Certificate of recommendation 1 name _ _ _ _ _ _ _
Gender _ _ _
Age _ _ _
Outpatient service number _ _ _ _ _
Hospital number _ _ _ _ _ _ _
Contact phone number _ _ _ _ _ _ _
Go to the medical institution _ _ _ _ _ _ _ _ _ _ _ _ _
Cost _ _ (medical insurance, free medical care, new rural cooperative medical system, self-funded and others)
Current diagnosis: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Sick now: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Reason for recommendation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signature of referring doctor
Referral certificate 2 The patient (male or female) is _ _ years old, lives in _ _ administrative village in _ _ _ township, and has cooperative medical certificate number. Because of illness, he needs to be transferred to hospital for treatment.
Estimated admission time: _ _ Referral unit (seal)
_ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _
Note: 1. This certificate can only be used for one recommendation and is valid for 20 years. Referral is required for every hospitalization or examination.
2. When reimbursing hospitalization expenses, you need to go to the township joint management office for reimbursement with this referral certificate, cooperative medical certificate, ID card (or household registration book), hospitalization invoice of the hospital where you live, list of medical and drug expenses, copy of hospitalization medical records, diagnosis certificate, and return visit list of patients outside the county (please go to the township joint management office to get it).
3. When the outpatient expenses of chronic diseases are reimbursed, you need to go to the township joint management office for reimbursement with this referral certificate, cooperative medical certificate, ID card (or household registration book), outpatient invoice, outpatient medical record, outpatient list or prescription.
4. Address of County Referral Office: Floor 4, Outpatient Building, New Campus of Cao Xian People's Hospital. Tel: _ _.
Recommendation certificate 2
All designated hospitals, insured units and insured persons:
In order to strengthen the management of the medical insurance fund, standardize the medical treatment behavior of the insured, and put an end to fraudulent medical insurance fund behaviors such as false hospitalization, according to the Interim Measures for the Basic Medical Insurance for Urban Workers in Huadu District (Huafu [20xx] No.2) and other relevant regulations, the transfer and referral of the insured are as follows:
First, all referrals should be transferred to a designated hospital at the next higher level in principle, and the referral examination and approval procedures should be handled in the first-visit hospital according to regulations. Each referral application is valid within two days from the date of approval. The attending physician transferred from the hospital should write the medical record truthfully, issue the diagnosis certificate and fill in the date truthfully.
Second, all referrals must be transferred to the designated hospitals in Huadu District Medical Insurance Service Management Center (hereinafter referred to as the District Medical Insurance Center) or 15 Guangzhou designated hospitals. Every time you are hospitalized, you must go through the transfer procedures, otherwise you will not enjoy the corresponding medical insurance benefits.
Three, the need for outpatient treatment of specific projects, should be required by the insured or their relatives to carry relevant information for specific project outpatient application, after the approval of the district medical center, the insured in the selected hospital, enjoy the corresponding treatment. Outpatient specific project approval and referral are valid in this medical insurance year, and the new medical insurance year needs to be re-approved.
Four, due to illness, in the area of hospital outpatient treatment directly transferred to Guangzhou for hospitalization, transferred to the hospital must fill in the Huadu District Urban Workers' Basic Medical Insurance Transfer Diagnosis and Treatment Application Form, and signed by the deputy chief physician or director, medical department audit seal, the director in charge of the signature. This form is made in duplicate. One copy is kept by the transferred hospital in the district, and sent to the medical insurance center by the transferred hospital at the end of the month. The other copy is carried to the transferred hospital by the insured or their relatives and stamped, and submitted to the medical insurance center together with other materials at zero. At the same time, the transferred hospital should do a good job of written registration and report to the district medical insurance center. Insured patients or relatives should hold the "Application Form" to the supervision and inspection department of the district medical insurance center for the record within 2 working days after transfer.
Five, transferred due to illness or transferred to a designated hospital in Guangzhou, transferred from the hospital must fill in the Huadu District Urban Workers' Basic Medical Insurance Transfer Diagnosis and Treatment Application Form, which must be signed and agreed by the deputy chief physician or the director of the department, reviewed and sealed by the medical department, signed and agreed by the dean in charge, and recorded in the medical insurance information system. This form is made in duplicate, one of which is sent to the district medical insurance center by the monthly statement of the transfer-out hospital (this one does not need to be stamped by the transfer-out hospital), and the other one is carried to the transfer-out hospital by the insured or his relatives, and the zero-point report and other materials are submitted to the medical insurance center.
6. Where the insured person is transferred without the consent of the designated hospitals in the district or directly hospitalized in the designated hospitals in Guangzhou 15 in our district, the insured person or his relatives should bring the insured person's ID card and medical insurance card to the supervision and inspection department of the district medical insurance center to handle the Registration Form for Going to the Designated Hospitals in Guangzhou within 2 working days after the insured patient is admitted to the hospital. Before leaving the hospital, show the form to the attending doctor in time, check his identity, fill in the date of hospitalization, diagnosis and signature, and the inpatient department of the hospital will stamp it. When reimbursing medical expenses, you need to bring this form and related reimbursement materials, but the payment ratio of each fund is still reduced by 35% according to the regulations. Non-emergency patients who fail to go to the designated hospitals in Guangzhou within the specified time cannot enjoy the corresponding medical insurance benefits.
Seven, district, Guangzhou level two basic medical insurance designated medical institutions do not have the conditions for examination, treatment, rescue patients, need to be transferred to hospitals outside Guangzhou 15 designated hospitals for treatment and hospitalization, by the district medical insurance center according to the patient's condition, the designated secondary hospital expert consultation agreed, by the consulting hospital issued a referral certificate, and to the district medical insurance center for referral examination and approval procedures, after approval, can be transferred. Two consulting hospitals fill in the Application Form for the Diagnosis and Treatment of Urban Workers' Basic Medical Insurance in Huadu District, which is signed and agreed by doctors or department directors above the deputy director, reviewed and sealed by the medical department, and signed and agreed by the competent dean. The application form for referral for diagnosis and treatment is in duplicate, which shall be filled in by the consultation hospital. The insured person or relatives shall go through the examination and approval procedures for referral to the district medical insurance center, and can be transferred only after approval. When the insured person is hospitalized, he should bring this form in duplicate to the hospital for confirmation, and submit time reports and other materials to the medical insurance center.
8. All insured patients who have been transferred for referral or transferred by themselves shall go directly to the designated hospital in Guangzhou 15. The designated hospital in our district shall handle medical expenses reimbursement within one month after discharge. Those who fail to declare within the specified time, apply for reimbursement within the specified time limit, or provide corresponding forms and materials as required, cannot enjoy the corresponding medical insurance benefits.
List of designated hospitals (excluding branches) that can be transferred to Guangzhou:
General hospitals: Guangdong Provincial People's Hospital, First Affiliated Hospital of Sun Yat-sen University, Second Affiliated Hospital of Sun Yat-sen University, Southern Hospital of Southern Medical University, Guangdong Provincial Hospital of Traditional Chinese Medicine, First Affiliated Hospital of Guangzhou University of Chinese Medicine, First Affiliated Hospital of Guangzhou Medical College and Second Affiliated Hospital of Guangzhou Medical College.
Specialized hospitals: Cancer Hospital affiliated to Sun Yat-sen University, Eye Hospital affiliated to Sun Yat-sen University, Guangzhou Brain Hospital (Psychiatric Hospital), Guangzhou Chest Hospital (Tuberculosis Hospital), Guangzhou Cancer Hospital and Guangzhou Eighth People's Hospital (Infectious Disease Hospital).
Ten, the insured to the hospital outside the hospital designated by the district, district medical insurance center, all medical expenses shall be borne by myself, and the overall fund shall not be paid.
Eleven, the original provisions are inconsistent with this notice, according to the relevant provisions of this notice.
XII. This Notice shall be implemented as of July 1 2007.
Social insurance management center:
The insured (social security number) of our unit was treated in the hospital on, and needed to be transferred for further treatment due to illness. Please review and go through the relevant formalities.
Note: this certificate is invalid without an official letter from the company.
(Signature of the insured unit)
(Signature of designated medical institution)
date month year
date month year