CIRCULAR

ELABORATING ON IMPLEMENTATION OF SEVERAL ARTICLES ON HEALTH IN THE LAW ON SOCIAL INSURANCE AND THE LAW ON OCCUPATIONAL SAFETY AND HYGIENE

Circular No. 56/2017/TT-BYT dated December 29, 2017 of the Minister of Health, elaborating on implementation of several Articles on health in the Law on Social Insurance and the Law on Occupational Safety and Hygiene, in force as from March 1, 2018, is amended and supplemented by:

Circular No. 18/2022/TT-BYT dated December 31, 2022 of the Minister of Health on amendments to the Circular No. 56/2017/TT-BYT dated December 29, 2017 of the Minister of Health, elaborating on implementation of several Articles on health in the Law on Social Insurance and the Law on Occupational Safety and Hygiene.

Pursuant to the Law on Social Insurance No. 58/2014/QH13 dated November 20, 2014;  

Pursuant to the Law on Occupational Safety and Hygiene No. 84/2015/QH13 dated June 25, 2015;

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

At the request of Director of the Legal Department, Director of Medical Examination & Treatment Administration, Director of Maternal and Child Health Department,

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Chapter I

GENERAL

Article 1. Scope

This Decree shall prescribe:

1. Diseases, the authority to determine diseases eligible for lump-sum social insurance payout.

2. Medical assessment of work capacity reduction (whole person impairment) as the basis for workers and their relatives to receive social insurance payout.

3. Issuance of discharge notes, birth certificate, copies of medical records, confirmation of maternity leave, confirmation of poor postpartum health and confirmation of eligibility to receive social insurance benefits.

Article 2. Subjects of application

1. Workers participating in social insurance as specified in Clause 1 and Clause 4 Article 2 of the Law on social insurance and Article 43 of the Law on occupation safety and hygiene.

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3. Relatives of workers who participated in social insurance applying for medical assessment of work capacity reduction to receive death benefits for the workers (hereinafter referred to as worker’s relative).

Article 3. Interpretation of terms

In this Circular, these terms are construed as follows:

1. “Sick leave” means a period of time over which a worker is not healthy enough to work and is required by a physician to take a sick leave.

2. “Valid copy” means a copy that is extracted from the original book or has been compared with the original by a competent authority.

3. “Medical record summary” means the summary of a medical record prescribed by regulations of law on medical examination and treatment.

Chapter II

DISEASES ELIGIBLE FOR LUMP-SUM SOCIAL INSURANCE PAYOUT AND DOCUMENTS OF MEDICAL ASSESSMENT FOR SOCIAL INSURANCE PAYOUT

Article 4. Diseases eligible for lump-sum social insurance payout2

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Article 5. Documents of first medical assessment

1. Documents of first medical assessment due to an occupational accident:

a) Letter of introduction of the employer according to Annex 1 enclosed herewith in case the victim of occupational accidents is under the management of the employer at the time of medical assessment or the application for medical assessment according to Annex 2 enclosed herewith in case the victim is no longer under the management of the employer at the time of application for medical assessment;

b) Original copy or valid copy of the injury confirmation issued by the health facility (that provided treatment for the worker) in accordance with the template specified in Decision No. 4069/2001/QD-BYT dated September 28, 2001 of the Minister of Health;

c) Original copy or valid copy of the record of occupational accident investigation in accordance with Annex 7 enclosed together with Joint Circular No. 12/2012/TTLT-BLDTBXH-BYT dated May 21, 2012 of the Ministry of Labor, War Invalids and Social Affairs and the Ministry of Health guiding the statement, investigation, statistics and reports on occupational accidents;

d)3 The original or valid copy of the hospital discharge note or the medical record summary as specified in Appendix 3 and Appendix 4 to this Circular.   In case the worker does not receive in-patient or out-patient treatment, he/she must have documents on injury examination and treatment suitable to the time of the occupational accident and injury to request assessment.

In case the assessed person is an entity described at Point c, Clause 1, Article 47 of the Law on Occupational Safety and Hygiene: The medical record summary must clearly state that the injury caused by the occupational accident cannot be entirely treated.

dd) One of the following documents with photo: ID; Citizen Identification; passport that remains valid. If there are no abovementioned documents, a written confirmation with a photo bearing a seal issued by the police authority of the Commune within the last 03 months from the time of application for medical assessment.  

2. Documents of first medical assessment of occupational diseases:

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b) Original copy or valid copy of the occupational disease record;

c) Medical record summary of treatment for occupational diseases of the worker relevant to occupational diseases (if any).

In case the assessed person is an entity described at Point c, Clause 1, Article 47 of the Law on Occupational Safety and Hygiene: the medical record summary must clearly state that the occupational diseases cannot become stable after treatment.

d) One of the documents specified in Point dd Clause 1 this Article.

34. Documents of medical assessment as the basis for provision of pension for a worker:

a) Letter of introduction for assessment of the employer according to Annex 1 enclosed herewith in case the worker is paying compulsory social insurance or the application for medical assessment according to Annex 2 enclosed herewith in case of workers whose social insurance participation period is reserved and retired workers pending pension or monthly benefits, in which the worker self-declares in the application form the injury or illness requested for assessment;

b) Original copy or valid copy of at least one of the following medical documents:

- Medical record summary;

- Certificate of disability;

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- Health record booklet;

- Health record paper;

- Subclinical results paper;

- Prescriptions of the health facility;

- Records of occupational diseases;

- Minutes of the most recent medical assessment of the person who has been assessed;

c) One of the documents specified at Point dd, Clause 1 of this Article.

4. Documents of medical assessment as the basis for provision of death benefits:

a) Application for medical assessment according to Annex 2 enclosed herewith;

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- Medical record summary;

- Certificate of disability;

- Discharge note;

- Health record booklet;

- Diagnosis and treatment documents, including: Health record paper or subclinical results paper or prescription of the health facility;

- Records of occupational diseases or Minutes of the most recent medical assessment of the person who has been assessed.”

c) One of the documents specified in Point d Clause 1 this Article.

5. Documents of medical assessment for confirmation of inadequate postpartum health, inadequate health after receiving the child due to surrogacy or maternity leave;   

a) Application for assessment according to Annex 2 enclosed herewith;

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- Medical record summary;

- Certificate of disability;

- Discharge note;

- Health record booklet;

- Diagnosis and treatment documents, including: Health record paper or subclinical results paper or prescription of the health facility;

- Records of occupational diseases or Minutes of the most recent medical assessment of the person who has been assessed;

c) One of the documents specified at Point dd, Clause 1 of this Article.

6. Documents of medical assessment for lump-sum social insurance payout:

a) Application for medical assessment according to Annex 2 enclosed herewith;

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- Medical record summary;

- Certificate of disability;

- Discharge note;

- Health record booklet;

- Diagnosis and treatment documents, including: Health record paper or subclinical results paper or prescription of the health facility;

- Records of occupational diseases or Minutes of the most recent medical assessment of the person who has been assessed;

c) One of the documents specified at Point dd, Clause 1 of this Article.

Article 6. Documents of re-assessment due to relapse

1. Documents of medical re-assessment due to relapse of injury from an occupational accident:

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b) Original copy or valid copy of medical record summary according to the template specified in Annex 4 enclosed herewith or discharge note according to the template specified in Annex 3 enclosed herewith which clearly specifies the injury relapse.

In case the assessed person is an entity described at Point c, Clause 1, Article 47 of the Law on Occupational Safety and Hygiene: the medical record summary must clearly state that the injury from occupational accident cannot become stable after treatment.

c) Original copy or valid copy of the latest medical assessment record enclosing with the injury confirmations which bears the injuries assessed in the record.

In case the assessed person is one of the subjects specified in Clause 2 Article 12 hereof: original copy of the latest medical assessment record, in which the conclusion about the time limit for re-assessment must be specified.

d) One of the documents specified in Point dd Clause 1 Article 5 of this Circular.

2. Documents of medical re-assessment due to relapse of occupational diseases:

a) Application for medical assessment according to Annex 2 enclosed herewith;

b) Original copy or valid copy of the occupational disease record;

c)8 The original or valid copy of the hospital discharge paper or summary of the medical record as prescribed in this Circular or the occupational disease recorded with more serious occupational disease injuries.

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d) Original copy or valid copy of the latest medical assessment record. In case the assessed person is one of the subjects specified in Clause 2 Article 12 hereof: original copy of the latest medical assessment record, in which the conclusion about the time limit for re-assessment must be specified.

dd) One of the documents specified in Point dd Clause 1 Article 5 this Circular.

Article 7. Documents of general medical assessment

1. Letter of introduction of the employer according to Annex 1 enclosed herewith in case the person being generally assessed is under the management of the employer at the time of medical assessment or the application for medical assessment according to Annex 2 enclosed herewith in case the worker is retired or no longer does the jobs posing risk of occupational diseases is detected any occupational disease within the coverage period of the disease, including workers whose social insurance participation period is reserved, retired workers pending pension or monthly benefits and workers on pensions or monthly benefits.

2. Original copy or valid copy of the latest medical assessment record (if assessed).

3. Other documents as specified in Clause 1, Clause 2 Article 5 or Article 6 of this Circular in conformity with the subject and type of assessment.

4. One of the documents specified in Point dd Clause 1 Article 5 this Circular.

Article 8. Documents of reassessment by Central Medical Assessment Council if the case is beyond capacity

1. Letter of introduction prepared by the head of the governing organization of the Medical Assessment Council bearing the signature and seal as specified in Annex 1 enclosed herewith.

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3. Medical assessment record in case the provincial Medical Assessment Council has carried out the medical assessment of the subject or there are sealed and signed minutes of meeting of the Medical Assessment Council saying the case is beyond its capacity if no assessment has been carried out.

Article 9. Documents of reassessment by Central Medical Assessment Council at the request of organizations or individuals

1. Written request for reassessment by Central Medical Assessment Council of one of the following agencies:

a) The Medical Examination and Treatment Administration, the Ministry of Health;

b) The Ministry of Labor, Invalids and Social Affairs;

c) The Department of Health;

d) The Department of Labor, Invalids and Social Affairs;

dd) Social insurance authorities at provincial level or more;

e) Employers;

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2. Valid copy of the medical assessment record as specified in Article 5, 6 or 7 this Circular in conformity with each subject and type of assessment.

3. Original copy or valid copy of the medical assessment record of the provincial Medical Assessment Council.

Article 10. Documents of final medical reassessment

1. Written request for final reassessment by Central Medical Assessment Council of one of the following agencies:

a) Ministry of Health;

b) The Ministry of Labor, Invalids and Social Affairs;

c) Vietnam Social Security:

d) Employers;

dd) The Central Medical Assessment Council in case the Central Medical Assessment Council has carried out the medical assessment but the person disagrees with the conclusion given by the Central Medical Assessment Council and requests the reassessment.

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2. Decision on establishment of the final Medical Assessment Council issued by the Minister of Health.

3. Medical assessment record as specified in Article 8 or 9 this Circular in conformity with each subject and type of medical assessment.

4. Medical assessment record of the Central Medical Assessment Council.

Article 11. Responsibility for preparing the documents of medical assessment

1. The worker shall prepare the documents of medical assessment and sent them to the Medical Assessment Council in the following cases:

a) The worker applies for assessment for lump-sum social insurance payout;

b) First assessment pending provision of pension for a worker whose social insurance participation period is reserved or a retired worker pending pension or monthly benefits;

c) Assessment of a retired worker or a worker suffering an occupational disease whose social insurance participation period is reserved;

d) Assessment for confirmation of inadequate postpartum health, inadequate health after receiving the child due to surrogacy or maternity leave;   

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g) Assessment of relapse, including retired workers applying for assessment of relapse;

h) General assessment of a worker whose social insurance participation period is reserved or a retired worker.

If the worker specified in this Clause cannot prepare the documents by himself/herself due to health problems, the employer or relatives of the worker may prepare the documents of medical assessment on behalf of the worker. The application for medical assessment must be in accordance with Annex 2 enclosed herewith, in which the confirmation on the worker’s personal status issued by the People’s Committee or police authority at the Commune must be included.

2. The relative of the worker shall prepare the documents of medical assessment and sent them to the Medical Assessment Council in case of request for medical assessment for monthly benefits. The application for medical assessment must be in accordance with Annex 2 enclosed herewith, in which the confirmation on the worker’s personal status issued by the People’s Committee or police authority at the Commune must be included.

3. The employer shall prepare the documents of medical assessment and sent them to the Medical Assessment Council in the following cases:

a) Cases not specified in Clause 1, 2, 4 and 5 this Article;

b) Workers specified in Article 47 of the Law on occupational safety and hygiene.

4. Governing organization of the Provincial Medical Assessment Council shall prepare the documents of reassessment by Central Medical Assessment Council.

5. Governing organization of the Central Medical Assessment Council shall prepare the documents of final reassessment.

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19. As for cases of re-assessment of occupational accidents and occupational diseases, workers are entitled to take the initiative to take an assessment of the level of working capacity reduction and is paid a fee for assessment in case the assessment results are satisfactory to raise the allowance for occupational accidents and diseases.

2. In case of determination of continuously progressed injury from an occupational accident or occupational disease which leads to change in level of injury, the Medical Assessment Council may conclude the time limit for the next medical assessment shorter than the time limit prescribed in Clause 1 this Article.

3. An assessed person other than the subjects defined in Clauses 1 and 2 of this Article but have a new medical record summary or a new discharge note showing that they have other diseases or the assessed disease changes its level of illness compared to the status of the disease, disability concluded in the latest medical assessment record may be requested to be assessed in a period of 03 months from the issuance date of the new medical record summary or the new discharge note.

Article 13. Procedure and content of medical assessment

1. The processing of documents of medical assessment and procedure of medical assessment shall comply with Circular No. 52/2016/TT-BYT dated December 30, 2016 of the Minister of Health on tasks, rights, liaison and operation of Medical Assessment Council at all level (hereinafter referred to as Circular No. 52/2016/TT-BYT).

2. Content of medical assessment of an occupational accident:

a) Content of first medical assessment of an occupational accident according to the injuries recorded in the injury confirmation;

b) Content of medical assessment of relapse: carry out medical assessment of all injuries recorded in the injury confirmation and:

- Injury relapse recorded in the medical record summary in accordance with the injury confirmation;

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- Continuously progressed injury from an occupational accident which is recorded in the medical record summary as specified in Clause 2 Article 12 this Circular;

c) Content of general medical assessment of many occupational accidents under Point a and b this Clause and in accordance with each case.

3. Content of medical assessment of occupational diseases:

a) Content of first medical assessment of occupational diseases under the occupational disease record and injuries due to occupational diseases within the occupational disease coverage period in accordance with law provisions;

b) Content of medical assessment of occupational disease relapse: carry out medical assessment of all injuries recorded in the occupational disease record and:

- Injury relapse recorded in the medical record summary in accordance with the latest occupational disease and assessment record of occupational disease;

- Injury which cannot become stable after treatment and is recorded in the medical record summary regarding the subjects specified in Point c Clause 1 Article 47 of the Law on occupational safety and hygiene;

- Continuously progressed injury from an occupational accident which is recorded in the medical record summary as specified in Clause 2 Article 12 this Circular;

c) Content of general medical assessment of many occupational diseases under Point a and b this Clause and in accordance with each case.

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In case there is a record of assessment of occupational accident, occupational disease or wounded soldier or disease, illness, deformities or malformations related to toxic chemicals, the assessment of the injuries and diseases mentioned in that record shall not be carried out again. The Medical Assessment Council shall sum up the whole person impairment rating determined in the previous medical assessment minutes with the impairment rating seeking assessment does not collapse with acknowledged impairment.

If the worker is suffering from one of the life-threatening diseases such as cancer, polio, dropsy cirrhosis, leprosy, severe tuberculosis, HIV infection that has progressed to AIDS, the original or a valid copy of the hospital discharge note or the medical record summary shall prevail for claims of benefits.

If a worker suffers from other diseases or illnesses that eligible for lump-sum social insurance payout, the medical assessment record must clearly state in details the diseases or illnesses that result in at least 81% of work capacity reduction or impairment level and total loss of the worker’s functions, self-control or he/she is unable to keep personal hygiene and complete other everyday tasks without other people watching, helping and taking care of him/her. 

5. The content of general medical assessment shall be implemented as follows:

a) Content of general medical assessment as specified in Clause 2, 3 this Article and in accordance with each case;

b) When a person who is already suffering from an injury or occupational disease catches another injury or occupational disease which causes the same disability:

The rate of work capacity reduction shall be determined based on results of examination of all current injuries and occupational diseases in accordance with Joint Circular No. 28/2013/TTLT-BYT-BLDTBXH dated September 27, 2013 of the Ministry of Health and the Ministry of Labor, War Invalids and Social Affairs on ratings of impairments caused by injuries, illness, disability and occupational diseases (hereinafter referred to as Joint Circular No. 28/2013/TTLT-BYT-BLDTBXH).

c) When a person who is already suffering from an injury or occupational disease catches another injury or occupational disease which causes a different disability:

The rate of work capacity reduction caused by the new injury or occupational disease shall be aggregated with that of the previous occupational accident or occupational disease written in the previous medical assessment record in accordance with Joint Circular No. 28/2013/TTLT-BYT-BLDTBXH.

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- In case the medical assessment record acknowledges duplicate injuries in one or more organs or body parts, the Medical Assessment Council shall re-examine all the injuries acknowledged in the record. This medical assessment record (including both duplicate and non-duplicate injuries) and combined with the whole person impairment rating stated in the medical assessment record does not have duplicate injuries as prescribed, and then issue a new medical assessment record.

- In case a person has been assessed due to an occupational accident or occupational disease for 02 or more times but has a summary of the medical record or hospital discharge note or an occupational disease record that states the injuries that are more serious or minor than those stated in the medical assessment record of these assessment visits, the Medical Assessment Council shall perform an assessment for all injuries stated in the medical assessment record that there is a change in the state of injuries and combining with the whole person impairment rating with the whole person impairment rating stated in the remaining medical assessment record according to regulations, and then issue a new medical assessment record.

- In addition to the above cases, the Medical Assessment Council shall combine the whole person impairment ratings of those assessment records according to the method specified in Joint Circular No. 28/2013/TTLT-BYT-BLDTBXH dated September 27, 2013 of the Minister of Health, the Minister of Labor, War Invalids and Social Affairs on the whole person impairment ratings due to injuries, illnesses, diseases and occupational disease and issuance of new medical assessment records.

Article 14. Expiry date of a medical assessment record

A medical assessment record shall be unexpired until the issuance of the next medical assessment record with the same content and objective.

Chapter III

ISSUANCE OF DISCHARGE NOTES, BIRTH CERTIFICATE, SUMMARY OF MEDICAL RECORDS, CONFIRMATION OF MATERNITY LEAVE AND CONFIRMATION OF POOR POSTPARTUM HEALTH

Article 15. Issuance of discharge notes

1. Authority to issue discharge notes: Licensed health facilities providing inpatient treatment.

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3.12 In case patients are allowed to stay at commune health stations for medical stations that are decided by the Department of Health to have beds according to the provisions of Point b, Clause 5, Article 4 of Circular No. 39/2018/TT-BYT dated 30 November 2018 of the Ministry of Health uniformly stipulating the price of medical examination and treatment services covered by health insurance among hospitals of the same class nationwide and guiding the application of prices and payment of medical examination and treatment expenses covered by insurance. In some cases, they will be granted a certificate of leave for enjoying social insurance according to the form specified in Appendix 7 issued with this Circular, clearly stating the number of days of stay at the commune health station. and the number of days off to enjoy social insurance but not exceeding 30 days.

Article 16. Issuance of birth certificates

1. Authority to issue birth certificates:  Licensed health facilities providing midwifery service.

2. Procedures for issuance, reissuance and adjustment of birth certificates are specified in Circular No. 17/2012/TT-BYT and Circular No. 34/2015/TT-BYT.

3. The birth certificate template is provided in Annex 5 enclosed herewith.

The birth certificate of a child born from surrogacy shall be issued in accordance with Circular No. 34/2015/TT-BYT.

Article 17. Issuance of medical record summary

1. Authority to issue medical record summary: Licensed health facilities providing inpatient treatment.

2. The discharge note medical record summary template is provided in Annex 4 enclosed herewith.

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Article 18. Issuance of maternity leave confirmation

1. Authority to issue maternity leave confirmations:

a) Any licensed general hospital having an obstetrics department or maternity hospital may issue maternity leave confirmations due to obstetric diseases;

b) Any licensed general hospital or Medical Assessment Council may issue maternity leave confirmations due to sickness;

c) Practitioners at a health facility specified in Point a or b of this Clause may issue maternity leave confirmations due to obstetric diseases or sickness as authorized by the head of such facility.

2. The confirmation of maternity leave shall be based on the result of consultation held by departments relevant to the patient’s sickness.

3. The confirmation of maternity leave shall be carried out as follows:

a) The template specified in Annex 6 enclosed herewith shall be applied to pregnant workers who resigned and receive outpatient treatment; 

b) The confirmation of eligibility to receive social insurance benefits in accordance with Annex 7 enclosed herewith shall be applied to pregnant workers paying compulsory social insurance who receive outpatient treatment;    

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d) The medical record summary according to the template specified in Annex 4 enclosed herewith or discharge note according to the template specified in Annex 4 enclosed herewith. 

4. The medical assessment record must describe in detail the health status or name of the disease in case of assessment for maternity leave. In case of illness requiring long-term treatment, the disease code shall be inscribed; if the disease code is not available, the full name of the disease shall be written. The recording of the disease code and name shall comply with the provisions of Circular No. 46/2016/TT-BYT.

Term of maternity leave is based on the conclusions of the Medical Assessment Council: The decision on the number of days of leave must be based on the patient's medical condition, but must not exceed 30 days for an issuance of maternity leave confirmation.

The start date of leave must coincide with the day the patient visits the hospital.

Example: The date of doctor’s visit is July 13, 2018 and must go on a leave for 30 days. The “days absence from work” part must be written as 30 days from July 13, 2018, to August 11, 2018.

The medical assessment record for maternity leave is only valid in the granting of illness and maternity benefits.

5. Only one maternity leave confirmation shall be issued each doctor visit. In cases the patient needs to rest for more than 30 days or when the term of leave inscribed on the granted maternity leave confirmation is almost over, the patient must be conducted a follow-up examination so that the practitioner can consider and decide. 

6. In case the maternity leave confirmation is lost within 05 working days from the issuance date:

a) The person granted the maternity leave confirmation shall prepare a written request for issuance of a copy of the maternity leave confirmation and send it to the authority issuing the lost maternity leave confirmation;

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7. In case the maternity leave confirmation is lost as from the 6^th working day after the issuance date: the person must carry out the procedure for request of issuance of maternity leave confirmation again.

Article 19. Issuance of confirmation or poor postpartum health or poor health after receiving the child from surrogacy

1. The authority to issue confirmations or poor postpartum health or poor health after receiving the child from surrogacy: Provincial Medical Assessment Councils and above.

2. The medical assessment record shall be prepared in accordance with the Annex enclosed in Circular No. 52/2016/TT-BYT in which shall specifies that the mother is not healthy enough to provide care for her newborn child.

3. The conclusion specified in Clause 2 this Article is only used for grant of maternity benefits.

Chapter IV

ISSUANCE AND MANAGEMENT OF CONFIRMATION OF ELIGIBILITY TO RECEIVE SOCIAL INSURANCE BENEFITS

Article 20. Rules for issuance of confirmation of eligibility to receive social insurance benefits

1. The issuance of confirmation of eligibility to receive social insurance benefits shall comply with the following regulations:

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b) Be appropriate with the scope of operation of the health facility that issues the confirmation which is approved by a competent authority;

c) Be appropriate with the patient’s medical condition and professional instructions of the Minister of Health.

213. Only one certificate of leave qualified for social insurance payout will be issued for each examination. If the patient needs to take leave for more than 30 days, on or before expiry of the certificate of covered leave that he/she holds, he/she is required to make a medical revisit to seek practicians’ decisions. 

In case an employee is examined by two or more specialties of different health facilities at the same time and is granted multiple certificates of leave qualified for social insurance, that employee will only be entitled to one of the certificates with the longest leave period.

In case an employee undergoes medical examination and treatment with many specialties on the same day at the same health facility with many different diseases, only one certificate of leave qualified for social insurance payout shall be issued and he/she is only eligible for the disease with the highest insurance payout.

In case a patient is treated for tuberculosis under the National Tuberculosis Program, the maximum leave time shall not exceed 180 days for a certificate of leave qualified for social insurance payout.

In case an employee has a miscarriage, abortion, or stillbirth with a gestational age of 13 weeks or more, the maximum leave period prescribed by the Law on Social Insurance shall not exceed 50 days for one certificate of leave eligible for social insurance payout.

3. Practitioners at such health facility may sign the confirmation of eligibility to receive social insurance benefits as authorized by the head of such facility; if the health facility is not a juridical person, the practitioner must register his/her signature with the social insurance authority.

Article 20a. Issuance of hospital discharge notes and certificates of leave qualified for social insurance payout to COVID-19 infected patients treated at health facilities as follows:14

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People infected with COVID-19 receiving inpatient or outpatient treatment at the following health facilities:

a) Health facilities established under the Law on Medical Examination and Treatment 2009;

b) COVID-19 admission and treatment facilities established under Point a, Clause 1, Article 1 of Resolution No. 168/NQ-CP dated December 31, 2021 of the Government on mechanisms and policies on COVID-19 prevention and control as follows:

- COVID-19 field hospitals;

- COVID-19 hospitals;

- COVID-19 intensive care hospitals;

- Centers for the intensive care of COVID-19 patients.

2. Issuing persons:

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

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a) After finishing treatment at health facilities, patients are granted hospital discharge notes and certificates of leave qualified for social insurance payout according to this Circular. In case the certificate issued before the effective date of this Circular does not conform to the form prescribed in Circular No. 56/2017/TT-BYT, the health facility shall have to re-issue it according to the provisions of this Circular. The date of admission, the date of discharge in hospital discharge note shall conform to the inpatient medical record; and the date on the signature of the health practitioner shall conform to the date of issue;

b) In case the employee has been treated for COVID-19 but has not yet been issued a hospital discharge note or a certificate of leave qualified for social insurance payout, the health facility where the employee has been treated for COVID-19 based on that person's request and medical records to issue a hospital discharge note or a certificate of leave qualified for social insurance payout. The date of admission, the date of discharge in hospital discharge note shall conform to the inpatient medical record; and the date on the signature of the health practitioner shall conform to the date of issue

c) In case the patient is discharged from hospital and the hospital discharge note contains information about the period of continued outpatient treatment or the period of isolation, the leave period shall be determined according to the time stated in the discharge note;

d) In case the patient is discharged from hospital and the hospital discharge note does not include information on the period of continued outpatient treatment but the patient must be isolated according to regulations, the leave period shall be determined according to the isolation period specified in Appendix 9 to this Circular;

dd) In case the COVID-19 admission and treatment facility has been dissolved, the health facility which is assigned to manage and operate the COVID-19 admission and treatment facility as prescribed in Clause c, Section V of Decision No. 4111/QD-BYT dated August 26, 2021 of the Minister of Health on the promulgation of documents guiding the establishment of COVID-19 admission and treatment facilities under the 3-tier pyramid model is responsible for granting or re-issuing or renewing hospital discharge notes and certificates of leave qualified for social insurance payout to patients;

e) The issuance and use of the hospital discharge note form and the certificate of leave qualified for social insurance payout shall comply with Appendix 3 and Appendix 7 issued together with this Circular.

Article 21. Forms of issuance of certificates of leave qualified for social insurance payout and guidance for the contents of certificates of leave qualified for social insurance payout15

1. As for workers or children aged under 7 of workers receiving impatient treatment: The hospital discharge note with the form specified in Annex 3 enclosed herewith shall be used.

If the person is referred to another health facility during the treatment, a valid copy of the outward referral form shall be provided.

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2. As for workers or children aged under 7 of workers receiving outpatient treatment: a certificate of leave qualified for social insurance payout according to the form specified in Appendix 7 issued with this Circular shall be used.

If a patient needs to take a leave for outpatient treatment after discharged from the hospital, the social insurance authority shall provide social insurance payout according to the leave period (days) written on the discharge note.

3. The form and content of a certificate of leave qualified for social insurance payout shall comply with Appendix 7 issued with this Circular.

a) The first day off is the date on which the patient comes for medical examination and treatment;

b) The date on the signature of the health practitioner in the certificate of leave qualified for social insurance payout shall be written as follows:

- According to the date on which the patient finishes medical examination and treatment;

- According to the date on which the health facility issues the certificate of leave qualified for social insurance payout in a case where the worker requests for re-issuance according to this Circular;

c) In case of re-issuance, the word "RE-ISSUANCE" must be shown on the certificate of leave qualified for social insurance payout.

4. The recording of the code and the name of the long-term disease on the certificate of leave qualified for social insurance payout, the hospital discharge note must comply with the Circular No. 46/2016/TT-BYT dated December 30, 2016 of the Government on promulgation of the list of diseases requiring long-term treatment. In case the disease code stated in the certificate of leave qualified for social insurance payout, the hospital discharge note matches the disease code specified in Circular No. 46/2016/TT-BYT, but the name of the disease does not match the name of the disease specified in the Circular No. 46/2016/TT-BYT, the disease code specified in Circular No. 46/2016/TT-BYT shall prevail.

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IMPLEMENTATION RESPONSIBILITIES

Article 22. Responsibilities of affiliates of the Ministry of Health

The Medical Examination & Treatment Administration shall take charge and cooperate with the Mother and Child Health Department, the Traditional Medicine Administration and Ministry Inspectorate in:

1. Organizing the implementation and reviews of implementation of this Circular nationwide.

2. Carrying out inspections, dealing with violations and handling issues arising during the implementation of this Circular in accordance with effective law provisions.

Article 23. Responsibilities of the Vietnam Social Security

1. Provide instructions for social insurance authorities on implementation of this Circular.

2. Direct Social Securities at the provinces to provide instructions for health facilities on posting the list of facilities entitled to issue confirmation of eligibility to receive social insurance benefits on the websites of Vietnam Social Security and provincial social insurance authorities.  Inspect the issuance of confirmation of eligibility to receive social insurance benefits by health facilities.

Article 24. Responsibilities of Provincial Departments of Health 

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2. Carry out inspections, dealing with violations and handling issues arising during the implementation of this Circular in accordance with effective law provisions.

Article 25. Responsibilities of Medical Assessment Councils

1.16 Update the conclusion of the medical assessment record into the national medical examination and treatment database to communicate with the data system of the social insurance agency.

2. Provide the following documents to the assessed person after the assessment is completed:

a) Assessment record;

b) Assessment bill and invoice;

c) List of assessment contents. In case the assessment contents are carried out by another health facility, the name of such health facility must be written in the “note” column.

Article 26. Responsibility of health facilities

1. Disseminate the content of this Circular among their practitioners and employees.

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3. Issue medical examination and treatment documents, apply for registration of samples of seals and signatures or authorization on the Web Portal receiving data on the Health Insurance Assessment Information System of Vietnam Social Insurance, and bear legal liability for the legitimacy and accuracy of dossiers and papers as a basis for performing electronic transactions in the field of social insurance as prescribed in the Government’s Decree No. 166/2016/ND-CP dated December 24, 2016 on e-transactions in the field of social insurance, health insurance, unemployment insurance and the roadmap for implementation advised by Vietnam Social Security.

4. Transferring health facilities shall provide copies of referral notes bearing their seals on request.

5. Health facilities issuing discharge notes, birth certificate, confirmation of maternity leave, confirmation of poor postpartum health and confirmation of eligibility to receive social insurance benefits shall:

a) Re-issue the discharge notes, birth certificate, confirmation of maternity leave, confirmation of poor postpartum health and confirmation of eligibility to receive social insurance benefits in the following cases:

- It is lost or broken;

- The person signing the confirmations is ultra-vires;

- The seals appended on the confirmations are invalid;

- Information recorded on the discharge notes, birth certificate, confirmation of maternity leave, confirmation of poor postpartum health or confirmation of eligibility to receive social insurance benefits is incorrect.

In case of re-issuance, a “re-issuance’ seal shall be appended on the discharge notes, birth certificate, confirmation of maternity leave, confirmation of poor postpartum health and confirmation of eligibility to receive social insurance benefits.

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After the supplementation, such documents must bear the seal of the health facilities (the seal which is registered with the social insurance authority) where it is supplemented.

c) Register seal and signature samples which are used on the confirmation of eligibility to receive social insurance benefits as follows:

- Register seal samples in accordance with Annex 8 enclosed herewith if the health facility is a juridical person;

- Register seal and signature samples of the practitioners authorized to sign the confirmation of eligibility to receive social insurance benefits in accordance with Annex 8 enclosed herewith if the health facility is not juridical person.

In case the health facility changes the seal sample or the person authorized to sign the confirmation of eligibility to receive social insurance benefits on behalf of the organization head, the health facility must send a written notice to the provincial or district-level social insurance authority (as prescribed by the Vietnam Social Security) where its head office is located within 05 working days from the date of change.

The application of electronic signature shall comply with law provisions on electronic signature.

d) Authorize a person to sign on the confirmation of eligibility to receive social insurance benefits.

The authorization must be in writing and be sent to the provincial social insurance authority where the facility’s head office is located. The authorized person shall not re-authorize. The written authorization shall specify the following contents: Full name and position of the authorized person; scope of authorization (the authorized person may sign or seal on the documents on which case) and period of authorization.

6.17. In case the employee has received medical examination and treatment but has not been issued with a hospital discharge note, certificate of live birth, certificate of maternity leave, certificate of insufficient health to take care of the child after birth, certificate of leave qualified for social insurance payout, the health facility where the employee has received medical examination and treatment shall, based on this Circular and the employee’s written request, issue a hospital discharge note, certificate of live birth, certificate of maternity leave, certificate of insufficient health to take care of the child after birth, certificate of leave qualified for social insurance payout, in which the date on the signature of the health practitioner shall be written according to the date of issue.

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18. Adding Appendix 9 to this Circular.

19. Appendix 4 to this Circular shall replace Appendix 4 and Appendix 5 to Joint Circular No. 20/2016/TTLT-BYT-BLDTBXH dated June 30, 2016 of the Minister of Health and the Minister of Health, and the Minister of Labor, War Invalids and Social Affairs, providing instructions about medical examination and assessment of diseases, illnesses, deformities and impairments related to exposure to toxic chemicals for partisans and their natural children.

Chapter VI

IMPLEMENTATION PROVISIONS

Article 27. Entry into force18

1. This Circular is entering into force as from March 1, 2018.

2. Circular No. 56/2017/TT-BYT dated December 29, 2017 of the Minister of Health, elaborating on implementation of several Articles on health in the Law on Social Insurance, shall be invalidated as from the effective date of this Circular.

Article 28. Grandfather clauses

1. Discharge notes, birth certificates, confirmations of eligibility to receive social insurance benefits, injury confirmations and death certificates issued by the health facilities within their powers and professional regulations prescribed by the Ministry of Health from July 01, 2016 to before the effective date of this Circular but their forms, dates, seals or signatures are incorrect, they shall remain valid for granting social insurance benefits.

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Article 29. Terms of reference

In case the legislative documents and regulations cited in this Circular are changed or replaced, the newer ones shall apply.

Difficulties that arise during the implementation of this Circular should be promptly reported to the Ministry of Health (via the Medical Examination & Treatment Administration) for consideration./.

CERTIFIED AS A CONSOLIDATED DOCUMENT BY

PP. MINISTER
DEPUTY MINISTER




Tran Van Thuan