Quyết định 20/2008/QD-BYT

Decision No. 20/2008/QD-BYT of June 09, 2008, to issue the “standard of medical fitness for seafarers working on Vietnamese ships”

Nội dung toàn văn Decision No. 20/2008/QD-BYT to issue the “standard of medical fitness for seafar

THE MINISTRY OF HEALTH --------	SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness -------
No. 20/2008/QD-BYT	Hanoi, June 09^th 2008

DECISION

TO ISSUE THE “STANDARD OF MEDICAL FITNESS FOR SEAFARERS WORKING ON VIETNAMESE SHIPS”

THE MINISTER OF HEALTH

Pursuant to the Government's Decree No. 188/2007/ND-CP dated December 27^th 2007, defining the functions, tasks, powers and organizational structure of the Ministry of Health;

Pursuant to the Maritime Code No. 40/2005/QH11 dated June 14^th 2005 of the National Assembly of the Socialist Republic of Vietnam;

Pursuant to the Official Dispatch No. 2345/BGTVT-TCCB dated April 11^th 2008 of the Ministry of Transport, providing suggestions on “Standards of medical fitness for seafarers working on Vietnamese ships”;

At the request of the Director of the Department of Medical examination and treatment and the Director of the Legal Department

DECIDES:

Article 1. To issue the “Standard of medical fitness for seafarers working on Vietnamese ships” together with this Decision.

Article 2. The Standard of medical fitness for seafarers is applicable in medical facilities that provide medical examination and issue Health Certificates to seafarers.

Article 3. This Decision takes effect after 15 days from the day on which it is published on the Official Gazette. Clause 3.4, Section 3, Part I of the “Standard of medical fitness for operators of motor vehicles” enclosed with the Decision No. 4132/QD-BYT dated October 04^th 2011 of the Minister of Health is annulled.

Article 4. The Chief of the Ministry Office, the Chief Inspector of the Ministries, Directors of Departments, the Directors of Departments affiliated to the Ministry of Health, Directors of hospitals and institutes affiliated to the Ministry of Health, Directors of Services of Health, and Directors of relevant medical facilities are responsible for the implementation of this Decision.

PP THE MINISTER
DEPUTY MINISTER

Nguyen Thi Xuyen

STANDARD

OF MEDICAL FITNESS FOR SEAFARERS WORKING ON VIETNAMESE SHIPS
(Issued together with the Decision No. 20/2008/QD-BYT dated June 09^th 2008 of the Minister of Health)

I. GENERAL PROVISIONS

1. Subjects of application

a) Standards of medical fitness for seafarers working on Vietnamese ships (hereinafter referred to as standards of medical fitness for seafarers) are applicable to Vietnamese citizens and foreigners working on Vietnamese ships (hereinafter referred to as seafarers).

b) Standards of medical fitness for seafarers are to serve:

- Pre-employment medical examination and periodic medical examination for seafarers, and pre-promotion medical examination.

- Pre-enrolment medical examination and periodic medical examination for maritime students.

2. Standards of medical fitness for seafarers include:

a) Standards of physical fitness;

b) Standards of mental and physiological functions;

c) The list of diseases and disabilities unfit for service at sea.

3. Health Certificate

a) The Health Certificates issued to seafarers on domestic routes shall be made in Vietnamese, and those issued to seafarers on international routes shall be made in both Vietnamese and English The template of the Health Certificate is provided in Appendix 1 to this Standard.

b) The issuance and expiration dates of Health Certificates

- The seafarers that satisfy the standards of medical fitness for seafarers shall be issued with Health Certificates. A Health Certificate shall be valid for 24 months from the date on which it is signed.

- Where a seafarer does not satisfy the standards of medical fitness for seafarers (having one of the diseases subject to case-by-case assessment in Point 2.3 of Section II), but the ship-owner demands his or her service; he or she shall make a written health guarantee (according to the template provided in Appendix 2 to this Standard). Then the medical facility may issue a Health Certificate that is valid for 6 – 12 months starting when it is signed.

c) Health Certificate extension

Where a Health Certificate of a seafarer expires in the middle of an international route, the ship-owner shall submit that seafarer’s Health Certificate (the archived copy) to the medical facility that issued the Health Certificate and apply for an extension. After considering the condition of the seafarer in the Health Certificate and the confirmation of the medic officer of the ship (via Tele-Medicine), the medical facility shall extend the Health Certificate to no more than 03 months. This Health Certificate shall expires when such seafarer is sick or injured and has been treated or rested on the ship for more than 30 days without being healthy enough to go back to work, or leaves the ship due to health problems.

4. Standards and conditions of medical facilities that provide medical examination for seafarers are specified in Appendix 3 to this Standard.

II. STANDARDS OF MEDICAL FITNESS FOR SEAFARERS

1. Physical fitness standards

Examinee Standard	Seafarer (Pre-employment and periodic)		Student (Pre-enrolment)
Examinee Standard	Deck	Other	Deck	Other
Height (cm) (This standard is not applicable to the subjects recruited before the issuance of these standards)	³ 164	³ 161	³164	³ 161
Body weight (kg)	³ 55	³ 52	³ 50	³ 48
Mean chest circle	≥ 50% of the height, applicable to all examinees
Body mass index	18.1 - 25, applicable to all examinees
Gripping force of the preferred hand (kg)	³ 31	³ 31	³ 31	³ 31
Gripping force of the non-preferred hand (kg)	³ 28	³ 28	³ 28	³ 28
Pulling force of the body (kg)	≥ 200% of the body weight

2. Standards of physiological functions

Examinee Standard	Seafarer	Student
2.1. Cardiovascular system
- Heart rate	60-80 bpm	60-80 bpm
- Systolic pressure	100 - 139 mmHg	100 - 130 mmHg
- Diastolic pressure	50 - 89 mmHg	50 - 80 mmHg
- Arterial pressure	³ 30mmHg	³ 40 mmHg
- Electrocardiogram	Normal	Normal
- After stress test (Martinet) (only carried out if myocardial ischemia is found during clinical examination)	Heart rate increases by ≤ 20 bpm; no myocardial ischemia shown on the electrocardiogram	Heart rate increases by ≤ 20 bpm; no myocardial ischemia shown on the electrocardiogram
2.2. Respiratory system
- Respiratory rate	15 – 20 breaths per minute	15 – 20 breaths per minute
- Respiratory function
- Slow vital capacity or forced vital capacity	³ 80 % of normal SVC	³ 80 % of normal SVC
- Respiratory functional residual capacity (RFRC)	³ 80%	³ 80
- Tiffeneau or Geansler index	³ 80%	³ 80%
- Chest X-ray	Normal	Normal
2.3. Assessment of function of the vestibular system	Only applicable to people that have not been at sea for more than 02 years: Pass the seasickness test at medium level or above	Only applicable to pre-employment medical examination Pass the seasickness test at medium level or above
2.4. Eye function
- Visual acuity of each eye + Without corrective lens + With corrective lens	³ 8/10 10/10	10/10 10/10
- Visual acuity of both eyes	³ 16/10	³ 18/10
- Visual field	90-95% to the temples	90-95% to the temples
	50-60% upwards	50-60% upwards
	60% to the nose	60% to the nose
	70% downwards	70% downwards
- Intraocular pressure (measured by Malakoff tonometer)	19.40 ± 5.00 mmHg	19.40 ± 5.00 mmHg
2.5. Neurological system - psychology (Applicable to new recruits only)
- H.J Eysenck’s personality test	Stable	Stable
- Information processing ability	≥ 0.3 bit per second	≥ 0.3 bit per second
- Neurovegetative index (Kerdo index)	From -10 to +10	From -10 to +10
- Eye-heart test (conducted when neurovegetative disorders are found)	Heart rate decreases by ≤ 20 bpm	Heart rate decreases by ≤ 20 bpm
- EEG	Normal	Normal
2.6. Musculoskeletal system
- Body, muscle	Well-proportioned	Well-proportioned
- Bone-joint system: active ranges of joints	Normal	Normal
2.7. Blood test
- Peripheral erythrocyte count	³ 3.7 T/litre	³ 3.7 T/litre
- Hemoglobin	³ 130 g/litre	³ 130 g/litre
- Peripheral leukocyte count	5 - 9 G/litre	5 - 9 G/litre
- AOB blood group
- Bleeding time	Normal	Normal
- Howell’s time	Normal	Normal
- Leukocyte formula	Normal	Normal
- VDRL - TPHA	Negative Negative	Negative Negative
- HIV testing	Negative	Negative
- Viral hepatitis testing + HBsAg (if (+),conduct test for HbeAg) + HCV + HAV	Negative Negative Negative	Negative Negative Negative
- Blood glucose	Normal	Normal
- Blood alcohol concentration	Negative	Negative
- Blood fat criteria (applicable to periodic medical examination for seafarers ≥ 40 years of age)	Normal	Normal
2.8. Urine test
- Total urine	Normal	Normal
- Narcotic	Negative	Negative
2.9. Stool test (only applicable to workers in the kitchen, waiters and waitresses)
- Worm eggs	Negative
- Amoebe	Negative

3. List of diseases and disabilities unfit for service at sea.

No.	Code (according to ICD 10)	Diseases and disabilities	Maritime students	Seafarers on international routes	Seafarers on domestic routes
3.1. Bacterial and viral contamination
1	A06	Untreated amoebiasis	unfit	unfit	unfit
2	A15-19	Unstable pulmonary and extrapulmonary tuberculosis	unfit	unfit	unfit
3	A 30	Infectious leprosy	unfit	unfit	unfit
4	A 53	Untreated syphilis	unfit	unfit	unfit
5	A 54	Untreated acute or chronic gonorrhoea	unfit	unfit	unfit
6	B15-19	Viral hepatitis: - Acute hepatitis; - Chronic viral hepatitis; - Carriers of anti-HBsAg and anti-HBeAg (+)	unfit unfit unfit	unfit unfit unfit	unfit unfit unfit
7	B20-24	Acquired immunodeficiency syndrome (AIDS)	unfit	unfit	unfit
8	B35-B36	Dermatophytosis	subject to case-by-case assessment	unfit	unfit
9	B50-B53	Untreated malaria	subject to case-by-case assessment	unfit	unfit
10	B86	Scabies	subject to case-by-case assessment	unfit	unfit
3.2. Neoplasms
11	C 00 - 96	Malignant neoplasms	unfit	unfit	unfit
12	D 10-21	Benign neoplasms of lip, face, soft tissues, skin that affect the appearance, not functions.	subject to case-by-case assessment	subject to case-by-case assessment	subject to case-by-case assessment
3.3. Diseases of the blood, blood-forming organs and the immune system
13	D50-52	Iron, vitamin B12, and folate deficiency anaemia	unfit	subject to case-by-case assessment	subject to case-by-case assessment
14	D55-56	Haemolytic anaemia	unfit	unfit	unfit
15	D60-64	Aplastic and other anaemias	unfit	unfit	unfit
16	D65-68	Coagulation defects	unfit	unfit	unfit
17	D 70	Agranulocytose	unfit	unfit	unfit
18	D 73	Hypersplenism	unfit	unfit	unfit
19	D 80	Immunodeficiency	unfit	unfit	unfit
3.4. Endocrine and metabolic diseases
20	E 02-03	Acquired hypothyroidism	unfit	unfit	unfit
21	E 05	Hyperthyroidism	unfit	unfit	unfit
22	E 10-14	Diabetes mellitus	unfit	unfit	subject to case-by-case assessment
23	E 15-16	Hypoglycemias	unfit	unfit	unfit
24	E 22	Hyperpituitarism	unfit	unfit	unfit
25	E 23	Hypopituitarism and other disorders	unfit	unfit	unfit
26	E 24	Cushing's disease	unfit	unfit	unfit
27	E 27-1	Addison's disease	unfit	unfit	unfit
28	E 31	Polyglandular dysfunction	unfit	unfit	unfit
3.5. Mental and psychiatric disorders
29	F 06	Other mental disorders due to brain damage and dysfunction and to diseases	unfit	unfit	unfit
30	F 10	Mental disorders due to alcohol dependence	unfit	unfit	unfit
31	F 11-14	Cocaine dependence	unfit	unfit	unfit
32	F 16	Mental and behavioral disorders due to the use of hallucinogens	unfit	unfit	unfit
33	F 20-29	Schizophrenia, schizotypal disorders and delusional disorders	unfit	unfit	unfit
34	F 30-39	Mood (affective) disorders	unfit	unfit	unfit
35	F 40-42	Anxiety and obssessive disorders	unfit	unfit	unfit
36	F 60-63	Disorders of adult personality and behaviour (such as obsession, paranoia, etc.)	unfit	unfit	unfit
37	F 91-5	Palilalia	unfit	subject to case-by-case assessment	subject to case-by-case assessment
38	G 11	Syndromes of cerebellar disorders such as ataxia, intention tremor, hypotonia, nystagmus, systematic vertigo, language disorder.	unfit	unfit	unfit
39	G 21	Parkinsonism	unfit	unfit	unfit
40	G 24	Dystonia	unfit	unfit	unfit
41	G 40-41	Epilepsy	unfit	unfit	unfit
42	G 43	Migraine	unfit	unfit	unfit
43	G50	Paralysis of trigeminal nerve	unfit	unfit	subject to case-by-case assessment
44	G 51	Paralysis of facial nerve	unfit	unfit	subject to case-by-case assessment
45	G54	Nerve root and plexus disorders	unfit	unfit	unfit
46	G 57- 0	Lesion of sciatic nerve	unfit	unfit	unfit
47	G 83.0	Monoplegia or diplegia of upper limbs	unfit	unfit	unfit
48	G 83.1	Monoplegia or diplegia of lower limbs	unfit	unfit	unfit
3.6. Diseases of the eye
49	H 11	Untreated third-degree pterygium Recurring third-degree pterygium that cause adhesion	unfit unfit	unfit unfit	unfit unfit
50	H 25	Normal vision after treatment of cataract (with corrective lens)	unfit	unfit	subject to case-by-case assessment
51	H 30 - 36	Retinal detachments and breaks	unfit	unfit	unfit
52	H 40	Glaucoma	unfit	unfit	unfit
53	H 43	Inflammation of the uvea, festooned pupil	unfit	unfit	unfit
54	H 46- 47	Papilledema, degeneration of maculae of both eyes	unfit	unfit	unfit
55	H 52- 0-1	Myopia and hypermetropia of more than 4 diopters	unfit	unfit	unfit
56	H 52 - 2	Astigmatism treated by corrective lenses that satisfy standards visual acuity in “physiological functions” part	unfit	unfit	subject to case-by-case assessment
57	H 53 - 5	Achromatopsia	unfit	unfit	unfit
58	H 53 - 6	Night blindness	unfit	unfit	unfit
59	H 49	Strabismus that affects visual acuity and visual field	unfit	unfit	unfit
60	A 71	Uncomplicated trachoma Complicated trachoma that affects visual acuity	unfit unfit	subject to case-by-case assessment unfit	subject to case-by-case assessment unfit
3.7. Diseases of ear, nose, and throat
61	J 31	Rhinitis	unfit	unfit	subject to case-by-case assessment
62	J 32	Chronic maxillary and frontal sinusitis with mucousal degeneration or multiple sinusitis	unfit	unfit	subject to case-by-case assessment
63	J 33	Untreated nasal polyp	unfit	unfit	unfit
64	J 34	Deformities of the ear and throat that cause respiratory disorders and speaking difficulties	unfit	unfit	unfit
65	H 60	Chronic inflammation of the ear canal that cause bilateral stenosis	unfit	subject to case-by-case assessment	subject to case-by-case assessment
66	H 70 - 0 -1	Acute and chronic mastoiditis, with hearing loss ≥ 25 dBA	unfit	unfit	unfit
67	H 67	Secretory otitis media	unfit	unfit	unfit
68	H 81	Ménière's disease	unfit	unfit	unfit
69	H90	Deafness and hearing loss: ≤ 25 dBA, measured by machines	unfit	subject to case-by-case assessment	subject to case-by-case assessment
3.8. Diseases of the circulatory system
70	I 05 - I 08	Rheumatic valve diseases	unfit	unfit	unfit
71	I 10	Hypertension stage II (according to JNC VII), no successful treatment.	unfit	unfit	unfit
72	I 20 - 25 Q 21 - 28	Ischemic heart diseases Congenital cardiovascular diseases that are not completely treated.	unfit unfit	unfit unfit	unfit unfit
73	I 27	Chronic pulmonary heart diseases	unfit	unfit	unfit
74	I 30 - 32	Acute and chronic pericarditis	unfit	unfit	unfit
75	I 33	Acute and chronic endocarditis	unfit	unfit	unfit
76	I 44	Atrioventricular block: First degree Second degree or above	Unfit unfit	subject to case-by-case assessment unfit	subject to case-by-case assessment unfit
77	I 47	Arrhythmia: Complete arrythmia Paroxysmal tachycardia Recurrent tachycardia more than 110 bpm, no successful treatment	unfit unfit unfit	unfit unfit unfit	unfit unfit unfit
78	I 50	Heart failure, regardless of causes	unfit	unfit	unfit
79	I 69	Sequelae of cerebrovascular disease	unfit	unfit	unfit
80	I 73	Arterial and vein occlusions	unfit	unfit	unfit
81	I 83	Varicose veins of lower extremities	unfit	unfit	unfit
82	I 84	Recurrent external haemorrhoids	unfit	unfit	unfit
83	I 95	Low systolic pressure (often < 95 mmHg)	unfit	unfit	subject to case-by-case assessment
3.9. Diseases of the respiratory system
84	J 44	Chronic obstructive pulmonary disease	unfit	unfit	unfit
85	J 45	Asthma	unfit	unfit	unfit
86	J 47	Bronchiectasis	unfit	unfit	unfit
87	J 90 - 92	Acute pleurisy Pleural plaque	unfit unfit	unfit unfit	unfit subject to case-by-case assessment
88	J 93	Pneumothorax	unfit	unfit	unfit
89	J 96	Chronic respiratory failure	unfit	unfit	unfit
3.10. Diseases of the digestive system
90	K 02	Loss of 8 teeth or more without dentures	unfit	unfit	subject to case-by-case assessment
91	K 05	Growing periodontitis of 12 teeth or more, with complication	unfit	unfit	unfit
92	K 25 -26	Gastric ulcer and duodenal ulcer Growing Treated Recurrent with many complications in a year, haemorrhage, or pyloric stenosis	unfit unfit unfit	unfit subject to case-by-case assessment unfit	unfit subject to case-by-case assessment unfit
93	K 40 - 41	Hernia (scrotum and other location), treated	subject to case-by-case assessment	unfit	subject to case-by-case assessment
94	K 51	Progressing hemorrhagic ulcerative colitis and enterocolitis Chronic ulcerative colitis	unfit unfit	unfit subject to case-by-case assessment	unfit subject to case-by-case assessment
95	K 73	Progressing chronic hepatitis	unfit	unfit	unfit
96	K 74	Fibrosis and cirrhosis of liver	unfit	unfit	unfit
97	K 80	Calculus of gallbladder, calculus of bile duct Removed calculus of bile duct that threatens to recur.	unfit unfit	unfit unfit	unfit unfit
3.11. Diseases of the skin and subcutaneous tissue
98	L 23	Allergic contact dermatitis due to chemicals	unfit	unfit	subject to case-by-case assessment
99	L 40	Psoriasis	subject to case-by-case assessment	subject to case-by-case assessment	subject to case-by-case assessment
100	L 86	Albino	subject to case-by-case assessment	subject to case-by-case assessment	subject to case-by-case assessment
101	Q 80	Congenital ichthyosis	unfit	unfit	unfit
3.12. Diseases of the musculoskeletal system and connective tissue
102	M 00 - 01	Arthropathies due to infection or other causes	unfit	unfit	unfit
103	M 05	Rheumatoid polyarthritis	unfit	unfit	unfit
104	M 10	Gout	unfit	subject to case-by-case assessment	subject to case-by-case assessment
105	M 21	Pes planus and deformities of limbs	unfit	unfit	unfit
106	M 30-36	Systemic connective tissue disorders	unfit	unfit	unfit
107	M 40	Kyphosis and lordosis	unfit	unfit	unfit
108	M 50-51	Spinal disc herniation	unfit	unfit	unfit
109	M 88	Paget’s diseases (of the frontal bone or other bones)	unfit	unfit	unfit
110	Z 89	Acquired absence of limb: Absence of 3 fingers of a hand or absence of a thumb Absence of a hand Absence of an arm Absence of a foot Absence of the upper 1/3 of thigh	unfit unfit unfit unfit unfit	unfit unfit unfit unfit unfit	unfit unfit unfit unfit unfit
111	T 92-93	Deformities of limbs after bone facture: Due to mal-union Artificial joints after injyries of limb	unfit unfit	unfit unfit	unfit unfit
3.13. Diseases of the genito-urinary system
112	N 03	Chronic nephrosis	unfit	unfit	unfit
113	N 04	Nephrotic syndrome	unfit	unfit	unfit
114	N 13	Bilateral hydronephrosis or pyonephrosis	unfit	unfit	unfit
115	N 17-18	Chronic and acute renal failure	unfit	unfit	unfit
116	N 20	Bilateral or unilateral calculus of kidney and ureter without renal dysfunction Untreated cystolith	unfit unfit	unfit unfit	unfit unfit
117	N40	Prostate cancer that affects urination	unfit	unfit	unfit
118	N43	Hydrocele and spermatocele	unfit	unfit	unfit

APPENDIX 1

HEALTH CERTIFICATE FORM
(issued together with the Decision No. 20/2008/QD-BYT dated June 09^th 2008 of the Minister of Health)

BỘ Y TẾ/ SỞ Y TẾ
MINISTRY OF HELATH/ HEALTH SERVICE
Bệnh viện- Hospital.................................
-----

CỘNG HOÀ XÃ HỘI CHỦ NGHĨA VIỆT NAM
THE SOCIALIST REPUBLIC OF VIETNAM
Dộc lập - Tự do - Hạnh phúc
Independence - Freedom – Happiness
-------

Color picture

(4 x 6 cm)

GIẤY CHỨNG NHẬN SỨC KHOẺ

Certificate of health

Dùng cho học viên nghề biển, thuyền viên làm việc trên tầu biển

(Minimum requirements for the medical examination of Maritime Students & Seafarers)

A. Thông tin chung:

1. Họ và tên (viết chữ in hoa)-Name (last, first, middle)_____________________________

2.Giới (Sex): nam (male) ¨ nữ (female) ¨ 3. Ngày sinh (Date of birth) (ngày/ tháng/năm –day/month/year) ___/___/

4. Quốc tịch (Nationality): ________________________ 5. Số CMND hoặc hộ chiếu hoặc sổ thuyền viên (ID No/ Passport No./Discharge Book No): ______________________________ 6. Ngày cấp (Date of issue) (ngày/ tháng/năm –day/month/year) ___/___/_____

7. Hộ khẩu thường trú: _______________________________________________________

Permernent place of residence: ________________________________________________

8. Chỗ ở hiện tại: ____________________________________________________________

Home address ______________________________________________________________

9. Dối tượng (Objective): 1. Học sinh, sinh viên (student) ¨ 2. Thuyền viên (seafarers) ¨

10. Tên và Dịa chỉ của Truờng hoặc Cơ quan quản lý thuyền viên: ___________________

___________________________________________________________________________

Name and Address of School or Shipowner_______________________________________

___________________________________________________________________________

11. Loại tầu sẽ phục vụ (container, tầu dầu, tầu khách, tầu cá): ______________________

Type of ship (container, tanker and passenger, fishing):_____________________________

12. Chức vụ/ nghề nghiệp trên tàu______________________________________________

Position/occupation on the ship_________________________________________________

13. Khu vực hoạt Dộng của tầu (ven biển, vùng nhiệt Dới, hàn Dới, viễn dương, ) _____

Trade area (e.g., coastal, tropical, worldwide):_____________________________________

14. Lý do khám sức khoẻ (Purpose of health examination):

1. Làm hồ sơ dự tuyển (Registration form) ¨ 2. Khi tuyển dụng (Pre-sea) ¨

3. Khám Dịnh kỳ (Periodic) ¨ 4. Khám khác (Others) ¨

B. Khám sức khoẻ

I. Tiền sử sức khoẻ của NGƯỜI DƯỢC khám sức khoẻ (Examinee’s personal declaration)

(Do bác sỹ hỏi- Assistance should be offered by medical staff)

Bạn Dã có bệnh hoặc tình trạng nào sau Dây không (Have you ever had any of the following conditions) ?

Bệnh, tình trạng bệnh *Condition*	Có *Yes*	Không No	Bệnh, tình trạng bệnh *Condition*	Có *Yes*	Không No
01..Bệnh mắt/thị giác ( Eye/vision problem)			17. Mất ngủ (Sleep problem)
02. Suy giảm sức nghe (Hearing problem)			18. Nghiện rượu, ma túy (Drug or alcohol abuse)
03. Tăng huyết áp (high blood presure)			19..Hút thuốc lá (do you smoke) ?
04. Bệnh tim- mạch (heart/ vascular disease)			20. Dã phẫu thuật (operation/surgery) ?
05. Giãn tĩnh mạch (Varicose veins)			21. Dộng kinh/ cơn co giật (Epilepsy/seizures)
06. Hen/Viêm phế quản (Asthma/ bronchitis)			22. Mất ý thức (Loss of consciousness)
07. Bệnh máu (Blood disorder)			23. Rối loạn tâm lý (Psychiatric problem)
08. Bệnh tiểu Dường (Diabetes)			24. Tình trạng suy nhược (Depression)
09. Bệnh tuyến giáp (Thyroid problem)			25. Hoang tưởng tự sát (Attempted suicide)
10.Bệnh tiêu hoá (Digestive disorder)			26. Mất trí nhớ (Loss of memory)
11. Bệnh thận (Kidney problem)			27. Rối loạn thăng bằng (Balance problem)
12. Bệnh ngoài da (Skin problem)			28. Dau Dầu nặng (Severe headaches)
13. Bệnh dị ứng (Allergies)			29. Bệnh tai, mũi, họng (Ear/ nose/ throat problem)
14. Bệnh nhiễm trùng/lây (Infectious diseases)			30. Vận Dộng hạn chế (Restricted mobility)
15. Thoát vị (Hernia )			31. Chứng Dau lưng (Back problem)
16. Các rối loạn sinh dục (Genital disorders)			32. Gãy xương, trật khớp (Fractures/ dislocation)

Nếu trả lời bất kỳ một câu hỏi nào ở trên là "có", Dề nghị mô tả chi tiết:

(If any of the above questions were answered “yes”, please give details).

__________________________________________________________________________________

Câu hỏi khác (Additional questions)	Yes	No
20. Bạn Dã từng bị cắt hợp Dồng vì sức khoẻ hoặc bị cho hồi hương từ tàu chưa? (Have you ever been signed off as sick or repatriated from a ship?)
21. Bạn Dã từng phải nằm viện? (Have you ever been hospitalized?)
22. Bạn Dã bao giờ bị xác nhận không Dủ sức khoẻ công tác trên tàu biển? (Have you ever been declared unfit for sea duty?)
23. Chứng chỉ sức khoẻ của bạn Dã bao giờ bị hạn chế hay huỷ bỏ chưa? (Has your medical certificate ever been restricted or revoked?)
24. Bạn có Dược bác sỹ cảnh báo là bạn có vấn Dề về sức khoẻ, bệnh tật không? (Are you aware that you have any medical problems, diseases or illnesses?)
25. Bạn có cảm thấy thật sự khoẻ mạnh và Dủ khả năng Dể tham gia vào các nhiệm vụ Dược giao? (Do you feel healthy and fit to perform the duties of your designated position/ occupation?)
26. Bạn có bị dị ứng với bất kỳ loại thuốc nào không? (Are you allergic to any medications?)

Nhận xét (Comments):_______________________________________________________________

__________________________________________________________________________________

45. Bạn có Dang uống thuốc theo Dơn hoặc tự dùng thuốc không? (Are you taking any non-prescription or prescription medication?)

Nếu có, xin hãy ghi danh mục các loại thuốc Dó, cả về lý do dung thuốc và liều lượng (If yes, please list the medications taken and the purpose (s) and dosage (s). ____________________________________

__________________________________________________________________________________

Tôi xin cam Doan những Diều Dã khai trên Dây hoàn toàn Dúng với sự thật theo sự hiểu biết cuả tôi.

(I hereby certify that the personal declaration above is a true statement to the best of my knowledge.)

Chứng nhận chủng vacxin (Vaccination status recorded): Yes No

Ngày/ tháng/ năm (day/month/year): ___/___/_____

Chữ ký của Dối tượng khám sức khoẻ
Signature of examinee

Xác nhận của bác sĩ
Witnessed by Doctor (Signature)

II. phần Khám sức khoẻ -Medical examination

1. Thể lực (Physical): - Chiều cao (Height): _____cm - Cân nặng (Weight): _______ kg

- Vòng ngực trung bình (mean chest circle): _____ cm - Chỉ số BMI (BMI index): _______

- Lực kéo thân (pulled force of body): _____ kg

- Lực bóp tay thuận (pressed force of favourable hand): _____ kg)

- Lực bóp tay không thuận (pressed force of unfavourable hand): ______ kg;

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

2. Mạch, huyết áp (Pulse, blood pressure):

- Tần số mạch (Pulse rate): ____/ phút (per minute); - Nhịp (Rhythm):_________________

- Huyết áp tâm thu (Systolic): ______ mm Hg; - Huyết áp tâm trương (Diastolic): _____ (mm Hg);

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3. Khám lâm sàng (clinical examination)

3.1. Tuần hoàn (circulatory system)_____________________________________________

___________________________________________________________________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3.2. Hô hấp (respiratory system)________________________________________________

___________________________________________________________________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3.3. Tiêu hoá ( digestive system)_______________________________________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3.4. Thận-tiết niệu-sinh dục (Kidney-Urine-Genital system)___________________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3.5. Thần kinh (Neurologic)_____________________________________________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3.6. Tâm thần (Psychiatric)____________________________________________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3.7. Hệ vận Dộng (Mobility system)_____________________________________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3.8. Nội tiết (Endocrine system)________________________________________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3.9. Da liễu (skin)____________________________________________________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3.10. Mắt (eyes)

a) Thị giác (Sight)

	Thị lực (Visual acuity)						Thị trường (Visual fields)
	Không kính (Unaided)			Có kính (Aided)
	Mắt phải (Right eye)	Mắt Trái (Left eye)	Hai mắt (Binocular)	Mắt phải (Right eye)	Mắt trái (Left eye)	Hai mắt (Binocular)		Bình thường (Normal)	Hạn chế (Defective)
Xa (Distant)-5m							Mắt phải (Right eye)
Gần (Near)							Mắt trái (Left eye)

b) Thị giác mầu (Colour vision): Bình thường (Normal) Mù mầu (Doubtful)

Hạn chế (Defective)

c) Bệnh mắt (other diseases)__________________________________________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3.11. Tai mũi họng (Ear-nose-throat)

a) Thính giác (Hearing):

	*Thử âm Dơn giản và Do sức nghe* ( Dơn vị Do là dB) Pure tone and audio metry (threshold values in dB)						*Thử bằng nói thường và nói thầm* Speech and whisper test (meters)
	500 Hz	4,000 Hz	2,000 Hz	3,000 Hz	4,000 Hz	6,000 Hz		Nói thường (Normal)	Nói thầm (Whisper)
Tai phải (Right ear)							Tai phải (Right eye)
Tai trái (Left ear)							Tai trái (Left eye)

b) Bệnh tai mũi họng (other diseases of ear, nose and throat)_______________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

3.12. Răng hàm mặt (Teeth-Jaw-face)___________________________________________

Kết quả (result): Bình thường (normal) Không bình thường (abnormal)

Ký tên (signature) _______________________________________

4. Cận lâm sàng (paraclinical)

Xét nghiệm (Test)	Kết quả (Result)	Xét nghiệm (Test)	Kết quả (Result)	XN (Test)	Kết quả (Result)
4.1. Xét nghiệm máu (Blood test)
Nhóm máu (Blood Group):		Dường máu (Glucose)		HAV
Số lượng hồng cầu (Erythrocyte)		Nồng Dộ alcohol máu(alcohol test):		HIV
Hemoglobin (G/l)		VDRL		Lipid
Tiểu cầu (Thrombocyte) (G/l)		TPHA		Cholesterol
Số lượng bạch cầu (Leucocyte )		HbsAg		Triglycerid
Công thức BC (Leucocyte formula )		HbeAg		HDL
Thời gian Howell (Howell’s time)		HCV		LDL
4.2. Xét nghiệm nước tiểu (urine test)
Dường (Glucose):.........		Bạch cầu (Leucocyte)		Nitrit
Hồng cầu ( Erythrocyte)		Bilirubine		Narcotic
Kết quả (result): Bình thường (normal) Không bình thường (abnormal) Ký tên (signature) ______________________________________________
4.3. Xét nghiệm phân (stools test)
Trứng giun (worm egg)		Amip
Kết quả (result): Bình thường (normal) Không bình thường (abnormal) Ký tên (signature) ______________________________________________

4.4. Cận lâm sàng khác (other paraclinical)

Xét nghiệm (Test)	Kết quả (Result)	Ký tên (signature)
a) X quang tim phổi (result of chest X-ray)
b) Diện tâm Dồ (ECG):
c) Chức năng hô hấp (Respiratory function)
d) Thử nghiệm thần kinh - tâm lý (Neuro-Psychological test):
e) Khả năng chịu sóng (seawave withstand capacity):	Tốt (good) ; Trung bình (Average) ; Kém (Bad)
f) Others
g) Others
Kết quả (result): Bình thường (normal) Không bình thường (abnormal) Ký tên (signature) ______________________________________________

C. Dánh giá về tình trạng sức khoẻ Dối với học /làm nghề Di biển (Assessment of fitness for service at sea): Căn cứ vào tiền sử sức khoẻ, kết quả khám lâm sàng và xét nghiệm, chúng tôi chứng nhận tình trạng sức khoẻ của học sinh/thuyền viên như sau (On the basis of the examinee’s personal declaration, my clinical examination and the diagnostic test results recorded above, I declare the examinee medically):

Dủ sức khoẻ học/ làm việc (Fit for look-out duty)

Không Dủ sức khoẻ học tập/ làm việc (Not fit for look-out duty)

	Nghề boong (Deck service)	Nghề máy (Engine service)	Nghề phục vụ viên (Catering service)	Các chức danh khác (Other services)
Phù hợp với (Fit for)
Không phù hợp (Unfit for)

Không hạn chế (Without restriction) Có hạn chế (With restriction) ;

Yêu cầu Deo kính (Visual aid required): có (yes) không (no)

Nêu rõ những hạn chế, như chức danh, loại tàu, khu vực thương mại (Describe restriction,e.g., specific position, type of ship, trade area) __________________________________________________________________

Ngày khám (Date of examination): ____/___/______

Ngày hết hạn của chứng chỉ sức khoẻ (ngày/tháng/năm) (Medical certificate’s date of expiration (day/month/year)
____/___/______

Thủ trưởng cơ quan khám sức khoẻ
Authorized by (competent authority):
(ký tên, Dóng dấu/ signature, seal)

APPENDIX 2

HEALTH GUARANTEE FORM
(issued together with the Decision No. 20/2008/QD-BYT dated June 09^th 2008 of the Minister of Health)

SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
---------------------

HEALTH GUARANTEE

My name is: ................................................................................................................

Date of birth: ..............................................................................................................

Workplace: .................................................................................................................

Family’s address: ........................................................................................................

...................................................................................................................................

Phone number: ............................................................................................................

I has undergone a medical examination on [date]

at [name of the medical facility): ..................................................................................

And diagnosed with: ...................................................................................................

...................................................................................................................................

I hereby guarantee that I am capable of service at sea from … [date] to … [date] …. as a … [position]

Type of ship ...............................................................................................................

and will comply with the doctor’s prescription throughout the trip. After the trip, I will be treated at a medical facility. I am totally responsible for any issues relating to my condition while working at sea.

Confirmation of the ship owner
(Signature, full name, and seal)

[Location and date]
Seafarer
(Signature and full name)

APPENDIX 3

STANDARDS AND CONDITIONS OF MEDICAL FACILITIES PROVIDING MEDICAL EXAMINATION FOR SEAFARERS
(issued together with the Decision No. 20/2008/QD-BYT dated June 09^th 2008 of the Minister of Health)

Medical facilities that provide medical examination for seafarers shall satisfy the standards and conditions in the Circular No. 13/2007/TT-BYT dated November 21^st 2007, providing guidance on medical examination, and the following standards and conditions:

1. Personnel

- The physicians participating in medical examination must hold maritime medical certificates (this requirement takes effect on January 01^st 2011).

- Physicians or technicians in charge of physiology function testing.

- Capable of implementing the regulations in Section II of the Standard of medical fitness for seafarers

- The persons who judges seafarers’ condition are physicians holding post-graduate degrees (specialist’s, master’s, PhD), maritime medical certificates (this requirement takes effect on January 01^st 2011), and an English Level B Certificates or above.

2. Equipment

- Dynamometers to measure grip strength and body strength

- Stopwatch

- ECG machine

- Cardiovascular ultrasound machine

- Spiro-analyzer

- Ophthalmoscope

- Trial lens set

- Ishihara atlas for color perception test

- Landolt C chart

- Malakoff or Schiotz or Goldmann tonometer

- Eysenck's Personality Questionnaire

- Seafarer’s psychology test

- Information processing measurement device or reflex measurement devices

- Seasickness test device

Notes: The medical facilities that do not have information processing measurement device, reflex measurement device, or seasickness test device may cooperate with another medical facility that has them to conduct medical examination. From January 01^st 2011, all medical facilities participating in providing medical examinations for seafarers shall have all devices stated above.

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Thuộc tính Văn bản pháp luật 20/2008/QD-BYT
Loại văn bản	Quyết định
Số hiệu	20/2008/QD-BYT
Cơ quan ban hành	Bộ Y tế
Người ký	Nguyễn Thị Xuyên
Ngày ban hành	09/06/2008
Ngày hiệu lực	12/07/2008
Ngày công báo	...
Số công báo
Lĩnh vực	Lao động - Tiền lương, Thể thao - Y tế
Tình trạng hiệu lực	Hết hiệu lực 01/07/2017
Cập nhật	16 năm trước
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Decision No. 20/2008/QD-BYT to issue the “standard of medical fitness for seafar
Loại văn bản	Quyết định
Số hiệu	20/2008/QD-BYT
Cơ quan ban hành	Bộ Y tế
Người ký	Nguyễn Thị Xuyên
Ngày ban hành	09/06/2008
Ngày hiệu lực	12/07/2008
Ngày công báo	...
Số công báo
Lĩnh vực	Lao động - Tiền lương, Thể thao - Y tế
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Cập nhật	16 năm trước

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Văn bản liên quan Decision No. 20/2008/QD-BYT to issue the “standard of medical fitness for seafar

Luật 40/2005/QH11

The Vietnam Maritime Code No. 40/2005/QH11 of June 14, 2005.

Ban hành: 14/06/2005

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Nghị định 188/2007/ND-CP

Decree No. 188/2007/ND-CP of December 27, 2007, defining the functions, tasks, powers and organizational structure of the Ministry of Health.

Ban hành: 27/12/2007

Ngày hiệu lực: 19/01/2008

Hiệu lực: Hết hiệu lực

Ngày hết hiệu lực: 20/10/2012

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Quyết định 20/2008/QĐ-BYT về "Tiêu chuẩn sức khoẻ của thuyền viên làm việc trên tầu biển Việt Nam" do Bộ trưởng Bộ Y tế ban hành

Ban hành: 09/06/2008

Ngày hiệu lực: 12/07/2008

Hiệu lực: Hết hiệu lực

Ngày hết hiệu lực: 01/07/2017

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Decision No. 20/2008/QD-BYT of June 09, 2008, to issue the “standard of medical fitness for seafarers working on Vietnamese ships”

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Văn bản liên quan Decision No. 20/2008/QD-BYT to issue the “standard of medical fitness for seafar

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