Chương V Luật khám bệnh chữa bệnh 2023: Chuyên môn kĩ thuật

Chapter V

PROFESSIONAL AND TECHNICAL EXPERTISE IN HEALTHCARE

Article 61. Emergency care

1. Emergency care activities shall include the following:

a) In-hospital emergency;

b) Out-of-hospital emergency.

2. Emergency must be performed on the basis of assessment, classification and application of professional and technical measures appropriate to the patient's health condition. Where it is necessary to apply urgent emergency measures without the consent from the patient's representative, the person in charge of professional practices or the shift-working chief at a medical establishment shall have the right to make the final decision.

3. When the work of emergency care requires professional and technical assistance, in the specific circumstances, the medical establishment receiving the patient in need of emergency care must perform one or a number of the following activities:

a) Hold a medical consultation pursuant to Article 64 herein;

b) Request other medical establishment to assist in emergency care;

c) Offer support by providing remote healthcare services;

d) Refer the patient in need of emergency care to an appropriate medical establishment.

4. Medical establishments shall be responsible for reserving the optimum conditions in terms of their human resources, medical equipment and medications for the work of emergency care of patients and transferring patients in need of emergency care to appropriate medical establishments.

5. Out-of-hospital emergency care service shall include the following activities:

a) First aid procedures performed by persons who have knowledge about, or are trained in out-of-hospital emergency care;

b) Emergency care procedures performed by paramedics or medical practitioners.

6. The out-of-hospital emergency care system shall be organized according to the following basic criteria:

a) It must be commensurate with the population size;

b) It is fitted to the geographical characteristics of each local area;

c) It is capable of receiving and transporting patients to medical establishments in the shortest time possible.

7. Sources of funding for the out-of-hospital emergency care shall include the following:

a) The state budget’s funding for investment in setting up the state-owned system of out-of-hospital emergency care facilities; the system of receiving information and coordinating emergency services; payment of costs of ambulance rides and charges for medical crew services on emergency ambulances in case of accidents, natural disasters, calamities, particularly dangerous infectious diseases capable of very rapid and/or widespread transmission, those causing high death rate, or those with unknown causative agents; payment of general and administrative expenses for management and operation of state-owned out-of-hospital emergency facilities;

b) Charges for out-of-hospital emergency services paid by users of these services pursuant to Article 18 and 110 herein, except as defined in point a of this clause.

8. Provincial People’s Committees shall have the duty to organize the state-owned out-of-hospital emergency care system in local areas falling within their remit.

9. The Government shall impose detailed regulations on provision of funding for emergency services as referred to in point a of clause 7 of this Article.

Article 62. Medical examination, prescription for treatment methods (or therapies) and medications

1. Medical examination, prescription for treatment methods (or therapies) and medications shall follow regulations on professional and technical expertise in healthcare issued or endorsed by the Minister of Health.

2. Medical practitioners assigned the duties to provide medical care shall assume the following responsibilities:

a) Carry out the medical examination, prescription for treatment methods (or therapies) and medications in a timely, accurate and accountable manner;

b) Based on a patient's medical condition, the medical practitioner can prescribe him/her outpatient, day or inpatient treatment. If the medical establishment does not have any bed available for that patient needing the inpatient treatment, they must refer him/her to another appropriate medical establishment.

Article 63. Medication administration in treatment

1. Administration of medications in healthcare shall adhere to the following principles:

a) Ensure that medications are prescribed only when really needed; serve the right purposes; are administered in a safe, reasonable and efficacious manner;

b) The prescription of medications must be closely associated with a patient's diagnosis and medical condition;

c) Storage, dispensing and use of medications must be lawful.

2. When prescribing any medication, a medical practitioner must fully and clearly enter in a prescription or medical record such information as name, content, dosage regimen, directions for use and duration of use; shall not be allowed to include functional food products in a prescription.

3. When dispensing medications to a patient, the medical practitioner charged with dispensing prescription medications shall assume the following responsibilities:

a) Check over the prescription, itemized drug receipt, drug name, concentration, content, dosage regimen and directions for use;

b) Check again the prescription against such information as drug name, concentration, content, shelf life and quantity when receiving the medication;

c) Check through the patient’s name, drug name, dosage form, content, concentration, dosage regimen, directions for use and duration of use before dispensing medications to patients;

d) For a patient undergoing inpatient treatment, fully record the time of dispensing of medications; monitor and promptly detect complications, and notify the medical practitioner directly in charge of the patient case.

4. Patients shall be responsible for taking medicines as instructed by medical practitioners. Patients or patients’ representatives must promptly inform medical practitioners or medical establishments of any abnormal sign after the patients take the prescribed drugs.

Article 64. Medical consultations

1. A medical consultation shall be held when a patient case goes beyond the diagnosis and treatment competence of the medical practitioner or medical establishment, or when the patient’s health condition does not improve or worsens after the treatment course. Results of the medical consultation must be recorded and stored in the medical record.

2. Forms of medical consultation shall be as follows:

a) Intradepartmental, interdepartmental and entire-hospital consultation;

b) Inter-institutional consultation between domestic medical establishments; between domestic and foreign medical establishments;

c) Others.

3. Types of consultations shall be as follows:

a) In-person consultation;

b) Telehealth (telemedicine) consultation.

4. Based on consultation results, the medical practitioner directly in charge of the patient case shall make the decision on appropriate diagnosis or treatment for the patient.

Article 65. Implementation of surgical and other invasive procedures

1. Surgical operations and other invasive procedures may be performed only after receiving the consent from patients or their representatives referred to in point a, b, c and d of clause 2 of Article 8 herein.

2. Surgical operations or other invasive procedures may be rendered to the patients who lose their capacity to perform civil acts; have difficulties in cognition, behavior control; have the limited capacity to perform civil acts; minor patients; the patients without families as specified in Article 15 herein.

Article 66. Patient care

1. Patient care is the act of implementation of professional and supportive intervention techniques to care for patients during the healthcare process as prescribed by medical practitioners.

2. Patient care shall encompass the following activities:

a) Determine the needs of clinical care; make the nursing diagnosis; prescribe patient care intervention medicine;

b) Divide levels of care;

c) Perform medical intervention and support procedures to care for patients, and guide patients or patient family caregivers to perform several care activities;

d) Monitor the patient's condition; measure care intervention results.

Article 67. Nutrition in healthcare

1. Nutrition in healthcare is a clinical nutrition activity and involves the counseling and guidance on nutrition regimes in healthcare.

2. Objectives of nutrition in healthcare shall comprise the following:

a) Examination, assessment, classification of malnutrition, counseling, professional guidance on pathological nutrition and monitoring of nutritional status of patients;

b) Nutrition education and communication.

Article 68. Functional rehabilitation

1. Principles of delivery of functional rehabilitation medicine shall include the following:

a) Prevent and reduce the effects of disability; carry out medical examination for implementation of early rehabilitation interventions;

b) Assess the needs for functional rehabilitation interventions in the course of medical examination and treatment of patients;

c) Ensure that intervention measures must be carried out in a continuous and comprehensive manner according to the stages of disease progression;

d) Cooperate between the rehabilitation department and others; between medical establishments on one side, and individuals, families and community and other agencies and organizations on the other side; implement community-based rehabilitation.

2. Functional rehabilitation shall comprise the following activities:

a) Examine, diagnose and determine the patient's rehabilitation needs;

b) Utilize movement therapy, physical therapy, occupational therapy, speech therapy, psychotherapy, chiropractic, medical devices, rehabilitation equipment and other interventions;

c) Offer patients and their families counsels on rehabilitation, psychology, education, career guidance and community integration;

d) Adjust and improve access to living environment suitable for health status;

dd) Propagate the practice of prevention of disabilities and diseases.

Article 69. Medical record

1. Patients undergoing inpatient treatment, day treatment or outpatient treatment in medical establishments shall have their medical records created or updated.

Physical and electronic medical records shall be of the same legal value. Forms or templates of medical records and medical record summaries shall be made available for use by the Minister of Health.

2. Medical records shall be safekept and kept confidential in accordance with law; if the medical record is classified as a state secret, the regulatory provisions of law on protection of state secrets shall govern. Depositing or archiving of medical records shall be subject to the regulatory provisions regarding archives.

3. Access to medical records of patients in treatment shall be as follows:

a) Learners, students, trainees, researchers of research institutions, training institutions, medical practitioners, persons directly involved in the treatment of patients at medical establishments may read medical records, and may copy medical records only when obtaining the consent from the safekeeping medical establishments;

b) Practitioners from other medical establishments may read and copy them with the consent of the safekeeping medical establishments.

4. Access to medical records of patients completing treatment that are kept as archives shall be as follows:

a) Representatives of state management agencies in charge of health, investigative agencies, procuracies, courts, health inspectors, forensic organizations, forensic psychiatrists, and patients' lawyers shall be allowed to access and provide medical records to perform their tasks in accordance with relevant laws;

b) Learners, students, trainees, researchers of research institutions, training institutions, medical practitioners at medical establishments may borrow medical records to read on the spot, or may copy medical records for later use in their researches or the work relating to their professional expertise with the consent of the safekeeping medical establishments;

c) Representatives of social insurance agencies or state compensation settlement agencies may borrow medical records to read or take notes on the spot, or request copies of the given medical records to serve the purpose of performing their assigned tasks with the consent of the safekeeping medical establishments;

d) Patients or their representatives specified in point c and d of clause 2 of Article 8 herein shall be entitled to read, view, copy and take notes from their medical records, and be provided with medical record summaries upon written request;

dd) Patients’ representatives specified in point a and d of clause 2 of Article 8 herein shall be entitled to medical record summaries upon written request.

5. When using information included in medical records, those specified in clause 3 and 4 of this Article must treat such information completely confidential and only use them for the given purposes as registered with the medical establishments.

Article 70. Shift work in healthcare

1. Medical establishments with inpatient beds and/or beds for monitoring and treatment of patients and out-of-hospital emergency care centers shall organize the on-call and continuous medical shift system according to the working hours specified in operating licenses, including holidays, New Year's Days or days-off, in order to promptly give emergency care and maintain other medical activities.

2. Shift work practice in healthcare shall cover the following components:

a) Leadership shift work;

b) Clinical shift work;

c) Subclinical shift work;

d) Logistics and administrative shift work.

3. Shift work practice in healthcare at medical establishments shall include all of the foregoing components; Shift work in healthcare defined in clause 1 of this Article at a medical establishment which is not a hospital shall be subject to the regulations promulgated by the Minister of Health.

4. Heads of medical establishments defined in clause 1 of this Article shall assume the following responsibilities:

a) Design the shift worker’s schedule;

b) Ensure the sufficient number of emergency ambulances according to the form of organization of healthcare of each medical establishment; fully provide essential medical equipment and medications used in emergencies;

c) Implement the shift-based reporting regime.

Article 71. Prevention of medical incidents at medical establishments

1. The prevention of medical incidents shall be practised on the basis of identifying; reporting; conducting analyses to find the causes of; giving cautions and solutions to prevent and avoid the recurrence of medical incidents to improve the quality of healthcare services and patient safety.

Cautions and solutions aimed at preventing medical incidents shall be published on the healthcare management information system.

2. Heads of medical establishments and staff working for medical establishments shall be charged with the prevention of incidents in hospital.

Article 72. Reception and management of patients without families

1. When receiving patients without families and rendering healthcare services to them, medical establishments shall be responsible for tallying, making a tally report of and keeping the patient's belongings.

2. Within 48 hours after receiving a patient, if it is impossible for a medical establishment to identify a patient’s family, the medical establishment shall have the following responsibilities:

a) Report the patient case to the commune-level People's Committee of the locality where the medical establishment is located in order for it to post the notification of search for the patient’s missing family via mass media;

b) If the child patient under 6 months of age is abandoned at the medical establishment, the receiving medical establishment shall submit an application package for admission of the social protection beneficiary to the social welfare centers in accordance with laws on social protection.

3. With regard to a patient who loses his/her capacity to perform civil acts; faces impaired cognition, difficulties in behavior control; has limited capacity to perform civil acts, if the receiving medical establishment fails to identify his/her family after his/her being restored to a stable condition after end of the treatment, that medical establishment shall submit an application package for admission as an extremely disadvantaged social protection beneficiary to a social welfare center in accordance with laws on social protection.

4. If a patient is dead, the medical establishment receiving that patient shall take action under Article 73 herein.

5. Medical establishments shall be responsible for offering care, nursing, medical examination and treatment services for a patient during the period from reception to completion of referral to social welfare centers, or until that patient is dead.

6. The Government shall impose regulations on payment of costs of care, nursing, medical examination and treatment services to those beneficiaries referred to herein, and on management of patients without families who are foreign nationals.

Article 73. Management of death cases

1. Management of death cases prior to arrival at a medical establishment shall be subject to the following regulations:

a) If the receiving medical establishment manages to find the dead patient’s identification documents and successfully contacts his/her family, they shall inform his/her family of the death and request them to come to claim the dead body;

b) If the receiving medical establishment finds out the dead patient’s identification documents; or finds out the dead patient’s identification documents, and fails to contact his/her family, in either case, they shall issue a notification of the dead patient to the commune-level People’s Committee of the locality where that medical establishment is located within 24 hours from the time of receipt of the dead body.

The commune-level People's Committee of the locality where the receiving medical establishment is located shall receive and bury the dead body within a maximum of 48 hours after receipt of the aforesaid notification.

2. A medical establishment shall manage a death case according to the following regulations:

a) That medical establishment shall have the duty to issue a death notice; conduct a death review meeting; complete and deposit the patient's medical record; take and store any specimen of the dead body needed for later identification of the patient's identities as specified in point b of clause 1 of this Article; notify the patient's family in order for them to prepare for burial activities;

b) That medical establishment shall have the duty to notify the commune-level People's Committee of the locality where the medical establishment is located within 24 hours from the time of the death of the patient if the patient's dead body is left unclaimed or denied.

The commune-level People's Committee of the locality where the receiving medical establishment is located shall receive and bury the dead body within a maximum of 48 hours after receiving the notification specified in point b of this clause.

3. The Government shall impose regulations on management of death cases involving foreign patients without families, and on payment of costs of the burial service specified in point b of clause 1 and point b of clause 2 of this Article.

Article 74. Hospital-acquired infection control

1. Infection control in the healthcare setting shall include the following measures:

a) Surveillance of healthcare-associated infections and epidemic-prone diseases;

b) Monitoring of compliance with infection control practices;

c) Standard precautions, transmission-based precautions;

d) Infection control for medical instruments and equipment;

dd) Hand hygiene;

e) Environmental hygiene;

g) Prevention and treatment of microorganism-associated infections;

h) Food safety;

i) Other infection control measures.

2. Medical establishments shall assume the following responsibilities:

a) Implement infection control measures specified in clause 1 of this Article;

b) Sufficiently provide physical facilities, equipment, protective clothing, and personal hygiene conditions for hospital staff, patients and other healthcare visitors subject to hospital-acquired infection control requirements;

c) Offer patients and their families counsels on infection control measures;

d) Organize infection control systems in place at medical establishments.

Article 75. Medical waste management and environmental protection in the healthcare setting

Medical establishments shall be responsible for medical waste management and environmental protection at medical establishments in accordance with laws on environmental protection.

Article 76. Outpatient treatment

When the inpatient treatment is not required, the outpatient treatment may be applied.

Article 77. Inpatient treatment

1. Inpatient treatment shall be applied when the patient must remain at a medical establishment to receive medical care as recommended by the medical practitioner.

2. Depending on its corresponding specialization and operational condition, a medical establishment may provide inpatient treatment services. Private polyclinics located in poor, extremely poor areas, border areas or islands; state-owned regional polyclinics; maternity wards; commune health stations are allowed to set medical beds ready for monitoring and treatment of patients within a maximum of 72 hours, except in case of force majeure events, such as natural disasters, catastrophes or epidemics.

3. Interdepartmental referral shall be carried out as follows:

a) Such referred shall be permitted if it is discovered that other specialized department is suitable to treat a patient's condition;

b) The referring department is required to complete the patient’s medical record, transfer the patient and his/her medical record to the receiving department.

4. Where an inter-institutional referral is required, the referring medical establishment shall complete the medical record and refer the patient to the receiving one.

If such inter-institutional referral is carried out at the request of the patient referred to in Article 15 herein, or his/her representative, that patient or his/her representative shall be required to give a written commitment on his/her personal responsibility for such referral.

5. A patient may leave a medical establishment when:

a) that patient has recovered or his/her condition is stable;

b) the patient who loses his/her capacity to perform civil acts, has impaired cognition or difficulties in behavior control or limited capacity to perform civil acts; the minor patient; or his/her representative applies for such leaving and submits their commitment.

6. When a patient is leaving, the medical establishment shall assume the following responsibilities:

a) Complete his/her medical record;

b) Provide self-care instructions;

c) Recommend the patient to undergo the outpatient treatment where necessary;

d) Deal with payments on medical bills;

dd) Give out the completed hospital discharge form.

Article 78. Day treatment

1. A patient may undergo the day treatment when they are prescribed the inpatient treatment by the medical practitioner without needing to remain in hospital.

2. Day treatment shall be as specified in Article 77 herein.

Article 79. Mobile healthcare

1. Mobile healthcare services shall include the following:

a) Mobile or outreach health activities taking place at venues other than the official address specified in the operating license of the medical establishment organizing these activities;

b) Home or workplace healthcare services

c) Humanitarian outreach healthcare campaigns organized at intervals.

2. Conditions for provision of mobile healthcare services shall be as follows:

a) The mobile health care activities and services specified in point a and b of clause 1 of this Article must be provided by a medical establishment with a sufficient number of medical practitioners, equipment, facilities and other suitable conditions corresponding to the scale and scope of mobile health services, except for home healthcare services performed by local village or community health workers and midwives;

b) The mobile health care activities and services specified in point c of clause 1 of this Article must conform to the conditions set out in clause 2 of Article 88 herein;

c) The mobile healthcare services and activities specified in point a and c of clause 1 of this Article can commence with the consent of a health agency under the People's Committee of the province where they are planned to take place, except as medical establishments under the People’s armed forces render these services and activities to patients under these armed forces’ authority.

3. The Government shall elaborate on this Article.

Article 80. Telehealth and telehealth support

1. Telehealth occurring between medical practitioners and patients shall be carried out as follows:

a) It shall depend on the scope of practice of the medical practitioner; the remote treatment shall be delivered according to the nomenclature of diseases or medical conditions sanctioned by the Minister of Health;

b) Medical practitioners shall be liable for their clinical diagnosis results, prescription for therapies or remedies and medications.

2. Telehealth support occurring between medical establishments shall be carried out as follows:

a) Medical practitioners directly in charge of patient cases at the supported medical establishments shall be responsible for their medical examination and treatment results;

b) The supported medical establishments must pay costs of telehealth support to the supporting ones at the prices agreed upon between them.

3. The Government shall impose detailed regulations on telehealth and telehealth support.

Article 81. Family medicine

1. Family medicine shall be delivered by family medical establishments or other healthcare facilities whose family medicine is one of their scope of professional services or activities.

2. The medical establishments defined in clause 1 of this Article shall perform the following tasks:

a) Render primary health monitoring and care services in local areas falling within their remit;

b) Provide counsels and preventive medicine services relating to diseases, bodily impairments, and health improvement;

c) Deliver primary emergency care and medical services;

d) Provide home-based healthcare, functional rehabilitation, palliative care and end-of-life care services;

dd) Make decisions to refer patients under their management to other medical establishments; receive and manage the health of patients received from other medical establishments;

e) Perform other tasks assigned by competent authorities.

Article 82. Involuntary treatment

1. Patient cases subject to the involuntary treatment requirements in accordance with this Law shall be defined as follows:

a) Persons suffering from group-A infectious diseases that are defined in laws on prevention and control of infectious diseases;

b) Persons with depression susceptible to suicidal thoughts and behaviors; persons with mental illness in an agitated state that is likely to harm himself or with behaviors harming other persons, or destroying property;

c) Others defined by law.

2. The Government shall regulate involuntary treatment measures applied to those defined in clause 1 of this Article.

Article 83. Medical examination

1. Types of medical examination shall be as follows:

a) Periodic health check-ups;

b) Health checks for health classification for study and employment;

c) Health screenings at school for pupils and students;

d) Health checks designed for particular occupations or job positions;

dd) Health screenings for detection of occupational diseases;

e) On-demand health checks;

g) Others.

2. The Minister of Health shall lay down regulations on medical examination standards and medical examination activities prescribed in clause 1 of this Article, except as defined in clause 3 of this Article.

3. The Minister of National Defence and the Minister of Public Security shall promulgate regulations on particular health standards and medical examination activities applied to persons undergoing medical examination under their authority.

Article 84. Medical assessment

1. Medical assessment is classified into initial assessment, reassessment, review assessment and final assessment.

2. Assessment conclusions must be relevant to questions of the assessment sought or requested by entities or persons. Entities or persons publishing assessment findings shall be legally responsible for these findings.