BAa HIEM xA HOI VI~T NAMBAo HIEM xA HOI TP. HO CHI MIl\TJI

S6 :Aft? /BHXH-NVGDI

CONG HoA xA HQI CHU NGHlA VI~T NAMDQc I~p - Tl.r do - H~nh phuc

Tp. H6 Chi Minh, ngay,J. I"thang J; ndm 2014

VIv huang d~n h~ thong xay dung danh muc giacac dich V\I icy thuat .

Kinh giri: Cac co So' kham chtra benh BHYT.

DS thong nhfit ap dung gia DVKT theo qui dinh tai Thong nr s6 03/2006/TTL T-BYT-BTC-BLDTB&XH ngay 26/1/2006 va Thong nr 04/2012/TTLT-BYT-BTC ngay 291212012;Quyet dinh 4070/QD-UBND ngay 25/8/2011, Bao hiem xil hQi Tp. H6 Chi Minh dS nghi nhirsau:

1. D6i voi cac don vi nganh, don vi nr nhan:

1.1. TiJn khdm benh, tiJn ngay giuong benh:

- Cac don vi thuoc nganh: din cir vao phan hang benh vien dil duoc phe duyet d~xay dtrng bang gia kharn benh va ti@nngay giuong benh theo hang benh vien taiThong tu s6 04.

- Cac den vi ill nhan clnra duoc x~p hang: tarn thai ap gia tien ngay giuong, tienkham benh (muc A,B trong Thong ill 04) nrong dirong benh vien hang 3 va phongkham da khoa, trong khi cho tham dinh xet tirong dirong hang benh vien.

1.2. Cac dich V(.L kY thudt tai Thong tu s6 04:

Ap gia theo mire gia cua UBND Tp. H6 Chi Minh phe duyet (dinh kern quyet dinhs6 17/2014/QD-UBNI? ngay 09/5/2014).

2. Cac don vi h~ thong danh muc gia vien phi theo Thong tir 03/2006/TTLT -BYT-BTC-BLDTB&XH, Thong tir 04/2012/TTLT-BYT-BTC va Quyet dinh 4070/QD-UBND cancir vao danh muc Icy thuat ail duoc phe duyet, cu th§:

- Cac dich vu Icy thuat dil duoc phe duyet hoac the a thuan tai Thong ur 03 va Thongnr 04 tnr muc C4 cua Thong tir 04 t6ng hop vao mau Ml.

Cac dich vu ky thuat tai muc C4 cua Thong tir 04 dil diroc phe duyet hoac thoathuan don vi tong hop vao m~u M2 (hru Y chi xay dung cac DVKT chua diroc banhanh gia tai Thong tu 03,va Thong nr 04).

- Cac dich vu ky thuat tuong dirong tai Quyet dinh 407(J chua co gia cu th~ trongThong tu 03 va Thong ill 04: don vi tong hQ'P vao m~u M3.

D@nghi cac don vi truy c~p vao trang web cua Bao hiSm xii hQi Tp.H6 Chi Minhwww.bhxhtphcm.gov.vn.ml.lC Van Ban -7 Van ban cua BHXH TPHCM -7 Giam dinhBHYT -7 "Khung gia dich vu KCB tir 01/06/2014", hoac theo dirong link:http://bhxhtphcm.!lov. vnJResource/vanban/giavienphi20 14-1.xlsx

3. H6 so goi vS BHXH Tp.H6 Chi Minh baa g6m:

- Danh muc gia DVKT (m§u Ml, M2, M3): 4 bang + file dien tir va cac quyet dinhgia da duoc phe duyet hoac thoa thuan.

Danh muc dich vu ky thuat: 4 bang sao + file di911 tir.

-- ---------- -----~

Lu'u y:- File dien tu giri theo dia chi mail: bhxhtphcm nvgdI(a),bhxhtphcm.gov.m va

danhmucd\'kt@gmail.com .

- H6 sa giay gui theo dia chi: Phong Nghiep vu Giam dinh 1 - lI7C Nguyen DinhChinh - PI5 - Quan Phil Nhuan tnroc ngay 31/7/2014 d~ thoa thuan thanh toancho ngiroi co the BHYT.

£)~ nghi cac don vi nhanh chong thuc hien, neu co virong mac vui long lien h~giam dinh vien tai benh vien hoac lien h~ 56 dien thoai 3.99.79.039 - llQi bQ 1816 d~ducc huang d~n.

Tran tn;ll1g./~_

Nai nhiin:- Nhu tren;- Sa Y t~ (d~p/h)- Luu Vl',NVGD 1,2l-

s-:

UY BAN NHAN DANTHAKH PHO HO cHi MINH

CONG HOA xX HOI CHU NGHIA VI~T NAfdf>Qc l~p - Tu' do - Hanh ph uc

S6>11- /20 14/Q0-UBND Thanh ph6 H6 Chi Minh, ngay C9 thdng 5 110m 2014

Can cir Luat T6 chirc HQi d6ng nhan dan va Uy ban nhan dan ngay 26thang II narn 2003;

Can cir Lu?t Bao hiern y t1~ngay 14 thang 11 nam 2008;

Can cir Luat Kham benh, chfra benh ngay 23 ·t}ULT1g 11 nam 2009;

Can cir Nghi dinh s6 43!20061ND-CP ngay 25 thang 4 nam 2006 cua Chinhphu quy dinhquyen tir chu, 17'chiu trach nhiern v8 thuc hien Dhj~m VV: t6 CJl1',C L~)",,' '.: l-·:e-, ,-he ,,~,t'''j chinh d;i vci don ,.; sir -ohif:.) "'~'''''O l::::y....J_('~_' ~ ....• 1 .•.•...••. ~.~. ""...L ~ V 1. 'f!~; L~::.J --~:-.i _\.,.:..1.1= .•.•.••.1 :

Can cir Nghi dinh s0 85/2012/ND-CP ngay 15 thang ]0 nam 2012 CJ3.

Chinh phu vS co' ch~ heat 09ng, co che tai chinh ddi voi cac don vi S\T nghiep y tfcong i~pva gia dich vu kham benh, chtra benh cua cac co s6 kham b~nh, chirab~nhcong l~p;

Can cir Thong tu lien tich s6 04/2012/ITLT-BYT-BTC ngay 29 thang 02rram 2012 cua BQ Y t~ - BQ Tai chinh ban hanh rmrc t6i da khung gia ID0t s6 dichV\l kham benh, chua benh trong cac co sa kham benh, clnra benh cua nha ruroc;

Can cir Quyet dinh s6 1223/QB-BYT ngay 18 thang 4 narn 2012 cua BQtrirong BQ Y t@ v~ viec dinh chinh TI10ng tu lien tich s6 04/2012ffTLT-BYT-BTC ngay 29 thang 02 nam 2012 cua Lien B9 Y t~ - B9 Tal chinh ban hanh rnuct6i da khung gia mQt 56 dich vu kharn benh, _chfra benh trong cac ~a so kharnb~nh, chira benh cua Nha mroc;

Can cir Quyet dinh s6 1904/199 8/QD- BYT ngay 10 thang 8 naTI1 1998 cuaB9 truong B9 Y te y~viec ban hanh danh muc phan loai phau thuat va thu thuat;

Can cir Quyet dinh s6 2590/2004/QD-BYT ngay 30 thing 7 Dam 2004 cuaBQ truong BQ Y tE vS viec ban hanh danh muc phan loai thu thust duoc huangp hu dp theo Quyet dinh s6 155/2003/QD-TTg ngay 30 thang 7 nam 2003 cuaThu nrong Chinh phu quy dinh sira d6j, b6 sung mot s6 ch€ c1Q phu c~p Q?C thud6i voi cong chuc, vien chirc nganh y tS;

032

Can CtI Quyet dinh 58 355/QD-BYT ngay 09 thing 02 narn 2012 cua 86truong B9 Y·t~ phe duyet danh muc dinh rnirc tarn thai thuoc, boa chat vi v~t n.rrieu hao c1~lam co So' xay dung gia dich vu y t~;

Can CLr Quyet dinh s6 S08/QD-BYT ngay 20 thang 02 narn 2012 cua B<)tr uong B9 Y te v~ viec ban hanh tam thai Q~ rmrc kinh t~ J,:}" thuat lam co sa.ay dung gia dich vu kham benh, chfia benh;

Can cir Cong van s6 22 1OIBYT-KH-TC ngay 16 thang 4 narn 2012 cua B9Y t~ v8 viec huang dftn trien khai Thong tir lien tjch s6 04/2012rrTLT-BYT-BTC' ,

Can err C6ng van s6 1513/BHXH-CSYT ngay 20 thang 4 nam 2012 cuaBaa hiem Xa h9i Vi~t Nam v~ viec huang d~n trien khai Thong tu lien tich s604120 12/TTLT-BYT-BTC;

Can cir Nghi quyet s6 33/2013/NQ-HDND ngay 10 thang 12 nam 2013 cuaI-I9i d6ngnhan dan Thanh ph6 ve viec di~u chinh mot phan gia cac dich V1,l kharnb~nh, chfra benh ap dung cho cac co sa y t~ cong l~p tren dia ban Thanh ph6B6 Chi Minh thee Thong tu lien tich s6 0412012/ITLT-BYT-BTC ngay 29 thang02 nam 2012 cua B9 Y tS - B9 T?1i chinh;

Xet To trinh s6 7258/Tfr-SYT ngay 31 thang 10 nam 2013 cua So' Y tS \'~vi~c ci~uchinh mot phan gia cac dich vu kham benh, chtra benh ap dung cho cacco sa y tE ccng l~p tren cia ban Thanh ph6 H6 Chi Minh theo Thong nr lieu tich~6 O·V2012/TI1":"-Y-BYT-BTC cua B9 Y tG - BQ Tai chinh, .

Di~ll L 1 Jay cii'~uchinh mot phan gia cac dich vu k iam terti';, chtra benh :"pd:)Dg cho cac co sa y t6 cong l~p tren dia ban Thanh ph6 H6 Chi Minh. TheaThong nr lien tich s6 0412012ITTLT-BYT-BTC ngay 29 thang 02 narn 2012 cuaBQ y t~ - B9 Tai chinh, nhu sau: .

1. D6i tirong ap dung dieu chinh gia mot s6 dich vu kharn benh, chfra bcnhap d1).I1gcho cac co So' y t@ cong I~p tren cia ban Thanh ph6 H6 Chi Minh TheaThong tu lien tich sa 04/2012/1TLT-BYT-BTC ngay 29 thang 02 nam 2012 cuaBe? Y t2 - BQ Tai chinh: .

Cac co sa y t~ coni lap tren dia ban Thanh ph6 H6 Chi Minh th\Ic hienclnrc nang kham, chfra benh, g6m: ~

* Tuyen thanh ph6: gem 29 benh vi~'n, 01 Khu Di~u trj, 02 Trung Him;01 Phong kharn chuyen khoa.

* Tuyen huyen: g6m 23 benh vien quan - huyen,

* Tuy§n co So': g6m 322 tram Y tS phirong - xa, thi tdn.2. Phuong all Qi~u chinh gia rn9t s6 dich VI,l kham benh, chfra benh ap dung

cho cac co sa y t~ cong l~p tren dia ban Thanh ph6 H6 Chi Minh theo Thong]:ulien tich s6 0412012fITLT-BYT-BTC ngay 29 thang 02 nam 2012 cua BQY te -09 Tai chinh (diro'i aayviSttfitla TTLT04/2012).

2

a) Xay dung theo 19 rrinh 3 nam (nam 2014, narn 2015, nam 2016, dj~uchinh hang nam), dat mire t6i da khung gia den nam 2016. Tli1JC hien viec di~uchinh bat dAu tir ngay 01 thang 6 narn 2014 vci 19 trinh cu th~ nhu sau:

- Tit ngay 01 thang 6 narn 2014:

+- Ph§.n A, B, C (trir C4): 75% TTLT 0412012 (477 dich vu ky thuat);

+ Phan C4: 65% TTLT04/2012 (1.519 dich vu kg thuat).

- Tit ngay 01 thang 6 nam 2015:+ Ph&n A, B, C (trir C4): 85% TILT 0412012;

+ Phan C4: 75% TlL T 0412012.

- Tir ngay 01 thang 6 narn 2016:

Phfm A, B, C: 100% TTLT 0412012.

b) Rieng d6i voi 25 dich vu ky thufit ducc quy dinh tai TILT 0412012 c6gia bang hoac ihgp hem gia ell (Thong nr lien be) 86 14/fTLB ngay. 30 thang 9narn 1995 cua Be) Y t8 - Be) Tai chinh - Bi) Lao dong - Thuong binh va Xa hQi -.Ban V~t gia Chinh phu va Thong tu lien tich s6 03/2006/TTLT-BYT-BTC-BLBTBXH ngay 26 thang 01 nam 2006 cua Be? Y t~ - Bi) Tai chinh - Be? Laod¢ng - Thuong binh va Xa hoi): thuc hien mire 100% khung gia TILt 0412012.

c) £>6i voi 1.038 dich vu kY thuat khong quy dinh tai TTLT 04/2012 ge.m:911 dich V1} leY thu?t cua Thong tir lien tich s6 03/20U6rfTLT-BYT-BTC-BLDITXH ngay ::6 thang 01 nam 2006 cua Be) Y t,~ - B9 Tai chinh - BQ L".(~d¢ng -rTlnrang binh va Xa h9i va 127 dich vu k5r thu~t tl!OTIg dirong thee Ql1-,'.it.~.. , ,r}-l'~D~P"~'1' ,~-, - 0 ~ ~011 . U 1. .~ ,.', ".,"C1!Ilii. so :il it-,/~~· -lJ1Jl;( J ngay ~J tuang O nsm z ...~ C":..l:1 ')' 0311 r..r.:.~l:Jl.t'~1 li~ .. 'l!

ph6: giu nguyen gia (do khong bi di~u chinh boi TTLT 0412012).

Bi~u 2. Quyet dinh nay co hieu lire sau 10 ngay, k~ illngay ley.Di~u 3. Chanh Van phong 0y ban nhan dan Thanh pho, Giam ct&c So' y t~,

Gillin d6e So' Tai chinh, Thu tnrong cac sa .. nganh Thanh pho, Chu tich 11)' banrihttn clan quan ..huyen va 111Utnrong cac co quan, don vi co lien quan chiu trachrihiern thi hanh Quyer dinh nay.,'.

iVO'i 11.hpn:.. NnU £>i~u3;- C\lC Ki€m tra van ban ..Bq Tu phap;- Thuong we Thanh uy;- Thucng we HBND. TP;- TTIJB: CT, cac PCl';- Oy ban MTIQ Vi@tNarn TP;- VP Thanh uy va cac Ban Thanh uy:- Cae Ban Hqi c16ng nhan dan Tb3M p::6;~ Cac Benh vien, CO' sa y t~ cong I?p

iren cia ban Thanh pho:- \lPL13: Csc pVP;- Phong VX, THKH, TCDvIDV; TTeE;-Luu:VT,(VX!P)I:I ..f~ ,'.,.- . ." ..' <" '~"~~'I'".:.r ....~\.~ !. ~j/\r··~'~..~'.';\':I!j

}~r::~.y_L~L !rH~,r:,-,_(_, "tlrr.~{~L)-. ,.', ··.s.:i:·.,:.yl..-:>_':- __ /sv~,_ri>- ,.. TL.·Gf;~~\ o6c S(J y 'T~

. ~. .. CHr\N{/VAN F'HONG

i;">:'-.~l:i~~_ ,.c' :. \ 'rh", r''7-,~).'~?&,dnLJ"t.l. r?!lf ~

HUaNG DAN NHAp THONG TIN DANlI MUC I(Y THUAT. .'

- Sau khi xay dung xong Bang gia DVKT, cac CSKCB gCrilai nhu sau:+ GCrivao 2 email: bhxhtphcm_nvgdl@bhxhtphcm.gov.vnvadanhmucdvkt@gmail.com+ Chi gCriDUY NI-JAT 1 file t;,XCEL chira afry au thong tin cua 4 Sheet: "Mau I", "Mau 2", "Mau r,va "Mau PTKT"+ Ten file theo dlu true: MaCSKCB_TenCSKCB_DVKT_Ngaythangguifile+ Tieu a€ mail: MilCSKCB_TenCSKCB_DVKT_Ngaythangguifile+ VD: 79014_NgllyenTrai.J20n014

Nguyen t~c chung- Cac CSKCB giG'nguyen ten muc luc, s6 thu W cua bang gia.- Cac CSKCB gifr lai dong clnra DVKT rna CO" so' minh DUQC PI-IE DUYET thuc hien, xoa cac dong chira DVKT ma CO" so'minh KHONG DUQC PHE DUYET thuc hien.- Cac CSKCB giG'nguyen dir lieu cac cQt (2) - Mil hoa, cot (3) - Cac loai DVKT, cot (10) - Glti chu.- Cac CSKCB chi ducc thay a6i dir lieu cot (7) khi c6 quyet dinh phe duyet gia rieng.

1) HU'()'ng dfin di~n thong tin Mfiu 1

(A)

.. 1. ~ ,. DMKT dU'Q'cphe duy~t Gi••DVKT dU'Q'cphe duyetSTT MaH6a r; cse lo~iDVKT Ma DVKTtheo Ngayban ., ...• Ngay ban GHICHU

S60D GlaDVKT .' SoOO" 0023 (OD43) , hinh ., hinh

111 121 (3\ (4\ (5\ (61 m /8\ r"/9\ (10)

Phan C: Khung gia cac dich vl} ..ky thu~t va xet nghi~m:

;, Ch~n dean b~ng hinh anhI

SII:U AM

40 n04.C1.1.1 Sieu arn (B) QD43.NOI.TH.314 1163fOf)-SYT 01/04/2014 35,000 1335/Qf)-SYT 26f05/2014

Sieu am Doppler mau tim 4 0 .'

~ 1 n04.Cl1.2'3D REAL TIME)

278,000

I) TT04.C1.1.3 Sieu am Doppler rnau timimach 510,000,-mau qua IhLfC ouan -,

<,

,

SitU am trong long mach hoac Chu'a bao gam be dilU do Situam, b6 dung cu do du',lrQ'lu'u

-\3 TT04.CUA 80 d~I'trlf luu IU'(~ngaQng rnacn 1,538,000 , IUQ-ng dong tn;;lch vanh va cacvanh FFR dVng cu de dlfa vao long macn, ,

I -

(1\)LUll 'I:- Cac CSKCB giu' nguyen ten m\IC !\IC chfnh+ VD: D~ khai bao 4 DVKT nhu tren, cac CSKCI3 phai gilt lai t'::n 2 Il1\lC chinh 1;\ "Ch~n dean hinh anh", va "Sieu am"- Cac CSKCB oi6n thong tin vao cac cQt (4), (5), (6), (8), (9). Ma cac DVKT dung d~ dib vao cQt (4) QUQ'c lfty tir Sheet "QB43" hoac "QD 23".

+ VO: BY diroc phe duy) dich vu "Sieu am" co ma dich vu la TT04.C1.1.1:+ lYra phan tuyen thee QD43 Iii QD43. OI.TH.314, 56 quy~t dinh la 1163/QD-SYT, ngay ban hanh la 01104/2014.+ Quyct djnh phe duyet gia co 56 quyet dinh lit: 1335/QD-SYT, ngay ban hanh lit 26/05/2014.

(8)

, DMKT dl1O'c phe duy~t Gla DVKT dl1O'C phe duyeti (C)STT MiH6a NQIDUNG MiDVKTtheo S6QD Ngay ban S600 Ngayban GHICHU! QD23 (QD43) hanh

GiiOVKThanh

. (i) (2) (3) (4} (5) (6) (7) (8) (9) (10)

956 TT03.C2.5.2.17 Iiy tdng rang 1 ham (co mang) (da900,000 iThkl m5' - ): goai pham \1bao g6tU thuoc t~\"Iring)

957 TTOJ.C2's.2.1Sray tr:ing rang 2 ham (co mang) (da

1,300,000 Tham m)' - ?\goai pham \ibao g6m thu6c t~\' tr.ing)IRang gia thao lap

953 TT03.C2's.3.! Ham 1J1lUlgdue (chra tinh rang) 750,000

959 TT03.C2.5.3.2 ~19t ham thao Ijp nlnJJ loin phin650,000 Thfun 015' - ~goai pham vi

(14 rang)Rang gia co dinh

960 TT03. C2.5.4.l Rang gia c6 djnh tren Implant (clnra4,800,000 Tham my - t\goai pham \"i

bao g6m Implant, cui gia thay th~)

(C) - Liru y voi nhirng muc GUQ"cGhi chu (cot (10)) la: "Ngoai pham vi", "Th~m mY" thi cac CSKCB khong GlTQ'cchon

2) IIu'o'ng elfin di&n thong tin Mfiu 2

I mIKT dll'1 c phe du\'et Cli DVKT dll\tc phe duyet .Dlch \1,1 di(R)~iaI

ISIT :Ui Haa XQIDL"XC xn DYh.'T thee :,\~ir NKoQ- cm cao; ss oo Cl.lDVKT S&QD 41mycQD23 (QD 43) be binb banbinh

~~l) (2) (3) (4) ~~ (6) (7) (8) (9) (10) (11)Phau thu~t ~~nh tim bam sinh: thOng lien

i nhi thong lien tha~tIi cluing Falle!, vi!50 TT01C.J.QDI90UT.l.2

xong \ 'alsava, die Ilw;re cac rnach mau3,250,000 TT03.C2.1.20

"'M'~ __ '_"_'_ .._---_ .._-----_ .._._ .._- ....-._-_ .._- \.~.~_a_~~~:.~~_~~___....___..______.___.______._ ..---.--- ..~..-..,-.,....- ---- -. .._-"" ...'''' ----- •...------ •.... -- --.-------.-- _.- .._._--_ ..__ ., ._ ..-_ ..... __ .•... ___ MM. _ ••• _._ •• ___ •· __ ••• ~H~.~v .H~~ __ .~ ••• _., ••••••• ~ •• __ ••• _v__ ••,

PI benh tim m~c phii. thay sua van 2 la, .\-= dQng rnach chu, \"311 3 Ia. van dQng

51 ITO-l.C -I.QDI90UT.1.3 rnach pbo~u trong tim, ph6ng thjt trai, 3,150,000 TTOJ.C2. I .20bjc cau dqng mach clui ra oQngmach ,\':inh -------- -----"._ ..... ._.._.-. __ . _._------------ --------_._-----_ .._--- ---_._--

- Cach di~n thong tin cua cac c<)t (4), (5), (6), (7), (8), (9) urong 1\1' nhu Mall 1LUll Y:

(D) - LUll)1 voi nhirng DVKT diroc baa r~ng t6n tai gia tai mot rnuc nao truce do (cot (11)) thi cac CSKCB cfing khong diroc chon

3) nll'D'ng elfin l1i~n thong tin Mfiu 3

" D~fKT dllo'c phe duy~t • Gili D\'KT dllO'C phe duy~t(E)Ten pb£u thu~t. thu thu~t ~IiSIT ~ra H6a ~Ia H6a tbeo IT03fIT04

S8QDNgiy Gia

SSQD:'\gay Ghi chu

D\'KTban hub DVKT ban hinb

(QD43)(1) (2) (3) (4) (5) (6) . (7) (8) (9) (10) (11)

nxxa ~Il.·C mCH vu ICY rar.vr n;'Q);"CDc'Q);"CTHEO TTLT 03CHUYENKHOA1\GO.~PH.J..UTHU..~T LO.~ D..:\C BIt;.T

QD-l070.I.3 Tan soi m~! bing laser (chua baoTT03.C1.1.75

g6m d~u dt laser) 1,500,000QD-l070.I.12 l\Qi soi khau chop xoav • IT03.C2.1.J04 2,000,000QD-l070.I.13 l\qi soi mai mom cung don TI03.C2.1.104 2,000,000

QD~070.I.14 l\qi soi dt 19CS\U1 vien truce tren - IT03.C2.1.J04khau gall chop xoay 2,000,000

QD4070.1.15 l\qi soi c:h hoar mac \1e111 TI03.C2.1.104 2,000,000QD.J070.I.16 KQi soi Plica TT03.C2.1.I04 2,000,000QD-1070.I.17 J\qi soi tdn tlnrong rnam chav TT03.C2.1.104 / . 2,000,000

IPilau thuat bk cau trong t5c dong .

QD4070.I.20mach man tinh chi dmi'i

TT03.C2.1.191 6,000,000

••••••'~A-I~OHXAH~~H'':Hi NJ--'"--

- each dien thong tin cua cac cQt (5), (6), (7), (9), (J 0) tuong nr 111mMfrll I, Mall 2(E) - LUll Y tren ph~n mern vien phi PHA.I sir dung bi? Ma DVKT tai cot (2) (QD4070 ... )

- KHONG slr dung Cot (4) 1113. tuong duong, cot (4) chi mung tinh chat tham khao.

4) Ihl'o'lIg dnn di~n thong tin Mnu PTKT

TT :--'15 DVKT DA,)'""Hxn,c K'\- TKC_-\T (F) PI-L~" T1..:YE~ K'\' THC.-\ T

(1) l2) , (3) - - (-I).....

I II : III IY

QD-B.HSCC I. HOI Sl:'C c.-tP CL"t- \ '..i. CHOXG f)QC

A: TU_-L~ HO_~"'\f' " " .' . , .' . ''. -.' .. ,.;,\'<i':::':: ;!;',:"; , .. ' ,: '.J.: ~~".t·~!. .¥QD·B.HSCC.TH : ;';.' .. '",

1 QD~3.HSCC.TH.l The o doi huvet ap litn p,IC khong xam nhap tai gittCTng ::; S gii1 x x x,

~QD·nHScc.TH.~ Chi di~ntim cap ciru q.i g\\.t-.j'ng x x x

- Cac CSKCB dua vao clu' !i~u trong Sheet "Qf 43" ci€ chon citing ten DVKT va ma tuong u'ng, ciiSn vao Sheet "Mall PTKT"06 khai bao tuyen Slf dung DVKT cho co s6 minh

LUll Y- Cac CSKCB giu' lai ten muc chinh cua DVKTVD: d6khai bao 6 DVKT nlur tren, cac CSKCB phai giii lai ten 2 Muc chinh la: "I. Hal sue ckp cuu v A CHONG DOC",va itA, TUAN HOA.NIt

(F) LUll Y c1i~nth~t chinh xac cct (4)

I •

Mau lIDVKTKHUNG GIA DICH VU KHAM CHUA BENH TU 01106/2014.. .(THEO TTLT 03 & TTLT04, KHONG BAO GOM Ml)C C4)

DMKT dU'Q'c phe duy~t Gia DVKT dU'Q'c phe duy~tSTT Ma H6a Cac leal DVKT Ma DVKT theo

S6QDNgay ban Gici DVKT S6QD

Ngay ban GHI CHUQD23 (QD 43) hanh \ hanh

(1 ) (2),

(3) (4) (5) (6) (7) (8) (9) (10).'

J'<"

':'?~.AY~~r

~1au 3iDYKT

KHUNG GIA DICH VU I{HAM CHUA BENH TU 01/06/2014•• •(TUO G DUONG QI>4070/QI>-UBND)

DMKT durrc phe duvet : . Gia'DVKT duo'c nhe

STT MiiH6a Cac lo~i DVKTMil H6a theo MaDVKT sa Ngay ;Gh~ . sa ' Ngay Ghi chuTT03/TT04 thco QD23 ban ban

(QI> 43)QD

hanhDVKT QD

hanh(1) (2) " (3) (4) (5) (6) (7) (8) (9) (10) (11)

"

M§u 2/DVKT

KIIUNG GIA. DICH VU I(HA.M CHUA BENH TU 01/06/2014•• •(MVC C4: THEO QD 1904& QD 2590)

, < DMKT dlfQ'c phf duy~t Ghi DVKT du'Q'cphf duy~t. ,.Djch vu dii co

MiiDVKT Ngay :Ngay .-STT MaH6a Cac Ioai DVKT sa Ghi sa, GHICHU ghithco QD23 ban ban

QD DVKT QD , tai muc(QD 43) hanh \ hanh

(1) (2) (3) (4) (5) (6) (7) ;' (8) (9) (10) (11)

~