Beruflich Dokumente
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TABLE OF CONTENTS
PAGE
i. Index
1. Introduction
2. Purpose
3. Patient classification
4. Out Patients
5. In patients
6. Provisional classification
7. Erroneous classification
8. Re-classification
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Declaration Form
Registrations and Admission Form
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i. Index
Definitions in this procedure manual otherwise indicates
admit means the admittance of a person to or at a hospital and
includes the re- admittance of such a person;
admitting officer means an official employed by the hospital,
working in admissions or wards . He or She deals with patient
administration work.
applicant means a person applying , or on whose behalf application
is made ,for admission;
assets means the total value of the fixed and movable property of a
person;
dependant means every
(a) Person who is dependent upon someone for maintenance or
support by reason of marriage wife or husband
(b)Biological child who is a minor under the age of 21 years who is
in the care of a breadwinner;
donor means a person who voluntary reports at a hospital for the
donation of an organ, blood ,milk or tissue, and is admitted for such
purposes, or a person who died in hospital and whose family has given
permission for the donation of an organ or organs or tissue for the
purpose of a transplantation;
exempted patient means a person who receive services free of
charge for a specific condition due to an illness and circumstance;
family unit means a household consisting of a breadwinner with one
or more dependants;
foreign patient means a person from outside the borders of the
Republic of South Africa including foreign tourists or an employee of a
foreign company visiting the RSA but excluding the following:
(a) Immigrants permanently resident in the RSA but who have
not attained citizenship
(b) Non South African citizens with temporary residence or work
permits.
(c) Persons from SADEC states (Angola, Botswana, Democratic
Republic of Congo,
Lesotho, Malawi, Mauritius, Mozambique,
Namibia, Seychelles, Swaziland, Tanzania,
Zambia and
Zimbabwe) Citizens from SADEC countries who are illegal or asylum
seekers
(d) Persons who are asylum seekers with correct documentation.
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1. Introduction
Gauteng Department of Health is mandated to provide health care
services to every member of the community without discrimination on
the basis of color, creed or affordability. This document provides for
guidance on how a patient should be classified prior to being registered
and admitted. All patients must be registered electronically or manually
in which full details are to be obtained from the patient or his/her escort.
The information shall be used for the sole purpose of rendering health
care services and related activities. Agents of the department shall have
access to patient information while executing the services but the
information cannot be used for any other purpose. Patient confidentiality
is key (primary) and shall be maintained at all times by the users of this
information. The Revenue Management unit is responsible for
identification, collection, recording, reconciliation and safeguarding of
information about revenue in the Department of Health.
The guiding documents for revenue management and patient
administration are:
(1)Public Finance Management Act No 1 of 1999 as Amended by Act
29 of 1999 (section 45).
(2)National Health Care Act No 61 of 2003.
(3)Promotion of Access to Information Act No. 2 of 2000.
(4) Uniform Patient Fee Schedule (UPFS) Book. Provides guidance on how to
charge patients, it consist of :
a) UPFS User guide, which describe all the Tariffs, how they must
be used, when and for who must they be applied to.
b) Tariff guide indicates fees to be charged. It is revised annually
through and promulgated in the Provincial Gazette Extraordinary.
c) Procedure code books: they entail major, minor theatre
procedures and ambulatory procedures which are categorized
into A, B, C, D and E. A facility and Professional fee is chargeable
when these procedures are done.
(5)Administrative Procedure Manual Part II.
(6)Hospital Ordinance 14 of 1958.
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2. Purpose
The purpose of this policy manual is to comply with the current legislation
and obtain correct and complete patient information for categorizing
patients for purposes of affordability to pay for services. The classification
will determine the fees payable under the UPFS tariff structure for
services rendered. Everyone has a right to health care services and those
that can afford will be billed based on their classification.
3. Patient Classification
(1) Every person who consults or is admitted for treatment at a public
health institution (hospitals) should be classified in one of the following
categories:
a) Full paying patients
b) Subsidized patients
c) Patients receiving free services.
d) Exempted patients
(2) Every patient shall be classified according to his or her income status,
in an appropriate classification and tariff category. If the income of a
patient cannot be determined, such patient should be
provisionally
classified, see section 6 of this document.
(3) The classification of a dependent is determined by the classification of
the person upon whom he or she is dependent, except in a case of an
exempted patient where a dependant is qualified to be exempted.
(4) Every patient must on registration be informed verbally or in writing
of his/her classification category and fees payable.
(5) As stipulated on Section 25 (14) & (15) of National Health Act No.61 of
2003, all patients or users must give consent to disclose information for
billing purposes either on the Registration/ Admission form or the printed
version from billing system.
(6) Explanation of Classification Categories:
a) Full Paying Patients
This category of patients include externally funded patients (see table 1),
patients being treated by their private practitioners, Folateng patients,
and certain categories of non South African citizens. This category of
patients is liable for the full UPFS fees as listed in Provincial Gazette
Extraordinary for Tariffs revision.
b) Subsidized patients
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In terms of Section 41 (1) of the National Health Act No .61 of 2003, the
Minister and the relevant MEC may prescribe procedures and criteria for
admission to and referral from a health establishment. Subsidized
patients are categorized based on their ability to pay for health services
into three categories: H1, H2 and H3
c) Free Patients
Patients in this category receive all services free of charge and are
categorized as H zero (H0). This category comprises of recipients of social
pension or grants and the formally unemployed. Patients must provide
proof of the type of pension or social grant, or a letter from the
Department of Labour to proof that they are recipients of the
unemployment insurance in order to be classified into this category. If on
Medical Aid, the patient will forfeit the free service benefits.
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4. Out Patients
(1)An outpatient must be classified at the time of his or her first visit
to a hospital and such classification shall remain in force for a
period of 12 months, where after he/she shall be classified
anew.
(2) On the 12 month an outpatient must re submit his/ her proof
documents and be reassessed
(3)Patients that have their medical aid terminated or exhausted
should notify the admitting officer on their next visit, with proof
documents, and shall be classified accordingly. The
classification will remain for 12months. The reassessment of
patients applies to patients who receive free services, exempted
and subsidized after 12 month period.
(4)Patient classification shall remain for a period of 12 months,
however if the patient is externally funded e.g. RAF, COID, e.t.c,
the patient shall be classified accordingly.
5. In- Patient
(1) An in- patient should be classified every time he or she is admitted
at the hospital and such classification shall remain applicable until the
patient is discharged.
(2) The provisions shall not apply to a person:
(a)
Who is an in-patient on the day that precedes the
implementation of the revised tariffs; or
(b) Whose admission and classification as an in-patient had been
approved before the implementation of the revised tariffs for
the period ending on the date upon which he/ she is discharged
from the hospital concerned.
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8. Reclassification of Patients.
(1)A request to move from the patients current classification to a
lower classification category may be made by or on behalf of
the patient on the following grounds:
(a) If the patient became liable for considerable costs of
treatment or the
anticipated costs of treatment being
received will entail excessive financial burden. Reclassification
does not apply for patients attending Folateng wards and
patients treated by their own private practitioners.
(b) A patient whose medical benefits are exhausted in terms of
the medical scheme rules whereby it has been proven by the
doctor or case manager that the patient is not being treated for
any Prescribed Minimum Benefit (PMB) condition.
(2)A request for a reclassification must be made on an application
form for reclassification. The application form must be fully
completed in all respects to enable the chief executive officer or
his or her delegate to make an informed decision
(3)If a request for a reclassification is based on the grounds of
financial burden:
(a) Documentary evidence to indicate the financial burden or
status must be furnished, and copies must be attached to
the relevant application form and kept for audit purposes.
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GROUP
DESCRIPTION
Externally Funded
Patient
whose
health services
are funded or
partly funded
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CLASSIFICATION
Patient treated
Patient treated by
by Medical
Private Medical
Practitioner on
Practitioner
duty
PH (RAF)
PH (M)
PH (COI)
PH (CRB)
PH (DOD)
PH (SAPS)
PH (DOJ)
PH (DCS)
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P (M)
2.Subsidized Patients
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Patient treated by a
private practitioner
P (S)
PH (F)
P (F)
H1
P (S)
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Consultations,
Cosmetic
Surgery,
Assistive
devices, Treatments, Radiation Oncology and
Nuclear Medicines.
(c) Individuals with
Income less than R72
000 per annum.
(d) Household with
Income less than R
100 000 per annum
3.Free Service
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Social pensioners
H2
P (S)
H3
P (S)
H0
P(S)
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Formally unemployed
Deceased
patient
4. Exempted
patients
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unknown
Pregnant women
H0
HG
P (S)
H0
P (S)
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Termination of Pregnancy
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HG
P (S)
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HG
P (S)
HG
P (S)
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Infectious, formidable
and/or Notifiable
Diseases
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HG
P (S)
HG
P (S)
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Donors
Lodger
5.Provisional
Classification
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province
16. A donor is a person who, of their own free
will, presents themselves specifically for the
donation of an organ, blood, milk or human
tissue.
The exemption refers to services
rendered in respect of the donation.
17. A lodger who is admitted on the written
authority of the Chief Executive Officer or officer
acting on his behalf, by reason of the fact that in
the opinion of a medical practitioner, her
presence is necessary for the recovery of a
patient at such hospital.
**Note: Patients with no authority to lodge at
the hospitals are considered as Boarders and
the rates as stipulated on the Provincial Gazette
Extraordinary are to be settled in advance,
unless prior arrangement has been made. Note
that the Boarder rates are not routinely
reimbursed by the Medical Schemes.
HG
P (S)
HG
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ANNEXURE A
REGISTRATION/ADMISSION FORM
Hospital Name
GPF 3
Practice No: 56
PATIENTS DETAILS
Patient File No:Postal Address
Patient No.
:
ID Number
:
Pass port/ Asylum no:
Postal code.
Date of Birth :
Tel/Cell No:
Surname
: Title.
First Names :.
Marital Status :
Gender
:..
Race
:
Next of Kin
Nationality
:
Citizenship
:................................................................................
Name:
Address:..
Religion
:
Residential Address
Relationship:...
Tel/Cell No:
Postal code
Province
:.
.
EMPLOYMENT DETAILS
Employment Status :Occupation:Employee/Persal No.
Employer Name:.
Address:...
Tel No: Fax No:.
Income Details
Weekly
Bread Winner
Spouse
Other(assets)
Monthly
Annually
Number of Dependants:
Hospital Classification
Tel/Cell No
.....
PARTICULARS OF REGISTRATION
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PARTICULARS OF ADMISSION
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Date of Visit .
Time
Date of AdmissionTime..
Admitting Doctor..
Service Point
Speciality Unity..................
First Visit
Follow Up
Referred by
State Department
GP
GW
ICU
HC
DAY
Chronic
Bed Type
ICD10 Codes
Hospital
Clinic
Date of Discharge/Transfer..
Province
Self
Reclassification DateFrom.To.
COID
DCS
SAP
S
Medical Scheme
Other Province
DOJ
SAND
F
Foreigner
Funder Name :.
Member No:..
Individual Details
Name:
Relationship to
patient
ID Number:
.
N
N
N
N
Code ..
Residential Address:
..
..
Employment Details:
Employer Name:
..
Patient advised to bring documentation on:
Address
Date:DateDate
REMARKS:
..
.
.. Tel: Fax:.
....
Employee/Persal number.
PARTICULARS OF ACCIDENTS/INJURY
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Passenger
Pedestrian
PATIENT CONSENT
I, the undersigned hereby grant permission that: The nature of my/the patients illness or condition may be disclosed for billing
Purposes to external funders. Relevant copies of my medical records may also be supplied for billing purposes.
Patient/Guardian Name(Print)..Relationship.
Patient / Guardian Signature Date
Administration Officer Name(Print) .SignatureDate..
ANNEXURE B
DECLARATION OF INCOME/ASSETS
GPF 4
DECLARATION OF INCOME /ASSETS IN CASE OF UNEMPLOYED
PATIENTS OR APPLICANTS
NAME OF PATIENT......................................................................................
ID NUMBER:.................................................................FILE
NUMBER
I ........................................................................................declare that I
have the following assets and I am unemployed.
Value:
House
R........................................
Car
R........................................
Clothing
R........................................
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Furniture
R........................................
Cell phone
R........................................
Other (Specify).....................................................
R.........................................
I declare that I have other income means as listed below:
Small Business
Income per month
R...........................................
Donations
R ...........................................
Value
_______________________
________________________
Signature of applicant
Date
_________________________
________________________
Admitting officer
Date
ANNEXURE C
DOCUMENTS CHECKLIST FORM
GPF 5
NAME OF HOSPITAL:
NAME OF PATIENT:
FILE NO:..
DOCUMENTS REQUIRED
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PROVIDED
NOT
PROVIDED
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YE
S
COPIES
:
Identity
Documen
t
Driver
s
Licens
e
PROOF
OF
Pay slip
Medic
al
INCOM
E:
Declarati
on
Form
DATE
N
O
DATE
Birth Certificate
aid
Departmen
tal
Pensio
n
Card
documents
Card
PROOF
OF
RESIDENC
E:
Municipality
Any Account
Bill
REMARKS:
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