Circular No. 16/2014/TT-BYT guiding the pilot program on family doctors and family doctor clinics

CIRCULAR

Pilot Guidelines on Family Doctors and Family Doctor Clinics

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Pursuant to the Law on Medical Examination and Treatment dated November 23, 2009;

Pursuant to Decree No. 87/2011/ND-CP dated September 27, 2011 of the Government detailing and guiding the implementation of certain provisions of the Law on Medical Examination and Treatment;

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 on Pilot Guidelines on Family Doctors and Family Doctor Clinics.

PART I

GENERAL PROVISIONS

Article 1. Scope of Regulation and Applicability

2. Applicability:

This Circular provides guidance on:

a) Functions, tasks, and rights of family doctors, conditions, authority, procedures, and files for issuing practice certificates and registering to practice as a family doctor;

b) Organization, operation, conditions, authority, procedures, and files for issuing permits to operate family doctor clinics.

Matters not specified in this Circular shall be implemented in accordance with the Law on Medical Examination and Treatment and guiding documents.

第二条 组织和实施奖励工作的支出水平，如政府第152/2025/NĐ-CP号决定关于分级授权和奖励领域的分权规定

a) This Circular applies on a pilot basis in eight centrally governed cities and provinces, including Hanoi, Ho Chi Minh City, Hai Phong, Can Tho, Thai Nguyen, Thua Thien Hue, Khanh Hoa, and Tien Giang, pursuant to Decision No. 935/QD-BYT dated March 22, 2013 approving the Project on Building and Developing the Model of Family Doctor Clinics during the period 2013-2020.

b) In addition to the eight centrally governed cities and provinces applying the pilot program as stipulated in Point a Clause 2 of this Article, individuals and organizations in other localities who request issuance of practice certificates and permits to operate family doctor clinics shall have their provincial Department of Health send a letter to the Ministry of Health requesting guidance on the application of this Circular.

Article 2. Principles of Operation of Family Doctors

1. Family doctors operate based on the principles of continuous, comprehensive, integrated, coordinated, preventive care, focusing on families and communities.

2. Family doctors build and maintain trustworthy and long-term relationships with individuals, households, and communities.

Article 3. Forms of Organization of Family Doctor Clinics

Family doctor clinics may be organized in one of the following forms:

1. Private family doctor clinics, including:

a) Independent private family doctor clinics;

b) Family doctor clinics within private multi-specialty clinics or private general hospitals.

2. Family doctor clinics within the outpatient department of state-owned general hospitals.

3. Health stations at the commune level that incorporate and supplement the functions of family doctor clinics.

Chapter II

FUNCTIONS, TASKS, CONDITIONS, AUTHORITY, PROCEDURES FOR ISSUING PRACTICE CERTIFICATES FOR FAMILY DOCTORS

Article 4. Functions and Tasks of Family Doctors

1. Family doctors have the function of examining, treating diseases, managing, protecting, caring for, and improving the overall health of individuals, households, and communities.

2. Family doctors perform the following tasks:

a) Managing the overall health of individuals, households, and communities continuously.

b) Screening and early detection of various diseases.

c) Providing emergency care, medical examination, treatment, and rehabilitation services for individuals, households, and communities in accordance with the scope of practice specified in the practice certificate.

d) Advising on health, disease prevention, and health risk reduction to enhance the capacity of individuals, households, and communities in proactively protecting, caring for, and improving their health.

đ) Providing information related to the health of individuals and households managed by family doctors in accordance with the law.

e) Other tasks consistent with the scope of practice specified in the practice certificate.

Article 5. Rights of family doctors

1. To participate in health insurance medical examinations and treatments when meeting the conditions stipulated by the law on health insurance.

2. To transfer patients to appropriate medical examination and treatment facilities in accordance with the regulations of the Ministry of Health regarding the referral system for medical examinations and treatments when necessary.

3. To receive feedback information from medical examination and treatment facilities that have received patients transferred from the family doctor's clinic.

4. To be trained and further educated to enhance their professional expertise.

Article 6. Conditions for issuing a practice certificate for family doctors for Vietnamese citizens

Vietnamese citizens who meet the following conditions shall be considered for issuance of a practice certificate for family doctors:

1. Educational qualifications:

a) For those applying for a practice certificate for family doctors before January 1, 2016, they must have at least a bachelor’s degree in general medicine and a certificate of specialized training in family medicine for a minimum of three months issued by a training institution recognized by the Ministry of Health or the Department of Health.

b) For those applying for a practice certificate for family doctors from January 1, 2016 onwards, they must have at least a bachelor’s degree in general medicine and one of the following qualifications: a first-level specialist certificate, a second-level specialist certificate, a master’s degree, or a doctoral degree in family medicine, or a specialty training certificate in family medicine obtained in Vietnam or recognized in Vietnam.

2. Conditions regarding practical experience in medical examinations and treatments:

For those applying for a practice certificate for family doctors before January 1, 2016, they must have a document confirming their practical experience in medical examinations and treatments at medical examination and treatment facilities for a period of 18 months according to the Law on Medical Examinations and Treatments and Circular No. 41/2011/TT-BYT dated November 14, 2011, issued by the Minister of Health guiding the issuance of practice certificates for practitioners and operating licenses for medical examination and treatment facilities;

b) For those applying for a practice certificate for family doctors from January 1, 2016 onwards, they must have a document confirming their practical experience in family medicine for a continuous period of 18 months or more at a general hospital.

For those holding a first-level specialist certificate, a second-level specialist certificate, or a specialty training certificate in family medicine, the practical experience time will be equivalent to the training time. A certified copy of the first-level specialist certificate, second-level specialist certificate, or specialty training certificate in family medicine will be considered as a confirmation of practical experience time. For those holding a specialty training certificate in family medicine, in addition to the equivalent practical experience time to the training time, there must also be a continuous practical experience confirmation document to ensure a total of 18 months.

3. Not falling under the cases specified in Clause 4, Article 18 of the Law on Medical Examinations and Treatments.

Article 7. Conditions for issuing and recognizing practice certificates for family doctors for foreign nationals and overseas Vietnamese

1. Foreign nationals and overseas Vietnamese who meet the following conditions shall be considered for issuance of a practice certificate for family doctors:

a) Meeting the conditions stipulated in Article 6 of this Circular;

b) Not falling under the cases specified in Clause 4, Article 18 of the Law on Medical Examinations and Treatments;

c) The conditions stipulated in Clauses 2, 3, and 4, Article 19 of the Law on Medical Examinations and Treatments.

2. Foreign nationals and overseas Vietnamese who already hold a practice certificate for family doctors issued abroad shall follow the provisions set out in Article 22 of the Law on Medical Examinations and Treatments.

Article 8. Competence, application materials, procedures for issuing and reissuing practice certificates and registering to practice as a family doctor

The competence, application materials, and procedures for issuing and reissuing practice certificates and registering to practice as a family doctor shall be carried out in accordance with Circular No. 41/2011/TT-BYT dated November 14, 2011, issued by the Minister of Health on guiding the issuance of practice certificates for practitioners and operating licenses for medical examination and treatment facilities, and other relevant legal documents.

Chapter III

ORGANIZATION, ACTIVITIES, CONDITIONS, COMPETENCE, PROCEDURES FOR ISSUING OPERATING LICENSES

OF FAMILY DOCTOR CLINICS

Article 9. Position, functions, and tasks of family doctor clinics in the system of medical examination and treatment facilities

1. Family doctor clinics are among the first facilities to receive patients in the system of medical examination and treatment facilities.

2. The tasks of family doctor clinics include:

a) Screening, emergency care, medical examination, treatment, and transferring patients to other medical examination and treatment facilities according to regulations on referral for medical examination and treatment and receiving patients to continue managing, protecting, caring for, and improving their health.

b) Closely coordinating with other medical examination and treatment facilities within the system of medical examination and treatment to ensure the operation of health management, medical examination, and treatment for individuals, households, and communities.

c) Contacting to transfer patients under the health management scope of the family doctor clinic to suitable medical examination and treatment facilities for medical examination and treatment.

Article 10. Specialized technical level, specialized technical service list of family doctor clinics

1. Independent private family doctor clinics and integrated communal health stations apply the functions and tasks of family doctor clinics according to the specialized technical level and specialized technical service list prescribed in Circular No. 43/2013/TT-BYT dated December 11, 2013, of the Minister of Health detailing the specialized technical level for the system of medical examination and treatment facilities (hereinafter referred to as Circular No. 43/2013/TT-BYT).

2. Family doctor clinics belonging to private multi-specialty clinics or private general hospitals apply the specialized technical level and technical service list according to the level of private multi-specialty clinics or private general hospitals based on the provisions of Circular No. 43/2013/TT-BYT.

3. Family doctor clinics belonging to the outpatient department of public general hospitals apply the specialized technical level and technical service list according to the level of public general hospitals based on the provisions of Circular No. 43/2013/TT-BYT.

Article 11. Implementation of medical examination and treatment under health insurance by family doctor clinics

Family doctor clinics are permitted to implement medical examination and treatment under health insurance according to the laws on health insurance.

Article 12. Management of medical records, case histories, statistics, and storage of family doctor clinics

1. Family doctor clinics are responsible for recording and storing information about medical examinations and treatments according to the laws on medical examinations and treatments.

2. Family doctor clinics must have comprehensive health management files for individuals and households registered for health management. Clinics are responsible for keeping personal information of those registered for health management confidential according to the laws.

3. The management of medical records, case histories, statistics, and storage of family doctor clinics shall be carried out according to the laws applicable to medical examination and treatment facilities.

Article 13. Service fees for medical examination and treatment at family doctor clinics

1. Service fees for medical examination and treatment are defined as follows:

a) Public family doctor clinics apply service fees for medical examination and treatment approved by competent state authorities;

b) Private family doctor clinics have the right to determine service fees but must publicly display service fees for medical examination and treatment and collect fees according to the displayed prices as stipulated by the laws on pricing.

2. Service fees for medical examination and treatment under health insurance are applied according to the laws on health insurance.

Article 14. Conditions for Issuing a Business License for Independent Private Family Doctor Clinics

1. Infrastructure

a) Construction and Design:

- A fixed location separate from family living areas;

- Solid construction with adequate lighting, ceiling dust-proofing, walls and floors made of easily washable and cleanable materials;

b) Must have a reception area; examination rooms and health consultation rooms with a minimum area of 10 square meters;².

c) In addition to the conditions stipulated in Points a and b of this Clause, depending on the scope of registered medical activities, the clinic must also meet additional conditions prescribed by laws on medical examinations and treatments consistent with its organizational form and scope of registered medical activities;

d) Ensure the handling of medical waste and infection control in accordance with the provisions of the law;

đ) Must have equipment to apply information technology in health management and medical examinations and treatments;

e) Ensure sufficient electricity, water, sanitary facilities, and other conditions to serve patient care.

2. Medicines and Medical Equipment

Must have sufficient medical equipment, tools, and medicines appropriate to the scope of registered medical activities, including at least a first aid kit and sufficient specialized emergency medicines.

3. Personnel

a) The person responsible for the clinic's professional activities must meet the following conditions:

- For family doctor clinics applying for a business license before January 1, 2018, the person responsible for the clinic's professional activities must be a doctor with a certificate in family medicine and at least three years of practice in medical examinations and treatments;

- For family doctor clinics applying for a business license from January 1, 2018, the person responsible for the clinic's professional activities must be a doctor with a certificate in family medicine, at least three years of practice in medical examinations and treatments, including at least two years in family medicine;

b) Doctors directly examining patients and managing health must have a family doctor practice certificate;

c) Clinic staff engaged in professional work must have a certificate suitable for their field of practice;

d) In addition to the conditions stipulated in this Clause, practitioners must also have a certification or confirmation of having completed specialized training as required by technical standards.

4. Scope of Professional Activities

Family doctor clinics may carry out the following professional activities:

a) Medical examination and treatment:

- Screening and early detection of diseases, especially epidemics;

- Conduct medical examinations and treatments according to the approved technical procedure list by competent state authorities;

- Provide comprehensive health management for individuals, households, and communities;

- Implement health care and early disease screening;

- Participate in referral systems for medical examinations and treatments;

- Participate in palliative care and end-of-life care services;

- Carry out other specialized techniques approved by competent state authorities based on the actual conditions of the clinic;

- May conduct the following activities at patients' homes, including: conducting medical examinations, prescribing common medications; performing certain procedures: changing bandages, removing sutures, taking blood and urine samples for testing, nebulization; administering injections and intravenous fluids in emergencies.

b) Rehabilitation:

- Organize community-based rehabilitation activities for those in need;

- Implement rehabilitation techniques, physiotherapy, health exercises, and qigong for patients and the community.

c) Traditional Medicine:

- Conduct medical examinations and treatments using traditional medicine (with and without medication);

- Use finished traditional medicine products produced by other establishments and approved by the Ministry of Health for medical examinations and treatments;

- Prepare raw herbs into decoctions and weigh prescriptions for patients.

d) Disease Prevention and Primary Health Care:

- Participate in monitoring and early detection of diseases in the community;

- Participate in vaccination programs and national health programs;

- Guide environmental hygiene, food safety, prevention of infectious and non-infectious diseases;

- Participate in occupational disease management, maternal and child health care, elderly health care, regular health check-ups to detect diseases early; maintain continuous comprehensive health records for individuals and families in accordance with the Ministry of Health's regulations.

đ) Health Counseling:

- Advise on medical examinations, treatments, disease prevention, health protection, and improvement;

- Participate in health communication and education to enhance public awareness about proactive and active disease prevention and risk factor prevention affecting health.

e) Scientific Research and Training

- Conduct scientific research on family medicine and related issues;

- Participate in family medicine specialty training programs;

- Participate in continuous training programs of the family medicine specialty to continuously improve professional skills.

Article 15. Conditions for operation of family doctor clinics within private multi-specialty clinics or outpatient departments of multi-specialty hospitals

1. Family doctor clinics within private multi-specialty clinics or outpatient departments of multi-specialty hospitals must ensure the conditions stipulated in Article 14 of this Circular.

2. Private multi-specialty clinics or multi-specialty hospitals that organize family doctor clinics shall implement the following procedures:

a) For newly established private multi-specialty clinics or multi-specialty hospitals that organize family doctor clinics, when issuing the business license, they must assess and ensure compliance with the operating conditions for family doctor clinics as prescribed in Article 14 of this Circular.

b) For private multi-specialty clinics or multi-specialty hospitals that have already been issued a business license and subsequently establish a family doctor clinic, they must have a decision to establish the clinic from the competent authority and submit a request to the state agency that issued the business license to review and supplement the scope of specialized medical activities in the business license.

Article 16. Competence, Documents, and Procedures for Issuing Business Licenses for Independent Family Doctor Clinics

The competence, documents, and procedures for issuing business licenses for independent family doctor clinics established and registered by individual family doctors shall be carried out in accordance with Circular No. 41/2011/TT-BYT dated November 14, 2011, of the Minister of Health on guiding the issuance of practice certificates for practitioners and business licenses for healthcare facilities, and other relevant legal regulations.

Article 17. Incorporation of Family Doctor Clinic Tasks into Rural Health Stations

1. Implementation of the incorporation and supplementation of family medicine tasks at rural health stations as follows:

a) In addition to current duties, rural health stations may carry out activities related to family medicine.

b) Rural health stations may set up a separate unit to perform family medicine tasks or employ a family doctor to conduct such activities.

2. Conditions for Implementing Family Medicine Activities:

Rural health stations that conduct family medicine activities must meet the material and equipment conditions, and human resources requirements specified in Article 15 of this Circular, consistent with the scope of specialized activities of the rural health station in the field of family medicine.

Chapter IV

RESPONSIBILITIES FOR IMPLEMENTATION

Article 18. Management of Family Doctor Clinics

1. The Department of Medical Examination and Treatment serves as the focal point to assist the Minister of Health in managing national operations of family doctor clinics.

2. Provincial Health Departments under centrally governed cities manage all family doctor clinics within their respective localities comprehensively.

3. District Health Departments participate in inspecting and supervising the operations of family doctor clinics within their respective localities according to regulations.

Article 19. Responsibilities of Units Under the Ministry of Health

1. The Department of Medical Examination and Treatment:

a) Assist the Minister of Health in directing and organizing the implementation of building and developing models of family doctor clinics.

b) Serve as the focal point, coordinating with relevant agencies and units to develop detailed annual plans for constructing and developing family doctor clinic models, reporting to the Minister for consideration and approval, and implementing approved activities according to assigned functions and responsibilities.

c) Serve as the focal point for assessing the issuance of family doctor practice certificates according to authority. Guide, inspect, and supervise the implementation of professional regulations concerning the operation of family doctor clinics; the implementation of information technology at clinics and throughout the system.

d) Guide provincial health departments under centrally governed cities in organizing the issuance and revocation of family doctor practice certificates; assessing and issuing and revoking business licenses for family doctor clinics in accordance with the Law on Medical Examination and Treatment and other regulatory documents guiding its implementation.

đ) Direct, guide, inspect, and supervise the implementation of legal regulations and professional provisions for family doctor clinics.

2. Department of Health Insurance: Lead and coordinate with the Department of Medical Examination and Treatment and related units to guide and inspect the implementation of regulations regarding health insurance medical examination and treatment by family doctor clinics.

3. Department of Science, Technology, and Training: Lead and coordinate with the Department of Medical Examination and Treatment and related units to guide and organize the development and assessment of training programs and continuous training to issue family doctor practice certificates.

4. Department of Information Technology: Lead and coordinate with the Department of Medical Examination and Treatment to direct the implementation of information technology applications in the operations of family doctor clinics.

5. Department of Planning and Finance: Coordinate with the Department of Medical Examination and Treatment to develop, supplement, and guide the implementation of regulations on service fees for medical examination and treatment within the scope of specialized activities of family doctor clinics.

6. Department of Cadres and Civil Servants: Coordinate with the Department of Medical Examination and Treatment to guide, inspect, and supervise the implementation of regulations on functions, responsibilities, systems, and policies for family doctors.

Article 20. Responsibilities of the Health Services Departments of provinces and centrally governed cities to pilot implement

1. Organizing the establishment and development of family doctor clinic models at the local level;

2. Issuing, reissuing, and revoking practice certificates for family doctors for practitioners; organizing reviews and granting permits for family doctor clinics in accordance with laws on medical examination and treatment;

3. Managing all family doctor clinics comprehensively.

Chapter V

IMPLEMENTING PROVISIONS

Article 21. Effective Date

1. This Circular takes effect from July 15, 2014.

2. Abolish the provisions regarding family doctor clinics in Article 25 of Circular No. 41/2011/TT-BYT dated November 14, 2011, issued by the Minister of Health guiding the issuance of practice certificates for practitioners and licenses for medical examination and treatment facilities from the date this Circular takes effect.

Article 22. Transitional provisions

Those who have been granted practice certificates for medical examination and treatment in the field of family medicine and are currently practicing in this field may continue to use their existing practice certificates to practice in the field of family medicine without needing to reissue them but must continuously update their medical knowledge to ensure they meet the standards set out in Article 6 of this Circular.

Article 23. Cross-referencing Provisions

In cases where the referenced documents in this Circular are amended, supplemented, or replaced, they shall be implemented according to the amended, supplemented, or replaced documents.

Article 24. Responsibility for Implementation

The Director of the Department of Medical Examination and Treatment Management, the Head of the Ministry's Office, the Inspector General of the Ministry, the Heads of the Departments, Bureaus, and General Departments under the Ministry of Health, the Directors of Provincial Health Services, the Heads of Health Services of sectors, and the Heads of related agencies, organizations, and units are responsible for implementing this Circular.

During implementation, if there are any difficulties, agencies, organizations, and individuals are requested to promptly report them to the Ministry of Health (Department of Medical Examination and Treatment Management) for study and resolution./.