Disease Management

• Applying and promoting disease management, health promotion, and wellness concepts and strategies to assigned patients and those identified for disease management. 
• Providing one on one patient education regarding to chronic comorbidities.
• Encourage SMART (Specific, Measurable, Achievable, Realistic and Timely) goals and follow up with each patient through face to face appointment or telephone conversations.
• Intervene, advocate, and provide care plan in collaborations with medical and nursing team to improve patient's health outcome.
• Promote wellness and health promotion with participation of health events such as Women's Health Day, Healthy Heart Day, radio talk, pamphlets, etc.