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138 Pages·2016·1.71 MB·English

MINISTRY OF HEALTH SOCIALIST REPUBLIC OF VIETNAM
------- Independence - Freedom - Happiness
---------------
No.: 43/2013/TT-BYT Hanoi, 11 December 2013

CIRCULAR
DETAILING LEVELS OF TECHNICAL SERVICE DELIVERY APPLICABLE TO HEALTH FACILITIES
Pursuant to the Law on Medical Examination and Treatment dated 23/11/ 2009;
Pursuant to Decree 63/2012/ND-CP of the Government dated 31/08/2012 stipulating functions, duties,
powers, and organizational structure of the MoH;
At the proposal of the MSA’s Director;
The Minister of Health hereby issues this Circular detailing levels of technical service delivery
applicable to health facilities.
Article 1. Governing scope and applicable entities
This Circular provides for levels of technical service delivery, the list of techniques, categorization of
levels of technical service delivery, and authority to approve the list of techniques applicable to health
facilities.
This Circular is applicable to public and private health facilities all over the country, except for those
managed by the Ministry of National Defense.
Article 2. Principles for categorization of levels of technical service delivery applicable to
health facilities
1. Levels of technical service delivery refer to the categorization of health facilities according to
technical capacity as stipulated in Article 81 of the Law on Medical Examination and Treatment.
2. Requirements in terms of scope of specialized work, operational scale, infrastructure, equipment,
human resources, and technical capacity of health facilities shall be the basis for categorizing levels of
technical service delivery.
3. Categorization of levels of technical service delivery does not hinder technical development of
health facilities.
Article 3. Levels of technical service delivery
1. Central level (hereinafter called Level 1) covers the following health facilities:
a) Special-grade hospitals;
b) Grade-I hospitals under the MoH;
c) Grade-I hospitals under provincial Departments of Health (hereinafter called DoHs) or under other
ministries authorized by the MoH as the tertiary level.
2. Provincial level (hereinafter called Level 2) covers the following health facilities:
a) Grade-II or lower-grade hospitals under the MoH;
b) Grade-I or grade-II hospitals under the MoH or other ministries, except for those stipulated in Point
c, Clause 1 of this Article;
3. District level (hereinafter called Level 3) covers the following health facilities:
a) Grade-III or grade-IV hospitals, non-categorized hospitals, district health centers performing the
function of medical examination and treatment in localities having no district hospitals and provincial
police clinics;
b) Polyclinics, specialized clinics, and maternity hospitals.
4. Commune level (hereinafter called Level 4) covers the following health facilities:
a) Commune health stations;
b) Clinics of offices, units, and organizations;
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c) Family doctors’ clinics.
5. Levels of technical service delivery applicable to private health facilities:
a) Based on the technical capacity, scope of specialized work, mode of organization, operational
scale, infrastructure, equipment, and human resources of private health facilities, competent
authorities (the MoH or DoHs) granting operating licenses to the facilities shall decide (in writing) on
the levels of technical service delivery applicable to the facilities in accordance with this Circular.
Article 4. List of techniques in medical examination and treatment
1. A list of techniques in medical examination and treatment (hereinafter called the List of techniques)
shall be issued as an attachment to this Circular, consisting of 28 specialties and structured as follows:
a) Column 1: Numbers, from 01 until the end of the list.
b) Column 2: Names of specialties and techniques.
c) Column 3: Levels of technical service delivery, including 4 sub-columns:
- Column 3A: Techniques to be performed at level 1.
- Column 3B: Techniques to be performed at level 2.
- Column 3C: Techniques to be performed at level 3.
- Column 3D: Techniques to be performed at level 4.
2. The list of techniques issued as an attachment to this Circular includes specialized techniques in
medical examination and treatment that are allowed to be performed in Vietnam. A technique can be
categorized into various specialties; however, the techniques in this Circular have been arranged into
the most appropriate specialties.
3. The list of techniques according to levels of technical service delivery reflects the technical capacity
at each level. Health facilities shall be able to perform most techniques at their respective levels of
technical service delivery.
4. Health facilities are encouraged to improve their technical capacity and perform techniques
applicable to higher levels. Health facilities at higher levels should lessen the use of techniques that
those at lower levels are able to perform.
Article 5. Development of lists of techniques applicable to health facilities
1. Based on the list of techniques issued as an attachment to this Circular, health facilities shall base
themselves on the following conditions to develop the lists of techniques applicable to their facilities
and submit them to competent authorities stipulated in Article 6 of this Circular for consideration and
approval.
a) Scope of specialized work, mode of organization, and operational scale of health facilities approved
by competent authorities.
b) Actual conditions in terms of infrastructure, equipment, human resources, and technical capacity of
health facilities.
Article 6. Authority to approve lists of techniques applicable to health facilities
1. The Minister of Health:
a) Granting approval of initial and supplemented lists of techniques applicable to health facilities under
the MoH, health facilities under other ministries, and private health facilities holding operating licenses
issued by the MoH;
b) Granting approval of lists of techniques applicable to health facilities in the case stipulated in Point
b, Clause 2 of this Article.
2. DoH Directors:
a) Granting approval of initial and supplemented lists of techniques applicable to health facilities under
DoHs, health facilities under other ministries based in their localities, and private health facilities
holding operating licenses issued by DoHs, except for those stipulated in Point b, Clause 1 of this
Article.
b) In case the lists of techniques are within the approval authority of DoH Directors while DoHs are not
capable of performing technical verification, the MoH shall take charge of the verification and approval.
Article 7. Documents required for the approval of initial list of techniques
1. Request for approval.
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2. Minutes of meeting of the Technical Board according to Article 9 of this Circular.
3. The list of techniques to be submitted for approval includes:
a) Techniques currently performed by the health facility according to their respective technical
capacity;
b) Techniques applicable to higher levels but currently performed by the health facility;
c) Documents describing capacity of the health facility in terms of infrastructure, human resources,
medical equipment, socio-economic impacts, and methodology.
The proposed list of techniques shall be properly presented (i.e. names of specialties, numbers of
techniques, and names of techniques shall be accurately entered) according to Clause 1, Article 4 of
this Circular.
Article 8. Document required for the approval of supplemented list of techniques
1. Request for approval.
2. Minutes of meeting of the Technical Board according to Article 9 of this Circular.
3. The list of techniques to be submitted for approval includes:
a) Techniques applicable to the level of technical service delivery of the health facility to be added;
b) Techniques applicable to higher levels that the health facility is fully capable to perform;
c) Documents describing capacity of the health facility in terms of infrastructure, human resources,
medical equipment, socio-economic impacts, and methodology.
The proposed list of techniques shall be properly presented (i.e. names of specialties, numbers of
techniques, and names of techniques shall be accurately entered) according to Clause 1, Article 4 of
this Circular.
Article 9. Procedure for approval of lists of techniques
1. Health facilities shall submit 01 set of documents as stipulated in Article 7 or Article 8 of this Circular
to MSA or DoH according to their authority. Health facilities under the Ministry of Public Security shall
submit 01 set of documents to the Health Department – Ministry of Public Security; and health facilities
under the Ministry of Transport shall submit 01 set of documents to the Health Department – Ministry
of Transport.
2. Within 05 working days from the date of receipt of documents in person or by mail (based on the
date of receipt recorded in the ‘incoming correspondence’ register of the authority receiving the
documents), the authority shall consider their validity. In case the documents are deemed invalid, the
authority shall notify the health facility in writing for revision. The written notification shall detail
required additional documents and other contents to be revised. The health facility shall revise the
documents accordingly and submit the revised documents to the authority. In case the revised
documents are still deemed invalid, the health facility shall continue to revise them according to this
Article until they are accepted.
3. Within 20 working days from the date of receipt of valid documents (based on the date of receipt
recorded in the ‘incoming correspondence’ register of the authority receiving the documents), the
authority shall arrange verification and issue a decision approving the list of techniques applicable to
the health facility. Where necessary, the authority shall establish a Technical Board to verify parts or
the whole of the proposed list of techniques. After verification, the Health Department – Ministry of
Public Security or the Health Department – Ministry of Transport shall submit the verification results to
MSA or DoHs for approval according to Article 6 of this Circular.
4. For techniques beyond verification capacity of the authority receiving documents, the authority shall
guide the health facility on submission to MSA for verification and approval.
Article 10. Organization of implementation
1. Health facilities at higher levels are responsible for directing and providing technical support to
those at lower levels in accordance with Clause 3, Article 81 of the Law on Medical Examination and
Treatment, and directives of the MoH.
2. Health facilities are responsible for ensuring required conditions in terms of infrastructure,
equipment, and qualified personnel for performance of lists of techniques approved by competent
authorities. Health facilities are responsible for making public announcements in an appropriate way
on their lists of techniques approved by competent authorities for information of other facilities, units,
and the public.
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Article 11. Transitional provisions
Lists of techniques applicable to health facilities approved by competent authorities according to
Decision 23/2005/QD-BYT of the MoH dated 30/8/2005 on levels of technical service delivery and lists
of techniques in medical examination and treatment before the effective date of this Circular shall be
valid until further revision.
Article 12. Implementation provisions
1. This Circular shall become effective on 01/02/2014.
2. Decision 23/2005/QD-BYT of the Minister of Health dated 30/8/2005 on levels of technical service
delivery and lists of techniques in medical examination and treatment shall be rendered null and void
from the effective date of this Circular.
3. MSA Director, DoH Directors, heads of health units in other ministries and sectors, heads of health
facilities, related organizations and individuals are responsible for executing this Circular.
In case of any problems arising during implementation, related organizations, units, and individuals
are requested to notify MSA for consideration and settlement./.

pp. MINISTER
VICE MINISTER
Recipients:

- NA Office;

- Govt Office (Official Gazette, Govt Portal)

- Minister of Health (for reporting)

- Vice Ministers of Health;
- Ministries and ministry-level authorities; Nguyen Thi Xuyen
- VSS;
- PPCs;
- Board for Health Care of Central Cadres;
- MoH Depts, General Depts, Cabinet, Inspectorate;
- DoHs, PSS;
- MoH units;
- Health units of other ministries;
- MoH Portal,
- MSA Portal;
- Filing: Administration, Legal Dept, MSA.

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LIST
OF TECHNICAL SERVICES AND LEVELS OF TECHNICAL SERVIVE DELIVERY
(issued as an attachment to Circular No. 43/2013/No.-BYT dated 11 December 2013
of the Health Minister detailing levels of technical service delivery applicable to health
facilities)

# of
No. Specialty Page
procedures
I Emergency Intensive Care and Toxicology 304
II Internal Medicine 431
III Pediatrics 4.170
IV TB 41
V Skin diseases 89
VI Psychiatrics 83
VII Endocrinology 245
VIII Traditional medicine 482
IX Anesthesiology 4.777
X Surgery 1.113
XI Burn 131
XII Oncology 401
XIII Obstetrics 241
XIV Ophthalmology 287
XV ENT 357
XVI Orthodontics 347
XVII Rehabilitation 156
XVIII Radiology 675
XIX Nuclear medicine 390
XX Endoscopic diagnosis and intervention 106
XXI Functional exploration 127
XXII Hematology and blood transfusion 564
XXIII Biochemistry 223
XXIV Parasitology 336
XXV Pathology and cyto-pathology 90
XXVI Microsurgery 58
XXVII Endoscopic surgery 498
XXVIII Plastic surgery 494
Total 17.216

I. EMERGENCY INTENSIVE CARE AND TOXICOLOGY
No. Procedure Applicable level
1 2 3
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A B C D
A. CIRCULATION
Non-invasive continuous monitoring of blood
1 x x x
pressure at patient bed for ≤ 8 hour
2 Emergency ECG at patient bed x x x
Emergency continuous ECG monitoring at
3 x x x
patient bed for ≤ 8 hours
5 Test of capillary refill x x x x
Peripherally inserted central venous
6 x x x x
catheterization
Single-lumen inserted central venous
7 x x x
catheterization
Multiple-lumen inserted central venous
8 x x x
catheterization
10 Care for venous catheter x x x
12 Bone conduction x x x
15 Measurement of central venous pressure x x x
18 Emergency echocardiography at patient bed x x x
Emergency vascular ultrasound (Doppler) at
19 x x x
patient bed
Ultrasound for emergency venous
20 x x x
catheterization
Ultrasound for emergency arterial
21 x x x
catheterization
Continuous SPO monitoring at patient beds
28 2 x x x x
for ≤ 8 hours
32 Emergency electrical cardioversion x x x
Recovery of sinus rhythm for patients with
34 x x x
arrhythmia by a defibrillator
Recovery of sinus rhythm for patients with
35 x x x
arrhythmia by medicines
External emergency temporary cardiac
36 x x x
pacing
37 Internal emergency temporary cardiac pacing x x x
39 Lowering of blood pressure for ≤ 8 hours x x x
40 Ultrasound-guided pericardiocentesis x x x
41 Emergency pericardiocentesis x x x
Emergency pericardial window at patients
43 x x x
bed
44 Emergency pericardial drainage for ≤ 8 hours x x x
45 Use of anti-coagulant x x x
High-dose insulin therapy to treat poisoning
50 x x x
(for increasing blood pressure) for ≤ 8 hours
51 Shock resuscitation for ≤ 8 hours x x x x
B. RESPIRATION
Stop of posterior nosebleed with a balloon
52 x x x x
pack
Placement of nasal cannula, oropharyngeal
53 x x x x
cannula
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Open endotracheal suction in mechanically
54 x x x x
ventilated patients (once)
Open endotracheal suction in non-
55 x x x
mechanically ventilated patients (once)
Closed endotracheal suction in mechanically
56 x x x
ventilated patients (once)
57 Oxygenation with nasal prong (for hours) x x x x
Oxygenation with non-reservoir mask
58 x x x x
8 hours)
Oxygenation with rebreather reservoir mask
59 x x x x

Oxygenation with non-rebreather reservoir
60 x x x x
mask
61 T-tube breathing x x x x
Long-term oxygenation for treating chronic
62 x x x x
respiratory failure for ≤ 8 hours
Oxygenation with venturi mask
63 x x x
hours)
Heimlich maneuver (for removing a foreign
64 object from the airway) for adults and x x x x
children
65 Mask CPAP x x x x
66 Endotracheal intubation x x x
Emergency endotracheal intubation with
68 x x x
Combitube
69 Emergency laryngeal mask airway insertion x x x
71 Emergency tracheostomy x x x
72 Cricothyroidotomy x x x
73 Routine tracheostomy x x x
Emergency percutaneous tracheostomy for
74 x x x
patients with choking
75 Care for endotracheal tube (once) x x x
76 Care for tracheal incision (once) x x x
77 Change of endotracheal tube x x x
78 Removal of endotracheal tube x x x
79 Removal of tracheal cannula x x x
80 Replacement of tracheal cannula x x x
Measurement of the severity of asthma with
81 x x x x
a peak flow meter
Measurement of the severity of COPD with
82 x x x x
FEV1 (once)
84 Measurement of exhaled CO2 x x x
Therapeutic exercise for treating respiratory
85 x x x
diseases
86 Emergency nebulized medication (once) x x x x
Nebulized medication for mechanically
87 x x x
ventilated patients
88 Warming of airway with a mist sprayer x x x
89 Placement of a 2-lumen tracheal cannula x x x x
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Nasotracheal aspiration through the cricoid
91 x x x
membrane
93 Thoracocentesis with needle or catheter x x x
94 Low-pressure pleural drainage for ≤ 8 hours x x x
95 Emergency thoracostomy x x x
96 Mini –thoracostomy with trocar x x x
97 Continuous pleural drainage for ≤ 8 hours x x x
106 Emergency bronchoscopy x x x
111 Bronchoscopy for removing foreign bodies x x x
128 Non-invasive ventilation for ≤ 8 hours x x x
CPAP ventilation with Boussignac valve for ≤
129 x x x
8 hours
130 Non-invasive CPAP ventilation for ≤ 8 hours x x x
131 Non-invasive BiPAP ventilation for ≤ 8 hours x x x
132 Invasive ventilation for ≤ 8 hours x x x
133 Invasive VCV ventilation for ≤ 8 hours x x x
134 Invasive PCV ventilation for ≤ 8 hours x x x
135 Invasive A/C (VCV) ventilation for ≤ 8 hours x x x
136 Invasive SIMV ventilation for ≤ 8 hours x x x
137 Invasive PSV ventilation for ≤ 8 hours x x x
138 Invasive CPAP ventilation for ≤ 8 hours x x x
144 Ventilation during transportation x x x
Discontinuation of mechanical ventilation
145 x x x
(SIMV mode) for ≤ 8 hours
Discontinuation of mechanical ventilation
146 x x x
(PSV mode) for ≤ 8 hours
Discontinuation of mechanical ventilation (T-
147 x x x
tube intermittent breathing) for ≤ 8 hours
151 CPAP spontaneous breathing trial x x x
Monitoring of lung function parameters for ≤
154 x x x
8 hours
Continuous anesthesia for mechanically
155 x x x
ventilated patients for ≤ 8 hours
157 Stabilization of thorax due to rib fracture x x x x
158 Basic CPR x x x x
159 Advanced CPR x x x
C. KIDNEY-DIALYSIS
160 Urine drainage x x x x
161 Suprapubic aspiration x x x
162 Percutaneous suprapubic bladder drainage x x x
163 Suprapubic cystostomy x x x
164 Cystostomy x x x x
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165 Bladder washout to flush blood clots x x x
Therapeutic exercise to treat bladder
166 x x x
diseases
170 Forced diuresis for ≤ 8 hours x x x
Urinary alkalinization to enhance elimination
171 x x x
of toxins for ≤ 8 hours
173 Emergency dialysis x x x
174 Emergency hemodialysis x x x
175 Routine hemodialysis x x x
D. NEUROLOGY
201 Emergency funduscopy x x x
202 Lumbar puncture x x x
Therapeutic exercise for immovable patients
211 x x x x
at patient bed for ≤ 8 hours
Treatment of continuous convulsion for ≤ 8
213 x x x
hours
Treatment of muscle relaxation in emergency
214 x x x
for ≤ 8 hours
DD. DIGESTION
Induction of vomiting for poisoned patients
215 x x x x
through digestive system
216 Nasogastric intubation x x x x
217 Endoscopic gastrostomy x x
218 Emergency gastric lavage x x x x
Gastric lavage with a closed system to
219 x x x x
remove toxin
Lavage of the digestive system (stomach,
220 x x x
small intestine, large intestine)
221 Cleansing enema x x x x
222 Barium enema x x x x
223 Insertion of rectal catheter x x x x
224 Nasogastric feeding (once) x x x x
Nasogastric feeding with a manual pump
225 x x x x
(once)
226 Intestinal feeding for ≤ 8 hours x x x
227 Continuous NG-tube feeding for ≤ 8 hours x x x
228 G-tube feeding (once) x x x x
229 Peripheral parenteral nutrition for ≤ 8 hours x x x x
230 Total parenteral nutrition for ≤ 8 hours x x x
Insertion of Blakemore tube for stopping
231 x x x
bleeding
Emergency gastroesophageal endoscopic
232 x x x
diagnosis to stop bleeding
Emergency gastroesophageal endoscopy
233 x x x
with venous anesthesia
234 Emergency rectal endoscopy x x x
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235 Flexible fiber colonoscopic diagnosis x x x
236 Flexible fiber colonoscopy to stop bleeding x x x
237 Colonoscopic biopsy x x x
238 Measurement of intra-abdominal pressure x x x
Emergency abdominal ultrasound at patient
239 x x x
bed
240 Emergent abdominal aspiration x x x
Emergency intra-abdominal drainage for ≤ 8
241 x x x
hours
242 Emergency peritoneal lavage x x x
Intra-abdominal drainage in acute
243 x x x
pancreatitis for ≤ 8 hours
244 Ultrasound-guided abscess drainage x x x
E. WHOLE BODY
Weighing patients at patient bed with hook
245 x x x
balance or electronic balance
246 Measurement of urine volume for 24 hours x x x x
247 Lowering of body temperature x x x
248 Increasing of body temperature x x x
249 Stress reduction x x x
250 Pain management in emergency x x x
Venous blood sampling, intravenous injection
251 x x x x
(one shot)
Drug infusion, intravenous infusion for ≤ 8
252 x x x x
hours
253 Inguinal sampling x x x x
Transfusion of blood and other blood
254 x x x x
products
255 pH control with bicarbonate for ≤ 8 hours x x x
Increase/lowering of serum potassium with
256 x x x
intravenous drugs
Increase/lowering of serum sodium with
257 x x x
intravenous drugs
258 Control of hypertension for ≤ 8 hours x x x
259 Detox eye wash x x x
260 Eye care for patients with coma (once) x x x
261 Special dental cleaning (once) x x x x
262 Hair washing for patients at patient bed x x x x
263 Detox hair washing for patients x x x x
264 Bath for patients at patient bed x x x x
265 Detox bath for patients x x x x
266 Massage for preventing ulcers x x x x
267 Dressing change for necrotic wounds (once) x x x
Recovery of mobility, speaking, swallowing
268 functions for patients in emergency for x x x
hours
Immobilization as first aid for patients with
269 x x x x
snake bites
Use of tightly-compressed bandage to stop
270 x x x x
bleeding
271 Use of detoxicant for treating poisoning x x x
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