This Act comes into effect from the day of enforcement of the Medical Practitioners' Act.

①A clinic, or a hospital having facilities for accommodating 20 or more patients, that has received permission for establishment pursuant to the provisions of Article 21 of the National Medical Care Act (Act No. 70 of 1942; hereinafter referred to as the "Former Act") or that is deemed to have received permission pursuant to the provisions of Article 74 of the Ordinance for Enforcement of the National Medical Care Act (Ministry of Health and Welfare Order No. 48 of 1942; hereinafter referred to as the "Former Regulations"), and that exists at the time of the enforcement of this Act, is deemed to have received permission to establish a hospital or clinic, or to have filed notification of the establishment of a clinic, pursuant to the provisions of Article 7 or Article 8, paragraph (1).

②A hospital having facilities to accommodate 19 patients or fewer that has received permission for establishment pursuant to Article 21 of the Former Act, or is deemed to have received permission pursuant to Article 74 of the Former Regulations, and that exists at the time of enforcement of this Act, is deemed to have received permission for the establishment of a clinic or to have filed a notification of establishment pursuant to Article 7 or Article 8, paragraph (1). However, for six months from the day of enforcement of this Act, the former name may continue to be used notwithstanding Article 3, paragraph (2).

③For the buildings and equipment of a hospital or clinic falling under the preceding two paragraphs, the provisions of the Former Act may continue to apply for three years from the day of enforcement of this Act. However, in the case where it is necessary to make a significant change to the buildings and equipment and the permission of the prefectural governor of the area in which the hospital or clinic is situated has been received, the provisions of the Former Act may continue to apply for the time being even after three years have passed from the day of enforcement of this Act.

①A person who has received the permission of the prefectural governor pursuant to the proviso to Article 45, paragraph (1), paragraph (2) or the proviso to Article 51 of the Former Regulations, or a person who is deemed to have received permission pursuant to Article 75 of the Former Regulations, is deemed to be a person who has received permission pursuant to the proviso to Article 12, paragraph (1) or paragraph (2), or the proviso to Article 18.

②A person who has received the permission of the Minister of Health and Welfare pursuant to Article 36, paragraph (1), item (ii) of the Former Regulations is deemed to have received permission pursuant to Article 6-6, paragraph (1).

With regard to a hospital or clinic that has been in continuous suspension since before the enforcement of this Act, a notification of suspension under the provisions of the Former Act is deemed to have been made pursuant to the corresponding provisions of this Act.

A disposition made by the prefectural governor pursuant to Article 57 or Article 58 of the Former Regulations, or deemed to have been made pursuant to Article 80 of the Former Regulations, is deemed to have been made pursuant to the corresponding provisions of this Act.

①The national government may, for the time being, within the scope of the budget, lend to an establisher of a hospital or clinic, without interest, part of the funds to be applied to the expenses required for the improvement of a hospital or clinic that falls under Article 2, paragraph (1), item (ii) of the Act on Special Measures Concerning Promotion of Social Infrastructure Development Through Use of Proceeds from Sale of the Stock of Nippon Telegraph and Telephone Corporation (Act No. 86 of 1987; hereinafter referred to as the "Social Infrastructure Development Special Measures Act").

②The national government may, for the time being, within the scope of the budget, lend to a prefecture, without interest, part of the funds to be applied to the expenses that the prefecture subsidizes to the establisher of a hospital or clinic with respect to the improvement of a hospital or clinic that falls under Article 2, paragraph (1), item (ii) of the Social Infrastructure Development Special Measures Act.

③The repayment period of the loans by the state under the preceding two paragraphs is a period specified by Cabinet Order within five years (including a deferment period of two years or less).

④In addition to what is provided for in the preceding paragraph, the method of repayment of the loans under the provisions of paragraphs (1) and (2), the advance of the repayment deadline, and other matters necessary for repayment are specified by Cabinet Order.

⑤In the case where the national government has made a loan to a prefecture or an establisher of a hospital or clinic pursuant to paragraph (1) or (2), it is to provide a subsidy in an amount equivalent to the loan for the improvement of the hospital or clinic that is the subject of the loan, and that subsidy is to be provided by paying an amount equivalent to the repaid amount of the loan at the time of its repayment.

⑥With regard to the interest-free loan that a prefecture or an establisher of a hospital or clinic has received pursuant to paragraph (1) or (2), in the case where it repays the loan in advance of the repayment deadline determined based on the provisions of paragraphs (3) and (4) (excluding the cases specified by Cabinet Order), for the purpose of applying the provisions of the preceding paragraph, that repayment is deemed to have been made when that repayment deadline arrives.

From April 1, 2013 to March 31, 2033, in preparing a medical care plan, a prefecture is to give appropriate consideration, in light of the special circumstances of medical care in an area designated as a remote island development measures implementation area pursuant to Article 2, paragraph (1) of the Remote Islands Development Act (Act No. 72 of 1953), so that necessary medical care is ensured in that area through ensuring the availability of physicians, etc., securing hospital beds, etc.

The Minister of Health, Labour and Welfare is to establish and publicize the guidelines necessary for the national government, prefectures, administrators of hospitals or clinics and other related parties to deal appropriately for the time being with the matter so that physicians can provide high-quality and appropriate medical care by reducing the working hours of physicians whose work extends over long hours and ensuring their health.

A prefecture is to take into account the guidelines referred to in the preceding Article, for the time being, in holding the consultations under Article 30-14, paragraph (1), Article 30-18-5, paragraph (1) and Article 30-23, paragraph (1).

The administrator of a hospital or clinic must, for the time being, establish the system necessary to ascertain the health condition of the physicians working at the hospital or clinic and to respond to it appropriately.

①The administrator of a hospital or clinic must, for the time being, pursuant to an Order of the Ministry of Health, Labour and Welfare, have face-to-face guidance conducted by a physician (limited to a person who meets the requirements specified by an Order of the Ministry of Health, Labour and Welfare as being appropriate to conduct face-to-face guidance (meaning guidance in which the physical and mental state is ascertained by medical interview or other means and the necessary guidance is given in person accordingly; the same applies hereinafter) for a physician subject to face-to-face guidance; hereinafter in this Article referred to as the "physician conducting face-to-face guidance") for those physicians working at the hospital or clinic whose working hours status in each month falls under the requirements specified by an Order of the Ministry of Health, Labour and Welfare (hereinafter in this Article referred to as "physicians subject to face-to-face guidance").

②A physician subject to face-to-face guidance must receive the face-to-face guidance provided by the administrator of the hospital or clinic pursuant to the preceding paragraph. However, this does not apply where, in the case of not wishing to receive face-to-face guidance conducted by the physician conducting face-to-face guidance designated by that administrator, the physician has received face-to-face guidance equivalent to the face-to-face guidance under that paragraph conducted by another physician conducting face-to-face guidance and has submitted a document certifying the result to that administrator.

③The administrator of a hospital or clinic must, pursuant to an Order of the Ministry of Health, Labour and Welfare, provide the physician conducting face-to-face guidance with information on the working hours of the physician subject to face-to-face guidance and other information specified by an Order of the Ministry of Health, Labour and Welfare as necessary for the physician conducting face-to-face guidance to conduct the face-to-face guidance appropriately.

④The administrator of a hospital or clinic must, based on the result of the face-to-face guidance under paragraph (1) or the proviso to paragraph (2), hear the opinion of the physician conducting face-to-face guidance, pursuant to an Order of the Ministry of Health, Labour and Welfare, on the measures necessary to maintain the health of the relevant physician subject to face-to-face guidance.

⑤The administrator of a hospital or clinic must, taking into account the opinion of the physician conducting face-to-face guidance under the preceding paragraph and where finding it necessary, take appropriate measures such as shortening working hours and reducing the number of night duty shifts, in consideration of the actual situation of the relevant physician subject to face-to-face guidance, pursuant to an Order of the Ministry of Health, Labour and Welfare.

⑥The administrator of a hospital or clinic must, in the case where the working hours status in each month of a physician subject to face-to-face guidance falls under the requirements specified by an Order of the Ministry of Health, Labour and Welfare as being of particularly long hours, take the measures necessary to shorten working hours for that physician, pursuant to an Order of the Ministry of Health, Labour and Welfare.

⑦The administrator of a hospital or clinic must, pursuant to an Order of the Ministry of Health, Labour and Welfare, record and preserve the contents of the face-to-face guidance under paragraph (1) and the proviso to paragraph (2), the hearing of the opinion of the physician conducting face-to-face guidance under paragraph (4), and the measures under the preceding two paragraphs.

⑧In the case where face-to-face guidance under Article 66-8, paragraph (1) of the Industrial Safety and Health Act (Act No. 57 of 1972) (limited to that which falls under the requirements specified by an Order of the Ministry of Health, Labour and Welfare) has been conducted for a physician subject to face-to-face guidance, notwithstanding the provisions of paragraph (1), it is not necessary to conduct the face-to-face guidance under that paragraph.

The administrators of hospitals or clinics must cooperate with each other while working in coordination with each other, in accordance with the guidelines referred to in Article 105 of the Supplementary Provisions, so that the face-to-face guidance under paragraph (1) of the preceding Article is appropriately conducted at the hospitals or clinics in the region.