Circular No. 14/2014/TT-BYT on the transfer between healthcare facilities for medical examination and treatment

CIRCULAR

Regulations on the transfer between healthcare facilities

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Pursuant to the Law on Diagnosis and Treatment No. 40/2009/QH12 dated November 23, 2009;

This Circular prescribes procedures for receiving, providing health care for domestic violence victims and statistical reports on domestic violence victims at medical facilities.

At the proposal of the Director of the Department of Medical Examination and Treatment;

The Minister of Health issues this Circular to regulate the transfer between healthcare facilities.

PART I

GENERAL PROVISIONS

Article 1. Scope of Regulation

This Circular stipulates the form, conditions, authority, procedures, and management of transferring patients between healthcare facilities at different levels of specialized technical expertise (hereinafter referred to as the transfer between healthcare facilities).

Article 2. Applicability

1. State-owned and private healthcare facilities as prescribed by the Law on Medical Examination and Treatment;

2. Healthcare facilities under the Ministry of National Defense participating in medical examination and treatment for civilians.

Article 3. Levels of Specialized Technical Expertise

1. The application of levels of specialized technical expertise in the transfer between healthcare facilities shall be implemented according to the provisions of Circular No. 43/2013/TT-BYT dated December 11, 2013, issued by the Minister of Health detailing the classification of specialized technical expertise for the healthcare system.

2. The application of levels of specialized technical expertise in the transfer between healthcare facilities for those under the Ministry of National Defense participating in medical examination and treatment for civilians shall be regulated by the Ministry of National Defense after obtaining written agreement from the Ministry of Health.

Article 4. Forms of Transfer

1. Transferring patients from lower-level facilities to higher-level facilities:

a) Transferring patients from lower-level facilities to adjacent higher-level facilities in sequence: level 4 to level 3, level 3 to level 2, level 2 to level 1;

b) Transferring patients not following the sequence specified in Point a of this Clause if the healthcare facility meets the conditions as stipulated in Point b of Clause 1 of Article 5 of this Circular.

2. Transferring patients from higher-level facilities to lower-level facilities.

3. Transferring patients between healthcare facilities within the same level.

Chapter II

CONDITIONS, AUTHORITY, PROCEDURES FOR TRANSFERS BETWEEN HEALTHCARE FACILITIES

Article 5. Conditions for Transfer

1. A healthcare facility transfers patients from a lower-level facility to a higher-level facility when it meets the following conditions:

a) The disease does not match the diagnostic and treatment capabilities and technical service list of the healthcare facility approved by the competent state authority on health, or the disease matches the diagnostic and treatment capabilities and technical service list of the healthcare facility approved by the competent state authority on health but due to objective conditions, the healthcare facility does not have the necessary conditions for diagnosis and treatment;

b) Based on the technical service list approved by the competent state authority on health, if the adjacent higher-level healthcare facility does not have appropriate technical services, the lower-level healthcare facility may be transferred to a higher level;

c) Before transferring, the patient must undergo a consultation and have a transfer recommendation (except for outpatient clinics and level 4 healthcare facilities).

2. A healthcare facility transfers patients from a higher-level facility to a lower-level facility appropriately when the patient has been diagnosed, treated through the emergency phase, and the condition has improved sufficiently to continue treatment at a lower level.

3. Conditions for transferring patients between healthcare facilities at the same level:

a) The disease does not match the technical service list of the healthcare facility approved by the competent state authority on health, or the disease matches the technical service list of the healthcare facility approved by the competent state authority on health but due to objective conditions, the healthcare facility does not have the necessary conditions for diagnosis and treatment;

b) The disease matches the technical service list of the healthcare facility at the same level intended for transfer, which has been approved by the competent state authority on health.

4. Transfers between healthcare facilities in border areas to ensure favorable conditions for patients:

a) The Director of the Department of Health provides specific guidance on the transfer between healthcare facilities in border areas within the province or centrally-administered city under their jurisdiction;

b) The Directors of Departments of Health coordinate and provide specific guidance on the transfer between healthcare facilities in border areas between provinces or centrally-administered cities under their jurisdiction.

5. Cases of transferring patients in accordance with the provisions of Clauses 1, 2, 3, and 4 of this Article are considered proper transfers. Cases of transferring patients not in accordance with the provisions of Clauses 1, 2, 3, and 4 of this Article are considered improper transfers. In cases where patients do not meet the conditions for transfer as stipulated in Clauses 1, 2, 3, and 4 of this Article but the patient or their lawful representative still requests a transfer, the healthcare facility shall facilitate the transfer to ensure the patient's right to choose a healthcare facility. The transferring healthcare facility must provide information to the patient about the scope of benefits and cost reimbursement for out-of-network medical examination and treatment under health insurance.

Article 6. Authority to sign transfer forms

1. For state medical examination and treatment facilities: The head of the medical examination and treatment facility or a person authorized by the head of the medical examination and treatment facility shall sign the transfer form.

2. For private medical examination and treatment facilities: The person responsible for the medical specialty at the medical examination and treatment facility or a person authorized by the person responsible for the medical specialty at the medical examination and treatment facility shall sign the transfer form.

3. During on-call shifts, the on-call leader shall sign the transfer form in emergency cases.

Article 7. Procedures for transferring patients

1. Medical examination and treatment facilities shall implement patient transfers to higher-level or same-level facilities according to the following procedures:

a) Informing and clearly explaining the reasons for the transfer to the patient or their legally authorized representative;

b) Signing the transfer form according to the model specified in Appendix 1 issued together with this Circular;

c) In emergency cases, the medical examination and treatment facility must contact the medical examination and treatment facility where the patient will be transferred; conduct a final check of the patient's condition before transfer; prepare the necessary equipment for emergency care during transportation;

d) If the patient requires technical support from the medical examination and treatment facility where they will be transferred, the transferring medical examination and treatment facility must provide specific information about the patient's condition and any required assistance so that the receiving facility can take appropriate measures;

đ) Handing over the transfer form to the escort, the patient, or the patient’s legally authorized representative to deliver to the medical examination and treatment facility where the patient will be transferred;

e) Transferring the patient and the transfer form to the receiving medical examination and treatment facility.

2. The procedure for transferring patients to lower-level facilities shall be carried out according to the provisions of points a, b, đ, and e Clause 1 of this Article.

Article 8. Transporting Patients During Transfers

1. Transporting patients in emergency situations: Medical examination and treatment facilities shall prepare conditions for transporting patients:

a) Ambulances or other suitable transport vehicles;

b) Medical equipment and emergency medications for use during transport (if necessary);

c) The escort must be a doctor, nurse, or midwife with the responsibility to monitor and promptly address any changes in the patient's condition during transport and to transport the patient using techniques appropriate to their condition.

2. Transporting patients in non-emergency situations: Based on the patient's medical condition and practical circumstances, the medical examination and treatment facility shall guide the patient or their legally authorized representative to choose an appropriate method and means of transport.

Chapter III

MANAGEMENT OF TRANSFERS IN MEDICAL EXAMINATIONS AND TREATMENTS

Article 9. Content of Information Management for Patient Transfers in Medical Examinations and Treatments

1. Collecting, compiling, and summarizing transfer information:

a) Information on transferring patients to various levels (upward transfer, same-level transfer, and downward transfer) of medical examination and treatment facilities shall be conducted according to the model specified in Appendix 2 issued together with this Circular;

b) Information on receiving patients from transferred levels (downward transfer to upward, same-level transfer to, and upward transfer to downward) shall be conducted according to the model specified in Appendix 2 issued together with this Circular.

2. Feedback of transfer information between levels

a) Regular monthly feedback to the medical examination and treatment facility transferring the patient regarding the diagnosis and treatment results according to the model specified in Appendix 3 issued together with this Circular;

b) Immediate feedback in case of professional errors or other necessary situations according to the model specified in Appendix 4 issued together with this Circular.

3. Medical examination and treatment facilities shall organize the management, storage, and provision of transfer information in accordance with the law.

Article 10. Reporting and Coordination Meeting System for Referral

1. Content of Referral Reports:

a) Monthly Report: Medical examination and treatment facilities compile monthly reports according to the model prescribed in Appendix 2 attached hereto;

b) Semi-annual and annual reports are compiled according to the model prescribed in Appendix 5 attached hereto.

2. Reporting System:

a) Medical examination and treatment facilities under the Ministry of Health shall submit their reports to the Ministry of Health (Department of Medical Examination and Treatment);

b) Medical examination and treatment facilities under the Ministry of Public Security, the Ministry of National Defense, and the Ministry of Transport shall submit their reports to the health management agencies of their respective ministries (Public Security Health Bureau - Ministry of Public Security, Military Medicine Bureau - Ministry of National Defense, Transport Health Bureau - Ministry of Transport);

c) Medical examination and treatment facilities under the Department of Health, under ministries and sectors (excluding medical examination and treatment facilities under the Ministry of Public Security, the Ministry of National Defense, and the Ministry of Transport), and private medical examination and treatment facilities located within the jurisdiction shall submit their reports to the Department of Health;

d) The Department of Health, the health management agencies of the Ministry of Public Security, the Ministry of National Defense, and the Ministry of Transport shall aggregate and report on referral work to the Ministry of Health (Department of Medical Examination and Treatment) for annual reporting.

3. Regular or emergency coordination meetings for referral to draw lessons from referral work:

a) Medical examination and treatment facilities shall hold regular monthly coordination meetings between departments, divisions, and related units;

b) Level 1 medical examination and treatment facilities shall organize coordination meetings with Level 2 medical examination and treatment facilities within the scope of their assigned referral guidance; Level 2 medical examination and treatment facilities shall organize coordination meetings with Level 3 medical examination and treatment facilities; Level 3 medical examination and treatment facilities shall organize coordination meetings with Level 4 medical examination and treatment facilities on a regular basis every three months;

c) The Ministry of Health, Departments of Health, and Sectoral Health shall hold regular coordination meetings with subordinate medical examination and treatment facilities every six months;

d) The Ministry of Health shall hold a national coordination meeting for referral annually.

Chapter IV

IMPLEMENTATION PROVISIONS

Article 11. Effective Date

1. This Circular takes effect from June 1, 2014.

2. Abolish the provisions on hospital transfer in Section 4 Part IV of the Hospital Regulations issued together with Decision No. 1895/1997/QD-BYT dated September 19, 1997 of the Minister of Health from the date this Circular takes effect.

Article 12. Cross-referencing Provisions

In cases where the referenced documents in this Circular are replaced or amended, the replacement or amended documents shall apply.

Article 13. Implementation Organization

1. The Department of Medical Examination and Treatment shall be responsible for:

a) Serve as the focal point to coordinate with relevant units to organize the implementation, provide guidance, conduct inspections, and evaluate the implementation of this Circular;

b) Aggregate, report, and hold coordination meetings on referral as stipulated in this Circular.

2. Departments of Health, Sectoral Health have the responsibility:

a) Serve as the focal point to coordinate with relevant units to organize the implementation, provide guidance, conduct inspections, and evaluate the implementation of this Circular within the scope of their management at the sectoral and local levels;

b) Aggregate, report, and hold coordination meetings on referral as stipulated in this Circular.

3. Medical facilities shall be responsible for:

a) Implement this Circular at medical examination and treatment facilities;

b) Strengthen and improve training centers and referral guidance departments, referral guidance divisions, or allocate staff to serve as focal points for managing referral work at medical examination and treatment facilities;

c) Aggregate and report on referral as stipulated in this Circular.

4. Compliance with referral regulations among medical examination and treatment facilities is a criterion for assessing the completion of tasks, considering commendation and awarding honors for individuals and organizations within medical examination and treatment facilities, and evaluating the quality and ranking of medical examination and treatment facilities.

5. Based on the aggregated referral reports and annual inspection results, competent authorities shall assess the completion of tasks for heads of medical examination and treatment facilities and decide not to consider commendation and awarding honors for medical examination and treatment facilities with a referral rate that does not comply with regulations exceeding 10% of the total number of referrals.

1. The Minister, Heads of Ministries equivalent to ministries, Heads of government agencies, Chairmen of provincial People's Committees under the central government, and related agencies, units, and individuals are responsible for implementing this Circular.

The Director of the Department of Medical Examination and Treatment, the Head of the Ministry's Office, the Inspector General of the Ministry, Heads of Departments, Directors of Bureaus, and General Directors of Bureaus and General Directorates under the Ministry of Health, Directors of Departments of Health, Heads of Sectoral Health, and Heads of relevant agencies, organizations, and units are responsible for implementing this Circular. In the course of implementation, if there are difficulties or obstacles, they are requested to promptly reflect them to the Ministry of Health (Department of Medical Examination and Treatment) for research and resolution.

During the implementation process, if there are difficulties or obstacles, they are requested to promptly reflect them to the Ministry of Health (Department of Medical Examination and Treatment) for research and resolution./.