Thông tư 14/2013/TT-BYT

Circular No.14/2013/TT-BYT of May 06, 2013 guiding medical examination

Nội dung toàn văn Circular No.14/2013/TT-BYT guiding medical examination


THE MINISTRY OF HEALTH
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SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
---------------

No. 14/2013/TT-BYT

Hanoi, May 06, 2013

 

CIRCULAR

GUIDING MEDICAL EXAMINATION

Pursuant to the November 23, 2009 Law on medical examination and treatment;

Pursuant to the June 18, 2012 Labor Code;

Pursuant to the November 29, 2006 Law on Vietnamese workers going abroad for work under contract;

Pursuant to the Government’s Decree No. 06/CP dated January 20, 1995 detailing a number of articles of the Labor Code on labor safety and hygiene and the Government's Decree No. 110/2002/ND-CP dated December 27, 2002 on amending and supplementing a number of articles of the Government’s Decree No. 06/CP dated January 20, 1995 detailing a number of articles of the Labor Code on labor safety and hygiene;

Pursuant to the Government’s Decree No. 126/2007/ND-CP dated August 01, 2007 detailing and guiding implementation of a number of articles of the Law on Vietnamese workers going abroad for work under contract;

Pursuant to the Government’s Decree No. 34/2008/ND-CP dated March 25, 2008, stipulating on employment and administration of foreigners working in Vietnam and the Decree No. 46/2011/ND-CP dated June 17, 2011 amending and supplementing a number of articles of Decree No. 34/2008/ND-CP dated March 25, 2008, stipulating on employment and administration of foreigners working in Vietnam;

Pursuant to the Government’s Decree No. 63/2012/ND-CP dated August 31, 2012, defining the functions, tasks, powers and organizational structure of the Ministry of Health;

At the proposal of Director of the Medical Examination and Treatment Management Department and Director of the Legal Affair Department;

The Minister of Health promulgated the Circular guiding medical examination.

Chapter 1.

GENERAL PROVISIONS

Article 1. Scope of regulation and Subjects of application

1. This Circular guides dossiers, procedures, contents of medical examination (ME), classification of health and conditions of medical examination and treatment (ME&T) establishments permitted to perform ME.

2. This Circular is applicable to the following subjects:

a. Vietnamese persons, foreigners who are living and working in Vietnam wish to do ME when apply for employment, periodical ME, ME when registering study in universities, colleges, professional high schools, vocational schools and other subjects;

b. ME for Vietnamese workers when going abroad for work under contract.

3. This Circular is not applicable to the following cases:

a. Outpatient, inpatient diagnoses in ME&T establishments;

b. Medical assessment, forensic and mental forensic examination;

c. Examination for injury certificate;

d. Examination for occupational diseases;

e. ME when recruiting in armed forces and ME in armed forces.

4. ME will be performed at only ME&T establishments that are licensed operation as prescribed in Law on medical examination and treatment and eligible as prescribed in this Circular.

5. For persons possessing the ME certificate that is issued by foreign competent medical establishment, the ME certificate will be used in case where Vietnam and country or territory where issuing ME certificate have mutual recognition agreements and the use duration of that ME certificate not exceed 6 months from the day of issuance. The ME certificate must be translated into Vietnamese and that translation must be authenticated.

Article 2. Use of health standard for health classification

1. The health classification of person performed ME shall comply with the Decision No. 1613/BYT- QD dated August 15, 1997 of the Minister of Health on promulgating standard on health classification for recruitment examination and periodical examination for workers (hereinafter abbreviated to the Decision No. 1613/BYT- QD).

2. For cases of ME under the set of specialized health standard that is promulgated or recognized by competent state management agencies of Vietnam, the health classification shall be based on regulation of the set of specialized health standard.

3. For cases of ME at the request but not examining all medical specialties according to the Form of ME certificate specified in this Circular, ME&T establishments where perform ME (hereinafter abbreviated to ME establishments) may examine, conclude with each specialty at the request of person performed ME and not classify health.

Article 3. Expenses for medical examination

1. Organizations, individuals requesting for ME must pay expenses to the ME establishments at the price of ME&T services already approved by competent state agencies or under agreement between two units, except for cases being exempted or reduced as prescribed by law.

2. If person being performed ME request to be issued for two or more ME certificates, he/she must pay additionally charge for issuance of ME certificate as prescribed by law.

3. The collection, remittance, management and use of funding source from the ME operation shall be comply with regulations of law.

Chapter 2.

PROCEDURES FOR AND CONTENT OF MEDICAL EXAMINATION

Article 4. Dossier of medical examination

1. ME Dossier of person at full 18 (eighteen) years or older is the ME certificate made according to the set form in Annex 1 promulgated together with this Circular, pasted with a portrait at size of 04cm x 06cm, taken on white background, within 06 (six) months counted to the day of submitting ME dossier.

2. ME Dossier of person under 18 (eighteen) years is the ME certificate made according to the set form in Annex 2 promulgated together with this Circular, pasted with a portrait at size of 04cm x 06cm, taken on white background, within 06 (six) months counted to the day of submitting ME dossier.

3. For persons who is lost, incapable or limited of civil acts requesting ME but not in case of periodical ME, ME dossier includes: ME certificate as prescribed in clause 1 or clause 2 of this Article and written consent of their father or mother of legal guardian.

4. For persons performed periodical ME, ME dossier includes:

a. Periodical ME book made according to the set form in Annex 3 promulgated together with this Circular;

b. Letter of introduction of agencies, organizations where that person working for case of separate periodical ME or named in list of periodical ME confirmed by agencies, organizations where that person working for periodical ME under contract.

Article 5. Procedures for medical examination

1. Dossier of medical examination is submitted at ME establishment.

2. After receiving dossier of ME, the ME establishments shall implement the jobs:

a. Comparing the picture in ME dossier with the person who arrives for ME;

b. Affixing with an integrity seal on picture after comparing as prescribed in point a this clause for cases specified in clauses 1, 2 and 3 Article 4 of this Circular;

c. Checking and comparing ID card or passport of guardian of person performed ME for case specified in clause 4 Article 4 of this Circular;

d. Guiding the ME process for the person performed ME, hi/her guardian (if any);

e. ME establishments implement ME under process.

Article 6. Contents of medical examination

1. In case of ME for persons at full 18 (eighteen) years or older but not case of periodical ME: Examining under contents inscribed in ME certificate specified in Annex 1 promulgated together with this Circular.

2. In case of ME for persons under 18 (eighteen) years but not case of periodical ME: Examining under contents inscribed in ME certificate specified in Annex 2 promulgated together with this Circular.

3. For case of periodical ME: Examining under contents inscribed in periodical ME book specified in Annex 3 promulgated together with this Circular.

4. For cases of ME under the set of specialized health standard: Examining under contents inscribed in ME certificate specified in the ME certificate form of that speciality.

5. For cases of ME at the request: Examining under content required by person performed ME.

Article 7. Classification of health

1. Persons performing clinical examination, preclinical examination for ME subjects must clearly inscribe result of examination and classification of health by speciality, signing and taking responsibility before law for their medical examination and medical examination result.

2. Based on the medical examination result of each speciality, person allocated by ME establishments for making conclusion on the health classification and signing in ME certificate, periodical ME book (hereinafter abbreviated to the conclusion person) shall perform conclusion on the health classification as follows:

a. Classifying health of person performed ME as prescribed in the Decision No. 1613/BYT- QD or Classifying health as prescribed in the set of specialized health standard for case of specialized ME;

b. Clearly inscribing the diseases of the person performed ME (if any). In case where the persons performed ME get diseases, the conclusion person must advice the plan on medical treatment, functional rehabilitation or introduce speciality examination for medical examination and treatment.

3. After classifying health, the conclusion person must sign, clearly inscribe full name and affix with the seal of ME establishments in ME certificate or periodical ME book (the seal used for official transaction of ME establishments as prescribed by law on management and use of seal). If the person performed ME request for issuing more ME certificate, seal will be affixed after copying the ME certificate as prescribed in Article 8 of this Circular.

Article 8. Issuance of medical examination certificate

1. ME certificate is issued 01 (one) copy for the person performed ME. If the person performed ME request for issuing more ME certificates, the ME establishments shall be implemented as follows:

a. Copying ME certificate signed by the conclusion person before stamping seal. Number of copied ME certificates depends on request of the person performed ME;

b. After copying, stick the pictures, affix with an integrity seal on the copies of ME certificate and stamp as prescribed in clause 3 Article 7 of this Circular.

2. Time limit for returning ME certificate or periodical ME book:

a. For case of separate ME: ME establishments shall return ME certificate or periodical ME book for the person performed ME within 24 (twenty four) hours after ending ME, except for cases required for additional medical examination and making tests at the request of the person performed ME;

b. For case of collective ME under contract: ME establishments will return ME certificate, periodical ME book to the persons performed ME according to agreement in contract.

3. Use value of ME certificate, periodical ME book:

a. ME certificate shall be valid within 12 (twelve) months from the day of signing health conclusion; In case making ME for Vietnamese workers going abroad for work under contract, value of ME certificate shall comply with regulation of country or territory where the Vietnamese workers arriving for work;

b. Result of periodical ME has use value as prescribed by law.

4. In case where the person performed ME has a HIV-positive test; this test result must be informed as prescribed by law on HIV/AIDS prevention and control.

Chapter 3.

CONDITIONS FOR MEDICAL EXAMINATION AND TREATMENT ESTABLISHMENTS PERMITTED TO PERFORM MEDICAL EXAMINATION

Article 9. Conditions of personnel

1. The person performing clinical examination, preclinical examination must has the practicing certificate of medical examination and treatment as prescribed by Law on medical examination and treatment in line with speciality which such person is assigned task of examination. In case the person performing preclinical examination techniques that law not requires to have to have the practicing certificate of medical examination and treatment, he/she must have specialized degrees in line with the assigned job.

2. The conclusion person must meet the following conditions:

a. Being doctors possessing the practicing certificate of medical examination and treatment and having time of medical examination and treatment of at least 54 (fifty four) months;

b. Being assigned by competent persons of ME establishments so as to make health conclusions, to sign in the ME certificate and periodical ME book. The assignment must be performed in writing and affixed with a legal seal of ME&T establishments.

3. For ME establishments serving foreigners, Vietnamese persons residing in foreign country and Vietnamese persons going abroad for work under contract (hereinafter abbreviated to ME establishments involving foreign elements) apart from meeting provisions in clauses 1 and 2 this Article, they must meet additionally the following conditions:

a. The persons who perform clinical examination, the conclusion persons must be the specialized doctors at grade I or medical masters or higher.

b. When the person performed ME and the person performing ME is not fluent in the same language, a translator is required. The translator must have certificate of translation eligibility in medical examination and treatment as prescribed by Law on medical examination and treatment.

Article 10. Conditions on material facilities, equipment

1. Having rooms for clinical examination, preclinical examination of each speciality as prescribed by the Ministry of Health in line with content of ME.

2. Having sufficient material facilities and essential medical equipment as prescribed in Annex 4 promulgated together with this Circular.

Article 11. Conditions and scope of professional operation

1. Conditions for ME establishments not involving foreign elements: To perform the professional techniques in line with contents inscribed in ME certificate specified in Annexes 1, 2, 3 promulgated together with this Circular.

2. Conditions for ME establishments involving foreign elements, apart from meeting provisions in clause 1 this Article, they must be able to implement the following preclinical examination techniques:

a. Blood test: Blood formula, ABO blood, Rh blood, erythrocyte sedimentation rate, hemoglobin percentage, urea blood;

b. Searching malaria parasite in blood;

c. A, B, C, E hepatitis tests;

d. Syphilis serology;

dd. Test for affirming status of HIV infection (positive HIV);

e. Mantoux test;

d. Pregnancy test;

a. Drug test;

i. Stool test to search parasites;

k. Electrocardiogram (ECG);

l. Electroencephalogram (EEG);

m. Ultrasonic;

n. Test to diagnose leprosy.

If ME establishments involving foreign elements have not yet had conditions to implement techniques specified in point dd and n clause 2 this Article, they must sign contract for specialized support with ME&T establishments possessing operational license and permitted to implement those techniques.

3. Specialized scope:

a. ME&T establishments eligible as prescribed in clause 1, clause 2 Article 9, Article 10 and clause 1 Article 11 of this Circular may organize ME but not ME involving foreign element.

b. ME&T establishments eligible as prescribed in clause 3 Article 9, Article 10 and clause 2 Article 11 of this Circular may organize ME including ME involving foreign element.

Article 12. Dossiers of and procedures for announcing on medical examination

1. Dossier of announcing on eligibility for ME:

a. Written announcement on eligibility for ME made according to the set form in Annex 5 promulgated together with this Circular;

b. Authenticated copy of license for medical examination and treatment operation of establishments;

c. List of ME participants made according to the set form in Annex 6 promulgated together with this Circular (affixed with a seal on each page and an integrity seal between the pages);

d. List of material facilities and medical equipment as prescribed in Annex 4 promulgated together with this Circular.

dd. Report on specialized operation scope of ME establishments;

e. Authenticated copy of contract providing specialized support for case specified in clause 3 Article 11 of this Circular (if any).

2. Procedures for announcing on medical examination:

Before organizing initial ME, the ME&T establishments must send dossier of announcing ME as prescribed in clause 1 this Article to the state management agencies in health field, specified as follows:

a. For ME&T establishments attached the Ministry of Health: Dossier may send to the Department of medical examination and treatment management - the Ministry of Health;

b. For ME&T establishments under the management competence of the Ministry of National Defense, the dossier may send to the Army’s Health Department - the Ministry of National Defense; ME&T establishments under the management competence of the Ministry of Public Security, the dossier may send to the Health Department - the Ministry of Public Security; ME&T establishments under the management competence of the Ministry of Transport, the dossier may send to the Health Department - the Ministry of Transport;

c. For ME&T establishments under the management competence of the Departments of Health of central-affiliated cities and provinces (hereinafter abbreviated to as the provincial Department of Health); ME&T establishments with head offices locating in central-affiliated cities and provinces (except for ME&T establishments specified in point a, point b clause 2 this Article): Dossier may send to the provincial Department of Health where ME&T establishments locating their head offices.

Article 13. Duration and order for solving dossier of announcing eligibility for ME

1. Within 02 working days after receiving dossier of announcing eligibility for ME, the state management agencies in health field specified in clause 2 Article 12 of this Article (hereinafter abbreviated to agencies receiving dossiers) shall send a receipt slip of dossier to the ME&T establishments announcing eligibility (hereinafter abbreviated to establishments announcing eligibility) as prescribed in Annex 7 promulgated together with this Circular.

2. Within 10 working days after receiving dossier, the agencies receiving dossiers must appraise dossier.

If dossier is not valid, the agency receiving dossier must notify in writing the establishments announcing eligibility for completing dossier. The written notice must specify documents that must be supplemented and contents that must be revised. Establishments announcing eligibility must supplement, revise according to content of the written notice only. When receiving the written notice regarding invalid dossier, the establishments announcing eligibility must complete and send dossier for supplementation to the agency receiving dossier.

Within 02 working days after receiving supplemented dossier, the agencies receiving dossiers must send a receipt slip of supplemented dossier to the establishments announcing eligibility. If the establishments announcing eligibility has supplemented dossier but inconsistently with request, they must continue completing dossier according to the procedures specified in this clause until dossier meets request.

3. Within 20 working days after day of the receipt of dossier for valid dossier or day of the receipt of supplemented dossier for invalid dossier, if agencies receiving dossiers fail to have written reply, the establishments announcing eligibility for ME may carry out ME operation in proper with the specialized scope as announced.

Chapter 4.

RESPONSIBILITIES FOR IMPLEMENTATION

Article 14. Responsibilities of the persons performed ME

1. To supply truthful information on personal heath records, diseases and take responsibility for the supplied information.

2. To abide by guides, directions of the person performing ME during the course of ME implementation.

3. To produce dossier of ME as prescribed in Article 4 of this Circular to the person performing ME for checking whenever a clinical examination or preclinical examination activity is performed.

Article 15. Responsibility of establishments using laborers, universities, colleges, professional high school and vocational school

1. To take responsibility for ME for subjects under their management competence as prescribed by law.

2. To manage periodical ME books of subjects under their management competence.

Article 16. Responsibilities of medical examination establishments

1. To take responsibility before law for ME result performed by them.

2. To sum up results of ME operation performed by them in their reports on general operations and report as prescribed on make statistics and report.

Article 17. Responsibilities of the provincial Department of Health and state management agencies in health field of other Ministries, sectors

1. To direct, guide the ME operation at ME&T establishments under their management competence.

2. To check, inspect operations of ME establishments as prescribed; to suspend or propose for suspension of ME operation or handling of violations under their competence for ME establishments fail to be eligible as prescribed in this Circular.

Article 18. Responsibility of the Department of medical examination and treatment management - the Ministry of Health

1. To direct, guide the ME operation at ME&T establishments nationwide.

2. To check, inspect operations of ME establishments as prescribed by law; to suspend or propose for suspension of ME operation or handling of violations under its competence for ME establishments fail to be eligible as prescribed in this Circular.

Chapter 5.

IMPLEMENTATION PROVISIONS

Article 19. Effect

This Circular takes effect on July 01, 2013.

The Circular No. 13/2007/TT-BYT dated November 21, 2007 of the Ministry of Health guiding ME and the Joint Circular No. 10/2004/TTLT-BYT-BLDTBXH-BTC dated December 16, 2004 of the Ministry of Health, the Ministry of Labor – Invalids –and Social Affairs and the Ministry of Finance

Guiding the health examination and certifying for Vietnamese workers going abroad for work cease to be effective on the effective date of this Circular.

Article 20. Provisions for reference

In case documents referred in this Circular are replaced or amended and supplemented, the documents replacing or amending and supplementing shall be applied.

Article 21. Transitional provisions

ME&T establishments performing the ME operation before the effective day of this Circular may continue performing the ME operation till December 31, 2013. After that, if they wish to continue performing the ME operation, they must meet conditions and comply with process, dossier of announcing eligibility for ME specified in this Circular.

In the course of implementation, any arising problems should be reported to the Ministry of Health (Department of medical examination and treatment management) for consideration and settlement.

 

 

FOR THE MINISTER OF HEALTH
DEPUTY MINISTER




Nguyen Thi Xuyen

 

ANNEX 1

FORM OF CERTIFICATE OF HEALTHY EXAMINATION FOR PERSON OF FULL 18 YEARS OR OLDER
(Enclosed with the Circular No. 14/2013/TT-BYT dated May 06, 2013, of the Minister of Health)

...........[1]..........
...........[2]..........
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SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
-----------------

No.:    /GKSK-....[3].....

 

 

CERTIFICATE OF HEALTHY EXAMINATION

 

 

Picture

(4 x 6cm)

 

 

Full name (uppercase letter): ………….………………………...…....………

Sex:           Male □          Female □         Age: ………………

ID card or passport number:  ................…….. date of issue ……./………/.................at…………………………

Current residence place:………………………………………….

………………….................…...………………….....…………….……...…

Reason of healthy examination:………………………………..

Disease History of object of healthy examination

1. Family history:

Has any member in your family got one of diseases?: Contagious disease, heart disease, diabetes, tuberculosis, bronchial asthma, cancer, epilepsy, mental disorders, other disease:

a) No        □;  b) Yes     □;          

If “yes”, it is required to clearly state name of disease:……

2. Personal history: Have you ever got any disease, or disease situation below? Contagious disease, heart disease, diabetes, tuberculosis, bronchial asthma, cancer, epilepsy, mental disorders, other disease: a) No              □;  b)  Yes       □

If “yes”, it is required to clearly state name of disease:  ……………………………...

…………………………………………………..……………………………………………….

3. Other questions (if any):

a) Are you treated any disease? If yes, please list drugs and dose you are using:

………………………………………………………………………………………………

….…………………………………………………..…………..………….…………………….…

b) Maternity history (for female): …………………………………………………….

………………………………………………………………………………….……………….

I hereby certify that the above declaration is true entirely according to the best of my knowledge.

 

 

................. date .......... month........year................
The requester for healthy examination
(signature, full name)

 

I. PHYSICAL EXAMINATION

Height: ……………cm; Weight: ………….kg; BMI: ……………..

Pulse: ................…….times/minute;      Blood pressure:.................... /..................... mmHg

Physical classification:…………………………………………………

II. CLINICAL EXAMINATION

Content of examination

Full name and signature of Physician

1. Internal medicine

a) Circulation organ: .....................................................................................................

.......................................

Classification:…………………………………………………

b) Respiratory organ .......................................................................................................

..............................................

Classification:…………………………………………………

c) Digestion: .....................................................................................................

.............................................

Classification:…………………………………………………

d) Kidney-Urology: ....................................................................................................

................................

Classification:…………………………………………………

dd) Muscle- bone-joints: ......................................................................................................

..........................

Classification:…………………………………………………

e) Neurological status: ........................................................................................................

........................................

Classification:…………………………………………………

g) Mental health:  .......................................................................................................

..........................................

Classification:…………………………………………………

2. Surgical medicine: ...................................................................

...................................................................

Classification:…………………………………………………

3. Obstetrics:  .............................................................................

.....................................................

Classification:…………………………………………………

4. Eyes:

- Result of vision examination:

Without glasses:      Right eye: ................. Left eye: ....................

With glasses:           Right eye: ................. Left eye: ....................

- Eye diseases (if any): ................................................................

- Classification: ...............................................................................

5. Ears-nose-throat

- Result of hearing ability examination:

Left ear:    speaking normally: ………..m; whispering:…………..m

Right ear:  speaking normally: ………..m; whispering:…………..m

- Ear-nose-throat diseases (if any):………………………………

- Classification: ................................................................................................

.................................................

6. Teeth-Jaw-Face

- Result of medical examination:

+ Maxilla: …………………………………………

+ Mandible: ………………………………………

.........................................................................

- Teeth-Jaw-Face diseases (if any):………………………………

- Classification:…………………………………………………

7. Dermatological disease: ........................................................................................

.............................................................

Classification:…………………………………………………

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III. SUBCLINICAL EXAMINATION

Content of examination

Full name and signature of Physician

1. Blood test:

a) Blood formula: Erythrocyte quantity: ..........................................

                           Leukocyte quantity: .............................................

                                        Platelet quantity:………………………….

b) Blood biochemical examination: Blood sugar: ............................

Urine:………………………….. Creatinine:……………………..

ASAT (GOT):.........................   ALAT (GPT): ........................

c) Other (if any):………………………………

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2. Urine test:

a) Sugar: ........................................................................................

b) Protein: .......................................................................................

c) Other (if any)........................................................................

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3. Image diagnosis: 

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IV. CONCLUSION

1. Health classification:………………………………..[4]...........................................................

2. Diseases (if any): ............................................[5]...................................................................

..................................................................................................................................................

..................................................................................................................................................

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…………date…… month……… year............
THE CONCLUDING PERSON
(Signature, full name and seal)

 

ANNEX 2

FORM OF CERTIFICATE OF HEALTHY EXAMINATION FOR PERSON UNDER 18 YEARS OLD
(Enclosed with the Circular No. 14/2013/TT-BYT dated May 06, 2013, of the Minister of Health)

...........[6]..........
...........[7]..........
-------

SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
------------------------

No.:    /GKSK-....[8].....

 

 

CERTIFICATE OF HEALTHY EXAMINATION

 

 

Picture

(4 x 6cm)

 

 

Full name (uppercase letter): ………………………...…………...……

Sex:      Male □        Female □    Age: …………………..

ID card or passport number (if any):  ...............................................

 date of issue ……./……/............at…………………….......

Full name of parent or guardian:………………………

……………………...….................…………………………………...…

Current residence place:…………………………………

……………………...…….................………………………………...…

Reason of healthy examination:………………………………..

............................................................................................................

............................................................................................................

HISTORY OF DISEASE

1. Family history:

Has any member in child’s family (grandparents, parents, sisters and brothers)   got congenital diseases, contagious diseases?       

 No          □       Yes      □

If “yes”, it is required to clearly state name of disease:……

.....................................................................................................................................................

.....................................................................................................................................................

.....................................................................................................................................................

.....................................................................................................................................................

2. Personal history:

Obstetrics:

- Normal.

- Abnormal: Premature birth; overdue birth; birth with interference; birth asphyxia, mother got disease during pregnancy (if any, it is required to clearly state name of disease:

.....................................................................................................................................................

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b) Vaccinations:

No.

Vaccine type

Status when injecting/drinking vaccine

Yes

No

Fail to miss clearly

1

BCG

 

 

 

2

Diphtheria, pertussis, tetanus

 

 

 

3

Measles

 

 

 

4

Polio

 

 

 

5

Japanese B encephalitis

 

 

 

6

Hepatitis B

 

 

 

7

Other kinds

 

 

 

c) History of disease: (congenital and chronic diseases)

- No                 

- Yes                □

If “yes”, it is required to clearly state name of disease:……

.....................................................................................................................................................

.....................................................................................................................................................

d) Is child being treated any disease?  If yes, please clearly state name of disease and list drugs which are used:

.....................................................................................................................................................

.....................................................................................................................................................

.....................................................................................................................................................

I hereby certify that the above declaration is true entirely according to the best of my knowledge.

 

 

................. date .......... month........year............
The requester for healthy examination
(or father/mother or guardian) 
(signature, full name)

 

I. PHYSICAL EXAMINATION 

Height: ……………cm; Weight: ………….kg; BMI: ……………..

Pulse: ................…….times/minute;   Blood pressure:.................... /..................... mmHg

Physical classification:…………………………………………………

II. CLINICAL EXAMINATION

 

1. Pediatrics

a) Circulation: .......................................................................................................

......................................................................................................

b) Respiratory organ: ...................................................................

......................................................................................................

c) Digestion: .................................................................................

......................................................................................................

Full name and signature of Physician

..........................................

..........................................

..........................................

..........................................

..........................................

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Pediatrics

 

d) Kidney-Urology: …………………………………………………..

......................................................................................................

...............................

dd) Neuropsychiatry: ....................................................................

......................................................................................................

e) Other clinical examination:………………………………………

......................................................................................................

2. Eyes:

a) Result of vision examination:

Without glasses:  Right eye:……..  Left eye:…….. ....................

With glasses:        Right eye: .............Left eye:……..

b) Eye diseases (if any):………………………………………………

......................................................................................................

3. Ears-nose-throat

a) Result of hearing ability examination:

Left ear:    speaking normally: ………..m; whispering:…………..m

Right ear:  speaking normally: ………..m; whispering:…………..m

b) Ear-nose-throat diseases (if any):………………………………

......................................................................................................

......................................................................................................

4. Teeth-Jaw-Face

a) Result of medical examination:

+ Maxilla: …………………………………………

+ Mandible: ......................................................

b) Teeth-Jaw-Face diseases (if any):………………………………

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..........................................

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..........................................

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..........................................

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III. SUBCLINICAL EXAMINATION

Content of examination

Full name and signature of Physician

Hematological / biochemical / X-ray tests and other tests as indicated by physician:

Result:............................................................................................

......................................................................................................

.......................................................................................................

.....................................................................................................

..........................................

..........................................

..........................................

..........................................

..........................................

IV. GENERAL CONCLUSION

Normal health ………………………………..[9].............................................   

Or health matters which should pay attention to:…………….. [10]................................

.................................................................................................................................

.................................................................................................................................

 

 

…………date…… month……… year............
THE CONCLUDING PERSON
(Signature, full name and seal)

 

ANNEX 3

FORM OF PERIODIC HEALTHY EXAMINATION BOOK
(Enclosed with the Circular No. 14/2013/TT-BYT dated May 06, 2013, of the Minister of Health)

SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness

------------------

 

 

Picture

(4 x 6cm)

 

 

1. Full name (uppercase letter): ………………..…………...……………

2. Sex:   Male □       Female □  Age: ………………….. 

3. ID card or passport number:  ...................  date of issue ……./……/............at…………………….......

4. Permanent residence address:………………………………

……………………...……………………….................…………….

………………………..……………….................…………………

5. Current residence place:…………………………………

........................................................................................................

PERIODIC HEALTHY EXAMINATION BOOK

6. Occupation: .......................................................[11].............................................................

7. Place of working or learning:………….[12]............................................................

8. The beginning day of learning/working at current unit: …..….../…..…./…….....…......

9. Occupation, jobs in past time (listing the jobs in 10 last years, counted from the nearest time):

a) ...........................................................................[13]....................................................................

working duration......…[14]........year(s)….

[15]........month(s), from the date …....…/….....…/.............to …..…../……../…….…..

b) .......................................................................[16]........................................................................

Working duration ….........… year(s) ….......… month (s) from date….…/………../…………. to …...…../……../………..

10. History of disease in family: ......................................................................................

.......................................................................................................................................................

11. Personal history:

Name of disease

Detected year

Name of occupational disease

Detected year

a)

 

a)

 

b)

 

b)

 

 


Certification of laborer
(signature, full name)

……date …… month … year ………
The person making periodic healthy examination book
(signature, full name)

 

PERIODIC HEALTHY EXAMINATION

I. HISTORY OF DISEASE

.........................................................................................................................................................

.........................................................................................................................................................

.........................................................................................................................................................

.........................................................................................................................................................

I. PHYSICAL EXAMINATION

Height: ……………cm; Weight: ………….kg; BMI: ……………..

Pulse: ................…….times/minute; Blood pressure:.................... /..................... mmHg

 Physical classification:…………………………………………………

II. CLINICAL EXAMINATION

Content of medical examination

Full name and signature of Physician

1. Internal medicine

a) Circulation: .....................................................................

........................................................................

Classification:…………………………………………………

b) Respiratory organ: ...........................................................................................

..........................................................

Classification:…………………………………………………

c) Digestion: .............................................................................................

.....................................................

Classification:…………………………………………………

d) Kidney-Urology: ..........................................................

........................................................................

Classification:…………………………………………………

dd) Endocrine: ....................................................................

.................................................................................

Classification:…………………………………………………

e) Muscle- bone-joints:

Classification:…………………………………………………

g) Neurological status: ..................................................

............................................................................................

Classification:…………………………………………………

h) Mental health:  ......................................................

........................................................................................

Classification:…………………………………………………

2. Eyes:

- Result of vision examination:

Without glasses:  Right eye:……..  Left eye:…….. ....................

With glasses:        Right eye: ............. Left eye: ....................

- Eye diseases (if any):………………………………………………

- Classification: ................................................................

................................................................................................

3. Ears-nose-throat:

- Result of hearing ability examination:

Left ear:    speaking normally: ………..m; whispering:…………..m

Right ear:  speaking normally: ………..m; whispering:…………..m

- Ear-nose-throat diseases (if any):………………………………

- Classification: ................................................................................................

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4. Teeth-Jaw-Face

- Result of medical examination:

+ Maxilla: …………………………………………

+ Mandible:  .....................................................

- Teeth-Jaw-Face diseases (if any):………………………………

- Classification:…………………………………………………

5. Dermatological disease: ........................................................................................

.............................................................

Classification:…………………………………………………

..........................................

..........................................

..........................................

..........................................

..........................................

..........................................

..........................................

..........................................

..........................................

..........................................

III. SUBCLINICAL EXAMINATION

Content of medical examination

Full name and signature of Physician

Hematological / biochemical / X-ray tests and other tests as indicated by physician

a) Result:………………………………………………………….

.................................................................................................

...............................

b) Assessment:………………………………………………………

..........................................

..........................................

..........................................

..........................................

..........................................

..........................................

IV. CONCLUSION

1. Health classification:………………………………..[17]........................................................   

2. Diseases (if any): ........................................[18]......................................................

.......................................................................................................................................................

.......................................................................................................................................................

.......................................................................................................................................................

 

 

………date…..…month……… year...........
THE CONCLUDING PERSON
(Signature, full name and seal)

 

ANNEX 4

LIST OF MATERIAL FACILITIES AND MEDICAL EQUIPMENT OF THE HEALTHY EXAMINATION ESTABLISHMENTS 
(Enclosed with the Circular No. 14/2013/TT-BYT dated May 06, 2013, of the Minister of Health)

No.

Content

Quantity

I. MATERIAL FACILITIES

1

Reception room

01

2

Specialized clinics: Internal medicine, Pediatrics, Surgical medicine, Obstetrics, eyes, ears-nose-throat, teeth-jaw-face, dermatology

08

3

X-ray room

01

4

Laboratory

01

II. MEDICAL EQUIPMENT

1

Cabinet of medical records / storage device of healthy examination dossiers

01

2

First-aid cabinet / box

01

3

Sets of tables and chairs for medical examination

02

4

Medical examination beds

02

5

Chairs for persons waiting for medical examination

10

6

medical drying cabinet

01

7

Autoclave for medical instruments

01

8

scale and height measuring equipment/ tape measure

01

9

Cardiopulmonary stethoscopes

02

10

Sphygmomanometers

02

11

Radiology film viewing equipment

01

12

Reflex hammer

01

13

The equipment set for skin examination (magnifier)

01

14

Ophthalmoscopy lamp

01

15

Box of glasses for vision test

01

16

Eye testing board

01

17

Color vision test plate

01

18

The ears-nose-throat examination set: Lamp, 20 sets of instruments and trays

01

19

The teeth-jaw-face examination set

01

20

Medical exam table and the gynecological instrument set

01

21

Equipment for hematology analysis

01

22

Equipment for biochemical analysis

01

23

Equipment for urine analysis / the set of urine test instruments

01

24

X-ray Equipment

01

III. APART FROM EQUIPMENT STATED IN SECTION II OF THIS Annex, THE HEALTHY EXAMINATION ESTABLISHMENTS INVOLVING FOREIGN ELEMENTS MUST HAVE ADDITIONALLY THE FOLLOWING MEDICAL EQUIPMENT:

25

EEG device

01

26

Ultrasonic device

01

27

ECG device

01

 

ANNEX 5

FORM OF DOCUMENT ANNOUNCING THE ELIGIBILITY FOR HEALTHY EXAMINATION
(Enclosed with the Circular No. 14/2013/TT-BYT dated May 06, 2013, of the Minister of Health)

...........[19]..........
...........[20]..........
-------

SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
------------

No.:    /VBCB-....[21].....

                 ......[22]......., date......month.......year ...... 

 

WRITTEN ANNOUNCEMENT OF

MEDICAL EXAMINATION AND TREATMENT ESTABLISHMENTS ELIGIBLE FOR HEALTHY EXAMINATION

Respectfully to: ...............................................[23].....................................................

Name of applicant:……………………………...........................................................................

Location: ...........................................[24] ..............................................................................

Telephone: ................................................ Email (if any): ...................................................

To announce the eligibility for healthy examination and enclose this document a set of dossier including the following papers:

1.

Authenticated copy of the operational license of establishments

2.

List of persons participating in healthy examination

3.

List of material facilities and medical equipment 

4.

Report on the specialized operational scope of the healthy examination establishments

5.

Lawful contracts of specialized professional and technical support for case defined in Clause 3 Article 11 of this Circular.

 

 

DIRECTOR
(Signature, full name and seal)

 

ANNEX 6

LIST FORM OF PERSONS PERFORMING THE HEALTHY EXAMINATION
(Enclosed with the Circular No. 14/2013/TT-BYT dated May 06, 2013, of the Minister of Health)

...........[25]..........
...........[26]..........
-------

SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
--------------

No.:    /..............

......[27]......., date......month......year ......

 

LIST OF PERSONS PERFORMING THE HEALTHY EXAMINATION

No.

Full name

Professional diplomas

Number of practice certificate

Professional position

Duration of medical examination and treatment

1

.................[28]............

.........[29]........

......[30]...........

.......[31]..........

........[32].........

2

 

 

 

 

 

3

 

 

 

 

 

4

 

 

 

 

 

.... ....

 

 

 

 

 

 

 

DIRECTOR
(Signature, full name and seal)

 

ANNEX 7

FORM OF THE RECEIPT OF DOSSIER ANNOUNCING THE ELIGIBILITY FOR HEALTHY EXAMINATION
(Enclosed with the Circular No. 14/2013/TT-BYT dated May 06, 2013, of the Minister of Health)

...........[33]..........
-------

SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
--------------

No.:    /PTN-....[34].....

......[35]......., date.......month.......year........

 

THE RECEIPT OF

Dossier announcing the eligibility for healthy examination 

Name of applicant:…………………………….............................................................................

ocation: ...........................................[36] ..................................................................................

Telephone: ................................................ Email (if any): .....................................................

............................[37].............................. have received dossier of announcing the eligibility for healthy examination including:

1.

Authenticated copy of the operational license of establishments

2.

List of persons participating in healthy examination

3.

List of material facilities and medical equipment 

4.

Report on capability to perform subclinical techniques

5.

Lawful contracts of specialized professional and technical support for case defined in Clause 3 Article 11 of this Circular.

 

 

RECEIVER OF DOSSIER
(Signature, full name and seal)

 

To receive dossier added for first time, date      month      year Signature of receiver

The added content and documents:…………………..

 

To receive dossier added for second time, date   month   year Signature of receiver

The added content and documents:…………………..



[1] Name of agency managing the healthy examination establishments

[2] Name of the healthy examination establishments

[3] Abbreviated-name letters of the healthy examination establishments

[4] The classification of healthy according to Decision No. 1613/BYT-QD or  classification of healthy according to  regulation of the standard set of healthy under specialized sector for cases of specialized healthy examination

[5] Clearly stating diseases, measures for medical treatment and functional recovery or introducing for specialized medical examination for medical examination and treatment

[6] Name of agency managing the healthy examination establishments

[7] Name of the healthy examination establishments

[8] Abbreviated-name letters of the healthy examination establishments

[9] In case where there is no problem about healthy, inscribing: it is normal.

[10] Clearly stating diseases, measures for medical treatment and functional recovery or introducing for specialized medical examination for medical examination and treatment

[11] Clearly inscribing: current job .

[12] Clearly inscribing name, address of agency, unit where the person examined healthy is working, learning

[13] Clearly inscribing previous jobs

[14] Number of years of working such jobs of the person examined healthy

[15]Number of months of working such jobs of the person examined healthy

[16] Clearly inscribing previous jobs

[17] The classification of healthy according to Decision No. 1613/BYT-QD or  classification of healthy according to  regulation of the standard set of healthy under specialized sector for cases of specialized healthy examination

[18] Clearly stating diseases, measures for medical treatment and functional recovery or introducing for specialized medical examination for medical examination and treatment

[19] Name of agency managing the healthy examination establishments

[20] Name of the healthy examination establishments

[21] Abbreviated-name letters of the healthy examination establishments

[22] Location

[23] Name of agency receiving dossier as prescribed in clause 3 article 12 of this Circular

[24] Specific address of the medical examination and treatment establishments

[25] Name of agency managing the healthy examination establishments

[26] Name of the healthy examination establishments

[27] Location

[28] Full name of the person performing healthy examination

[29] Clearly stating the professional diplomas of the person performing healthy examination

[30] Number, sign of the practice certificate of the person performing healthy examination

[31] Clearly stating the assigned professional position of the person performing healthy examination. Example: in charge of clinical examination or certification of test result or reading and conclusion about radiograph or conclusion

[32] Number of years of performing medical examination and treatment of the person performing healthy examination

[33] Name of agency receiving dossier

[34] Abbreviated-name letters of agency receiving dossier

[35] Location

[36] Specific address of the healthy examination establishments

[37] Name of agency receiving dossier


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