Over the past few years, the population of the aged has grown rapidly in Taiwan which makes Taiwan become a country of the elderly. Along with the longevity, it brings problems of disability and high rates of chronic disease. Because these problems need long-term care, they usually cause the high hospital admission rate and longer length of stay. If before the discharge, the patient and their family can learn the correct medical information and get appropriate nursing care after discharge, we can reduce unnecessary admission and medical costs. This will also be helpful to lighten their families' economic burden and to lower the re-admission rate. According to a survey in our hospital, no nurses in medical wards will execute discharging plan until the time of patient discharged. This is because of the lack of a partial evaluation tool, which can offer the nurse's guidelines to evaluate the patients' condition. The lacking also result in the nurses' failure of the nurses to evaluate the patient's need, such as the care of drainage tubes, sputum suction and wound care, etc. Moreover, seeking for a nursing care institution or social service can also prolong the hospitalization. Therefore, an effective evaluation tool is essential for a nurse to excavate discharging problem on the early days of the patient admission, and to make the most individually suitable discharge planning for each patient. Concerning the conditions and needs of patients in medical wards, this report sets up a list to screen patient. By putting the list into effect, we hope that all nurses can complete evaluating patients on the early days of admission. Making up an individual discharge planning, and together with the discharging service term, we can offer patient appropriate home care information and transfer services.