The conditions for applying for special outpatient services mainly include the following points:

1. Suffering from specific diseases. Urban workers suffering from specific diseases, such as dialysis treatment for renal failure, radiotherapy and chemotherapy for malignant tumors, anti-rejection treatment for organ transplantation, etc., can apply for special disease clinics.

2. Meet the conditions for hospitalization. For certain diseases, if the conditions for hospitalization are met, you can apply for special outpatient services.

3. Specific types of diseases. Including coronary heart disease, hypertension, diabetes, pulmonary heart disease, rheumatoid arthritis, systemic lupus erythematosus, aplastic anemia, chronic active hepatitis, cirrhosis, chronic renal failure, malignant tumors, uremic dialysis treatment, renal Anti-rejection drug treatment after transplantation, schizophrenia, Parkinson's disease, etc.

To apply for special outpatient services, you need to prepare the following materials:

1. "Application Form for Special Outpatient Treatment Benefits": You can get it at the hospital or from the medical insurance website of the province or city where you are insured. Download and print.

2. ID card: used to prove personal identity.

3. Diagnosis Certificate: It needs to be signed by the doctor and stamped with the official seal of the hospital.

4. Medical records: including inpatient medical records or outpatient medical records.

5. Relevant test reports: such as blood test reports or CT results, etc., depending on the doctor's prescription.

6. Pathology report: If necessary, you can bring the patient’s ID card to the medical record room for copying.

7. Discharge summary: A discharge summary recording the course of chemotherapy/radiotherapy treatment needs to be stamped on the first floor of the surgical building.

8. Copy of social security card: stamped.

In summary: Special outpatient clinics should be reviewed every 3 months, and outpatient special diseases that meet the first category of diseases should be reviewed every 6 months.

Legal basis:

"Guiding Opinions of the People's Republic of China on Carrying out Outpatient Coordination of Basic Medical Insurance for Urban Residents"

Article 6

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Explore methods suitable for outpatient cost control mechanisms and settlement management. Based on the characteristics of outpatient medical treatment and medical expense expenditures, actively explore cost settlement methods such as total prepayment or capitation payment. Give full play to the advantages of medical insurance group purchasing, adopt methods such as setting service institutions, setting service items, setting assessment indicators, setting settlement standards, and setting payment methods to explore comprehensive outpatient management methods that integrate medical treatment, payment, and settlement, and effectively control outpatient services. Medical expenses.