Circular No. 01/2023/TT-BYT provides detailed regulations on the activities and working relationships of Medical Appraisal Councils at all levels.

CIRCULAR

DETAILING THE ACTIVITIES AND WORK RELATIONSHIPS OF MEDICAL EXPERT BOARDS AT ALL LEVELS

On the basis of Decree No. 131/2021/ND-CP dated December 30, 2021 of the Government detailing and implementing measures for the Ordinance on preferential treatment for those who have rendered meritorious service to the revolution;

Pursuant to Decree No. 95/2022/NĐ-CP dated November 15, 2022 of the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of the Director Generalof the Department of Medical Examination and Treatment;The Minister of Health

issues this Circular detailing the activities and work relationships of Medical Expert Boards at all levels.ORGANIZATION OF MEDICAL EXPERT BOARDS AT ALL LEVELS ARTICLE 1. Principles for Establishing Medical Expert Boards 1. Medical Expert Boards at all levels are specialized medical boards established to determine the health status and degree of bodily injury (if any) due to injuries, diseases, disabilities, deformities, or congenital defects upon request from agencies, organizations, or individuals.

PART I

2. Medical Expert Boards at all levels shall have their own seals for use in confirming the Medical Expert Report. The term of operation of the Medical Expert Board is five (5) years, starting from the date of issuance of the decision establishing the board, except for the final Medical Expert Review Board.

Section 1

3. Composition of the Medical Expert Board:

a) The provincial-level Medical Expert Board and central-level Medical Expert Boards shall consist of five (5) members, operating under a part-time mechanism, including the positions of Chairman, Vice-Chairman, Standing Member, and Professional Member;

b) The final Medical Expert Review Board shall consist of at least five (5) members, operating under a part-time mechanism, including the positions of Chairman, Vice-Chairman, Standing Member, and Professional Member.

4. Members of the Medical Expert Board and medical experts who have participated in the medical examination of the subject shall not participate in the final Medical Expert Review Board.

ARTICLE 2. Composition of the Medical Expert Board

1. Composition of the provincial-level Medical Expert Board:

a) The Chairman shall be the leader of the specialized agency under the Provincial People's Committee responsible for managing state administrative functions related to medical examinations (hereinafter referred to as the specialized agency under the Provincial People's Committee);

b) Two Vice-Chairmen: One permanent Vice-Chairman shall be the leader of the provincial Medical Expert Board's permanent agency; one professional Vice-Chairman shall be the leader of the provincial general hospital;

c) Members must be medical examiners, with the Standing Member being a staff member of the provincial Medical Expert Board's permanent agency.

2. Composition of the central-level Medical Expert Board:

a) The Chairman shall be the leader of a hospital under the Ministry of Health assigned by the Minister of Health;

b) One Vice-Chairman shall be the leader of the agency specified in Clause 3, Article 161 of Decree No. 131/2021/ND-CP dated December 30, 2021 of the Government detailing and implementing measures for the Ordinance on Preferential Treatment for Those Who Have Rendered Meritorious Service to the Revolution (hereinafter referred to as Decree No. 131/2021/ND-CP);

c) Members must be medical examiners, with the Standing Member being a staff member of the central-level Medical Expert Board's permanent agency.

3. Composition of the final Medical Expert Review Board:

a) The Chairman shall be the leader of the Department of Medical Examination and Treatment;

b) One Vice-Chairman shall be the Chairman of the central-level Medical Expert Board or the Chairman of the Medical Expert Board of Ministries authorized to conduct final medical reviews;

c) Members must be medical examiners, with the Standing Member being a staff member of the central-level Medical Expert Board's permanent agency or the permanent agency of the Medical Expert Board of Ministries authorized to conduct final medical reviews.

3. Members of the Medical Appraisal Council for Final Reconsideration:

a) The Chair is the Leader of the Department of Medical Examination and Treatment;

b) A Vice-Chair is the Chair of the Central Medical Appraisal Council or the Chair of the Medical Appraisal Councils of Ministries with authority to conduct final reconsideration medical appraisals;

c) The Members are medical appraisers, among whom the Standing Member is an official from the permanent office of the Central Medical Appraisal Council or the permanent office of the Medical Appraisal Councils of Ministries with authority to conduct final reconsideration medical appraisals.

Article 3. Competence to establish Medical Appraisal Boards at various levels

1. The Medical Appraisal Board at the provincial level shall be established by the specialized agency under the Provincial People's Committee.

2. The Central Medical Appraisal Board shall be established by the Ministry of Health.

3. The Ministry of National Defense, the Ministry of Public Security, and the Ministry of Transport shall decide on establishing the Medical Appraisal Boards of their respective Ministries based on the provisions of this Circular, in accordance with Clause 2, Point b, Article 161 of Decree No. 131/2021/NĐ-CP.

Article 4. Competence of the Medical Appraisal Board at the provincial level

1. Conduct initial medical appraisals and re-appraisals for individuals working or residing within the province.

2. Conduct initial appraisals and re-appraisals for individuals managed by the Ministry of Public Security or the Ministry of Transport upon written request from the managing authority or the permanent office of the Medical Appraisal Board of the Ministry of Public Security or the Ministry of Transport.

Article 5. Competence of the Medical Appraisal Boards of Ministries

The Medical Appraisal Boards of Ministries shall conduct medical appraisals in accordance with Clause 2, Article 162 of Decree No. 131/2021/NĐ-CP.

Article 6. Competence of the Central Medical Appraisal Board

1. Conduct initial and re-medical appraisals for individuals working or residing in centrally-administered cities and provinces, pursuant to the assignment decision of the Minister of Health when requested by the managing authority or the individual, except for those who have rendered meritorious service to the revolution, relatives of those who have rendered meritorious service to the revolution, and persons with disabilities.

2. Conduct final medical appraisals in cases where:

a) The provincial Medical Appraisal Board or the Medical Appraisal Board of the Ministry of Transport exceed their professional capabilities;

b) The individual or their lawful representative disagrees with the conclusion of the provincial Medical Appraisal Board or the Medical Appraisal Board of the Ministry of Transport;

c) Individuals managed by the Ministry of Public Security, upon request from the managing authority or the permanent office of the Medical Appraisal Board of the Ministry of Public Security.

Article 7. Competence of the Final Medical Appraisal Board

Conduct final medical appraisals for individuals when they or their lawful representatives disagree with the conclusions of the Central Medical Appraisal Board or the Medical Appraisal Board of the Ministry of National Defense or the Ministry of Public Security.

Article 8. Duties and Powers of the Chairman of the Board

1. Chair and direct the meeting to conclude the Medical Appraisal Board or authorize in writing the Vice-Chairman to chair and direct the meeting in case he cannot attend the concluding meeting of the Medical Appraisal Board. Such authorization must be in writing and can only be given to the Vice-Chairman who is the permanent member of the Board, not the Vice-Chairman who is the specialist of the Board.

2. Together with other members of the Medical Appraisal Board, bear responsibility for the conclusions of the Medical Appraisal Board during meetings attended.

3. Sign the Minutes of the Medical Appraisal Board Meeting and the Medical Appraisal Report during meetings chaired and directed according to regulations.

4. Participate in discussions and reserve opinions on matters related to medical appraisals recorded in the Minutes of the Medical Appraisal Board Meeting.

5. Chair the resolution of issues arising during the Medical Appraisal Board meeting.

6. Direct the resolution of issues related to medical appraisals based on proposals from the leadership of the permanent office of the Medical Appraisal Board.

Article 9. Duties and Authorities of the Vice Chairman of the Council

1. The Vice-Chairman of the Medical Appraisal Board chairs and directs the concluding meeting of the Medical Appraisal Board when authorized by the Chairman of the Medical Appraisal Board and performs the duties of the Chairman of the Medical Appraisal Board during the authorized meeting.

2. Together with other members of the Medical Appraisal Board, bear responsibility for the conclusions of the Medical Appraisal Board during meetings attended.

3. Sign the Minutes of the Medical Appraisal Board Meeting during meetings attended personally; sign the Medical Appraisal Report when authorized to chair and direct the meeting.

4. Participate in discussions and reserve opinions on matters related to medical appraisals; reserved opinions must be fully recorded in the Minutes of the Medical Appraisal Board Meeting.

5. Participate in resolving issues arising during the Medical Appraisal Board meeting at the request of the Chairman of the Medical Appraisal Board.

6. Participate in resolving issues related to medical appraisals based on proposals from the leadership of the permanent office of the Medical Appraisal Board.

Article 10. Standing Member and Specialized Member of the Medical Examination Board

1. Shall be responsible for the results of medical examination and appraisal conducted by themselves and shall jointly with other members of the Medical Examination Board bear responsibility for the conclusions of the Medical Examination Board during sessions they attend.

2. Shall fully participate in sessions of the Medical Examination Board at the request of the leadership of the standing body of the Medical Examination Board. In case of inability to attend, a written report must be submitted to the leadership of the standing body of the Medical Examination Board.

3. Shall sign the Minutes of the Medical Examination Board session in which they participate.

4. Shall contribute opinions and have their individual opinions recorded in the Minutes of the Medical Examination Board session regarding matters related to specialized medical examination and appraisal.

5. Shall participate in resolving issues arising during the Medical Examination Board session according to the requirements of the person chairing the session.

6. Participate in resolving issues related to medical appraisals based on proposals from the leadership of the permanent office of the Medical Appraisal Board.

7. Shall perform other tasks assigned by the Chairman or Vice-Chairman of the Board.

Section 2

STANDING BODY OF THE MEDICAL EXAMINATION BOARD

Article 11. Tasks of the standing body of the provincial Medical Examination Board

1. Propose the establishment and improvement of the Medical Examination Board, the appointment and removal of Appraisers of the Medical Examination Board.

2. Receive, review, and process applications for medical examination and appraisal in accordance with the provisions of Decree No. 131/2021/NĐ-CP.

3. Conduct medical examination and appraisal in accordance with the procedures stipulated in Appendix 1 issued together with this Circular.

4. Take the lead and coordinate with relevant units to propose professional and technical work on medical examination and appraisal, organizational work, material infrastructure, equipment, and human resources for medical examination and appraisal activities.

5. Resolve or propose solutions to requests, suggestions, complaints, and reports related to medical examination and appraisal.

6. Manage the seal of the Medical Examination Board.

7. Archive medical examination and appraisal files in accordance with the law.

8. Annually summarize and report on the results of medical examination and appraisal activities to the direct management agency and the central standing body of the Medical Examination Board.

Article 12. Tasks of the standing body of the central Medical Examination Board

1. Perform the tasks specified in Clauses 1, 2, 3, 4, 5, 6, and 7 of Article 11 of this Circular.

2. Provide professional and technical guidance on medical examination and appraisal.

3. Implement line directives, inspections, supervision, training, continuous training, and professional and technical seminars on medical examination and appraisal.

4. Conduct scientific research, provide advice, and participate in building policies, laws, and professional regulations in the field of medical examination and appraisal.

Article 13. Tasks of the standing body of the final appellate Medical Examination Board

1. The standing body of the final appellate Medical Examination Board is the central standing body of the Medical Examination Board, or the standing body of the final appellate Medical Examination Board under the Ministry of National Defense, or the standing body of the final appellate Medical Examination Board under the Ministry of Public Security that has conducted medical examination and appraisal on the subject.

2. Perform the tasks specified in Clauses 1, 2, 3, 4, 5, and 7 of Article 11 of this Circular.

Section 3

APPRAISER

Article 14. Standards for medical examiners and members of the Medical Examination Council

1. Standards for medical examiners:

a) Possessing a medical degree working at state health examination and treatment facilities, holding a practice certificate within the scope of practice appropriate to the specialty they have been appointed to;

b) Holding a training certification or continuous training or training on medical examination issued by authorized agencies or units.

2. Standards for medical examiners who are regular members and specialized members of the provincial Medical Examination Council:

a) Possessing a medical degree of a first-level specialist doctor or a master's degree in medicine or higher;

b) Having at least three (3) years of work experience in their specialty field, including the time spent studying that specialty;

c) Meeting the standards specified in point b, Clause 1 of this Article.

3. Standards for medical examiners who are regular members and specialized members of the central Medical Examination Council and the final appellate Medical Examination Council:

a) Possessing a medical degree of a second-level specialist doctor or a doctorate in medicine;

b) Having at least five (5) years of work experience in their specialty field, including the time spent studying that specialty;

c) Meeting the standards specified in point b, Clause 1 of this Article.

4. Standards for medical examiners who are members of the Medical Examination Councils of Ministries:

a) Medical examiners who are regular members and specialized members of the Medical Examination Councils of Ministries with authority to conduct initial examinations and re-examinations: Must meet the standards prescribed in Clause 2 of this Article;

b) Medical examiners who are regular members and specialized members of the Medical Examination Councils of Ministries with authority to conduct final appellate examinations: Must meet the standards prescribed in Clause 3 of this Article.

Article 15. Appointment of medical examiners

1. Medical examiners of the central Medical Examination Council are appointed by the Ministry of Health based on the proposal of the permanent office of the central Medical Examination Council and the Department of Medical Examination and Treatment.

2. Medical examiners of the provincial Medical Examination Council are appointed by the competent agency under the Provincial People's Committee based on the recommendation of the permanent office of the provincial Medical Examination Council.

3. Medical examiners of the Medical Examination Councils of Ministries are appointed by the Ministries based on the recommendation of the permanent office of the Medical Examination Councils under the Ministries.

4. The number of medical examiners of the Medical Examination Council is determined by the authorized person based on the requirements and tasks of the Medical Examination Council. Each specialty must have at least two (2) medical examiners. In cases where the Medical Examination Council does not have doctors in specialties such as Cardiology, Pulmonology, Urology, Gastroenterology, Orthopedics, Hematology-Blood Transfusion, Endocrinology, Immunology, a general internal medicine specialist can be appointed as a substitute. In this case, each medical examiner is only assigned to examine and evaluate no more than two (2) specialties to ensure the quality of the examination and evaluation.

Article 16. Dismissal of medical examiners

1. The leadership of the permanent office of the Medical Examination Council proposes the authorized body specified in Article 15 of this Circular to consider dismissal when the medical examiner falls into one of the following situations:

a) Violating professional rules, medical examination regulations, and professional ethics;

b) Not having sufficient professional capacity to perform medical examination tasks;

c) Not having sufficient health to work;

d) Submitting a request not to continue participating as a medical examiner and receiving approval from the direct management agency.

2. A person appointed as a medical examiner who retires according to regulations or transfers to another job will automatically cease to be a medical examiner from the date of retirement or transfer.

Article 17. Duties and Authorities of the Expert Examiner

1. Duties of the Expert Examiner:

a) Conduct specialized medical examinations according to the content requested on the Specialized Medical Examination Form sent by the Standing Office of the Medical Appraisal Council to the Expert Examiner. After completing the examination, return the results to the Standing Office of the Medical Appraisal Council, while also recording the examination results in the specialized medical examination logbook at the place where the Expert Examiner works;

b) Participate in specialized consultations according to the content requested by the Standing Office of the Medical Appraisal Council;

c) An Expert Examiner who performs their duties concurrently shall be responsible under the law for the results of specialized medical examinations conducted individually;

d) Attend the conclusion meeting of the Medical Appraisal Council when invited by the Council.

2. Authorities of the Expert Examiner:

a) Be entitled to attend continuous training courses and workshops on specialized and professional knowledge related to medical appraisals;

b) Enjoy benefits and treatment when participating in specialized medical examination activities, specialized consultations, and Council meetings as stipulated by law and by the Standing Office of the Medical Appraisal Council;

c) Have the right to request not to perform or cease performing as an Expert Examiner;

d) Have the right to refuse to conduct an appraisal when the subject or the legitimate representative of the subject being appraised intentionally does not cooperate.

Chapter II

ACTIVITIES OF THE MEDICAL APPRAISAL COUNCIL

Article 18. Principles of Operation of the Conclusion Meeting of the Council

1. The Council operates through collective discussion based on the medical appraisal files provided by the Standing Office and evidence from the subjects or recorded audiovisual materials during the appraisal process as specified in Article 19 of this Circular.

2. The conclusion of the Medical Appraisal Council can only be approved if at least three members of the Council present at the Council meeting agree, whereas for the final reconsideration conclusion of the Medical Appraisal Council, it can only be approved if at least two-thirds of the members present at the Council meeting agree.

3. The conclusion of the Medical Appraisal Council is recorded in the form of a Medical Appraisal Minutes:

a) For subjects who have made contributions to the revolution or their dependents: the Medical Appraisal Minutes are implemented according to the model prescribed in Appendix No. 78 attached to Decree No. 131/2021/NĐ-CP;

b) For subjects not falling within the cases prescribed in point a of this Clause: the Medical Appraisal Minutes are implemented according to the model prescribed in Appendix No. 2 issued together with this Circular.

4. The content of the Medical Appraisal Council meeting is recorded in the form of a Council Meeting Minutes according to the model prescribed in Appendix No. 3 issued together with this Circular.

Article 19. Participants in the Conclusion Meeting of the Medical Appraisal Council

1. The conclusion meeting of the Medical Appraisal Council can only be organized if there are at least three members of the Medical Appraisal Council present, and for the final reconsideration conclusion meeting, at least two-thirds of the members must be present, and must include the following components:

a) The Chairman of the Council or the Vice-Chairman authorized by the Chairman;

b) A permanent member of the Council in cases of medical appraisals for subjects regulated by Decree No. 131/2021/NĐ-CP;

c) The subject being appraised, except for cases prescribed in Clause 3 of this Article;

d) The physician handling the file, who is an employee of the Standing Office of the Medical Appraisal Council. In case of absence, the Standing Office must appoint someone to report in their place.

2. If necessary, the Medical Appraisal Council may invite specialized expert examiners or representatives of relevant agencies, organizations, or individuals to attend the conclusion meeting of the Medical Appraisal Council. Invited participants have the right to express opinions at the conclusion meeting of the Council but do not have the right to vote on the Council's conclusion.

3. Cases allowed to be absent from the conclusion meeting of the Medical Appraisal Council:

a) Having attended previous Council meetings, been designated by the Medical Appraisal Council to undergo supplementary clinical and paraclinical examinations, and now have the results of these supplementary examinations;

b) Being in a state of injury, illness, or severe disability that prevents them from attending the Medical Appraisal Council for medical appraisal, and having been organized for on-site medical appraisal by the management agency or the legitimate representative of the subject, approved by the Chairman or Vice-Chairman of the Medical Appraisal Council. The on-site medical appraisal process for such subjects must be recorded in audio and video, to be presented during specialized consultation meetings and the conclusion meeting of the Council. Representatives of the management agency or the legitimate representative of the subject must attend the conclusion meeting of the Council;

c) Having undergone clinical and paraclinical examinations, now having the results of the medical appraisal, but being in a state of injury, illness, or severe disability that prevents them from attending the Medical Appraisal Council for participation in the meeting, with approval from the management agency or the legitimate representative of the subject, approved by the Chairman or Vice-Chairman of the Medical Appraisal Council. Representatives of the management agency or the legitimate representative of the subject must attend the conclusion meeting of the Council.

Article 20. Procedure for the conclusion meeting of the Council

1. The physician handling the medical examination file shall be responsible for reporting a summary of the results of the medical examination in the examination file, including: the anticipated condition of injury, illness, disability, and the percentage (%) of bodily damage of each examined subject. The file shall only be presented to the Council after being approved at the specialized consultation meeting organized by the Council's permanent body.

2. Members attending the conclusion meeting of the practical medical examination Council shall verify the actual condition of injury, illness, disability of the examined subject, except in cases provided for in Clause 3, Article 19 of this Circular.

3. The examined subject or their legally authorized representative may express opinions (if any) before the entire Council.

4. The Council discusses and votes on the conclusions

a) The condition of injury, illness, disability, percentage (%) of bodily damage, other conclusions in accordance with the provisions of the law and the medical examination request of individuals and organizations;

b) In cases where there is insufficient basis for conclusion, the Council may designate additional clinical or paraclinical examinations or refer to treatment records and related documents to help the Council have more grounds for concluding the condition of injury, illness, disability, and the percentage (%) of bodily damage of the examined subject;

c) In cases where healthcare facilities in the province or region do not have the conditions to conduct specialized examinations (clinical or paraclinical), the Council may send the examined subject to healthcare facilities that have the legal basis and conditions to conduct specialized examinations, serving as a basis for the Council to examine, consider, and conclude the condition of injury, illness, disability, and the percentage (%) of bodily damage of the examined subject.

5. Members of the Council attending the meeting shall be responsible for signing the Council Meeting Minutes. The person recording the Council Meeting Minutes shall be assigned by the Head of the Council's permanent body.

Chapter III

RELATIONSHIP OF WORK OF THE MEDICAL EXAMINATION COUNCILS AT DIFFERENT LEVELS

Article 21. Relationship between the provincial Medical Examination Council and the Medical Examination Councils of Ministries, the Central Medical Examination Council, and the Final Re-examination Medical Examination Council

1. The provincial Medical Examination Council has an equal relationship with the Medical Examination Councils of Ministries authorized to conduct initial and re-examinations.

2. The Central Medical Examination Council and the Final Re-examination Medical Examination Council are higher-level councils than the provincial Medical Examination Council.

Article 22. Relationship between the Medical Examination Councils of Ministries and the Central Medical Examination Council and the Final Re-examination Medical Examination Council

1. The Medical Examination Councils of Ministries authorized to conduct final re-examinations have an equal relationship with the Central Medical Examination Council.

2. The Final Re-examination Medical Examination Council is a higher-level council than the Medical Examination Councils of Ministries authorized to conduct final re-examinations.

Article 23. Relationship between the Central Medical Examination Council and the Final Re-examination Medical Examination Council

1. The Central Medical Examination Councils have an equal relationship with each other.

2. The Final Re-examination Medical Examination Council is a higher-level council than the Central Medical Examination Council.

Chapter IV

IMPLEMENTATION

Article 24. Effective Date

This Circular takes effect from April 15, 2023

Circular No. 52/2016/TT-BYT dated December 30, 2016 of the Minister of Health regarding the tasks, powers, work relationships, and activities of Medical Examination Councils at different levels shall cease to be effective from the date this Circular takes effect.

Article 25. Transitional Provisions

1. Medical Examiners appointed by the competent authority before the effective date of this Circular shall continue to perform their duties until the end of their term. In cases of supplementary appointment or new appointment of Medical Examiners from the date this Circular takes effect, such appointments must comply with the provisions of this Circular.

2. Medical Examination Councils established before the effective date of this Circular shall continue to operate until the end of their term.

Article 26. Responsibility for Implementation

Responsibilities of the Ministry of Health (Department of Medical Examination and Treatment Management):

a) Directing, guiding, and training on medical examination activities for Medical Examination Councils and the permanent bodies of Medical Examination Councils nationwide;

b) Taking the lead in coordinating with relevant agencies and organizations to inspect, audit, review, and summarize the medical examination activities of Medical Examination Councils and the permanent bodies of Medical Examination Councils at all levels across the country;

c) Advising the Minister of Health on the establishment of the Central Medical Examination Council and the Final Re-examination Medical Examination Council, the appointment and dismissal of Medical Examiners, the assignment of professional technical guidance, and specific tasks for the permanent body of the Central Medical Examination Council;

d) Managing the seal of the Final Re-examination Medical Examination Council.

Responsibilities of the Ministry of National Defense, the Ministry of Public Security, and the Ministry of Transport:

a) Directing health management agencies and related agencies to organize the implementation, supervise, audit, and inspect the activities of Medical Examination Councils and the permanent bodies under their jurisdiction.

Responsibilities of the People's Committee of the Province:

a) Directing the Department of Health and related agencies to organize the implementation, supervision, audit, and inspection of the activities of the Provincial Medical Examination Council and its permanent body in accordance with the provisions of this Circular;

b) Directing healthcare facilities to ensure material resources, equipment, and human resources for specialized examinations of examined subjects.

Responsibilities of the specialized agencies under the People's Committee of the Province:

a) Directing and guiding the medical examination activities of the Medical Examination Council and the permanent body of the Medical Examination Council under their jurisdiction;

5. Medical examination and treatment establishments shall be responsible for coordinating and creating favorable conditions for the Medical Appraisal Council and the permanent bodies of the Medical Appraisal Council at all levels to utilize the material resources and medical equipment of their units in conducting medical appraisals. During the implementation process, if there are any difficulties, they are advised to report to the Ministry of Health (Department of Medical Examination and Treatment) for consideration and resolution.

During the implementation process, if there are any difficulties, they are advised to report to the Ministry of Health (Department of Medical Examination and Treatment) for consideration and resolution./.