Circular No. 18/2022/TT-BYT amends and supplements some Articles of Circular No. 56/2017/TT-BYT dated December 29, 2017, issued by the Minister of Health detailing the implementation of the Social Insurance Law and the Labor Safety and Health Law in the field of health.

CIRCULAR

Amending and supplementing some articles of Circular No. 56/2017/TT-BYT dated December 29, 2017 of the Minister of Health detailing the implementation of the Social Insurance Law and the Labor Safety and Health Law in the field of health

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Pursuant to the Social Insurance Law on November 20, 2014;2. In cases where the referenced documents in this Circular are replaced or amended, the replacement or amended documents shall apply.Pursuant to the Labor Safety and Health Law on June 25, 2015;

Pursuant to Decree No. 95/2022/NĐ-CP dated November 15, 2022 of the Governmentstipulating the functions, tasks, powers, and organizational structure of the Ministry of HealthDepartment of Medical Examination and Treatment, Department of Maternal and Child Health,

Health ; issues this Circular amending and supplementing some articles of Circular No. 56/2017/TT-BYT dated December 29, 2017 of the Minister of Health detailing the implementation of the Social Insurance Law and the Labor Safety and Health Law in the field of health (hereinafter referred to as Circular No. 56/2017/TT-BYT).Article 1. Amending and supplementing some articles of Circular No. 56/2017/TT-BYT dated December 29, 2017 of the Minister of Health detailing the implementation of the Social Insurance Law and the Labor Safety and Health Law in the field of health (hereinafter referred to as Circular No. 56/2017/TT-BYT);

3. Supplement Appendix 35 Guidelines for diagnosing and assessing occupational COVID-19 disease attached hereto.4. Supplement Appendix 36 Record of Occupational Exposure to SARS-CoV-2 Virus attached hereto.Article 4. Cases of illness entitled to one-time social insurance benefitsIn addition to cases where individuals are suffering from one of the life-threatening diseases such as cancer, polio, cirrhosis, leprosy, severe tuberculosis, HIV/AIDS as specified in point c, Clause 1, Article 60 of the Social Insurance Law, individuals with disabilities or illnesses resulting in a reduction in work capacity of 81% or more and who cannot self-manage or perform daily activities without constant supervision, assistance, and full care shall be entitled to one-time social insurance benefits." 2. Amend point d, Clause 1, Article 5 as follows:

Minister of "d) The original or a certified copy of the discharge summary or a summary of the medical record as prescribed in Appendix 3 and Appendix 4 issued together with this Circular. If the worker has not been hospitalized or treated as an outpatient, they must have documents related to the examination and treatment of occupational injuries or diseases corresponding to the time of the accident and the injury for which assessment is requested. For individuals subject to assessment under point c, Clause 1, Article 47 of the Labor Safety and Health Law: The summary of the medical record must clearly state the occupational injury that cannot be stably treated." Ministry of Health 3. Amend Clause 3, Article 5 as follows:2. In cases where the referenced documents in this Circular are replaced or amended, the replacement or amended documents shall apply."3. Documents for occupational disease and disability assessment for retirement benefits for workers: a) A letter of introduction for assessment from the employer according to the model prescribed in Appendix 1 issued together with this Circular for workers who are still contributing to mandatory social insurance or a request for assessment according to the model prescribed in Appendix 2 issued together with this Circular for workers who are preserving their contribution period or workers who have a decision to stop working pending resolution of retirement benefits or monthly allowances, in which the worker clearly states the occupational injuries or diseases for assessment in the request;

b) The original or a certified copy of one of the following documents:

1. Amend Article 4 as follows:

"- Summary of the medical record;

- Certificate of disability;

- Discharge summary;

- Medical visit book;

- Medical examination form;

- Clinical test results form;

- Prescription from a medical facility;

- Occupational disease file;

- The most recent medical assessment report for those who have already been assessed;"

4. Amend point b, Clause 4, Article 5 as follows:

"b) The original or a certified copy of one of the following documents:

- The most recent medical assessment report for those who have already been assessed."

5. Amend point b, Clause 5, Article 5 as follows:

6. Amend point b, Clause 6, Article 5 as follows:

- The most recent medical assessment report for those who have already been assessed."

7. Amend point c, Clause 2, Article 6 as follows:

"c) The original or a certified copy of the discharge summary or a summary of the medical record as prescribed in this Circular or an occupational disease file noting the severity of the occupational disease.

For individuals subject to assessment under point c, Clause 1, Article 47 of the Labor Safety and Health Law: The summary of the medical record during treatment must clearly state the occupational disease that cannot be stably treated."

8. Amend Clause 1, Article 12 as follows:

"1. For cases of re-assessment of occupational accidents and occupational diseases, workers can proactively undergo assessment of the degree of reduced work capacity and be reimbursed for the assessment fee if the assessment result meets the conditions to increase the level of occupational accident and occupational disease benefits."

9. Amend and supplement Clause 4, Article 13 as follows:

4. Amend point b, Clause 4, Article 5 as follows:

"b) The original or a certified copy of one of the following documents:

- The most recent medical assessment report for those who have already been assessed."

5. Amend point b, Clause 5, Article 5 as follows:

6. Amend point b, Clause 6, Article 5 as follows:

- The most recent medical assessment report for those who have already been assessed."

7. Amend point c, Clause 2, Article 6 as follows:

"c) The original or a certified copy of the discharge summary or a summary of the medical record as prescribed in this Circular or an occupational disease file noting the severity of the occupational disease.

"4. Contents of assessment for retirement benefits, survivor benefits, and leave due to insufficient health to raise children after childbirth or maternity leave, assessment for one-time social insurance benefits based on the documents specified in Clauses 3 and 4, Article 5 and Clause 2, Article 12 of this Circular, appropriate to each case.

If there is already an Occupational Accident and Disease Assessment Report, War Invalids' Assessment Report, or an Assessment Report of Diseases, Disabilities, Deformities, and Congenital Defects related to chemical toxins, then these assessments will not be repeated. The Medical Assessment Board will consolidate the percentage of body damage determined in previous Medical Assessment Reports with the percentage of body damage proposed for assessment that does not overlap with previously recorded damages and determine the percentage of body damage.

9. Amend and supplement Clause 4, Article 13 as follows:

4. Amend point b, Clause 4, Article 5 as follows:

"b) The original or a certified copy of one of the following documents:

- The most recent medical assessment report for those who have already been assessed."

5. Amend point b, Clause 5, Article 5 as follows:

6. Amend point b, Clause 6, Article 5 as follows:

- The most recent medical assessment report for those who have already been assessed."

7. Amend point c, Clause 2, Article 6 as follows:

"c) The original or a certified copy of the discharge summary or a summary of the medical record as prescribed in this Circular or an occupational disease file noting the severity of the occupational disease.

"4. Contents of assessment for retirement benefits, survivor benefits, and leave due to insufficient health to raise children after childbirth or maternity leave, assessment for one-time social insurance benefits based on the documents specified in Clauses 3 and 4, Article 5 and Clause 2, Article 12 of this Circular, appropriate to each case.

If individuals are suffering from one of the life-threatening diseases such as cancer, polio, cirrhosis, leprosy, severe tuberculosis, HIV/AIDS, the original or a certified copy of the discharge summary or a summary of the medical record will be used to consider and resolve the benefit.

9. Amend and supplement Clause 4, Article 13 as follows:

4. Amend point b, Clause 4, Article 5 as follows:

"b) The original or a certified copy of one of the following documents:

- The most recent medical assessment report for those who have already been assessed."

5. Amend point b, Clause 5, Article 5 as follows:

6. Amend point b, Clause 6, Article 5 as follows:

- The most recent medical assessment report for those who have already been assessed."

7. Amend point c, Clause 2, Article 6 as follows:

"c) The original or a certified copy of the discharge summary or a summary of the medical record as prescribed in this Circular or an occupational disease file noting the severity of the occupational disease.

For other diseases entitled to one-time social insurance benefits, the Medical Assessment Report must clearly conclude the contents of the diseases, disabilities with a reduction in work capacity of 81% or more and who cannot self-manage or perform daily activities without constant supervision, assistance, and full care."

7. Amend Point c Clause 2 Article 6 as follows:

"c) The original or a certified copy of the discharge certificate or a summary of the medical record in accordance with this Circular or the occupational disease file recording the occupational disease at a more severe level.

In cases where the person undergoing appraisal falls within the category specified in Point c Clause 1 Article 47 of the Labor Safety and Health Law: The summary of the medical treatment record must clearly state that the occupational disease cannot be stabilized through treatment."

8. Amend Clause 1 Article 12 as follows:

"1. For cases of re-appraisal of work-related accidents and occupational diseases, workers are entitled to proactively undergo examination for disability assessment and have the examination fees reimbursed if the examination results meet the conditions to increase the level of work injury and occupational disease benefits."

9. Amend and supplement Clause 4 Article 13 as follows:

"4. The content of examinations for entitlement to retirement benefits, survivor benefits, and leave due to insufficient health to care for children after childbirth or post-pregnancy leave, and leave for surrogate motherhood, and examinations for one-time social insurance benefits shall be based on the documents stipulated in Clause 3 or Clause 4 Article 5 and Clause 2 Article 12 of this Circular, appropriate to each case.

Where there is already an Appraisal Record of Work-Related Accidents, Occupational Diseases, War Invalids, or Illnesses, Disabilities, Deformities related to chemical toxins, no further examination shall be conducted for injuries, illnesses, disabilities already recorded in such Appraisal Records. The Medical Appraisal Board shall consolidate the percentage of bodily impairment previously determined in previous Medical Appraisal Records with the percentage of bodily impairment proposed for examination which does not overlap with the recorded impairments and determine the overall percentage of bodily impairment.

In cases where the person suffers from life-threatening diseases such as cancer, polio, cirrhosis, leprosy, severe tuberculosis, or HIV/AIDS, the original or a certified copy of the discharge certificate or a summary of the medical record shall be used to consider and resolve the benefit scheme.

In cases of other diseases eligible for one-time social insurance benefits, the Medical Appraisal Record must conclude clearly the contents of suffering from diseases, disabilities causing a reduction in working capacity of 81% or more and unable to self-control or perform daily personal activities without full assistance, monitoring, and care from others."

10. Amend Point d Clause 5 Article 13 as follows;

"d) In cases where the subject has been examined and appraised due to work-related accidents or occupational diseases two or more times but the percentage has not yet been compiled:

- If the medical examination records note overlapping injuries in one or more body organs or parts, the Medical Appraisal Board shall re-examine all recorded injuries (including both overlapping and non-overlapping injuries) and compile them with the percentage of bodily injury recorded in the medical examination record without overlapping injuries according to regulations and issue a new medical examination record;

- If the subject has been examined and appraised due to work-related accidents or occupational diseases two or more times and there is a summary of the medical history or discharge certificate or occupational disease file noting a more severe or less severe injury compared to the injury recorded in the medical examination records of these examinations, the Medical Appraisal Board shall examine and appraise all recorded injuries in the medical examination records showing changes in injury status and compile the percentage of bodily injury with the percentage of bodily injury recorded in the remaining medical examination records according to regulations and issue a new medical examination record;

- In other cases, the Medical Appraisal Board shall compile the percentage of bodily injury from these appraisal records according to the method prescribed in Circular Joint No. 28/2013/TTLT-BYT-BLDTBXH dated September 27, 2013 of the Minister of Health and the Minister of Labor, War Invalids and Social Affairs on the percentage of bodily injury caused by injury, illness, disability, and occupational disease and issue a new medical examination record.";

11. Amend Clause 3 Article 15 as follows:

"3. In cases where patients are hospitalized at commune health stations that have beds for hospitalization as decided by the Department of Health according to Point b Clause 5 Article 4 of Circular No. 39/2018/TT-BYT dated November 30, 2018 of the Ministry of Health on unified prices for medical services for health insurance between hospitals of the same level nationwide and guidance on applying prices and settling costs for medical services under health insurance in certain cases, they shall be issued a certificate of leave for social insurance according to the model prescribed in Appendix 7 attached to this Circular, clearly stating the number of days hospitalized at the commune health station and the number of days of leave for social insurance but not exceeding thirty days.";

12. Amend Clause 2 Article 20 as follows:

"2. One examination only entitles the patient to one certificate of leave for social insurance. In cases where the patient needs to take more than thirty days off, when the leave period recorded on the certificate of leave for social insurance issued expires or is about to expire, the patient must undergo a re-examination for the practitioner to consider and decide.

In cases where a worker is examined by two or more specialties of different healthcare facilities and is issued certificates of leave for social insurance, they can only enjoy the certificate with the longest leave period.

In cases where a worker is examined by multiple specialties in the same day at the same healthcare facility for different illnesses, only one certificate of leave for social insurance will be issued and the social insurance benefit will be granted for the illness with the highest benefit.

In cases where a patient is treated for tuberculosis under the National Tuberculosis Control Program, the maximum leave period for one issuance of a certificate of leave for social insurance does not exceed one hundred eighty days.

In cases where a worker suffers miscarriage, abortion, suction, or stillbirth with a fetal age of thirteen weeks or more, the maximum leave period according to the Law on Social Insurance but not exceeding fifty days for one issuance of a certificate of leave for social insurance.";

13. Add Article 20a after Article 20 as follows:

"Article 20a. Issuance of discharge certificates and sick leave certificates for persons infected with COVID-19 treated at medical facilities shall be carried out as follows::

1. Recipients:

 Persons infected with COVID-19 undergoing inpatient or outpatient treatment at the following medical facilities:

a) Medical facilities established in accordance with the Law on Medical Examination and Treatment 2009;

b) COVID-19 reception and treatment centers established in accordance with point a, Clause 1, Article 1 of Resolution No. 168/NQ-CP dated December 31, 2021 of the Government on certain mechanisms and policies in preventing and controlling the COVID-19 pandemic, as follows:

- Field hospitals treating COVID-19;

- Hospitals treating COVID-19;

- Hospitals providing intensive care for COVID-19 patients;

- Centers for intensive care of COVID-19 patients.

2. Competent authority to issue:

The heads of the facilities specified in Clause 1 of this Article or persons authorized by the heads in accordance with the law.

3. Provisions on issuance of discharge certificates and sick leave certificates:

a) After completing treatment at medical facilities, patients shall be issued discharge certificates and sick leave certificates in accordance with this Circular. In cases where certificates issued before the effective date of this Circular do not comply with the format prescribed in Circular No. 56/2017/TT-BYT, the medical facility shall reissue them in accordance with this Circular. For discharge certificates, the admission and discharge dates shall be recorded according to the inpatient treatment records, and the date on the signature section of the practitioner shall be the date of issuance;

b) In cases where workers have been treated for COVID-19 but have not yet received discharge certificates or sick leave certificates, the medical facility where the worker was treated shall issue such certificates based on the patient's request and medical records. For discharge certificates, the admission and discharge dates shall be recorded according to the inpatient treatment records, and the date on the signature section of the practitioner shall be the date of issuance;

c) In cases where patients, after being discharged, have information about continued outpatient treatment or quarantine period recorded in their discharge certificate, the sick leave period shall be determined according to the time recorded in the discharge certificate;

d) In cases where patients, after being discharged, do not have information about continued outpatient treatment in their discharge certificate but must undergo quarantine as required, the sick leave period shall be determined according to the quarantine period stipulated in Appendix 9 attached to this Circular;

đ) In cases where COVID-19 reception and treatment centers have been dissolved, the medical facility assigned to manage and operate the center in accordance with point c, Section V of Decision No. 4111/QĐ-BYT dated August 26, 2021 of the Minister of Health on issuing guidelines for establishing COVID-19 reception and treatment centers under the three-tier model shall be responsible for issuing, reissuing, or issuing new discharge certificates and sick leave certificates for patients;

e) The issuance and use of discharge certificates and sick leave certificates shall follow the formats prescribed in Appendices 3 and 7 attached to this Circular."

14. Amend Article 21 as follows:

"Article 21. Form of issuance of work cessation certificates for social insurance benefits and recording content of work cessation certificates for social insurance benefits

1. In cases where employees or children under seven years old of employees have been hospitalized: discharge certificate according to the model prescribed in Appendix 3 issued together with this Circular.

In cases where there is a transfer between hospitals during treatment, a valid copy of the hospital transfer certificate shall also be provided.

In cases where patients die at healthcare facilities, no discharge certificate shall be issued. The implementation of social insurance benefits for the period when the patient was treated at the healthcare facility before death shall be based on the date recorded on the death notice according to Circular No. 24/2020/TT-BYT dated December 28, 2020 of the Ministry of Health regarding the death cause diagnosis form, issuance of death notice, and death statistics at healthcare facilities.

2. In cases where employees or children under seven years old of employees are undergoing outpatient treatment: work cessation certificate for social insurance benefits according to the model prescribed in Appendix 7 issued together with this Circular.

If the patient needs to rest for outpatient treatment after being discharged from the hospital, the social insurance agency shall base the number of days off recorded in the remarks section of the discharge certificate to process social insurance benefits according to regulations.

3. The format and recording method of work cessation certificates for social insurance benefits shall be implemented according to the provisions in Appendix 7 issued together with this Circular.

a) Recording the start date of leave from the day the patient visits the healthcare facility for examination and treatment;

b) Recording the date in the date, month, year section on the signature part of the medical practitioner on the work cessation certificate for social insurance benefits shall be carried out as follows:

- According to the date and month the patient finishes examination and treatment;

- The date the healthcare facility issues the work cessation certificate for social insurance benefits in cases where employees request reissuance according to this Circular;

c) In case of reissue, the content "REISSUED" must be indicated on the work cessation certificate for social insurance benefits.

4. Recording the disease code and long-term disease name on work cessation certificates for social insurance benefits and discharge certificates shall be carried out strictly according to the provisions in Circular No. 46/2016/TT-BYT dated December 30, 2016 of the Minister of Health on the list of diseases requiring long-term treatment.

In cases where the disease code recorded in the work cessation certificate for social insurance benefits and discharge certificate matches the disease code specified in Circular No. 46/2016/TT-BYT but the disease name does not match the disease name specified in Circular No. 46/2016/TT-BYT, the long-term disease treatment shall be processed according to the disease code specified in Circular No. 46/2016/TT-BYT.

15. Amend Clause 1 of Article 25 as follows:

"1. Update the conclusion of the medical examination report into the national health examination and treatment database to link with the data system of the social insurance agency."

16. Add Clause 6 to Article 26 as follows:

"6. In cases where employees have undergone medical examination and treatment but have not yet received a discharge certificate, birth certificate, maternity leave certificate, certificate of insufficient health to care for newborns, or work cessation certificate for social insurance benefits, the healthcare facility where the employee underwent medical examination and treatment shall issue the discharge certificate, birth certificate, maternity leave certificate, certificate of insufficient health to care for newborns, or work cessation certificate for social insurance benefits based on this Circular and the request of the employee, with the date, month, and year section on the signature part of the medical practitioner recorded according to the date of issuance."

17. Amend Appendices 1, 2, 3, 4, and 7 issued together with this Circular.

18. Add Appendix 9 issued together with this Circular.

Article 2. Effective Date

1. This Circular takes effect from February 15, 2023.

2. Appendix 4 and Appendix 5 issued together with Joint Circular No. 20/2016/TTLT-BYT-BLDTBXH dated June 30, 2016 of the Minister of Health and the Minister of Labor, Invalids, and Social Affairs guiding medical examination and diagnosis of diseases, disabilities, deformities, and defects related to exposure to chemical toxins for those who participated in the resistance war and their offspring shall cease to be effective from the date this Circular takes effect.

Article 3. Responsibility for Implementation

The Director of the Department of Medical Examination and Treatment, the Head of the Legal Department, the Head of the Women's and Children's Health Department, the Director of the Office of the Ministry, the Inspector General, Heads of Departments, Directors of Bureaus, and General Directors of all Departments, Bureaus, and General Departments under the Ministry of Health, Heads of units directly under the Ministry of Health, and relevant organizations and individuals are responsible for implementing this Circular./.