Standards For The Reference and Counter-Reference Process

“RULES FOR THE REFERENCE AND COUNTER REFERENCE PROCESS IN
ESSALUD” IN THE SOCIAL HEALTH INSURANCE – ESSALUD”
GENERAL MANAGEMENT DIRECTIVE Nº -GG-ESSALUD-2020 V.1.1

SIGNATURE AND
NAME POST DATE
V°B°
Cesar
Produced Central Health
Eduardo
by Benefits Manager
Carreño Diaz
reviewed William Jesus Central Planning and

by Cuba Arana Budget Manager
Renzo
reviewed Kenneth Central Legal Advice
by Zarate Manager
Miranda
Alfredo
Approved Roberto
General manager
by Barredo
Moyano
CHANGE CONTROL
EFFECTIVE
No. ITEMS DESCRIPTION OF THE CHANGE VERSION DATE
Initial version of the document 1.0 31/15/2015

1
2 Updated version 1.1 20/04/2020

INDEX
CHAPTER I.....................................................................................................................1
INITIAL PROVISIONS.....................................................................................................1
CHAPTER II....................................................................................................................3
RESPONSIBLE BODIES................................................................................................3
CHAPTER III...................................................................................................................4
PROVISIONS..................................................................................................................4
ANNEXES.....................................................................................................................16
CHAPTER I
INITIAL PROVISIONS
Article 1 Objective
Establish processes and procedures that regulate the Reference and Counter-
Reference System in institutional and extra-institutional IPRESS.
Article 2 Purpose
Standardize the Implementation of the care process of the Reference and Counter-
Reference System, in order to achieve continuity of care in institutional and extra-institutional
IPRESS.
Article 3 Regulatory Framework
3.1 Law No. 2705, Law of Creation of Social Health Insurance – ESSALUD, its Regulations,
approved by Supreme Decree No. 002-99-TR, and its amendments.
3.2 Law No. 2790, Law on the Modernization of Social Security in Health and amendments;
and its Regulations approved by Supreme Decree No. 009-97-SA and amendments.
3.3 Law No. 2842, General Health Law and its amendments.
3.4 Law No. 2705, Law for the Creation of Social Health Insurance (ESSALUD) and its
Regulations, approved by Supreme Decree No. 002-99-TR, and amendments.
3.5 Civil Service Law No. 30057 and its Regulations approved by Supreme Decree No. 040-
2014-PCM.
3.6 Supreme Decree N" 013-200ó-SA, which approves the Regulation of Health
Establishments and Medical Support Services.
3.7 Supreme Decree N" 005-2012-SA, which approves the Complementary Provisions
related to the Benefit Exchange, between the Health Establishments financed by the
Comprehensive Health Insurance - SIS and the Social Health Insurance - ESSALUD
within the framework of Law 29344, Framework Law for Universal Health Insurance.
3.8 Supreme Decree No. 020-2014-SA that approves the Single Ordered Text (TUO) of Law
No. 29344, Framework Law for Universal Health Insurance.
3.9 Regulations of Law No. 29344, Framework Law for Universal Health Insurance, approved
by Supreme Decree No. 008-2010-SA and amendments.
3.10 Supreme Decree No. 031-2014-SA, which approves the "Regulation of infractions and
Sanctions of the National Superintendence of Health -SUSALUDU and amendments.
3.11 Superintendency Resolution No. 092-2014-SUSALUD/S that approves the "Regulations
for the Collection, Transfer and Dissemination of information on Health Benefits
generated by the Health Services Providing Institutions (IPRESS) and IPRESS
Management Units" .
3.12 Ministerial Resolution No. 18ó-2015-PCM, which approves the manual to improve citizen
service in public administration entities.
3.13 Executive Presidency Resolution No. 938-PE-ESSALUD-2013, which approves Directive
No. 01-PE-ESSALUD-2013 Standards for the granting and rendering of tickets, travel
expenses and allowance for travel and installation expenses in ESSALUD within the
Territory National".
3.14 Executive Presidency Resolution No. ó5ó-PE-ESSALUD-2014, approves the Organic
Structure and the Regulation of Organization and Functions of the Social Health Security
- ESSALUD and amendments.
3.15 General Management Resolution 1471-GG-ESSALUD-2013, which approves Directive
018-GG ESSALUD-2013 "Definition, characteristics and general functions of Social
Security health establishments (ESSALUD)".
3.16 Directive No. 12-GG-ESSALUD-2014 "Programming of Care Activities of Health
Professionals and Non-Health Professionals in ESSALUD", approved with General
Management Resolution No. 1008-GG-ESSALUD-2014.
3.17 General Management Resolution No. 1517 –GG-ESSALUD – 2015 that approves
Directive No. 014 –GG-ESSALUD – 2015 “Standards of the Reference and Counter-
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Reference process in Social Health Insurance – ESSALUD”

3.18 Executive Presidency Resolution No. 222-PE-ESSALUD-2018, Provide the details and
modifications in Executive Presidency Resolution No. 125-PE-ESSALUD-2018.
3.19 Directive No. 002 -GG-ESSALUD-2017 v.01; "Standards for the Formulation, Approval,
Publication and Update of Directives in ESSALUD" and amendments.
3.20 Executive Presidency Resolution No. 222-PE-ESSALUD-2018, Provide the details and
modifications in Executive Presidency Resolution No. 125-PE-ESSALUD-2018.
Article 4 Scope of application
This directive applies to IPRESS itself and to third parties at the national level.
Article 5 Definitions
5.1 COMPANION: Person or family member who would accompany the insured
during the transfer to the destination IPRESS.
5.2 ACCREDITATION: Attribute of the registration of the natural person with which
the right to coverage of the affiliated insurance plan is enabled.
5.3 COMPLEMENTARY ACCREDITATION : It is the recognition of the right to
benefits that the insured has, after verification of compliance with the
requirements and criteria of the insurance to which he or she is affiliated to grant
accreditation.
5.4 RESOLUTIONAL CAPACITY: This refers to the capacity of each IPRESS
according to its category and level of complexity, to provide services for
diagnostic and therapeutic purposes, which are determined, among others, for
the services, human resources, specialties and equipment of the [PRESS. It is
subdivided into: Qualitative Resolution Capacity, when it refers to the type of
specialty or equipment that the IPRESS has; and, Quantitative Resolution
Capacity, when it refers to the number of specialists and equipment it has.
5.5 MEDICAL COUNTER REFERENCE: It is an administrative care procedure
through which the responsibility for medical management, helping with the
diagnosis and/or treatment of the patient, is returned to the treating doctor of the
IPRESS of Origin. Counterreferral is not a procedure used to support the
passages of a treated patient.
5.6 PHARMACOLOGICAL COUNTER REFERENCE: the Administrative Procedure
through which the treating physician of the IPRESS of Destination returns the
responsibility for the medical management of the patient to the IPRESS of Origin,
clearly indicating the long-term treatment that will be followed (up to 0 or months)
and grants prescriptions. for 45 days, to those patients who have chronic
diseases who periodically receive multiple prescriptions.
5.7 EXTENSION OF THE REFERENCE: It is the procedure carried out by the
treating physician or head of the Admission Office/Unit, Medical Records,
References and Counter-References, of the IPRESS of Destination when there is
no resolution capacity in the destination service to guarantee continuity. of the
requested attention, generating a reference to another IPRESS. The Extension is
made to any [PRESS, own or Extra-institutional, with the available resolution
capacity.
5.8 COMPLEX DIAGNOSTIC AID EXAMS: These are understood as exams
performed by highly specialized professionals, with specific infrastructure and
technology for this purpose, and high-cost medical supplies and material.
5.9 IPRESS: These are health establishments and medical support services, public,
private or mixed, created or to be created, that provide health care for the
purposes of prevention, promotion, diagnosis, treatment and/or rehabilitation; as
well as those complementary or auxiliary services of medical care, which have
the purpose of contributing to the prevention, promotion, diagnosis, treatment
and/or rehabilitation of health.
5.10 IPRESS OF ORIGIN: It is the IPRESS that refers the patient to the IPRESS of
Destina for the granting of healthcare benefits that exceed its resolution capacity.
5.11 DESTINATION IPRESS: It is the IPRESS that receives the referred patient and
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that has sufficient resolution capacity to provide the care benefits that are the
reason for the referral.
5.12 EXTENSION IPRESS: It is the IPRESS to which the patient is referred through a
Reference Extension due to lack of specialists in the Destination IPRESS.
5.13 TREATMENT PHYSICIAN: He is the one who receives the patient in the first
consultation for a new injury or pathology and takes responsibility for his care;
requests comprehensive evaluation exams if relevant and, depending on the
clinical status, requests consultations with other specialties and/or referrals to
Health Professionals if required. The role of the treating physician ends upon
discharge, referral or corresponding Counter-Reference.
5.14 NEW TRANSFER AND INFORMATION SCHEME (NETI): Project that will make
available to ESSALUD the Information that is currently sent through plain files to
a secondary database server located in ESSALUD facilities, which is an online
replica from a primary server located in SUNAT facilities.
5.15 ADMINISTRATIVE REFERENCE: It is the administrative resource that is used to
facilitate care for a patient who requires a referral, to be treated in an
extraordinary manner at a Destin IPRESS under specific parameters using the
Medical Record code.
5.16 OBSERVED REFERENCE: It is one not admitted in the Reference Unit of the
PRESS of Origin and/or Destination.
5.17 PATIENT REFERENCE: It is an administrative care procedure, through which a
treating doctor of the PRESS transfers the responsibility for the medical
management and/or assistance in the diagnosis of a patient to another doctor of
an institutional or extra-institutional IPRESS with greater resolution capacity or
capacity. resolution available regardless of its category.
5.18 MEDICAL REFERENCE: It is the document through which the medical
management of the patient is transferred from an IPRESS of Origin to another
PRESS of Destination.
5.19 REFERENCES AND COUNTERREFERENCES SYSTEM: It is the set of
processes that articulate the granting of health benefits between IPRESS of
EsSalud and Extra-institutional health entities with the purpose of guaranteeing
the continuity of care, considering the operational resolution capacity.
5.20 REFERENCES IN PROCESS DUE TO INSUFFICIENT OFFER: It is that
approved reference, which has not yet obtained an appointment at the Destine
PRESS due to lack of specialist.
5.21 VISA REFERENCE: It is one that is accepted at the Destine IPRESS, being
suitable for granting the appointment
CHAPTER II
RESPONSIBLE BODIES
This directive applies to IPRESS itself and to third parties at national level)
Article 6 Responsibilities
6.1 Central Manager of Health Benefits.

6.2 Central Operations Manager.
6.3 Central Manager of Insurance and Economic Benefits.
6.4 Central Manager of Financial Management.
6.5 Central Manager of People Management.
6.6 Central Manager of Information and Communications Technologies.
6.7 Central Planning and Development Manager.
6.8 Deconcentrated Network Manager / Healthcare Network Manager or Director.
6.9 Flexible Offer Manager.
6.10 Manager of the National Center for Renal Health.
6.11 Deputy Manager of Health Network Operations.
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6.12 Director of the National Cardiovascular Institute.

6.13 Manager / Director of own and third-party IPRESS
6.14 Heads of Benefit Coordination and Primary Care Offices
6.15 Head of Department I Service.
6.16 Head of the Management and Development Office.
6.17 Head of the Admissions and Medical Records Office.
6.18 Head of the Admission Office/Unit, Medical Records, Referral and Counter-References as
appropriate.
6.19 Head of the IT Support Offices.
6.20 Head of the Insurance Office or as appropriate.
CHAPTER III
PROVISIONS
Article 7 General Provisions
7.1 The care of the referred patient is exclusive to the Diagnosis that generates the
referral. When the case warrants, the treating doctor can make up to three
interconsultations with specialties related to the pathology that gave rise to the
referral, with a maximum of 02 appointments for each specialty according to medical
criteria and Clinical Practice Guidelines according to availability.
7.2 The hours of attention to the Public in the Office/Admission Unit, Medical Records,
Reference and Counter-References, the area that takes its place, is a minimum of 8
hours from Monday to Friday and a minimum of 6 hours on Saturdays.
7.3 The Directors/Managers of the institutional and Extra-institutional IPRESS carry out
the necessary actions for the monthly update of the list of sub-activities and
procedures available in the Reference and Counter-Reference System.
7.4 The Manager or Director of the IPRESS establishes the necessary mechanisms for
receiving the Reference Request forms at other times, as required (mailboxes,
Admissions staff, among others).
7.5 Patients referred from networks in the interior of the country have priority for care in
the Diagnostic Aid services and procedures through their own offer or through third
parties, and control consultations within a maximum period of 72 hours.
7.6 The Extension of the reference is only admitted in the process for insufficient offer
due to lack of specialist in the IPRESS of Destina. Any reference in process in the
Destination IPRESS for reasons other than that indicated must be resolved under the
responsibility of the owner of the Network.
7.7 The Central Operations Management permanently monitors the patient waiting list for
specialized care in order to improve the opportunity for referral care. The maximum
period for attention at the destination IPRESS is 30 days from the date of registration
of the reference
7.8 The results of the Diagnostic Aid tests generated at the IPRESS of Origin must be
taken into account for the treatment at the IPRESS of Destination, avoiding
unnecessary repetition of tests.
7.9 Administrative References have a Medical Record code of 9999 and are generated
by the treating physician for the services required (Annex 02). These are carried out
in the following cases:
i. Reference of Patients with Oncological Diagnosis

ii. High Risk Neonate Patient.
iii. Patient affected with HIV-AIDS.
iv. Patient affected with Multidrug Resistant Tuberculosis (MOR TB) and Extremely
Drug Resistant Tuberculosis (XDR TB).
v. Patient with Terminal Chronic Kidney Disease, stage 5.
vi. Patient in Pre-Transplant study and Post-Transplant Control.
vii. Rare Diseases
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viii. Other high risk conditions at the exceptional disposal of the owner of the Network
Table N° 01 - Assignment of Administrative References according to Organs, Devices, Systems

affected according to the Neoplasia
Genitourinary system
Hematological tissue
Skin and soft tissues
Uterus and annexes
Ophthalmic system
respiratory system
system and spinal
Osseous system
digestive organs
lymphoid tissue
central nervous
Head and neck
Cardiovascular
system
Mother
cord
General Surgery x x
Head and neck surgery x x
Cardiovascular Surgery x
Breast Surgery
Chest Surgery x
Maxillofacial Surgery x
Gynecology x x
Breast Pathology x
Urology x
Otorhinolaryngology x
Ophthalmology x x
Orthopedics and Traumatology x x

Vascular Neurosurgery and
x
Tumors
Neurotraumatology x
Neuroradiology x
Dermatology x
Endocrinology x
Neurology x
Pneumology x
Nephrology x
Hematology x x
Gastroenterology x
Medical Oncology x x x x x x x x x x x x x
Gynecologic Oncology x x
Radiotherapy x x x x x x x x x x x x x
pain therapy x x x x x x x x x x x x x
Table N° 02 -Assignment of Administrative References Special Pathologies
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Guy
Pre-transplant study
Living organ donors

High-risk neonates.
and post-transplant
complete disability
MDR TB and XDR
HIV-AIDS disease
Kidney Disease in
Terminal Chronic
Permanent and
for transplants.
Rare Diseases
Hemodialysis
follow-up
TB.
Service
Chest Surgery x
General Surgery
Maxillofacial Surgery x
Vascular surgery x
Dermatology x x
Endocrinology x
Gastroenterology x x
Gynecology x x
Infectology x
Physical Medicine and Rehabilitation x x x
Nephrology x x
Neonatology x
Pneumology x x
Neurology x x x
Ophthalmology x x x
Medical Oncology x x
Otorhinolaryngology x x
Orthopedics and Traumatology x x x
Pediatrics x x
Psychiatry x x
Urology x x
Services according to protocols x x x x x
7.10 In the event that the patient and/or family member rejects the referral to the
Destination IPRESS, the Reference Unit staff informs that they will lose3. the
appointment granted and the consequences of their decision are communicated, and
the patient and/or family member must sign the corresponding form (Annex 08).
7.11 The Head of the Admission Office/Unit, Medical Records, Reference and Counter-
Reference, or whoever takes his place, monitors the Reference and Counter-
Reference indicators (Annex 13) and issues a monthly report to the Manager or
Director of the IPRESS for your evaluation.
7.12 Provincial references are identified with the IT system and prioritized in relation to
local references.
7.13 References are made from an IPRESS with lower resolution capacity to another with
greater resolution capacity or with available resolution capacity, regardless of its
Category, whether managed by itself or by third parties, taking into consideration its
geographical accessibility (Annex 22).
7.14 The minimum acceptance criteria for the Reference are set out in Annex 24 and the
reference and Counter-Reference criteria for the second to third level of care in
Annex 25.
7.15 Requests for complex Diagnostic Aid exams require filling out the References and
Counter-References form after verification of accreditation.
7.16 Conventional and low-cost Diagnostic Aid Tests do not require the generation of
referrals.
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Article 8 Specific Provisions

8.1 About the organization of the reference and counter-reference system
8.1.1 The Central Operations Management through the Territorial Operations
Management conducts and supervises the Reference and Counter-Reference
System at the national level.
8.1.2 The Deputy Management of Health Network Operations/Benefits and Primary
Care Coordination Office of the Desconcentrad Network/Asistence Network
8.1.3 Controls the Reference and Counter-Reference System in the assigned territorial
area.
8.1.4 The Admission, Medical Records, Reference and Counter-Reference Office/Unit
has human resources, infrastructure and equipment in accordance with the
provisions of annexes 19 and 20.
8.1.5 The person responsible for the Admission Office/Unit, Medical Records,
Reference and Counter-Reference periodically informs the Manager/Director, in
accordance with the provisions of this standard, regarding the behavior of the
system indicators.
8.1.6 The Central Operations Management through the Territorial Operations
Management conducts and supervises the Reference and Counter-Reference
System at the national level.
8.1.7 The Health Network Operations Sub-Management/Benefits and Primary Care
Coordination Office of the Desconcentrad Network/Assistance Network controls
the References and Counter-References in the assigned territorial area.
8.1.7.1 The Admission, Medical Records, Reference and Counter-Reference
Office/Unit carries out the operational activities of the Reference and Counter-
Reference System at the IPRESS; includes:
6 Reference management
i. Coordination with the Heads of IPRESS reference units of origin, destination
and Extension
ii. Coordination with the Heads of healthcare services
iii. Appointment assignment for referred patients
iv. Monitoring system indicators
v. Counterreferral Management
8.1.8 OF THE REFERENCE
A. FROM THE EXTERNAL CONSULTATION
8.1.9.1 The IPRESS destinations of the third level of care reserve 25% of their
spaces for new referred patients; The IPRESS destinations of the second
level of care reserve 15% of their spaces for new referred patients.
8.1.9.2 The Assistance Digitizer of the referral unit verifies whether the insured is
accredited. The type of insurance to which it belongs must be specified in
the current institutional information system.
8.1.9.3 Policyholders who appear in the system as non-accredited access
complementary accreditation through the Service Platform (Insurance
Offices, Insurance Agencies and Insurance Modules) or the Insurance
Support Module in the case of Lima, in accordance with the provisions of
current regulations. For these purposes, the insured must comply with the
provisions of Annex 20, a procedure that will be used until the
Implementation of the New Transfer and Information Scheme (NETI).
8.1.9.4 Doctors issue referrals to patients affiliated with the independent Insurance,
exclusively for the Diagnoses or procedures that appear on the list of
insurable conditions, available in the office and known to the insured.
8.1.9.5 If the patient affiliated with the Independent Insurance requires a benefit that
7
is not on the list of insurable conditions, the Admission, Insurance Module

staff or whoever acts in their place, proceed to inform the insured of the
available alternatives.
8.1.9.6 Every reference is the product of a dental medical consultation originating in
the Outpatient Consultation, Hospitalization or Emergency, as appropriate,
for which the Reference Request Form set out in Annex 08 is used, the
procedure for which is described in Annex 01. It is not appropriate to
request a disability qualification, exclusive pharmacological prescription and
support services such as Nutrition, Psychology and Social Work.
8.1.9.7 Referrals of low-risk pregnant women can be generated by the obstetrics
professional exceptionally at the first level with the approval of the Surgical
Medical Chief or whoever acts in his place.
8.1.9.8 The obstetrics professional records the required data in the Reference
Request Form in a clear and legible manner (Annex 08); Destina's IPRESS
data is recorded in the Admission Office/Unit, Medical Records, Reference
and Counter-Reference according to the available resolution capacity.
8.1.9.9 The Care Enterer registers the References and Counter-References in the
Web-based Reference and Counter-Reference System on the same day
they are received. You should consider the following information:
i. Date of receipt of the Reference Request Form.

ii. Number of the Medical Record that corresponds to the care at the IPRESS
of Origin and when the appointment is assigned at the IPRESS of
Destination.
iii. Medical history number.
iv. Telephone, email or some means of communication with the patient.
v. Medical service where the referral was generated.
vi. Destination medical service.
vii. Summary of clinical history and results of diagnostic tests.
viii. Patient diagnosis(es) with the corresponding ICD 10 code.
ix. Registration of the Medical College Number of the Treating Physician.
8.1.9.10 The Director of the IPRESS of Destina or whoever acts in his place,
arranges the necessary actions for the care of all referred patients on the
assigned date. In the absence of the Doctor or lack of availability to carry
out the procedure(s) to Aid Diagnosis and Treatment due to unforeseen
situations, he arranges corrective measures to provide care on the same
day, or on the earliest date.
8.1.9.11 The person responsible for References and Counter-References at the
Destina IPRESS approves the reference in a period of no more than two
(02) business days.
8.1.9.12 The person responsible for References and Counter-References at the
Destina IPRESS consults the relevance of the requested reference with the
Head of Service or Head of Department, in cases where it is required.
8.1.9.13 The care entry of the Office/Admission Unit, Medical Records, References
and Counter-References of the IPRESS of Destin assigns the appointment
of the endorsed reference within a period of no more than one (01) business
day for Outpatient Consultation and no more than two ( 02) business days
for Exams and procedures to Help Diagnosis and Treatment. The
appointment is confirmed according to what is indicated in Annex 23.
8.1.9.14 The Head of the Admission Office/Unit, Medical Records, References and
Counter-References of the IPRESS of Destination communicates to the
Head or person responsible for the Unit of the IPRESS of Origin, the
reference observed, within a period of no more than two (02) days. business
days of receiving the reference. The Head of the Office/Admission Unit,
Medical Records, References and Counter-References of the IPRESS of
Origin, or the person to whom he delegates, is responsible for correcting the
observation and communicates it one (01) day later to the Head of the
Admissions Unit. the IPRESS of Destina; or cancels the reference, if
applicable.
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8.1.9.15 The Head of the Admission, Medical Records, References and Counter-
References Office of the IPRESS of Origin, processes the referral preferably
to the IPRESS where the patient has a medical history, for the continuity of
their treatment under the following conditions:
i. Patients with Oncological Diagnosis.

ii. Patient in Pre-Transplant study and Post-Transplant control.
iii. High-risk neonates.
iv. Other high risk conditions
B. OF EMERGENCY SERVICES
8.1.8.16 Patient referrals to the emergency service are made through coordination
between the Heads of Guard via telephone and email. The IPRESS of
Origin registers the Reference Request within a maximum period of 24
hours after the reference has been made. The acceptance, observation or
rejection of the Reference must be recorded in the Clinical History.
8.1.8.17 If the patient treated in an emergency with priority I or II requires a
Reference, it must be communicated to the patient and/or family; If not
accepted, the Chief of Guard to whom he delegates must communicate the
fact to the prosecutor on duty.
8.1.8.18 Every patient treated in the Emergency Service of an IPRESS to which they
are not affiliated, and who was hospitalized, can receive one (01) control
benefit in an outpatient consultation, after discharge from hospitalization in
the corresponding service. At the end of it, the treating doctor makes the
Counter-Referral to the IPRESS of affiliation.
8.1.8.19 The Head of Emergency Guard of the IPRESS of Origin authorizes the
method of transportation for the transfer of the patient in the appropriate
cases and for such purposes applies the Reference Request Form (Annex
08) and the request for tickets (Annex 10). .
C. HOSPITALIZATION
8.1.8.20 The referral of patients referred between Hospitalization services is carried

out through the coordination of the corresponding Service Heads, according
to the following:
i. Access to the Destina IPRESS is through the Emergency Service.

ii. The Head of the Service in the IPRESS assigns or assigns the bed to
which the patient will be transferred, a fact that is made known to the Head
of the Guard.
iii. The treating physician of the IPRESS of Origin makes the Reference
Request in duplicate. The original is transferred with the patient and the
duplicate remains in the Admission, Medical Records, References and
Counter-References Office/Unit.
iv. The Office/Unit of Admission, Medical Records, References and Counter-
References of the IPRESS of Origin registers the Reference Request Form
in the Computer System within a maximum period of 24 hours.
8.1.8.21 Patients referred to Hospitalization can access all the benefits required
during their stay.
8.1.8.22 The validity of the referral for Hospitalization ends upon discharge of the
patient, a procedure that must be accompanied by the epicrisis and the
Counter-Referral form (Annex 09) to be referred to the Admission
Office/Unit, Medical Records, References and Counter-References.
D. FOR BENEFITS TO AID IN DIAGNOSIS AND TREATMENT
8.1.8.23 The reference for diagnostic and treatment assistance services is valid until
the test or procedure is performed.
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8.1.8.24 The results of Examinations to Aid Diagnosis and Treatment are signed by
the responsible doctor and delivered to the Head of the Office/Admission
Unit, Medical Records, References and Counter-References at the end of
the day to form part of the Counter-Reference.
8.1.8.25 The Head of the Office/Admission Unit, Medical Records, References and
Counter-References records the results in the Web Reference System as
an attached file (scanned copies) as a Medical Counter-Reference within a
period of no more than two (02) business days. The service that performs
the exam
8.1.8.26 Provides a copy of the result to the patient if requested.
8.1.8.27 The Head of the Diagnostic Assistance Services of the destination IPRESS
is responsible for providing access at all times to the Diagnostic and
Treatment Assistance Results Modules of their institutional Information
systems to the specialists of the origin IPRESSS.
8.1.8.28 In case of diagnostic confirmation of oncological conditions VJH-AIDS Multi-
Resistant Tuberculosis, Extremely Resistant Tuberculosis and Chronic
Kidney Disease stages 3b, 4 and 5, the Head of the Diagnostic Assistance
Service, if the Destina [PRESS] has the resolution capacity and necessary
operational, generates the Administrative Reference(s) to the corresponding
Service(s) as indicated in Tables 01 and 02. For these purposes, Medical
Act 9999 is used. Proceed in the same way when results are found that
indicate other high-risk conditions.
8.1.8.29 The institutional IPRESS resort to the Extra-institutional IPRESS, if
necessary, to provide help with diagnosis and treatment.
8.1.8.30 The transportation of samples for studies to aid diagnosis and treatment
does not generate referrals.
8.1.8.31 Patients referred for services to assist in diagnosis and treatment or
procedures who do not keep appointments within one month are
administratively counter-referred under the responsibility of the Reference
and Counter-referral Unit.
E. THE EXTRA-INSTITUTIONAL IPRESS FOR ELECTIVE BENEFITS
8.1.8.32 The Deconcentrated Network I Healthcare Network has contracts and/or

agreements with Extra-institutional IPRESS for the referral of patients for
elective clinical, surgical and diagnostic and therapeutic procedures.
8.1.8.33 The Head of the Office/Unit of Admission, Medical Records, References
and Counter-References of the IPRESS uses the existing resources in its
own and third-party IPRESS, within the scope of geographical influence of
the Deconcentrated Care Network I, in order to provide the services · that
are required.
8.1.8.34 Given the lack of sufficient supply in its area of geographical influence, the
Head of the Office of the Admission, Medical Records, Referrals and
Counter-referrals Unit of the IPRESS evaluates the possibility of care in
another Deconcentrated I Care Network or National EsSalud Provider body.
o IPRESS Extra-institutional public and private that has the resolution
capacity in the national territory.
8.1.8.35 The private Extra-institutional IPRESS have the EsSalud Reference and
Counter-Reference System, a condition that is part of the contractual terms.
In the case of public Extra-institutional IPRESS, we proceed according to
the benefit and information exchange mechanisms agreed upon between
the parties.
8.1.8.36 The extra-institutional IPRESS provides the required care and counter-
refers the patient using the Counter-Referral Form with the following
documents, as appropriate:
i. Help result Diagnosis or procedures

ii. Medical report
iii. Epicrisis
iv. Corresponding administrative documents
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F. EXTRA-INSTITUTIONAL IPRESS FOR BENEFITS IN EMERGENCY

SITUATIONS
8.1.8.37 The Deconcentrated Network / Assistance Network has contracts and/or

agreements with Extra-institutional IPRESS for the Referral of patients in
emergency situations.
8.1.8.38 The reasons for Referral to IPRESS Extra-institutional are:
i. Not having the specialist doctor on call or on duty to provide the care that is
required.
ii. Not having beds available in the emergency observation room, post-
anesthesia recovery room or adult, pediatric or neonatal intensive care
rooms.
iii. Not having an Operating Room/Procedure Room available.
iv. Not having operational equipment for emergency diagnosis or treatment.
v. When there is excessive surgical demand and a deferral is planned that
limits or prevents the emergency in a place that does not put the patient's
life at risk or does not cause sequelae.
8.1.8.39 In the circumstances described in the preceding paragraph, the
authorization of the Chief Medical Officer on Duty is sufficient. In other
circumstances, authorization from the Surgical Manager or the Assistant
Manager of Health Network Operations is required, as appropriate.
8.1.8.40 The Chief of Guard of the IPRESS of Origin coordinates with the Chief of
Guard of the IPRESS of Destination with a current agreement or contract,
for the transfer of the patient. Likewise, in the event of difficulties in
executing the referral, the solution of which is beyond its reach, coordinate
with the Surgical Manager or Deputy Manager of Health Network
Operations, as appropriate.
8.1.8.41 The private Extra-institutional IPRESS have the EsSalud Reference and
Counter-Reference System, a condition that is part of the contractual terms.
In the case of public Extra-institutional IPRESS, it is preceded according to
the benefit and information exchange mechanisms agreed upon between
the parties.
8.1.8.42 The treating Physician of the IPRESS of Origin prepares the Reference
Request in the format set forth in annex 09, a duplicate. The original is
transferred with the patient and the duplicate is available to be delivered to
the Admission, Medical Records, References and Counter-References
Office/unit.
8.1.8.43 The Office/Unit of Admission, Medical Records, References and Counter-
References of the IPRESS of Origin registers the Reference Request Form
in the Computer System within a maximum period of 24 hours.
8.1.8.44 The Extra-institutional IPRESS provides the required care and refers the
patient using the Counter-Referral Form with the following documents, as
appropriate:
i. Copy of authenticated or certified medical history
ii. Epicrisis
iii. Corresponding administrative documents
8.1.8.45 The Surgical Manager, the Clinical Manager or the Assistant Manager of
Network Operations of the IPRESS of Origin, as appropriate, issues the
conformity and refers the documentation to the respective instances for the
corresponding administrative actions.
8.1.8.46 The deconcentrated bodies are responsible for implementing, supervising
and reporting monthly to the Central Operations Management of the
requirement and execution of the service contracts provided by the Extra-
institutional IPRESS.
G. OF THE EXTENSION OF THE REFERENCE
8.1.8.47 The Head of Referrals and Counter-Referrals and/or treating doctor as

appropriate, only to avoid having specialist doctors. In such a situation, a
reference is generated in the institution's computer system to another
11
IPRESS with available resolution capacity using Annex 09.
H. OF PATIENTS AFFILIATED WITH A HEALTH PROVIDER ENTITY (EPS)
8.1.8.48 The care of patients under the indicated condition is in accordance with
what is established in the EPS Referral Procedure (Annex 03).
8.1.8.49 The referral of EPS patients is made to the establishments with the greatest
resolution capacity of the Deconcentrated/Care Network to which they
belong according to Diagnosis and priority criteria.
I. FROM NON-ATTENDANCE TO APPOINTMENT
8.1.8.50 The patient referred within the same city who does not attend his
appointment, for reasons beyond ESSALUD, having been duly notified,
must go to the Office/Unit of Admission, Medical Records, References and
Counter-referrals of fa IPRESS of Destina, to register the reason for your
absence and request your next appointment.
8.1.8.51 In the event that the patient referred from another city travels and does not
attend his appointment, he must justify his absence to the Referral and
Counter-Referral Unit of the IPRESS of Destina and this manages the
rescheduling.
8.1.8.52 In the event that the patient does not travel, they must justify their absence
at the Reference and Counter-Reference Unit of the IPRESS of Origin and
this manages the rescheduling.
8.1.8.53 Those responsible for the Reference and Counter-Reference area of the
IPRESS of origin are responsible for canceling patient referral requests,
based on the following considerations:
i. Patients with observed reference greater than 90 days.
ii. Requests for references whose reason for observation is “reference
can be resolved at the IPRESS of origin”
iii. The following Reference States will not be annulled: In processes due
to insufficient offer, visas, extensions, Counter-referral and
summonses.
J. OF THE CANCELLATION OF REFERENCES
8.1.8.54 Those responsible for the References and Counter-References area of the
IPRESS of Origin are responsible for canceling patient referral requests,
based on the following considerations:
i. Patients with observed Reference greater than 30 days.

ii. Requests for References whose reason for observation is reference
can be resolved at the IPRESS of origin."
iii. Patients who voluntarily reject the IPRESS of the Reference
destination.
iv. Deceased patients.
v. Patients who to date have lost their current accreditation and do not
have a latency period
vi. Patients not located due to change of address and affiliation to another
IPRESS or residents abroad.
vii. Patients treated for the reason of referral in other IPRESS
viii. institutional or extra-institutional under contract or agreement.
ix. Patients for whom the reference for an absolute medical
contraindication to Destina's IPRESS is no longer applicable.
x. Patients who reject the indicated medical treatment.
xi. Patients who repeatedly fail to attend their medical appointment more
than 2 times.
8.1.9 OF COUNTERREFERENCE
12
8.1.9.1 Counterreferrals are of 3 types: Medical, and Pharmacological and

Administrative.
8.1.9.2 The treating physician makes the corresponding Counter-Reference for the
IPRESS of Origin upon discharge of the patient. For this purpose, the
Counter-Reference Procedure is applied as the case may be (Annex 04 and
05) and the corresponding format (Annex 09), which is filled out in clear and
legible handwriting.
8.1.9.3 The Counter-Reference is issued only if a reference from the IPRESS of
Origin has been generated.
8.1.9.4 The IPRESS of Origin carries out the necessary actions in order to have the
medications prescribed and recorded in the Pharmacological Counter-
References. The restrictions on use by level of complexity in accordance
with the provisions of the Regulations for the use of pharmacological
requests have no effect in these cases. The Pharmacy services carry out
the actions that are necessary to comply with the provisions of this
provision.
8.1.9.5 The IPRESS of Destination issue Pharmacological Counter-References to
the IPRESS of Extra-institutional Origin, according to the contractual terms.
If applicable, they coordinate the transfer of medications with the Medication
Office of the Decentralized/Assistance Network.
8.1.9.6 Patients referred for outpatient care or diagnostic and treatment support
services or procedures are subject to Administrative Counter-Referral for
the following reasons:
i. Referred patients who are not seen within 0 or months without medical
indication.
ii. If the patient has died
iii. Patients who voluntarily reject the IPRESS of reference destination
iv. Patients who reject the indicated medical treatment.
v. Patients who to date have requested their credibility and when the
latency period has ended
8.1.10 OF TRANSPORTATION OF REFERRED PATIENTS
8.1.10.1 The treating Physician of the IPRESS of Origin determines the means of
transportation (land, air or river) for the transfer of the patient and his
companion (family and/or healthcare) if necessary, duly supported by the
Reference Request Form and validated by the corresponding head of
service. (Annex 08).
8.1.10.2 The Central Operations Manager authorizes the Air Ambulance service, if
the recoverability criteria are met, evaluated by a Medical Board made up of
specialists from the IPRESS of Origin and/or Destination, in person or
through video conference.
8.1.10.3 The need for a companion (family and/or healthcare) is conditional on cases
of patients with severe orientation restrictions and/or physical dependence,
as well as those under 18 years of age and those over 70 years of age.
8.1.10.4 The companion must be over 18 years old and in good physical and mental
condition.
Counter-References signs the ticket request prior to authorization from the
Director of the IPRESS of Origin (Annex 10).
8.1.10.6 The care of the insured in the emergency service of an IPRESS to which
they are not affiliated, does not generate the transportation benefit for the
return to their entire Origin or IPRESS of affiliation.
8.1.10.7 The Manager or Director of the Deconcentrated/Care Network or National
Hospital is responsible for authorizing exceptions to the scope of the
preceding paragraph according to the patient's conditions.
8.1.10.8 Accompanying healthcare personnel, if required, can remain at the Destina
IPRESS for a maximum of 48 hours, and the granting of tickets and
subsistence allowances is governed in accordance with Executive
13
Presidency Resolution No. 938-PE-ESSALUD-2013, which approves

Directive No. 01-PE-ESSALUD-2013 "Rules for the granting and rendering
of tickets, travel expenses and Allocation for expenses of transfers and
installation in ESSALUD within the National Territory."
8.1.11 OF THE GRANTING OF TICKETS
8.1.11.1 Includes round trip tickets for the patient and/or companion, for
appointments at the IPRESS located outside the province. The Logistics
area supplies the required tickets in a timely manner.
8.1.11.2 The documents required for the issuance of tickets are the following:
i. Reference request format

ii. Control appointment or appointments for consultations, procedures or
exams to help with diagnosis.
iii. Hospitalization Order as the case may be
iv. Proof of care, in the case of continuing patients.
8.1.11.3 The staff of the Admission Office/Unit, Medical Records, References and
Counter-References confirms the appointment date prior to processing the
tickets for continuing patients at the Destina IPRESS.
8.1.11.4 The Deconcentrated/Care Network of Origin assumes the travel expenses
in the event that the Reference has been extended to another
Deconcentrated/Care Network.
8.1.11.5 The procedure for granting tickets is set out in Annex 11.
8.1.11.6 Tickets for elective benefits are delivered at least 72 hours before the travel
date. The administrative areas carry out the corresponding control and
inform the patient or companion that the penalties for changing the date of
departure or return are not assumed by ESSALUD. Likewise, it informs that
if you use it and do not attend the scheduled appointment at the Destina
IPRESS, you must reverse the fare blanket.
8.1.11.7 The rescheduling of the appointment and therefore of the travel date is
carried out only for imponderables that affect the transfer of the patient,
verified by the person in charge of the Admission Office/Unit, Medical
Records, References and Counter-references of the IPRESS of Origin .
8.1.11.8 The death of a referred patient gives rise to the generation of the Medical
Counter-Referral.
8.1.11.9 The IPRESS of Origin generates the request to transfer the body by
entering the data into the Reference and Counter-Reference System.
8.1.11.10The IPRESS of Origin assumes the costs of transporting the body, upon
request of the responsible family member, in strict compliance with the
provisions of the Civil Code.
8.1.11.11The Fa IPRESS Social Workers of Destination and Origin coordinate the
corresponding procedures for the transfer of the body and attach copies of
the Medical Counter-Reference and the Death Certificate. ·
8.1.12 ACCESS TO THE REFERENCE AND COUNTER REFERENCE SYSTEM ON

THE WEB
Counter-References is the person who grants access codes to users with
Data Entry or Medical profiles respectively, according to regulations. It is
responsible for the proper assignment and deregistration of users and
passwords, as well as the supervision and monitoring of transactions
carried out in the Reference and Counter-Reference System.
8.1.12.2 The user with the access key is responsible for the operations performed
with it. Improper use of the access code constitutes an administrative
offense, which gives rise to the corresponding disciplinary administrative
procedure or the application of the corresponding contractual clauses.
14
Counter-References, or whoever acts in his place at the IPRESS, is

responsible for informing the Central Operations Management of any
modification in the system's user table: activation, modification and
deactivation.
Counter-References, or whoever acts in his place, or the Deputy Manager
of Operations of the Decentralized Network are the only professionals
authorized to request Electronic access to the system from the Central
Operations Management. for your staff in charge, specifying the user profile.
8.1.13 OF TRAINING
8.1.13.1 The Manager or Director of the Deconcentrated / Care Network, National

Hospital, National Cardiovascular Institute, National Center for Renal
Health, through the competent area, is responsible for the annual training of
the staff of the Reference and Counter-Reference Offices/Units, for the
good functioning of the system.
8.1.14 OF THE VALIDITY OF THE REFERENCE
8.1.14.1 The validity period of the references is according to the following detail:
i. III Level of care: 3 or 5 days

ii. II Level of care: 270 days.
iii. I Level of care: 120 days.
8.1.14.2 The treating doctors of the Destination IPRESS determine the continuity of
care and authorize the extension, up to a period similar to that granted the
first time.
8.1.14.3 In case of patients with the following pathologies:
i. Patients with Oncological Diagnosis

ii. High Risk Neonate Patient
iii. Patient affected with HIV – AIDS
iv. Patient affected with Multidrug Resistant Tuberculosis (MDR-TB) and
Extremely Drug Resistant Tuberculosis (XDR TB).
v. Patient with Chronic, Terminal Kidney Disease, stage 5.
vi. Patient in Pre-Transplant study and Post-Transplant control.
vii. Rare Diseases.
viii. People with permanent and complete disabilities.
In the cases mentioned above, the validity is for up to 5 years, and can be
extended by the treating doctor for up to 5 more years.
8.1.15 OF THE QUALITY OF THE RECORD
Counter-References, or whoever takes his place, is responsible for
monitoring the quality of the registration of the reference and Counter-
Reference (Annexes 15 and 1) and informing the Manager/Director of the
IPRESS.
Counter-References, or whoever acts in his/her place at the Destination
IPRESS is responsible for reporting the list of observed references (Annex
12) to the Manager/Director of the Origin IPRESS.
8.1.16 COMPLEMENTARY PROVISIONS
8.1.16.1 The Managers/Directors of the IPRESS carry out the actions that are
necessary in order to have the supply that is required to promptly meet the
15
demand of the population in their area of affiliation, for which they make use
of all the options offered by the institution (Decentralized Support,
Telemedicine, purchase of services, inter-institutional agreements, among
others). The referral and counter-referral system is applied after having
exhausted all available alternatives for care at the local level.
8.1.16.2 The IPRESS have Telemedicine Centers to access timely care with
specialist doctors where they are not available, avoiding referrals and
transfers of the insured to distant cities. It is used in the pre-clinical
appointment for telediagnosis, teleconsultation, remote monitoring, medical
meetings to obtain a second opinion (teleconference), digital storage of data
or medical records.
8.1.16.3 Access to the Reference and Counter-Reference System for
Complementary Medicine Care Centers (CAMEC) and Occupational Risk
Prevention Centers (CEPRIT) is done through a lPRESS of the
Deconcentrated / Assistance Network, as long as registration is managed in
RENAES (National Registry of Establishments) in accordance with current
regulations.
8.1.16.4 Failure to comply with the provisions contained in this Directive by the
Managers, Deputy Managers, Directors of IPRESS themselves and third
parties, Heads of Department, Heads of Service, professional and non-
professional health workers, constitutes a lack of disciplinary or contractual
nature. and is sanctioned according to current regulations.
8.1.16.5 The initiation of administrative disciplinary procedures and the imposition of
sanctions that may correspond to the employees belonging to the labor
regimes included under Legislative Decree No. 27ó (Public), Law of Bases
of the Administrative Career and Remunerations of the Public Sector, and
its modifications; the Single Ordered Text of Legislative Decree No. 728
(Private), Labor Productivity and Competitiveness Law, approved for
Supreme Decree No. 003-97-TR, and its amendments; and Legislative
Decree No. 1057 (CAS), Decree that regulates the special regime for
administrative contracting of services, is carried out in accordance with the
rules contained in the Civil Service Law No. 30057 and its Regulations
approved by Supreme Decree No. 040 -2014-PCM, as well as Directive No.
002-2015- SERVIR/GPGSC approved by Executive Presidency Resolution
No. 101-2015- SERVIR-PE.
8.1.16.6 The Manager I Director and the Head of the Administration Office of the
Deconcentrated / Assistance Network are responsible for compliance with
this Directive in all the IPRESS of their jurisdiction.
ANNEXES
ANNEX 01: PROCEDURE FOR REQUESTING REFERENCES
ANNEX.02: ADMINISTRATIVE REFERENCE PROCEDURE FOR ONCOLOGY
PATIENTS. WITH TB MOR AND XDR. HIGH RISK NEONATES, HIV-AIDS
PATIENTS WITH STAGE 5 TERMINAL RENAL DISEASE, RARE AND
PSYCHIATRIC DISEASES
ANNEX 03: EPS REFERENCE PROCEDURE
ANNEX 04: COUNTER REFERENCE PROCEDURE
ANNEX 05: PHARMACOLOGICAL COUNTERREFERENCE PROCEDURE
ANNEX 06: REFERENCE EXTENSION PROCEDURE
ANNEX 07: PROCEDURE FOR RECONFIRMATION OF RESCHEDULING OR
CANCELLATION OF APPOINTMENTS FROM ESSALUD ONLINE AND/OR
ADMISSION
ANNEX 08: REFERENCE PROCEDURE FOR CARE IN THE EMERGENCY SERVICE
ANNEX 09: REFERENCE PROCEDURE FOR THE HOSPITALIZATION SERVICE
ANNEX 10: REFERENCE PROCEDURE TO EXTRA-INSTITUTIONAL IPRESS FOR
16
ELECTIVE BENEFITS
ANNEX 11: FLOW OF THE REFERENCE AND COUNTER REFERENCE PROCESS OF
PATIENTS
ANNEX 12: FLOW OF PHARMACOLOGICAL COUNTERREFERENCES
ANNEX 13: REFERENCE FLOW OF PATIENTS IN EMERGENCY SITUATION A
EXTRA-INSTITUTIONAL IPRESS
ANNEX 14: REFERENCE REQUEST FORM
ANNEX 15: COUNTER REFERENCE FORMAT
ANNEX 16: REFERENCE CARE RECORD FORMAT
ANNEX 17: QUALITY VALIDATION FORMAT OF THE REGISTRATION OF THE
REFERENCE
COUNTERREFERENCE
ANNEX 19: TICKET REQUEST
ANNEX 20: GRANTING OF TICKETS
ANNEX 21: LIST OF REFERENCES OBSERVED IN THE DESTINATION IPRESS
ANNEX 22: INDICATORS OF REFERENCES AND COUNTERREFERENCES
ANNEX 23: TABLE OF REFERENCE STATES
ANNEX 24: HUMAN RESOURCES IN THE REFERENCE AND COUNTER REFERENCE
UNITS
ANNEX 25: INFRASTRUCTURE AND EQUIPMENT IN THE REFERENCE AND
COUNTER REFERENCE UNITS
ANNEX 26: REQUIREMENTS FOR COMPLEMENTARY ACCREDITATION
ANNEX 27: REFERENCE ROADMAP
ANNEX 28: MINIMUM CRITERIA FOR ACCEPTANCE OF REFERENCES
ANNEX 29: REFERENCE AND COUNTER REFERENCE CRITERIA OF THE SECOND
TO THE THIRD LEVEL OF CARE
ANNEX 30: LIST OF MEDICAL SPECIALTIES AND SERVICES
ANNEX 01: PROCEDURE FOR REQUESTING REFERENCES
ESSALUD PROCEDURES
GCPS Central
Version:
Health Benefits
REFERENCE
Management
Pass
DESCRIPTION OF ACTIVITIES RESPONSIBLE
ed
Enter the data in legible handwriting in the Reference Form
Origin IPRESS
01 (Annex 12) without filling out the space corresponding to the
Treating Physician
IPRESS of Destina.
Origin IPRESS
Transfer the Reference Form issued to the References and Patient or family
02
Counter-References area Consulting
Technician
03 Evaluate and rate the relevance of the reference; If it is a Origin IPRESS
matter of observation, consult in the first instance with the Referral Physician
treating doctor; and in the second instance, to the immediate
17
superior, if applicable, for the respective correction and return

within a period of no more than 24 hours.
If the endorsement is appropriate, follow step 05.
04 If it is inappropriate, assign the patient an appointment with Origin IPRESS
the treating doctor for information and follow-up of the case, Doctor of
within a maximum period of 02 (two) business days. References
Verify the data recorded in the printed format, then register IPRESS of Origin
and send the Reference form through the Reference and Enterer or
Counter-Reference System or another means of Administrative
05
communication within 48 hours of receipt. Technician
If the patient has problems with accreditation, continue with
Step 06; Otherwise continue with Step 07.
Carry out the verification of the accreditation of law and its
coverage. If not accredited, inform the patient about the
Origin IPRESS
limitations of their care.
06 Accreditation
To accredit, print the affiliation sheet, endorse and seal.
Manager
Deliver the Reference Form plus the affiliation form to the
References area or the one that takes its place.
Destination IPRESS
Head of the
Evaluate the relevance of the Reference. For accepted
07 Reference and
references: Step 08. For observed References: Step 09.
Counter-Reference
Unit
Destination IPRESS
Grant the appointment date in a space no longer than 24 hours
Reference and
08 for Outpatient Consultation and 48 hours for Diagnostic
Counter-Reference
Assistance Services, after obtaining the visa.
Unit
Register the reason for observing the endorsement in the Destination IPRESS
Reference and Counter-Reference System and report to the Head of the
09 IPRESS of origin Reference and
Counter-Reference
Unit
Destination IPRESS
Evaluate the reason for observation:
Head of the
1. It is worth lifting the observation and resending. Step 11
10 Reference and
2. It is not worth resending, cancel the reference and go to Step
Counter-Reference
04.
Unit
Destination IPRESS
11 Make appointment
Digitizer
Print the appointment managed and sent for the Reference
and Counter-Reference System.
Inform the patient of the date and make the appointment 48 Origin IPRESS
12
hours in advance, deliver the appointment to the patient, Digitizer
together with the Original Reference and the tests performed.
Reconfirmation of appointments (Annex 23)
Go directly to the office or service where you are scheduled
Destination IPRESS
13 and must be present 30 minutes before the time indicated in
Patient
the reference form.
ANNEX.02: ADMINISTRATIVE REFERENCE PROCEDURE FOR ONCOLOGY
PATIENTS. WITH TB MOR AND XDR. HIGH RISK NEONATES, HIV-
AIDS PATIENTS WITH STAGE 5 END KIDNEY DISEASE,
RARE AND PSYCHIATRIC DISEASES
ESSALUD
GCPS Central Health PROCEDURES Version:
Benefits Management 01-2015
PASS
ED
Evaluate the confirmatory results of the patient's clinical
and/or Diagnostic Aid examinations for the indicated IPRESS of Treating
01
conditions. Record the Diagnostic Reference Form under Medical Destination
ICD-10 coding the request for Administrative References.
18
Transfer the Reference Form to the References and Counter- IPRESS of

References Unit. Destination,
Patient, Family
02
Member or
Administrative
Technician
Enter the Reference(s) in the Reference and Counter- IPRESS
Reference System, assign appointments Destination
03 Enterer or
Administrative
Technician
Communicate appointments to the patient IPRESS
Destination
04 Enterer or
Administrative
Technician
ANNEX 03: EPS REFERENCE PROCEDURE
ESSALUD PROCEDURES Version:

GCPS Central
Health Benefits REFERENCE
Management
Passed DESCRIPTION OF ACTIVITIES RESPONSIBLE
Receive from the insured the Reference Request form with
Diagnostic Aid results and carry out the following:
a) Verify validity of accreditation in the benefit system.
• Corresponds, continue in literal b.
• It is not appropriate to refer the case to the
Insurance Area to verify information. Destination IPRESS
01
Director or Manager
b) Evaluate Diagnosis (complex layer) and
relevance of the Reference:
• It is appropriate to assign a medical
appointment.
• Not applicable, inform the insured
02 End of the process
ANNEX 04: COUNTER REFERENCE PROCEDURE
ESSA LUD
Central
Management of PROCEDURES Version:
Health Benefits
GCPS
PASS
ED
1 Counter-referrals are of 3 types: Medical, and Pharmacological and Destination
19
IPRESS
Administrative
Treating Physician
Generate the Counter-Reference in duplicate indicating the
recommendations to the patient, enter the medical act number,
Destination
probable date of the next appointment (if applicable) and others, as
2 IPRESS
required in the Counter-Reference Form (Annex 09). Deliver the
Treating Physician
original and copy of the form to the Patient, Family Member or Care
Technician
Destination
Transfer the forms to the Reference and Counter-Reference Unit.
IPRESS
The original with the receipt seal stays with the patient and the copy
3 Patient, Family
in the Office/Unit of Admission, Registration, Doctors, References
Member or Care
and Counter-referral
Technician
Destination IPRESS
Office
Enter the Counter-References into the System (Includes scan copies Enterer/Admission
of diagnostic aid results or others as appropriate) within a maximum Unit, Medical
4
period of two business days from receipt of the form, having to Records,
manage the appointment at the IPRESS of origin. References and
Counter-
References
Patients referred for outpatient care or diagnostic and treatment
support services or procedures are subject to Administrative Counter-
Referral for the following reasons:
Yo. Referred patients who are not seen within 6 months without
medical indication. Destination
5 ii. If the patient has died IPRESS
iii. Patients who voluntarily reject the IPRESS of reference Treating Physician
destination
iv. Patients who reject the indicated medical treatment.
v. Patients who to date have requested their credibility and when the
latency period has ended
ANNEX 05: PHARMACOLOGICAL COUNTERREFERENCE PROCEDURE
ESSALUD PROCEDURES
Central
Version: 01-
Management
of Health 2015
Benefits GCPS REFERENCE
20
Pass
ed
If the doctor has a PC in the office:
- Enter the Counter-Reference Form in the computer system with the
indications for pharmacological treatment for up to 6 months; record:
conclusions and recommendations of clinical and analytical controls,
name of the medication, concentration, presentation, dose, total number
of medications and administration time in months (interval).
- Prescribe a prescription for 45 days for care at the Destination IPRESS
Pharmacy, indicating that it is a Pharmacological Counter-Reference
(seal or manuscript). Destination
- print 01 copy of the Counter-Reference Form and give it to the patient. IPRESS
1
(step 04) If the doctor does not have a PC in the office: Treating
- Fill out the Counter-Reference Form (Annex 04) in duplicate with the Physician
indications for pharmacological treatment for up to 6 months; record:
conclusions and recommendations of clinical or analytical controls,
name of the medication, concentration, presentation, dose, total number
of medications and administration time in months (interval).
- Prescribe a prescription for 45 days for care in the Pharmacy of the
IPRESS of Destination, indicating that it is a Pharmacological Counter-
Reference (seal or manuscript).
- Deliver original and copy of the Counter-Reference Form to the patient.
Destination
Transfer the forms to the References and Counter-References Unit. The IPRESS
original with the receipt stamp remains with the patient and the copy in Patient, Family
2
the Member or
Admission Office/Unit, Medical Records, Referral and Counter-Referral. Care
Technician
Enter the Pharmacological Counter-Reference to the Reference and
Destination
Counter-Reference System on the Web. Attach the copy (scanned) of the
IPRESS
3 Pharmacological Counter-Reference form to the System within the next
Digitizer
02 business days maximum.
Reference Unit
Manage the appointment at the IPRESS of Origin for 45 days.
Within 4 working days of receiving the pharmacological Counter-
Origin IPRESS
Reference, inform the Pharmacy Area, so that provisions can be made
4 Digitizer
for the supply of medication, according to what is indicated in the
Reference Unit
Counter-Reference.
Make the medication requirements indicated by the treating doctor,
Origin IPRESS
according to Pharmacological Counter-Reference for future prescriptions,
5 Head of
Keep track of these medications, so that they are part of the regular
Pharmacy
supply.
Confirm an appointment at the corresponding service for the control and
prescription of the drugs indicated by the destination IPRESS for the Origin IPRESS
6 continuity of treatment. Admission
print the Pharmacological Counterreference and file in the Clinical Keyer
History.
ANNEX 06: REFERENCE EXTENSION PROCEDURE
ESSALUD
Central PROCEDURES
Management of Version: 01-2015
Health Benefits REFERENCE
GCPS
Passe
d
Destination
IPRESS
Evaluates the patient's clinical picture and auxiliary examinations.
1 Treating Physician
Enter the data in the Reference Extension Format
or Interconsultation
Physician
2 Moves the Reference Extension Format to the References and Destination
21
IPRESS
Counter-References area
Patient
Verify and endorse compliance with the completion of the Form. Destination
If the service is available, inform the patient about the limitations of IPRESS
their care at the destination. Head of the
3
If compliance exists, it will be entered as one more reference to References and
Destina's lPRESS with the medical act that produced the extension Counter-
of the service. References Unit
ANNEX 07: PROCEDURE FOR RECONFIRMATION OF RESCHEDULING OR

CANCELLATION OF APPOINTMENTS FROM ESSALUD ONLINE AND/OR
ADMISSION
PROCEDURE FOR RECONFIRMATION, RESCHEDULING OR CANCELLATION OF

APPOINTMENTS FROM ESSALUD ONLINE AND/OR ADMISSION MODULE
Reconfirm the appointment granted, no less than 48 hours in advance or

Aim:
reschedule/cancel the appointment no less than 24 hours in advance.
ESSALUD online and Admission Units, Registries, doctors, References and Counter-
Scope:
referrals of IPRESS with and without assigned population.
22
No. Description of Activities Responsible
ESSALUD Online
1 List of Appointments for the next 48 hours Enterer or Admission
Module.
ESSALUD Online
2 Telephone call to policyholders 48 hours in advance Enterer or Admission
Module.
(Insured person answers the call)
Ask about the appointment:
a) If you reconfirm your appointment, you enter it into the

computer system.
b) If you do not reconfirm, the appointment is cancelled.
ESSALUD Online
• If you request rescheduling, the new appointment enters the
3 Enterer or Admission
computer system
Module.
• If you do not request, end of the process.
c) If you reconfirm your appointment, you enter it into the
computer system.
d) If you do not reconfirm, the appointment is cancelled.
• If you request rescheduling, the new appointment enters the
computer system
e) If you do not request, end of the process.
(The insured does not answer the call) ESSALUD Online
Keeps unreconfirmed appointments reserved in the system Module.
ESSALUD Online
Telephone call back to policyholders with unreconfirmed
appointments, 24 hours in advance
Module.
(Insured person answers Hamada)
ESSALUD Online
Ask about the appointment:
Module.
(The insured does not respond)
ESSALUD Online
Maintains reservations in the system
Module.
appointments not reconfirmed
ANNEX 08: REFERENCE PROCEDURE FOR CARE IN THE EMERGENCY SERVICE
ESSALUD PROCEDURES
Central Management of
Health Benefits REFERENCE FOR CARE IN THE Version:
GCPS EMERGENCY SERVICE
Pass
ed
1 Patient treated and stabilized in the medical unit. Treating physician determines Origin IPRESS
the need for referral due to lack of resolution capacity and/or availability, Treating Physician Emergency
prepares the Reference Request Form, records clinical findings and the auxiliary Service or Hospitalization
23
examinations that support the diagnosis.

Origin IPRESS
Coordinate the acceptance of reference with the Head of Guard of the Treating Physician Emergency
2
Destination IPRESS by telephone or email. Service or Hospitalization /
Head of Guard
Evaluates clinical picture, availability of service and accepts the referral request.
Go to step 05. Destination IPRESS
3 Head of Guard Emergency
In case of rejection of the application due to lack of offer available in the IPRESS Service
itself, go to step 04.
Coordinate the reference with IPRESS of third parties with whom an agreement Origin IPRESS
4
or contract has been signed. Guard Chief
Origin IPRESS
Determine IPRESS of Destination, authorize means of transportation for transfer
Chief of Emergency Service
5 and health professional to accompany the patient. Fill out the Ticket Request
Guard or Chief of
Form, as appropriate.
Hospitalization Service
Origin IPRESS
6 Inform the patient and/or family about their transfer. Treating Physician Emergency
Service or Hospitalization
Origin IPRESS
7 Transfer the patient for care.
Licensed health professional
Destination IPRESS
8 Receive the patient and arrange for their care in the Emergency Service. Head of Guard Emergency
Service
Destination IPRESS
After the patient is admitted, verify their accreditation and the coverage plan, Personnel in charge of
9
register their data in the System, without hindering their access to care. Admission/Module or Insurance
and Economic Benefits Office
Transfer, within a maximum period of 1 business day after the transfer of the
Origin IPRESS
10 patient, a copy of the Reference Request Form to the Reference and Counter-
Emergency Intake Personnel
Reference Unit or Area for registration.
Origin IPRESS
Register, on the day of receipt, the Reference Request in the Web Reference Enterer or Administrative
11
System. Technician of the Reference
Unit or Area
Destination IPRESS
Physician in charge of the Unit
Approve the reference request in the Web-based Reference and Counter- or Reference Area or Head of
12
Reference System once the patient has registered their admission. the Admission and Medical
Records Office or Director of
the IPRESS.
Destination IPRESS
Register as an appointment in the Web Reference and Counter-Reference
Enterer or Administrative
13 System, the date of care of the patient in the Emergency Services of the
Technician of the Reference
Destination IPRESS.
Unit or Area
Destination IPRESS
Discharge the patient, prepare the Epicrisis and the Counter-Reference Form, a
14 Treating Physician Emergency
copy of which must be sent to the Reference and Counter-Reference Unit.
Service or Hospitalization
Destination IPRESS
Register the Counter-Reference Form, in the corresponding computer system, Enterer or Administrative
15
within a maximum period of 24 hours. Technician of the Reference
Unit or Area
ANNEX 09: REFERENCE PROCEDURE FOR THE HOSPITALIZATION SERVICE
ESSALUD
Central PROCEDURES
Management of Version:
Health Benefits REFERENCE FOR HOSPITALIZATION SERVICE
GCPS
PASS
ED
1 Enter, in clear and legible handwriting, in the Reference Request Form the Origin IPRESS
information related to the clinical findings and auxiliary examinations that Treating Physician
support the diagnosis, the reason for the referral and the diagnosis with the Hospitalization Service
corresponding ICD 10 code .
24
The Reference Request Form must be filled out in triplicate. The original is
transferred with the patient, a copy is attached to his/her Medical Record and
the second copy is delivered to the Reference and Counter-Reference Unit.
Coordinate the acceptance of reference with the Head of Assistance Service of Origin IPRESS
2
the Destination IPRESS by telephone or email. Head of Hospitalization Service
Evaluates the clinical picture, bed availability for the patient and accepts the
referral request by informing the Head of the Destination IPRESS Guard. Go to
step 05. Destination IPRESS
3
Head of Hospitalization Service
In case of rejection of the application due to lack of offer available in the
IPRESS itself, go to step 04.
Coordinate the reference with IPRESS of third parties with whom an agreement Origin IPRESS
4
or contract has been signed. Head of Hospitalization Service
Determine IPRESS of Destination, authorize means of transportation for
Origin IPRESS
5 transfer and health professional to accompany the patient. Fill out the Ticket
Request Form, as appropriate.
Origin IPRESS
6 Inform the patient and/or family about their transfer. Treating Physician
Transfer the patient for care at the Destination IPRESS and admit them through Origin IPRESS
7
the Emergency Service. Licensed health professional
Destination IPRESS
8 Receive the patient and arrange for his transfer to the assigned bed.
or person responsible for the
Nursing Service
Destination IPRESS
After the patient is admitted, verify their accreditation and the coverage plan,
9 Admission Technician or
register their data in the System, without hindering their access to care.
Enterer
Transfer, within a maximum period of 1 business day after the transfer of the
Origin IPRESS
10 patient, a copy of the Reference Request Form to the Reference and Counter-
Hospitalization Staff
Reference Unit or Area for registration.
Origin IPRESS
Register, on the day of receipt, the Reference Request in the Web Reference Enterer or Administrative
11
System. Technician of the Reference
Unit or Area
Destination IPRESS
Physician in charge of the Unit
Approve the reference request in the Web-based Reference and Counter- or Reference Area or Head of
12
Reference System once the patient has registered their admission. the Admission and Medical
Records Office or Director of
the IPRESS
Destination IPRESS
Register as an appointment in the Web-based Reference and Counter-
13 Reference System the date of transfer of the patient from the Emergency
Technician of the Reference
Service to hospitalization at the Destination IPRESS.
Unit or Area
Destination IPRESS
Discharge the patient, prepare the Epicrisis and the Counter-Reference Form, a
14 Treating Physician
copy of which must be sent to the Reference and Counter-Reference Unit.
Destination IPRESS
Register the Counter-Reference Form, in the corresponding computer system, Enterer or Administrative
15
within a maximum period of one (01) business day. Technician of the Reference
Unit or Area
ANNEX 10: REFERENCE PROCEDURE TO EXTRA-INSTITUTIONAL IPRESS FOR

ELECTIVE BENEFITS
ESSALUD PROCEDURES
Central
Management of REFERENCE TO THE EXTRA-INSTITUTIONAL Version:
Health Benefits IPRESS FOR ELECTIVE BENEFITS
GCPS
PASS
ED
1 Enter, in clear and legible handwriting, in the Reference Request Form the Origin IPRESS
information related to the clinical findings and the auxiliary tests that support the Treating Physician
diagnosis, as well as the destination service, the reason for the referral, the
diagnosis with which corresponding ICD 10 code.
25
In applicable cases, authorize the means of transportation for the transfer of the
patient, through the Ticket Request Form.
Origin IPRESS
Transfer the Reference Request Form issued to the Reference and Counter-
2 Patient or family member
Reference Unit or Area.
Consultation Technician
Evaluate and rate the relevance of the reference:
Origin IPRESS
Physician in charge of
- If appropriate, register the Extra-institutional IPRESS of Destination in
the Unit or Reference
accordance with the agreements or contracts signed.
3 Area or Head of the
Admission and Medical
- If it is a matter of observation, coordinate with the corresponding Head of
Records Office or Director
Service for the correction or support of the reference, within a period of no more
of the IPRESS
than 24 hours.
Verify the patient's identification data recorded in the Reference Request Form,
Origin IPRESS
the validity of the accreditation and the insured's coverage plan, if applicable.
4
Technician of the
If the patient has problems with their accreditation, continue with Step 05;
Reference Unit or Area
Otherwise continue with Step 06.
Verify the accreditation of the right and its coverage. If you agree, update
information in the Insurance System, print and endorse the accreditation sheet, Origin IPRESS
attach it to the Reference Request Form and return the file to the Reference and Manager of the
5
Counter-Reference Unit or the one that takes its place. Insurance and Economic
Benefits Module or Office
If not accredited, inform the patient about the limitations of their care.
Origin IPRESS
Register the Reference Request Form in the Web-based Reference and Counter- Enterer or Administrative
6
Reference System on the same day of receipt. Technician of the
Reference Unit or Area
Destination Extra-
institutional IPRESS
7 Check the reference on the same day of receipt.
Doctor or responsible
personnel
Destination Extra-
Assign the date of the reference appointment on the same day of receipt in the
8 institutional IPRESS
Reference and Counter-Reference System.
Digitizer
Print the appointment sent by the Reference and Counter-Reference System. Origin IPRESS
9
Give the patient the appointment along with the original Reference Request Form Technician of the
and the tests performed, if applicable. Reference Unit or Area
Go directly to the office or service where you are scheduled at the Destination Destination Extra-
10 Extra-institutional IPRESS, and must be present 30 minutes before the appointed institutional IPRESS
time. Patient
Caring for the patient, issuing counter-referral and, as appropriate, the results of Destination Extra-
11 diagnostic tests, medical report, epicrisis, and corresponding administrative institutional IPRESS
documents. Treating doctor
Origin IPRESS
Issue the conformity of the service and refer the documentation to the respective
12 Head of Assistance
instances for the corresponding administrative actions.
Service
26
“RULES FOR THE REFERENCE AND COUNTER REFERENCE PROCESS IN ESSALUD” IN THE SOCIAL HEALTH INSURANCE – ESSALUD”
ANNEX 11: FLOW OF THE REFERENCE AND COUNTER REFERENCE PROCESS OF

PATIENTS
27
ANNEX 12: FLOW OF PHARMACOLOGICAL COUNTERREFERENCES
28
ANNEX 13: REFERENCE FLOW OF PATIENTS IN EMERGENCY SITUATION A

EXTRA-INSTITUTIONAL IPRESS
29
ANNEX 14: REFERENCE REQUEST FORM
FORMATO DE SOLICITUD REFERENCIA N°
EsSalud Extrainstitucional Área Destino

IPRESS Origen Consulta Externa
Servicio de Origen Hospitalización
Servicio de Destino Emergencia
Numero de Historia Clínica Ayuda al diagnóstico
Numero de Acto Médico
Fecha de Atención Médica
I. Identificación del paciente

Apellido paterno Sexo
Apellido materno Edad
Nombres Teléfono fijo/celular
Número de DNI Correo electrónico
II. Resumen de la historia clínica

Detallar el cuadro clínico y estado actual del paciente:
Indicar los resultados de exámenes auxiliares que sustenten su diagnóstico:
Comentarios adicionales:
Motivo de referencia:
Diagnóstico de referencia Presuntivo Definitivo CIE10

1
2
III. Tipo de transporte según prescripción médica

Terrestre Fluvial Aéreo En caso de Transporte Aéreo sustentar en el Formato N° 10
Sustento en caso requiera acompañante terrestre o fluvial:

Requiere acompañante NO SI Tipo de Acompañante: Familiar Asistencial
IV. Identificación del médico tratante o responsable

CMP
Médico Tratante Jefe de la Unidad de Referencia

(o quien haga de sus veces)
Adjuntar toda documentación que permita una adecuada continuación del tratamiento del paciente en el destino.
RECIBI INFORMACION DE LAS IMPLICANCIAS QUE CONLLEVA EL RECHAZO DE LA REFERENCIA Y ASUMO LA

RESPONSABILIDAD DE LAS CONSECUENCIAS DE LA DECISIÓN.
CARGO DE RECHAZO DE LA REFERENCIA Firma _________________________ DNI ____________
30
ANNEX 15: COUNTER REFERENCE FORMAT
31
ANNEX 16: REFERENCE CARE RECORD FORMAT
32

REFERENCE
33

COUNTERREFERENCE
34
ANNEX 19: TICKET REQUEST
35
ANNEX 20: GRANTING OF TICKETS
ESSALUD PROCEDURES
Central Management
of Health Benefits
Version:
GCPS REFERENCE
Passe
d
Destination
Generate the reference and support the need for the companion if IPRESS
1
justified Treating
Physician
Register the reference in the system, manage the reference and
appointment. enter and process the ticket request to the administrative Origin IPRESS
2 area. Inform the patient that they must present the destination's proof of Digitizer
care to make the next appointment; communicate the implications and Reference Unit
penalties for improper use of the ticket.
Grant the ticket to the patient and register in the registered expense Admissions
3
system Manager
Destination
IPRESS
4 Caring for the patient and signing a certificate of care
Treating
Physician
Head of
Administration
Unit
Receive the patient the certificate of care and verify the attendance of
5 Medical records
the Appointment in the System
References and
Counter
References
ANNEX 21: LIST OF REFERENCES OBSERVED IN THE DESTINATION IPRESS
Patient surnames Treating Reason for

ICD 10 Diagnosis
and names Physician Observation
10
36
11
12
37
ANNEX 22: INDICATORS OF REFERENCES AND COUNTERREFERENCES
INDICATOR 1
PERCENTAGE OF MEDICAL COUNTER REFERENCES
It is a process indicator to measure the effectiveness of the Referrals and Counter-References process in completing
the care cycle. Through the referral, the responsibility for the medical management and/or assistance in the
diagnosis of a patient is transferred to another doctor from an IPRESS with greater resolution capacity or resolution
Basis capacity available regardless of its category; The process ends with the return of the patient to the IPRESS of origin
once the condition that motivated the referral has been resolved; However, there are situations in which for various
reasons the patient is not Counter-Referred, resulting in the process not being completed. This indicator seeks to
evaluate the completion and effectiveness of the process.
“Provide comprehensive care to the insured with the highest quality standards, within the framework of a strong
To which Institutional Strategic Objective commitment of the State to the well-being of the insured, improve the treatment of the insured, change the care
does it Contribute? model to one based on primary care and act on the social determinants of health, with emphasis on preventive-
promotional aspects, counting on technical support from PAHO/WHO.
Indicator Type Continuous increase
Aim Measure process effectiveness
Area of application IPRESS that participate in the referral and counter-referral process
No. of medical counter-references issued x 100

Calculation form
Total References Received Cited
No. of Counter-referrals issued: These are the Counter-referrals made by doctors and dental surgeons
Operational Definition Total T of References Received Cited : Sum of References in the Destination IPRESS that have an appointment
Goal 201ó / Baseline Specialties. Surgical = 90%Specialties. Clinics = 80%

Information Source (Data Source) Reference and Counterreference System
Frequency of sending information Quarterly
Indicator Evaluation Frequency Biannual
Office / Management Responsible for
registration and consolidation in the Head or Responsible for the References and Counter-References Unit.
Benefit/Assistance Network
Office / Management Responsible for the
Consolidation and Evaluation of Central Operations Management
information at the Central Level
37
INDICATOR 2: PERCENTAGE OF PHARMACOLOGICAL COUNTERREFERENCES

When the patient is discharged, or once the provision of care benefits for which the referral is made has ended, and if prolonged
pharmacological treatments are required, the IPRESS of Origin manages the availability of the prescribed medications recorded
Basis
in the counter-referrals. Restrictions on use by level of complexity have no effect in such cases in accordance with the provisions
of the Regulations for the use of the Pharmacological Request. For this, the Pharmacy services comply with what is indicated.
“Provide comprehensive care to the insured with the highest quality standards, within the framework of a strong commitment of
To which Institutional Strategic Objective the State to the well-being of the insured, improve the treatment of the insured, change the care model to one based on primary
does it Contribute? care and act on the social determinants of health, with emphasis on preventive-promotional aspects, counting on the technical
support of PAHO/WHO for this purpose.”
Indicator Type Determination of baseline during a 6-month exercise, and after that, continuous increase.
Aim Measure the effectiveness of the pharmacological counterreference process.
Area of application IPRESS involved in the Reference and Counter-Reference system
Number of pharmacological counter-referrals managed and attended to in IPRESS of origin x 100

Calculation form
Number of Counterreferrals with pharmacological prescription issued in the destination IPRESS
Numerator:
These are counter-referrals with prescriptions for drugs with restrictions on use by specialty, managed by the head of the URyCR
and attended to at the IPRESS of origin.
Operational Definition
Denominator
Total counter-referrals with drug prescriptions with restrictions on use by specialty, issued by doctors and dental surgeons in the
destination IPRESS.
Goal 201ó / Baseline Progressive increase from baseline

Frequency of sending information Monthly
Indicator Evaluation Frequency Quarterly
Office / Management Responsible for the
Consolidation and Evaluation of Central Operations Management
38
INDICATOR 3
PERCENTAGE OF REFERENCES IN PROCESS DUE TO INSUFFICIENT OFFER IN THE DESTINATION OR EXTENSION IPRESS
Intermediate indicator that allows measuring the availability of supply in the destination IPRESS. References received at the
Basis destination IPRESS may be waiting to be approved and an appointment granted due to a lack of specialists at the destination
IPRESS.
“Provide comprehensive care to the insured with the highest quality standards, within the framework of a strong commitment
To which Institutional Strategic of the State to the well-being of the insured, improve the treatment of the insured, change the care model to one based on
Objective does it Contribute? primary care and act on the social determinants of health, with emphasis on preventive-promotional aspects, counting on
technical support from PAHO/WHO.
Indicator Type Continuous decline

Aim Measure the availability of the offer in the destination or extension IPRESS
Area of application Target IPRESS involved in the referral and counter-referral system.
Number of references in process due to insufficient offer due to lack of specialist x 100
Calculation form
Total References in insufficient offer process
Number of references endorsed in process due to insufficient offer: These are the References without an appointment due to
Operational Definition lack of specialist at the destination or extension IPRESS.
Total References Approved : Sum of References in the Destination IPRESS References in the process of insufficient offer
Goal 201ó / Baseline < 3%

Frequency of sending information Monthly
Indicator Evaluation Frequency Monthly
the Consolidation and Evaluation of Central Operations Management
INDICATOR 4: DEFERRAL OF CARE FOR PATIENTS REFERRED FROM OUTPUT CONSULTATION TO LEVEL II AND III IPRESS
39
The deferral of care for patients referred for outpatient consultation to IPRESS of level II and III is a process
Basis
indicator that measures the average waiting time of the patient and the lack of offer at the destination IPRESS.
“Provide comprehensive care to the insured with the highest quality standards, within the framework of a
To which Institutional Strategic strong commitment of the State to the well-being of the insured, improve the treatment of the insured, change
Objective does it Contribute? the care model to one based on primary care and act on the social determinants of health, with emphasis on
preventive-promotional aspects, counting on technical support from PAHO/WHO.
Indicator Type Continuous decline.
Aim Measure the effectiveness of the process
Area of application Target IPRESS involved in the referral and counter-referral process.
Add days (Destination IPRESS medical care appointment date – Origin IPRESS medical care appointment date)
Calculation form Number of referrals received
Operational Definition Average waiting time in days for the patient referred to be treated at the Destination IPRESS
III Level <= 17 days

Goal 201ó / Baseline
II Level <= 12 days
Indicator Evaluation Frequency Weekly, monthly, quarterly and yearly

the Consolidation and Evaluation of Central Operations Management
INDICATOR 5: ADMINISTRATIVE WAITING TIME FOR ATTENTION OF THE REFERENCE AT THE DESTINATION IPRESS OF LEVEL II AND III
40
This indicator makes the difference between measuring the total process with the administrative process only. It is the waiting
Basis time that the Destination IPRESS reference unit takes to assign the appointment. It is a process indicator that measures the
efficiency of the administrative staff of the Reference Unit.
“Provide comprehensive care to the insured with the highest quality standards, within the framework of a strong commitment of
To which Institutional Strategic the State to the well-being of the insured, improve the treatment of the insured, change the care model to one based on primary
Objective does it Contribute? care and act on the social determinants of health, with emphasis on preventive-promotional aspects, counting on technical
support from PAHO/WHO.
Aim Measure the effectiveness of the process
Sum of days ( Date of assignment of the IPRESS Destination appointment – Date of consignment of the IPRESS Origin
Calculation form reference )
Number of references received at the IPRESS Destination
Waiting time at the Destination IPRESS of the Level II and III IPRESS: It is the administrative time measured in days that the
referral is attended to in the Referral Unit of the Destination IPRESS.
Goal 201ó / Baseline 1 day
Information Source (Data Reference and Counterreference System

Source)
Indicator Evaluation Frequency Monthly, quarterly and annual
Office / Management
Responsible for registration and
Head or Responsible for the References and Counter-References Unit.
consolidation in the
Office / Management
Responsible for the
Central Operations Management
Consolidation and Evaluation of
INDICATOR 6: NEW PATIENTS IN REFERENCE
41
Intermediate indicator that allows measuring the opportunity of places for new referred patients in the destination
Basis
IPRESS.
“Provide comprehensive care to the insured with the highest quality standards, within the framework of a strong
To which Institutional Strategic commitment of the State to the well-being of the insured, improve the treatment of the insured, change the care
Objective does it Contribute? model to one based on primary care and act on the social determinants of health, with emphasis on preventive-
promotional aspects, counting on technical support from PAHO/WHO.
Aim Measure the effectiveness of the counterreferral opportunity
Calculation form Number of new referrals / Number of referrals * 100
New referred patient: Patient for whom a new referral is generated and who has not had any other referral request
in the previous 02 years.
III Level ≥35%
Goal 201ó / Baseline
II Level ≥ 25%
Information Source (Data
Reference and Counterreference System
Source)
Indicator Evaluation Frequency Semiannual and Annual
Office / Management
Responsible for registration
Head or Responsible for the References and Counter-References Unit.
and consolidation in the
Office / Management
Responsible for the
Consolidation and Evaluation Central Operations Management
of information at the Central
Level
42
ANNEX 23: TABLE OF REFERENCE STATES
1. WAITING
2. OBSERVED- (IPRESS Reason of Origin)
3. VISA
4. IN PROCESS DUE TO INSUFFICIENT SUPPLY - Lack of specialist in the destination IPRESS
5. QUOTED
5. EXTENDED
6. COUNTER REFERENCE
7. VOID
8. EXTENDED
Observed for causes attributable to the IPRESS of Origin
a) Inconsistent patient affiliation data.

b) Multiple inconsistent patient data.
c) Lack of medical record.
d) Inadequate signs/symptoms/summary.
e) Bad referral process.
f) Bad registration of the intended subactivity.
g) Poor registration of the reference area.
h) Bad diagnosis record.
i) Bad registration of the reference reason.
j) Bad record of the Destination Service.
k) Bad Origin Service record.
l) Does not comply with service protocol requirement.
m) Patient was Counterreferred for pharmacological treatment.
n) Patient accreditation problem (pregnant women, parentage letter).
o) Reference corresponds to the IPRESS with the highest resolution capacity.
p) Reference corresponds to the IPRESS with the lowest resolution capacity.
q) Reference can be resolved in your Deconcentrated / Assistance network.
r) Reference can be resolved in your I PRESS.
s) Reference can be resolved on your Network or Micro Network.
t) You have an appointment at IPRESS, no reference is needed.
43
ANNEX 24: HUMAN RESOURCES IN THE REFERENCE AND COUNTER REFERENCE

UNITS
A. MEDICAL STAFF
Auditor Medical
Complexity Level (*} Medical or Responsible Number
Number Mandatory
National Hospital and institutes 1 1
Hospital I, II and Ill 1 1
Polyclinics and Medical Up to 6 hours per day as

Centers Specialized Center appropriate {Health -
Professional).
(*) Name according to Directive 018-GG-ESSALUD-2013
B. DIGITATING STAFF
Activities Average times

32 min. (with ticket)
Reference sent
22 min (without ticket)
Reference received 12 min
Counter reference received 8min
Counter reference sent 4min
(*) Name according to Directive 018-GG-ESSALUD-2013
44
ANNEX 25: INFRASTRUCTURE AND EQUIPMENT IN THE REFERENCE AND

COUNTER REFERENCE UNITS
The Reference and Counter-Reference Areas have a minimum of the following:

resources:
1. Differentiated environment that meets the basic standards of a customer service office,
and with accessibility to all types of patients.
2. At the National Cardiovascular Institute, National Center for Renal Health,

National Hospitals and Hospitals IV: 01 hotline for national access.
3. In all IPRESS: 01 direct telephone line for local access and an Annex with telephone
link that guarantees communication with other IPRESS.
4. 01 telephone line (landline and/or mobile) with local range wireless connection.
5. 01 computer for each Assistance Digitizer
6. 01 laser printer.
7. 01 Attention module for each Assistance Digitizer
8. Furniture(s) Filing cabinet(s).
9. 01 scanner for each IPRESS.
10. Institutional Email, for the Head of References and Counter-References.
11. Institutional Email, for the Medical Auditor.
12. Institutional Email for the References and Counter-References Unit of each
IPRESS.
ANNEX 26: REQUIREMENTS FOR COMPLEMENTARY ACCREDITATION
45
ANNEX 27: REFERENCE ROADMAP
46
NORTH ZONE
ZONE SUB ZONES LAND ROUTE SKYWAY
Tumbes - Piura Tumbes - Piura
Tumbes - Lambayeque Tumbes - Lima
TUMBES Region
Tumbes - Trujillo Tumbes - Trujillo
Tumbes - Chimbote Tumbes - Chimbote
Piura - Piura
Piura - Chiclayo Piura - Chiclayo
Piura - Trujillo Piura - Trujillo
PIURA Region
Piura - Cajamarca Piura - Cajamarca
Piura - Chimbote Piura - Chimbote
Piura - Lima Piura - Lima
Chachapoyas - Bagua Chica
Chachapoyas - Bagua
Grande
Chachapoyas - Chiclayo Chachapoyas - Chiclayo
Chachapoyas - Piura Chachapoyas - Piura
AMAZON Region Chachapoyas - Trujillo Chachapoyas - Trujillo
Chachapoyas - Jaen
Chachapoyas - Cajamarca
Chachapoyas - Moyobamba
Chachapoyas - Tarapoto
Chachapoyas - Lima Chachapoyas - Lima
Cajamarca - Cajamarca
NORT Cajamarca - Jaen
H Cajamarca - Chiclayo Cajamarca - Chiclayo
CAJAMARCA Region Cajamarca - Piura Cajamarca - Piura
Cajamarca - Trujillo Cajamarca - Trujillo
Cajamarca - Chimbote Cajamarca - Chimbote
Cajamarca - Lima Cajamarca - Lima
Chiclayo - Chiclayo
Chiclayo - Piura Chiclayo - Piura
Chiclayo - Trujillo Chiclayo - Trujillo
LAMBAYEQUE Region
Chiclayo - Chimbote
Chiclayo - Cajamarca Chiclayo - Cajamarca
Chiclayo - Lima Chiclayo - Lima
Trujillo - Trujillo
Trujillo - Chicla yo Trujillo - Chicla yo
Trujillo - Piura Trujillo - Piura
FREEDOM Region
Trujillo - Cajamarca Trujillo - Cajamarca
Trujillo - Chimbote
Trujillo - Lima Trujillo - Lima
Chimbote - Chimbote
Chimbote - Chiclayo
Chimbote - Trujillo
ANCASH COSTA Region
Chimbote - Piura
Chimbote - Huaral
Chimbote - Lima
NORTH AREA - EAST

RIVER
ROUTE
47
Iquitos -
Iquitos - Iquitos Iquitos - Pucallpa
Iquitos
Loreto Region Iquitos -
Iquitos - Tarapoto
Pucallpa
Iquitos - Lima
Moyobamba -
NORTH-
Tarapoto
EAST
Moyobamba - Moyobamba -
San Martin Chachapoyas Chachapoyas
Region Moyobamba - Chiclayo Moyobamba - Chiclayo
Moyobamba - Piura Moyobamba - Piura
Moyobamba - Trujillo Moyobamba - Trujillo
Moyobamba - Lima Moyobamba - Lima
CENTRAL COAST AREA

Lima Region Lima - Callao
Callao Region Callao - Lima
CENTRAL COAST Huaraz - Chimbote
Ancash Sierra Region Huaraz - Trujillo
Huaraz - Lima Huaraz - Lima
CENTRAL EAST AREA

ZONE SUB ZONES LAND ROUTE SKYWAY RIVER
48
ROUTE
Huánuco - Huánuco
Huánuco - Pucallpa Huánuco - Pucallpa
Huanuco - Huanuco -
Huancayo Huancayo
Huánuco Region Huánuco - Cerro de Huánuco - Cerro de
Pasco Pasco
Huánuco - La
Oroya
Huánuco - Lima Huánuco - Lima
Pucallpa -
Pucallpa - Huánuco
Huánuco
Pucallpa - Cerro de
Pasco
Pucallpa -
Huancayo
Ucayali Region
Pucallpa - La Oroya
Pucallpa - Tarma
Pucallpa - La
Merced
Pucallpa - Lima
Cerro de Pasco -
Huánuco
Cerro de Pasco -
Pucallpa
Cerro de Pasco -
La Merced
Pasco Region Cerro de Pasco -
Huancayo
EAST Cerro de Pasco -
CENTER La Oroya
Cerro de Pasco -
Lima
Huancayo -
Huancayo
Huancayo - La
Oroya
Huancayo - Huancayo -
Huánuco Huánuco
Junin Region Huancayo-Pucallpa Huancayo-Pucallpa
Huancayo - Lima Huancayo - Lima
Huancayo- lca Huancayo-lca
Huancayo -
Huamanga
Huancayo -
Huancavelica
Pampas -
Northeast Huancavelica Huancayo
Region Churcampa -
Huancayo
Huancavelica - Huancavelica -
Huancayo Huancayo
Huancavelica - La
Oroya
Central Ayacucho Huancavelica -
Region - North Pisco
Huancavelica -
Chincha
49
Huánuco Huánuco
Pasco Pasco
Huancavelica -
Huancavelica - Lima
Lima
Urcay- Pisco
Lircay-Chincha
Lircay- Huancayo
Lircay- Ayacucho
Lircay - Lima
Acobamba - Pisco
Acobamba -
Chincha
Acobamba -
Huancayo
Acobamba-
Ayacucho
Acobamba - Lima
Kimbiri - Huamanga
Kimbiri - Huanta
Kimbiri - San
Miguel
Kimbiri -
Huancavelica
Kimbiri - Lima
Luciana -
Huamanga
Luciana - Huanta
Cusco Northwest Luciana - San
Region Miguel
Luciana -
Huancavelica
Luciana - Lima
San Francisco -
Huamanga
San Francisco -
San Miguel
San Francisco -
Huamanga
San Francisco -
Uma
San Martin South Uchiza - Huánuco
Region Uchiza - Pucallpa
Uchiza - Tingo
María
Uchiza - Tarapoto
Uchiza -
Moyobamba
Uchiza - Cerro de
Pasco
Uchiza - La Merced
Uchiza - Lima Uchiza - Lima
Tocache - Huánuco
Tocache - Pucallpa
Tocache - Tingo
María
50
Tocache - Tarapoto
Tocache -
Moyobamba
Tocache - Cerro de
Pasco
Tocache - La
Merced
Tocache - Lima Tocache - Lima
CENTRAL EAST AREA

Ica - Ica
Ica - Pisco
Ica - Chincha
Ica Region Ica - Cañete
Ica - Arequipa
Ica - Ayacucho
Ica - Lima Ica - Lima
Huaytara - Pisco
Huaytara - Cañete
Huaytara - Ica
Huancavelica South Huaytara - Lima
Region - West Castrovirreyna - Pisco
Castrovirreyna - Cañete
Castrovirreyna - Ica
Castrovirreyna - Lima
Coracora - Ica
Coracora - Nazca
SOUTH EAST Ayacucho South Coracora - Lima
Region - West Puquio - Ica
Puquio - Nazca
Puquio - Lima
Cusco - Cusco
Cusco - Arequipa Cusco - Arequipa
Cusco Region Cusco - Juliaca Cusco - Juliaca
Cusco - Puno
Cusco - Lima Cusco - Lima
Pucallpa - Cusco Pucallpa - Cusco
Apurimac Region Pucallpa - Juliaca Pucallpa - Juliaca
Pucallpa - Lima Pucallpa - Lima
Puerto Maldonado - Cusco
Puerto Maldonado - Puno
Madre de Dios Region Puerto Maldonado - Juliaca Puerto Maldonado - Juliaca
Puerto Maldonado - Arequipa Puerto Maldonado - Arequipa
Puerto Maldonado - Lima Puerto Maldonado - Lima
Northwest Region of Yura, Chala, Acari - Ica
51
Yura, Chala, Acari - Nazca

Yura, Chala, Acari - Pisco
Arequipa Yura, Chala, Acari - Chincha
Yura, Chala, Acari - Cañete
Yura, Chala, Acari - Lima
Puno - Puno
Puno - Juliaca
Puno - Cusco Puno - Cusco
Puno Region Puno - Lima Puno - Lima
Juliaca - Juliaca
Juliaca - Cuzo Juliaca - Cuzo
Juliaca - Lima Juliaca - Lima
Tacna - Tacna
Tacna - Moquegua
Tacna - Arequipa Tacna - Arequipa
Tacna Region Tacna - Puno
Tacna - Juliaca Tacna - Juliaca
Tacna - Cusco Tacna - Cusco
Tacna - Lima Tacna - Lima
Moquegua - Ilo
Moquegua - Arequipa Moquegua - Arequipa
Moquegua Region Moquegua - Tacna
Moquegua - Ica Moquegua - Ica
Moquegua - Lima Moquegua - Lima
Arequipa - Arequipa
Arequipa - Cusco Arequipa - Cusco
Arequipa - Puno
Arequipa Region
Arequipa - Juliaca Arequipa - Juliaca
Arequipa - Ica Arequipa - Ica
Arequipa - Lima Arequipa - Lima
Note: These routes are referential, leaving it to the discretion of those responsible at the
three decision levels to choose the most appropriate routes to extend the complementarity
and efficiency of the good use of their own, public and private offer.
ANNEX 28: MINIMUM CRITERIA FOR ACCEPTANCE OF REFERENCES
a) Complete completion of all the details of the reference request form.

b) Registration of the medical act.
c)Complete description of signs and symptoms
52
d) Correct registration of the Reference reason.

e) Registration of the Destination Service.
f) Registration of the Origin Service.
g) Current accreditation
h) Correspondence between the Diagnosis and resolution capacity of the destination and
origin IPRESS.
ANNEX 29: REFERENCE AND COUNTER REFERENCE CRITERIA OF THE SECOND

TO THE THIRD LEVEL OF CARE
The following specialties are referential
SURGERIES REFERENCE AND COUNTER REFERENCE CRITERIA
DIAGNOSES (ICD10) PRE-REQUISITE FOR COUNTERREFERENCE

REFERENCE CRITERIA
REFERENCE CRITERIA
Neoplasms For Surgical Treatment with
Secondary malignant tumor anatomical pathological They will be transferred
diagnosis and with disease upon surgical discharge to
AP result, typing.
staging the oncology services, and
from there to their hospital
of origin.
Trauma 0 injuries Clinical Diagnosis after having At the end of the procedure.
of 6 organs exhausted the studies.
Clinical diagnosis after

Congenital malformations At the end of the procedure.
having exhausted their
studies.
Patients with prolonged post-
Artificial nutritional support surgical fasting, signs of
Intercutaneous fistula Patient discharge.
(enteral or parenteral). malnutrition and inability to
eat normally
INTERNAL MEDICINE HIV
53
DIAGNOSIS (CE 10) REFERENCE PRE-REQUISITES COUNTER

CRITERIA FOR REFERENCE REFERENCE
CRITERIA
B20 Diseases caused by the human Confirmed diagnosis of Stable patients who do
immunodeficiency virus (HIV), HIV infection not yet require
resulting in infectious and parasitic antiretroviral therapy
ELISA and/or rapid test
diseases
CD4>500
Test confirmed for HIV
B24 Human immunodeficiency virus
infection
(HIV) diseases, not otherwise
specified With CD4 less than or
equal to 500
B21Human immunodeficiency virus
(HIV) diseases, resulting from HIV-positive pregnant
malignant tumors patients
B21Diseases caused by the human
immunodeficiency virus (HIV), in
other specific diseases
Other complicated infectious That require specialized Prior coordination
diseases treatment and with the Service
management Headquarters
Basic laboratory
R50 fever of unknown origin Fever for 3 weeks Established Diagnosis
exam
without diagnosis after and Treatment
Complete Clinical
relevant tests
Examination Stable patient
Chest plate
Ultrasound
Negative Blood
Cultures and Others
Tomography
54
ANNEX 30: LIST OF MEDICAL SPECIALTIES AND SERVICES
55
MEDICAL SPECIALTIES SERVICE

ALLERGY A11 ALLERGY
PEDIATRIC ALLERGY A12 PEDIATRIC ALLERGY
PATHOLOGICAL ANATOMY FA1 PATHOLOGICAL ANATOMY
FA2 CYTOPATHOLOGY AND CYTOGENETICS
FA3 SURGICAL PATHOLOGY AND NECROPTY
ANESTHESIA, ANALGESIA AND RESUSCITATION BB1 ANESTHESIA ANALGESIA AND RESUSCITATION
BB5 CARDIOVASCULAR ANESTHESIOLOGY
BB4 OBSTETRIC ANESTHESIOLOGY
BB3 RESUSCITATION AND PAIN THERAPY
CARDIOLOGY A21 CARDIOLOGY
A23 NON-INVASIVE CARDIOLOGY
PEDIATRIC CARDIOLOGY A24 PEDIATRIC CARDIOLOGY
HEAD AND NECK SURGERY B11 HEAD AND NECK SURGERY
B36 HEAD AND NECK ONCOLOGICAL SURGERY
PEDIATRIC HEAD AND NECK SURGERY B12 PEDIATRIC HEAD AND NECK SURGERY
CHEST AND CARDIOVASCULAR SURGERY B32 CHEST SURGERY
B31 CHEST AND CARDIOVASCULAR SURGERY
PEDIATRIC CHEST AND CARDIOVASCULAR SURGERY B34 PEDIATRIC CHEST AND CARDIOVASCULAR SURGERY
SURGERY IN BREAST PATHOLOGY C15 BREAST PATHOLOGY
GENERAL SURGERY B38 ABDOMINAL SURGERY
B41 GENERAL SURGERY
B42 GENERAL SURGERY 1
ONCOLOGIC SURGERY B39 ONCOLOGIC SURGERY
B35 ABDOMINAL ONCOLOGICAL SURGERY
B37 ONCOLOGICAL SURGERY OF BREAST, SOFT TISSUE AND SKIN
PEDIATRIC SURGERY D13 PEDIATRIC SURGERY
PLASTIC SURGERY, PEDIATRIC BURNS B52 PLASTIC SURGERY, PEDIATRIC BURNS
PLASTIC, BURN AND REPAIR SURGERY B51 PLASTIC, BURN AND REPAIR SURGERY
DERMATOLOGY A31 DERMATOLOGY
PEDIATRIC DERMATOLOGY A32 PEDIATRIC DERMATOLOGY
ENDOCRINOLOGY A41 ENDOCRINOLOGY
PEDIATRIC ENDOCRINOLOGY A42 PEDIATRIC ENDOCRINOLOGY
INFECTIOUS AND TROPICAL DISEASES AJ1 INFECTIOUS AND TROPICAL DISEASES
PEDIATRIC INFECTIOUS AND TROPICAL DISEASES AJ2 PEDIATRIC INFECTIOUS AND TROPICAL DISEASES
EPIDEMIOLOGY AL1 EPIDEMIOLOGY
GASTROENTEROLOGY A51 GASTROENTEROLOGY
PEDIATRIC GASTROENTEROLOGY A52 PEDIATRIC GASTROENTEROLOGY
GENETICS A61 GENETICS
GERIATRICS A71 GERIATRICS
HEALTH MANAGEMENT AND ADMINISTRATION M01 HEALTH MANAGEMENT AND ADMINISTRATION
GYNECOLOGY AND OBSTETRICS C12 GYNECOLOGY
C11 GYNECOLOGY AND OBSTETRICS
C14 HIGH RISK OBSTETRICS
GYNECOLOGY AND OBSTETRICS OF CHILDREN AND GYNECOLOGY AND OBSTETRICS OF CHILDREN AND
ADOLESCENTS C17 ADOLESCENTS
MEDICAL SPECIALTIES SERVICE MEDICAL SPECIALTIES
HEMATOLOGY A83 SPECIAL HEMATOLOGY
CLINICAL HEMATOLOGY A81 CLINICAL HEMATOLOGY
PEDIATRIC HEMATOLOGY A82 PEDIATRIC HEMATOLOGY
IMAGENOLOGY FD1 RADIO DIAGNOSIS
FD8 INTERVENTIONAL RADIOLOGY
FD4 MAGNETIC RESONANCE
FD2 SONOGRAPHY
56

FD5 TOMOGRAPHY
FAMILY AND COMMUNITY MEDICINE AM3 FAMILY AND COMMUNITY MEDICINE
COMPLEMENTARY MEDICINE A91 COMPLEMENTARY MEDICINE
EMERGENCY AND DISASTER MEDICINE BC1 EMERGENCY AND DISASTER MEDICINE
REHABILITATION MEDICINE AA1 PHYSICAL MEDICINE AND REHABILI
AA6 OTHER HANDICAPS AND DISABILITIES
AA4 SYSTEM REHABILITATION LOCOMOTOR
AA5 TRAUMATOLOGICAL AND OCCUPATIONAL REHABILITATION
REHABILITATION MEDICINE RP1 PROFESSIONAL REHABILITATION
ADOLESCENT MEDICINE AM1 ADOLESCENT MEDICINE
AM2 SPORTS MEDICINE
FAMILY AND COMMUNITY MEDICINE AM3 FAMILY AND COMMUNITY MEDICINE
GENERAL MEDICINE AB1 GENERAL MEDICINE
INTENSIVE MEDICINE AK1 INTENSIVE MEDICINE
PEDIATRIC INTENSIVE MEDICINE AK2 PEDIATRIC INTENSIVE MEDICINE
INTERNAL MEDICINE AC1 INTERNAL MEDICINE
AC2 INTERNAL MEDICINE 1
LEGAL MEDICINE AM4 LEGAL MEDICINE
NUCLEAR MEDICINE FD3 NUCLEAR MEDICINE
FD6 RADIO ONCOLOGIST
OCCUPATIONAL AND ENVIRONMENTAL MEDICINE AM6 OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
TRANSFUSIONAL MEDICINE / BLOOD BANK FC2 HISTOCOMPATIBILITY AND ORGAN BANK
FC1 TRANSFUSIONAL MEDICINE / BLOOD BANK
GENERAL MEDICINE AB1 GENERAL MEDICINE
NEPHROLOGY AD1 NEPHROLOGY
PEDIATRIC NEPHROLOGY AD4 PEDIATRIC NEPHROLOGY
NEONATOLOGY D14 NEONATOLOGY
PNEUMOLOGY AE1 PNEUMOLOGY
PEDIATRIC PNEUMOLOGY AE3 PEDIATRIC PNEUMOLOGY
PEDIATRIC NEUROSURGERY B65 PEDIATRIC NEUROSURGERY
NEUROSURGERY B66 SPINE AND PERIPHERAL NERVE SURGERY
B61 NEUROSURGERY
B63 VASCULAR NEUROSURGERY AND TUMORS
NEUROLOGY AF1 NEUROLOGY
PEDIATRIC NEUROLOGY AF2 PEDIATRIC NEUROLOGY
OPHTHALMOLOGY B71 OPHTHALMOLOGY
B72 OPHTHALMOLOGY 1
B73 OPHTHALMOLOGY 2
B74 ONCOLOGICAL OPHTHALMOLOGY
PEDIATRIC OPHTHALMOLOGY B75 PEDIATRIC OPHTHALMOLOGY
GYNECOLOGICAL AND BREAST ONCOLOGY AG2 GYNECOLOGY AND BREAST ONCOLOGY
MEDICAL ONCOLOGY AG3 MEDICAL ONCOLOGY
ORTHOPEDIC AND TRAUMATOLOGY B81 ORTHOPEDIC AND TRAUMATOLOGY
MEDICAL SPECIALTIES SERVICE MEDICAL SPECIALTIES
B81 ORTHOPEDIC AND TRAUMATOLOGY
B82 ORTHOPEDIC AND TRAUMATOLOGY 1
B82 ORTHOPEDIC AND TRAUMATOLOGY 2
B21 HAND SURGERY
B62 NEURO-TRAUMATOLOGY
PEDIATRIC ORTHOPEDIC AND TRAUMATOLOGY B84 PEDIATRIC ORTHOPEDIC AND TRAUMATOLOGY
ENT LARYNGOLOGY PEDIATRIC B92 PEDIATRIC OTORHINOLARYNGOLOGY
OTORHINOLARYNGOLOGY B91 OTORHINOLARYNGOLOGY
CLINICAL PATHOLOGY FB2 HEMATOLOGY
FB5 IMMUNOLOGY
FB4 MICROBIOLOGY
FB1 CLINICAL PATHOLOGY
57
PEDIATRICS D11 PEDIATRICS

PSYCHIATRY AH3 ADDICTIVE BEHAVIORS
PSYCHIATRY AH1 PSYCHIATRY
PEDIATRIC PSYCHIATRY AH2 CHILDREN-JUVENILE PSYCHIATRY
RADIOLOGY B64 NEURORADIOLOGY
PEDIATRIC REHABILITATION AA7 DEVELOPMENTAL PATHOLOGY
AA3 PEDIATRIC REHABILITATION
RHEUMATOLOGY AI1 RHEUMATOLOGY
PEDIATRIC RHEUMATOLOGY AI2 PEDIATRIC RHEUMATOLOGY
TRANSPLANT H13 LIVER TRANSPLANT
H12 KIDNEY TRANSPLANT
UROLOGY BA1 UROLOGY
PEDIATRIC UROLOGY BA3 PEDIATRIC UROLOGY
58

Standards For The Reference and Counter-Reference Process

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“RULES FOR THE REFERENCE AND COUNTER REFERENCE PROCESS IN

ESSALUD” IN THE SOCIAL HEALTH INSURANCE – ESSALUD”

GENERAL MANAGEMENT DIRECTIVE Nº -GG-ESSALUD-2020 V.1.1

“RULES FOR THE REFERENCE AND COUNTER REFERENCE PROCESS IN

reviewed William Jesus Central Planning and

Initial version of the document 1.0 31/15/2015

2 Updated version 1.1 20/04/2020

Article 3 Regulatory Framework

Reference process in Social Health Insurance – ESSALUD”

Article 4 Scope of application

6.1 Central Manager of Health Benefits.

6.12 Director of the National Cardiovascular Institute.

i. Reference of Patients with Oncological Diagnosis

Table N° 01 - Assignment of Administrative References according to Organs, Devices, Systems

Head and neck surgery x x

Orthopedics and Traumatology x x

Table N° 02 -Assignment of Administrative References Special Pathologies

Living organ donors

Physical Medicine and Rehabilitation x x x

Orthopedics and Traumatology x x x

Services according to protocols x x x x x

Article 8 Specific Provisions

8.1.8 OF THE REFERENCE

A. FROM THE EXTERNAL CONSULTATION

is not on the list of insurable conditions, the Admission, Insurance Module

i. Date of receipt of the Reference Request Form.

i. Patients with Oncological Diagnosis.

8.1.8.20 The referral of patients referred between Hospitalization services is carried

i. Access to the Destina IPRESS is through the Emergency Service.

D. FOR BENEFITS TO AID IN DIAGNOSIS AND TREATMENT

E. THE EXTRA-INSTITUTIONAL IPRESS FOR ELECTIVE BENEFITS

8.1.8.32 The Deconcentrated Network I Healthcare Network has contracts and/or

i. Help result Diagnosis or procedures

F. EXTRA-INSTITUTIONAL IPRESS FOR BENEFITS IN EMERGENCY

8.1.8.37 The Deconcentrated Network / Assistance Network has contracts and/or

8.1.8.47 The Head of Referrals and Counter-Referrals and/or treating doctor as

IPRESS with available resolution capacity using Annex 09.

H. OF PATIENTS AFFILIATED WITH A HEALTH PROVIDER ENTITY (EPS)

I. FROM NON-ATTENDANCE TO APPOINTMENT

J. OF THE CANCELLATION OF REFERENCES

i. Patients with observed Reference greater than 30 days.

8.1.9.1 Counterreferrals are of 3 types: Medical, and Pharmacological and

8.1.10 OF TRANSPORTATION OF REFERRED PATIENTS

Presidency Resolution No. 938-PE-ESSALUD-2013, which approves

8.1.11 OF THE GRANTING OF TICKETS

i. Reference request format

8.1.12 ACCESS TO THE REFERENCE AND COUNTER REFERENCE SYSTEM ON

Counter-References, or whoever acts in his place at the IPRESS, is

8.1.13.1 The Manager or Director of the Deconcentrated / Care Network, National

8.1.14 OF THE VALIDITY OF THE REFERENCE

i. III Level of care: 3 or 5 days

i. Patients with Oncological Diagnosis

8.1.15 OF THE QUALITY OF THE RECORD

8.1.16 COMPLEMENTARY PROVISIONS

ANNEX 01: PROCEDURE FOR REQUESTING REFERENCES

superior, if applicable, for the respective correction and return

Transfer the Reference Form to the References and Counter- IPRESS of

ANNEX 03: EPS REFERENCE PROCEDURE

ESSALUD PROCEDURES Version:

ANNEX 04: COUNTER REFERENCE PROCEDURE

ANNEX 05: PHARMACOLOGICAL COUNTERREFERENCE PROCEDURE

ANNEX 06: REFERENCE EXTENSION PROCEDURE