XLS《诊所》

"附件3",,

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"苏州市区社会基本医疗保险定点医疗机构协议管理现场核查表(诊所)",,

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"年月日",,

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"单位名称",,

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"统一社会信用代码",,

"注册地址",,

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"法定代表人或负责人姓名",,

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"执业许可证号",,

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"单位社保编号",,

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"联系人",,

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"联系电话","固话", ,,

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,"手机", "核查项目",,

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"核查标准","核查要点","核查情况" ,,

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"1","资质证照","《医疗机构执业许可证》或《备案证》",,

"1.

相关证照齐全;

2.证照在有效期间内;

3.证照许可内容、发证机关真实有效4.在2018年6月30日(含)前取得卫生行政部门认定的医疗执业资质并已正常营业","1.查验医疗机构相关证照原件2.有等级的医疗机构,查验相关证明材料", ,,

"《营业执照》或《民办非企业单位登记证》或《事业单位法人登记证》",,

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"卫计行政部门出具的等级医疗机构证明材料",,

,"无等级医疗机构无需查验此项", "2","科室设置",,

"诊室","必设","1.查验《医疗机构执业许可证》等资质证件原件2.查看内部科室设置实际情况", ,,

,"治疗室","必设",,

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,"处置室","必设",,

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,"选设1",,

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,"选设2",,

, "3","人员配备","执业医师","执业满5年执业医师","至少有1名取得执业医师资格,经注册后在医疗、保健机构中执业满5年,身体健康的执业医师","查阅各类人员资质原件", ,,

,"其他执业医师",,

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"护理人员","注册护士","至少1名",,

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,"其他护理人员",,

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"医技人员","所设医技科室专业卫技人员","如设有医技科室的,每医技科室至少有1名相应专业的卫生技术人员",,

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"4","房屋状况","服务面积","实用服务面积","应达到200O","1.查阅房屋产权权属证书及租房协议书2.现场实测", ,,

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"房间布局","每室独立","每室独立且符合卫生学布局及流程","1.查验《医疗机构执业许可证》2.查看机构内科室设置实际情况", ,,

,"治疗室、处置室、观察室使用面积","治疗室、处置室的使用面积均不少于10O,如设观察室,其使用面积不少于15O","现场实测", "5","设施设备","基本设备","诊桌等(详见表后备注)","应配备","现场查看", ,,

"其他设备","与开展的诊疗项目相应的其他设备","应配备相应设备,其中,临床检验、消毒供应与其他合法机构签订相关服务合同,由其他机构提供服务的,可不配备化验室和消毒供应室设备",,

"6","规章制度",,

"诊所工作制度","具有国家统一规定的各项规章制度和技术操作规范,制定诊所人员岗位职责","现场查看", ,,

,"人员岗位制度",,

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,"技术操作规范",,

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"7","诚信情形",,

"一年内是否因严重违规受过市其他相关行政部门的行政处罚情形","一年内未因严重违规受过市其他相关行政部门的行政处罚","1.查看一年内是否存在因严重违规受过市其他相关行政部门的行政处罚情形2.查验《江苏省社会法人信用信息查询报告》原件", ,,

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,"法人是否存在严重失信行为情形","法人征信报告不存在严重失信行为",,