The item to be evaluated must have lasted or be expected to last at least 12 months unless otherwise specified. 1. Specialized care, at least one review a year. 1. Specialized care, at least one review a year. Less than four specialtiesMore than four specialties or follow-up in a complex chronic patient unit or palliative care unit 2. Medication for chronic use, prescribed by primary or hospital care.2. Medication for chronic use, prescribed by primary or hospital care.Less than five medications at least three days a weekFive or more medications at least three days a weekHospital-administered or immunosuppressive medications, including oral chemotherapy and biologicsHome intravenous medication, periodic transfusions or antibiotic therapy two or more cycles in the last twelve months 3. Hospitalizations in the last 12 months. 3. Hospitalizations in the last 12 months. NoneTwo unscheduled hospitalizations or one hospitalization longer than one monthThree or more unscheduled hospitalizations or two hospitalizations greater than one month 4. Specific feeding needs4. Specific feeding needsNoneAdapted or extensive exclusion dietFeeding via enteral nutrition device with the possibility of dividing feedingsFeeding through enteral nutrition device without the possibility of dividing feedingParenteral nutrition 5. Need for specific respiratory care.5. Need for specific respiratory care.NoneNeed for non-invasive monitoring, pulse oximetry or cardiorespiratory monitorNeed for daily aspiration of secretionsOxygen dependence, continued use or during sleepNon-invasive ventilation that allows disconnectionsNon-invasive ventilation that does not allow disconnections, more than sixteen hours a dayTracheostomyInvasive tracheostomy ventilation that allows disconnectionsInvasive ventilation through tracheostomy that does not allow disconnections, more than sixteen hours a day 6. Psychomotor development, mobility problems, functional limitations6. Psychomotor development, mobility problems, functional limitationsNormalPsychomotor delay or mild functional limitations, excludes paraplegiaModerate psychomotor delay or moderate functional limitations, including paraplegiaSevere psychomotor delay or severe functional limitations with complete dependence on the caregiver in all areas 7. Visual pathology or alteration of visual acuity with impact on daily lifePresent, not stackable with other neurological deficitsnot present 8. Other devices or techniques. Mechanical valve prosthesis or pacemaker or implantable defibrillatorHearing aid or cochlear implantVentriculoperitoneal shunt valveReservoir or central catheter, including hemodialysisColostomy or ileostomy, at least six monthsVesicostomy or ureterostomy, at least six monthsOstomy not assessed in another sectionIntermittent or permanent urinary catheter, at least six monthsNeed for rectal irrigation at least three times a week, at least six monthsNeed for hemodialysis, at least six months or waiting for transplantNeed for peritoneal dialysis, at least six months or waiting for transplant 9. Need for specific therapies.9. Need for specific therapies.NoneNeed for follow-up in early care, occupational therapy or motor physiotherapyNeed for therapy with a swallowing or language therapist or speech therapyNeed for respiratory physiotherapy or use of cough assist deviceNeed for psychological therapy or need for follow-up by the Mental Health Team 10. Special educational needs10. Special educational needsNoneOrdinary center in specific classroom or need for Therapeutic Pedagogy or Hearing and Language TeacherSpecific special education centerInability to attend school or need for home schoolingInability to attend daycare or need for adaptation or specific training in professionals to attend it 11. Life expectancy of less than 1 year or patient whose death can be expected in the following 12 months. Presentnot present TotalTotal CalculateClear fields
