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Amended Patient Classification Policy Manual

TABLE OF CONTENTS

PAGE

i. Index

1. Introduction

2. Purpose

3. Patient classification

4. Out Patients

5. In patients

6. Provisional classification

7. Erroneous classification

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
20-21
Annexure B: GPF 3
22

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Declaration Form
Registrations and Admission Form

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i. Index
Definitions 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.

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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 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

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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;

1. Introduction
Gauteng 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.
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NB: This document replaces the Patient Administration Procedure


Manual on Classification of Patients par. 10.1.9

2. Purpose
The 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.

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 patients
b) 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 Patients
This 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 patients

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In 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 Patients
Patients 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.

(d) Exempted Patients


In 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 and
Persons 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 Document
b)Medical aid card
c)Appointment card
d)Pay slip/ salary advice
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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 patients 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
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.

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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.

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.
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(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 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

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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 patients 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.

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(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

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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.
(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.

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


CLASSIFICATION

GROUP

DESCRIPTION

1.Full Paying Patients

Externally Funded
Patient
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)
A medical scheme registered in terms of the
Medical Schemes Act, 1998 (Act No 131 of 1998).
The Compensation for Occupational Injuries and
Diseases Act, 1993 (Act No 130 of 1993),
Patients treated on the account of another
province (cross border)
Patients treated on the account of another
state department:
(a) A South African National Defense Force
patients
Any 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.
b) South African Police Service (SAPS)

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CLASSIFICATION
Patient treated
Patient treated by
by Medical
Private Medical
Practitioner on
Practitioner
duty
PH (RAF)

PH (M)
PH (COI)
PH (CRB)

PH (DOD)

PH (SAPS)

c) Department of Justice (DOJ)

PH (DOJ)

(d)Department of Correctional service (DCS)

PH (DCS)

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P (M)

2.Subsidized Patients

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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 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.

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

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

P (S)

PH (F)

P (F)

H1

P (S)

The following Tariffs are to be charged as per


provincial Gazette Extraordinary for Revised
Tariffs: Dialysis, Medical Reports, Inpatients,

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Consultations,
Cosmetic
Surgery,
Assistive
devices, Treatments, Radiation Oncology and
Nuclear Medicines.
(c) Individuals with
Income less than R72
000 per annum.
(d) Household with
Income less than R
100 000 per annum

(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

3.Free Service

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Social pensioners

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, Consultations,
Minor
Theatre
procedure,
major
Theatre
procedures, Treatments, Emergency Medical
Services, Assistive
Devices & Prosthesis,
Cosmetic
Surgery,
Radiation
Oncology,
Ambulatory Procedures
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.
7.

Recipients of the following types of


pension/grants are
classified
as social pensioners and receive
all services free of charge:

Old age pensioners

H2

P (S)

H3

P (S)

H0

P(S)

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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.
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
Deceased
patient

4. Exempted
patients

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unknown

Pregnant women

8. Persons supported by the Unemployment


Insurance Fund (UIF). Proof of unemployment
must be produced.
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

10. NOTICE 657 OF 1994, 1 July 1994


As 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

HG

P (S)

H0

P (S)

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Termination of Pregnancy

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

HG

P (S)

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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 womans life

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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 1977


Services 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 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.

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Child Care Act

13. Child Care Act No 74 of 1983, Section 15.

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Persons with mental


disorders

Infectious, formidable
and/or Notifiable
Diseases

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Children who in terms of the above Act are


committed to the care of a childrens home,
industrial school or foster parents.
14. Mental Health Care Act No 17 of 2002
The 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.
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
Pellagra
all medical aid patients no free services Any
other condition or service as determined by a

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Donors

Lodger

5.Provisional
Classification

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province
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.
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.

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REFERE TO SECTION 7 of this document.

Page 1

ANNEXURE A

REGISTRATION/ADMISSION FORM

Hospital Name

GPF 3
Practice No: 56

PATIENTS DETAILS
Patient File No:Postal Address
Patient No.
:

ID Number
:
Pass port/ Asylum no:
Postal code.
Date of Birth :
Tel/Cell No:
Surname
: Title.
First Names :.
Marital Status :
Gender
:..
Race
:
Next of Kin
Nationality
:
Citizenship
:................................................................................
Name:
Address:..
Religion
:

Residential Address

Relationship:...

Tel/Cell No:
Postal code
Province
:.
.
EMPLOYMENT DETAILS
Employment Status :Occupation:Employee/Persal No.
Employer Name:.
Address:...
Tel No: Fax No:.
Income Details
Weekly
Bread Winner
Spouse
Other(assets)

Monthly

Annually

Number of Dependants:
Hospital Classification

EMERGENCY CONTACT PARTICULARS


Patient brought in by:Contact No.
Emergency contact person:Relationship.
Address
:..

Tel/Cell No
.....
PARTICULARS OF REGISTRATION

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PARTICULARS OF ADMISSION

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Date of Visit .
Time

Date of AdmissionTime..
Admitting Doctor..

Service Point
Speciality Unity..................
First Visit

Follow Up

Referred by

State Department

GP

GW
ICU
HC
DAY
Chronic
Bed Type
ICD10 Codes

Hospital

Clinic

Date of Discharge/Transfer..

Province

Self

Reclassification DateFrom.To.

PARTICULARS OF RESPONSIBLE PERSON/FUNDER FOR PAYMENT


RAF

COID

DCS

SAP
S
Medical Scheme

Other Province

DOJ

SAND
F
Foreigner

Funder Name :.
Member No:..

Individual Details
Name:

Relationship to
patient
ID Number:
.

Med Aid Option:


Benefit Date from:.
Authorization number:..
Reference number:
Funders contact person..
Telephone:..
Documentation check list
Copy Income Y
Copy of ID

N
N

Salary Declaration Form Y


Proof of Social Grant

N
N

Copy of Medical Scheme or Documents from other funders


Y

Postal Address(where account will be send)

Code ..
Residential Address:

..

..
Employment Details:

Employer Name:
..
Patient advised to bring documentation on:
Address
Date:DateDate

REMARKS:

..
.
.. Tel: Fax:.
....
Employee/Persal number.

PARTICULARS OF ACCIDENTS/INJURY

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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 accidentVehicle registration no:


TPH 99 Serial Number:

PATIENT CONSENT
I, the undersigned hereby grant permission that: The nature of my/the patients 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) .SignatureDate..

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

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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
R ...........................................

Value

The total value of my assets/income is


R...........................................

_______________________

________________________

Signature of applicant

Date

_________________________

________________________

Admitting officer

Date

ANNEXURE C
DOCUMENTS CHECKLIST FORM
GPF 5
NAME OF HOSPITAL:
NAME OF PATIENT:
FILE NO:..
DOCUMENTS REQUIRED

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PROVIDED

NOT
PROVIDED

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YE
S
COPIES
:

Identity
Documen
t

Driver
s
Licens
e

PROOF
OF

Pay slip

Medic
al

INCOM
E:

Declarati
on
Form

DATE

N
O

DATE

Birth Certificate

aid

Departmen
tal

Pensio
n

Card

documents

Card

PROOF
OF
RESIDENC
E:

Municipality

Any Account

Bill

REMARKS:

CLASSIFICATION CORRECTED BY:


.. DATE:..
DOCUMENTS REQUESTED BY:
1Date:
2..Date:
3..Date:.
Supervisor:..Date:.

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