Amended Patient Classification Policy Manual

TABLE OF CONTENTS PAGE

i. Index 3

1. Introduction 5

2. Purpose 5

3. Patient classification 6

4. Out Patients 8

5. In patients 8

6. Provisional classification 9

7. Erroneous classification 9

8. Re-classification 10

9. Appeals against classification 11

TABLE 1: EXPLANATION OF THE CLASSIFICATION OF PATIENTS FOR THE DETERMINATION OF FEES 13- 19

Annexure A: GPF 4 Declaration Form 20-21

Annexure B: GPF 3 Registrations and Admission Form 22

We Page 1

i. IndexDefinitions 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.

‘hospital patient’ means a person who is treated at a hospital by a medical practitioner who is in the service of such hospital at an inclusive tariff;‘income’ in relation to a person ,means the total income on admission, before deduction there from of any contribution to a pension fund, medical aid or fund ,any premium on an insurance policy, any charge in respect of board and lodging, or of any other amount whatsoever not being expenditure incurred or to be incurred in the

We Page 1

earning of such income which person receives or anticipates receiving by way of derived from salary , wage ,bonus ,commission, pension, interest, maintenance, divided, rent, the carrying on of farming operations or any trade ,business, profession, or occupation, any other assets or any other way from any other source whatsoever;’individual’ means a responsible person without dependants; ‘lodger’’ means a person 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, his presence is necessary for the recovery of a patient in or at such hospital;‘’member of a medical scheme’ means any person who has been enrolled or admitted as and still is a member of the scheme or who in terms of the medical Scheme Act or rules of the scheme is a member of the scheme;

medical scheme’ means any medical scheme as defined in section 1 of the Medical scheme Act ,1967 (Act 72 of 1967)‘month’ means the period extending from the first day to the last day ,both days included ,in any one of the 12 months of a calendar year;

’patient companion’ means any person either a family member or an acquaintance of a patient who accompanies that patient without any reason to a hospital and requires accommodation without any reason for caring and security to a hospital because he has no other refuge; ’ Non South African resident’ means a person from outside the borders of the Republic of South Africa visiting the RSA. ’private hospital patient ’ means a person who has been classified as a private patient at a hospital but is treated by a medical practitioner who is in the service of such hospital (PH);‘private patient’ means a person who is treated in or at hospital by a medical practitioner who is not in the service of such hospital(P)‘relative’ means a member of family of a patient who with the written authorization of the superintendent, or officer acting on his behalf is admitted for examination in order to assist in the diagnosis of the condition of such patient ’’ ’resident baby’ a new born baby of a mother who is still a maternity patient in the hospital;‘resident child’ means an infant who does not receive medical treatment or nursing care, but who is cared for and fed by its mother who is a patient in the hospital;‘Responsible person’ means a person who is not a dependant, whether he has dependants or not;

We Page 1

1. IntroductionGauteng 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.NB: This document replaces the Patient Administration Procedure Manual on Classification of Patients par. 10.1.9

2. PurposeThe 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.

We Page 1

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 patientsb) 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 PatientsThis 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 patientsIn 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 PatientsPatients 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.

We Page 1

(d) Exempted PatientsIn terms of section 4 of the National Health Act no.61 of 2003, The Minister of Health, after consultation with the Minister of Finance and; section 41(1) relevant Member of Executive Councils, may prescribe conditions subject to which categories of persons are eligible for free health services at public health establishments.

(i) Pregnant and lactating women and children below the age of six years must receive free health care, provided they are not members or beneficiaries of medical aid schemes. (ii) All persons, except members of medical aid schemes and their dependants andPersons receiving compensation for compensable occupational diseases, must receive free primary health care services

Patients under (a) circumstances will receive free health care services only when these conditions are confirmed and they will be exempted from paying prescribed fees irrespective of any additional diagnosis, their income or normal classification. A full list of patients qualifying for these statutory based circumstances is elaborated under Table 1.

(7) Every person presenting himself/herself at the provincial hospital shall provide the following documents to an Admitting Officer before he/she is registered or admitted, for the purpose of determining a classification and tariff category:

a)Identity Documentb)Medical aid cardc)Appointment cardd)Pay slip/ salary advice e)Proof of address (residential or postal address)f)Documentation from other Organs of State

(8) Declaration OF Income/Assets GPF 4 (Annexure B)

a) All patients who have no proof of income should fill the Declaration of Income form (Annexure A). b) This form will assist the admitting officer to determine the classification category using the patient’s assets.c) The admitting officer shall add all values and determine classification according to the means test.

(9) Registration or Admission Form GPF 3 (Annexure A)a) All patients must be registered on the GPF 3 form or computerized systems before any consultation or admission to a hospital.b) The GPF 3 form must be completed by the admitting officer or patient/ other person on his/her behalf except in cases of illiteracy or a computerized system.c) It must be used in case of non-computerized registration/admissions areas or when the Information Technology (IT) Systems are off-line.d) Information as stipulated on the Registration or Admission form or Billing system should be furnished by patients during consultation or admission

We Page 1

e) It is the responsibility of the admitting officer to ensure that information on the GPF 3 or IT systems is completely captured.

f) In terms of section 14 of the National Health Act No.61 of 2003, all information concerning a user, including information relating to his or her health status, treatment or admission in a health establishment is confidential and no person may disclose any information unless the user consents to that disclosure in writing. g) The admitting officer must sign the form and ensure that the patient also attach his/her signature on both the manual form and printed version from the computerized systems. The patient will thus give the health institution consent to use his/her medical information for billing purposes.h) All forms must be checked daily and randomly by the supervisors in charge of the registration and admissions areas to ensure accuracy and completeness. The supervisors must attach their signatures on all forms randomly checked, and keep record for audit purposes.

i) The GPF 3 form is self explanatory and must be completed legibly, completely and accurately.

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.

We Page 1

6. Provisional Classification of Patients(1) In the case of any Out Patient hospital visit whereby the information required is not readily available to determine the classification and tariff category of the patient and the head of medical services or a medical practitioner on duty is of the opinion that the treatment of a patient cannot be deferred without danger or detrimental consequences to such patient, such patient shall be registered and classified as follows:

(a) First OPD visit- Classify as H1. Tick in the relevant form GPF 5 (Annexure C) and indicate the date required to submit the documents.(b) Second OPD visit- Classify as H1. Tick in the relevant form GPF 5 (Annexure C) and indicate the date required to submit the documents.

(c) Third OPD visit- classify as Provisional H3 if no documents are furnished. (d) All patients must be informed of their Provisional classification and be requested to furnish the required information as soon as possible. (e) If the required information is furnished the patient shall be correctly classified but will remain liable to pay for the incurred medical costs from the Provisional Classification.

(2) In the case of any admission whereby the information required is not readily available to determine the classification and tariff category of the patient and the head of medical services or a medical practitioner on duty is of the opinion that the treatment of a patient cannot be deferred without danger or detrimental consequences to such patient, such patient shall be admitted and classified as follows:

(a) The patient with no documentation shall be classified provisionally as H3.(b) Ward clerks must ensure that all provisionally classified patients are followed up regularly to provide documentation before being discharged.

(c) If the required information is not furnished, the patient will be liable to pay the incurred medical costs unless all the required documentation is provided.

(3) All patients must be informed of their Provisional classification and be requested to furnish the required information as soon as possible.

7. Erroneous Classification of Patients(1) An erroneous classification arises when a patient is incorrectly classified in any

classification category as a result of any false, incorrect or misleading declaration, information or document having been made available or furnished, or as a result of any error or any incorrect application or interpretation of the policy or for any other acceptable reason.

(2) Whenever it is discovered that a patient has been erroneously classified as a result of any of the reasons mentioned in above such patient shall be classified afresh in the correct category with effect from the date of such erroneous classification.

(3) An erroneous classification must not be confused with a reclassification. A classification which is corrected as a result of error is not a reclassification but is

We Page 1

merely a correction of a wrong classification. A reclassification is something completely different and is further described below after an erroneous classification

(4) The correction of an erroneous classification must be approved by a senior official designated by the chief executive officer for this purpose. The following are examples of erroneous classifications:

(a) A patient claims that he or she has been injured on duty and is therefore entitled to treatment in terms of the Compensation for Occupational Injuries and Diseases Act No 130 of 1993 and is accordingly classified as a private patient in category PHCOI or PCOI. Later his or her claim is rejected by the employer or Compensation Commissioner. In such case the patient was erroneously classified and must therefore be classified anew with effect from the date of the erroneous classification.

(b) A patient furnishes incorrect information regarding his or her income intentionally and is classified accordingly. Later the correct amount of his or her income is determined, by whichever means or from whichever source. The patient must be classified anew according to his or her correct income with effect from the date of the erroneous classification. Such classification may remain the same or may be in a lower or higher category

(c) A patient is erroneously classified as a result of an error or an incorrect application or interpretation of the policy by the officer admitting the patient. In such case the erroneous classification must be corrected with effect from the date of such erroneous classification.

8. Reclassification of Patients.(1) A request to move from the patient’s 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.

We Page 1

(b)The head of medical services or his or her delegate must verify the anticipated costs indicated in the application form.

(4) The reclassification of an applicant or patient is considered solely on the information furnished. If a reclassification is considered, the applicant or patient is reclassified to a lower category where the patient will be able to afford.

(5) In the case where the patient has already paid an amount in advance, no refunds will be made and reclassification shall take effect upon expiry of the period in respect of which such payment was made.

(6) The reclassification of an applicant or patient shall remain in force for a period of 12 months except:

(a) an outpatient or inpatient who is a member of a medical scheme, whose benefits are renewed before expiry of the period of 12 months, in which case the reclassification shall lapse on the day immediately preceding the day on which his or her benefits are renewed.

(b) There is any change in circumstances which gave rise to the reclassification before the expiry of the 12 months period i.e. when the regulations relating to the classification and tariffs are amended.

(7) When an applicant or patient —(a) notwithstanding considerable costs for treatment already incurred or

anticipated, does not qualify for a reclassification, and his or her present classification will probably entail excessive financial hardship; or

(b) whose request for reclassification has been granted, considers himself or herself to remain unduly burdened, notwithstanding such reclassification,

(8) A written request for reclassification or for further reclassification for any sound reason, other than those already advanced in his or her original request, may be

submitted to the chief executive officer. If the chief executive officer or his or her delegate considers that a reclassification or further reclassification is justified,

he or she shall classify the applicant or patient in such lower category as he or she may consider reasonable in the circumstances, with effect from the date upon which he or she received such request.

9. Appeals against Classification(1) Whenever an applicant or patient is aggrieved by any classification,

reclassification or refusal of a request for reclassification, he or she may appeal to the hospital board of the hospital concerned against the decision regarding such classification.

(2) Pending the ruling of the board, the decision against which the appeal is lodged, shall remain in full force and effect.

(3) An appeal shall be lodged — (a) by giving a written notice to that effect to the chief executive officer within

seven days of the classification or reclassification setting out fully in such notice the grounds on which it is contended.

We Page 1

(4) The board shall at its first ordinary meeting after receipt of such notice and any comments thereon, consider such appeal and may call for such additional information as it may deem necessary or desirable, from any person, including the applicant or patient who lodged such appeal.(5)The Board will review the classification and take an informed decision. The ruling of the board in upholding or dismissing an appeal shall be final.

We Page 1

Table 1: Explanation of the Classification of patients for the determination of fees

CLASSIFICATION GROUP DESCRIPTION CLASSIFICATIONPatient treated by Medical Practitioner on duty

Patient treated by Private Medical Practitioner

1.Full Paying Patients Externally FundedPatient whose health services are funded or partly funded

1. All patients visiting Gauteng institutions who were involved in a Road Accident should be classified as Private patients: The Road Accident Fund Act, 1996 (Act No 56 of 1996)

PH (RAF)

A medical scheme registered in terms of the Medical Schemes Act, 1998 (Act No 131 of 1998).

PH (M) P (M)

The Compensation for Occupational Injuries and Diseases Act, 1993 (Act No 130 of 1993),

PH (COI)

Patients treated on the account of another province (cross border)

PH (CRB)

Patients treated on the account of another state department: (a) A South African National Defense Force patientsAny person who, in terms of the provisions of the Defense Act No 44 of 1957 is entitled to treatment in a hospital at the expense of the State.

PH (DOD)

b) South African Police Service (SAPS) PH (SAPS)

c) Department of Justice (DOJ) PH (DOJ)

(d)Department of Correctional service (DCS) PH (DCS)

Patient treated by a private practitioner

2. Any patient treated by his or her own private practitioner in a public health care facility will be liable to pay the full facility fee component for services rendered by the private practitioner at the facility and the full UPFS fee for any other service received by the patient. These patients are classified

P (S)

We Page 1

as Private Self Funded :P (S)Non South African citizens 3. All Non South African citizens are classified as

Private Patients excluding the following categories where means test is applied and the patients receive the same health benefits as South Africans:(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 who enters the Republic of South Africa illegally. (d) Persons who are asylum seekers with correct documentation.

These patients are classified as Private Hospital Foreign patients : PH (F) or P (F) if they opt to be treated by their own medical practitioners

PH (F) P (F)

2.Subsidized Patients Means Test apply for (a) Individuals with Income less than R36 000 per annum (b)Household with Income less than R 50 000 per annum

4. Receive a percentage of subsidization from the full Uniform Patient Fee Schedule on selected tariff categories.

The following Tariffs are to be charged as per provincial Gazette Extraordinary for Revised Tariffs: Dialysis, Medical Reports, Inpatients, Consultations, Cosmetic Surgery, Assistive devices, Treatments, Radiation Oncology and Nuclear Medicines.

H1 P (S)

(c) Individuals with Income less than R72 000 per annum. (d) Household with Income less than R 100 000 per

5. Receive a percentage of subsidization from the full Uniform Patient Fee Schedule on selected tariff categories. The following Tariffs are to be charged as per provincial Gazette Extraordinary for Revised Tariffs : Anesthetics, Dialysis, Medical reports, Imaging, In-patients, Oral health,

H2 P (S)

We Page 1

annum Consultations, Minor Theatre procedure, major Theatre procedures, Treatments, Emergency Medical Services, Assistive Devices & Prosthesis, Cosmetic Surgery, Radiation Oncology, Ambulatory Procedures

(e) Individuals with Income greater or equal to R72 000 per annum (f) Household with Income equal to or greater than R 100 000 per annum

6. Receive a percentage of subsidization from the full Uniform Patient Fee Schedule. Not all Tariffs are charged at a discounted rate.The following Tariffs are to be charged as per provincial Gazette Extraordinary for Revised Tariffs:Anesthetics, Dialysis, Medical reports, Imaging, In-patients, Mortuary,Pharmaceutical, Oral health, Consultations, Minor Theatre procedure, Major Theatre procedures, Treatments, Emergency Medical Services, Assistive Devices & Prosthesis, Cosmetic Surgery, Laboratory Services, Nuclear Medicine, Radiation Oncology, Ambulatory Procedures, Bloods and Blood Products, Hyperbaric Oxygen Therapy, Consumables, Autopsies.

H3 P (S)

3.Free Service Social pensioners 7. Recipients of the following types of pension/grants areclassified as social pensioners and receive all services

free of charge: Old age pensioners Child support grant Veteran's pension Care dependency grant Pension for the blind Family allowance Maintenance grant Disability grant Single- care grant –(Persons with mental

disorders in need of care discharged from hospitals for the mentally ill but has not been decertified.)

Should the social pensioners also belong to a medical scheme, they will be regarded as full paying patients.

H0 P(S)

We Page 1

Civil Pensioners are classified according to their income under subsidized patient category. Those that belong to a medical scheme, they are regarded as full paying patients

Formally unemployed 8. Persons supported by the Unemployment Insurance Fund (UIF). Proof of unemployment must be produced.

H0 P (S)

Deceased unknown patient 9. An unknown, Unconscious patient who had been provisionally classified , who dies in hospital, and whom no particulars are known or obtainable must be reclassified as an HO

H0

4. Exempted patients Pregnant women 10. NOTICE 657 OF 1994, 1 July 1994As from 1 June 1994, free health services must be provided to :(a) pregnant and lactating women for the period commencing from the time the pregnancy is diagnosed to 42 days after the pregnancy has terminated, or if a complication has developed as result of the pregnancy, until the patient has been cured or the conditions as result of the complication has stabilized;(b) children under the age of six years;(c) Non-citizens of South Africa who are in the groups mentioned in Table 1: No 3 (a-d) and who incidentally develop a health problem whilst in South Africa.NB:*Free health services included the rendering of all available health services to the persons mentioned in above, including the rendering of free health services to pregnant women for conditions that are not related to the pregnancy.**The following persons are excluded from the free health services:(i) Persons and their dependents who are members of a medical scheme.(ii) Non-citizens of South Africa who visit South Africa specifically for the purpose of obtaining health care … section 3 (i) of the National Health Act .

HG P (S)

Termination of Pregnancy 11. Termination of Pregnancy Act No 92 of 1996.(a) Services in respect of the termination of pregnancy to be

HG P (S)

We Page 1

rendered free of charge and, if complications have developed as a result of the termination, until the patient has been cured or the conditions as a result of the complication have stabilized, under the following conditions:-

Upon request of a women during the first 12 weeks of pregnancy;

From the 13th to the 20th week of pregnancy if a medical practitioner, after consultation with the woman, is of the opinion that

continued pregnancy poses a risk to the woman’s physical or mental health

a substantial risk exists that the fetus would suffer from a severe physical or mental abnormality

the pregnancy resulted from rape or incest the continued pregnancy would significantly affect

the social or economic circumstances of the woman(b) after the 20th week of pregnancy if a medical practitioner, after consultation with another medical practitioner or midwife, is of the opinion that continued pregnancy would:

endanger the woman’s life result in severe malformation of the fetus would pose risk of injury to the fetus

Criminal Procedure Act 12. Criminal Procedure Act No 51 of 1977Services rendered in terms of the above act, as well as the following, when requested by the responsible authorizing body.(a) Assault: The examination of the alleged victim and

taking of samples and completion of the necessary documentation

(b) Rape: The examination of the alleged victim and taking of samples and completion of the necessary documentation

(c) Post mortem: The performance of Autopsies and

HG P (S)

We Page 1

attendance at exhumations.(d) Corporal Punishment: Preliminary examination for the

administration of corporal punishment by the Police Service and attendance at the administration at corporal punishment in prisons.

Child Care Act 13. Child Care Act No 74 of 1983, Section 15.Children who in terms of the above Act are committed to the care of a children’s home, industrial school or foster parents.

HG P (S)

Persons with mental disorders

14. Mental Health Care Act No 17 of 2002The examination of prisoners and detainees for medico-legal purposes with a view to their referral for observation in terms of the Act. Payment of services rendered to the mental care users are in terms of section 46 of the Mental Health Care Regulations.

HG P (S)

Infectious, formidable and/or Notifiable Diseases

15. Venereal diseases (excluding complications)m- only on an outpatient basis and including the following:(a) Syphilis, gonorrhoea, chancroid, LGV (lymphogranuloma venereum), non-specific urethritis, venereal warts, granuloma inguinale, ulcers molle, herpes genitals.(b) Pulmonary tuberculoses.(c) Leprosy.(d) Cholera.(e) Diphtheria.(f) Plague.(g) Typhoid and paratyphoid.(h) Haemorrhagic fevers.(i) Meningococcal meningitis.(j) Aids – All patients who are subsidized will receive treatment related to HIV and AIDS conditions free of charge. Note that all funded patients will pay for all services.(k) Persons suffering from the following diseases for treatment only relating to such diseases:

Malnutrition

HG P (S)

We Page 1

Pellagraall medical aid patients no free services Any other condition or service as determined by a province

Donors 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.

HG P (S)

Lodger 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

5.Provisional Classification REFERE TO SECTION 7 of this document.

We Page 1

ANNEXURE A REGISTRATION/ADMISSION FORM GPF 3Hospital Name Practice No: 56

PATIENTS DETAILSPatient File No:……………………………………………………………………Patient No. :………………………………………………………………………

ID Number :…………………………………………………………………Pass port/ Asylum no:………………………………………………………………Date of Birth :………………………………………………………………………

Surname : …………………………………………… Title……………….

First Names :.……………………………………………………………………Marital Status :……………………………………………………………… Gender :..…………………………………………………………………Race :………………………………………………………………………Nationality :……………………………………………………………………Citizenship :…................................................................................

Religion :……………………………………………………………………

Residential Address………………………………………………………………………………………………………………………………………………………………………………………………………………………………Postal code…………………Province :……………………………………………………..

Postal Address………………………………………………………………………………………………………………………………………………………………Postal code…………………………………….

Tel/Cell No:……………………………………

Next of Kin

Name:……………………………………………Address:………………………………………..…………………………………………………………………………………………………………

Relationship:…………………………………...

Tel/Cell No:……………………………………

EMPLOYMENT DETAILS

Employment Status :………………………Occupation:……………………Employee/Persal No………………………. Employer Name:……………………………………………………………………………………………………………….Address:…………………………………………..…………………………………………………………………………….Tel No:…………………………………………… Fax No:…………………………………………….

Income Details

Weekly Monthly Annually Number of Dependants:

Hospital ClassificationBread Winner

Spouse

Other(assets)

EMERGENCY CONTACT PARTICULARS

Patient brought in by:…………………………………………………………………Contact No……………………….

Emergency contact person:……………………………………………………Relationship…………………………….Address :………………………………………………………………………………………………….. ……………………………………………………………………………………………………Tel/Cell No ………………………………………………….....

PARTICULARS OF REGISTRATION PARTICULARS OF ADMISSION

Date of Visit …………………………………….Time ……………………………………

Service Point……………………………………

First Visit Follow Up

Referred by

Date of Admission…………………………Time…………………..

Admitting Doctor……………………………………………………..

Speciality Unity…………………………………………..................

Bed TypeICD10 Codes……………………………………………………………

Date of Discharge/Transfer…………………………………………..

Reclassification Date……………………From……….To………….

We

GP

Hospital

State Department

Clinic

Province Self

DAYHCICUGW Chronic

Page 1

PARTICULARS OF RESPONSIBLE PERSON/FUNDER FOR PAYMENT

Funder Name :…………………………………………….

Member No:…………………………………………………………………..

Med Aid Option:……………………………………………………………

Benefit Date from:………………………………………………………….

Authorization number:…………………………………………………..

Reference number:………………………………………………………

Funders contact person………………………………………………..

Telephone:…………………………………………………..

Documentation check list

Copy Income Salary Declaration Form

Copy of ID Proof of Social Grant

Copy of Medical Scheme or Documents from other funders

Patient advised to bring documentation on:Date:……………………Date……………………………Date……………REMARKS:………………………………………………………………………………………………………………………………………………………………..…………………………………………………………………………………......

Individual Details

Name:…………………………………………………………………Relationship to patient………………………………………………

ID Number:…………………………………………………………….

Postal Address(where account will be send)………………………………………………………………………………………………………………………………………………………………………………………………………………………………Code ……………..

Residential Address:…………………………………………………………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………..

Employment Details:

Employer Name:……………………………………………………..Address………………………………………………………………………………………………………………………………….………………………………………Tel: ………………………… Fax:…………………….Employee/Persal number……………………….

PARTICULARS OF ACCIDENTS/INJURY

Patient brought in by:………………………………………………………………………………Contact no. …………………………………………….

Mode of Transport (e.g. Car, Ambulance, Helicopter e.t.c):…………………………………………Vehicle Registration no………………………….

Date of Accident:………………….. Time of Accident:……………….. Place of Accident:………………………………………………………………………..

Short Description of accident………………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………………………………….

Patient was a: Driver Passenger Pedestrian

Description of Vehicle involved in accident…………………………………………………Vehicle registration no:…………………………………

TPH 99 Serial Number:………………………………

PATIENT CONSENT

We

Y

Y

N

YN

N

N

YY

Other Province

Y

N

Medical Scheme Foreigner

RAF SANDF

SAPS

COID DOJDCS

Page 1

I, the undersigned hereby grant permission that: The nature of my/the patient’s 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) ………………………………………………….Signature…………………………………Date…………………..

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

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 Value R ...........................................

The total value of my assets/income is R...........................................

We Page 1

_______________________ ________________________

Signature of applicant Date

_________________________ ________________________

Admitting officer Date

ANNEXURE C

DOCUMENTS CHECKLIST FORM GPF 5

NAME OF HOSPITAL:…………………………………………………………………

NAME OF PATIENT:………………………………………………………………

FILE NO:………………………………………………..

DOCUMENTS REQUIRED PROVIDED NOT PROVIDED

YES DATE NO DATE

COPIES: Identity Document

Drivers License

Birth Certificate

PROOF OF

INCOME:

Pay slip Medical

aid

Card

Departmental

documents

Pension

Card

Declaration

Form

PROOF

OF

RESIDENCE:

Municipality

Bill

Any Account

REMARKS:

CLASSIFICATION CORRECTED BY:………………………………………………………….. DATE:………………………..

We Page 1

DOCUMENTS REQUESTED BY:

1…………………………………………………………………Date:…………………… 2………………………………………………………………..Date:……………………

3………………………………………………………………..Date:…………………….

Supervisor:………………………………………………..Date:……………………….

We Page 1