I hereby promulgate the Medical Service Law. Signed:HIROHITO, Seal of the Emperor This thirtieth day of the seventh month of the twenty-third year of Showa (July 30, 1948) Prime Minister ASHIDA Hitoshi Law No.205 Medical Service Law Chapter I. General Provisions

Art.1. In this Law "the hospital" means the place where medical practitioners or dentists give medical or dental practice to the public or to the specific masses and which possesses the equivalents with the capacity for not less than 20 patients, and it shall be an institution organized and conducted primarily for the purpose of providing facilities where the sick and injured may by given scientific and ethical medical care. In this Law, "the clinic" means the place where medical practitioners or dentists give medical or dental practice to the public or to the specific masses and which possesses no equipments for receiving patients or possesses the equipments with the capacity for not more than 19 patients.

Art.2. In this Law, "the midwifery home" means the place where midwives carry out their practice (excepting one prctised in hospitals or clinics) for the public or for the specific masses. The midwifery home shall not have equipments with the capacity for more than 10 women in pregnancy or in childbed.

Art.3. The places where the treatment of the disease (including the midwifery) is carried out and which are not hospitals or clinics shall not be titled as hospitals, branch hospitals, maternity hospitals, sanatoria, clinics or medical practitioners'offices or attached the names liable to be confused with hospitals or clinics. The clinics shall not be titled as hospitals, branch hospitals pr maternity hospitals, or attached the names liable to be confused with hospitals. The places which are not midwifery homes shall not be titled as midwifery homes, or attached the names liable to be confused with the places where midwives carry out their practice.

Art.4. The hospital, which possesses equiments with the capacity for not less than 100 patients and has treatment departments of internal medicine, surgery, gynaecology, ophthalmology and otorhinolaryngology at least and has those equipments mentioned in each item of Art.22, may be titled as General Hospital (Sogobyoin in Japanese), having obtained the approval by the governor of the prefecture where it is situated. The places which are not General Hospitals shall not be titled as General Hospitals or attached the names liable to be confused with General Hospitals.

Art.5. In case of medical practitioners, dentists or midwives engaged in treatment or in their practice exclusively by means of visiting for the public or the specific masses, their dwelling places shall be considered as their clinics or midwifery homes and the provisions of Art.8, Art.9 and Art.39, or Art.41 shall be applicable to them.

Art.6. Concerning the application of the provisions of this Law to the hospitals, clinics and midwifery homes established by the state, special rules shall be fixed by Cabinet Order.

Chapter II. Hospitals, Clinics and Midwifery Homes

Art.7. Those who want to establish hospitals, those who are not medical practitioners or dentists and want to establish clinics or those who are not midwives and want to establish midwifery homes shall receive the permission of the governor of the prefecture where they are going to be established. To those who want to establish hospitals, clinics or midwifery hones for the purpose of making profit, the permission mentioned in the preceding paragraph may not be given.

Art.8. Medical practitioners, dentists, or midwives who have established clinics or midwifery homes shall report to the governor of the prefecture where clinics or midwifery homes are located within 10 days of hire establishment.

Art.9. The establishers of hospitals, clinics or midwifery homes, in case they have suspended or abolished the same hospitals, clinics or midwifery homes, shall report it to the governor of the prefecture within 10 days. When the establishers of the hospitals, clinics or midwifery homes have reopened the hospitals, clinics or midwifery homes under suspension, the same procedure shall be taken. In case the establisher of a hospital, a clinic or a midwifery home has died or has been sentenced as missing, the obligor for the reporting of dying or missing according to the provisions of the Censusregister Law (Law No.224 of 1947) shall report it to the governor of the prefecture where it is located within 10 days.

Art.10. The establisher of a hospital or a clinic shall, in case the same hospital or clinic carries on medical practice, have a medical practitioner manage it, and, in case it carries on dental practice, have a dentist do that. The establisher of a hospital or a clinic which cassies on both medical and dental practice shall, in case the same hospital or clinic carries on chiefly medical practice, have a medical practitioner manage it, and, in case it carries on chiefly dental practice, have a dentist do that.

Art.11. The establisher of a midwifery home shall have a midwife manage it.

Art.12. The establisher of a hospital, a clinic or a midwifery home shall, in case he is qualified for the manager of a hospital, a clinic or a midwifery home, manage it himself; provided that, in case he has obtained the permission of the governor of the prefecture where the hospital, clinic or midwifery home is located, he may be allowed to have another person manage this. The medical practitioner, the dentist or the midwife managing a hospital, a clinic or a midwifery home shall be the one who does not manage any other hospital, clinic or midwifery home, unless he has obtained the permission of the governor of the prefecture where the hospital, the clininc or the midwifery home is located.

Art.13. Managers of clinics shall not accommodate each patient for more than 48 hours. However, concerning patients who have been given the first aid and whom it is very difficult to transfer within 48 hours, this rule shall not apply. The manager of the clinic concerned shall, in case he accommodated patients more than 48 hours according to the provisions of the proviso to the preceding paragraph, report it without delay to the director of the health center of the area where the clinic is located.

Art.14. Managers of midwifery homes shall not accommodate more than 10 women in pregnancy or in childbed at any time. However, in case of pregnant women who may be about to deliver children having no other places to go this rule shall not apply. The manager of the midwifery home concerned shall, in case she accommodated more than 10 women in pregnancy or in childbed at the same time according to the provision of the proviso to the preceding paragraph, report it without delay to the director of the health center of the area where the midwifery home is located.

Art.15. Managers of hospitals or clinics shall supervise over medical practitioners, dentists, pharmacists and other workers serving in the same hospitals or clinics and pay necessary attention in order that they may be able to carry on their practice ro business without failure. Managers of midwifery homes shall supervise over midwives and other workers serving in the same midwifery homes and pay necessary attention in order that they may be able to carry on their business without failure.

Art.16. Managers of hospitals where medica lcare is given shall have medical practitioners be on night duty. However, in case medical practitioners serving in the hospital live in the neighbouring place of the same hospital and the permission of the governor of the prefecture where it is located has been given, this rule shall not apply.

Art.17. Except for what are provided for in the preceding four Articles, those matters which the manager of a hospital, a clinic or a midwifery home shall comply with concerning its construction and equipments, administration of medicines and other articles and accommnodation of patients and women in pregnancy and in childbed shall be fixed by Ministerial Ordinance.

Art.18. In the hospitals, or in the clinics with not less than three medical practitioners serving full time the establishers shall employ full time pharmacists; provided that, in case the permission of the governor of the prefecture where the hospitals or clinics are located has been given, this rule shall not apply.

Art.19. The establisher of a midwifery home shall make a certain contract withh a definite medical practitioner.

Art.20. Hospitals, clinics or midwifery homes shall keep themselves clean and the construction and equipments of them shall besa fe from the view-point of hygiene, prevention of fire and public peace.

Art.21. The hospitals shall, in accordance with the provisions of the Ministerial Ordinance, possess personnel, equipments, and records mentioned in the following items: (1) Numbers of medical practitioners, dentists, nurses and other workers fixed by Ministerial Ordinance; (2) Consultation-rooms for each department; (3) Operation-rooms; (4) Treatment-rooms; (5) Equipments for clinical examination; (6) X-rays apparatus; (7) Dispensary; (8) Disinfecting equipments; (9) Equipments for boarding; (10) Equipments for water-supply; (11) Heating equipments; (12) Equipments for washing; (13) Filth-treating equipments; (14) Records concerning medical treatment; (15) Equipments other than those mentioned above and fixed by Ministerial Ordinance. The Cabinet is hereby authorized to include penal provisions in the Cabinet Order providing that violaters of provisions of Ministerial Ordinances issued according to the provisions of item 1 and item 15 of the preceding paragraph shall be liable to a fine not more than 5,000 yen.

Art.22. The General Hospitals shall possess equipments mentioned in the following items, besides what are mentioned in the preceding Article: (1) Equipments for chemical, bacteriological and pathological examination; (2) Rooms for pathological dissection; (3) Rooms for study; (4) Rooms for lecture; (5) Library; (6) Equipments fixed by Ministerial Ordinance other than those mentioned above. The Cabinet is hereby authorized to include penal provisions in the Cabinet Order providing that violators of provisions of Ministerial Ordinances issued according to the provision of item 6 of the prdceding paragraph shall be liable to a fine not more than 5,000 yen.

Art.23. Except for what is provided for in the preceding two Articles, necessary standard of the construction and equipments of hospitals, clinics and midwifery homes shall be fixed by Ministerial Ordinance, in order that they may be sufficient from the view-point of ventilation, lighting, illumination, prevention of dampness, preservation of peace, refuge, cleanlinses and other hygienical matters. The Cabinet is hereby authorized to include penal provisions in the Cabinet Order providing that violators of provisions of Ministerial Ordinances issued according to the provision of the preceding paragraph shall be liable to a fine not more than 5,000 yen.

Art.24. The governor of the prefecture may, in case a hospital, a clinic or a midwifery home does not keep itself clean, or in case he considers the construction and equipments thereof to be against the provisions of Art.21 or Art.22, or the Ministerial Ordinance under the preceding Article or harmful from the hygienical point of view or dangerous to public peace, restrict or prohibit the use of the whole or a part of them for a fixed term or order the repair or reconstruction of them to the establisher thereof.

Art.25. The Minister of Welfare or the governor of the prefecture may, when he considers to be necessary, cause establishers or managers of hospitals, clinics or midwifery homes to report necessary matters or cause competent government or public officials to inspect hospitals clinics or midwifery homes and examine the cleanliness, constructions and equipments or patients record books, midwifery record books and other books and documents. The competent government or public officials shall, when they inspect and examine according to the preceding paragraph, take the certificate with them and show it to those concerned upon their request.

Art.26. Medical care inspectors shall be put in the state and prefectures to carry out the official power of the competent government or public officials mentioned in par.1 of the preceding Article. The Medical care inspectors shall be appointed by the Minister of Welfare of the governor of the prefecture from among government official or public officials of prefectures. Except what is provided for in the preceding two paragraphs, necessary matters concerning medical care inspectors shall be fixed by Ministerial Ordinance.

Art.27. Clinics or midwifery, homes which possess equipments for receiving patients or women in pregnancy or in childbed, or hospitals shall not be used, unless they have passed through the inspection of the governor of the prefecture where they are located and been given licence by the said governor concerning their construction and equipments.

Art.28. The governor of the prefecture may, in case the manager of a hospital, a clinic or a midwifery home has committed crimes or done unjust deeds concerning medical affairs or is considered unfit for the management, order the establisher thereof to change him for another.

Art.29. The governor of the prefecture may cancel the permission for the establishment of hospitals, clinics or midwifery homes or order the suspension of their function for a fixed term to their establishers, in case they come under one of the following items: (1) In case hospitals, clinics or midwifery homes do not begin practice without any proper reason for 6 months or more after having obtained the permission for the establishment of them; (2). In case establishers of hospitals, clinics or midwifery homes violated orders according to the provisions of Art.24. or the preceding Article; (3) In case establishers of hospitals, clinics or midwifery homes have committed crimes or done unjust deeds concerning medical affairs. The governor of the prefecture may, in case General Hospitals have come not to fulfil the necessary conditions stipulated in Art.4, par.1, cancel his approval.

Art.30. Such steps as provided for by Art.24, Art.28 or Art.29 shall not be taken until after a hearing has been held before a public official or an employee designated for such purpose by the prefectural governor. In this case, a reasonable advance notice shall be made to those concerned. The notice shall state the date and place of hearing, and state further the ground or grounds constituting the reason for the proposed action. The person complained against shall be heard in his defence either in person or by counsel, and may produce witnesses to testify in his behalf. The person conducting the hearing shall take and preserve a record of hearing, and shall make a written report of his findings and a recommendation to the prefectural governor for decision. The prefectural governor may, when he considers that there is imminent danger to sanitation or public peace, take immediate action notwith standing the provision of par.1. In such emergency cases, a hearing upon reasonable advance notice shall be granted as soon as possible, and in no event longer than 3 days after taking the action.

Chapter III. Public Medical Facilities

Art.31. In this chapter public medical facilities mean hospitals or clinics established by prefectures, cities, towns, villages or those who are fixed by the Minister of Welfare.

Art.32. The Council for the arrangement of medical facilities under the jurisdiction of the Minister of Welfare or the prefectural governor shall be set up in the Ministry of Welfare or a prefecture to investigate and deliberate important matters concerning the arrangement of medical facilities in response to the inquiry of the said Minister or the governor. The composition, term of office of members, method of decision and other matters necessary for the Council for the arrangement of medical facilities shall be fixed by Cabinet Order.

Art.33. The Government may, in case there is special necessity for the diffusion of medical treatment, give grants-in-aid within the scope of the budget which shall be a part of the expenditure necessary for the establishment of the public medical facilities to prefectures, cities, towns, villages or to those who are fixed by the Minister of Welfare.

Art.34. The Minister of Welfare may, in case he considers especially necessary for the diffusion of medical treatment, order to those mentioned in the preceding Article to establish public medical facilities, hearing the opinion of the Council for the arrangement of medical facilities. In the case of the preceding paragraph, the Government shall give grants-in-aid within the scope of the budget which shall be a part of the expenditure necessary for the establishment thereof.

Art.35. The Minister of Welfare or the prefectural governor may order the establishers or managers of public medical facilities the following matters: (1) To permit duly licensed medical practitioners or dentists who are not serving in the public medical facilities concerned to utilize whole or a part of the building, equipments, apparatuses and utensils of the hospitals or clinics for their medical treatment or study, if there is no obstacle against the medical or dental practice of the same hospitals or clinics; (2) To be furnished with necessary conditions so that the practical training provided for in Art.11 of the Medical Practitioner Law (Law No.201 of 1948) or the Dentist Law (Law No.202 of 1948) may be done in them. Except for what is provided for in each item of the preceding paragraph, the Minister of Welfare or the prefectural governor may make necessary indications to the establishers of public medical facilities their management.

Art.36. The Counsil for the management of public medical facilities under the jurisdiction of the prefectural governor shall be set up to investigate and deliberate upon important matters concerning the management of the public medical facilities in response to the inquiry of the said governor. The composition, term of office of members, method of decision and other matters necessary for the Council for the management of public medical facilities shall be fixed by Cabinet Order.

Art.37. The Minister of Welfare may regulate concerning the sums of fees for medical treatment which the establishers of public medical facilities are allowed to demand.

Art.38. The Council for Medical Fees under the iurisdiction of the Minister of Welfare shall be set up, in order to deliberate upon matters concerning the fees for medical treatment provided for in the preceding Article in response to the inquiry of the said Minister.

Chapter IV. Advertisements concerning Medical or Dental Profession or Midwifery Practice

Art.39. The advertisements concerning medical or dental profession or hospitals or clinics shall not be made by documents or any other method by any person, except the matters specified in the following items: (1) That he is a medical practitioner or a dentist; (2) Names of the treatment departments as provided for in Art.40, par.1; (3) Names of hospitals or clinics, telephone numbers and matters denoting the sites of hospitals or clinics; (4) Names of medical practitioners or dentists engaged in treatment; (5) Days for treatment or hours for treatment; (6) Existence of the equipments for hospitalization; (7) Matters other than those mentioned above and permitted by the prefectural governor. Any one, in case he advertises the matters mentioned in item 4 of the preceding paragraph, if the medical practitioners or the dentists are not engaged in treatment full time, shall advertise the days and hours for treatment of the same medical practitioners or dentists, at the same time. Any one, in case he advertises the matters mentioned in each item of par.1, shall not denote any matter concerning ability, methods of treatment, personal history or degree of medical practitioners or dentists.

Art.40. Names of the treatment departments provided for in item 2 of par.1 of the preceding Article shall be as follows: (1) Concerning medical profession:Internal Medicine, Psychopathology, Pediatrios, Surgery, Orthopaedy, Dermatourology (or Dermatology, Urology), Obstetrics and Gynaecology (or Obstetrics, Gynaecology), Ophthalmology, Otorhinolaryngology, Physical Treatment Department (or Radiant Rays Department); (2) Concerning Dental profession Dentistry; (3) The names of the departments outside of the preceding two items, of which the medical practitioners or dentists who are engaged in the treatment concerned, have obtained the permission by the Minister of Welfare. The Minister of Welfare shall, in case he gives permission according to the provisions of item 3 of the preceding paragraph, beforehand hear the opinion of the Council for medical morality. In case of the advertisement of the names of treatment departments according to the provision of par.1, item 3, the name of the medical practitioner or the dentist who has been given permission concerning the department concerned shall be advertised at the same time.

Art.41. The advertisements concerning practice of a midwife ar a midwifery home shall not be made by documents or any other method by any person, except the matters specified in the following items: (1) That she is a midwife; (2) Names and telephone numbers of midwifery homes and matters denoting the sites of midwifery homes; (3) Names of midwives engaged in practice; (4 ( Days for practice; (5) Existence of the equipments for accommodation; (6) Matters other than those mentioned above and permitted by the prefectural governor. Any one, in case he advertises the matters mentioned in item 3 of the preceding paragraph, if the midwives are not engaged in practice full time, shall advertise the days and hours for practice of the same midwives, at the same time. Any one, in case he advertises the matters mentioned in each item of par.1, shall not denote any matters concerning ability or personal history of midwives.

Chapter V. Penal Provisions

Art.42. Those who come under any one of the following items shall be liable to penal servitude not more than 6 months or a fine not more than 10,000 yen: (1) Those who violated the provisions of Art.7, par.1, Art.39, Art.40, par.3 or Art.41; (2) Those who violated the provision of Art.14; (3) Those who violated the orders or dispositions according to the provisions of Art.24, Art.28, or Art.29.

Art.43. In case the competent government or public official or one who has been at the post has let out, without any reason, the secrets on business or the personal secrets of medical practitioners, dentists at midwives found at the inspection of the patients record books or midwifery record books in accordance with the provisions of Art.25, he shall be punished with penal servitude of not more than 6 months or a fine not more than 10,000 yen. In case other public servants or former public servants who came to know the secrets while on duty have let out the secrets without any reason, the same as in the preceding paragraph shall apply.

Art.44. Those who come under any one of the following items shall be liable to a fine not more than 5,000 yen: (1) Those who violated the provisions of Art.3, Art.4, par.2, Art.8 to Art.13, inclusive Art.16, Art.18, Art.19, item 2 to item 14 inclusive of Art.21, item 1 to item 5 inclusive of Art.22 or Art.27; (2) Those who neglected reports mentioned in the provision of Art.25, par.1 or made false reports, or refused, hindered or evaded the inspection of the competent government or public officials according to the same provision.

Art.45. In case the representative of a juridical person or the substitute the employee or other workers of a juridical person or a person has done the offensive deeds under Art.42 or Art.44 concerning the affairs of the same juridical person or the person, the same juridical person or the person shall be liable to a fine provided for in the Articles, concerned besides punishing the actual offender.

Supplementary Provisions:

Art.46. This Law shall come into force as from the day of the enforcement of the Medical Practitioner Law.

Art.47. Clinics or hospitals with the capacity for not less than 20 patients which have been given permission of establishment according to the provision of Art.21 of the National Medical Treatment Law (Law No.70 of 1942, hereinafter referred to as the Former Law) or which have been deemed to have been given permission of establishment according to the provision of Art.74 of the Enforcement Regulations of the National Medical Treatment Law Ministry of Welfare Ordinance No.48 of 1942, hereinafter referred to as the Former Regulations) and are actually in existence at the time of the enforcement of this Law, shall be deemed to have obtained thep ermission for the establishment of hospitals or clinics or to have reported the establishment of clinics according to the provisions of Art.7 of Art.8. Hospitals with the capacity for not more than 19 patients which have been given permission of the establishment according to the provision of Art.21 of the Former Law or have been deemed to have been given permission according to the provision of Art.74 of the Former Regulations and are actually in existence at the time of the enforcement of this Law, shall be deemed to have obtained the permission for the establishment of clinics or to have reported the establishment of clinics according to the provisions of Art.7 or Art.8. However, these clinics may, for 6 months after the enforcement of this Law, be titled former names, notwithstanding the provision of Art.3, par.2. Concerning the construction and equipments of hospitals or clinics mentioned in the preceding two paragraphs, provisions of the Former Law may be applicable for three years after the enforcement of this Law. However, in case it is necessary to make important changes to the construction and equipments, and the permission of the governor of the prefecture where the hospitals or clinics are located, has been given, the provisions of the Former Law may be applicable for 2 years more. Concerning those places which have been deemed to have been given permission of the establishment of clinics or to have reported the establishment of clinics according to the provisions of par.1 or par.2, the provisions of Art.13 may not be applicable for 3 years after the enforcement of this Law. However, in case of clinics established in those areas where there are not sufficient number of hospitals and the permission of the governor of the prefecture where they are located has been given, provisions of Art.13 may not be applicable for 2 years more.

Art.48. Of the advertisements concerning medical or dental profession, practice of midwife, hospitals or clinics which are actually in existence at the time of the enforcement of this Law and are contrary to the provisions of Art.39, Art.40, par.3 or Art.41, the provisions of the Former Law may be appliable for 6 months after the enforcement of this Law.

Art.49. Of those places which come under midwifery homes provided for in this Law and are actually in existence at the time of the enforcement of this Law, the provisions of this Law may not be applicable for 6 months after the enforcement of this Law. Concerning the construction and equipments of those midwifery homes mentioned in the preceding paragraph which have obtained the permission of the establishment of midwifery homes according to the provisions of Art.7 or have reported the establishment of midwifery homes according to the provisions of Art.8 within 6 months after_the enforcement of this Law the provisions of this Law may not be applicable for 2 years after the enforcement of this Law.

Art.50. Those who have obtained the permission of the prefectural governor according to the provisions of Art.45, par.1, proviso, par.2 or Art.51, proviso of the Former Regulations or have been deemed to have obtained the same permission according to the provisions of Art.75 of the Former Regulations shall be deemed to have obtained the permission according to the provisions of Art.12, par.1, proviso, par.2 or Art.18, proviso. Those who have obtained the permission of the Minister of Welfare according to the provisions of Art.36, par.1, item 1 of the Former Regulations shall be deemed to have obtained the permission according to the provisions of Art.40, par.1, item 3.

Art.51. As to the hospitals or clinics continually in suspension of practice before the enforcement of this Law, the peporting of suspension according to the provisions of the Former Law shall be deemed to have been done according to the corresponding provisions of this Law.

Art.52. In case there are the establishers of hospitals or clinics who have died or been sentenced as missing before the enforcement of this Law, as to those who have not yet reported according to the provisions of Art.43, par.2 of the Former Regulations and whose term of reporting is not yet expired at the time of the enforcement of this Law, the reporting shall still be made according to the former provisions.

Art.53. Measures which have been taken by the prefectural governor according to the provisions of Art.57 or Art.58 of the Former Regulations or have been deemed to have been taken according to the provisions of Art.80 of the same Regulations, shall be deemed to have been done according to the corresponding provisions of this Law.

Minister of Finance KITAMURA Tokutaro Minister of Welfare TAKEDA Giichi Prime Minister ASHIDA Hitoshi