so Y TE TINH KON TUMPHONG NGHI~P Vl) Y

CONG HOA xA HQI CHU NGHiA VI~T NAMDQc i~p - Tl}' do - Hanh phuc

Kon Tum, ngay jA thong s: ndm (to, 19

PHIEU TRiNHV~ vi~c cong b8 co' so' du di~u ki~n tiern chung cua phong .kham Da khoa va

tiem chung Hanh Tam tren Trang thong tin di~n tir SO'Y t~

Kinh trinh: Lanh dao So Y t@.

1.Tom t~t nQi dung c~n trinh:

Xem xet, phe duyet va cong b6 tren Trang thong tin dien nr So Y t@co so audi~u kien tiem chung.

Tom t~t no: dung h6 so nhu sau:

1.1.Thong tin v~ co' so':

- Ten co so: Phong kham Da khoa va tiem chungHanh Tam.

- Dia chi: s6 23 Hoang van Thu, phuong Quyet Thang, thanh ph6 Kon Tum,tinh Kon Tum.

- Nguoi dai dien co so: Nguy~n Thi Bich Ha- s6 dien thoai: 02603.835.479

1.2. Thanh phan hi>so bao gam:

- Van ban cong b6 co so du dieu kien tiem chung (dung, d~y du noi dungtheo m§.u quy dinh).

- Danh sach nhan sv lam vi~c t';li phong tiern chung v~c xin dich V\l, kemban sao chlmg nh~n tham dl,J t~p hu~n v~ tiem chung, hqp d6ng lao dQng, chungchi hanh ngh~, b~ng t6t nghi~p trung dip chuyen nghi~p tra len.

- Bi:m ke khai trang thiSt bi phong tiem chung v~c xin ciich Vl,l.

- Ban ke khai co sa v~t ch~t, nhan Il,l'c.

- Gi~y phep hO';ltdQng kham b~nh, chi:i'a b~nh .

. 2. Y ki~n d~ xufit cua ngU'()i trinh:

H6 so d~y du, dung theo quy dinh t';li f)j~u 9, M\lc 3, Chuang II Nghi dinh s6104/2016/Nf)-CP ngay 0117/2016 cua Chinh phu quy dinh v~ hO(;ltd9ng tiem chungva Nghi dinh 155/20181ND-CP ngay 12/1112018 sLrad6i, b6 sung m9t s6 quy dinhIi,enquan dSn di~u ki~n d~u tu kinh doanh thu9c ph';lm vi quan Iy Nha nu6c cua B9 Yteo

1

3. Y ki~n ella Truong phong:

Da kiSm tra, reiscat hE>sa dam bao thea dung quy dinh cua thu tuc hanh chinh"Cong b6 co sa du dieu kien tiem chung" duoc ban hanh tai Quyet dinh 3871QD­UBND ngay 23/5/2019 v~ viec cong b6 thu rue hanh chinh moi 'ban hanh; sua d6i, b6sung, thay thS va bai bo nganh Y tS thuoc tham quyen giai quyet cua co quan hanhchinh nha mroc cac cap tren dia ban tinh Kon Tum.

Kinh trinh lanh-dao So' Y tS xem xet, phe duyet viec cong b6 tren Trang Thongtin dien nr So' Y tSI

NGUOI TRiNH

Nguy~n Le Thuy H~nh

No'i nhiin:- Lanb dao So Y t~;- Trang Thong tin dien tu' So' Y t~;- Luu: Phong chuyen mon.

LANH f)~O SO' Y TIt

f)~ng Cong Lan Tr~n Ai

2

sa Y TE TiNE KON TUMCONG TY TNHH MTV Y

TE H';'NH TAM

CONG HOA xA HOI CHU NGHiA VI:E:TNAMDQc I~p - Tl}'do - Hanh phuc

Kon Tum, ngay .~~thang ..11nam 2019

CONGBOCO' SO' du di~u ki~n ti(~mchung

Kinh giri: Sa Y t€ tinh Kon Tum

Ten co sa thong bao: Phong kham Da khoa va tiem chung Hanh Tam - Congty TNllliMTV Y t€ H?nh Tam

Via chi: 23 Hoang Van Th\l, p. Quyet Th~ng, Tp. Kon Tum, tinh Kon Tum;Nguoi dung dfiu co sa: Nguyen Thi Bich HaDien thoai lien he: 02603.835.479Can cir Nghi dinh s6 104/20 16/NV-CP ngay 01 thang 7 nam 2016 cua Chinhphu quy dinh v~ hoat dong tiem chung.Can cir Nghi dinh 155/20 18/NV-CP ngay 12/11120 18 v~ viec sua d6i b6 sung

mot s6 quy dinh lien quan d€n di~u kien dfiu tu kinh doanh thuoc pham vi quan lyNha mroc cua B9 Y t€.

Kinh d~ nghi Sa Y t€ xem xet, dang Uti thong tin theo quy dinh.

PHU TRAcH PHONG KHAM BENH. .

Nguy~n Thi Bich Hit

so Y TE TiNH KON TUMCONG TY TNHH MTV

Y Tit H';'NH TAM

CQNG HoA xA HQI CHU NGHiA VI~T NAMDQc l~p - Tl}' do - Hanh phuc

S6: Ot ICV -PKDK Kan Tum, ngay } I thdng Ifl.nam 2019

Kinh gui: Sa Y tS tinh Kon Tum.

Phong kham Da khoa va tiem chung Hanh Tam thuoc Cong ty TNHHMTV Y tS Hanh Tam kinh trinh Sa Y tS tinh Kon Tum xem xet v~ viec d~ nghicong b6 lai co sa kham benh, chua benh du di~u kien tiem chung voi 1y do co SO'thay d6i mo hinh t6 clnrc til' phong kham chuyen khoa sang phong kham da khoa( Co ta trinh xin cong b6 co sa auai~ukien tiem chung kem thea).

Kinh trinh Sa Y ts Kon Tum xem xet va dang tai tren Trang thong tindien nr theo dung quy dinh,

PHV TR.ACH PHONG KHAM

Nguy~n Thi Blch Hit

-- - --------

so Y TE TiNH KON TUMCONG TY TNHH MTV Y TE

H~NHTAM

CONG HOA xA HOI CHU NGHiA Vl¢T NAMDQc l~p - Tl}'do - Hanh phuc

Kon Tum, ngay .... thong .... nam ....

PHl}Ll}C 1Bang ke khai nhan s,! cua phong tiem chung vic xin djch VI} tai Phong kham Da khoa va tiem chung Hanh Tam

Dang hanh ngh~ tai co sO'khamSTT HQ va ten Trinh dQ S6 clumg chi ThiYi gian Vi tri chuyen benh, chfra benh khac

ngrriYi hanh chuyen hanh ngh~ da dang ky lam " Ko Co:monngh~ " drrQ'c c§p vi~c tai co sO' ThiYi Dia di~m Vi trimon

tiem chiing gian chuyen"mon

1 Nguyen Thi Bac sy 0000791KT- Toan thai Phu trach chung XBfch Ha Chuyen CCRN gran vS chuyen mono

khoa Noi

2 V5 Minh Duc Bac sy 0001611KT- Ngoai gio +Kham, sang loc, Trong Trung Bac sy dada khoa CCRN hanh chinh tu vfrn, theo doi gia tam phap khoa, kham

Cap ngay tre, va xu tri phan hanh y tinh diSu tri,30/8/2012, va

ung sau tiem. chinh Kon Tum thuc hi~ngifry chung cac chuang

nh~n t~p hufrn tri~ y t~vS tiem chung quoc gia.

PHVTRACHPHONGKHAM

+Cho y lenh thirchien cac ky nangtiem chung

3 Truong Thi Bac sy 0018081KT- Ngoai gio +Kham, sang loc, Trong Trung Bac sy daMyH:;tnh da khoa CCRN hanh chinh nr van, thea doi gia tam phap khoa, kham

C~p ngay tre, va xu tri phan hanh y tinh diSu tri,25/4/2016, va img sau tiem chinh Kon Turn th1JChiengiay clurng +Th6ng ke bao cac chuangnhan tap huan cao trinh y tSvS tiem chung

4 Vfi Van Duc Dieu 00 19451KT- Ngoai gio +Tiep don benh Trong B~nh Dieu duongduang CCRN hanh chinh nhan, cham soc gia vien da trung hoc

C~p ngay nguoi benh. hanh khoa tinh14/6/2016, va +Th1Jchien cac chinh Kon Turngi~y clnrng ky thuat vS tiemnhan t~p hu~n chungvS tiem chung

5 Nguyen Ngoc Dieu 0012521KT- Ngoai gio +Tiep don benh Trong B~nh Dieu duongAnh Thy duang CCRN hanh chinh nhan, cham soc gia vien da trung hQcda

trung hQc C~p ngay nguai b~nh. hanh khoa tinh khoada khoa 27/09/2013, +Th1Jchi~n cac chinh Kon Turn

va gi~y chung ky thu~t vS tiemnh~n t~p hu~n chungvS tiem chung

Nguy~n ThjBiehHit

SO Y TE TtNH KON TUMCONG TY TNHH MTV

Y T:E H~NH TAM

CONG HOA xA HOI CHU NGHiA VI¥T NAMDQc l~p - T\f do - Hanh phuc

Kon Tum, ngay ... thang ... nam 2019

BAN KE KHAI CO Sa v~T CHAT, NHAN Ll/C, THIET BI YTE CUA CO sa TIEM CHUNG

I.Ph§n ke khai v~ coo sO'v~t ch~t cua co sO'tiem chiing cB djnh

a. Coo sO'v~t ch~t:- Dien tich mat bang : 153.6m2

- T6ng dien tich xay dung: 141.6m2 dien tich 21m2/giuOng benh

- K@tc~u xay dung nha: nha 5 tang

b. Di~n tich cac khu v1!c, phong chuyen mfin:

- Khu V\fCdon tiep, phong cho: 27 m2

- Khu V\fCkham tir van, phan loai: 8 m2

- Khu V\fCthirc hien tiem chung :8 m2

- Khu V\fCthen doi va xu tri phan img sau tiern chung co dien tich 15 rrr'- Khu V\fCcong trinh phu, nha v~ sinh: 10,lm2

c. BB tri cac khu V1!Ctheo nguyen t~c m{>tchieu:

* Khu V\fCtiem chung bao dam che duoc mira, nang, kin gio, thongthoang va b6 tri then nguyen tic mot chieu nr don tiep, huang dan, tir van, khamsang loc, thirc hien tiem chung, theo d5i va xu tri phan Ung sau tiem chung:

- Khu V\fCng6i cha truac khi tiem co d~y du gh@ng6i;

- Khu V\fCth\fc hi~n tu v~n co ban, gh@ng6i duQ'c ng[m nhom kinh cao2.5m cua dong khi ra van dam bao kin dao;

- Khu V\fCth\fc hi~n tiem chung co d~t °1 cai ban a cua ra va~;

- Khu V\fCthen d5i va xu ly phan Ung sau tiem duQ'cb6 tri giuOng n~m vaco d~y du trang thi@tbi then d5i then dung Thong tu quy dinh.

* Quy trinh kham chua b~nh:B~nh nhan van phong cha ng6i dQ'itru6c khi tiem chung. Khi d~n luqt,

b~nh nhan d@nban don ti@pse duQ'chuang dan, Bac sy kham sang lQcva tu v~ntruac khi tiem. Sau do b~nh nhan duQ'chuang d~n sang phong tiem, t9-iday b~nhnhan duQ'c diSu duang da khoa (duQ'c t?P hu~n vS tiem chung) tiem vic xin vadua van khu V\fCthen d5i va xu tri tai bi@nsau tiem chung dong ghi van s6 thend5i tiem chung. Vi~c kham va tiem v~c xin do Bac sy va cac ky thu?t chuyenmon v~ di~u du6ng dam nh~n trong ph9-mvi h09-td(>ngquy dinh trong gi~y phep

hoat dong kham benh. Hoan t~t cac qua trinh tiem chung, benh nhan thanh toanphi.

d.Cac di~u ki~n v~ sinh moi trmrng:

+ Xu ly mroc thai: H~ thong thu gom mroc thai Y tS ( mroc thai sinh hoatcua benh nhan, y bac sy, thu thuat, phong xet nghiem, ... co chua nhiSu hoa chat,cac vi khuan gay benh) se diroc thu gom bang h~ thong rieng re voi h~ thongmroc rmra.Nuoc thai sau khi duoc thu gom vS bS chua tu hoai, xu ly qua bSchua bang vi sinh, bS lang tnroc khi thai ra moi tnrong.

+D6i voi rae thai Y tS: co hop dong voi DNTN LQcHoa dS xu ly rae thai ytS, co so co trach nhiem thu gom, phan loai dong bi nilon, v~t s~c nhon bo vaohop an toan dam bao van chuyen an toan, dam bao dung theo qui dinh vS raethai trong y tS, co lap s6 giao nhan voi nguai quan ly rac thai b~nh vi~n.( kerntheo Hqp d6ng s6 49IHDKTT ngay 01/07/2019).

+ D6i vai rac thai sinh ho~t: co sa thu gom t~p trung vao thimg rac congcQng dS Cong ty C6 ph~n Moi truOng Do thi Kon Tum thu gom va xu ly ch~tthai r~n sinh ho~t theo dung quy dinh.

+ Ch~t thai sinh ho~t thong thuOng duQ'cthu gom, luu tru rieng, hqp d6ngvai cong ty V~ sinh moi truOng do thi thu gom hang ngay.

II. Ph~n ke khai nhan Il!c cua CO' sO-tiem chung

- Bac sy Nguy~n Thi Btch Ha chiu trach nhi~m ph\l trach chung vSchuyen mon;

- Bac sy Vo Minh Duc chiu trach nhi~m kham, sang lQc, tu v~n, theo doitre, va xu tri phan Ung sau tiem; Cho y l~nh th\1'chi~n cac ky nang tiem chung.

- Bac sy Truang Thi My H~nh chiu trach nhi~m kham, sang IQc, tu v~n,theo doi tre, va xu tri phan Ung sau tiem; Th6ng ke bao cao

- DiSu duang Vil Van Duc, Nguy~n NgQc Anh Thy chiu trach nhi~m tiSpdon, cham soc b~nh nhan, th\1'chi~n cac ky thu~t vS tiem chung.

III.Ph~n ke khai v~ thi~t bi y t~ cua CO' sO-kham b~nh, tiem chung

Ky hi~u Hang Xu~tNam s6

STT Ten thi~t bi san sanTinh tr~ng su Ghi

(MODEL xu dl}ng (%) chuxuAt xuAt

1U'Q'ng)

May huyst SwelabBoule

Th\lY1 Medical 2018 01 T6t, mai

hQc 23ts Alfa Plus DiSnAB

2 May sinhMONAR Biorex Anh 2018 01 T6t, mairl-l - ni~an{)<;:

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hoa tu dong MODULE tics-1000

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May pt mroc MisionU120

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Dominus

May sieu ammau 2D. 3d~u do ( DopplerLiner,

conver, san)

May sieu ammau 4D. 4d~u do (Liner,

conver, san

May dientim

CM300

May dodirong huyet

Accu ceckactive

May noi soida day, daitrang (Gd 2nang cap)

2600

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2019 01 T6t, moithuat G2-3 OneM Quoc

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17 Riester Duc 01 T6t, moikhiquan standard

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NgU'o; dung diu CO' sO' kham b~nh, tiem chiing

Nguy~nThj Blch Hit