e-' c tqnh }[u-i: uy so-yteban nhan dantinh hoa binhtinh...

TAP BOAN VINGROUPQUY THIEN JAM

So: 10-CV/20I7-QTTV/v: Quy Thi$n Tarn tai trqiphau thugt tgi

he thong B4nh vien Da khoa Quoc le Vinmec

SO Y C I II :;iNH

CQNG HOA XA KQI CHU NGHIA VIET NAMD6c lap - Tur do - Hanh phuc

HaNQi,ngciy 24 thdng 4 ndm2017

A/ e-' C TQnh }[u-i: Uy ban Nhan dan tinh Hoa BinhT So- Y te tinh Hoa Binh

ChuyeiTNgay..,2^/.jr!/20^ Hoi ChQ-Thap Do tinh Hoa Binh

LtAihosdso: Quy.Thien T;Im (thuoc Tap dean Vingroup) xin giii tai Quy Ca quan lai chiic suekhoe va lai chao tran trqng nhat.

Quy Thien Tarn la mot t6 chuc tu thien - xa hgi thuoc Tap doan Vingroup, boatdong phi Igi nhuan vdi nhiem vu xay dung, trien khai cac chuang trinh nhan dao, tu thienva van hoa... Tir khi thanh lap vao nam 2006 den nay, moi nSm Quy deu da trien khai ratnhiSu cac boat dong tai trg cho cac dja phuong trong toan quoc vai nhieu ITnh vuc nhuAn sinh xa hoi, xoa doi giam ngheo, den an dap nghTa, phong chong thien tai, xay dungcac cong trinh y te, giao due, van hoa... vdi tong so tien tai trg hang nam len tdi tren1.000 ty dong.

Trong ke hoach boat dong nam 2017, vdi muc dich ho trg cho cac benh nhanngheo, ngudi c6 cong vdi each mang va nhung ngudi benh khong du kha nang tai chinhdugc phau thuat tai cac Benh vien Vinmec tren toan quoc (bao gom cac Benh vienVinmec tai Ha Ngi, Ha Long, Nha Trang, Phu Quoc, TP. Ho Chi Minh), Quy Thien Tarntiep tuc d^h ngan sach de thgc hien "Chuang trinh tu thien 1.500 ty dong nham ho trgphau thuat tai cac chuyen khoa tien tien nhat cua he thong Benh vien da khoa Quoc teVinmec". Theo ki hoach nay, tat ca mgi boat dOng kham, phau thuat sS dugc thuc hi?ntrue tiep bdi cac y bac sT gidi, cac benh nhan se dugc hudng che dg kham, phau thuat,dieu tri, dieu duong theo dung tieu chuan 5 sao quoc te cua Vinmec.

(Chi tlet Dank muc l<y thugt y te duac ho trg theo chuang trinh tgi moi benh vienvd huang dan ve chinh sdch ho trg, hu&ng dan Idm ho so gui kem theo van bdn).

DI viec lam y nghia nay phat buy hieu qua thiet thgc nhat, danh cho dung doitugng, Quy Thien Tarn rat mong nhan dugc su phoi hgp va tao dieu kien h6 trg cua QuyCa quan trong viec chi dao cac cap tai dia phuong de lua chon nhung benh nhan phu hgptieu chi va gui ho so cho Quy Thien Tarn.

Quy Thien Tarn rat tin tudng, su hgp tac, giup dd ciia Quy Co quan se khongnhdng dem lai thanh cong, hieu qua tot dep cho Chuang trinh ma con la nguon dgngvien, CO vu Ian doi vdi nhung boat dong mang tinh cong dong ciia chung toi.

Xin tr^ trong cam an!

Noi nh|in:- Nhu kinh gui;- Lifu QTT.

GIAMDONG

QUAN

TAM

Tuan

Tai li^u gu'i kem:Phu luc 01- Danh muc ky thu^t chuyen mon y te duac ho trgPhu luc 02- Mau dang ky, Quy dinh ve ho so

Dja chi va thong tin Hen lac cua Quy Thien Tarn - TSp do^n Vingroup:- Dia chi: S6 7 duong Bang L5ng 1, phucmg Viet Hung, qu^ Long Bien, Ha Ngi• Email cua chuong trinh: info@,quvthientam.com• So dien thoai hotline: 0938889639

A/

QUf THtEN TJfiVl

HOI DONGPh^ iucOl

T CHUYEN MON TRONG CHlTCfNG TRINH TtTXHIfN • QUY THI$N TAMThuc hj?n t?i B?nh vien VINMEC TIMES CITY{458 Minh Khai, Vinh Tiiy, Hai Ba Trimg, Ha riQi)

(Kem theo cong van)

STT Ten djch vu ky. thuSt

I. TIM MACH

A Ngoai Tim m^ch Phlu thu$t l6ng ng\rc

1 D$ng mach chii

2 M6 tim bdm sinh va Van

3 B?nh 1^mach maungio?! biSn

4 B?nh long ngyc, u ph6i, u trung thdt

5 M6 bdc cdu CABG, D§ng mgch vînh

B Can thiep tim mach (1 Stent)

1 Chup vk can thifp m?ich

2 Chup va can thifp m^ch mdu nSo (Dpng m?ch c^, dpng mîch dot song ngoai sg va trong sg)

3 Thay van dgng m^ch chd qua da (TAVI)

4 Bit duTim bam sinh (bit thong lien nhl, thong lien that, c6n 6ng dgng mach)

5 Can thigp ngi mach d^t Stent Graft Dgng m^ch chu trong diû trjcac bgnh ly ve Dgng mach chu ngyc, dgng mach chu bung,

6 Cay may tsio nhjptimvinhviln

11. UNG Bi/caj

A Ung thir Nlii

1 Unguyen bao thin kinh

2 U nguyen bao Gan

3 U nguyen bô v5ng mac

B Ung thir ngu-M Idn

1 U Lympho

2 Ung thu vu

3 Ung thu Phy khoa

4 Ung thudubng tieu hoa(6ng tieu hoa v^Gan Mat Tuy)

5 Phat trien ky thuat xatrjmdi: phlukhung c6djnh than (SBRT), Xg trjd6ng bO h6a theo nhjp thd.

III. Y HQC TAITAO

I BN Ghep TBG Dieu trj teo m$t

. 2 Ghep TBG Dieu triR6i Ipan cothat sau in6 tho^t vj mang nio tiiy

3 Ghep TBG Dieu trj Roi loan than kinh rupt

' 4 Ghep TBG Dieu trj lo?in san phot So sinh

5 Ghep TBG Dieu trjBenh phoi tic nghen COPD

6 Ghep TBG Dieu trj NhSi mau nao

7 Gh^p TBG Dieu trj B|nh Thalassemia

8 Ghap TB Milndich

9 Ghdp TBG Dieu tri B^ nao

10 Gh^p TBG dieu tri xo gan do nipu

n Ghep TBG dieu trj t^rki

12 GhepTBGdieutri tieu duOTg Tu^ 1

IV. GHEP Ti^NG

1 Ghep th^n

2 Ghep Gan

N

|>-'

NH6 TR<? PHAU THUAT TAI Hf TH6NG B$NH VIf;N DA KHOA QU6cTfc VINMEC

NHVEHO SO BENH NHAN VA CHINH SACK h6 TRQQUAN

STT

\

Loai gily tb

/ VHyngheo/c|nngheo/ khdkhSn

HS trp' 100%viSn phfbaogom Thuoc va Vat liry ti

Ngircri c6 cong v61cdch mangHo trpf 70% vl|n phi baogim Thuic vi Vlt tiry te

Doi tupug khtaHStr9'10%-70%viln phi(tLiy lirng nhdm djch vg V

tl)

Veu ciu Khtahh4ng nop cho

Vinmec khi dinkhAm

Hi so HA so Hd so

1Don dang kyiheo miu (gOikem tî Phg Igc 02)

Ban scan Ban scan Bdn scan BAn gOc

2 Chung minh nhan dan Ban scan Ban scan Bta scan Bta sao cAng clnhig

3 Sohpkhiu Ban scan Bta scan Ban scan Bta sao cSng chung

A The BHYT ciia b?nh nhSn Ban scan the BHYT hAnghdo.Ban scan The bao hiim y techo ngubi c6 c6ng

Ban scan Thd b4o hiim y teNApban photocopyva mang bta chlnhdl dAi chilu

5

GiSy chtrngnhgn, giSyxdcnhSn hd nglieo, cSn nghdo,hp c6 iioan canh dac biStkho khan, ngubi c6 c6ngvdi each mang,

Ban scan so hAnêo/cpnnghta, chimg nhgn hpngheo/cpnngheo/ hp c6 hotacanh d|c bi?t kho khta

Bin scan The hojc giay lAchiing nhta la thuongbinh,bAnhbinh, nguoi huAngchinh stah nhu thuong binh,LSo thanh each mang, B4 mpViAtnam Anh hiing

Bta sao cOng chOng

6

Hosabfnhan baogom:

1. Thong tin ve tien sir b?nh.2. Thong tin bpnh sii.3. Ket qua tham kham, chindodn (H6 so benh an).4.Kit qua c?nlam stag (X6tnghiim, Chan dota hlnhtah).

Ban scan Bta scan Ban scan Bta photocopy

H6 scrgui vS qua Email: [email protected] ho|c qua biru difn theo dja chi: S6 T-Dirfrng B3ng LSng- Khu d6 Ihi sinh thii VinhomcsRiverside- Phirimg Vl|t Hung- Qu§n Long Bien- Hk NqiSS dicn thoai hotline cua chutmg trinh: 0938889639Liru v: h6 sogiiri v6 chirong trlnh sS duyc thSm djnh ho4n c4nh v4 tham dinh chuyen ra6n, saudd chuvng trinh sS thOng tinden ngudî b|nhketqua xirly hS so.

QUfTHTgNTAM

AT

HOI DONG

'?,V QUAN LYU DON DANG KY

**#_

Hp vl tSn: Ngay th^g nam sinh:

Lit doi tupng:

So CMND hoac Hp chieu:NgiiY cap:

Ncri cap:

Gicfi ti'nh: Can n^ng:

Hp khau thucrag tni:

Djachi hien tai;

S6 dien tho^i

86 the Bao hiem v te (neu c6):

Lo^i benh (theo chart dean):

Hoan cSnh bj benh:

Ten Bfnh vien/ca sa Y tS (neu ten & dia chi):

Tieu sur bpnh dS tCmg dieu tri, cac thu6c da/ dang stidpng:

Tinh trying berth hien nay:

Hoan canh kinh tl

NgirM llm don(Ky & ghi ro hp tin)

QUAN

qu?thi$-ntAm

DAN VIET DON DANG KY(Dinh kemphu luc 02)

Hpva ten: NguyinVanA Ngay thang nam sinh: 01/10/1982

La doi tupng: Hp ngheo

S6 CMND hoac Ho chik: 112494666

Ngay cip: 12/2/2012

Noi cip: Cong an TP HaNoi

Gidi ti'nh: Nam Can nang: 56 Kg

Hp khau thuong tni: Thon ....Xa...Huyen.... TP HaNgi

Dia chi hientm: Than:... Xa:....Huyen....TPHaNoi

So dien thorn 043974XXX 096772Ixxx

So the Bao hi6m y t6 (n6u c6): HNxxxxxxxxx

Loai bpnh (thee chindodn): Havan2 Idngng...

Ho^ c^nh bi benh: Bdm sink

Ten Benh vien/co sdYte tiip nhan (neu ten & dia chi):Benhvi^n Da khoa Quoc ti Vinmec Times City( 458MinkKhai, Vinh Tuy, Hai Ba Trung, Ha

noi)

Tieusii benhd§tumg diSu trj, cac thuoc da/ dangsiidung:

Da timg mo tgi Benh viin ....Bi di ung vai thudc...

Tinh trang bSnh hi?n nay:C6 chi dinhphdu thugt.... nhimgchua c6 tiin

de Idm....

Ho^ c&ih kinh teHq ngheo, lam nghe nong, thu nhgp thdp 3

triiu/ thdng,nu6i 5 khdu.

Nguoi lam don(Ky & ghi ro hg tin)

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BQYtE

V/v Qu^ ThiSii Tto tai trg' pliliiVtbu?t inicn phtt '̂i h? tii6ng:B|rih

viîi da kboa qu6c tl Vimec^

CONG HOAXAiHOj GHU^GHU VI?;T NAiV©^c;T§p - Tu' do - Hanii pliuc

idm 2016

KiniigiM:- So YtS c^c tinh, thanli ph6 t^c thugc trung irang- Benh vien true thuflc Bo Y tS

- Y te ngkili

. J ta nlian dugc cong van.s6 10-CV/2,016-QTT ngay 17/10/2016 cua C1higii Iam thugc Jap dean Vingrbup ve viec trlen khai Cliuong trinh jdIiIu th^^vmiSn phi' tai he thSng Bgnh vi|n,da:klioa quoc td Yinmec tren to^ quoc. cho ngiralbgnh nghtto eo hoan eanh dac biel kho khan gmi (Io9n:2016-20i7, sau day goi tSCliuang trinh phau thuat mien phf (C6ng;Van'40-CV/2016-(51T va cWng irchi tiet dugc guikem theo). /

Be taug cu^g tiep can^vai" dich vy phauiliugt mien phf va hieu qua Iri^nicChuongtrinh phauthuat miSn phi Bgnfi vien da khoa quocti'Vimtren toki qiiqc chqmîrdti b|nh ngh^g^ct -HMii bahlr. d?c bigj kho khSii giafedc2016-2017,Bg Ytg^denghi: " . fa, •

1- Cac bgnh vign,h-vrc tHuSeBgJuiichbnrrigucri':^^^^ hgp vbijiieu chi.Chucmg trinh phlu thu|t: milri phi dS giai tliieu, chuvSn ngudf benh t6i Quy ThTarn de dugc ho trg kham» ch&a b|nh.

2. Scf Yti cac ,tinh,^thanh ph6, ytingmh-.chi dao cac ca sa kham benh, ohbenh trong tinh lua, chgn cac nguM, benh phu hgp voi tieu chi cua Chuong. tr:,phau thuat mien phi de' gidi ihieu, ^huyln, ngudl b?nh tdi Quy thiSh Tarn de dih6trgkhdm,-chijabSnh. " '

. b^nhpho! hgpv^ cung dp glcthShg tin vitftisô cfiepjai ligu hjso bdh,an cOa ngubl benh (tlieo yeli cd ck/Qhuangitr 3'phau thuit inien phi iren co sg phu hop vdi cao. quy dinh phap lu5l hifil hanh) -'6Quy "Tluen Tdm va h| thong/Bfnh vidr^d KKoa qu6c te Vihinec trSh toki qdtrong trlen khai Chuong trinh.phiu thi4t,mTenJhi/J , ' • I

trghg carn-gn.

nltgn:T.tslur iren;- trirftigNguylnThi kihufiin cdbTi• Luu;VT.KCB. " ' "

Cfcan? Oiii: BO Vli , -KgAyky: 52/12/2016 16:49:22.KO ll.unsVOnic«DO V 7c

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Nguyen Viet Tieh

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e-' c tqnh }[u-i: uy so-yteban nhan dantinh hoa binhtinh...

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