Circular No. 18/2000/TT-BYT provides guidelines on medical examination files and procedures for workers participating in social insurance.

CIRCULAR

Issued by the Ministry of Health Decision No. 18/2000/TT-BYT dated October 17, 2000
Guidelines on medical examination dossier and procedures
for employees participating in social insurance

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- Based on Article 33 Chapter 4 Law on People's Health Protection regarding medical examination dated June 30, 1989

- Based on Chapter II Rules of Social Insurance attached to Government Decree No. 12/CP dated January 26, 1995 and Government Decree No. 45/CP dated July 15, 1995 concerning the Rules of Social Insurance for workers participating in social insurance; officers, professional military personnel, non-commissioned officers, and soldiers of the Vietnam People's Army and police officers of the Vietnam People's Public Security Force;

- Based on the standards for disability and loss of labor capacity due to illness issued together with Circular No. 12/TT-LB dated July 26, 1995 of the Ministry of Health - Ministry of Labor, Invalids and Social Affairs;

To unify the implementation of medical examinations for civil servants, public officials, state employees, armed forces, and workers participating in social insurance (hereinafter referred to collectively as workers), following the consensus of the Ministry of Labor, Invalids and Social Affairs in Document No. 2700/LDTBXH-BHXH dated August 15, 2000 and the Vietnam Social Security in Document No. 1921/BHXH-CDCS dated September 20, 2000, the Ministry of Health guides the establishment of dossiers and procedures for medical examinations to implement social insurance benefits for workers as follows:

I. APPLICABLE OBJECTS

1. Subjects as stipulated in Article 3 of the Rules of Social Insurance issued together with Government Decree No. 12/CP dated January 26, 1995; Article 3 of the Rules of Social Insurance for military personnel and police officers issued together with Government Decree No. 45/CP dated July 15, 1995 of the Government

2. Workers and experts from Vietnam working abroad for a limited period according to Government Decree No. 152/1999/NĐ-CP dated September 20, 1999, after completing their term of service abroad and returning to Vietnam.

3. Workers participating in social insurance according to Decision No. 49/1998/QĐ-TTg dated February 28, 1998 of the Prime Minister for athletes and coaches.

4. Workers suffering from work-related accidents or occupational diseases that have not been examined or who have already received one-time compensation or monthly compensation upon recurrence.

5. Workers who have stopped working and are waiting to reach the age to receive monthly pension when they suffer from reduced labor capacity.

6. Workers currently receiving monthly compensation for loss of labor capacity who need to be re-examined for labor capacity.

II. DOSSIER AND PROCEDURES FOR MEDICAL EXAMINATION

1. Dossier and procedures for medical examination of injuries caused by work-related accidents

1.1. Subject:

Workers injured in cases determined to be work-related accidents, or those receiving one-time compensation for work-related accidents (including those still working and those who have stopped working), and workers receiving monthly compensation for work-related accidents when old wounds recur.

1.2. Initial examination dossier includes:

- Accident investigation report (according to model) prescribed in Joint Circular No. 03/1998/TT-LT/BLĐTBXH-BYT-TLĐLĐVN dated March 26, 1998 of the Ministry of Labor, Invalids and Social Affairs - Ministry of Health - General Confederation of Trade Unions of Vietnam. In cases of traffic accidents considered as work-related accidents, an additional traffic accident report (copy) must be included. If the accident site does not have the conditions to prepare an accident report, a confirmation letter from the local authority at the accident site or a confirmation from the traffic police department must be provided.

- Certificate of injury due to work-related accident (model number 05) issued by the hospital where the worker was treated (signed by the Director or Deputy Director of the hospital) according to the regulations of the Ministry of Health.

- Discharge certificate.

1.3. Initial examination procedure:

- When a worker is considered to have suffered a work-related accident, the employer has the responsibility to promptly report to relevant authorities and prepare an accident report at the scene or an accident investigation report according to Joint Circular No. 03/1998/TTLT/BLĐTBXH-BYT-TLĐLĐVN dated March 26, 1998 after the worker has been stabilized in treatment. The employer is responsible for preparing, completing, and transferring the work-related accident dossier of the worker including: Accident investigation report, certificate of injury due to work-related accident, and discharge certificate to the Provincial Social Insurance (hereinafter referred to collectively as Provincial Social Insurance).

- The Provincial Social Insurance has the responsibility to review the dossiers, if complete and in accordance with regulations, it will introduce (according to model number 02) and transfer the work-related accident dossier of the worker to the Medical Examination Council of the province (hereinafter referred to collectively as Provincial Medical Examination Council) or the Central Medical Examination Council for examination.

1.4. Re-examination of work-related accidents.

1.4.1. Cases for re-examination:

- Recurrence of old injuries.

- The worker, employer, or social insurance agency disagrees with the conclusion of the Medical Examination Council (hereinafter referred to as the Requester).

1.4.2. Re-examination dossier includes:

- Application for labor capacity examination due to work-related accident (model number 01)

- Introduction letter from the Provincial Social Insurance (model number 02)

- Treatment documents for recurring injuries (In cases of re-examination requested by the Requester, treatment documents for recurring injuries are not required).

- Copy of previous dossier including: Examination record, decision of the Provincial Social Insurance Director on monthly or one-time work-related accident compensation. In cases of re-examination requested by the Requester, the re-examination dossier is the initial examination dossier.

1.4.3. Re-examination procedure

- When old injuries recur, after stable treatment, the worker submits an application to the employer if still working or to the Provincial Social Insurance if already retired, along with treatment documents for recurring injuries.

- The employer is responsible for accepting treatment documents for recurring injuries, transferring the dossier, and introducing the worker to the Provincial Social Insurance (if the worker is still working)

- The Provincial Social Insurance shall be responsible for copying the file including: the previous medical examination report, the decision of the Provincial Social Insurance Director on monthly work injury allowance or a lump sum payment together with the treatment documents for recurrent injuries transferred by the unit, transferring the file along with the employee's referral letter to the Medical Examination Board to re-examine the work injury disability (according to the classification of the Medical Examination Department).

- Those who suffered work injuries before January 1, 1995 but have not been referred for disability assessment according to Circular No. 843/LĐ-TBXH dated March 25, 1996 of the Ministry of Labor, Invalids and Social Affairs; based on Circular No. 908/TLĐ dated July 25, 1996 of the Vietnam General Confederation of Labor, the Provincial Social Insurance shall be responsible for requesting the Trade Union and Industry Union (previously managing social insurance) to hand over complete files as prescribed and refer for assessment.

2. Files and procedures for assessing work capacity to implement retirement benefits:

2.1. Subjects:

- Workers whose health has deteriorated.

- Workers who have stopped working and are waiting to reach the age to receive monthly retirement benefits.

2.2. Initial work capacity assessment files include:

- Application of the worker for work capacity assessment (according to Form No. 01)

- Summary of the worker's file (according to Form No. 03)

- Detailed medical record (according to Form No. 04).

2.3. Initial work capacity assessment procedure:

2.3.1. For workers still employed:

- When workers fall ill or their work capacity decreases, they submit an application for work capacity assessment (according to Form No. 01) to the employer.

- The employer is responsible for receiving the completed application from the worker, completing the file as prescribed, referring (according to Form No. 02), and transferring the worker's file to the Provincial Medical Examination Board or the Central Medical Examination Board for work capacity assessment.

2.3.2. For those awaiting retirement:

- Workers awaiting retirement who suffer illness or accidents leading to decreased work capacity should submit an application for work capacity assessment (according to Form No. 01) along with a certificate of pending retirement benefit receipt to the Provincial Social Insurance where they are managed.

- The Provincial Social Insurance is responsible for receiving the application, copying the certificate of pending retirement benefit receipt sent by the worker awaiting retirement, guiding them to establish a detailed medical record to complete the file including:

+ Application for work capacity assessment (according to Form No. 01)

+ Copy of the certificate of pending retirement benefit receipt (replacing the summary of the worker's file)

+ Detailed medical record (according to Form No. 04)

Detailed medical records for workers awaiting retirement must be established by state healthcare facilities such as central hospitals, provincial hospitals, hospitals under ministries and sectors, military region hospitals, military corps hospitals, district health centers, multi-disciplinary clinics, medical stations of armed forces units, and primary health care centers according to Decree No. 01/1998/NĐ-CP dated January 3, 1998 of the Government on the organization of local health systems. After completing the file as prescribed, the Provincial Social Insurance will refer and transfer the file of the worker awaiting retirement to the Medical Examination Board for work capacity assessment.

3. Files and procedures for assessing work capacity due to occupational diseases:

3.1. Subjects:

Workers suffering from occupational diseases.

3.2. Initial files and procedures for assessing occupational diseases include:

3.2.1. Initial occupational disease assessment files:

- Application for work capacity assessment (according to Form No. 01)

- Results of workplace environment measurements (or certified copies issued by provincial preventive healthcare centers under the central government) where the worker has worked in the last 12 months. If these results are insufficient, previous measurement results should be attached.

- Occupational disease patient file according to Joint Circular No. 08/1998/TT-LT dated April 20, 1998 of the Ministry of Health and Ministry of Labor, Invalids and Social Affairs, and related documents (copies).

3.2.2. Initial occupational disease assessment procedure:

- The employer is responsible for completing the file as prescribed, transferring the file of the worker suffering from an occupational disease to the Provincial Social Insurance where the unit participates in social insurance.

- The Provincial Social Insurance is responsible for reviewing the file if it is complete and correct, referring (according to Form No. 02), and transferring the file of the worker suffering from an occupational disease to the Medical Examination Board for work capacity assessment according to the classification of the Medical Examination Department.

- Once all required files are available, the Medical Examination Board will accept and conduct the examination according to the regulations of the Medical Examination Department.

3.3. Files and procedures for subsequent occupational disease assessments:

3.3.1. Subsequent occupational disease assessment files include:

- Application for reassessment of work capacity (according to Form No. 01)

- Previous Medical Examination Board's assessment report (original).

- Workplace environment measurement results, if the worker has stopped working, only the measurement results during employment are needed.

- Occupational disease patient file according to Joint Circular No. 08/1998/TT-LT dated April 20, 1998 of the Ministry of Health and Ministry of Labor, Invalids and Social Affairs, and related documents (copies).

3.3.2. Subsequent occupational disease assessment procedure:

- Workers apply for work capacity assessment and are responsible for submitting relevant documents to the employer if still employed or to the Provincial Social Insurance if retired.

- The employer is responsible for receiving the file transferred by the worker, completing the file fully as prescribed, and transferring the file to the Provincial Social Insurance where the unit participates in social insurance.

- The Social Insurance Provincial Office shall be responsible for receiving, examining the files submitted by the employer or directly accepting and completing the files in accordance with regulations for those who have retired, introducing and transferring the files of workers suffering from occupational diseases to the Medical Examination Board (as classified by the Medical Examination Department) for re-examination of their work capacity.

4. Files for re-examining work capacity for those currently receiving disability benefits.

Workers currently receiving monthly disability allowances due to illness or hospitalization, accidents, or risks, and whose health has deteriorated requiring a re-examination of their work capacity must submit an application along with their medical records, treatment documents, and discharge papers to the Social Insurance Provincial Office.

The application for re-examination includes:

4.1. Application for re-examination of work capacity (according to form number 01).

4.2. Medical examination report of the previous Medical Examination Board (original copy).

4.3. Medical records, treatment documents, and discharge papers.

After completing the file in accordance with regulations, the Social Insurance Provincial Office will introduce and transfer the application for re-examination of work capacity to the Medical Examination Board of the province or the Central Medical Examination Board for examination.

For individuals receiving disability benefits under Resolution No. 16/HĐBT dated February 8, 1982, of the Council of Ministers (now the Government), the Social Insurance Provincial Office will make a copy of the "Summary of Health Condition" prepared by the health department of the agency to replace the original report of the previous work capacity examination. In cases where the "Summary of Health Condition" is not included in the disability benefit file, the Social Insurance Provincial Office will guide the preparation of detailed medical records as required for retirees awaiting their first work capacity examination as stipulated in point 2.3.2 section 2 part II above, but the introduction letter must also include information about disability benefits according to Resolution No. 16/HĐBT dated February 8, 1982, of the Council of Ministers (now the Government).

The period for re-examining work capacity must be at least one year (12 months or more) from the initial examination to the re-examination.

In addition to the regulations on injury examination files due to workplace accidents or work capacity examination files for implementing social insurance benefits, parties must present their national identity cards when attending the Medical Examination Board.

The transfer of files to the Medical Examination Board must be guaranteed through postal service, if sent directly, the files must be sealed in an envelope with a sealing stamp.

III. IMPLEMENTATION

1. Employers are responsible for requesting workers to submit relevant documents, preparing, completing, and transferring the worker's files to the Medical Examination Board or the Social Insurance Provincial Office as stipulated above.

2. The Medical Examination Board consists of:

- The Central Medical Examination Board

- The Central Medical Examination Board I Branch in Ho Chi Minh City

- The Central Medical Examination Board II Branch in Da Nang City

- The Medical Examination Boards of provinces and centrally administered cities.

- The Medical Examination Boards of sectors: National Defense, Public Security, and Transportation.

They are responsible for strictly adhering to inter-ministerial regulations, and must base their determinations of the percentage of lost work capacity on the national standards already issued.

If the employer, worker, and social insurance agency disagree with the conclusion of the Medical Examination Board, they have the right to request a higher-level Medical Examination Board for re-examination.

2.1. The Medical Examination Board will only proceed with the examination when all legal procedures are completed based on the documents and files submitted by the employer or the Social Insurance Provincial Office.

2.2. The Medical Examination Board is responsible for organizing and conducting the examination according to the examination procedure from the time of receiving the file until the Medical Examination Board issues its conclusion report, with the earliest possible deadline, but not exceeding 60 days.

2.3. When the Medical Examination Board convenes to conclude, the party cannot be absent.

The conclusion report of the Medical Examination Board is established in five copies of equal value:

- One copy retained by the Medical Examination Board.

- Four copies returned to the recommending authority (one copy for the employer, one copy for the worker, two copies for the social insurance agency) to implement social insurance benefits.

2.4. The Medical Examination Board will only examine injuries and illnesses recorded in the received files transferred by the employer or the Social Insurance Provincial Office.

3. The Social Insurance Provincial Office of centrally administered cities is responsible for receiving, preparing, checking, completing, and transferring the files of workers to the Medical Examination Board as stipulated and implementing social insurance benefits for workers based on the conclusions of the Medical Examination Board.

IV. IMPLEMENTATION PROVISIONS.

1. This Circular takes effect 15 days after the date of issuance, replacing the documents and procedures specified in the annex accompanying the Inter-Ministry Circular No. 12/TT-LB dated July 26, 1995, of the Ministry of Health and the Ministry of Labor, Invalids, and Social Affairs for the examination of injuries due to workplace accidents, work capacity examination, and the enjoyment of social insurance benefits.

2. Provincial Health Departments, sectoral health departments, and Social Insurance Provincial Offices are responsible for disseminating, guiding, and directing subordinate units to implement the provisions of this Circular.

3. The Institute of Medical Examination is responsible for directing Medical Examination Boards at all levels to implement in accordance with the provisions of this Circular.

During implementation, if there are difficulties or obstacles, units and localities need to promptly reflect them to the Ministry of Health (Treatment Department, Institute of Medical Examination) for research and timely resolution.