What are the rules and procedures for referral in Dongguan

Legal analysis: conditions for processing

The attending doctor of the designated community health service organization proposes referral according to the condition of the insured person and fills in the "referral notification form", and after the approval of the community health service organization of the town (street), the insured person will go to the referred medical institution with the "referral notification form" and handle the reimbursement formalities at the outpatient charging office of that medical institution. After the approval of the town (street) community health service organization, the insured person will go to the referral medical institution for consultation and go through the reimbursement procedures at the outpatient charging office of the designated medical institution with the "referral notification form".

Processing materials

1. Referral notification form;

2. Person's ID card or social security card.

Process

First step

Application. Participants to the selected community health service organization attending doctor according to the participant's condition proposed referral and fill out the "referral notification form", approved by the town (street) community health service organization, the participant with the "referral notification form" to the referral hospital.

The second step

Acceptance. Upon receipt of the application materials, the staff will immediately make a decision on whether or not to accept the outpatient referral for reimbursement. After review, the participant meets the eligibility requirements, and the materials are complete, standardized format, in accordance with the statutory form, to be accepted outpatient referral reimbursement, the participant does not meet the eligibility requirements, the staff informed of the reasons for the inadmissibility of outpatient referral reimbursement; incomplete or not in accordance with the statutory form of the materials, the staff informed of all the content of the need to make corrections at one time.

The third step

Review. The participant cooperates with the staff to verify the identity information.

Step 4

Decision. Outpatient referral reimbursement, the staff to meet the settlement eligibility, and complete materials, format standardization, in line with the legal form to be handled on-site settlement, the participant to enter the social security card password password verification, password verification through the completion of the on-site settlement of the reimbursement, the participant to pay the amount of personal out-of-pocket payments, to receive the relevant documents; the participant does not meet the qualifications or criteria for settlement will not be processed for the on-site settlement, the staff to inform the reasons not to be If the participant does not meet the qualifications or criteria for settlement, the staff will inform the participant of the reasons for not handling the on-site settlement; if the materials are incomplete, not in standardized format, or not in accordance with the legal form, the on-site settlement will not be handled, and the staff will inform the participant of all the contents that need to be corrected.

Legal basis: "on further strengthening the community health service system construction of a number of opinions"

Further standardize the community service institutions referral, the formation of "small illnesses to the community, serious illnesses to the hospital, rehabilitation back to the community," a good pattern of medical care.

Adhering to the principle of hierarchical diagnosis and treatment

Clearly identifying the different diagnostic and treatment tasks undertaken by medical institutions at all levels, starting from the patient's condition, using the community first diagnosis, two-way referral system to guide and regulate the flow of patients, and the rational use of existing medical and health care resources, to improve the overall effectiveness of medical services.

Community health service organizations carry out outpatient treatment and rehabilitation services for common and common diseases, chronic diseases with clear diagnosis;

Hospitals mainly carry out inpatient hospitalization for acute and critical illnesses, difficult diseases and necessary emergency services.

Referral process

For the convenience of the public to seek medical treatment, to reduce the referral link, if the condition requires referral, in principle, the first by the community health service institutions to the town (street) hospitals, such as the need for medical conditions, can be directly referred by the community health service institutions to the higher level of hospitals, for the transfer of referrals, no need to be from the community health service station to the community health service center and then transferred to the hospital