Circular No. 50/2017/TT-BYT Amending and Supplementing Provisions Related to Payment for Medical Examination and Treatment Costs

CIRCULAR

AMENDMENTS AND SUPPLEMENTS TO PROVISIONS RELATED TO PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS

Pursuant to the Health Insurance Law No. 25/2008/QH12 dated November 14, 2008, which has been amended and supplemented with certain Articles by Law No. 46/2014/QH13 dated June 13, 2014;

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

Pursuant to the Statistics Law No. 89/2015/QH13 dated November 23, 2015;

Pursuant to Decree No. 75/2017/NĐ-CP dated June 20, 2017 of the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of the Heads of Departments: Legal Affairs, Health Insurance, Planning and Finance, and the Directors of the Agencies: Medical Examination and Treatment Management, Traditional Medicine Management Agency;

The Minister of Health issues this Circular to amend and supplement provisions related to payment of medical examination and treatment costs.

Article 1. Amending and Supplementing Decision No. 1895/1997/QĐ-BYT dated September 19, 1997 of the Minister of Health on the issuance of the Hospital Regulations

1. Amending and supplementing Point i Item 2 of the Radiology Department Work Regulation regarding the tasks of radiologists and radiologic technicians as follows:

"Medical examination and treatment facilities organize the storage of radiographic images in electronic form or film, except for outpatient examinations and treatments.

- Information from radiographic imaging of inpatients must be reflected in the patient's medical record and the Radiographic Imaging Register of the medical examination and treatment facility.

- In cases of transfer to another facility, it is necessary to transfer the radiographic films along with the transfer papers and certificates: the doctor transferring the patient is responsible for signing on the photocopied version of the response report sent and recording the information about the transfer of films in the corresponding imaging request forms (including: X-ray Request Form; CT Scan Request Form; MRI Request Form; X-ray Response Report; CT Scan Response Report; MRI Response Report) and storing them together with the medical record.

- In cases where the person being imaged is an outpatient: return the radiographic films taken along with the corresponding response report to the person. The patient or their representative must sign to confirm receipt of the radiographic images at:

+ Outpatient Registration Book of the medical examination and treatment facility (indicating the number of films received) for patients not covered by health insurance;

+ Payment receipt for medical examination and treatment (indicating the number of films received) for patients covered by health insurance."

2. Adding Point d in Clause 3 Part II of the Medical Record Model as follows:

"-D: Model 'Public Disclosure of Inpatient Medical Examination and Treatment Services: 1 type'"

Article 2. Amending and Supplementing Decision No. 4069/2001/QĐ-BYT dated October 28, 2001 of the Minister of Health on the issuance of the Medical Record Model

Amending and supplementing the guidance on using the Surgical/Procedure Form as follows:

"-For surgeries that require the use of a form and drawing a diagram;

-For procedures using general anesthesia or requiring performance in an operating room or interventional vascular procedures (excluding injections and infusions), airway management: Use the procedure form and draw a procedure diagram (if necessary).

-For other procedures: No need to fill out a surgical/procedure form but must record the indication and content of service provision in the medical record and have the signature of confirmation from the patient or their representative after each treatment session."

Article 3. Amend and supplement Circular No. 28/2014/TT-BYT dated August 14, 2014 of the Minister of Health on the content of the health statistics index system.

Amend the concept and definition part of Index No. 20 regarding the average number of days of inpatient treatment for one inpatient episode as follows:

"Inpatient treatment day: Is a day during which the patient has an inpatient medical record and enjoys at least one of the following regimes: monitoring, diagnosis, treatment, or care."

Article 4. Amend and supplement Circular No. 40/2014/TT-BYT dated November 17, 2014 of the Minister of Health promulgating the List of new drugs within the scope of payment by the Health Insurance Fund.

Amend and supplement the List of new drugs in Circular No. 40/2014/TT-BYT as follows:

1. Amend the name of drug "Iodized fatty acid ethyl ester" in row No. 636 column No. 2 to "Iodized fatty acid ethyl ester in poppy seed oil".

2. Amend the name of drug "Calcium-3-methyl-2-oxovalerate + calcium-4-methyl-2-oxovalerate + calcium-2-methyl-3-phenylpropionate + calcium-3-methyl-2-oxobutyrate + calcium-DL-methyl-2-hydroxy-4-methylthiobutyrate + L-lysine acetate + L-threonine + L-tryptophan + L-histidine + L-tyrosine + Nitrogen + calcium" in row No. 1039 column No. 2 to "Calcium-3-methyl-2-oxovalerate + calcium-4-methyl-2-oxovalerate + calcium-2-oxo-3-phenylpropionate + calcium-3-methyl-2-oxobutyrate + calcium-2-hydroxy-4-methylthiobutyrate + L-lysine acetate + L-threonine + L-tryptophan + L-histidine + L-tyrosine + Nitrogen + calcium".

Article 5. Amend and supplement Circular No. 05/2015/TT-BYT dated March 17, 2015 of the Minister of Health promulgating the List of traditional Chinese medicine, herbal medicines, and traditional medical ingredients within the scope of payment by the Health Insurance Fund. t sAmend and supplement the List of traditional Chinese medicine, herbal medicines as follows: t sregarding traditional medicine and herbal drugs as follows:

1. Amend and supplement the medicine "Phyllanthus urinaria, Artemisia scoparia, Imperata cylindrica, Maize silk/Corn silk, (Lonicera japonica), (Curcuma longa)" in row No. 26 column No. 1 to "Phyllanthus urinaria, Artemisia scoparia, Imperata cylindrica, (Maize silk/Corn silk), (Lonicera japonica), (Curcuma longa)".

2. Amend and supplement the medicine "Phyllanthus urinaria, Houttuynia cordata, Echinacea purpurea, Polygonum aviculare" in row No. 28 column No. 1 to "Phyllanthus urinaria/Phyllanthus amarus, Houttuynia cordata, Echinacea purpurea, Polygonum aviculare".

3. Amend and supplement the medicine "Lonicera japonica, Artemisia scoparia, Coix lacryma-jobi, Curcuma longa, Rehmannia glutinosa, Echinacea purpurea, Glycyrrhiza uralensis" in row No. 34 column No. 1 to "Lonicera japonica, Artemisia scoparia/Artemisia capillaris, Coix lacryma-jobi, Curcuma longa, Rehmannia glutinosa, Echinacea purpurea, Glycyrrhiza uralensis".

4. Amend and supplement the medicine "Clematis chinensis, Cinnamomum cassia/Cinnamomum burmannii, Clematis hexapetala, Angelica sinensis, Zanthoxylum bungeanum, Ligusticum wallichii, Atractylodes macrocephala, Paeonia lactiflora, Taxillus chinensis, Rehmannia glutinosa/Rehmannia preparata/Rehmannia glutinosa root, Dipsacus asper, Dioscorea opposita, Polyporus umbellatus/Poria cocos, Glycyrrhiza uralensis, (Codonopsis pilosula/Ginseng)" in row No. 58 column No. 1 to "Clematis chinensis, Cinnamomum cassia/Cinnamomum burmannii, Clematis hexapetala, Angelica sinensis, Zanthoxylum bungeanum/Drynaria fortunei, Ligusticum wallichii, Atractylodes macrocephala, Paeonia lactiflora, Taxillus chinensis, Rehmannia glutinosa/Rehmannia preparata/Rehmannia glutinosa root, Dipsacus asper, Dioscorea opposita, Polyporus umbellatus/Poria cocos, Glycyrrhiza uralensis, (Codonopsis pilosula/Ginseng)".

5. Amend and supplement the medicine "Ophiopogon japonicus, Ginseng/Codonopsis pilosula, Atractylodes macrocephala, Polyporus umbellatus/Poria cocos, Pinellia ternata, Oryza sativa, Zingiber officinale, Glycyrrhiza uralensis, Zanthoxylum bungeanum, Coptis chinensis, (Euphorbia helioscopia)" in row No. 88 column No. 1 to "Ophiopogon japonicus, Ginseng/Codonopsis pilosula, Atractylodes macrocephala, Polyporus umbellatus/Poria cocos, Pinellia ternata, Oryza sativa, Zingiber officinale, Glycyrrhiza uralensis, Zanthoxylum bungeanum, Coptis chinensis/Euphorbia helioscopia".

6. Amend and supplement the medicine "Prunus mume seed, Angelica sinensis, Dioscorea opposita, Poria cocos, Lycium barbarum, Schisandra chinensis, Polygala tenuifolia, Amber, Gardenia jasminoides, Dracontomelon dao, Bone glue, Salvia miltiorrhiza, Bupleurum falcatum" in row No. 141 column No. 1 to "Prunus mume seed, Angelica sinensis, Dioscorea opposita, Poria cocos, Lycium barbarum, Schisandra chinensis, Polygala tenuifolia, Amber, Gardenia jasminoides, Dracontomelon dao, Bone glue extract, Salvia miltiorrhiza, Bupleurum falcatum".

7. Amend and supplement the medicine "Ligusticum wallichii, Atractylodes macrocephala, Saposhnikovia divaricata, Angelica sinensis, Ophiopogon japonicus, Panax ginseng, Euphorbia helioscopia, Schisandra chinensis, Borneol" in row No. 143 column No. 1 to "Ligusticum wallichii, Atractylodes macrocephala, Saposhnikovia divaricata, Angelica sinensis, Ophiopogon japonicus, Panax ginseng, Euphorbia helioscopia, Schisandra chinensis, Borneol/Bomeol".

8. Amend and supplement the medicine "Polygonatum odoratum, Tussilago farfara, Stemona sessilifolia, Lophatherum gracile, Magnolia officinalis, Asarum sieboldii, Polyporus umbellatus/Poria cocos, Glycyrrhiza uralensis, Scutellaria baicalensis, (Cineole/Menthol)" in row No. 158 (column 1) to "Polygonatum odoratum, Tussilago farfara, Stemona sessilifolia, Lophatherum gracile, Magnolia officinalis, Asarum sieboldii, Polyporus umbellatus/Poria cocos, Glycyrrhiza uralensis, Scutellaria baicalensis, Cineole, (Menthol)".

9. Amend and supplement the medicine "Codonopsis pilosula, Polyporus umbellatus/Poria cocos, Atractylodes macrocephala, Glycyrrhiza uralensis, Rehmannia preparata/Rehmannia glutinosa root, Paeonia lactiflora, Ligusticum wallichii, Atractylodes macrocephala, Angelica sinensis" in row No. 196 column No. 1 to "Codonopsis pilosula, Polyporus umbellatus/Poria cocos, Atractylodes macrocephala, Glycyrrhiza uralensis, Rehmannia preparata/Rehmannia glutinosa root, Paeonia lactiflora, Angelica sinensis, Ligusticum wallichii, Angelica sinensis".

10. Amend and supplement the medicine "Herba Ecliptae, Hemerocallis minor, Sophora japonica, Evodia rutaecarpa, Camphor, Curcuma longa, Euphorbia helioscopia, Schisandra chinensis, Clove, Cinnamon, Ginger, Methyl salicylate, Gelatin, Ethanol" in row No. 223 column No. 1 to "Herba Ecliptae, Hemerocallis minor, Sophora japonica, Evodia rutaecarpa, Camphor, Curcuma longa, Euphorbia helioscopia, Schisandra chinensis, Clove, Cinnamon, Ginger, Methyl salicylate, Glycerin, Ethanol".

11. Amend and supplement the name of the traditional medicine ingredient "Angelica sinensis (Whole root)" in row No. 296 column No. 1 to "Angelica sinensis (Whole root, Root head, Root tail/root hair)".

12. Amend the origin of the traditional medicine ingredient "Rehmannia preparata/Rehmannia glutinosa root" in row No. 301 column No. 1 from "N" to "N-B".

12. Amend the origin of the medicinal ingredient "Thục địa" in the first column "N" with serial number 301 to "N-B".

Article 6. Amend and supplement Circular No. 41/2015/TT-BYT dated November 16, 2015 amending and supplementing some Articles of Circular No. 41/2011/TT-BYT dated November 14, 2011 of the Minister of Health guiding the issuance of practice certificates for practitioners and permits for medical examination and treatment establishments.

1. Amend and supplement Article 7a as follows:

"Article 7a. Scope of professional activities recorded on the practice certificate

1. The scope of professional activities recorded on the practice certificate shall be according to the groups of specialties specified in Appendix 4b issued together with this Circular.

2. A practitioner who has been granted a practice certificate with a scope of professional activities in a particular specialty may perform the technical services of that specialty, except in cases where certain special surgeries or procedures are performed as prescribed in Circular No. 50/2014/TT-BYT dated December 26, 2014 of the Minister of Health regarding the classification of surgeries and procedures and staffing levels for each surgery or procedure, which require additional training certificates or certifications.

The person responsible for technical services at medical examination and treatment establishments shall base their decision on the scope of professional activities recorded on the practice certificate, diplomas, certificates, or certifications, and the capabilities of the practitioner to issue a written authorization allowing the practitioner to perform specific technical services at the establishment they manage.

2. Amend and supplement Appendix 4b issued together with Circular No. 41/2015/TT-BYT as follows:

"1. General Internal Medicine Specialist: Medical examination and internal disease treatment.
1b. Rehabilitation Medicine Specialist."

Article 7. Amend and supplement Circular No. 35/2016/TT-BYT dated September 28, 2016 of the Minister of Health promulgating the List t sof items, đpayment conditions for medical technology services within the scope of health insurance benefits

1. Amend and supplement Point b Clause 1 Article 3 as follows:

"b) Shall be carried out according to the professional procedures approved by the competent authority, specifically:

- Medical examination and treatment establishments must implement the professional guidance materials on diagnosis, treatment, and technical procedures issued by the Ministry of Health or established by the head of the medical examination and treatment establishment based on the professional guidance materials and technical procedures issued by the Ministry of Health and the actual conditions of the establishment.

- For medical examination and treatment services for which the Ministry of Health has not issued professional guidance or technical procedures, the head of the medical examination and treatment establishment shall develop and issue professional guidance or technical procedures for implementation at the establishment based on references from authoritative sources, scientific evidence, and the conditions of the establishment.

- When issuing professional guidance or technical procedures for implementation at the establishment, the head of the medical examination and treatment establishment shall have the responsibility to send the issued guidance or procedures to the social insurance agency in the province where the medical examination and treatment establishment is located."

2. Amend the example at Point b Clause 3 Article 4 as follows:

"Example: A patient belonging to the category entitled to 95% reimbursement for medical examination and treatment costs, is prescribed to undergo the medical technology service "Whole-body Computed Tomography Scan" (without contrast media), as follows:

In the case of a prescription for "Evaluation of stages of tumor or multiple trauma", payment will be made according to the price of the medical technology service "Whole-body Computed Tomography Scan" priced at 6,606,000 VND (without contrast media), as follows:

- Health Insurance Fund pays: 6,606,000 VND x 95% = 6,275,700 VND.

- Patient pays the co-payment portion: 6,606,000 VND x 5% = 330,300 VND.

In other cases, payment will be made according to the price of the medical technology service "Computed Tomography Scan 1-32 slices" priced at 536,000 VND (without contrast media), as follows:

- Health Insurance Fund pays: 536,000 VND x 95% = 509,200 VND.

- Patient pays the co-payment portion: 536,000 VND x 5% = 26,800 VND.

- The difference in cost is = 6,606,000 VND - 536,000 VND = 6,070,000 VND, which the patient does not need to pay."

3. Amend and supplement Clause 2 Article 5 as follows:

"2. For medical technology services where the payment conditions stipulate that the performer must have a Training Certificate but has been issued a Training Certificate instead of a Training Certificate, the Training Certificate shall continue to be used in accordance with the provisions of Government Decree No. 109/2016/NĐ-CP dated July 1, 2016 on granting practice certificates for practitioners and permits for medical examination and treatment establishments."

4. Amend Items 1, 10, and 14 of List 1 - Medical Technology Services with specific conditions, rates, and payment prices as follows:

||| 4. Amend Sections 12, 13, 39, and 65 of List 2 - Medical Technical Services with specific payment conditions as follows:

Article 8. Amend and supplement Circular No. 04/2017/TT-BYT dated April 14, 2017 issued by the Minister of Health on the payment conditions for medical supplies within the scope of benefits for health insurance participants. t sof items, đpayment conditions for medical supplies within the scope of benefits for health insurance participants

1. Amend and supplement Point c Clause 2 Article 3 as follows:

“c) For technical services involving the placement of coronary artery stents that require the use of more than one drug-coated stent, the total cost of medical supplies including the first stent and other medical supplies outside the stent used in one service session shall be paid according to the payment guidelines set out in point b Clause 2 of this Article. In addition, the Health Insurance Fund will pay half (1/2) of the cost of the second stent based on the purchase price of the healthcare facility but not exceeding 18,000,000 VND.

Example: Drug-coated stent A has a purchase price at a healthcare facility of 40,000,000 VND; the payment level for drug-coated stents as stipulated in Column 5 of the Medical Supplies Catalogue attached as Appendix 01 of this Circular is 36,000,000 VND. The patient is admitted to the healthcare facility to undergo a stent placement procedure with the prescription to place three drug-coated stent A. The cost of other medical supplies outside the stent that have not been included in the service price, examination fee, bed day charge, or bundled payment (hereinafter referred to as other medical supplies) is 15,000,000 VND; these medical supplies do not have a payment level specified in Column 5 of the Medical Supplies Catalogue attached as Appendix 01 of this Circular.

- In the case where the patient is a health insurance participant entitled to 100% coverage who seeks treatment at an in-network facility, the total payment for medical supplies in one service session according to the example illustrating point b Clause 2 of Article 3 is 54,450,000 VND. The total cost of one drug-coated stent A and other medical supplies is 36,000,000 + 15,000,000 = 51,000,000 VND; this cost is less than 54,450,000 VND. The Health Insurance Fund will pay the patient:

+ The first stent and other medical supplies amounting to 51,000,000 VND;

+ The second stent: Since 1/2 x 40,000,000 = 20,000,000 VND exceeds 18,000,000 VND, the Health Insurance Fund will pay 18,000,000 VND for the second stent.

+ The third stent will not be paid.

Therefore, the Health Insurance Fund will pay a total of 51,000,000 + 18,000,000 = 69,000,000 VND for medical supplies in one service session for the patient;

If the patient seeks treatment at a central-level hospital out-of-network, the Health Insurance Fund will pay a total of (51,000,000 + 18,000,000) x 40% = 27,600,000 VND for medical supplies in one service session for the patient;

If the patient seeks treatment at a provincial-level hospital out-of-network, the Health Insurance Fund will pay a total of (51,000,000 + 18,000,000) x 60% = 41,400,000 VND for medical supplies in one service session for the patient;

- In the case where the patient is a health insurance participant entitled to 80% coverage who seeks treatment at an in-network facility but has not participated continuously for over five years, the total cost of one drug-coated stent A and other medical supplies is

36,000,000 + 15,000,000 = 51,000,000 VND; this cost is less than 54,450,000 VND. The Health Insurance Fund will pay the patient:

+ The first stent and other medical supplies amounting to 51,000,000 x 80% = 40,800,000 VND;

+ The second stent amounting to 18,000,000 VND;

+ The third stent will not be paid.

Therefore, the Health Insurance Fund will pay a total of 51,000,000 x 80% + 18,000,000 = 58,800,000 VND for medical supplies in one service session for the patient.

If the patient seeks treatment at a central-level hospital out-of-network, the Health Insurance Fund will pay a total of (51,000,000 x 80% + 18,000,000) x 40% = 23,520,000 VND for medical supplies in one service session for the patient.

If the patient seeks treatment at a provincial-level hospital out-of-network, the Health Insurance Fund will pay a total of (51,000,000 x 80% + 18,000,000) x 60% = 35,280,000 VND for medical supplies in one service session for the patient.”

2. Amend and supplement Appendix 01 Catalogue of Medical Supplies within the Scope of Benefits for Health Insurance Participants as follows:

a) Amend and supplement Item number 35, code N03.01.030 - "Various types and sizes of pressure infusion pumps" to "Various types and sizes of pressure infusion pumps, syringes";

b) Amend Item number 262, code N07.04.050 - "Automatic cutting and suturing devices for various types and sizes of Doppler techniques (including Doppler probe for hemorrhoids)" to "Automatic cutting and suturing devices for various types and sizes (including automatic suturing clips)".

Article 9. Amend Circular No. 23/2011/TT-BYT dated June 10, 2011, issued by the Minister of Health, guiding the use of medicines in healthcare facilities with beds.

Amend Point a Clause 1 Article 6 as follows:

"a) Publicize daily medicines used for each patient by informing the patient before administering the medicine, and at the same time require the patient or their family to sign on the Daily Inpatient Medical Service Disclosure Form (according to the model issued in Appendix No. 01 accompanying this amended Circular on some provisions regarding medical examination and treatment costs under health insurance). The Daily Inpatient Medical Service Disclosure Form shall be kept clipped at the top or end of the patient's bed."

Article 10. Effectiveness.

1. This Circular takes effect from March 1, 2018.

2. Repeal the following provisions in the Hospital Regulations issued together with Decision No. 1895/1997/QĐ-BYT dated September 19, 1997, of the Minister of Health:

a) Point i Section 2 of the Imaging Department Work Regulation;

b) "After a full hospital consultation for Class III hospitals; a full department or inter-department consultation for Class I and II hospitals; after the consultation, a referral decision is made for the patient" in Point a Section 3 Part II of the Referral Regulation.

3. Repeal the definition section of Indicator No. 20 on the average number of days of treatment for one inpatient episode as stipulated in Circular No. 28/2014/TT-BYT dated August 14, 2014, issued by the Minister of Health, regulating the content of the statistical indicators system in the healthcare sector.

4. Repeal the names of the drugs specified at serial number 636, 1039 of Column 2 in the List of New Drugs within the scope of payment by the Health Insurance Fund issued together with Circular No. 40/2014/TT-BYT dated November 17, 2014, issued by the Minister of Health.

5. Repeal the following provisions in Circular No. 05/2015/TT-BYT dated March 17, 2015, issued by the Minister of Health, promulgating the List of Traditional Medicines, Herbal Medicines:

a) The names of the drugs specified at serial number 26, 28, 34, 58, 88, 141, 143, 158, 196, 233 of Column 1 in the List of Traditional Medicines, Herbal Medicines;

b) The name of the herbal medicine at serial number 296 of Column 1 in the List of Traditional Medicines, Herbal Medicines;

c) The source of the herbal medicine at serial number 301 of Column 1 in the List of Traditional Medicines, Herbal Medicines;

6. Repeal the following provisions in Circular No. 41/2015/TT-BYT dated November 16, 2015, amending and supplementing several Articles 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 permits for healthcare facilities:

a) Article 7a;

b) Clause 1 Appendix 4b.

7. Repeal the following provisions in Circular No. 35/2016/TT-BYT dated September 28, 2016, issued by the Minister of Health, promulgating the List and Proportions, Conditions for Payment of Medical Services within the Scope of Benefit for Health Insurance Participants:

a) Point b Clause 1 Article 3;

b) Clause 2 Article 5;

c) Item 1, 10, and 14 of List 1 - Medical Services with Specific Conditions, Proportions, and Payment Levels;

d) Item 12, 13, 39, and 65 of List 2 - Medical Services with Specific Payment Conditions.

8. Repeal the following provisions in Circular No. 04/2017/TT-BYT dated April 14, 2017, issued by the Minister of Health, promulgating the List and Proportions, Conditions for Payment of Medical Supplies within the Scope of Benefit for Health Insurance Participants:

a) Point c Clause 2 Article 3;

b) Serial number 35, code N03.01.030;

c) Serial number 262, code N07.04.050.

9. Repeal Point a Clause 1 Article 6 of Circular No. 23/2011/TT-BYT dated June 10, 2011, issued by the Minister of Health, guiding the use of medicines in healthcare facilities with beds.

Article 11. Article ktransitional provisions

1. The payment of medical examination and treatment costs under health insurance for cases that have undergone medical examination and treatment before this Circular takes effect, and for patients admitted to hospitals before this Circular takes effect but discharged after it takes effect shall be implemented in accordance with the provisions of legal documents issued prior to the date this Circular takes effect.

2. For hospitals that do not yet have doctors or university graduates in radiology, X-ray, or laboratory science specialties, they must send staff for training in these specialties or recruit practitioners with expertise in these fields to meet the specified professional conditions and complete such requirements by January 1, 2021.

Article 12. Article kcross-reference

In case the referenced documents in this Circular are replaced or amended, they shall be implemented according to the replacement document or the amended document.

Article 13. Implementation Organization

The Heads of the Ministry's Office, Department Directors, Bureau Chiefs, General Bureau Chiefs of Departments, Bureaus, and General Bureaus under the Ministry of Health, Provincial Health Service Directors, Central City Health Service Directors, Heads of Health Services of sectors, and related units are responsible for implementing the provisions of this Circular.

During the implementation process, if there are difficulties or obstacles, it is requested that agencies, organizations, and individuals report them in writing to the Ministry of Health for consideration and resolution./.