Circular No. 14/2016/TT-BYT dated May 12, 2016, guidelines for some Articles on health of the Law on Social insurance

• Official number: 14/2016/TT-BYT
• Legislation Type: Circular
• Organization: The Ministry of Health
• Signer: Pham Le Tuan
• Issued Date: 12/05/2016

MINISTRY OF HEALTH -------	SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness ---------------
No. 14/2016/TT-BYT	Hanoi, May 12, 2016

CIRCULAR

 GUIDELINES FOR SOME ARTICLES ON HEALTH OF THE LAW ON SOCIAL INSURANCE

Pursuant to the Law on Social insurance No. 58/2014/QH13 dated November 20, 2014;

Pursuant to the Law on Occupational hygiene and safety No. 84/2015/QH13 dated June 25, 2015;

Pursuant to the Law on Health insurance No. 25/2008/QH12 dated November 14, 2008 and the Law No. 46/2014/QH13 dated June 13, 2014 on amendments to the Law on Health insurance;

Pursuant to the Law on Medical examination and treatment No. 40/2009/QH12 dated November 23, 2009;

Pursuant to the Government's Decree No. 63/2012/ND-CP dated August 31, 2012 defining the functions, tasks, powers and organizational structure of the Ministry of Health;

At the request of Director of the Legal Department, Director of Medical Examination & Treatment Administration, Director of Mother and Child Health Department, Director of Health Insurance Department,

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Chapter I

GENERAL PROVISIONS

Article 1. Scope

This Circular provides for:

1. List of diseases, the power to determine diseases eligible for lump-sum social insurance payout.

2. Documents and procedures for assessment of work capacity reduction as the basis for workers and their relatives to receive social insurance payout.

3. Issuance of discharge notes, birth certificate, copies of medical records, medical record summaries, confirmation of maternity leave, confirmation of poor postpartum health and confirmation of eligibility to receive social insurance benefits.

4. List of diseases that require long-term treatment in Appendix 1 enclosed herewith.

Article 2. Regulated entities

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2. Workers specified in Clause 1 of this Article whose social insurance participation period is reserved or retired workers pending pension or monthly benefits; voluntary social insurance participants who have paid compulsory social insurance premiums for at least 20 years.

3. Relatives of dead workers who participated in social insurance applying for assessment of work capacity reduction to receive death benefits for workers (hereinafter referred to as worker’s relative)

Article 3. Definitions

For the purpose of this Circular, the terms below are construed as follows:

1. Worker means an employee who participates in compulsory social insurance in accordance with the Law on Social insurance.

2. Sick leave means a period of time over which a worker is not healthy enough to work and is required by a physician to take a sick leave.

3. First assessment means the first assessment of work capacity reduction of a person who:

a) suffers from an occupational accident;

b) suffers from an occupational disease;

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d) is a relative of a social insurance participant and has reduced work capacity that needs monthly benefits;

dd) suffers from any of the diseases specified in Clause 6 Article 4 of this Circular;

4. Reassessment means assessment from the second time onwards of work capacity reduction of a person who suffers from a disease or disability because of an occupational accident or occupational disease which recurs or develops after assessment.

5. General assessment means general assessment of work capacity reduction of a person who suffers from both an occupational accident and an occupational disease; suffers from multiple occupational accidents or multiple occupational diseases.

6. Assessment by Central Medical Assessment Council means an assessment carried out by Central Medical Assessment Council in the cases beyond the capacity of a Provincial Medical Assessment Council.

7. Reassessment by Central Medical Assessment Council means a reassessment carried out by Central Medical Assessment Council after an appeal against the result given by Provincial Medical Assessment Council is filed.

8. Final reassessment means the final reassessment carried out by a Medical Assessment Council established by the Minister of Health after an appeal against the result given by Central Medical Assessment Council is filed.

9. Valid copy means a copy that is extracted from the original book or authenticated by a competent authority or has been compared with the original.

10. Medical record summary means the summary of a medical record prescribed by regulations of law on medical examination and treatment.

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LIST OF DISEASES, POWER TO DETERMINE DISEASES ELIGIBLE FOR LUMP-SUM SOCIAL INSURANCE PAYOUT

Article 4. List of diseases eligible for lump-sum social insurance payout

1. The diseases specified in Point c Clause 1 Article 60 of the Law on Social insurance.

2. Diseases that result in at least 81% work capacity reduction which is unrecoverable.

Article 5. The power to determine diseases eligible for lump-sum social insurance payout

1. The diseases eligible for lump-sum social insurance payout mentioned in Clause 1 Article 4 of this Circular must be determined at medical facilities specified in Clause 1, 2, 4, 5 and 8 Article 4 of Circular No. 40/2015/TT-BYT.

2. Work capacity reduction rate mentioned in Clause 2 Article 4 of this Circular shall be determined by a Medical Assessment Council.

Article 6. Documents proving a patient’s eligibility for lump-sum social insurance payout

1. A person who suffers from any of the diseases mentioned in Clause 1 Article 4 of this Circular shall submit a medical record summary specified in Clause 1 Article 5 of this Circular.

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Chapter III

ASSESSMENT AS THE BASIS FOR SOCIAL INSURANCE PAYOUT

Section 1. ASSESSMENT DOCUMENTS

Article 7. Cases of assessment

1. Assessment of disability due to an occupational accident.

2. Assessment of occupational diseases.

3. Assessment as the basis for provision of pension or death benefits.

Article 8. Application for first assessment

1. First assessment of disability due to an occupational accident:

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b) A valid copy of the injury confirmation issued by the health facility that provided treatment for the worker according to the template in Appendix 4 enclosed herewith.

2. First assessment of occupational diseases:

a) The employer's letter of introduction according to the template in Appendix 3 enclosed herewith or a written request for assessment prepared by the worker whose social insurance participation period is reserved or a retired worker pending pension or monthly benefits;

b) A discharge note or occupational disease record or medical record summary.

3. Assessment as the basis for provision of pension for a person paying compulsory social insurance:

a) The employer’s letter of introduction according to the template in Appendix 3 enclosed herewith;

b) A valid copy of any of the following documents (if any): medical record summary, disability confirmation, discharge note, documents about examination or treatment of diseases, injuries or disabilities such as: health book, prescriptions, follow-up appointment forms, outpatient medical record summary.

4. Assessment pending early provision of pension for a worker paying social insurance premiums or a worker whose social insurance participation period is reserved or a retired worker pending pension or monthly benefits; assessment as the basis for provision of death benefits; assessment of a retired worker or a worker suffering an occupational disease whose social insurance participation period is reserved:

a) A written request for examination according to the template in Appendix 7 enclosed herewith.

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Article 9. Application for assessment of relapse

1. Assessment of occupational accident relapse:

a) A written request for assessment according to the template in Appendix 7 enclosed herewith;

b) Documents about treatment of injury relapse:

- For inpatient treatment: a valid copy of the discharge note according to the template in Appendix 5 or medical record summary according to the template in Appendix 6 enclosed herewith.

- For outpatient treatment: valid copies of documents about examination and/or treatment of diseases, injuries or disabilities caused by the occupational accident such as: health book, prescriptions, follow-up appointment forms or outpatient medical record summary.

c) Previous medical assessment record.

2. Assessment of occupational disease relapse:

a) A written request for assessment according to the template in Appendix 7 enclosed herewith;

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c) Documents about treatment of the occupational disease relapse:

- For inpatient treatment of the occupational disease or diseases, injuries or disabilities related to the occupational disease relapse: a valid copy of the discharge note according to the template in Appendix 5 or medical record summary according to the template in Appendix 6 enclosed herewith;

- For outpatient treatment: valid copies of documents about examination and/or treatment of diseases, injuries or disabilities caused by the occupational disease relapse such as: health book, prescriptions, follow-up appointment forms or outpatient medical record summary.

d) A valid copy of the previous medical assessment record.

Article 10. Application for general reassessment

1. The employer's letter of introduction according to the template in Appendix 3 enclosed herewith or a written request for assessment according to Appendix 7 enclosed herewith if the worker is having his/her social insurance participation period reserved or has retired.

2. A valid copy of the previous medical assessment record.

3. Other documents specified in Clause 1 and Clause 2 Article 8 or Clause 1 and Clause 2 Article 9 depending on the patient and type of assessment.

Article 11. Application for assessment by Central Medical Assessment Council

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2. Valid copies of the application for assessment specified in Article 8, 9 or 10 of this Circular depending on the patient and type of assessment.

3. Any of the following documents:

a) A valid copy of the medical assessment record prepared by the Provincial Medical Assessment Council if an assessment has been carried out;

b) Minutes of meeting of the Medical Assessment Council saying the case is beyond its capacity if no assessment has been carried out.

Article 12. Application for reassessment by Central Medical Assessment Council or final reassessment

1. Application for reassessment by Central Medical Assessment Council:

a) If the reassessment is requested by an organization: a written request for reassessment by Central Medical Assessment Council prepared by the Ministry of Health, the Ministry of Labor, War Invalids and Social Affairs, Social Security Administration of Vietnam or the employer;

b) If the reassessment is requested by an individual: a written request for reassessment by Central Medical Assessment Council prepared by the Provincial Medical Assessment Council bearing the signature and seal of the head of the governing organization of the Medical Assessment Council. The request shall specify the person that disagrees with the conclusion given by the Council and requests the reassessment and be enclosed with a written request for reassessment prepared by such person;

c) Valid copies of the application for assessment specified in Article 8, 9 or 10 of this Circular depending on the patient and type of assessment;

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2. Application for final reassessment:

a) If the reassessment is requested by an organization: a written request for reassessment by Central Medical Assessment Council prepared by the Ministry of Health, the Ministry of Labor, War Invalids and Social Affairs, Social Security Administration of Vietnam or the employer;

b) If the reassessment is requested by an individual: a written request for reassessment by Central Medical Assessment Council prepared by the Provincial Medical Assessment Council bearing the signature and seal of the head of the governing organization of the Medical Assessment Council. The request shall specify the person that disagrees with the conclusion given by the Central Medical Assessment Council and requests the reassessment and be enclosed with a written request for final reassessment prepared by such person;

c) Valid copies of the application for assessment specified in Article 8, 9 or 10 of this Circular depending on the patient and type of assessment;

d) The medical assessment record prepared by the Central Medical Assessment Council.

Article 13. Responsibility for preparing the application

1. The worker shall prepare the application and send it to the Medical Assessment Council in the following cases:

a) The worker is having his/her social insurance participation period reserved and applies for assessment to receive pension;

b) The worker is having his/her social insurance participation period reserved and applies for assessment to receive lump-sum social insurance payout;

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d) A retired worker applies for assessment of relapse.

2. The employer shall prepare the application and send it to the Medical Assessment Council in cases other than those specified in Clause 1, Clause 3 and Clause 4 of this Article.

3. Governing organization of the Provincial Medical Assessment Council shall prepare the application for reassessment by Central Medical Assessment Council

4. Governing organization of the Central Medical Assessment Council shall prepare the application for final reassessment.

Section 2. PROCEDURES FOR MEDICAL ASSESSMENT

Article 14. Time limits

1. Reassessment of an occupational accident or occupational disease shall be carried out at least after 02 years (24 months) from the day on which Medical Assessment Council gives a conclusion of the rate of work capacity reduction because of the occupational accident or occupational disease.

2. Where the worker’s health deteriorates rapidly, the governing organization of the Medical Assessment Council shall request the Chairperson or Deputy Chairperson of the Medical Assessment Council to consider carrying out a reassessment before the time specified in Clause 1 of this Article.

Article 15. Power to carry out medical assessment

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a) Carry out first assessment for workers or workers’ relatives (who applies to receive death benefits);

b) Carry out assessment of relapse and general assessment for workers, unless it has been carried out by another Medical Assessment Council;

c) Send patients other health facilities for clinical examination, testing or medical imaging where necessary.

2. Medical Assessment Councils affiliated to the Ministry of Public Security, the Ministry of National Defense, the Ministry of Transport are entitled to carry out assessments for workers of units under their management. To be specific:

a) Carry out first assessment for workers or workers’ relatives (who applies to receive death benefits);

b) Carry out assessment of relapse and general assessment for workers;

c) Send patients to other health facilities for clinical examination, testing or medical imaging where necessary.

3. Central Medical Assessment Council is entitled to:

a) Carry out first assessment for workers or workers’ relatives (who applies to receive death benefits);

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c) Carry out assessment of relapse and general assessment for workers who have undergone first assessment by Provincial Medical Assessment Councils;

d) Carry out reassessment requested by Provincial Medical Assessment Council and the Minister of Health.

Article 16. Receipt of application for medical assessment

1. Applications for medical assessment shall be received as follows:

a) The governing organization of a Provincial Medical Assessment Council or Central Medical Assessment Council shall receive applications for first assessment, reassessment or general assessment;

b) The governing organization of Central Medical Assessment Council shall receive applications for reassessment by Central Medical Assessment Council;

c) Regarding applications for final reassessment:

The individual or organization that disagrees with the result given by Central Medical Assessment Council shall send an application for final reassessment to the Ministry of Health.

2. After an application is received, the governing organization of the Medical Assessment Council or the Ministry of Health shall send the applicant a receipt note according to the template in Appendix 9 enclosed herewith.

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a) The Medical Assessment Council shall carry out assessment within 30 days from the day written on the receipt note;

b) The Minister of Health shall establish a Final Medical Assessment Council to carry out the final reassessment within 20 days from the day written on the receipt note.

Within 10 working days from the day on which a decision to establish the Final Medical Assessment Council, the Council shall carry out the final assessment.

4. If the application is not satisfactory, within 10 working days from the day written on the receipt note, the governing organization of the Medical Assessment Council or the Ministry of Health shall send a written notice to the applicant.

Article 17. Medical assessment procedures

1. Comparison: the person who carries out the medical assessment shall compare the patient with one of his/her documents: ID card, passport, confirmation by the police department of the commune where he/she resides (whether temporarily or permanently) which bears the patient’s picture (the picture must be taken on a white background within 6 months before the application is made out and bear a seal of the police).

2. Overall examination: a physician of the governing organization of the Medical Assessment Council shall act as an assessor who carries out the overall examination and prescribes specialist examinations and subclinical examinations. If such physician is not an assessor, the overall examination shall be carried out and the head of the governing organization shall prescribes specialist examinations and subclinical examinations.

3. Specialist examinations: specialists shall examine and draw conclusion according to prescriptions of the competent person.

4. Consultation: Chairperson of the Council or head of the governing organization of the Medical Assessment Council shall chair the consultation before the meeting of the Council. Where necessary, the governing organization of the Medical Assessment Council shall invite the patient and specialists to participate in the meeting.

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a) Conditions for holding the meeting:

- The meeting is participated by more than 50% of its members, two of whom must be specialists;

- The meeting is chaired by the chairperson or deputy chairperson of the Medical Assessment Council.

b) Conclusion given by Medical Assessment Council:

- The conclusion shall be given by voting by every member of the Council. In case of dissenting opinions, the chair of the meeting shall consider prescribing additional examinations or treatment before holding a ballot.

- In case of ballot, the result shall be announced at the meeting. The conclusion must be concurred with by more than 50% of participating members.

c) The conclusion shall be given in writing according to the template in Appendix 2 enclosed herewith. The governing organization of the Medical Assessment Council shall issue the medical assessment record.

6. The medical assessment record shall be circulated and retained by the governing organization of the Medical Assessment Council as follows:

a) 02 copies shall be sent to the patient who shall submit 01 copy to the social insurance authority (via the employer if the patient is still working);

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c) 01 copy shall retain at the governing organization of the Medical Assessment Council.

In case of assessment of relapse, reassessment by Central Medical Assessment Council and final reassessment, the conclusion must contain conclusions of all previous examinations.

7. The conclusion given by Medical Assessment Council is permanent, unless another conclusion is given by another Medical Assessment Council at the same or superior level.

8. Medical assessment documents shall be retained at the governing organization of the Medical Assessment Council in accordance with regulations of law on document retention.

Article 18. Assessment of work capacity reduction

1. Work capacity reduction shall be assessed in accordance with Circular No. 28/2013/TTLT-BYT-BLDTBXH.

2. Methods for assessment of work capacity reduction are specified in Circular No. 28/2013/TTLT-BYT-BLDTBXH.  Assessment of work capacity reduction for general assessment:

a) Where a person who is already suffering from an injury or disease or occupational diseases catches another injury or disease or occupational disease which causes the same disability:

The rate of work capacity reduction shall be determined according to results of examination of all the injuries, diseases or occupational diseases.

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The rate of work capacity reduction caused by the new injury, disease or occupational disease shall be aggregate with that of the previous occupational accident or occupational disease written in the previous medical assessment record.

c) In case of relapse of a person’s injury, disease or occupational disease, the rate of work capacity reduction shall be determined according to result of examination of the injury, disease or occupational disease.

3. The rate of work capacity reduction specified in this Article is valid until the next medical assessment record is issued.

Chapter IV

DISCHARGE NOTE, BIRTH CERTIFICATE, CERTIFICATION OF MATERNITY LEAVE, CERTIFICATION OF INADEQUATE POSTPARTUM HEALTH

Article 19. Discharge note

1. The following entities have the power to issue discharge notes:

a) Licensed health facilities providing inpatient treatment;

b) Practitioners at a health facility specified in Point a of this Clause authorized by the head of such facility.

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Article 20. Birth certificate

1. The following entities have the power to issue birth certificates:

a) Licensed health facilities providing midwifery services;

b) Practitioners at a health facility specified in Point a of this Clause authorized by the head of such facility.

2. Procedures for issuance of birth certificates are specified in Circular No. 17/2012/TT-BYT and Circular No. 34/2015/TT-BYT.

3. The birth certificate template is provided in Appendix 10 enclosed herewith.

Article 21. Confirmation of maternity leave

1. The following entities are entitled to issue confirmations of maternity leave:

a) Any hospital having an obstetrics department;

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c) Practitioners at a health facility specified in Point a or b of this Clause authorized by the head of such facility.

2. The issuance of confirmation of maternity leave by a general hospital or practitioner thereof shall be based on the result of consultation held by departments relevant to the patient’s sickness.

3. Templates of confirmation of maternity leave:

a) The template provided Appendix 12 enclosed herewith shall be used by hospitals specified in Clause 1 of this Article for pregnant workers paying compulsory social insurance who receive outpatient treatment.

b) The template provided Appendix 11 enclosed herewith shall be used by hospitals specified in Clause 1 of this Article for pregnant workers who resigned and receive outpatient treatment;

c) Template No. 2 provided in Appendix 2 enclosed herewith shall be used by Medical Assessment Councils;

d) Discharge note template provided in Appendix 5 of medical record summary template provided in Appendix 6 enclosed herewith.

4. The confirmation of maternity leave specified in Clause 2 of this Article must specifically describe the patient’s health and necessary duration (days) of maternity leave. The duration shall comply with instructions of the Ministry of Health and the patient’s health.

5. The conclusion specified in Clause 2 of this Article is valid for 6 months from the date written on the medical assessment record and only used for grant of maternity benefits.

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1. Provincial Medical Assessment Councils and above have the power to issue confirmations of poor postpartum health.

2. The template of medical assessment record is provided in Appendix 2 enclosed herewith, the conclusion in which shall specifies that the mother is not healthy enough to provide care for her newborn child.

3. The conclusion specified in Clause 2 of this Article is valid for 6 months from the date written on the medical assessment record and only used for grant of maternity benefits.

Chapter V

ISSUANCE AND MANAGEMENT OF CONFIRMATION OF ELIGIBILITY TO RECEIVE SOCIAL INSURANCE BENEFITS

Article 23. Rules for issuance of confirmation of eligibility to receive social insurance benefits

1. The issuance of a confirmation of eligibility to receive social insurance benefits must:

a) be issued by a competent authority specified in Article 23 hereof;

b) be appropriate for the scope of operation of the health facility that issues the confirmation which is approved by a competent authority;

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2. If a worker is issued with more than one confirmations of eligibility to receive social insurance benefits by various departments, the one with the longest duration shall apply.

Article 24. Power to issue confirmation of eligibility for social insurance benefits

1. Licensed health facilities.

2. Practitioners of health facilities specified in Point a of this Clause whose signatures have been registered with a social insurance authority.

Article 25. Types of confirmation of eligibility to receive social insurance benefits

1. The template provided in Appendix 5 enclosed herewith shall be used for workers receiving inpatient treatment or children aged under 7 of workers.

2. The template provided in Appendix 12 enclosed herewith shall be used for workers receiving outpatient treatment.

If a patient needs to take a leave for outpatient treatment after discharged from the hospital, the social insurance authority shall provide social insurance benefits according to the leave duration (days) written on the discharge note.

Article 26. Provision of blank confirmations of eligibility to receive social insurance benefits

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2. Within 15 days from the receipt of the request, the social insurance authority shall provide blank confirmation of eligibility to receive social insurance benefits to the health facility. If the request is rejected, a written notice and explanation shall be sent.

Chapter VI

ORGANIZATION OF IMPLEMENTATION

Article 27. Responsibilities of affiliates of the Ministry of Health

1. Medical Examination & Treatment Administration shall:

a) Organize reviews of the implementation of this Circular nationwide;

b) Carry out inspections and deal with violations against this Circular in accordance with applicable law.

2. Mother and Child Health Department shall:

a) Cooperate with Medical Examination & Treatment Administration in organizing the implementation and reviews of implementation of this Circular nationwide;

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Article 28. Responsibilities of Social Security Administration of Vietnam

1. Provide instructions for social insurance authorities on implementation of this Circular.

2. Unify management of printing and provision of blank confirmation of eligibility to receive social insurance benefits.

3. Instruct health facilities to register issuance of confirmation of eligibility to receive social insurance benefits and post the list of facilities entitled to issue confirmation of eligibility to receive social insurance benefits on the websites of Social Security Administration of Vietnam and provincial social insurance authorities. Inspect the issuance of confirmation of eligibility to receive social insurance benefits by health facilities.

4. Ex offico review the implementation of this Circular and propose amendments to this Circular to competent authorities.

Article 29. Responsibilities of Provincial Departments of Health

1. Organize reviews of the implementation of this Circular within their provinces.

2. Carry out inspections and deal with violations against this Circular in accordance with applicable law.

Article 30. Responsibilities of health facilities and Medical Assessment Councils

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2. Provide documents for workers as the basis for receipt of social insurance benefits in accordance with this Circular; examine the content of documents specified in this Circular prepared by their practitioners and take legal responsibility for the accuracy and truthfulness thereof.

3. Update data about medical examination and treatment, issuance of documents and medical assessment records on the national medical examination and treatment database which is connected to the data of social insurance authorities.

4. Transferring health facilities shall provide copies of referral notes bearing their seals on request.

Chapter VII

IMPLEMENTATION CLAUSE

Article 31. Effect

This Circular comes into force on July 01, 2016.

Circular No. 11/1999/TTLB-BYT-BHXH, Circular No. 34/2013/TT-BYT, Circular No. 07/2010/TT-BYT, template of discharge note enclosed with Decision No. 4069/2001/QD-BYT of the Minister of Health; birth certificate template enclosed with Circular No. 17/2012/TT-BYT are no longer effective from the effective date of this Circular.

Article 32. Transition clause

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Article 33. Organization of implementation

Chief of the Ministry Office, Directors of Departments of the Ministry of Health, Directors of Provincial Departments of Health, Directors of health authorities and relevant units are responsible for the implementation of this Circular.

Difficulties that arise during the implementation of this Circular should be reported to the Ministry of Health for consideration./.

PP MINISTER
DEPUTY MINISTER




Pham Le Tuan

APPENDIX 1

LIST OF DISEASES THAT REQUIRE LONG-TERM TREATMENT
(enclosed with Circular No. 14/2016/TT-BYT dated May 12, 2016)

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Disease

ICD 10 Category

I

Infectious and parasistic diseases

1.

Tuberculosis during treatment and sequelae

A15 to A19.

2.

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B90.2

3.

Leprosy (Hansen’s disease) and sequelae

A30, B92

4.

Chronic viral hepatitis B

B1.8.1.

5.

Chronic viral hepatitis C

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6.

Acquired immunodeficiency syndrome (HIV/AIDS)

B20 to B24, Z21

7.

Sequelae of viral, infectious and parasitic encephalitis and meningitis

B94.1, B94.8, B94.9

8.

Candidal meningitis, cerebral cryptococcosis

B37.5, B45.1

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Neoplasms

9.

Malignant neoplasms and in situ neoplasms

C00 to C97; D00 to D09

10.

Benign neoplasm of bone and articular cartilage

D16

11.

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D37 to D48

III

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

12.

Polycythemia vera

D45

13.

Myelodysplastic syndromes

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14.

Myeloproliferative disease

D47.1

15.

Thalassemia

D56

16.

Hereditary haemolytic anaemias

D58

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Autoimmune haemolytic anaemias

D59.1

18.

Paroxysmal nocturnal haemoglobinuria (Marchiafava syndrome)

D59.5

19.

Aplastic anaemia

D61.9

20.

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D66

21.

Hereditary factor IX deficiency (Hemophilia B)

D67

22.

Von Willebrand disease

D68.0

23.

Qualitative platelet defects

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24.

Idiopathic thrombocytopenic purpura (Evans syndrome)

D69.3

25.

Primary polycythaemia

D75.2

26.

Haemophagocytic syndrome, infection-associated

D76.2

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Hypergammaglobulinaemia, unspecified

D89.2

IV

Endocrine, nutritional and metabolic diseases

28.

Hypothyroidism

E03

29.

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E04

30.

Hyperthyroidism (Basedow)

E05

31.

Subacute thyroiditis (de Quervain and chronic)

E06.1

32.

Type 1 and Type 2 diabetes mellitus

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33.

Hyperfunction of pituitary gland

E22

34.

Hypofunction and other disorders of pituitary gland

E23

35.

Cushing disease

E24.0

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Adrenocortical insufficiency

E27.4

37.

Hypoparathyroidism

E20

38.

Hyperparathyroidism and other disorders of parathyroid gland

E21

39.

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E83.0

40.

Postprocedural hypothyroidism

E89.0

V

Mental and behavioural disorders

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41.

Dementia in Alzheimer disease

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42.

Vascular dementia

F01

43.

Dementia in other diseases classified elsewhere

F02

44.

Unspecified dementia

F03

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Mental disorders due to brain damage and dysfunction and to physical disease

F06

46.

Mental and behavioural disorders due to use of alcohol

F10

47.

Mental and behavioural disorders due to use of opioids

F11

48.

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F12

49.

Mental and behavioural disorders due to use of hallucinogens

F16

50.

Schizophrenia

F20

51.

Paranoid schizophrenia

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52.

Persistent delusional disorders

F22

53.

Schizoaffective disorders

F25

54.

Bipolar affective disorder

F31

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Depressive episode

F32

56.

Recurrent depressive disorder

F33

57.

Persistent mood [affective] disorders

F34

58.

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F40

59.

Other anxiety disorders

F41

60.

Obsessive-compulsive disorder

F42

61.

Somatoform disorders

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62.

Disorders of adult personality and behaviour

F60 to F69

63.

Mental retardation  

F70 to F79

64.

Disorders of psychological development  

F80 to F89

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Behavioural and emotional disorders with onset usually occurring in childhood and adolescence

F90 to F98

VI

Diseases of the nervous system  

66.

Systemic atrophies primarily affecting central nervous system in diseases classified elsewhere

G13

67.

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G20

68.

Secondary parkinsonism

G21

69.

Dystonia

G24

70.

Alzheimer disease

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71.

Multiple sclerosis

G35

72.

Subacute necrotizing myelitis

G37.4

73.

Epilepsy

G40

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Myasthenia gravis

G70.0

VII

Diseases of the eye and adnexa

75.

Dry eye syndrome

H04.1.2

76.

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H16

77.

Lens-induced iridocyclitis

H20.2

78.

Harada disease

H30.8.1

79.

Chorioretinitis, choroiditis

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80.

Proliferative vitreo-retinopathy with retinal detachment

H33.4.1

81.

Central retinal vein occlusion

H34.8

82.

Retinal vasculitis

H35.0.6

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Central serous chorioretinopathy

H35.7.1

84.

Retinal disorders due to atherosclerosis

H36.6

85.

Glaucoma

B40

86.

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H44.1.2

87.

Nutritional optic neuropathy

H46.2

88.

Toxic optic neuropathy

H46.3

VIII

Diseases of the ear and mastoid process

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89.

Ménière disease

H81.0

90.

Sudden idiopathic hearing loss

H91.2

91.

Progressive hearing loss

...

...

...

Brain, meninges herniation into the ear - mastoid

93.

Cord VII tumor

94.

Cord VIII tumor

95.

...

...

...

96.

Sarcoidosis of the ear

97.

Occupational hearing loss

98.

Hearing loss acquired after temporal bone injury

...

...

...

99.

Congenital malformations of ear causing impairment of hearing

Q16

100.

Turner syndrome

Q96

IX

Diseases of the circulatory system

...

...

...

Acute coronary syndrome

I20, I21, I22, I23

102.

Chronic ischaemic heart disease

I25

103.

Pulmonary embolism

I26

104.

...

...

...

I27

105.

Acute pericarditis

I30

106.

Chronic constrictive pericarditis

I31.1

107.

Myocarditis

...

...

...

108.

Infective endocarditis

I33; I38

109.

Heart failure

I50

110.

Intracerebral haemorrhage

I61

...

...

...

Cerebral infarction

I63

112.

Stroke, not specified as haemorrhage or infarction

I64

113.

Aortic aneurysm and dissection

I71

114.

...

...

...

I74

115.

Phlebitis and thrombophlebitis

I80

116.

Postprocedural disorders of circulatory system

I97

X.

Diseases of the respiratory system

...

...

...

117.

Chronic laryngitis

J37.0

118.

Polyp of vocal cord and larynx

J38.1

119.

chronic obstructive pulmonary disease

J44

...

...

...

Asthma

J45

121.

Bronchiectasis

J47

122.

Coalworker pneumoconiosis

J60

123.

...

...

...

J61

124.

Pneumoconiosis due to dust containing silica

J62

125.

Pneumoconiosis due to other inorganic dusts

J63

126.

Unspecified pneumoconiosis

...

...

...

127.

Other interstitial pulmonary diseases

J84

128.

Abscess of lung and mediastinum

J85

129.

Chronic pyothorax

J86

...

...

...

Chronic respiratory failure.

J96.1

XI

Diseases of the digestive system

131.

Progressive chronic hepatitis

K73

132.

...

...

...

K74

133.

Autoimmune hepatitis

K75.4

134.

Calculus of bile duct with cholangitis

K80.3

135.

chronic pancreatitis

...

...

...

XII

Diseases of the skin and subcutaneous tissue

136.

Pemphigus

L10

137.

Pemphigoid

L12

...

...

...

Duhring Brocq disease

L13.0

139.

Epidermolysis bullosa

L14

140.

Exfoliative dermatitis

L26

141.

...

...

...

L40

142.

Pityriasis rubra pilaris

L44.0

143.

Erythema nodosum

L52

144.

Pyoderma gangrenosum

...

...

...

145.

Chronic ulcer of skin

L98.4

XIII

Diseases of the musculoskeletal system and connective tissue  

146.

Systemic lupus erythematosus

M32

...

...

...

Tuberculous arthritis

M01.1

148.

Reactive arthropathies

M02.8, M02.9

149.

Seropositive rheumatoid arthritis

M05

150.

...

...

...

M07.3

151.

Gout

M10

152.

Other crystal arthropathies

M11

153.

Arthrosis of hip

...

...

...

154.

Arthrosis of knee

M17

155.

Polyarteritis nodosa

M30

156.

Necrotizing vasculopathy, unspecified

M31.9

...

...

...

Dermatopolymyositis

M33

158.

Systemic sclerosis

M34

159.

Sicca syndrome (Sjogren’s syndrome)

M35.0

160.

...

...

...

M43.1

161.

Ankylosing spondylitis

M45

162.

Spondylosis

M47

163.

Tuberculosis of spine

...

...

...

164.

Cervical disc disorders

M50

165.

Chronic crepitant synovitis of hand and wrist

M70.0

166.

Adhesive capsulitis of shoulder

M75.0

...

...

...

Osteoporosis with pathological fracture

M80

168.

Nonunion of fracture [pseudarthrosis]

M84.1

169.

Pathological fracture

M84.4

170.

...

...

...

M85

171.

Osteomyelitis

M86

172.

Osteonecrosis

M87

173.

Algoneurodystrophy

...

...

...

174.

Fracture of bone in neoplastic disease

M90.7

175.

Acquired deformities of musculoskeletal system and connective tissue

M95

XIV

Diseases of the genitourinary system

...

...

...

Recurrent and persistent haematuria

N02

177.

Chronic nephritic syndrome

N03

178.

Nephrotic syndrome

N04

179.

...

...

...

N08

180.

Chronic tubulo-interstitial nephritis

N11

181.

Chronic renal failure

N18

182.

Incontinence

...

...

...

183.

Fistulae involving female genital tract

N82

XV

Pregnancy, childbirth and the puerperium 

184.

Hydatidiform mole

O01

...

...

...

Injury, poisoning and certain other consequences of external causes

185.

Sequelae of injuries

S64, S94, T09, T91, T92, T93

186.

Sequelae of burns of third degree and above

T20, T21, T22, T23, T24, T25, T26, T29, T30

187.

...

...

...

188.

Sequelae of war injuries

XVII

Factors influencing health status and contact with health services

189.

Corneal transplant

...

...

...

190.

Artificial openings of digestive tract

Z43.4

191.

Artificial openings of urinary tract

Z43.6

192.

Transplanted organ and post-transplant treatment

Z94

...

...

...

APPENDIX 2

MEDICAL ASSESSMENT REPORT FORM
(Issued together with Circular No. 14/2016/TT-BYT dated May 12, 2016)

GOVERNING BODY
MEDICAL ASSESSMENT BOARD
-------

SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
---------------

No. ……/GDYK - …..1...

..…[Location]……..,[date]……………

WORK-RELATED IMPAIRMENT ASSESSMENT BY MEDICAL ASSESSMENT COUNCIL ….

Medical Assessment Council ……………………2........................................................

...

...

...

Mr./Mrs.................................................................. Date of birth………………………….

Address:....................................................................................................................

ID/Citizen/Passport  number:… 3…… Date of issue: ……Place of issue:........................

Social security number (if any):...................................................................................

To undergo medical assessment at the request/recommendation of: ………..(name)......

Letter of introduction/request No. …. dated ………………… (if any)

Medical assessment …………………………….4............................................................

Work-related impairment or diseases to be assessed: ……..5.......................................

Being eligible for benefits for… (bodily injuries, diseases. Work-related diseases with the rate of…….%)

...

...

...

 (Specify the history of illnesses, injuries and work-related diseases, contents of the previous impairment assessment report as deemed necessary. The current clinical and subclinical findings that are valid for the board to reach a conclusion)

HEREBY DECIDES

Pursuant to Circular No. 14/2016/TT-BYT dated May 15, 2016 of the Ministry of Health on guidelines for the Law on Social insurance.

Mr./Mrs......................................................................................................................

is determined as ……………………………6...................................................................

Percentage of impairment: ……………% (in words .................................................. %)

In conjunction with percentage of impairment due to ...7..., the total percentage of impairment is: ………% (in words          %)

Requests: .................................................................................................................

...

...

...

Vice President or the Standing Member or Specialized Member
(Signature and full name)

Chairman
(Signature, full name and seal8)

APPENDIX 6

MEDICAL RECORD SUMMARY FORM
(Issued together with Circular No. 14/2016/TT-BYT dated May 12, 2016)

…………………….

Hospital: ……………….

MEDICAL RECORD SUMMARY

...

...

...

1. Full name (capital letter): ........................................................ 2. Year of birth: □□□□

3. Gender: Male □ Female □      4. Ethnic: ...................................................................

Health insurance card’s number (if any):........................................................................

5. Occupation: ...........................................................................................................

Workplace: .................................................................................................................

6. Address: House No. … village, neighborhood…., commune/ward/district-level town....

District (city):………………………Province, city..............................................................

7. Date of admission ……………; date of discharge ………………;

8. Admitting diagnosis: ..............................................................................................

...

...

...

10. Medical record summary:......................................................................................

a) Pathological and clinical progress:

...................................................................................................................................

b) Summary of subclinical test results for diagnosis:

...................................................................................................................................

c) Treatment:

...................................................................................................................................

d) Patient’s medical conditions when being discharged:

...................................................................................................................................

...

...

...

...................................................................................................................................

……….[Location]………,[date]……………..
Head of hospital
(signature and seal)

Documentation guide:

1. The medical record summary is documented in conformity with the respective medical record of the patient.

2. If the patient is a person who lacks of legal capacity or has limited legal capacity or a child aged under 16, full names of his/her parents or legal guardians must be inserted at the notes.

3. If the patient’s child/children die(s) after birth, the child/children’s date of birth and date of death, number of dead child/children will be inserted at the patient’s medical conditions when being discharged

...

...

...

2 Name of Medical Assessment Council that has held the meeting

3 If the citizen card or passport is not available, other valid  identity paper shall prevail (birth certificate, certification issued by police officer of  the commune of place of residence enclosed with a photo with fan stamping)

4 First assessment/Re-assessment/General assessment/Appeal assessment (Assessment beyond professional qualification and requests)/Final appeal assessment

5 Work-related disease assessment (specify the name of the work-related disease to be assessed - the duration of the disease), labor accident assessment (enclosed with the contents of the injury extract - time of injury)/early retirement assessment/assessment for monthly death/general assessment (specify the contents of the assessment, such as the name of the work-related disease, the contents of the injury extract, the contents of the previous medical assessment)/relapse assessment (referring to relapse or progressive injuries or work-related diseases)

6 Specify conclusion at the request for assessment

7 Only insert in case of general assessment

8 Use the seal of standing agency of Medical Assessment Council. In case of final appeal assessment, the Department of Medical Examination and Treatment will act as the standing agency of the Board and may use the Ministry of Health’s seal.