Circular No. 56/2017/TT-BYT provides detailed regulations to implement the Social Insurance Law and the Labor Safety and Health Law in the field of healthcare.

CIRCULAR

DETAILING THE IMPLEMENTATION OF THE SOCIAL INSURANCE LAW AND THE LABOR SAFETY AND HEALTH LAW IN THE FIELD OF HEALTH

 

Pursuant to the Social Insurance Lawn lo hidevelopmentm society sNo. 58/2014/QH13 dated November 20, 2014;13 days 20th month 11 year 2014;

Pursuant to the Labor Safety and Health LawNo. 84/2015/QH13 dated June 17, 2015;13 ngày 25 tháng 6 năm 2015;

On the basis of Decree No. 75/2017/NĐ-CP dated October 20, 6 Pursuant to the Decree No. 75/2017/NĐ-CP dated October 20, 2017 of the Government detailing the functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of the Director of the Department of Legal Affairs, the Director of the Department of Medical Examination and Treatment, and the Director of the Department of Maternal and Child Health,

The Minister of Health issues this Circular detailing the implementation of the Social Insurance Law and the Labor Safety and Health Law in the field of health.policies.

 

PART I

GENERAL PROVISIONS

Article 1. Scope of Regulation

This Circular stipulates on:

1. Diseases and the authority to determine diseases eligible for a one-time social insurance benefit.

2. Medical examination and assessment of the degree of reduction in work capacity (body injury rate) to receive social insurance benefits for workers and their dependents.

3. Issuance of discharge certificates, birth certificates, copies of medical records, certificates of maternity leave, certificates of insufficient health to care for children after childbirth, and certificates of sick leave with social insurance benefits.

Article 2. Applicability

1. Workers participating in social insurance as stipulated in Clause 1 and Clause 4, Article 2 of the Social Insurance Law and Article 43 of the Labor Safety and Health Law.

2. Workers as stipulated in Clause 1 of this Article who are on hold regarding their social insurance contributions or workers who have been decided to be on leave awaiting retirement or monthly allowance decisions; voluntary social insurance participants who have accumulated at least 20 years of mandatory social insurance contributions.

3. Individuals requesting medical examination and assessment of the degree of reduction in work capacity to receive survivor benefits, who are dependents of workers participating in social insurance (hereinafter referred to as "dependents of workers").

Article 3. Explanation of Terms

In this Circular, the following terms are understood as follows:

1. Time off for outpatient treatment is the period during which workers are not fit to work and are prescribed outpatient treatment by healthcare practitioners.

2. Certified copy is a copy issued by an authorized agency or organization from the original book or a certified copy from the original.

3. Copy of medical record is a summary of the medical record according to the laws on medical examination and treatment.

Chapter II

DISEASES ELIGIBLE FOR A ONE-TIME SOCIAL INSURANCE BENEFIT AND MEDICAL EXAMINATION AND ASSESSMENT FILES FOR SOCIAL INSURANCE BENEFITS AND THE FILE FOR MEDICAL EXAMINATION TO RECEIVE SOCIAL INSURANCE

Article 4. Diseases eligible for a one-time social insurance benefit

The diseases eligible for a one-time social insurance benefit include:

1. Cancer, paralysis, cirrhosis, leprosy, severe tuberculosis, HIV infection that has progressed to AIDS stage and simultaneously cannot self-control or self-perform daily activities such as walking, dressing, personal hygiene, and other activities serving daily needs that require constant supervision, assistance, and care from others.

2. Other diseases or disabilities outside those specified in Clause 1 of this Article with a reduction in work capacity or disability level of 81% or higher and simultaneously cannot self-control or self-perform daily activities such as walking, dressing, personal hygiene, and other activities serving daily needs that require constant supervision, assistance, and care from others.

Article 5. Initial medical examination and assessment files

1. Initial medical examination and assessment files due to workplace accidents:

a) An introduction letter from the employer according to the model attached as Appendix 1 to this Circular for cases where the worker involved in the accident is under the management of the employer at the time of the request for examination and assessment, or a request for examination and assessment form according to the model attached as Appendix 2 to this Circular for workers who are no longer under the management of the employer at the time of the request for examination and assessment;

b) The original or a valid copy of the Certificate of Injury issued by a healthcare facility (where the worker was treated) according to the model stipulated in Decision No. 4069/2001/QĐ-BYT dated September 28, 2001 of the Minister of Health on issuing the Model Medical Record;

c) The original or a valid copy of the Workplace Accident Investigation Report according to the model stipulated in Appendix 7 attached to Joint Circular No. 12/2012/TTLT-BLDTBXH-BYT dated May 21, 2012 of the Ministry of Labor, Invalids and Social Affairs and the Ministry of Health guiding the declaration, investigation, statistics, and reporting of workplace accidents;

d) Discharge certificate according to the regulations of the Minister of Health or a summary of the medical record. In cases where the worker did not undergo inpatient or outpatient treatment, there must be documentation about the examination and treatment of injuries consistent with the time of the workplace accident and the injury subject to assessment. For individuals assessed under Point c, Clause 1, Article 47 of the Labor Safety and Health Law: The summary of the medical record must clearly state that the workplace injury is not treatable.

đ) One of the following identity documents with a photo: Identity Card; Citizen Identification Card; Valid Passport. If none of these documents are available, there must be a Confirmation Letter from the Police Station at the commune level with a photo affixed and sealed over the photo, issued within three months prior to the date of the request for examination and assessment.

2. Initial medical examination and assessment files for occupational diseases:

a) An introduction letter from the employer according to the model attached as Appendix 1 to this Circular for cases where the individual being initially assessed for occupational disease is under the management of the employer at the time of the request for examination and assessment, or a request for examination and assessment form from the worker according to the model attached as Appendix 2 to this Circular for cases where the worker is no longer engaged in a job or occupation with risk of occupational disease but has been diagnosed with an occupational disease within the guarantee period of the disease, including workers on hold regarding their social insurance contributions, workers who have been decided to be on leave awaiting retirement or monthly allowance decisions, and workers currently receiving pension or monthly allowances;

b) The original or a valid copy of the Occupational Disease File;

c) A summary of the medical record of the treatment of occupational disease of the worker related to the occupational disease (if any).

In the case where the person being examined falls within the category specified in point c, Clause 1, Article 47 of the Labor Safety and Health Law: The summary of the medical record must clearly state that the occupational disease cannot be stably treated.

d) One of the documents prescribed in point d, Clause 1, of this Article.

3. Medical examination dossier for implementing retirement benefits for workers:

a) An introduction letter from the employer according to the model prescribed in Appendix 1 attached to this Circular for workers who are compulsorily contributing to social insurance, or a request for medical examination according to the model prescribed in Appendix 2 attached to this Circular for workers who are preserving their time of social insurance contribution or workers who have a decision to stop working pending resolution of retirement benefits or monthly allowances;

b) The original or a valid copy of one or more of the following medical examination and treatment documents: Summary of medical records, Disability confirmation certificate, Discharge certificate, Medical visit book, Copy of occupational disease file, Occupational disease examination report, work-related accident report for those who have been examined for occupational diseases or work-related accidents;

c) One of the documents prescribed in point d, Clause 1, of this Article.

4. Medical examination dossier for implementing survivor benefits:

a) A request for medical examination according to the model prescribed in Appendix 2 attached to this Circular;

b) The original or a valid copy of one or more of the following medical examination and treatment documents: Summary of medical records, Disability confirmation certificate, Discharge certificate, Medical visit book, Occupational disease examination report, work-related accident report for those who have been examined for occupational diseases or work-related accidents;

c) One of the documents prescribed in point d, Clause 1, of this Article.

5. Medical examination dossier to determine that female workers are not fit to care for their children after childbirth or after receiving children through surrogacy or must take maternity leave:

a) A request for examination according to the model prescribed in Appendix 2 attached to this Circular;

b) The original or a valid copy of one or more of the following medical examination and treatment documents: Summary of medical records (Obstetric medical record or other illness), Disability confirmation certificate, Discharge certificate, Medical visit book, Copy of occupational disease file, Occupational disease examination report, work-related accident report for those who have been examined for occupational diseases or work-related accidents;

c) One of the documents prescribed in point d, Clause 1, of this Article.

6. Medical examination dossier for claiming one-time social insurance benefit:

a) A request for medical examination according to the model prescribed in Appendix 2 attached to this Circular;

b) The original or a valid copy of one or more of the following medical examination and treatment documents: Summary of medical records, Disability confirmation certificate, Discharge certificate, Medical visit book, Copy of occupational disease file, Occupational disease examination report, work-related accident report for those who have been examined for occupational diseases or work-related accidents;

c) One of the documents prescribed in point d, Clause 1, of this Article.

Article 6. Resubmission Examination Dossier Due to Recurrence

1. Resubmission examination dossier for cases of recurrence of injury due to work-related accidents:

a) A request for medical examination according to the model prescribed in Appendix 2 attached to this Circular;

b) The original or a valid copy of the Summary of medical records according to the model prescribed in Appendix 4 attached to this Circular or the Discharge certificate according to the model prescribed in Appendix 3 attached to this Circular, clearly stating the recurrence of injury.

In the case where the person being examined falls within the category specified in point c, Clause 1, Article 47 of the Labor Safety and Health Law: In the summary of the medical record for treatment, it must clearly state that the injury caused by a work-related accident cannot be stably treated.

c) The original or a valid copy: The most recent Medical Examination Report accompanied by Certificates of Injury Recording the injuries examined in that Report.

In the case where the person being examined falls within the category specified in Clause 2, Article 12 of this Circular: The original of the most recent Medical Examination Report, which must clearly state the conclusion on the period requested for resubmission examination.

d) One of the documents prescribed in point d, Clause 1, Article 5 of this Circular.

2. Resubmission examination dossier for recurrent occupational diseases:

a) A request for medical examination according to the model prescribed in Appendix 2 attached to this Circular;

b) The original or a valid copy of the Occupational Disease File;

c) The original or a valid copy of the Summary of medical records according to the model prescribed in Appendix 4 attached to this Circular or the Discharge certificate according to the model prescribed in Appendix 3 attached to this Circular, clearly stating the recurrence of injury.

In the case where the person being examined falls within the category specified in point c, Clause 1, Article 47 of the Labor Safety and Health Law: In the summary of the medical record for treatment, it must clearly state that the occupational disease cannot be stably treated.

d) The original or a valid copy of the most recent Medical Examination Report.

In the case where the person being examined falls within the category specified in Clause 2, Article 12 of this Circular: The original of the most recent Medical Examination Report, which must clearly state the conclusion on the period requested for resubmission examination.

đ) One of the documents prescribed in point d, Clause 1, Article 5 of this Circular.

Article 7. Documents for Comprehensive Medical Examination and Appraisal

1. A letter of introduction from the employer according to the form prescribed in Appendix 1 attached to this Circular for cases where the person subject to comprehensive appraisal is under the management of the employer at the time of requesting examination and appraisal, or a request for medical examination according to the form prescribed in Appendix 2 attached to this Circular for cases where the worker no longer engages in work with occupational disease risk but has been found to have an occupational disease during the guarantee period of the disease, including workers who are preserving social insurance payment periods, workers who have received a decision to take leave pending retirement benefit resolution, monthly allowances, and workers currently receiving pension, monthly allowances.

2. The original or a certified copy of the latest medical examination and appraisal record if already appraised.

3. Other documents as prescribed in Clause 1 or Clause 2 of Article 5 or Article 6 of this Circular, appropriate to the object and type of appraisal.

4. One of the documents prescribed in Point d of Clause 1 of Article 5 of this Circular.

Article 8. Documents for Reappraisal Due to Exceeding Professional Capacity

1. An introduction letter signed and stamped by the leadership of the Standing Office of the Medical Examination and Appraisal Council according to the form prescribed in Appendix 1 attached to this Circular.

2. Documents for examination and appraisal as prescribed in one of Articles 5, 6, or 7 of this Circular, appropriate to each object and type of examination.

3. The medical examination and appraisal record for cases where the provincial Medical Examination and Appraisal Council has examined and appraised the object, or a meeting record of the provincial Medical Examination and Appraisal Council determining the reason for exceeding professional capacity for cases where the provincial Medical Examination and Appraisal Council has not yet examined and appraised the object, signed and stamped by the leadership of the Standing Office of the Medical Examination and Appraisal Council.

Article 9. Documents for Reappraisal Requested by Organizations or Individuals

1. A document requesting reappraisal from one of the following agencies:

a) Department of Medical Examination and Treatment, Ministry of Health;

b) Ministry of Labor, Invalids and Social Affairs;

c) Department of Health;

d) Department of Labor, Invalids and Social Affairs;

đ) Social Insurance Agency at provincial level or higher;

e) Employer;

g) Provincial Medical Examination and Appraisal Council for cases where the provincial Medical Examination and Appraisal Council has already appraised the object but the object disagrees with the conclusion of that Council and requests reappraisal. The request must be signed and stamped by the leadership of the Standing Office of the provincial Medical Examination and Appraisal Council which has examined the object, clearly stating that the object disagrees with the conclusion of the Council and requests reappraisal, accompanied by a request for reappraisal of the object according to the form prescribed in Appendix 2 attached to this Circular.

2. A certified copy of the medical examination and appraisal documents as prescribed in one of Articles 5, 6, or 7 of this Circular, appropriate to each object and type of appraisal.

3. The original or a certified copy of the medical examination and appraisal record of the provincial Medical Examination and Appraisal Council.

Article 10. Documents for Final Reappraisal

1. A document requesting final reappraisal from one of the following agencies:

a) Ministry of Health;

b) Ministry of Labor, Invalids and Social Affairs;

c) Vietnam Social Security;

d) Employer;

đ) Central Medical Examination and Appraisal Council for cases where the central Medical Examination and Appraisal Council has already appraised the object but the object disagrees with the conclusion of that Council and requests reappraisal.

The request must be signed and stamped by the leadership of the Standing Office of the central Medical Examination and Appraisal Council which has examined the object, clearly stating that the object disagrees with the conclusion of the Council, accompanied by a request for final reappraisal of the object.

2. Decision to establish the Final Reappraisal Medical Examination and Appraisal Council by the Minister of Health.

3. Medical examination and appraisal documents as prescribed in Article 8 or Article 9 of this Circular, appropriate to each object and type of examination.

4. The medical examination and appraisal record of the central Medical Examination and Appraisal Council.

Article 11. Responsibility for Establishing Medical Examination and Appraisal Files

1. Workers shall be responsible for establishing and completing medical examination and appraisal files and submitting them to the Medical Examination Council in the following cases:

a) For medical examination and appraisal to receive one-time social insurance benefits;

b) For initial medical examination and appraisal to implement retirement benefits for workers who are preserving their social insurance contribution period or workers who have a decision to stop working while waiting for retirement benefits or monthly allowances;

c) For medical examination and appraisal of workers who have retired or are preserving their social insurance contribution period and suffer from occupational diseases;

d) For medical examination and appraisal to determine that they are not physically fit to raise children after childbirth, workers must take maternity leave or after receiving children through surrogacy or must take maternity leave;

đ) For medical examination and appraisal of subjects specified in point c, Clause 1, Article 47 of the Labor Safety and Health Law;

g) For recurrent medical examination and appraisal, including workers who have stopped working and request recurrent medical examination and appraisal;

h) Comprehensive medical examination and appraisal for cases where workers are preserving their social insurance contribution period or have retired.

In cases where workers specified in this Clause cannot establish the file due to health reasons, employers or relatives of the workers may establish the medical examination and appraisal file on behalf of the workers. The application for medical examination and appraisal according to the form prescribed in Appendix 2 attached to this Circular must include confirmation of personal status from the People's Committee or police station at the commune level.

2. Relatives of workers shall be responsible for establishing and completing medical examination and appraisal files and submitting them to the Medical Examination Council for requests for medical examination and appraisal to receive monthly pension allowances. The application for medical examination and appraisal according to the form prescribed in Appendix 2 attached to this Circular must include confirmation of personal status from the People's Committee or police station at the commune level where the person resides.

3. Employers shall be responsible for establishing and completing medical examination files and submitting them to the Medical Examination Council in the following cases:

a) Not falling under the provisions of Clauses 1, 2, 4, and 5 of this Article;

b) Workers as stipulated in Article 47 of the Labor Safety and Health Law.

4. The permanent office of the Provincial Medical Examination Council shall be responsible for establishing medical examination files for cases of re-examination.

5. The permanent office of the Central Medical Examination Council shall be responsible for establishing medical examination files for final re-examinations.

Article 12. Time Limit for Re-examination

1. For cases of re-examination of work-related accidents and occupational diseases, the time limit for re-examination shall be at least two years (24 months) from the date when the worker was concluded by the Medical Examination Council on the degree of labor capacity reduction due to work-related accidents and occupational diseases, except for cases specified in point c, Clause 1, Article 47 of the Labor Safety and Health Law.

2. If it is determined that injuries caused by work-related accidents and occupational diseases continue to progress gradually leading to changes in the degree of injury, the Medical Examination Council may conclude that the time limit for the next examination shall be shorter than the time limit prescribed in Clause 1 of this Article.

3. For those who have been examined outside the scope specified in Clause 1 and Clause 2 of this Article but have new Summary of Medical Records or Discharge Certificates indicating additional illnesses or changes in the severity of the illness or disability compared to the conclusion in the latest Medical Examination Report, they may request re-examination within three months from the date of the new Summary of Medical Records or Discharge Certificate.

Article 13. Procedure and Content of Medical Examination and Appraisal

1. The handling of medical examination files and the procedure for medical examination shall be carried out in accordance with the provisions of Circular No. 52/2016/TT-BYT dated December 30, 2016, issued by the Minister of Health on the tasks, powers, working relationships, and activities of the Medical Examination Council at all levels (hereinafter referred to as Circular No. 52/2016/TT-BYT).

2. Content of medical examination for work-related accidents:

a) Content of the first medical examination for work-related accidents based on injuries recorded in the Certificate of Injury;

b) Content of the re-examination for recurrent work-related accidents: Re-examine all injuries recorded in the Certificate of Injury and:

- Recurrent injuries recorded in the Summary of Medical Records must be consistent with the Certificate of Injury;

- Injuries that are not stable after treatment recorded in the Summary of Medical Records for subjects specified in point c, Clause 1, Article 47 of the Labor Safety and Health Law;

- Injuries caused by work-related accidents that continue to progress recorded in the Medical Examination Report in accordance with Clause 2, Article 12 of this Circular;

c) Content of comprehensive medical examination for multiple work-related accidents according to points a and b of this Clause shall be appropriate to each case.

3. Content of medical examination for occupational diseases:

a) Content of the first medical examination for occupational diseases based on the Occupational Disease File and occupational disease injuries within the time frame guaranteed by law;

b) Content of the re-examination for recurrent occupational diseases: Re-examine all injuries recorded in the Occupational Disease File and:

- Recurrent injuries recorded in the Summary of Medical Records must be consistent with the Occupational Disease File and the previous Medical Examination Report for occupational diseases;

- Injuries that are not stable after treatment recorded in the Summary of Medical Records for subjects specified in point c, Clause 1, Article 47 of the Labor Safety and Health Law;

- Injuries caused by work-related accidents that continue to progress recorded in the Medical Examination Report in accordance with Clause 2, Article 12 of this Circular;

c) Content of comprehensive medical examination for multiple occupational diseases according to points a and b of this Clause shall be appropriate to each case.

4. Content of medical examination for retirement benefits, survivor benefits, and leave due to insufficient health to care for children after childbirth or pregnancy leave, adoption of a child through surrogacy, and medical examination for one-time social insurance benefits based on the documents stipulated in Clause 3 or Clause 4, Article 5 and Clause 2, Article 12 of this Circular shall be appropriate to each case.

In cases where there is already a Medical Examination Report for work-related accidents, occupational diseases, or war veterans, a re-examination of the illnesses or disabilities recorded in such reports will not be conducted.

In cases where there is already a Medical Examination Report for injuries and disability rates due to work-related accidents, occupational diseases, or war veterans, which do not overlap with new illnesses, the disability rate due to work-related accidents, occupational diseases, or war veterans already determined will be added to the disability rate due to new illnesses proposed for examination.

In cases of medical examination for one-time social insurance benefits: The Medical Examination Report must clearly reflect the contents prescribed in Article 4 of this Circular.

5. Content of comprehensive medical examination shall be carried out as follows:

a) Comprehensive medical examination content in accordance with Clause 2 and Clause 3 of this Article shall be appropriate to each subject;

b) In cases where the subject has suffered from disabilities or occupational diseases and subsequently suffers from additional disabilities or occupational diseases overlapping with previous injuries:

Conduct a thorough and accurate examination of current disabilities or occupational diseases and determine the degree of labor capacity reduction based on the results of the examination using the method prescribed in Joint Circular No. 28/2013/TTLT-BYT-BLDTBXH dated September 27, 2013, jointly issued by the Ministry of Health and the Ministry of Labor, Invalids, and Social Affairs (hereinafter referred to as Joint Circular No. 28/2013/TTLT-BYT-BLDTBXH).

c) In cases where the subject has suffered from disabilities or occupational diseases and now suffers from additional disabilities or occupational diseases causing non-overlapping injuries:

Conduct a thorough and accurate examination of current disabilities or occupational diseases and add the degree of labor capacity reduction due to work-related accidents or occupational diseases concluded in the previous Medical Examination Report using the method prescribed in Joint Circular No. 28/2013/TTLT-BYT-BLDTBXH.

d) In cases where the subject has undergone medical examination for work-related accidents or occupational diseases two or more times but has not yet combined the disability rates:

- In cases where the subject has undergone medical examination for work-related accidents or occupational diseases two or more times before the effective date of this Circular, the Medical Examination Council shall combine the body injury rates of those examination reports according to the method prescribed in Joint Circular No. 28/2013/TTLT-BYT-BLDTBXH and issue a new Medical Examination Report.

- In other cases, the Medical Examination Council shall conduct a medical examination of all injuries recorded in the most recent Medical Examination Report and combine the body injury rates with the remaining body injury rates recorded in the other Medical Examination Reports.

Article 14. Validity Period of Medical Examination and Appraisal Report

The Medical Examination and Appraisal Report remains valid until a subsequent report with the same content and purpose is issued.

Chapter III

ISSUE OF DISCHARGE CERTIFICATE, BIRTH CERTIFICATE, SUMMARY OF MEDICAL RECORDS, LEAVE FOR PREGNANCY CARE, AND UNFITNESS TO CARE FOR CHILD AFTER BIRTH CERTIFICATE, LEAVE CERTIFICATE FOR PREGNANCY, LEAVE CERTIFICATE UNFIT TO CARE FOR CHILD AFTER GIVING BIRTH

Article 15. Issuance of Discharge Certificate

1. Authority to issue discharge certificate: Health examination and treatment facilities that have been granted permission to operate with the scope of activities including inpatient treatment.

2. The format and method of recording the discharge certificate shall be carried out in accordance with the provisions set forth in Appendix 3 attached hereto.

3. In cases where patients are retained at Village Health Stations in accordance with point a, Clause 4, Article 7 of Circular Joint No. 41/2014/TTLT-BYT-BTC dated November 24, 2014, guiding the implementation of health insurance when concluding treatment and follow-up at Village Health Stations, they shall be issued a discharge certificate according to the model prescribed in Appendix 3 attached hereto.

Article 16. Issuance of Birth Certificate

1. Authority to issue birth certificate: Health examination and treatment facilities that have been granted permission to operate with the scope of activities including delivery services.

2. Procedures for issuing, reissuing, and amending the birth certificate shall be carried out in accordance with the provisions of Circular No. 17/2012/TT-BYT dated October 24, 2012, of the Minister of Health on the issuance and use of Birth Certificates, and Circular No. 34/2015/TT-BYT dated October 27, 2015, of the Minister of Health amending and supplementing Clause 2 of Circular No. 17/2012/TT-BYT dated October 24, 2012, of the Minister of Health on the issuance and use of Birth Certificates.

3. The format and method of recording the birth certificate shall be carried out in accordance with the provisions set forth in Appendix 5 attached hereto.

In cases where children are born from surrogacy procedures, they shall be issued a Birth Certificate in accordance with the provisions of Circular No. 34/2015/TT-BYT dated October 27, 2015, of the Minister of Health amending and supplementing Clause 2 of Circular No. 17/2012/TT-BYT dated October 24, 2012, of the Minister of Health on the issuance and use of Birth Certificates.

Article 17. Issuance of Summary of Medical Records

1. Authority to issue summary of medical records: Health examination and treatment facilities that have been granted permission to operate with the scope of activities including inpatient treatment.

2. The format and method of recording the summary of medical records shall be carried out in accordance with the provisions set forth in Appendix 4 attached hereto.

3. In cases where patients are retained at Village Health Stations in accordance with point a, Clause 4, Article 7 of Circular Joint No. 41/2014/TTLT-BYT-BTC dated November 24, 2014, guiding the implementation of health insurance when concluding treatment and follow-up at Village Health Stations, they shall be issued a summary of medical records according to the model prescribed in Appendix 4 attached hereto.

Article 18. Issuance of Leave for Pregnancy Care Certificate

1. Authority to issue leave for pregnancy care certificate:

a) General hospitals with obstetrics departments or specialized obstetric hospitals that have been granted permission to operate: may issue leave for pregnancy care certificates due to the need for treatment of obstetric conditions;

b) General hospitals that have been granted permission to operate and Medical Examination and Appraisal Boards may issue leave for pregnancy care certificates due to the need for treatment of systemic diseases;

c) Practitioners working at facilities specified in points a and b of this clause may sign leave for pregnancy care certificates due to the need for treatment of obstetric and systemic diseases upon assignment by the head of the health examination and treatment facility.

2. Certification of leave for pregnancy care due to the need for treatment of systemic diseases must be based on the results of consultations among relevant specialties related to the patient's condition.

3. Certification of leave for pregnancy care shall be carried out as follows:

a) Leave for pregnancy care certificate according to the model prescribed in Appendix 6 attached hereto for female workers who have stopped work due to outpatient treatment;

b) Certificate of absence for social insurance benefits according to the model prescribed in Appendix 7 attached hereto for female workers who are contributing mandatory social insurance due to outpatient treatment;

c) Medical Examination and Appraisal Report according to the model prescribed in the accompanying circular No. 52/2016/TT-BYT for cases issued by the Medical Examination and Appraisal Board;

d) Discharge certificate according to the model prescribed in Appendix 3 attached hereto or summary of medical records according to the model prescribed in Appendix 4 attached hereto.

4. In cases of appraisal for leave for pregnancy care, the Medical Examination and Appraisal Report must specifically describe the health status or name the disease. If a long-term treatment disease is present, the disease code should be recorded; if there is no disease code, the full name of the disease should be recorded. Recording of disease codes and names shall be carried out in accordance with the provisions of Circular No. 46/2016/TT-BYT dated December 30, 2016, of the Minister of Health promulgating the list of long-term diseases.

The duration of leave for pregnancy care shall be implemented according to the conclusion of the Medical Examination and Appraisal Board: The decision on the number of days off must be based on the patient's health status but shall not exceed 30 days for each issuance of a leave for pregnancy care certificate.

The date of commencement of leave must coincide with the date the patient visited for examination.

Example: If the examination date is July 13, 2018, and the patient needs to rest for 30 days, then the number of days for treatment should be recorded as 30 days, clearly stating from July 13, 2018, to August 11, 2018.

The Medical Examination and Appraisal Report for leave for pregnancy care is only valid for resolving sick leave and maternity benefits.

5. Only one leave for pregnancy care certificate can be issued per visit. If the patient needs to rest longer than 30 days, when the leave period recorded on the previously issued leave for pregnancy care certificate is about to expire, the patient must undergo a re-examination for the practitioner to consider and decide.

6. In cases where the leave for pregnancy care certificate is lost within five working days from the date of issuance:

a) The person who issued the maternity leave certificate must submit a request for a copy of the maternity leave certificate and send it to the unit that issued the lost maternity leave certificate.

b) Within two working days from the date of receiving the request for a copy of the maternity leave certificate, the unit that issued the maternity leave certificate shall be responsible for issuing a copy of the maternity leave certificate.

7. In case the maternity leave certificate is lost within six working days from the date of issuance: the procedure for requesting a new maternity leave certificate must be initiated again from the beginning.

Article 19. Issuance of a Certificate of Insufficient Health to Care for a Child After Birth or After Receiving a Child Through Surrogacy

1. Authority to issue a certificate of insufficient health to care for a child after birth or after receiving a child through surrogacy: the Medical Appraisal Board at provincial level or higher.

2. The medical appraisal record shall be carried out in accordance with the provisions set forth in the Appendix attached to Circular No. 52/2016/TT-BYT, where the Conclusion section must clearly state that the mother does not have sufficient health to care for the child after birth.

3. The conclusion provided for in Clause 2 of this Article shall only be valid for resolving maternity benefits.

Chapter IV

ISSUANCE AND MANAGEMENT OF LEAVE CERTIFICATES TO ENJOY SOCIAL INSURANCE BENEFITS

Article 20. Principles for Issuing Leave Certificates to Enjoy Social Insurance Benefits

1. The issuance of leave certificates to enjoy social insurance benefits must meet the following requirements:

a) It must be issued by a healthcare facility that has been granted a license to operate. A practitioner working at such a healthcare facility may sign a leave certificate to enjoy social insurance benefits according to the assignment of the head of the healthcare facility;

b) It must be consistent with the scope of professional activities of the healthcare facility issuing the leave certificate, which has been approved by the competent authority;

c) It must be consistent with the health condition of the patient and the professional guidance of the Minister of Health.

2. Only one leave certificate to enjoy social insurance benefits can be issued for each examination. If the patient needs to take more than 30 days off, when the leave period recorded on the previously issued leave certificate is about to expire, the patient must undergo a re-examination so that the practitioner can review and decide.

In cases where a worker is examined and issued leave certificates to enjoy social insurance benefits by two or three different specialties of various healthcare facilities during the same time period, they can only enjoy one of the certificates with the longest leave period.

In cases where multiple specialties are examined on the same day at the same healthcare facility, only one leave certificate to enjoy social insurance benefits will be issued.

3. Practitioners working at healthcare facilities that have been granted a license to operate may sign leave certificates to enjoy social insurance benefits; if the healthcare facility is not a legal entity, the practitioner must register their signature sample with the social insurance agency.

Article 21. Form of Issuance of Leave Certificates to Enjoy Social Insurance Benefits and Content Recording on Leave Certificates to Enjoy Social Insurance Benefits

1. For cases where workers or children under seven years old of workers are hospitalized: Hospital discharge certificate according to the model prescribed in Appendix 3 attached to this Circular.

In cases where there is a transfer during treatment, a valid copy of the transfer certificate is also required.

In cases where the patient dies at the healthcare facility, no hospital discharge certificate will be issued. The implementation of social insurance benefits for the period the patient was treated at the healthcare facility before death is based on the time recorded on the death report according to the model TP/HT/1999-C1 stipulated in Decision No. 1203-QĐ/1998/TP-HT dated December 26, 1998 of the Minister of Justice regarding the issuance of civil status forms and registers.

2. For cases where workers or children under seven years old of workers are undergoing outpatient treatment: Leave certificate to enjoy social insurance benefits according to the model prescribed in Appendix 7 attached to this Circular.

If the patient needs to rest for outpatient treatment after being discharged, the social insurance agency will base the payment of social insurance benefits on the number of days off recorded in the notes section of the hospital discharge certificate according to the regulations.

3. The form and recording method of the leave certificate to enjoy social insurance benefits shall be implemented in accordance with the provisions set forth in Appendix 7 attached to this Circular.

4. The conclusion on health status provided for in Clause 4 of this Article shall only be valid for six months from the date recorded on the maternity leave certificate and shall only be valid for resolving maternity benefits.

Chapter V

RESPONSIBILITIES FOR IMPLEMENTATION

Article 22. Responsibilities of Units under the Ministry of Health

The Department of Medical Examination and Treatment shall be responsible for leading and coordinating with the Department of Maternal and Child Health, the Department of Traditional Medicine Management, and the Inspectorate of the Ministry to:

1. Organize the implementation, interim review, and final assessment of this Circular nationwide.

2. Inspect, audit, handle violations, and resolve difficulties arising from the implementation of this Circular in accordance with current laws.

Article 23. Responsibilities of the Vietnam Social Security

1. Direct and guide agencies within the social security system to organize the implementation of this Circular.

2. Direct local social security agencies to guide healthcare facilities on publicly posting on the Vietnam Social Security's website and provincial social security agency websites lists of facilities that have been issued certificates for leave to receive social insurance benefits, as well as the scope of such certificates. Check the issuance of certificates for leave to receive social insurance benefits at healthcare facilities.

Article 24. Responsibilities of Provincial Departments of Health

1. Lead the organization of the implementation and interim review, and final assessment of this Circular within their jurisdiction.

2. Inspect, audit, handle violations, and resolve difficulties arising from the implementation of this Circular in accordance with current laws.

Article 25. Responsibilities of the Medical Appraisal Council

1. Update medical file data, documents, and appraisal records into the national health examination and treatment database to link with the social insurance agency's data system. Create electronic medical transaction documents in accordance with Decree No. 166/2016/ND-CP dated December 24, 2016, of the Government on electronic transactions in social insurance, health insurance, unemployment insurance, and the schedule guided by the Vietnam Social Security, while bearing legal responsibility for the legality and accuracy of these documents.

2. Provide the following documents to the person being appraised upon completion of the appraisal:

a) Appraisal record;

b) Invoice and fee payment receipt for the appraisal;

c) List of appraisal contents. In cases where the appraisal content is performed by another healthcare facility, the name of the performing healthcare facility must be clearly noted in the remarks column.

Article 26. Responsibilities of Healthcare Facilities

1. Disseminate and ensure understanding of the content of this Circular among all practitioners and staff of the facility.

2. Issue complete and timely files and documents serving as grounds for social insurance benefits according to this Circular to workers; monitor the recording of information in the documents specified in this Circular by practitioners at the facility and bear legal responsibility for the accuracy and honesty of issuing these documents.

3. Update health examination and treatment data into the national health examination and treatment database to link with the social insurance agency's data system. Create electronic medical transaction documents in accordance with Decree No. 166/2016/ND-CP dated December 24, 2016, of the Government on electronic transactions in social insurance, health insurance, unemployment insurance, and the schedule guided by the Vietnam Social Security, while bearing legal responsibility for the legality and accuracy of these documents.

4. Healthcare facilities transferring patients shall provide a copy of the hospital transfer form stamped with the seal when requested by the patient.

5. Healthcare facilities that issue discharge certificates, birth certificates, maternity leave certificates, postpartum care leave certificates, and certificates for leave to receive social insurance benefits shall be responsible for:

a) Reissuing discharge certificates, birth certificates, maternity leave certificates, postpartum care leave certificates, and certificates for leave to receive social insurance benefits in the following cases:

- Lost or damaged;

- Signed by persons without authority;

- Stamped incorrectly;

- Contain errors in recorded information.

When reissued, the phrase "Reissued" must be stamped on the discharge certificate, birth certificate, maternity leave certificate, postpartum care leave certificate, and certificate for leave to receive social insurance benefits.

b) Supplementing and correcting information on discharge certificates, birth certificates, maternity leave certificates, postpartum care leave certificates, and certificates for leave to receive social insurance benefits in cases of errors in recorded information.

After supplementation and correction, the healthcare facility's stamp (registered with the social insurance agency) must be affixed to the section containing the changes.

c) Registering sample seals and signatures used on certificates for leave to receive social insurance benefits as follows:

- For healthcare facilities that are legal entities: register seals according to the model prescribed in Appendix 8 attached to this Circular;

- For healthcare facilities that are not legal entities: register the facility's seal and the signature model of authorized practitioners who can sign certificates for leave to receive social insurance benefits according to the model prescribed in Appendix 8 attached to this Circular.

If a healthcare facility changes its seal or changes or supplements the authorized representative signing on behalf of the head of the unit on certificates for leave to receive social insurance benefits, it must notify the provincial or district social insurance agency (as classified by the Vietnam Social Security) where the facility is located in writing within five working days from the date of change.

In cases where medical examination and treatment facilities have applied digital signatures, they shall comply with the provisions of the law on digital signatures.

d) Carry out the delegation to sign and affix the seal of the medical examination and treatment facility on the certificate for leave to receive social insurance benefits.

The delegation must be carried out in writing and sent to the provincial Social Insurance agency where the facility is located. The delegatee may not further delegate their authority. The delegation document must include at least the following contents: The name and position of the delegatee; scope of delegation (specifying clearly in which situations the delegatee is authorized to sign and affix the seal) and the term of delegation.

Chapter VI

IMPLEMENTING PROVISIONS

Article 27. Effective date.

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

2. Circular No. 14/2016/TT-BYT dated May 12, 2016, issued by the Minister of Health, detailing the implementation of certain provisions of the Social Insurance Law within the health sector, ceases to be effective from the date this Circular takes effect.

Article 28. Transitional Provisions

1. Discharge certificates, Birth certificates, Certificates of leave for social insurance benefits, Injury certificates, Death certificates issued by medical examination and treatment facilities within the period from July 1, 2016 to the date this Circular takes effect but issued using incorrect templates, recorded with incorrect dates, without the legal entity seal, seals placed incorrectly, signatures placed incorrectly, or lacking sufficient signatures shall still be valid as grounds for claiming social insurance benefits.

2. Templates for certificates of leave for social insurance benefits, discharge certificates, birth certificates issued before the issuance date of this Circular shall continue to be used until December 31, 2018.

Article 29. References

In cases where legal regulatory documents and regulations cited in this Circular are amended, supplemented, or replaced, the new legal regulatory documents shall apply. During the implementation process, if there are difficulties or obstacles, it is recommended that agencies, organizations, and individuals promptly report to the Ministry of Health (Department of Medical Examination and Treatment) for consideration and resolution.

During the implementation process, if there are difficulties or obstacles, it is recommended that agencies, organizations, and individuals promptly report to the Ministry of Health (Department of Medical Examination and Treatment) for consideration and resolution./.