Thông tư quy định hồ sơ bệnh án điện tử số 46/2018/TT-BYT

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Ngày 28 tháng 12 năm 2018, Bộ trưởng Nguyễn Thị Kim Tiến đã ký thông tư số 46/2018/TT-BYT quy định hồ sơ bệnh án điện tử. Thông tư quy định việc lập, sử dụng và quản lý hồ sơ bệnh án điện tử tại các cơ sở khám bệnh, chữa bệnh đã được cấp giấy phép hoạt động theo quy định của Luật Khám bệnh, chữa bệnh, hiệu lực của thông tư kể từ ngày 01 tháng 3 năm 2019.
Thông tư quy định chi tiết việc lập, sử dụng và quản lý hồ sơ bệnh án điện tửtại các cơ sở khám bệnh, chữa bệnh đã được cấp giấy phép hoạt động theo quy định của Luật Khám bệnh, chữa bệnh. Nguyên tắc thực hiện  là mỗi người bệnh chỉ có một mã số quản lý, lưu trữ hồ sơ bệnh án điện tử tại một cơ sở khám bệnh, chữa bệnh.Hồ sơ bệnh án điện tử phải đáp ứng các yêu cầu như: phải ghi nhận toàn bộ nội dung thông tin như hồ sơ bệnh án giấy;  Phải có chữ ký số của người chịu trách nhiệm nội dung thông tin được nhập vào hồ sơ bệnh án điện tử;  Tuân thủ việc bảo vệ thông tin cá nhân theo quy định tại Mục 2, Chương II Luật An toàn thông tin mạng; Cơ sở khám bệnh, chữa bệnh được phép sử dụng, lưu trữ hồ sơ bệnh án điện tử thay cho hồ sơ bệnh án giấy khi đáp ứng các quy định tại Thông tư này.
Thông tư sẽ bắt đầu có hiệu lực từ tháng 3/2019.
DOWLOAD TẠI ĐÂY 46/2018/TT-BYT

BỘ Y TẾ
——-

Số: 46/2018/TT-BYT

CỘNG HÒA XÃ HỘI CHỦ NGHĨA VIỆT NAM
Độc lập – Tự do – Hạnh phúc
—————

Hà Nội, ngày 28 tháng 12 năm 2018

THÔNG TƯ

QUY ĐỊNH HỒ SƠ BỆNH ÁN ĐIỆN TỬ

Căn cứ Luật Khám bệnh, chữa bệnh số 40/2009/QH12 ngày 23/11/2009 của Quốc hội;

Căn cứ Nghị định số 75/2017/NĐ-CP ngày 20/6/2017 của Chính phủ quy định chức năng, nhiệm vụ, quyền hạn và cơ cấu tổ chức của Bộ Y tế;

Theo đề nghị của Cục trưởng Cục Công nghệ thông tin và Vụ trưởng Vụ Pháp chế;

Bộ trưởng Bộ Y tế ban hành Thông tư quy định hồ sơ bệnh án điện tử.

Chương I. QUY ĐỊNH CHUNG

Điều 1. Phạm vi điều chỉnh

Thông tư này quy định việc lập, sử dụng và quản lý hồ sơ bệnh án điện tử tại các cơ sở khám bệnh, chữa bệnh đã được cấp giấy phép hoạt động theo quy định của Luật Khám bệnh, chữa bệnh.

Điều 2. Giá trị pháp lý của hồ sơ bệnh án điện tử

Hồ sơ bệnh án điện tử được lập, cập nhật, hiển thị, ký số, lưu trữ bằng phương tiện điện tử đáp ứng các quy định của Thông tư này thì có giá trị pháp lý như hồ sơ bệnh án giấy quy định tại Điều 59 Luật Khám bệnh, chữa bệnh.

Điều 3. Nguyên tắc thực hiện hồ sơ bệnh án điện tử

1. Mỗi người bệnh chỉ có một mã số quản lý, lưu trữ hồ sơ bệnh án điện tử tại một cơ sở khám bệnh, chữa bệnh.

2. Hồ sơ bệnh án điện tử phải đáp ứng các yêu cầu sau đây:

a) Phải ghi nhận toàn bộ nội dung thông tin như hồ sơ bệnh án giấy.

b) Phải có chữ ký số của người chịu trách nhiệm nội dung thông tin được nhập vào hồ sơ bệnh án điện tử.

c) Tuân thủ việc bảo vệ thông tin cá nhân theo quy định tại Mục 2, Chương II Luật An toàn thông tin mạng.

3. Cơ sở khám bệnh, chữa bệnh được phép sử dụng, lưu trữ hồ sơ bệnh án điện tử thay cho hồ sơ bệnh án giấy khi đáp ứng các quy định tại Thông tư này.

Chương II. QUẢN LÝ HỒ SƠ BỆNH ÁN ĐIỆN TỬ

Điều 4. Các loại và nội dung của hồ sơ bệnh án điện tử

1. Hồ sơ bệnh án điện tử bao gồm hồ sơ bệnh án nội trú, hồ sơ bệnh án ngoại trú và các loại hồ sơ bệnh án khác theo quy định của Bộ Y tế.

2. Nội dung của hồ sơ bệnh án điện tử gồm đầy đủ các trường thông tin theo mẫu của hồ sơ bệnh án sử dụng trong cơ sở khám bệnh, chữa bệnh quy định tại Quyết định số 4069/2001/QĐ-BYT ngày 28/09/2001 của Bộ trưởng Bộ Y tế về việc ban hành mẫu hồ sơ bệnh án và Thông tư số 50/2017/TT-BYT ngày 29/12/2017 của Bộ trưởng Bộ Y tế sửa đổi, bổ sung các quy định liên quan đến thanh toán chi phí khám bệnh, chữa bệnh, Quyết định số 4604/QĐ-BYT ngày 29/11/2010 của Bộ trưởng Bộ Y tế Ban hành “Mẫu bệnh án Y học cổ truyền”, Quyết định số 999/QĐ-BYT ngày 05/04/2011 của Bộ trưởng Bộ Y tế về việc ban hành mẫu hồ sơ bệnh án phá thai, Quyết định số 3443/QĐ-BYT ngày 22/09/2011 của Bộ trưởng Bộ Y tế về việc ban hành bổ sung mẫu hồ sơ bệnh án và một số biểu mẫu hồ sơ chuyên khoa mắt, Quyết định số 1456/QĐ-BYT ngày 04/05/2012 của Bộ trưởng Bộ Y tế về việc ban hành mẫu hồ sơ bệnh án bệnh tay chân miệng và các quy định khác có liên quan.

Điều 5. Lập, cập nhật hồ sơ bệnh án điện tử

1. Việc lập, cập nhật hồ sơ bệnh án điện tử được thực hiện theo quy định tại Điều 4 Thông tư này và Điều 59 Luật Khám bệnh, chữa bệnh.

2. Thời gian cập nhật hồ sơ bệnh án điện tử tối đa 12 giờ, kể từ khi có y lệnh khám bệnh, chữa bệnh. Trường hợp thời gian khám, chữa bệnh kéo dài trên 12 giờ hoặc có sự cố về công nghệ thông tin thì thời gian cập nhật hồ sơ bệnh án điện tử tối đa không quá 24 giờ.

Điều 6. Lưu trữ hồ sơ bệnh án điện tử

Cơ sở khám bệnh, chữa bệnh được phép lưu trữ hồ sơ bệnh án điện tử thay cho hồ sơ bệnh án giấy khi đáp ứng các yêu cầu sau đây:

1. Phần mềm hồ sơ bệnh án điện tử đạt mức nâng cao theo quy định tại Thông tư số 54/2017/TT-BYTngày 29/12/2017 của Bộ trưởng Bộ Y tế ban hành bộ tiêu chí ứng dụng công nghệ thông tin tại các cơ sở khám bệnh, chữa bệnh (sau đây viết tắt là Thông tư số 54/2017/TT-BYT).

2. Thiết bị lưu trữ phải có đủ dung lượng để lưu trữ hồ sơ bệnh án điện tử đáp ứng thời gian lưu trữ hồ sơ bệnh án theo quy định tại khoản 3 Điều 59 Luật Khám bệnh, chữa bệnh.

3. Hồ sơ bệnh án điện tử phải được lưu trữ dự phòng tại một cơ quan, tổ chức cung cấp dịch vụ lưu trữ dữ liệu (data center) đáp ứng tiêu chuẩn theo quy định của Bộ trưởng Bộ Thông tin và Truyền thông. Đối với các cơ sở khám bệnh, chữa bệnh thuộc thẩm quyền quản lý của Bộ Quốc phòng thì lưu trữ dự phòng hồ sơ bệnh án điện tử theo quy định của Bộ trưởng Bộ Quốc phòng.

4. Trường hợp cơ sở khám bệnh, chữa bệnh sáp nhập thì phải bàn giao dữ liệu hồ sơ bệnh án điện tử cho nơi sáp nhập tiếp nhận; trường hợp cơ sở khám bệnh, chữa bệnh giải thể thì phải bàn giao dữ liệu hồ sơ bệnh án điện tử cho cơ quan quản lý cấp trên trực tiếp trước khi giải thể tiếp nhận.

5. Định kỳ hằng tuần, cơ sở khám bệnh, chữa bệnh phải thực hiện lưu trữ dự phòng hồ sơ bệnh án điện tử theo quy định tại khoản 3 Điều này.

Điều 7. Sử dụng và khai thác hồ sơ bệnh án điện tử

1. Việc sử dụng và khai thác hồ sơ bệnh án điện tử được thực hiện theo quy định tại Khoản 4 và Khoản 5 Điều 59 Luật Khám bệnh, chữa bệnh.

Người đứng đầu cơ sở khám bệnh, chữa bệnh quyết định việc cho phép khai thác hồ sơ bệnh án điện tử trong các trường hợp sau đây:

a) Sinh viên thực tập, nghiên cứu viên, người hành nghề trong cơ sở khám bệnh, chữa bệnh được xem hồ sơ bệnh án điện tử tại chỗ hoặc sao chép điện tử để phục vụ cho việc nghiên cứu hoặc công tác chuyên môn kỹ thuật;

b) Đại diện cơ quan quản lý nhà nước về y tế trực tiếp quản lý cơ sở khám bệnh, chữa bệnh, cơ quan điều tra, viện kiểm sát, tòa án, thanh tra chuyên ngành y tế, cơ quan bảo hiểm, tổ chức giám định pháp y, pháp y tâm thần, luật sư được xem hồ sơ bệnh án điện tử tại chỗ hoặc sao chép điện tử hoặc sao chép giấy có xác nhận của Thủ trưởng cơ sở khám bệnh, chữa bệnh để phục vụ nhiệm vụ được giao theo thẩm quyền;

c) Người bệnh hoặc người đại diện của người bệnh được nhận bản tóm tắt hồ sơ bệnh án điện tử hoặc bản tóm tắt hồ sơ bệnh án giấy khi có yêu cầu theo quy định tại Khoản 1 Điều 11 Luật Khám bệnh, chữa bệnh. Bản tóm tắt hồ sơ bệnh án điện tử có các trường thông tin theo mẫu quy định tại Phụ lục 4 ban hành kèm theo Thông tư số 56/2017/TT-BYT ngày 29/12/2017 của Bộ trưởng Bộ Y tế quy định chi tiết thi hành Luật bảo hiểm xã hội và Luật an toàn vệ sinh lao động thuộc lĩnh vực y tế.

2. Các đối tượng quy định tại khoản 1 Điều này khi sử dụng thông tin trong hồ sơ bệnh án điện tử phải giữ bí mật và chỉ được sử dụng đúng mục đích như đã yêu cầu và được người đứng đầu cơ sở khám bệnh, chữa bệnh cho phép.

Điều 8. Quy định về phần mềm hồ sơ bệnh án điện tử

Phần mềm hồ sơ bệnh án điện tử phải đáp ứng các yêu cầu sau đây:

1. Tuân thủ các quy định về tiêu chuẩn công nghệ thông tin y tế và danh mục dùng chung trong hồ sơ bệnh án điện tử theo quy định tại Điều 14, Điều 15 Thông tư này và quy định có liên quan của Bộ trưởng Bộ Thông tin và Truyền thông, Bộ trưởng Bộ Y tế.

2. Bảo đảm khả năng kiểm soát truy cập của người dùng (nhân viên công nghệ thông tin và nhân viên y tế) tại bất kỳ thời điểm nào, trong đó:

a) Bảo đảm khả năng xác thực người dùng và cấp quyền cho người dùng.

b) Bảo đảm quyền riêng tư, bảo mật và kiểm tra truy vết.

3. Phần mềm hồ sơ bệnh án điện tử phải có khả năng kết xuất bản điện tử theo tập tin định dạng XML cụ thể như sau:

a) Tóm tắt hồ sơ bệnh án điện tử.

b) Thông tin trong quản lý, giám định và thanh toán chi phí khám bệnh, chữa bệnh bảo hiểm y tế theo quy định tại Quyết định số 4210/QĐ-BYT ngày 20/09/2018 của Bộ trưởng Bộ Y tế về việc quy định chuẩn và định dạng dữ liệu đầu ra sử dụng trong quản lý, giám định và thanh toán chi phí khám bệnh, chữa bệnh bảo hiểm y tế.

c) Thông tin hồ sơ sức khỏe cá nhân theo quy định tại Quyết định số 831/QĐ-BYT ngày 11/03/2017 của Bộ trưởng Bộ Y tế về việc ban hành Mẫu hồ sơ quản lý sức khỏe cá nhân phục vụ chăm sóc sức khỏe ban đầu.

4. Có khả năng hiển thị trên màn hình máy tính hoặc các thiết bị điện tử khác theo mẫu hồ sơ bệnh án.

5. Có khả năng kết xuất ra máy in theo mẫu hồ sơ bệnh án trong trường hợp cần thiết.

6. Phần mềm hồ sơ bệnh án điện tử phải có đầy đủ chức năng về quản lý cung cấp dịch vụ chăm sóc sức khỏe, quản lý thông tin hành chính, quản lý hồ sơ bệnh án và các chức năng chi tiết quy định tại bảng VIII “Bệnh án điện tử (EMR)” Phụ lục 1 ban hành kèm theo Thông tư số 54/2017/TT-BYT.

Điều 9. Thông tin định danh người bệnh trong hồ sơ bệnh án điện tử

Thông tin định danh người bệnh được xây dựng thống nhất trên toàn quốc theo quy định của Bộ trưởng Bộ Y tế.

Điều 10. Bảo mật và tính riêng tư của hồ sơ bệnh án điện tử

1. Việc truy cập, chia sẻ thông tin trong hồ sơ bệnh án điện tử cho các cơ quan, tổ chức, cá nhân được thực hiện theo quy định tại Điều 7 Thông tư này và các quy định liên quan khác của Bộ trưởng Bộ Y tế.

2. Cơ sở khám bệnh, chữa bệnh phải có biện pháp sau đây:

a) Kiểm soát truy cập của người dùng gồm xác thực người dùng, phân quyền người dùng theo từng vai trò công việc, thiết lập khoảng thời gian giới hạn cho phép người dùng truy cập vào phần mềm.

b) Bảo vệ, ngăn chặn việc truy cập trái phép vào hồ sơ bệnh án điện tử.

c) Phương án hoặc quy trình phục hồi dữ liệu trong trường hợp có sự cố.

d) Phương án phòng ngừa, phát hiện, ngăn chặn và loại bỏ phần mềm độc hại.

3. Việc liên thông, trao đổi dữ liệu hồ sơ bệnh án điện tử giữa các cơ sở khám bệnh, chữa bệnh phải được mã hóa trong quá trình trao đổi dữ liệu.

4. Thông tin khám, chữa bệnh của người bệnh phải được mã hóa theo hướng dẫn của Bộ trưởng Bộ Y tế.

5. Phần mềm hồ sơ bệnh án điện tử có khả năng ghi vết tất cả các giao dịch, tương tác của người dùng trên phần mềm hồ sơ bệnh án điện tử bao gồm ngày, thời gian khi xem, nhập mới, chỉnh sửa, hủy, khôi phục dữ liệu, thông tin trong hồ sơ bệnh án điện tử.

6. Cơ sở khám bệnh, chữa bệnh phải ban hành Quy chế về bảo mật thông tin và quyền riêng tư của người bệnh trên cơ sở các khoản 1, 2, 3, 4 và 5 Điều này.

Điều 11. Hệ thống lưu trữ và truyền tải hình ảnh (PACS)

Cơ sở khám bệnh, chữa bệnh được phép lưu trữ và truyền tải hình ảnh y tế thay cho việc in phim khi đáp ứng được các yêu cầu sau đây:

1. PACS đạt mức nâng cao theo quy định tại Thông tư số 54/2017/TT-BYT.

2. Thiết bị lưu trữ hình ảnh y tế phải có đủ dung lượng để đáp ứng thời gian lưu trữ hồ sơ bệnh án theo quy định tại Khoản 3 Điều 59 Luật khám bệnh, chữa bệnh.

Điều 12. Hệ thống thông tin xét nghiệm (LIS)

Cơ sở khám bệnh, chữa bệnh được phép lưu trữ thông tin xét nghiệm thay cho việc in giấy khi đáp ứng được các yêu cầu sau đây:

1. LIS đạt mức nâng cao theo quy định tại Thông tư số 54/2017/TT-BYT.

2. Thiết bị lưu trữ thông tin xét nghiệm phải có đủ dung lượng để đáp ứng thời gian lưu trữ hồ sơ bệnh án theo quy định tại Khoản 3 Điều 59 Luật khám bệnh, chữa bệnh.

Điều 13. Sử dụng chữ ký số trong hồ sơ bệnh án điện tử

1. Nhân viên y tế, người bệnh hoặc người đại diện cho người bệnh sử dụng chữ ký điện tử hoặc chữ ký số hợp pháp trong hồ sơ bệnh án điện tử.

2. Trong trường hợp người nhập thông tin vào hồ sơ bệnh án điện tử sử dụng chữ ký điện tử thì Thủ trưởng cơ sở khám bệnh, chữa bệnh hoặc người được Thủ trưởng cơ sở khám bệnh, chữa bệnh phân công, ủy quyền sử dụng chữ ký số hợp pháp để xác nhận chữ ký điện tử.

3. Thủ trưởng cơ sở khám bệnh, chữa bệnh phải ban hành Quy chế sử dụng chữ ký điện tử và chữ ký số của đơn vị mình trước khi triển khai thực hiện. Trường hợp đặc biệt (như bản cam kết của người bệnh, biểu đồ sinh hiệu, bảng công khai thuốc đầu giường, kết quả xét nghiệm nồng độ cồn), Thủ trưởng cơ sở khám bệnh, chữa bệnh quy định ký trên bản giấy, sau đó số hóa thành bản điện tử đính kèm hồ sơ bệnh án điện tử và phải lưu trữ bản giấy theo quy định.

Điều 14. Tiêu chuẩn công nghệ thông tin y tế

Hồ sơ bệnh án điện tử phải áp dụng các tiêu chuẩn công nghệ thông tin sau đây:

1. Tiêu chuẩn HL7 gồm kiến trúc tài liệu lâm sàng HL7 CDA và HL7 FHIR.

2. Tiêu chuẩn hình ảnh số và truyền tải trong y tế (DICOM) phiên bản 2.0 trở lên.

3. Tiêu chuẩn về an toàn thông tin y tế theo quy định của Bộ trưởng Bộ Thông tin và Truyền thông và Bộ trưởng Bộ Y tế.

Điều 15. Danh mục dùng chung trong hồ sơ bệnh án điện tử

Hồ sơ bệnh án điện tử sử dụng danh mục dùng chung theo quy định của Bộ trưởng Bộ Y tế.

Chương III. TRÁCH NHIỆM THỰC HIỆN

Điều 16. Trách nhiệm của các đơn vị thuộc Bộ Y tế

1. Cục Công nghệ thông tin chủ trì, phối hợp với Cục Quản lý Khám, chữa bệnh; Cục Quản lý Y, Dược cổ truyền và Vụ Sức khỏe Bà mẹ – Trẻ em có trách nhiệm:

a) Chỉ đạo, hướng dẫn và kiểm tra việc thực hiện Thông tư này trên phạm vi toàn quốc.

b) Công bố các cơ sở khám bệnh, chữa bệnh thực hiện việc lưu trữ hồ sơ bệnh án điện tử thay cho lưu trữ hồ sơ bệnh án giấy; lưu trữ và truyền tải hình ảnh y tế thay cho việc in phim và lưu trữ thông tin xét nghiệm thay cho việc in giấy trên Cổng thông tin điện tử Bộ Y tế và Trang thông tin điện tử của Cục Công nghệ thông tin (http://ehealth.gov.vn).

2. Cục Quản lý Khám, chữa bệnh chủ trì, phối hợp với Cục Quản lý Y, Dược cổ truyền, Vụ Sức khỏe Bà mẹ – Trẻ em, Cục Công nghệ thông tin và các cơ quan, tổ chức có liên quan khác bổ sung, hoàn thiện mẫu hồ sơ bệnh án giấy, hồ sơ sức khỏe cá nhân, tóm tắt hồ sơ bệnh án khi ra viện trình Bộ trưởng Bộ Y tế ban hành.

3. Vụ Bảo hiểm y tế chủ trì, phối hợp với các cơ quan, tổ chức có liên quan bổ sung, hoàn thiện chuẩn dữ liệu đầu ra sử dụng trong quản lý, giám định và thanh toán chi phí khám bệnh, chữa bệnh bảo hiểm y tế.

4. Văn phòng Bộ, Thanh tra Bộ, các Vụ, Cục, Tổng cục thuộc Bộ Y tế phối hợp với Cục Công nghệ thông tin xây dựng danh mục dùng chung của từng lĩnh vực chuyên môn và tham gia công tác quản lý nhà nước đối với hoạt động ứng dụng công nghệ thông tin theo chức năng, nhiệm vụ và quyền hạn được giao.

Điều 17. Trách nhiệm của Sở Y tế các tỉnh, thành phố trực thuộc Trung ương và Y tế Bộ, ngành

1. Chỉ đạo, hướng dẫn và kiểm tra việc thực hiện Thông tư này theo thẩm quyền quản lý.

2. Tổng hợp báo cáo Bộ Y tế định kỳ vào tháng 12 hằng năm về việc thực hiện Thông tư này.

Điều 18. Trách nhiệm của các cơ sở khám bệnh, chữa bệnh

1. Thủ trưởng cơ sở khám bệnh, chữa bệnh chủ động xây dựng kế hoạch và triển khai hồ sơ bệnh án điện tử tại cơ sở theo quy định của Thông tư này.

2. Trên cơ sở kết quả tư vấn của Hội đồng chuyên môn được quy định tại Điều 19 Thông tư này hoặc của đơn vị tư vấn độc lập, Thủ trưởng cơ sở khám bệnh, chữa bệnh quyết định việc quản lý, lưu trữ hồ sơ bệnh án điện tử thay cho bệnh án giấy, lưu trữ và truyền tải hình ảnh y tế thay cho in phim và lưu trữ thông tin xét nghiệm thay cho việc in giấy.

3. Trước khi thực hiện việc lưu trữ hồ sơ bệnh án điện tử thay cho lưu trữ hồ sơ bệnh án giấy; lưu trữ và truyền tải hình ảnh y tế thay cho việc in phim và lưu trữ thông tin xét nghiệm thay cho việc in giấy, Thủ trưởng cơ sở khám bệnh, chữa bệnh có văn bản thông báo với Cục Công nghệ thông tin – Bộ Y tế để đăng tải thông tin trên Cổng thông tin điện tử Bộ Y tế và Trang thông tin điện tử của Cục Công nghệ thông tin.

Điều 19. Hội đồng chuyên môn

1. Hội đồng chuyên môn do Thủ trưởng cơ sở khám bệnh, chữa bệnh thành lập, có chức năng tư vấn cho Thủ trưởng cơ sở khám bệnh, chữa bệnh quyết định việc sử dụng và lưu trữ hồ sơ bệnh án điện tử thay cho hồ sơ bệnh án giấy, lưu trữ và truyền tải hình ảnh y tế thay cho in phim và lưu trữ thông tin xét nghiệm thay cho việc in giấy.

2. Hội đồng chuyên môn có tối thiểu 07 thành viên, bao gồm Chủ tịch Hội đồng, Ủy viên kiêm Thư ký Hội đồng và các Ủy viên Hội đồng, trong đó phải có các Ủy viên Hội đồng có chuyên môn về công nghệ thông tin và khám bệnh, chữa bệnh.

3. Hội đồng chuyên môn hoạt động theo nguyên tắc thảo luận tập thể, quyết định theo đa số và tự giải thể khi hoàn thành nhiệm vụ.

Chương IV. ĐIỀU KHOẢN THI HÀNH

Điều 20. Lộ trình thực hiện

1. Giai đoạn từ năm 2019 – 2023

a) Các cơ sở khám bệnh, chữa bệnh hạng I trở lên chủ động nâng cấp hệ thống công nghệ thông tin tại cơ sở để triển khai hồ sơ bệnh án điện tử theo quy định tại Thông tư này.

b) Các cơ sở khám bệnh, chữa bệnh khác căn cứ vào nhu cầu, năng lực thực tế để chuẩn bị các điều kiện cần thiết cho việc triển khai hồ sơ bệnh án điện tử và triển khai hồ sơ bệnh án điện tử khi đáp ứng các yêu cầu quy định tại Thông tư này.

2. Giai đoạn từ năm 2024 – 2028

a) Tất cả các cơ sở khám bệnh, chữa bệnh trên toàn quốc phải triển khai hồ sơ bệnh án điện tử.

b) Trường hợp cơ sở khám bệnh, chữa bệnh trực thuộc Bộ Y tế, Bộ ngành khác chưa triển khai được hồ sơ bệnh án điện tử thì phải có văn bản báo cáo Bộ Y tế; các cơ sở khám bệnh, chữa bệnh thuộc thẩm quyền quản lý của Sở Y tế các tỉnh, thành phố trực thuộc Trung ương chưa triển khai được hồ sơ bệnh án điện tử phải có văn bản báo cáo Sở Y tế. Văn bản báo cáo của cơ sở khám bệnh, chữa bệnh phải nêu rõ lý do, lộ trình triển khai hồ sơ bệnh án điện tử nhưng phải hoàn thành trước ngày 31/12/2030.

Điều 21. Điều khoản tham chiếu

Trường hợp các văn bản tham chiếu trong Thông tư này được thay thế hoặc sửa đổi, bổ sung thì áp dụng theo văn bản đã thay thế hoặc văn bản đã được sửa đổi, bổ sung đó.

Điều 22. Điều khoản chuyển tiếp

Đối với hồ sơ bệnh án được lập trước ngày triển khai hồ sơ bệnh án điện tử, cơ sở khám bệnh, chữa bệnh phải lưu trữ hồ sơ bệnh án giấy theo quy định tại khoản 3 Điều 59 Luật Khám bệnh, chữa bệnh.

Điều 23. Hiệu lực thi hành

Thông tư này có hiệu lực kể từ ngày 01 tháng 3 năm 2019.

Trong quá trình thực hiện nếu có khó khăn, vướng mắc đề nghị các cơ quan, tổ chức, cá nhân kịp thời phản ánh về Bộ Y tế (Cục Công nghệ thông tin) để xem xét, giải quyết./.

Nơi nhận:
– Ủy ban Quốc gia về Chính phủ điện tử;
– Các Bộ, cơ quan ngang Bộ, cơ quan thuộc CP;
– Ủy ban về các vấn đề xã hội của QH (để giám sát);
– Văn phòng Chính phủ (Công báo, Cổng thông tin điện tử Chính phủ);
– Bộ Tư pháp (Cục Kiểm tra văn bản QPPL);
– Bộ trưởng, các Thứ trưởng Bộ Y tế;
– Các Vụ, Cục, Tổng cục, Văn phòng Bộ, Thanh tra Bộ;
– Các đơn vị trực thuộc Bộ Y tế;
– Y tế các Bộ, ngành;
– Sở Y tế tỉnh, thành phố trực thuộc TW;
– Cổng Thông tin điện tử Bộ Y tế;
– Lưu: VT, CNTT (03b), PC (02b).
Thông tư quy định hồ sơ bệnh án điện tử số 46/2018/TT-BYT

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    עבור צרכי הלקוח.

    Trả lời

  1299. Les versions de roulettes en ligne auxquelles vous jouez avec votre argent réel sont plus intéressantes, car elles offrent plus de frissons et d’excitation. Elles vous permettent aussi d’avoir des chances sérieuses de gagner de l’argent et de profiter des bonus offerts par les casinos en ligne. On peut donc dire que 4 Winning Directions, cela n’altère en rien l’expérience que nous avons eue sur le casino Magik. L’ordinateur fait alors lui même le blocage des cartes les plus intéressantes en terme de probabilité, la main avec le total le plus élevé gagne. Suite à l’assignation effectuée début septembre par l’ARJEL qui souhaitait que les FAI bloquent des sites de casino en ligne, ne vous inquiétez pas il y a le choix. Les machines à sous sont certainement les jeux de hasard les plus populaires parmi plusieurs joueurs du monde entier, n’importe quand. https://www.bigbrain3d.com/community/profile/basilrau7729205/ Dans le même temps, le principe même de fonctionnement de la machine à sous ne changera pas. Les machines à sous utilisent un générateur de nombres aléatoires qui détermine le résultat de chaque partie. Puisque le RNG est le cœur du système, les résultats des machines à sous sont complètement aléatoires et imprévisibles. Le jeu ne fonctionne pas par cycles, donc les jackpots dans les machines à sous ne sont pas non plus réguliers. L’issue du jeu est impossible à prédire, et tout se résume à la simple chance ou à la malchance. Chaque fois que vous mettez votre village à niveau, vous recevez une tonne de spins gratuits. Cependant, la mise à niveau nécessite un tas d’or que vous ne pouvez obtenir qu’à partir des spins. Ainsi, bien que les récompenses soient importantes, ce n’est pas une méthode sur laquelle vous pouvez compter en permanence.

    Trả lời

  1300. המעסים המנוסים של זמן מגע
    ביצעו כבר מאות טיפולי עיסוי מפנק בירושלים עד הבית לשביעות רצונם של כל המטופלים.
    עיסוי מפנק בקרית שמונה/נהריה
    הוא אחד הטיפולים הנפוצים ביותר ולא בכדי.
    מבין הטכניקות הריפוי הטבעיות תוכלו למצוא מזון ושתייה מבוססי חומרים טבעיים, ויטמינים ומינרליים החיוניים לגוף,
    עיסוי מקצועי בקרית שמונה/נהריה
    , יוגה ועוד. בנוסף, תוכלו למצוא
    אצלנו נערות ליוי ישראליות שגרות בצפון !
    תוכלו לבחור בקלות נערות ליווי בבאר שבע לפי הטעם והסגנון
    שלכם או לבחור דווקא נערות שלא חוויתן איתן סקס אף פעם… שלי לא
    זוכרת מתי בחייה קיבלה משהו חדש,
    או אם אי פעם היו לה מותרות. כל גבר צריך לקבל סקס טוב מידי פעם.
    אלה גברים אמיתיים, שרוצים לקחת את כל מה שאפשר מהחיים ולהנות עם נערות
    ליווי בצפון עד עור הבוקר. ברוכים
    הבאים למשרד לשירותי נערות ליווי שנמצא ופועל
    בעיר חיפה וצפון! ברוכים הבאים לג’ונגל
    שנקרא שוק הרכב הישראלי. שוק בו השקיפות
    והאמינות לוקות בחסר, בלשון המעטה.

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  1301. אך אם אתם מעוניינים בעיסוי מפנק בקרית שמונה לצורכי הנאה ורגיעה או לרגל אירוע שמחה מסוים,
    תוכלו לקרוא במאמר זה על שלושה סוגי עיסויים אשר מתאימים למטרה
    זו ויעניקו לכם יום בילוי מפנק ואיכותי
    במיוחד אשר סביר להניח שתרצו לחזור עליו שוב כבר בשנה
    שאחרי. מדובר באפשרות נוחה בה אתה מגיע לדירה והנערה מחכה לך בקליניקה פרטית כשהיא כבר מוכנה
    ומזומנה להגשים את כל החלומות שלך.

    במרחק נגיעה בלבד, פורטל אחד, תמונות
    מאומתות, כיף שאין כדוגמתו, יותר ויותר גברים כבר מביני עניין ולא נותנים לזה
    לברוח מבין הידיים. יש גברים החולמים על סקס, אבל מרגישים מוגבל כאשר מתקשרים
    עם חברים, מפחדים להידחות. ברוכים
    הבאים לפורטל היוקרתי והאקסקלוסיבי המעניק
    תמונות אמיתיות ומאומתות שלא ישאירו לכם ספק – אתם הולכים לבלות את היום, הרגע או השעה עם מיטב הבחורות שיודעות לא רק לדבר אלא גם להסב לכם הנאה עילאית.
    דירות אלו פזורות בכל רחבי
    הארץ ולכן באפשרותך אף להגיע לדירה בקרבת
    מקום מגוריך, או לחלופין אם אינך רוצה להיתפס ישנן דירות דיסקרטיות בטבריה רבות
    אשר אינן ממוקמות בעיר בה הנך מתגורר או נוהג לבלות כך שהסיכון להגיע אליהן יהיה נמוך יותר.

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  1303. י מספר טכנאים בעלי ניסיון רב בתחום תיקון מדפסות.
    ברחבי העיר קיימים מספר מתחמי בילוי,
    קניות ופנאי שחלקם פועל אל תוך השעות הקטנות של הלילה.
    עיסוי אירוטי ברחובות או כל מקום אחר מצריך פתיחות, זה קריטי שאם לא
    כן, אתם עלולים להרגיש אטימות וכך למעשה להיסגר אל מול תחושות ההנאה
    לשמן התכנסתם בפועל. זהו אחד מהעיסויים ברחובות הפופולאריים ביותר
    אשר לקוחות שאוהבים להתפנק מזמינים.
    כאן תוכל למצוא מגוון רחב של דירות סקס ברחובות
    והסביבה כולל כתובות, טלפונים וניווט שיביא אתכם היישר לעונג.
    ב”Our Spa” תוכל לשכור את המקום לכמה שעות, להביא את כולם ולפנק אותם ביחד איתכם.

    זה המקום האידאלי לממש לעצמכם חלום במפגש אינטימי ממגוון נערות ליווי באשדוד-אשקלון שתשמחנה להעניק
    לכם בילוי וחוויה בלתי נשכחת.
    תמלול הקלטות 2.0 המקום בו תמצאו כי שירותי קלדנות ותמלול לא חייבים לקרוע את הארנק.
    העיסויים הפכו לאטרקציה המרכזית בימי הפינוק השונים, אך כדאי
    לזכור כי מטרת העל של העיסוי היא לייצר שלווה ורוגע.

    העיסויים כוללים אופציות לחבילות ספא שונותכגון ספא לימי נישואין,
    חבילת ספא זוגית, חבילות לימי הולדת ועוד.
    ללימי הולדת מיוחדים לימי כיף לחברים ואירגונים.
    אם אתם מחפשים ספא זוגי
    מפנק במיוחד ליום האהבה, יום הולדת ו/או לכל
    אירוע כזה או אחר, הגעתם למקום הנכון ביותר!

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  1305. עיסוי מקצועי קלאסי, שוודי,עיסוי
    רקמות עמוקות ורפלקסולוגיה.
    אצלנו ניתן יהיה לבחור מתוך מגוון סגנונות,
    אותם נתאים באופן אישי לכל מטופל: עיסוי רפואי בנס
    ציונה, עיסוי רקמות עמוק בנס ציונה, עיסוי משולב בנס ציונה, עיסוי שוודי בנס ציונה, עיסוי לנשים בהיריון בנס ציונה ועיסוי לאחר לידה בנס ציונה.
    השאלה היא האם אתם מעוניינים בעיסוי שוודי, הוליסטי, עיסוי רקמות עמוק, עיסוי טאנטרי או עיסוי שיהיה משולב או
    אולי עיסו תאילנדי בהשרון והסביבה
    ? מעוניינים למצוא דירה דיסקרטית בנס ציונה ?
    הכל לפי ההעדפות שלכם ובמה שאתם מעוניינים.
    כפי שודאי הנחתם, ההבדלים העיקריים בין טיפול ספא
    סטנדרטי ובין עיסוי בחיפה והסביבה טיפולי
    המבוצע במסגרת רפואית או קליניקה טיפולית, הם
    בעיקר סביב המטרה שלשמה מבוצע העיסוי, וכמובן ההעדפות האישיות של כל מטופל
    שמביאות אותו להעדיף מסאז’ מסוג מסויים על פני סוג מסאז’
    אחר. אם זה מדובר בבית שלכם שיהיה
    נקי מעוצב, מרוהט ומסוגנן,
    ברכב חדש ומתקדם וכמובן בחופשה או בנופש.

    אני לא האמנתי כל כך למילים שלו
    ולא התייחסתי לזה ברצינות אבל הלכתי
    ליום פתוח במכללה ונרשמתי ללימודים לשנה אחת של עיסוי מוסמך כדי לנסות משהו חדש בחיים.

    כעת לא נצטרך להזניח את כל מה שמסייע לגופנו,
    ואנו נזכה לקבל אותו הרבה יותר קרוב.
    לפעמים, כאשר אנו חשים שחיקה גופנית או
    נפשית או את שניהם, אנו חושבים כי חופשה תשחרר אותנו מכל אלה.

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  1306. אם ברצונכם בבחורה בלונדינית, שמנה,
    רזה, אתיופית או כל פנטזיה אחרת שמעניינת אתכם,
    דירות דיסקרטיות נהריה והזמנת עיסוי אירוטי בנתניה הוא לגמרי המקום הנכון לממש את הפנטזיות האלו.
    עיסוי אירוטי בחולון , אחד מהרגעים המאושרים ביותר
    זו ההרפיה הזאת, עיסוי שהוא לגמרי
    לא מה שאתם מכירים אלא משהו מעורר חושים, מרטיט ובעיקר עונה לכם על כל הפנטזיות הלוהטות ביותר.
    כי בשביל כל אחד, לגיוון יש אופי אחר.
    זה יכול להיות עיסוי ארוטי במרכז עם בחורה ישראלית או עם בחורה ממוצא אקזוטי כזה או אחר.

    ויש גם זוגות שרוצים להגיע ביחד, לחווית מסאג’ אירוטי במרכז, מסוג אחר.
    אף אחד לא מצפה שאחרי מסאג’ אירוטי במרכז תהיה
    יציאה למסעדה או לסרט. מסאז’ אירוטי במרכז נותן לכם את זה.
    מבחינת עיצוב הצימרים כמובן שתוכלו להתרשם מגלריית
    התמונות ולקרוא בקצרה על כל יחידה ויתרונותיה, ישנם סוויטות מפוארות הכוללות ג’קוזי
    ספא בנוסף, ישנם צימרים עם בריכה
    לפי שעה וכמובן שישנם גם חדרי אירוח סטנדרטיים בעלויות נמוכות יותר, הכל
    שיקול שלכם ואם יש ספק או שאלה
    כמובן שהכי קל יהיה אם נצלצל ונשאל,
    המארחים ב צימר לפי שעה אדיבים
    ונחמדים ובמידה ותרצו דיסקרטיות כמובן
    שגם את זה תקבלו, אך יותר
    מכל המארחים ירצו שתצאו עם חיוך וכמובן שתיהנו!
    ויש כל כך הרבה דרכים לקבל עיסוי אירוטי במרכז.

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  1315. אני בחור שנראה טוב, יש לי ביטחון
    עצמי, אין לי בעיה להתחיל עם בחורות וגם דיי הולך לי,
    אבל אני לא יבוא לבחורה ואגיד לה מה
    הפנטזיות שלי, בעיקר בגלל שאני
    יודע שזה יכול להיתפס כסטייה.
    אין צורך להיות מוגבלים להזמנת נערות ליווי
    לבתי מלון או בתים פרטיים, כי באתר תמצאו
    דירות דיסקרטיות פנויות בכל השכונות.
    אתר Ymassage מרכז במקום אחד ובעזרת
    ממשק ידידותי במיוחד מגוון מטפלים
    להזמנת עיסוי באזור רחובות והסביבה כאשר רוב המטפלים בעלי ניסיון של לפחות 3
    שנים. ביקור במקום לפני הטיפול:
    אם אתם רוצים להיות בטוחים במאה אחוז בתמצאו מקום שעושה
    עיסוי ארוטי בהרצליה שעונה על הדרישות שלכם,
    אנו ממליצים להתחיל בשיחת טלפון ולשאול על טיפולי העיסוי, על ההסמכות של המטפלים ומה הם
    בעצם מציעים. הם תמיד צריכים להתחשב בבת
    הזוג אשר רוצה לעשות דברים שונים לגמרי.
    החיוך התמים שלה, הגוף הדק והיופי הטבעי שלה, הם אלה שהופכים את הבלונדינית הזו
    לנערת ליווי מושלמת עבור הפנטזיות והתשוקות… נערת הליווי הכי מושלמת שתפגוש.
    כמה עולה נערת ליווי בירושלים?
    נערות ליווי בכפר-סבא הן אמיתיות, לפחות בפורטל הבית היוקרתי שלנו!

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  1316. בשנים האחרונות, פיתח המשרד מומחיות בתכנון עשרות קליניקות ומרפאות.
    קליניקות ההופכות ל”אי של שקט” עבור המטופלים ומייצרות חוויית לקוח רב חושית המסייעת בהפחתת החששות ובהתמודדות עם
    חרדות טיפוליות. המעסים המנוסים של זמן מגע ביצעו כבר מאות טיפולי
    עיסוי מפנק בראש העין עד הבית לשביעות רצונם של כל המטופלים.
    עיסוי מפנק בראש העין יכול להינתן לכם על ידי מעסה גבר או מעסה אישה.
    עיסוי מפנק בקרית שמונה/נהריה
    כללי, הוא סוג עיסוי קלאסי שמטרתו להקל על המתח הגופני והעצבני.
    העיסוי מתבצע בדרך כלל בלבוש בגדים, וללא שמן עיסוי על מזרן או
    מיטת עיסוי. נכס חשוב זה התגלה על ידי המאסטרים הקדומים ברפלקסולוגיה והם
    גם הדגישו את עקרונות היסוד של העיסוי.
    במידה ואחד המטפלים לא זמין, כנראה שהוא בטיפול אז פשוט תשאירו הודעה והם יחזרו אליכם
    מיד בסיום הטיפול. אם הייתם משקיעים
    בטיפול רפואי קלאסי, למה שלא תשקיעו בעיסוי מפנק ורפואי בקרית שמונה/נהריה
    ? עם זאת, תוכלו לשבור את השגרה המוכרת והידועה
    מראש עם עיסוי בהשרון והסביבה כאנשי משפחה אתם משקיעים בילדכם וכאנשי קריירה אתם
    משקיעים בעבודה מסורה ומקצועית.

    מסאג׳ מקצועי ברמת הגולן כל האזורים חיפה והסביבה הרצליה חדרה
    תל אביב חולון בת ים ירושלים ראשון לציון רחובות גבעתיים אשדוד / אשקלון רמת גן ופתח
    תקווה באר שבע רמת הגולן
    נתניה … עיסוי ארוטי במרכז: ראשון לציון, תל אביב,
    רמת גן, רחובות, הרצליה או רעננה – זה לא משנה איפה תחפשו עיסוי ארוטי במרכז, באתר תוכלו להחשף לקליניקות המובילות בכל יישובי
    האזור.

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  1317. חנות המחשבים שלנו מציעה לך את המוצרים האיכותיים ביותר בשוק, עם זאת אין בכוונתנו לנסות ולמכור לך מחשב נחות מצרכיך או חמור מכך הרבה מעבר להם ולכן
    החנות שלנו מסודרת כך שתוכל למצוא
    את המוצר המתאים בדיוק לאופי השימוש שלך.
    ראשון עד רביעי אין בעיה של עומס ניתן לתאם ולהזמין נערה לשעה הקרובה כך שאם אתה
    רוצה גיחה קטנה באמצע היום בימי ראשון עד רביעי כל שנותר הוא להכנס לאתר ולהתקשר להזמין שעה מראש.

    המחיר לשעה החל מ- 48 ש”ח כולל מע”מ.
    בד נמתח וגמיש לעיצוב אנו גובים 15 ₪ למטר מרובע כולל גזירה, תפירה וחומר.
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  2347. 今彩539：您的全方位彩票投注平台

    今彩539是一個專業的彩票投注平台，提供539開獎直播、玩法攻略、賠率計算以及開獎號碼查詢等服務。我們的目標是為彩票愛好者提供一個安全、便捷的線上投注環境。

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    539彩票的遊戲號碼範圍為1至39，總共有39個號碼。
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    每期開獎時，彩票會隨機開出5個號碼作為中獎號碼。
    中獎規則：
    若玩家投注的5個號碼與當期開獎的5個號碼完全相符，則中得頭獎，通常是豐厚的獎金。
    若玩家投注的4個號碼與開獎的4個號碼相符，則中得二獎。
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  2393. 世界盃籃球、
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  2394. 玩運彩：體育賽事與娛樂遊戲的完美融合

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    體育投注一直以來都是運彩的核心內容之一。玩運彩提供了眾多體育賽事的線上投注平台，無論是NBA籃球、MLB棒球、世界盃足球、美式足球、冰球、網球、MMA格鬥還是拳擊等，都能在這裡找到合適的投注選項。這些賽事不僅為球迷帶來了觀賽的樂趣，還能讓他們參與其中，為比賽增添一份別樣的激情。

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  2401. 世界盃籃球、
    2023年的FIBA世界盃籃球賽（英語：2023 FIBA Basketball World Cup）是第19次舉行的男子籃球大賽，且現在每4年舉行一次。正式比賽於 2023/8/25 ~ 9/10 舉行。這次比賽是在2019年新規則實施後的第二次。最好的球隊將有機會參加2024年在法國巴黎的奧運賽事。而歐洲和美洲的前2名，以及亞洲、大洋洲、非洲的冠軍，還有奧運主辦國法國，總共8支隊伍將獲得這個機會。

    在2023年2月20日FIBA世界盃籃球亞太區資格賽的第六階段已經完賽！雖然台灣隊未能參賽，但其他國家選手的精彩表現絕對值得關注。本文將為您提供FIBA籃球世界盃賽程資訊，以及可以收看直播和轉播的線上平台，希望您不要錯過！

    主辦國家 : 菲律賓、印尼、日本
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    比賽場館 : 菲律賓體育館、阿拉內塔體育館、亞洲購物中心體育館、印尼體育館、沖繩體育館

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  2406. 世界盃
    2023年的FIBA世界盃籃球賽（英語：2023 FIBA Basketball World Cup）是第19次舉行的男子籃球大賽，且現在每4年舉行一次。正式比賽於 2023/8/25 ~ 9/10 舉行。這次比賽是在2019年新規則實施後的第二次。最好的球隊將有機會參加2024年在法國巴黎的奧運賽事。而歐洲和美洲的前2名，以及亞洲、大洋洲、非洲的冠軍，還有奧運主辦國法國，總共8支隊伍將獲得這個機會。

    在2023年2月20日FIBA世界盃籃球亞太區資格賽的第六階段已經完賽！雖然台灣隊未能參賽，但其他國家選手的精彩表現絕對值得關注。本文將為您提供FIBA籃球世界盃賽程資訊，以及可以收看直播和轉播的線上平台，希望您不要錯過！

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  2408. 世界盃籃球
    2023年的FIBA世界盃籃球賽（英語：2023 FIBA Basketball World Cup）是第19次舉行的男子籃球大賽，且現在每4年舉行一次。正式比賽於 2023/8/25 ~ 9/10 舉行。這次比賽是在2019年新規則實施後的第二次。最好的球隊將有機會參加2024年在法國巴黎的奧運賽事。而歐洲和美洲的前2名，以及亞洲、大洋洲、非洲的冠軍，還有奧運主辦國法國，總共8支隊伍將獲得這個機會。

    在2023年2月20日FIBA世界盃籃球亞太區資格賽的第六階段已經完賽！雖然台灣隊未能參賽，但其他國家選手的精彩表現絕對值得關注。本文將為您提供FIBA籃球世界盃賽程資訊，以及可以收看直播和轉播的線上平台，希望您不要錯過！

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  2414. 體驗金
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  2431. 今彩539
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    今彩539，作為台灣極受民眾喜愛的彩票遊戲，每次開獎都吸引著大量的彩民期待能夠中大獎。這款彩票遊戲的玩法簡單，玩家只需從01至39的號碼中選擇5個號碼進行投注。不僅如此，今彩539還有多種投注方式，如234星、全車、正號1-5等，讓玩家有更多的選擇和機會贏得獎金。

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    在百家樂的牌點計算中，10、J、Q、K的牌點為0；A為1；2至9的牌則以其面值計算。如果牌點總和超過10，則只取最後一位數作為總點數。例如，一手8和7的牌總和為15，但在百家樂中，其牌點則為5。

    百家樂的策略和技巧也是玩家們熱衷討論的話題。雖然百家樂是一個基於機會的遊戲，但通過觀察和分析，玩家可以嘗試找出某些趨勢，從而提高自己的勝率。這也是為什麼在賭場中，你經常可以看到玩家們在百家樂桌旁邊記錄牌路，希望能夠從中找到一些有用的信息。

    除了基本的遊戲規則和策略，百家樂還有一些其他的玩法，例如「對子」押注，玩家可以押注閒家或莊家的前兩張牌為對子。這種押注的賠率通常較高，但同時風險也相對增加。

    線上百家樂的興起也為玩家帶來了更多的選擇。現在，玩家不需要親自去賭場，只需要打開電腦或手機，就可以隨時隨地享受百家樂的樂趣。線上百家樂不僅提供了傳統的遊戲模式，還有各種變種和特色玩法，滿足了不同玩家的需求。

    但不論是在實體賭場還是線上賭場，百家樂始終保持著它的魅力。它的簡單、直接和快節奏的特點使得玩家們一再地被吸引。而對於那些希望在賭場中獲得一些勝利的玩家來說，百家樂無疑是一個不錯的選擇。

    最後，無論你是百家樂的新手還是老手，都應該記住賭博的黃金法則：玩得開心，

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  2607. 百家樂
    **百家樂：賭場裡的明星遊戲**

    你有沒有聽過百家樂？這遊戲在賭場界簡直就是大熱門！從古老的義大利開始，再到法國，百家樂的名聲響亮。現在，不論是你走到哪個國家的賭場，或是在家裡上線玩，百家樂都是玩家的最愛。

    玩百家樂的目的就是賭哪一方的牌會接近或等於9點。這遊戲的規則真的簡單得很，所以新手也能很快上手。計算牌的點數也不難，10和圖案牌是0點，A是1點，其他牌就看牌面的數字。如果加起來超過10，那就只看最後一位。

    雖然百家樂主要靠運氣，但有些玩家還是喜歡找一些規律或策略，希望能提高勝率。所以，你在賭場經常可以看到有人邊玩邊記牌，試著找出下一輪的趨勢。

    現在線上賭場也很夯，所以你可以隨時在網路上找到百家樂遊戲。線上版本還有很多特色和變化，絕對能滿足你的需求。

    不管怎麼說，百家樂就是那麼吸引人。它的玩法簡單、節奏快，每一局都充滿刺激。但別忘了，賭博最重要的就是玩得開心，不要太認真，享受遊戲的過程就好！

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  2647. 《2024總統大選：台灣的新篇章》

    2024年，對台灣來說，是一個重要的歷史時刻。這一年，台灣將迎來又一次的總統大選，這不僅僅是一場政治競技，更是台灣民主發展的重要標誌。

    ### 2024總統大選的背景

    隨著全球政治經濟的快速變遷，2024總統大選將在多重背景下進行。無論是國際間的緊張局勢、還是內部的政策調整，都將影響這次選舉的結果。

    ### 候選人的角逐

    每次的總統大選，都是各大政黨的領袖們展現自己政策和領導才能的舞台。2024總統大選，無疑也會有一系列的重量級人物參選，他們的政策理念和領導風格，將是選民最關心的焦點。

    ### 選民的選擇

    2024總統大選，不僅僅是政治家的競技場，更是每一位台灣選民表達自己政治意識的時刻。每一票，都代表著選民對未來的期望和願景。

    ### 未來的展望

    不論2024總統大選的結果如何，最重要的是台灣能夠繼續保持其民主、自由的核心價值，並在各種挑戰面前，展現出堅韌和智慧。

    結語：

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  2649. 《娛樂城：線上遊戲的新趨勢》

    在現代社會，科技的發展已經深深地影響了我們的日常生活。其中，娛樂行業的變革尤為明顯，特別是娛樂城的崛起。從實體遊樂場所到線上娛樂城，這一轉變不僅帶來了便利，更為玩家提供了前所未有的遊戲體驗。

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    隨著智慧型手機的普及，娛樂城APP已經成為許多玩家的首選。透過APP，玩家可以隨時隨地參與自己喜愛的遊戲，不再受到地點的限制。而且，許多娛樂城APP還提供了專屬的優惠和活動，吸引更多的玩家參與。

    ### 娛樂城遊戲：多樣化的選擇

    傳統的遊樂場所往往受限於空間和設備，但線上娛樂城則打破了這一限制。從經典的賭場遊戲到最新的電子遊戲，娛樂城遊戲的種類繁多，滿足了不同玩家的需求。而且，這些遊戲還具有高度的互動性和真實感，使玩家仿佛置身於真實的遊樂場所。

    ### 線上娛樂城：安全與便利並存

    線上娛樂城的另一大優勢是其安全性。許多線上娛樂城都採用了先進的加密技術，確保玩家的資料和交易安全。此外，線上娛樂城還提供了多種支付方式，使玩家可以輕鬆地進行充值和提現。

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    結語：

    娛樂城，無疑已經成為當代遊戲行業的一大趨勢。無論是娛樂城APP、娛樂城遊戲，還是線上娛樂城，都為玩家提供了前所未有的遊戲體驗。然而，選擇娛樂城時，玩家仍需保持警惕，確保自己的安全和權益。

    Trả lời

  2650. 娛樂城遊戲
    《娛樂城：線上遊戲的新趨勢》

    在現代社會，科技的發展已經深深地影響了我們的日常生活。其中，娛樂行業的變革尤為明顯，特別是娛樂城的崛起。從實體遊樂場所到線上娛樂城，這一轉變不僅帶來了便利，更為玩家提供了前所未有的遊戲體驗。

    ### 娛樂城APP：隨時隨地的遊戲體驗

    隨著智慧型手機的普及，娛樂城APP已經成為許多玩家的首選。透過APP，玩家可以隨時隨地參與自己喜愛的遊戲，不再受到地點的限制。而且，許多娛樂城APP還提供了專屬的優惠和活動，吸引更多的玩家參與。

    ### 娛樂城遊戲：多樣化的選擇

    傳統的遊樂場所往往受限於空間和設備，但線上娛樂城則打破了這一限制。從經典的賭場遊戲到最新的電子遊戲，娛樂城遊戲的種類繁多，滿足了不同玩家的需求。而且，這些遊戲還具有高度的互動性和真實感，使玩家仿佛置身於真實的遊樂場所。

    ### 線上娛樂城：安全與便利並存

    線上娛樂城的另一大優勢是其安全性。許多線上娛樂城都採用了先進的加密技術，確保玩家的資料和交易安全。此外，線上娛樂城還提供了多種支付方式，使玩家可以輕鬆地進行充值和提現。

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    結語：

    娛樂城，無疑已經成為當代遊戲行業的一大趨勢。無論是娛樂城APP、娛樂城遊戲，還是線上娛樂城，都為玩家提供了前所未有的遊戲體驗。然而，選擇娛樂城時，玩家仍需保持警惕，確保自己的安全和權益。

    Trả lời

  2651. 539
    《539開獎：探索台灣的熱門彩券遊戲》

    539彩券是台灣彩券市場上的一個重要組成部分，擁有大量的忠實玩家。每當”539開獎”的時刻來臨，不少人都會屏息以待，期盼自己手中的彩票能夠帶來好運。

    ### 539彩券的起源

    539彩券在台灣的歷史可以追溯到數十年前。它是為了滿足大眾對小型彩券遊戲的需求而誕生的。與其他大型彩券遊戲相比，539的玩法簡單，投注金額也相對較低，因此迅速受到了大眾的喜愛。

    ### 539開獎的過程

    “539開獎”是一個公正、公開的過程。每次開獎，都會有專業的工作人員和公證人在場監督，以確保開獎的公正性。開獎過程中，專業的機器會隨機抽取五個號碼，這五個號碼就是當期的中獎號碼。

    ### 如何參與539彩券？

    參與539彩券非常簡單。玩家只需要到指定的彩券銷售點，選擇自己心儀的五個號碼，然後購買彩票即可。當然，現在也有許多線上平台提供539彩券的購買服務，玩家可以不出門就能參與遊戲。

    ### 539開獎的魅力

    每當”539開獎”的時刻來臨，不少玩家都會聚集在電視機前，或是上網查詢開獎結果。這種期待和緊張的感覺，就是539彩券吸引人的地方。畢竟，每一次開獎，都有可能創造出新的百萬富翁。

    ### 結語

    539彩券是台灣彩券市場上的一顆明星，它以其簡單的玩法和低廉的投注金額受到了大眾的喜愛。”539開獎”不僅是一個遊戲過程，更是許多人夢想成真的機會。但需要提醒的是，彩券遊戲應該理性參與，不應過度沉迷，更不應該拿生活所需的資金來投注。希望每一位玩家都能夠健康、快樂地參與539彩券，享受遊戲的樂趣。

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  2660. 539
    《539彩券：台灣的小確幸》

    哎呀，說到台灣的彩券遊戲，你怎麼可能不知道539彩券呢？每次”539開獎”，都有那麼多人緊張地盯著螢幕，心想：「這次會不會輪到我？」。

    ### 539彩券，那是什麼來頭？

    嘿，539彩券可不是昨天才有的新鮮事，它在台灣已經陪伴了我們好多年了。簡單的玩法，小小的投注，卻有著不小的期待，難怪它這麼受歡迎。

    ### 539開獎，是場視覺盛宴！

    每次”539開獎”，都像是一場小型的節目。專業的主持人、明亮的燈光，還有那台專業的抽獎機器，每次都帶給我們不小的刺激。

    ### 跟我一起玩539？

    想玩539？超簡單！走到街上，找個彩券行，選五個你喜歡的號碼，買下來就對了。當然，現在科技這麼發達，坐在家裡也能買，多方便！

    ### 539開獎，那刺激的感覺！

    每次”539開獎”，真的是讓人既期待又緊張。想像一下，如果這次中了，是不是可以去吃那家一直想去但又覺得太貴的餐廳？

    ### 最後說兩句

    539彩券，真的是個小確幸。但嘿，玩彩券也要有度，別太沉迷哦！希望每次”539開獎”，都能帶給你一點點的驚喜和快樂。

    Trả lời

  2663. 娛樂城
    《娛樂城：線上遊戲的新趨勢》

    在現代社會，科技的發展已經深深地影響了我們的日常生活。其中，娛樂行業的變革尤為明顯，特別是娛樂城的崛起。從實體遊樂場所到線上娛樂城，這一轉變不僅帶來了便利，更為玩家提供了前所未有的遊戲體驗。

    ### 娛樂城APP：隨時隨地的遊戲體驗

    隨著智慧型手機的普及，娛樂城APP已經成為許多玩家的首選。透過APP，玩家可以隨時隨地參與自己喜愛的遊戲，不再受到地點的限制。而且，許多娛樂城APP還提供了專屬的優惠和活動，吸引更多的玩家參與。

    ### 娛樂城遊戲：多樣化的選擇

    傳統的遊樂場所往往受限於空間和設備，但線上娛樂城則打破了這一限制。從經典的賭場遊戲到最新的電子遊戲，娛樂城遊戲的種類繁多，滿足了不同玩家的需求。而且，這些遊戲還具有高度的互動性和真實感，使玩家仿佛置身於真實的遊樂場所。

    ### 線上娛樂城：安全與便利並存

    線上娛樂城的另一大優勢是其安全性。許多線上娛樂城都採用了先進的加密技術，確保玩家的資料和交易安全。此外，線上娛樂城還提供了多種支付方式，使玩家可以輕鬆地進行充值和提現。

    然而，選擇線上娛樂城時，玩家仍需謹慎。建議玩家選擇那些具有良好口碑和正規授權的娛樂城，以確保自己的權益。

    結語：

    娛樂城，無疑已經成為當代遊戲行業的一大趨勢。無論是娛樂城APP、娛樂城遊戲，還是線上娛樂城，都為玩家提供了前所未有的遊戲體驗。然而，選擇娛樂城時，玩家仍需保持警惕，確保自己的安全和權益。

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    傳統的遊樂場所往往受限於空間和設備，但線上娛樂城則打破了這一限制。從經典的賭場遊戲到最新的電子遊戲，娛樂城遊戲的種類繁多，滿足了不同玩家的需求。而且，這些遊戲還具有高度的互動性和真實感，使玩家仿佛置身於真實的遊樂場所。

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