Template for the Form of hospital discharge in Vietnam

Template for the Form of hospital discharge in Vietnam - image from internet

Legal basis: Circular 56/2017/TT-BYT

HOSPITAL DISCHARGE FORM
(Attached to Circular 56/2017/TT-BYT dated December 29, 2017, issued by the Minister of Health)

HOSPITAL DISCHARGE FORM

- Patient's full name: .............................................................. Age: ..........Male/Female.....

- Ethnicity: ................................................................Occupation: ...................................................

- Social Insurance Number/Health Insurance Card Number: ...................................................

- Address: .......................................................................................................................

- Admitted to the hospital at: ...........hour...........minutes, on the ........day of ........month, ........year.

- Discharged from the hospital at: ...........hour...........minutes, on the ........day of ........month, ........year.

- Diagnosis: ..................................................................................................................

-  Treatment method: ....................................................................................................

- Notes: .......................................................................................................................

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INSTRUCTIONS FOR FILLING OUT THE HOSPITAL DISCHARGE FORM

I. Section Social Insurance Number/Health Insurance Card:

Write the Social Insurance number or Health Insurance card number. The use of the Social Insurance code instead of the Social Insurance book number applies only when the official Social Insurance agency has announced the use of the Social Insurance code to replace the Social Insurance book number.

II. Diagnosis section:

- Provide specific descriptions of the health condition or write the name of the disease. In case of long-term diseases requiring treatment, write the disease code; if the disease has not been coded, provide the complete name of the disease. The coding of diseases and their names should be done according to the regulations in Circular 46/2016/TT-BYT dated December 30, 2016, issued by the Minister of Health, which specifies the list of long-term diseases.

- In the case of a terminated pregnancy, clearly state the reason for the termination.

III. Treatment method section:

Write the prescribed treatment method. In the case of terminated pregnancies:

- For pregnancies under 22 weeks, based on the actual circumstances, write the treatment method according to one of the following: miscarriage, abortion, suction curettage, surgical removal of the fetus, except when minimizing the fetus during in vitro fertilization.

- For pregnancies of 22 weeks or more, specify whether it was a normal delivery, instrumental delivery, or cesarean section.

The determination of the gestational age is based on the date of the last menstrual period or ultrasound results during the first three months of pregnancy. If the patient needs to terminate the pregnancy for medical reasons, specify the diagnosis according to the professional guidelines and include the term "(therapeutic abortion)" immediately after the diagnosis. Example: Ectopic pregnancy (therapeutic abortion).

IV. Notes section:

Include instructions from the physician. How to write instructions from the physician in specific cases:

- In the case of patients needing time off for outpatient treatment or to stabilize their health after inpatient treatment: Specify the number of days the patient needs to take off for outpatient treatment after discharge. The decision on the number of days off should be based on the patient's health condition, but should not exceed 30 days.

- For pregnant female workers taking time off for prenatal care, after specifying the number of days off, state "for prenatal care." Example: Number of days off: 10 days for prenatal care. The decision on the number of days off should be based on the patient's health condition, but should not exceed 30 days.

- In the case of pregnancies of 22 weeks or more that need to be terminated, indicate "preterm birth, fetal demise."

- In the case of preterm birth, specify the number of infants and the condition of the newborns.

- In the case of deceased patients or patients with limited legal capacity, or children under 16 years old, provide the full name of the father, mother, or legal guardian of the patient.

V. Date, month, year, and signature:

- The date written in the signature section of the treating department head must match the date of discharge.

- In the "Head of Department" section: The head of the department or deputy head of the department should sign according to the working regulations of the healthcare facility.

- In the "Unit Chief" section: The person in charge of the healthcare facility or the person authorized by the person in charge of the healthcare facility should sign and affix the official stamp of the healthcare facility.

If there is only one authorized person in the healthcare facility who has the authority to examine and sign the discharge form, that person only needs to sign and affix the stamp in the "Unit Chief" section.

Best regards!