Chương IV: Thông tư 40/2015/TT-BYT Chuyển tuyến khám bệnh, chữa bệnh bảo hiểm y tế

Chapter IV

REFERRALS IN MEDICAL EXAMINATION AND TREATMENT COVERRED BY HEALTH INSURANCE

Article 10. Referrals in medical examination and treatment covered by health insurance

The referrals in medical services shall comply with Circular No. 14/2014/TT-BYT dated April 14, 2014 of the Ministry of Health on referrals between health facilities according to medical techniques, except for particular cases prescribed in Article 11 of this Circular.

Article 11. Appropriate referrals

1. Each holder of health insurance card who registered for initial medical services at health facilities of communes or polyclinics or hospital of districts may get medical services at health stations of communes, polyclinics or hospitals of districts in the same province.

2. Each holder of health insurance card who registered for initial medical services at a health facility of commune may take a referral to a hospital of district, including grade I, II hospitals of district and hospitals of traditional medicine of province (if the hospital of district has no department of traditional medicine).

3. Each holder of health insurance card may take a referral from a hospital of district, including grade I, grade II hospital and polyclinic hospital, specialized hospital, specialized institute, specialized center of province, to a specialized center of province or polyclinic hospital, specialized hospital, specialized institute of province at the same level or lower level.

4. Emergency cases:

a) A patient shall be given emergency treatment at any health facilities. The doctor or physician assistant receiving the patient shall assess the emergency conditions and record in medical record.

b) After emergency treatment, the patient shall be admitted as an inpatient to the receiving facility or referred to another health facility for continuing treatment at the specialist requirements or referred to the original facility upon his/her rehabilitation.

5. In case the referred patient has another disease already, or a disease that is diagnosed apart from the disease specified in the outward referral form, the receiving facility shall give treatment to those diseases within its capacity.

6. When a holder of medical insurance card goes on a business trip, studies, works or resides temporarily for a period of under 12 months in another administrative division, he/she is eligible for medical services at a health facility in the administrative division at the same level with the initiating facility specified in his/her health insurance card. If that administrative division has no equivalent heath facility, the holder of health insurance card may choose another heath facility providing initial medical services.

Article 12. Using outward referral forms and follow-up appointment forms in medical services

1. Outward referral forms for patients having health insurance cards:

a) If a patient is referred to another heath facility, he/she is only required an outward referral form made by the heath facility that directly makes the referral.

b) In case a patient arrives at a heath facility other than his/her initiating heath facility and he/she is referred to another health facility, he/she is only required an outward referral form of the heath facility that directly makes the referral.

c) Each outward referral form shall be valid within 10 working days, from the day on which it is signed;

d) With regard to patients having health insurance cards that suffer from diseases, groups of disease and those eligible for using the outward referral form prescribed in Appendix 1 issued herewith, their outward referral forms shall be valid until December 31 of such calendar year. In case where a patient mentioned above, at the end of December 31 of the year, still be an inpatient in the health facility, his/her outward referral form only be valid until the end of such impatient treatment.

2. Follow-up appointment forms: Each follow-up appointment form shall be used only one time according to the mentioned time. The follow-up appointment form for patients covered by medical insurance shall be prescribed in Appendix enclosed herewith.