1. Family doctor: mainly responsible for diagnosis and treatment, physical examination and health guidance and consultation services. Grasp the basic health status, family situation and economic situation of each contracted resident, and formulate personalized health management plan.
2. Community Nurses: Grasp the basic health status, family status and economic status of each contracted resident, assist family doctors to establish, update and maintain residents' health files, and conduct follow-up and health management in outpatient clinics. Assist family doctors to make daily diagnosis and treatment appointments, coordinate consultation and referral, and follow up the referral in place.
3. Public health personnel (information officer): to master the basic health status, family status and economic status of each contracted resident, assist family doctors to evaluate the individual health status of residents, put forward suggestions on management measures, and establish, update and maintain residents' health records.
4. Team leader: under the unified management of primary medical and health institutions, fully responsible for the management and operation of the team. Responsible for forming a team and reasonably arranging the division of labor among members.
Working system of family doctor team
(1) Obey the unified management of the organization and strictly implement the rules and regulations of the organization.
(2) Establish a system of division of labor and cooperation among team members, and cooperate closely to carry out their duties.
(three) publicity team members' names, contact information, division of labor, service time and content, supervision institutions and telephone numbers, and take the initiative to accept supervision.
(4) Formulate telephone and WeChat consultation management systems and appointment management systems, and establish service records or files.
(five) the establishment of regular meetings, case discussion, quality control and learning and training system, standardize service processes and work records, improve service quality.
(six) the development of referral, consultation and results tracking system, inspection or home visit dress, equipment, services and medical risk control system, to ensure medical safety.
(seven) the development of performance appraisal system and contract service fee distribution system, to mobilize and improve the enthusiasm of team members.
(eight) to formulate other management systems such as complaint handling, denial of service handling and satisfaction survey.