①The prefectural governor may, for the time being, upon application by the establisher of the hospital or clinic, designate as an intensive skills training institution a hospital or clinic (limited to one situated in the area of the relevant prefecture) that falls under any of the following items and is found to have operations specified by an Order of the Ministry of Health, Labour and Welfare for which it is unavoidably necessary to have the physicians specified in the relevant item engage in work for long hours:

②The provisions of Article 113, paragraphs (2) through (7), Article 114 and Article 115 of the Supplementary Provisions apply mutatis mutandis to the designation of an intensive skills training institution under the preceding paragraph, the provisions of Article 116 of the Supplementary Provisions apply mutatis mutandis to a change in the operations prescribed in that paragraph of an intensive skills training institution, and the provisions of Article 117 of the Supplementary Provisions apply mutatis mutandis to the rescission of the designation of an intensive skills training institution under that paragraph. In this case, the term "engaged in the operations prescribed in that paragraph" in Article 113, paragraph (2) is deemed to be replaced with "specified in each item of Article 119, paragraph (1) who are engaged in the operations prescribed in that paragraph", the term "this Article" in paragraph (7) of that Article is deemed to be replaced with "Article 119", the term "Article 113, paragraph (1)" in Article 117, paragraph (1), item (i) is deemed to be replaced with "Article 119, paragraph (1)", and the term "each item of Article 113, paragraph (3)" in item (ii) of that paragraph is deemed to be replaced with "each item of Article 113, paragraph (3) as applied mutatis mutandis pursuant to Article 119, paragraph (2)".

①In order to train physicians with advanced skills in a specified field (meaning, among the fields of medicine, a field publicly announced by the Minister of Health, Labour and Welfare as one in which the training of physicians with advanced skills is found to be particularly necessary in the public interest), the prefectural governor may, for the time being, upon application by the establisher of the hospital or clinic, designate as a specified advanced skills training institution a hospital or clinic that conducts training for the acquisition of those skills and that is found to have operations specified by an Order of the Ministry of Health, Labour and Welfare for which it is unavoidably necessary to have physicians receiving that training (limited to persons who meet the requirements specified by an Order of the Ministry of Health, Labour and Welfare as persons for whom receiving that training is appropriate) engage in work for long hours (limited to one that is situated in the area of the relevant prefecture and has received confirmation from the Minister of Health, Labour and Welfare that it has the capacity to conduct that training efficiently).

②The provisions of Article 113, paragraphs (2) through (7), Article 114 and Article 115 of the Supplementary Provisions apply mutatis mutandis to the designation of a specified advanced skills training institution under the preceding paragraph, the provisions of Article 116 of the Supplementary Provisions apply mutatis mutandis to a change in the operations prescribed in that paragraph of a specified advanced skills training institution, and the provisions of Article 117 of the Supplementary Provisions apply mutatis mutandis to the rescission of the designation of a specified advanced skills training institution under that paragraph. In this case, the term "engaged in the operations prescribed in that paragraph" in Article 113, paragraph (2) is deemed to be replaced with "engaged in the operations prescribed in Article 120, paragraph (1) and receiving the training prescribed in that paragraph", the term "this Article" in paragraph (7) of that Article is deemed to be replaced with "Article 120", the term "Article 113, paragraph (1)" in Article 117, paragraph (1), item (i) is deemed to be replaced with "Article 120, paragraph (1)", and the term "each item of Article 113, paragraph (3)" in item (ii) of that paragraph is deemed to be replaced with "each item of Article 113, paragraph (3) as applied mutatis mutandis pursuant to Article 120, paragraph (2)".

①A hospital or clinic seeking to obtain the confirmation under paragraph (1) of the preceding Article must pay a fee in an amount specified by Cabinet Order in consideration of actual costs.

②The Minister of Health, Labour and Welfare may entrust all or part of the administrative work pertaining to the confirmation under paragraph (1) of the preceding Article to a person specified by an Order of the Ministry of Health, Labour and Welfare.

③A person entrusted pursuant to the preceding paragraph, an officer or employee of that person, or a person who has been any of these, must not disclose, without justifiable grounds, any secret learned in relation to the work pertaining to the entrustment.

①The administrator of a specified regional medical care provision institution, a collaborative specified regional medical care provision institution, an intensive skills training institution or a specified advanced skills training institution (collectively referred to as an "institution subject to specified labor management") must implement initiatives for shortening the working hours of physicians based on the plan for shortening working hours.

②The administrator of an institution subject to specified labor management must, at every interval specified by an Order of the Ministry of Health, Labour and Welfare within a range not exceeding three years, after hearing the opinions of the physicians working at the institution subject to specified labor management and other related parties, conduct a review for revising the plan for shortening working hours and, where finding it necessary, change the plan for shortening working hours and submit the plan for shortening working hours after the change to the prefectural governor who made the designation of the institution subject to specified labor management, pursuant to an Order of the Ministry of Health, Labour and Welfare.

③The administrator of an institution subject to specified labor management must, where it is found that there is no need to change the plan for shortening working hours as a result of conducting a review for revising it pursuant to the preceding paragraph, notify the prefectural governor who made the designation of the institution subject to specified labor management to that effect, pursuant to an Order of the Ministry of Health, Labour and Welfare.

①The administrator of an institution subject to specified labor management must, for those physicians working at the institution subject to specified labor management whose scheduled working hours status falls under the requirements specified by an Order of the Ministry of Health, Labour and Welfare (hereinafter referred to as "specified target physicians" in this Article and the following Article), ensure a continuous rest period, pursuant to an Order of the Ministry of Health, Labour and Welfare, by the time a period specified by an Order of the Ministry of Health, Labour and Welfare has elapsed from the start of the work specified by an Order of the Ministry of Health, Labour and Welfare for each specified target physician. However, this does not apply where the specified target physician is made to engage in night or day duty, pursuant to an Order of the Ministry of Health, Labour and Welfare, by the time a period specified by an Order of the Ministry of Health, Labour and Welfare has elapsed from the start of that work.

②In the case where the administrator of an institution subject to specified labor management needs, for an unavoidable reason specified by an Order of the Ministry of Health, Labour and Welfare, to have a specified target physician work during the rest period determined to be ensured pursuant to the preceding paragraph (hereinafter referred to as the "scheduled rest period" in this paragraph), the administrator may, notwithstanding the preceding paragraph, have the specified target physician work during the scheduled rest period. In this case, the administrator must ensure, after the end of the scheduled rest period, a rest period for the specified target physician equivalent to the time that the physician worked during the scheduled rest period, pursuant to an Order of the Ministry of Health, Labour and Welfare.

③In the case referred to in the proviso to paragraph (1), where the administrator of the relevant institution subject to specified labor management has had the specified target physician work during the night or day duty, the administrator must give consideration to ensuring the necessary rest period for the specified target physician after the night or day duty, pursuant to an Order of the Ministry of Health, Labour and Welfare.

④In the event of a temporary need arising from a disaster or other unavoidable cause, the administrator of an institution subject to specified labor management may, with the permission of the prefectural governor of the area in which the institution subject to specified labor management is situated, refrain from ensuring the rest periods under the main clause of paragraph (1) and the second sentence of paragraph (2) to the extent of that need. However, where there is no time to obtain the permission of that prefectural governor due to the urgency of the situation, the administrator must submit a notification afterwards without delay.

⑤In the case where a notification has been made pursuant to the proviso to the preceding paragraph, if the prefectural governor finds it inappropriate that the rest periods under the main clause of paragraph (1) and the second sentence of paragraph (2) were not ensured, the governor may order that the necessary rest period be ensured thereafter.

The administrator of an institution subject to specified labor management must, pursuant to an Order of the Ministry of Health, Labour and Welfare, prepare and preserve records concerning the ensuring of rest periods for specified target physicians under the main clause of paragraph (1) and the second sentence of paragraph (2) of the preceding Article.

①Where the administrator of an institution subject to specified labor management finds it necessary in order to appropriately ensure the rest periods prescribed in the main clause of Article 123, paragraph (1) and the second sentence of paragraph (2) of the Supplementary Provisions for physicians working at the institution subject to specified labor management who work at multiple hospitals or clinics, the administrator may request the necessary cooperation from the administrator of another hospital or clinic at which the physician works.

②The administrator of a hospital or clinic must endeavor to comply with a request when asked for cooperation pursuant to the preceding paragraph.

Where the prefectural governor finds that the administrator of an institution subject to specified labor management has, without justifiable grounds, not ensured the rest periods prescribed in the main clause of Article 123, paragraph (1) or the second sentence of paragraph (2) of the Supplementary Provisions, the prefectural governor may order the establisher of the institution subject to specified labor management to take the measures necessary for improvement, specifying a time limit.

With regard to the application of the provisions of Article 24-2 and Article 30, for the time being, the term "or paragraph (1) of the preceding Article" in Article 24-2, paragraph (1) is deemed to be replaced with ", paragraph (1) of the preceding Article, Article 111 or Article 126 of the Supplementary Provisions", and the term "or Article 29, paragraph (1) or (3)" in Article 30 is deemed to be replaced with ", Article 29, paragraph (1) or (3), Article 111 or Article 126 of the Supplementary Provisions".

With regard to the application of Article 141 of the Labor Standards Act (Act No. 49 of 1947) to physicians engaged in the operations prescribed in Article 113, paragraph (1) of the Supplementary Provisions at a specified regional medical care provision institution, physicians staffed from a collaborative specified regional medical care provision institution to another hospital or clinic (limited to those pertaining to the staffing prescribed in Article 118, paragraph (1) of the Supplementary Provisions), physicians engaged in the operations prescribed in Article 119, paragraph (1) of the Supplementary Provisions at an intensive skills training institution, or physicians engaged in the operations prescribed in Article 120, paragraph (1) of the Supplementary Provisions at a specified advanced skills training institution, for the time being, the term "in consideration of the health and welfare of the workers" in paragraph (2) of that Article is deemed to be replaced with "in consideration of the health and welfare of the workers as well as the nature of operations at an institution subject to specified labor management prescribed in Article 122, paragraph (1) of the Supplementary Provisions of the Medical Care Act (Act No. 205 of 1948) (referred to simply as an "institution subject to specified labor management" in the following paragraph)", and the term "in consideration of the requirements provided for in Article 36, paragraph (6) and workers' health and welfare" in paragraph (3) of that Article is deemed to be replaced with "in consideration of the requirements provided for in Article 36, paragraph (6) and workers' health and welfare, as well as the nature of operations at an institution subject to specified labor management".

In addition to what is prescribed in Article 113 of the Supplementary Provisions through the preceding Article, the procedures for applications concerning the designation of an institution subject to specified labor management and other matters necessary for institutions subject to specified labor management are specified by an Order of the Ministry of Health, Labour and Welfare.