CIRCULAR

ELABORATING ON OPERATIONS AND WORKING RELATIONSHIP OF MEDICAL ASSESSMENT COUNCILS AT ALL LEVELS

Pursuant to the Government’s Decree No. 131/2021/ND-CP dated December 30, 2021 on elaboration and measures for implementation of the Ordinance on preferential treatment of people with meritorious services to the revolution;

Pursuant to the Government’s Decree No. 95/2022/ND-CP dated November 15, 2022 defining the functions, tasks, powers and organizational structure of the Ministry of Health;

At the request of the Director General of the Vietnam Administration of Medical Services;

The Minister of Health hereby promulgates a Circular elaborating on operations and working relationship of Medical Assessment Councils at all levels.

Chapter I

ORGANIZATION OF MEDICAL ASSESSMENT COUNCILS AT ALL LEVELS

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Article 1. Principles of establishment of Medical Assessment Councils

1. Medical Assessment Councils (MACs) at all levels refer to the medical councils established to evaluate health status and rate bodily impairment (if any) by injuries, diseases, abnormalities, deformities or malformations at the request of an agency, organization or individual.

2. Every MAC shall use its own seal for certifying the medical assessment reports. The term of an MAC shall be 05 (five) years from the day on which its establishment decision is signed, except for the MAC for special reassessment.

3. Composition of an MAC:

a) A provincial/ministerial/central MAC has 05 (five) members and operates under the dual office holding regime. Those members include a Chair, Deputy Chair, standing member and specialized members;

b) An MAC for special reassessment has at least 05 (five) members and operates under the dual office holding regime. Those members include a Chair, Deputy Chair, Standing Member and specialized members.

4. Members of an MAC and assessors who previously participated in medical assessment of a patient shall not participate in the MAC for special reassessment.

Article 2. Composition of MACs

1. Composition of a provincial MAC:

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b) Two Deputy Chairs: a Standing Deputy Chair who is a senior representative of the provincial MAC’s standing agency; a Specialized Deputy Chair who is a senior representative of the provincial general hospital;

c) Members who are assessors, including a standing member who is a public employee of the provincial MAC.

2. Composition of a central MAC:

a) A Chair who is a senior representative of a hospital affiliated to the Ministry of Health and assigned tasks by the Minister of Health;

b) A Deputy Chair who is a senior representative of the standing agency specified in clause 3 Article 161 of the Government’s Decree No. 131/2021/ND-CP dated December 30, 2021 on elaboration and measures for implementation of the Ordinance on preferential treatment of people with meritorious services to the revolution (hereinafter referred to as “the Decree No. 131/2021/ND-CP”);

c) Members who are assessors, including a standing member who is a public employee of the central MAC's standing agency.

3. Composition of an MAC for special reassessment:

a) A Chair who is a senior representative of the Vietnam Administration of Medical Services;

b) A Deputy Chair who is the Chair of a central MAC or Chair of a ministerial MAC having the authority to carry out special reassessment;

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Article 3. Authority to establish MACs at all levels

1. A provincial MAC shall be established under the decision of a specialized agency affiliated to the provincial People’s Committee.

2. A central MAC shall be established under the decision of the Ministry of Health.

3. The Ministry of National Defense, Ministry of Public Security and Ministry of Transport shall rely on the regulations enshrined in this Circular to decide to establish a ministerial MAC under point b clause 2 Article 161 of the Decree No. 131/2021/ND-CP.

Article 4. Authority of a provincial MAC

1. Carry out the first assessment and reassessment of patients who are working, residing or staying in their provinces.

2. Carry out first assessment and reassessment of patients under the management of the Ministry of Public Security or Ministry of Transport if the agency managing such patients or standing agency of the MAC of the Ministry of Public Security or Ministry of Transport makes a written request for medical assessment.

Article 5. Authority of a ministerial MAC

Every ministerial MAC shall carry out medical assessment as prescribed in clause 2 Article 162 of the Decree No. 131/2021/ND-CP.

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1. Carry out the first assessment and reassessment of patients who are working, residing or staying in provinces and central-affiliated cities under the assignment decision of the Minister of Health at the request of the agency managing such patients, except for people with meritorious services to the revolution, their relatives and people with disabilities.

2. Carry out special reassessment in the following cases:

a) The case is beyond the specialized capacity of the provincial MAC or MAC of the Ministry of Transport;

b) The patient or his/her legal representative disagrees with the conclusion given by the provincial MAC or MAC of the Ministry of Transport;

c) The special reassessment of a patient under the management of the Ministry of Public Security is requested by the agency managing such patient or standing agency of the MAC of the Ministry of Public Security.

Article 7. Authority of MAC for special reassessment

Carry out special reassessment of patients when the patients or their legal representatives disagree with the medical assessment conclusion given by the central MAC or by the MAC for final reassessment affiliated to the Ministry of National Defense or Ministry of Public Security.

Article 8. Tasks and powers of the Council’s Chair

1. Chair or authorize the Council’s Deputy Chair in writing to chair the MAC’s conclusion meeting in case he/she is not able to participate in the meeting. Such authorization shall be made in writing and no one other than the Council’s Standing Deputy Chair is authorized to chair the meeting.

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3. Append his/her signature to the MAC’s minutes of meetings and the medical assessment report issued at the meeting which he/she chairs in accordance with regulations.

4. Give and have his/her opinions about the medical assessment contents recorded in the MAC’s minutes of meetings.

5. Preside over settling issues arising during the MAC’s meeting.

6. Direct settlement of medical assessment-related issues at the request of the head of the MAC’s Standing Agency.

Article 9. Tasks and powers of Council’s Chairs

1. Chair the MAC’s conclusion meetings with authorization of the MAC’s Chair and perform tasks of the MAC’s Chair at the authorized meetings.

2. Assume the joint responsibility with other members of the MAC for the conclusions drawn at the meetings in which he/she participates.

3. Append his/her signature to the MAC’s minutes of meetings in respect of the meetings in which he/she participates; sign the medical assessment reports issued at the meetings which he/she is authorized to chair.

4. Give and have his/her opinions about the medical assessment contents recorded; recorded opinions shall be fully written in the MAC’s minutes of meetings.

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6. Engage in settlement of medical assessment-related issues at the request of the head of the MAC’s standing agency.

Article 10. Council’s standing members and specialized members

1. Assume responsibility for results of examinations which he/she carries out and assume the joint responsibility with other members of the MAC for conclusions given at the meetings in which he/she participates.

2. Participate in all meetings of the MAC at the request of the head of the MAC’s standing agency. If a specialized member or standing member is not able to attend the MAC’s meeting, he/she must provide a written explanation to the head of the MAC’s standing agency.

3. Append his/her signature to the MAC’s minutes of meetings in respect of the meetings in which he/she participates.

4. Give and have his/her opinions about the specialist examination contents recorded in the MAC’s minutes of meetings.

5. Engage in settlement of issues arising during the MAC’s meeting at the request of the chair of the MAC’s meeting.

6. Engage in settlement of medical assessment-related issues at the request of the head of the MAC’s standing agency.

7. Perform other tasks as assigned by the MAC’s Chair or Deputy Chair.

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Article 11. Tasks of provincial MAC’s standing agency

1. Propose the establishment and consolidation of the MAC, appoint and dismiss assessors of the MAC.

2. Receive, review and process applications for medical assessment as prescribed in the Decree No. 131/2021/ND-CP.

3. Carry out medical assessment following the procedures specified in the Appendix 1 to this Circular.

4. Preside over and cooperate with relevant units in proposing organization and performance of medical assessment tasks, and providing facilities, equipment and personnel for medical assessment.

5. Settle or propose the settlement of requests, proposals, complaints and denunciations related to medical assessment.

6. Manage MAC's seal.

7. Archive medical assessment documentation as prescribed by law.

8. Annually review and submit a report on medical assessment results to its supervisory authority and central MAC’s standing agency.

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1. Undertake the tasks specified in clauses 1 through 7 Article 11 of this Circular.

2. Provide professional guidance on medical assessment.

3. Direct healthcare activities, inspect, supervise, offer training, continuing training and professional coaching courses in medical assessment.

4. Conduct scientific researches, provide advice on, propose and participate in formulation of policies, laws and regulations on medical assessment.

Article 13. Tasks of standing agency of the MAC for special reassessment

1. The standing agency of the MAC for special reassessment is a standing agency of the central MAC or standing agency of the MAC for final reassessment affiliated to the Ministry of National Defense or standing agency of the MAC for final reassessment affiliated to the Ministry of Public Security which has carried out assessment of the patient.

2. Undertake the tasks specified in clauses 1, 2, 3, 5 and 7 Article 11 of this Circular.

Section 3. ASSESSORS

Article 14. Standards to be satisfied by MAC’s assessors and members

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a) He/she must be a doctor who is working at a state-owned health facility and has a practicing certificate whose scope is relevant to his/her specialization to which he/she is appointed;

b) He/she has the certificate of completion of training or continuing training or coaching course in medical assessment issued by a competent authority.

2. Standards to be satisfied by a standing member or specialized member of the provincial MAC:

a) He/she must be a specialist level I or has a master of medicine or higher;

b) He/she has at least 03 (three) years of working experience in his/her specialty, including the period of training in such specialty;

c) He/she meets the standards set out in point b clause 1 of this Article.

3. Standards to be satisfied by an assessor being a standing member or specialized member of the central MAC or MAC for special reassessment:

a) He/she must be a specialist level II or has a doctor of medicine;

b) He/she has at least 05 (three) years of working experience in his/her specialty, including the period of training in such specialty;

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4. Standards to be satisfied by an assessor being a ministerial MAC’s member:

a) The assessor being a standing member or specialized member of the ministerial MAC having authority to carry out first assessment and reassessment shall satisfy the conditions specified in clause 2 of this Article;

b) The assessor being a standing member or specialized member of the ministerial MAC having authority to carry out special reassessment shall satisfy the conditions specified in clause 3 of this Article.

Article 15. Appointment of assessors

1. Assessors of the central MAC shall be appointed by the Ministry of Health according to the proposal of the central MAC’s standing agency and the Vietnam Administration of Medical Services.

2. Assessors of a provincial MAC shall be appointed by the specialized agency affiliated to the provincial People’s Committee at the request of the standing agency of that provincial MAC.

3. Assessors of the MAC of a Ministry shall be appointed by that Ministry at the request of the standing agency of that ministerial MAC.

4. The number of assessors of an MAC shall be decided by the person having the appointment authority depending on requirements and tasks of the MAC. There are at least 02 (two) assessors in charge of each specialty. If an MAC does not have any specialist in cardiology, respiratory medicine, urology, digestion, muѕᴄuloѕkeletal ѕуѕtem, hematologу - blood transfusion, endoᴄrinologу or immunologу, a specialist of the general internal medicine department may be employed. In this case, each assessor shall be assigned to take charge of no more than 02 (two) specialties to ensure the quality of medical assessment.

Article 16. Dismissal of assessors

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a) He/she violates regulations on medical assessment or code of professional ethics;

b) He/she is incapable of performing medical assessment tasks;

c) He/she is not fit for work;

d) He/she has submitted an application for resignation which has been also approved by his/her supervisory authority.

2. If a person who is appointed as an assessor retires or is reassigned, he/she shall be implicitly no longer an assessor from the date of retirement or reassignment.

Article 17. Tasks and powers of assessors

1. Tasks of an assessor:

a) Carry out specialist examinations according to the request for specialist examination received from the MAC’s standing agency. Send results of completed specialist examinations to the MAC’s standing agency and enter such results into the specialist examination record of the office where he/she is working.

b) Participate in medical consultations at the request of the MAC’s standing agency;

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d) Participate in a conclusion meeting of the MAC at its invitation.

2. Powers of an assessor:

a) Attend continuing and coaching training courses in medical assessment;

b) Receive benefits when participating in specialist examinations, medical consultations and meetings of the MAC in accordance with regulations of law and regulations of the MAC’s standing agency.

c) Apply for resignation from the position of assessor;

d) Refuse to carry out assessment if the patient or his/her legal representative deliberately fails to cooperate.

Chapter II

OPERATIONS OF MACS

Article 18. MAC’s working principles at its conclusion meetings

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2. The conclusion given by the MAC must be unanimously approved by at least 03 Council’s members present at the meeting while the conclusion given by the MAC for special reassessment must be unanimously approved by at least 2/3 (two-thirds) of its members present at the meeting.

3. The conclusion given by the MAC shall be made in the form of a medical assessment report:

a) For patients who are people with meritorious services to the revolution or their relatives: the medical assessment report shall be made using the template specified in the Appendix 78 to the Decree No. 131/2021/ND-CP;

b) For patients other than those specified in point a of this clause: the medical assessment report shall be made using the template specified in the Appendix 2 to this Circular.

4. Contents of an MAC’s meeting shall be included in minutes of MAC’s meeting which is made using the template specified in the Appendix 3 to this Circular.

Article 19. Participants in an MAC’s conclusion meeting

1. An conclusion meeting of the MAC is held only when it is attended by at least 03 Council's members are present while a conclusion meeting of the MAC for special reassessment is held only when it is attended by at least 2/3 (two-thirds). All of the following participants must be present:

a) The Council’s Chair or Council’s authorized Deputy Chair;

b) Council’s standing member in the case of medical assessment of the patients covered by the Decree No. 131/2021/ND-CP;

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d) The handling doctor who is a public employee of the MAC’s standing agency. If he/she is absent, the standing agency shall appoint another person to present reports on his/her behalf.

2. Where necessary, the MAC may invite a specialist assessor or representative of the related agency, organization or individual to attend the MAC's conclusion meeting. The invited person is entitled to express his/her opinions at the MAC's conclusion meeting but does not reserve the right to vote for the conclusions given by the MAC.

3. Cases in which a patient is entitled to be absent from the MAC’s conclusion meeting:

a) He/she has been present at the MAC’s previous meeting and has been requested by the Council to undergo clinical and/or subclinical examinations of which the results are available.

b) He/she is suffering from a serious injury or disease or has a severe disability so that he/she is unable to receive direct assessment from the MAC and has received on-the-spot assessment from the Council’s standing agency provided the written request of the managing authority or legal representative of the patient has been approved by the Council's Chair or Deputy Chair.  Audio and video recordings of on-the-spot assessment of this patient are required and shall be used at the medical consultation and conclusion meetings of the Council. Representative of the agency managing the patient or his/her legal representative must attend the Council’s conclusion meeting;

c) He/she has undergone clinical and/or subclinical examinations of which the results are available but is suffering from a serious injury or disease or has a severe disability so that he/she is unable to attend the MAC’s meeting provided the written request of the managing authority or legal representative of the patient has been approved by the Council's Chair or Deputy Chair. Representative of the agency managing the patient or his/her legal representative must attend the Council’s conclusion meeting.

Article 20. Procedures of Council’s conclusion meeting

1. The doctor who processes the medical assessment documentation shall present the summary report on medical assessment results specified in the medical assessment documentation, including anticipated results of injury, disease or disability and whole person impairment rate (%) of each patient.  Medical assessment documentation shall be submitted to the Council only after it has been approved at the medical consultation held by the Council’s standing agency.

2. Members participating in the MAC’s conclusion meeting shall verify the patient’s injury, disease or disability status, except for the case specified in clause 3 Article 19 of this Circular.

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4. The Council shall discuss and vote for the conclusion

a) The conclusion about the injury, disease, disability, whole person impairment rate and/or other conclusion given according to regulations of law and the application for medical assessment;

b) In case there are insufficient grounds for the conclusion, the Council may prescribe additional clinical and/or subclinical examinations and/or treatment and/or reference to medical records and other relevant documents to have more grounds for reaching the conclusion;

c) In case provincial or regional health facilities are not capable of carrying out specialist examinations (clinical or subclinical examinations), the Council may send the patient to a qualified public health facility to receive specialist examinations of which results shall be used as the basis for the Council to consider and reach conclusion on the injury, disease, disability, and whole person impairment rate (%) of the patient.

5. Members of the Council participating in the meeting shall append their signatures to the Council’s minutes of meetings.  The person writing up the Council’s minutes of meetings shall be assigned by the head of the Council’s standing agency.

Chapter III

WORKING RELATIONSHIP OF MACS AT ALL LEVELS

Article 21. Relationship between provincial MACs and ministerial MACs, central MACs and MAC for special reassessment

1. Provincial MACs maintain the same-level relationship with ministerial MACs having authority to carry out first assessment and reassessment.

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Article 22. Relationship between ministerial MACs and central MACs and MAC for special reassessment

1. Ministerial MACs having authority to carry out final reassessment maintain the same-level relationship with the central MAC.

2. The authority of MAC for special reassessment is superior to ministerial MACs having authority to carry out final reassessment.

Article 23. Relationship between central MACs and MACs for special reassessment

1. Central MACs maintain the same-level relationship with each other.

2. The authority of MAC for special reassessment is superior to central MACs.

Chapter IV

IMPLEMENTATION

Article 24. Effect

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2. The Circular No. 52/2016/TT-BYT dated December 30, 2016 of the Minister of Health prescribing tasks, powers, working relationship and operations of Medical Assessment Councils at all levels shall cease to have effect from the effective date of this Circular.

Article 25. Grandfather clause

1. Any assessor appointed by a competent authority before the effective date of this Circular shall keep holding his/her position until the end of his/her tenure.  The appointment of additional assessors or appointment of new assessors from the effective date of this Circular shall comply with the provisions of this Circular.

2. Any MAC established before the effective date of this Circular shall keep operating until the end of its term.

Article 26. Responsibility for implementation

1. The Ministry of Health (the Vietnam Administration of Medical Services) has the responsibility to:

a) Direct and provide guidance on medical assessment and offer coaching courses in medical assessment to MACs and their standing agencies nationwide;

b) Preside over and cooperate with relevant agencies and organizations in carrying out inspections, preliminary and final reviews of medical assessment activities of MACs and their standing agencies nationwide;

c) Advise the Minister of Health on establishing central MACs and MAC for special reassessment, appointing and dismissing assessors, assigning the tasks in healthcare activity direction and assigning specific tasks to central MACs' standing agencies.

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2. The Ministry of National Defense, Ministry of Public Security and Ministry of Transport have the responsibility to:

Direct health authorities and relevant authorities to organize supervision and inspection of operations of MACs and standing agencies under their management.

3. People’s Committees have the responsibility to:

a) Direct Departments of Health and relevant authorities to organize supervision and inspection of operations of MACs and standing agencies of provincial MACs under regulations of this Circular;

b) Direct health facilities to provide facilities, equipment and personnel for carrying out specialist examinations of patients undergoing medical assessment.

4. Specialized agencies affiliated to provincial People’s Committees have the responsibility to:

a) Direct and provide guidance on medical assessment by MACs and MACs’ standing agencies under their management;

c) Inspect the medical assessment by MACs and MACs’ standing agencies under their management; suspend or request the suspension of medical assessment or impose penalties for violations under their authority with respect to MACs and MACs’ standing agencies under their management.

5. Health facilities shall cooperate with and prime MACs and standing agencies of MACs at all levels to use their facilities and equipment to carry out medical assessment.

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PP. THE MINISTER
THE DEPUTY MINISTER




Tran Van Thuan