S.L. 458.23 Art. 17Serving. Matters in 1. The any) of the 2. Where the address of and addresses 3. The interest and the 4. The 5. The to be provided 6. The 7. the clinic. 8. The proposed to be 9. The distinguishing of patients in 10. The proposed to be 11. The 12. The 13. The nursing and than staff in the clinic. 14.

Nothing in these regulations shall be deemed to exempt any applicant or licensee from any requirement of the law regarding any other licences which may be needed in respect of any facility or service provided at the clinic. FIRST SCHEDULE

[Regulation 4(2)]

respect of which a health authority may require information to be furnished by an applicant for a licence full name and address, and professional or technical qualifications (if applicant. the application is made by a company, society, association or body, its registered office or principal place of business and the full names and technical qualifications (if any) of the directors or partners.

address of any other clinic in which the applicant has or had a business nature and extent of his interest.

situation of the clinic and its form of construction (plan to be attached). accommodation available, and the equipment and facilities provided or in the clinic. date on which the clinic was established or is to be established. Whether any other business is or will be carried on in the same premises as type of clinic services to be provided including list of operations carried out. number of patients (excluding staff) for whom it is proposed to be used between different categories of patients and indicating the age-range each category. full names, ages, qualifications and experience of persons employed or employed in the management of the clinic. arrangements for the management and control of the clinic. full names and qualifications of any employed medical practitioners.

full names and (where appropriate) qualifications and grades of the other professional, technical, administrative and ancillary staff (other included under paragraph 12 above) employed or proposed to be employed details of arrangements made or proposed to be made in respect of the facilities and services. arrangements made for the supply of blood and blood products. arrangements made for the provision of pathology and radiology arrangements made for the insurance of patients, staff and third parties accidents and other mishaps. Whether the clinic is intended to operate as a day care clinic only (i.e. with stay) or as a clinic with overnight stay of patients. SECOND SCHEDULE Amended L.N. [Regulation 9(9)] Part I

The following operations may be carried out in a clinic, as referred regulation (9) of regulation 9, provided that the facilities and resources, the condition or medical fitness of the patient are such as to enable such to be carried out under good medical, surgical and anesthetic practice guidelines established by international academic colleges of anesthesiologists recognised by the Superintendent.

Where day surgery is carried out this generally demands a high expertise, and should be undertaken only, or supervised, by practitioners. Such operations should be clean and elective surgical should normally require a relatively short general anesthesia and should risk of postoperative complications that normally require overnight and the patient is expected to recover sufficiently to return home evening. In particular haemostasis must be strictly ensured and where requires drainage, it may not always be suitable to be performed on a It is understood that the facilities should be similar to those required surgery with ward area near the operating theatre suite (including anesthetic and recovery room of the high dependency type) and, without prejudice generality of this requirement, must have adequate lighting, basic equipment, gases and gas scavenging devices. Basic equipment includes anesthetic monitoring apparatus, operating table, diathermy machine, dressing facilities as well as other equipment required in accordance with good anesthetic practice for specific operations. The elderly and infants are normally excluded and the arrangements operative care outside the clinic must be satisfactory. In particular the have adult attendance and it must be ensured that such patient is in close telephone for emergencies. After discharge from the clinic, the patient appropriate instructions following discharge and be accompanied home. If the patient is deemed to be unfit for discharge from the clinic on either on anesthetic or surgical grounds, it shall be the responsibility of charge of the clinic to make appropriate arrangements for in-patient clinic where overnight stay is allowed. In every case the prudent exercise of clinical judgement by the surgeon anesthetist, faced with an individual problem and particularly when faced ideal facilities, is mandatory. A. Paediatric Surgical Operations

(i) General Examination under anesthesia Repair of inguinal/umbilical/femoral/epigastric hernia Varicocele Ligation of communicating hydrocele Orchidopexy (unilateral or bilateral), excluding second stage or cases of high non-palpable testis Laparoscopy Circumcision, meatotomy Minor hypospadias Cystoscopy Division of tongue tie Proctoscopy, sigmoidoscopy, anal stretch, examination under anesthesia Excision of local skin lesions, including biopsy Lymph node biopsy Branchial sinus, thyroglossal cyst Correction of prominent ears Excision of accessory auricles and digits Correction of syndactyly Minor revision following cleft lip and palate surgery Biopsy/excision/destruction of lesions, or removal of excess mucosa, of mouth Removal of calculi from salivary ducts

Orthopaedic Arthroscopy Manipulations, closed reductions of simple fractures/dislocations Change of plaster Release of trigger finger Excision of ganglion

Dental Extractions/conservation dentistry Supernumerary or impacted teeth Biopsy of oral lesions, including excision Lingual or labial frenectomy Removal of fixators Enucleation of simple cysts

Ear, Nose and Throat Examination under anesthesia and removal of foreign body from ear, nose and throat Myringotomy and insertion/removal of tympanostomy tube Electro-cochleography Reduction for fractured nose Electro-cautery for bleeding of nose Submucosal diathermy Simple nasal polypectomy Antral puncture and washout Ophthalmic Correction of squint Electro-diagnostic tests Examination under anesthesia for ophthalmic conditions

B. Adult Surgery

(i) General Excision of lesions of skin and subcutaneous tissue, including ulcer Cautery/cryotherapy of skin Removal of foreign body in deeper tissue Dermabrasion Skin suture Insertion/removal of skin expander into tissue Repair of simple inguinal, femoral, umbilical or epigastric Anal fissure, anal stretch, sphincterotomy Excision of anal fistula Removal of anal warts Repair of anal trauma Rectal polypectomy Haemorrhoidectomy Diagnostic Laparoscopy Needle biopsy of liver Oesophagoscopy and dilatation Biopsy breast, lymph node, skin, lesions of mouth Removal of salivary calculus Ligation, stripping of/other operations for, varicose veins Excision of thyroglossal cyst Excision of bronchial sinus Incision and drainage of abscess, drainage of haematoma Microdochotomy

(ii) Orthopaedic Note: Facilities for image intensification and application where necessary should be available Axthroscopic procedures, including biopsy and operation cartilage Manipulation of joints, closed reduction of simple dislocations Removal of pins, plates or screws, external fixator Excision of ganglia, synovial cysts and benign synoviomata Decompression of carpal tunnel Decompression of peripheral nerve De Quervain’s release Removal of neuroma, e.g. on the hand Correction of minor deformity of hand/foot Minor amputation of the fingers and toes Operation on ingrowing toe nails Subcutaneous tenotomy Tendon transposition Primary repair of peripheral nerve Ulnar styloidectomy Excision of exostoses Interphalangeal fusion of the toes Hallus valgus and osteotomy of metatarsals Release of trigger finger Simple excision of palmar fascia in Dupuytren’s contracture Removal of foreign bodies Scar revision Biopsy, excision of small lesion, limited repair, of muscle

Urinary System Note: Uncatheterised patients should not be sent home before they have passed urine. Percutaneous nephrostomy fine needle biopsy of kidney Nephroscopic operations on ureter Ureteroscopic extraction of calculus of ureter Endoscopic examination/insertion/removal of prosthesis, ureter Endoscopic retrograde pyelography Operations on ureteric orifice Endoscopic destruction of lesion of bladder Endoscopic hydrostatic distention of bladder Endoscopic extraction of bladder calculus or foreign body Endoscopic dilatation of, or operations on, outlet of female bladder Repair of epispadias Endoscopic operations on urethra Endoscopic examination of urethra/removal of foreign body Dilatation of urethra Endoscopic biopsy of prostate

Genital System External meatotomy of urethral orifice Orchidectomy and excision of spermatic cord Orchidopexy Correction of hydrocele Excision of epididymal cyst, scrotal lesion Biopsy testis Operations on varicocoele Division of preputial adhesions Circumcision Vasectomy

(v) Ophthalmic Operations Cataract surgery Corneal transplant surgery Procedures on the eyelid or tarsal plate Operations on the lachrymal apparatus Correction of squint Surgery for refraction Laser surgery Keratoplasty Iridectomy

(vi) Ear, Nose and Throat Endoscopy of nasal cavity, sinuses, pharynx, larynx, including Removal of foreign body from the nose or ear canal Removal of impacted wax Excision of lesion of external ear Myringotomy/insertion/removal of tympanostomy tube Removal of simple nasal polyps Reduction of fracture nasal or molar bone Electro-cautery of the nasal septum Submucosal diathermy of the inferior turbinates Antral puncture and washout Removal of vocal polyp Diagnostic laryngoscopy, pharyngoscopy and oesophagoscopy

(vii) Endoscopic/Laparoscopic procedures of gastro intestinal Oesophagoscopy/oesophagostro duodenoscopy, including removal/laser or diathermy destruction of lesion Endoscopy and removal of foreign body/insertion dilatation/recanalisation of tumour mass Sigmoidoscopy including biopsy/removal/destruction of Fibreoptic colonoscopy including excision/biopsy/destruction Endoscopic retrograde cholangiopancreatography (viii)Plastic Surgery Excision of skin lesion: direct closure, split skin or full local flaps (other than grafts to the lower limbs) Scar revision and soft tissue contouring Separation and inset of certain flaps Debulking and revision of flaps Insertion and distension of tissue expanders Operations for axillary hyperhidrosis Laser and cryosurgery Excision of tattoos Blepharoplasty Rhinoplasty Mastopexy Limited Liposuction

Gynaecologyical Operations Note: Uncatheterised patients should not be sent home before they have passed urine Examination under anesthesia and curettage Colposcopy, cystoscopy, diagnostic hysteroscopy/laparoscopy, including biopsy and minor laparascopic surgery Biopsy/cautery of cervix, removal of cervical polyp Hormone implants Excision of vulval warts and other minor procedures to the vulva and vagina Marsupialisation of Bartholin’s cyst Endometrial ablation with laser or resectoscope Hysteroscopic resection of uterine septum Hysteroscopic myomectomy Laser treatment of cervical and vulval lesions Tubal ligation Biopsy of ovary or peritoneum Coagulation of mild endometriosis Aspiration of small ovarian cysts Lysis of mild to moderate adhesions Coagulation of moderate endometriosis Exploration of small ovarian cysts Uterine ventrosuspension Salpingectomy Salpingectomy for ectopic pregnancy

Oral and Maxillofacial Surgery Excision of uncomplicated impacted teeth and buried roots Exposure of unerupted teeth for orthodontic treatment Biopsy of hard and soft tissues Enucleation of small cysts of jaw Division of pedicles Removal of direct bone plates and wires Minor soft-tissue surgery EUA for suspected malignancy Cryoblockade of peripheral nerves Laser and cryosurgery of small lesions Reduction of nasal and molar fractures Temporomandlibular arthroscopy Salivary ductoplasty and removal of calculi

(xi) Other Bronchoscopy, including biopsy and/or remwal of foreign Oesophagoscopy and dilatation Removal of pectus bar Mediastinoscopy Chest drainage

(xii) Interventional Radiology CT Scan using contrast Isotope scanning Arteriography using small arterial catheters

(xiii)Pain Relief Epidural injections - cervical, lumbar or thoracic Peripheral nerve lesion - using injection, radiofrequency, phenol.

Part II

The following operations may be carried out in a clinic where patients overnight subject to the facilities referred to under regulation 9(9)(b) at the clinic: