. The DC has a policy on rules and regulations for writing in medical record files.
MOI.4.1. The medical records policy identifies the category of staff allowed to write in the medical record.
MOI.4.2. All entries in the patient's medical record are legible, dated, timed, and signed by the author.
MOI.4.3. There is uniform entry of data in medical records, whereby orders are written separately from assessments, care plans, and progress notes.
MOI.4.4. Entries written in error in the medical record are not deleted or erased. Instead, a line is passed through the error text and the entry is dated, timed, and signed by the author.
MOI.4.5. Only standardized and approved abbreviations and symbols are used in medical records.
MOI.5. The DC has a process for completing and storing patient medical record files.
MOI.5.1. The DC has a dedicated and secured storage method/area for all medical record files.
MOI.5.2. Regular checks are made on returned files to ensure completion (demographics, medical information, and authentication).
MOI.5.3. Noncompleted files are separated from completed ones in the storage area. They are completed in a time frame defined by the service.
MOI.5.4. The DC keeps a record for the percentage of incomplete records over time and uses this information to improve staff compliance with record completion.
MOI.6. The DC develops a policy and procedure for the use of information technology.
MOI.6.1. The policy and procedure on information technology highlights how generated information is stored and regularly backed up.
MOI.6.2. The policy and procedure describe the manual procedures required capture and record data in the event of system failure, maintenance, or repair.
MOI.6.3. Staff can demonstrate the manual procedure to be used in the event of system failure, maintenance or repair.
MOI.7. The leaders ensure the integrity and security of telemedicine, teleradiology, and interpretation of other diagnostic remote contracted services.
MOI.7.1. Telemedicine, teleradiology, and interpretation of other diagnostic remote contracted services are registered and comply with national health rules and regulations.
MOI.7.2. The leaders ensure the credentialing and privileging of all healthcare providers involved in the process of providing diagnostic remote services before starting the service.
MOI.7.3. The leaders ensure the security and confidentiality of patient information exposed because of the telecommunication process.
MOI.8. The DC implements an effective clinical documentation improvement (CDI) program.
MOI.8.1. The DC develops a policy and procedure for the clinical documentation improvement program.
MOI.8.2. The DC has, at a minimum, a physician and a nurse who are adequately trained on clinical documentation improvement.
Table 1: Tertiary Care level (outpatient and inpatient)
Diploma/bachelor
(SCHS accredited)
Saudi Board in ophthalmology (SCHS accredited)
Saudi Board (SCHS accredited)
Foot care clinic
Inside the center
Endocrinologist, educator and clinical dietician with accredited pump training (SCHS accredited)
Table 2 Diabetes clinic KPI's
Assessment:
This should be achieved within 5 years, after 1year, we are going to reassess benchmark locally and international and then you put a plan to reach ADA target.
**KPI well be 60% first year and then 5% annually increase.
*Although ADA recommend dilated eye exam but due to deficiency in personal providing the service we would indorse person with fundus camera service initially instead of dilated eye exam.
Table 3: autoimmune disease screening
Table 4: Long-term complication screening:
Last update: 13 April 2022
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