Thông tư 24/2020/TT-BYT Phiếu chẩn đoán nguyên nhân tử vong, cấp Giấy báo tử tại cơ sở KCB

CIRCULAR

Providing regulations on Medical Records of Cause of Death, grant of Death Notices and death statistics at medical examination and treatment establishments

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

Pursuant to the Government’s Decree No. 123/2015/ND-CP of November 15, 2015, on detailing a number of articles of, and measures to implement, the Law on Civil Status;

At the request of the Directors of the Legal Affairs Department; the Planning and Finance Department;

The Minister of Health promulgates the Circular providing regulations on Medical Records of Cause of Death, grant of Death Notices and death statistics at medical examination and treatment establishments as follows:

Article 1. Scope of regulation

This Circular provides regulations on filling up of Medical Records of Cause of Death; grant and re-grant of Death Notices and statistical reports on death figures at medical examination and treatment establishments.

Article 2. Subjects of application

This Circular shall apply to medical examination and treatment establishments that have been granted operation licenses according to the Law on Medical Examination and Treatment; agencies, organizations and individuals related to Medical Records of Cause of Death; grant and re-grant of Death Notices and statistical reports of death at medical examination and treatment establishments.

Article 3. Competence to sign Medical Records of Cause of Death and grant, re-grant Death Notices

The heads, persons responsible for professional and technical operations of medical examination and treatment establishments specified in Article 2 of this Circular shall be competent to sign Medical Records of Cause of Death and grant, re-grant Death Notices. The heads, persons responsible for professional and technical operations may authorize in writing other persons to sign Medical Records of Cause of Death and grant, re-grant Death Notices. The authorizing persons and the authorized persons must be responsible before law for the authorization and the documents signed by them.

Article 4. Regulations on Medical Records of Cause of Death

1. Medical Records of Cause of Death are only used for health agencies for the purposes of statistics, development of planning and policies, population structure analysis and research, assessment of care and provision of people's health care services.

2. When determining the status of a patient who has died by biological death: breathing cessation or cardiac arrest, the medical examination and treatment establishment where the patient died is responsible for filling in all items in the form of Medical Records of Cause of Death specified in Appendix I to this Circular.

3. Medical Records of Cause of Death at the medical examination and treatment establishments shall not be granted to the next of kin of the deceased but shall be kept together with records of critical discussion of death at the medical examination and treatment establishments; used as the basis for statistical reports as prescribed by law.

Article 5. Regulations on grant and re-grant of Death Notices

1. Grant of Death Notices

After determining a patient’s status of death, the medical examination and treatment establishment shall be responsible for fully filling up items in the form of Death Notices in Appendix II to this Circular. The next of kin of the deceased prescribed in Clause 19, Article 3 of the Law on Marriage and Family shall be responsible for reading it and checking information before signing it. The Death Notice shall be made into 02 copies with the same legal validity, 01 copy is given to the next of kin of the deceased to carry out procedures for death declaration and 01 copy is kept at the medical examination and treatment establishment.

2. Re-grant of Death Notices

a) In case of mistaken recording of a Death Notice:

The next of kin of the deceased shall make an application for re-grant of the Death Notice, made according to Appendix III to this Circular, enclosed with papers proving the mistaken contents, and send it to the medical examination and treatment establishment where the Death Notice has been granted. Within no more than 01 working day from the time of receiving valid papers, the medical examination and treatment establishment shall withdraw the Death Notice with mistaken contents for destruction. The application and proving papers shall be archived with the case history dossier kept at the medical examination and treatment establishment. The re-granted Death Notice must clearly state the number and serial number of the book of the previous Death Notice and be stamped with "Re-granted". In case the verification is required, the time limit for verification shall not exceed 05 working days.

Documents proving the mistaken contents: In case of mistaken contents about family name, middle name, first name, date of birth, nationality, passport number, people's identity card number, citizen’s identity card number, personal identification number of the deceased, a copy of one of the following documents proving the mistake shall be enclosed: Valid passport, people's identity card, citizen’s identity card or other valid papers with photos and personal information showing mistaken contents that is issued by a competent agency (household registration book, temporary residence book or another document proving the place of residence). The originals of the documents proving the mistaken contents shall be present for comparison.

b) In case a Death Notices is lost, torn, damaged:

The next of kin of the deceased must make an application for re-grant of the Death Notice, made according to Appendix III to this Circular and send it to the medical examination and treatment establishment that has issued the Death Notice for the first time. Within a maximum of 01 working day from the time of receiving an application for re-grant of the Death Notice, the medical examination and treatment establishment shall withdraw the torn or damaged Death Notice; check the information stated in the application and compare such Death Notice with the Death Notice kept at the medical examination and treatment establishment. The re-granted Death Notice must clearly state the number and number of the book of the old Death Notice and be stamped with "Re-granted". In case the verification is required, the time limit for verification shall not exceed 05 working days.

Article 6. Forms of Medical Records of Cause of Death at medical examination and treatment establishments, Death Notices and application for re-grant of Death Notices

1. To promulgates the following Forms together with this Circular:

a) Form of Medical Records of Cause of Death at medical examination and treatment establishments in Appendix I;

b) Form of Death Notices at medical examination and treatment establishments in Appendix II;

c) Application for re-grant of Death Notices in Appendix III.

2. Medical Records of Cause of Death are printed in A4 size (210x297 mm) with information related to the deceased. Medical Records of Cause of Death shall be together and preserved with case history dossiers of the deceased at medical examination and treatment establishments.

3. Death Notices shall be pre-printed and bound into books. The dimension of books of Death Notices is A4 (210x297 mm). Each page in a book shall be divided into 2 parts with the same contents to insert information related to the deceased. The first sheet shall be given to the next of kin of the deceased, the other shall be kept at the medical examination and treatment establishment for preservation of information. In case the medical examination and treatment establishment is using application for management, the books of Death Notices are not required but the printed and granted Death Notices must be in accordance with the form as prescribed in this Circular.

4. The Ministry of Health shall be responsible for posting the form of Medical Records of Cause of Death at medical examination and treatment establishments and the form of Death Notices on its website. Medical examination and treatment establishments shall print on their owns Medical Records of Cause of Death and Death Notices for their use.

5. Guidance on recording method is given in the forms issued together with this Circular.

Article 7. Statistical reports on figures related to Medical Records of Cause of Death and Death Notices

1. Contents of statistical reports on Medical Records of Cause of Death and Death Notices at medical examination and treatment establishments include: the quantity of Medical Records of Cause of Death of medical examination and treatment establishments; difficulties and problems arising in the course of formulating Medical Records of Cause of Death. Information in Medical Records of Cause of Death shall be reported at the same time of statistical reports on grant of Death Notices as specified in Clause 2 of this Article.

2. Regulations on statistical reports on figures of grant of Death Notices are provided in the Circular No. 20/2019/TT-BYT dated July 31, 2019 of the Minister of Health defining the system of basic statistical indicators in the health sector and the Circular No. 37/2019/TT-BYT dated December 30, 2019 of the Minister of Health regulating the statistical reporting regime in the heath sector.

Article 8. Effect

This Circular takes effect on February 01, 2021.

Article 9. Transitional provisions

The forms of Death Notices that are issued by the medical examination and treatment establishments before the effective date of the Circular shall continue to be used until the end of December 31, 2021.

Article 10. Implementation responsibility

1. The Department of Medical Service Administration shall be responsible for developing the professional documents, training and guiding the medical examination and treatment establishments specified in Article 2 of this Circular to implement activities stated in Medical Records of Cause of Death according to guidance of the World Health Organization; building the system of cause-of-death information management at medical examination and treatment establishments.

2. The Planning and Finance Department shall be responsible for guiding medical examination and treatment establishments specified in Article 2 of this Circular to carry out statistical report on figures related to Medical Records of Cause of Death and Death Notices according to the statistical reporting regime in the heath sector.

3. Heads of units under the Ministry of Health; directors of Departments of Health of provinces and centrally run cities, heads of medical sectors and relevant units shall, based on their functions and tasks as assigned, direct the implementation of this Circular.

Any difficulty and problem arising in the course of implementation should be promptly reported to the Ministry of Health (the Planning and Finance Department, the Department of Medical Service Administration) for consideration and and settlement ./.

* All Appendices are not translated herein.