Runny nose

Job description of a local doctor. Community Outreach Personnel and Job Responsibilities

1. General provisions

1. This job description defines the job responsibilities, rights and responsibilities of a local physician.

2. A person who has a higher medical education and has completed postgraduate training or specialization in the specialty “Therapy” is appointed to the position of a local general practitioner.

3. A local physician must know the basics of Russian legislation on healthcare; regulatory documents regulating the activities of healthcare institutions; the basics of organizing medical and preventive care in hospitals and outpatient clinics, ambulance and emergency medical care, disaster medicine services, sanitary-epidemiological services, drug provision for the population and health care facilities; theoretical foundations, principles and methods of medical examination; organizational and economic foundations of the activities of healthcare institutions and medical workers in the conditions of budgetary insurance medicine; fundamentals of social hygiene, organization and economics of healthcare, medical ethics and deontology; legal aspects of medical practice; general principles and basic methods of clinical, instrumental and laboratory diagnostics of the functional state of organs and systems of the human body; etiology, pathogenesis, clinical symptoms, clinical features, principles of complex treatment of major diseases; rules for providing emergency medical care; basics of examination of temporary disability and medical and social examination; basics of health education; internal labor regulations; rules and regulations of labor protection, safety, industrial sanitation and fire protection.

According to his specialty, a local therapist must know modern methods of prevention, diagnosis, treatment and rehabilitation; content and sections of therapy as an independent clinical discipline; tasks, organization, structure, staffing and equipment of the therapeutic service; current regulatory, legal, instructional and methodological documents in the specialty; rules for processing medical documentation; the procedure for conducting an examination of temporary disability and medical and social examination; principles of planning and reporting of therapeutic services; methods and procedures for monitoring its activities.

4. A local physician is appointed to a position and dismissed from a position by order of the chief physician of a healthcare facility in accordance with the current legislation of the Russian Federation.

5. The local therapist is directly subordinate to the head of the department, and in his absence, to the head of the health care facility or his deputy.

2. Job responsibilities

Provides qualified medical care in its specialty, using modern methods of prevention, diagnosis, treatment and rehabilitation, approved for use in medical practice. Determines the tactics of patient management in accordance with established rules and standards. Develops a plan for examining the patient, clarifies the scope and rational methods of examining the patient in order to obtain complete and reliable diagnostic information in the shortest possible time. Based on clinical observations and examination, medical history, data from clinical, laboratory and instrumental studies, establishes (or confirms) a diagnosis. In accordance with established rules and standards, prescribes and monitors the necessary treatment, organizes or independently carries out the necessary diagnostic, therapeutic, rehabilitation and preventive procedures and activities. Makes changes to the treatment plan depending on the patient's condition and determines the need for additional examination methods. Provides advisory assistance to doctors of other departments of health care facilities in their specialty. Supervises the work of the nursing and junior medical personnel subordinate to him (if any), assists them in the performance of their official duties. Monitors the correctness of diagnostic and therapeutic procedures, operation of instruments, apparatus and equipment, rational use of reagents and medications, compliance with safety and labor protection rules by nursing and junior medical personnel. Participates in conducting training courses for medical personnel. Plans his work and analyzes his performance indicators. Ensures timely and high-quality execution of medical and other documentation in accordance with established rules. Conducts sanitary education work. Complies with the rules and principles of medical ethics and deontology. Participates in the examination of temporary disability and prepares the necessary documents for medical and social examination. Qualifiedly and timely carries out orders, instructions and instructions from the management of the institution, as well as regulatory legal acts related to his professional activities. Complies with internal regulations, fire and safety regulations, and sanitary and epidemiological regulations. Promptly takes measures, including timely informing management, to eliminate violations of safety regulations, fire safety and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors. Systematically improves his skills.

A local physician has the right to:

1. independently establish a diagnosis in the specialty based on clinical observations and examination, medical history, data from clinical, laboratory and instrumental studies; determine patient management tactics in accordance with established rules and standards; prescribe instrumental, functional and laboratory diagnostic methods necessary for a comprehensive examination of the patient; carry out diagnostic, therapeutic, rehabilitation and preventive procedures using approved diagnostic and treatment methods; involve, when necessary, doctors of other specialties for consultations, examination and treatment of patients;

2. make proposals to the management of the institution to improve the diagnostic and treatment process, improve the work of administrative, economic and paraclinical services, issues of organization and conditions of their work;

3. control the work of subordinate employees (if any), give them orders within the framework of their official duties and demand their strict execution, make proposals to the management of the institution for their encouragement or imposition of penalties;

4. request, receive and use information materials and regulatory documents necessary to perform their official duties;

5. take part in scientific and practical conferences and meetings at which issues related to his work are discussed;

6. undergo certification in the prescribed manner with the right to receive the appropriate qualification category;

7. improve your qualifications through advanced training courses at least once every 5 years.

A local therapist enjoys all labor rights in accordance with the Labor Code of the Russian Federation.

4. Responsibility

The local therapist is responsible for:

1. timely and high-quality implementation of the official duties assigned to him;

2. organization of its work, timely and qualified execution of orders, instructions and instructions from management, regulations on its activities;

3. compliance with internal regulations, fire safety and safety regulations;

4. timely and high-quality execution of medical and other official documentation provided for by current regulatory documents;

5. provision of statistical and other information on its activities in the prescribed manner;

6. ensuring compliance with executive discipline and performance of their official duties by employees subordinate to him (if any);

7. promptly taking measures, including timely informing management, to eliminate violations of safety regulations, fire safety and sanitary rules that pose a threat to the activities of a healthcare institution, its employees, patients and visitors.

For violation of labor discipline, legislative and regulatory acts, a local therapist may be subject to disciplinary, material, administrative and criminal liability in accordance with current legislation, depending on the severity of the offense.

The organization of medical care to the population depends on the socio-economic, social and political changes occurring in the country. The main accessible and free type of medical care for the population in our country is primary health care (PHC), which since 2005 has been identified as a priority area for improving healthcare.

Primary health care includes treatment of the most common diseases, injuries, poisonings and other emergency conditions; carrying out sanitary-hygienic and anti-epidemic measures, medical prevention of the most important socially significant diseases; sanitary and hygienic education; family protection measures and other activities related to the provision of health care to citizens at their place of residence.

Order of the Ministry of Health of the Russian Federation No. 627 dated October 7, 2005 “On a unified nomenclature of state and municipal healthcare institutions” approved the following outpatient clinics:

Outpatient clinic.
Polyclinics, including city, consultative and diagnostic, physiotherapeutic, psychotherapeutic, central district, etc.

In the healthcare system, the outpatient service occupies a leading position. About 80% of patients receive care in an outpatient setting. The activities of polyclinics are based on the territorial-precinct principle of serving the population, when the polyclinic provides assistance to the population living in a designated territory.

Structure and organization of the clinic

Depending on capacity, there are five categories of clinics:

Approximate organizational structure of a city clinic:

Clinic management.

Administrative and economic part.

Information and analytical department:

Registry;
Organizational and methodological department (office) with a statistics department (office).

Prevention department(cabinet):

First aid room
Examination room;
Fluorography room;
Cabinet of health education and hygienic education of the population;
Health school office.

Treatment and prevention unit:

Therapeutic department;
Department of General Medical (Family) Practice;
Surgical department (office);
Dental department (office);
Maternity consultation (if not included in the maternity hospital);
Department of Rehabilitation Treatment;
Treatment room.

Consulting and diagnostic department:

Advisory department (offices of medical specialists);
Department (office) of functional diagnostics;
Department of Radiation Diagnostics;
Laboratory.

Emergency Department.

Ambulatory Surgery Center.

Day hospital.

Hospital at home.

Medical and paramedic health centers.

Equipping medical institutions with diagnostic equipment is carried out depending on the number of visits (up to 250, 250-500, more than 500) in accordance with the order of the Ministry of Health of the Russian Federation No. 753 dated December 1, 2005 “On equipping outpatient clinics and inpatient clinics of municipal institutions with diagnostic equipment formations."

Clinic opening hours: a six-day work week with specialist doctors and all departments working on Saturdays on a staggered schedule.

The staffing schedule depends on the number of population served (category of the clinic). The positions of clinic doctors are determined based on:

Job title	Number of positions per 10 thousand adult population attached to the clinic
Local therapist	5,9
General practitioner (adult population)	6,67
General Practitioner (Mixed Population)	8,4
Ophthalmologist	0,6
Neurologist	0,5
Otolaryngologist	0,5
Surgeon	0,4
Cardiologist	0,3
Rheumatologist	0,2
Urologist	0,2
Infectious disease doctor	0,2
Allergist-immunologist	0,015

The activities of any medical institution are largely determined by the level of its management, and a clear distribution of functional responsibilities of all officials working in the clinic, from the nurse to the chief physician, is of great importance. The practical activities of personnel are regulated by orders, regulations and instructions of the Ministry of Health and health care authorities. The functional responsibilities of employees can be adjusted locally, taking into account the specifics of the medical institution.

Depending on the capacity of the clinic, the chief physician has several deputies. The first deputy - the second person in the clinic is the deputy chief physician for medical work (chief medical officer), who is appointed as the chief physician from among the most qualified doctors with organizational skills. In the absence of the chief physician, the chief medical officer performs his duties. The medical director is responsible for all medical activities of the clinic. He organizes and controls the correctness and timeliness of examination and treatment of patients in the clinic and at home; monitors the implementation of modern, most promising methods of prevention, diagnosis, treatment and rehabilitation of patients, new organizational forms and methods of operation of the clinic.

The chief medical officer ensures continuity in the management of patients between the clinic and emergency medical care, clinics and hospitals, analyzes discrepancies in clinical and polyclinic diagnoses; organizes planned hospitalization of patients.

Under the leadership of the head of the medical department, all preventive work of the clinic is carried out: periodic and targeted medical examinations, timely implementation of preventive vaccinations and medical examinations of the population, sanitary educational work.

The Deputy Chief Physician for the Examination of Temporary Disability (ED), who heads the Medical Commission (MC), is responsible for the quality examination of work capacity and interaction with insurance companies.

If there are 6–8 positions of general practitioners in the clinic, a therapeutic department is created, which is headed by the head of the department. He is entrusted with the responsibility of monitoring the activities of the department’s doctors in all sections of work, organizational and methodological work, drawing up plans, reports with analysis of key indicators, and introducing new technologies into the diagnostic and treatment process.

The first acquaintance of visitors with the clinic begins at the reception desk. This is one of the main structural units of the clinic. The duties of the registry include:

organizing preliminary and emergency registration of patients for appointments with a doctor, both when the patient contacts them directly and by telephone;
ensuring clear regulation of the flow of patients in order to create an even workload for doctors by issuing appointment vouchers;
carrying out timely selection and delivery of medical documentation to doctors’ offices, proper maintenance and storage of the clinic’s file cabinet.

Organization of the work of the local therapeutic service

Medical services for the population in the clinic are organized on a local basis in accordance with Order No. 584 of the Ministry of Health of the Russian Federation dated 08/04/2006 “On the procedure for organizing medical services for the population on a local basis” and is carried out taking into account the criteria of territorial (including transport) accessibility of all types of medical (pre-hospital, medical and emergency medical = emergency) care. The following medical areas with the recommended population size can be organized in medical institutions:

therapeutic – 1,700 adults (18 years and older);
general practitioner (GP) – 1,500 adults;
family doctor – 1200 adults and children;
complex therapeutic area - 2000 or more adults and children.

A comprehensive therapeutic area is formed from the population of the medical area of an outpatient clinic (APU) with an insufficient number of attached population (understaffed area) or the population served by an outpatient physician and the population served by paramedic and obstetric stations.

The distribution of the population among areas is carried out by the heads of the APU, depending on the specific conditions for the provision of primary health care to the population in order to maximize its accessibility and respect for other rights of citizens.

In order to ensure the right of citizens to choose a doctor and a medical institution, the heads of the APU assign citizens living outside the service area of the APU to local general practitioners (GPs) for medical observation and treatment, without exceeding the population size for one position of a local doctor by more than 15% normative.

Treatment and preventive care for the population of the site is provided by a permanent local physician and nurse. The local principle allows the attending physician to know his area better, carry out dynamic observation taking into account working and living conditions, identify frequently and long-term ill people, timely carry out therapeutic and preventive measures, and prevent the occurrence of infectious diseases. All this ultimately determines the effectiveness of the clinic.

The appointment and dismissal of a local general practitioner is carried out by the chief physician of the clinic. In his work, he reports directly to the head of the therapeutic department, and in his absence, to the deputy chief physician for medical work.

Responsibilities of a local physician

The activities of a local general practitioner are regulated by Order of the Ministry of Health No. 765 dated December 7, 2005 “On the organization of the activities of a local general practitioner.”

Local therapist:

forms a medical (therapeutic) site from the population attached to it;
provides sanitary and hygienic education, advises on the formation of a healthy lifestyle;
carries out preventive measures to prevent and reduce morbidity, identify early and latent forms of diseases, socially significant diseases and risk factors, organizes and runs health schools;
studies the needs of the population served for health-improving activities and develops a program for their implementation;
carries out medical examination of the population, including those entitled to receive a set of social benefits;
organizes and conducts diagnostics and treatment of various diseases and conditions, including rehabilitation treatment of patients in an outpatient setting, day hospital and home hospital;
provides emergency medical care to patients in acute conditions (acute diseases, injuries, poisoning and other emergencies) in a clinic, day hospital and home hospital;
promptly refers patients for consultations with specialists, including for inpatient and rehabilitation treatment for medical reasons;
organizes and carries out anti-epidemic measures and immunoprophylaxis;
conducts an examination of temporary disability (TEI) and draws up documents for referring patients for a medical and social examination (MSE);
issues a conclusion on the need to refer patients for medical reasons to sanatorium-resort treatment and, if necessary, draws up a sanatorium-resort card after the examination;
interacts with medical organizations, medical insurance companies, and other organizations;
organizes, together with the social protection authorities, medical and social assistance to certain categories of citizens in need of care: lonely, elderly, disabled, chronically ill;
manages the activities of nursing staff providing primary health care;
maintains medical documentation, analyzes the health status of the assigned population and the activities of the medical department.

The local doctor is the main organizer of medical care for the population of the district, but he cannot and should not do what doctors of narrow specialties are supposed to do. It is not the local doctor who is obliged to work for doctors of other specialties, but on the contrary, all other specialists, including doctors in functional diagnostics, x-ray, and dental rooms, must provide him with the information necessary for social and hygienic analysis and planning of general treatment and health measures. The local general practitioner must coordinate all work carried out.

The main sections of the work of a local physician-therapist

Therapeutic work

The work of the local therapist is carried out according to the work schedule approved by the administration of the clinic. A rationally designed work schedule allows you to increase the availability of local services to the population of the site. The working day consists of working at the reception for 3-4 hours, answering calls (3 hours) and other types of work (sanitary education work, writing reports, etc.).

Reception of patients is an important part of the work of a local doctor. At the first examination of the patient, the doctor must make a preliminary diagnosis, prescribe examination and treatment.

A large place in the activities of a local general practitioner is occupied by medical care for home calls. On average, a local doctor’s time spent providing care at home should be 30–40 minutes per patient. It is more difficult to examine patients at home than in a clinic or hospital. Moreover, most calls are made to patients of older age groups. Having examined the patient at home on call, the local doctor must subsequently schedule him to appear for an appointment or, if necessary, actively visit him. Repeated (active) visits, when properly organized, account for up to 70–75% of the total number of calls (a doctor must handle at least 6 calls per day).

The most important part of the work of a local doctor is the preparation and referral of the patient to planned hospitalization. The patient should be examined as completely as possible. Data from the examination, treatment provided and the purpose of hospitalization are entered in form No. 057u-04. The referral from the medical record must include diagnoses of all existing diseases, as well as conditions that require clarification. The diagnosis is written in accordance with the accepted classification, indicating the form of the disease, severity, phase, functional disorders and complications. The main one is indicated first, then the competing and concomitant diseases. In case of emergency hospitalization, fill out a free-form referral on the health care facility form.

Working with accounting and reporting documentation

In his work, the local doctor must use only forms approved by orders of the Ministry of Health: No. 1030 of 10/04/80 “On approval of forms of primary medical documentation of healthcare institutions”, No. 255 of 11/22/04 “On the procedure for providing primary health care citizens entitled to receive a set of social services”, etc. The orders contain forms of primary documentation, rules for filling them out and storage periods in a medical institution. Therapists should use the following forms in their work:

№	Form name	Form number	Shelf life
1	2	3	4
1	Outpatient medical record	025у-04	25 years old
2	Dispensary observation checklist	030у-04	5 years
3	Card subject to periodic inspection	046-у	3 years
4	Card of preventive fluorographic examinations	052-у	1 year
5	Vaccination card	063-у	5 years
6	Vaccination log book	061-у	3 years
7	Doctor's appointment voucher	025-4-у	Year
8	Doctor's home call book	031-у	3 years
9	Certificate for obtaining a voucher (order No. 256)	070-у	3 years
10	Sanatorium-resort card (order No. 256)	072-у	3 years
11	Medical certificate (medical professional opinion)	086-у	3 years
12	Statistical card for registering final (refined) diagnoses	025-2-у	Year
13	Summary record of diseases registered in this institution	071-у	Year
1	2	3	4
14	Record of medical visits	039-u	Year
16	Referral to ITU (Project No. 77 dated January 31, 2007)	088/у-06	3 years
17	Referral for hospitalization, rehabilitation treatment, examination, consultation	057у-04
18	Emergency notification of an infectious disease, food poisoning, acute occupational poisoning, unusual reaction to vaccination	058-у	Year
19	Certificate of temporary disability for students attending vocational schools	095-у	Year
20	Journal for recording VK conclusions	035-y
21	Book of registration of certificates of incapacity for work	036-у	3 years
22	Journal of sanitary education work	038-у	Year
23	Medical death certificate	106	Year
24	Recipes (order No. 110 dated February 12, 2007)	107-1/у,
25	Referral for hematological analysis	201	Month
26	Referral for analysis	200	Month
27	Referral for biochemical blood test	202	Month
28	Outpatient voucher	025-12/у
29	Passport of the medical district of citizens entitled to receive a set of social services	030-P/u

For better control of the entire situation at the site and targeted work planning, the local doctor fills out medical passport (therapeutic) area(form 030-P/u), approved by order of the Ministry of Health of the Russian Federation No. 765 dated December 7, 2005 (Appendix No. 2).

The following sections must be highlighted in the passport:

Characteristics of the medical therapeutic area:

population size;
site plan indicating the number of floors of buildings, number of apartments, location of schools, preschool institutions;
list of enterprises and institutions indicating the number of employees (lists are updated annually and certified by the administration of the enterprises).

Characteristics of the attached population:

age and sex composition of the population;
working age population (men, women);
population over 60 years of age (men, women);
working population (men, women);
non-working population (men, women);
pensioners (men, women);
number of persons with occupational hazards (men, women);
the number of people belonging to risk groups and abusing alcohol, smoking, drugs (men, women);
a list of people suffering from socially significant diseases (tuberculosis, diabetes, neoplasms, cardiovascular diseases and damage to the musculoskeletal system).

Health status and treatment results of the attached population:

age composition of the population, including able-bodied and disabled men and women;
dispensary group (age and gender characteristics, movement “D” group, needed medical and recreational activities and received them (outpatient, inpatient treatment, VTMP, treatment in a day hospital, sanatorium treatment);
number of activities carried out: vaccinations, tests, studies, procedures, consultations;
the number of persons who received emergency medical care during travel (persons), including those sent to the hospital;
becoming disabled (total, in the reporting year);
number of deaths (total, including at home).

The local general practitioner is obliged to correctly draw up medical documentation. An important document is medical card outpatient(form No. 025/u), which is maintained in accordance with the Standard of Medical History of Inpatient and Outpatient Patients, approved by Order of the Ministry of Health of the Trans-Baikal Territory No. 155 dated 02/03/2009. The results of the examination, data on the prescribed treatment and examination are entered into the medical record. The diagnosis must correspond to complaints, objective examination data, and anamnesis. The formulation of the diagnosis is carried out in accordance with the accepted classification, indicating the clinical variant, severity of the course, phase, functional disorders and complications. It is necessary to distinguish the main, competing and concomitant diseases in the diagnosis.

The medical documentation contains information about the patient’s awareness and consent to examination and treatment, confirmed by his signature.

Diseases are coded by a doctor in accordance with ICD 10. Based on the doctor’s note, the nurse fills out a statistical form for each identified disease. If the disease is detected for the first time, the diagnosis is made with a “+” sign. If there is a chronic disease for which the patient was previously observed, the statistical coupon is filled out once a year with a “-” sign.

Statistical coupons(form 025-2/у) are used to record all cases of diseases; according to their presence, accounting form No. 071/u is drawn up "Summary list of diseases", based on the results of which morbidity and overall morbidity rates are calculated at each site, department and clinic. The form is prepared quarterly.

Total registered for the first time

identified diseases on site

Incidence = ——————————————- × 1000

Total registered

diseases on site

Total incidence = ————————————— × 1000

Number of people in the area

Doctor's appointment voucher(form 025-4/у) serves for uniform distribution of patients and compilation medical visit records(form No. 039-u), which reflects the time spent on reception and calls, the number of patients received, and other types of work. The form can be completed by a physician or centrally. On a monthly basis, based on data from form No. 039, load indicators at receptions, at home, preventive examinations, locality and activity (percentage of active calls) are calculated.

Number of visits to the local doctor

residents of their area

Locality = ——————————————————- × 100

Total visits to the local doctor

Number of visits Total number of visits to doctors at the clinic

for one = ———————————————————

inhabitants per year Average annual population,

living in the service area

clinics

Number of active visits by residents to their site

Activity = ———————————————————- × 100

Total number of home visits

Hospital-replacing technologies in the work of a local general practitioner

Hospital care is expensive, and according to studies, from 20 to 50% of patients receiving treatment in a hospital are unreasonably sent to hospital and could receive more effective and less expensive care in an outpatient setting. To do this, it is necessary to use hospital-replacing technologies: day hospitals(DS) hospitals and clinics, hospitals at home(SD).

The regulatory document on the organization of DS is the order of the Ministry of Health of the Russian Federation No. 438 dated 09.12.99 “On the organization of activities of day hospitals in medical institutions.”

The local general practitioner uses hospital-replacing technologies in his work, in particular SD, which is created for the treatment of patients with acute and chronic diseases that do not require round-the-clock medical supervision. SD is created for the treatment of patients with follicular tonsillitis (for at least three days), acute mild pneumonia, acute bronchitis, and exacerbation of chronic diseases (hypertension, peptic ulcer, etc.).

A patient with diabetes must undergo an examination (general blood test, urine test, ECG, consultation with the necessary medical specialists), the local general practitioner is obliged to examine the patient in the first days of the illness - daily, then - as needed. Treatment should be comprehensive: procedures are performed at home by a nurse (various types of injections, cupping, mustard plasters), massage, exercise therapy, etc. Information about the organization of diabetes is entered into the medical record.

The work of the Board of Directors can be carried out centrally or decentralized. In the first case, the clinic allocates a doctor to service diabetes throughout the entire territory, and he is provided with transport. The normal load is visiting patients at 16 - 18 SD per day. In a decentralized form, each local therapist independently visits patients with diabetes in his or her area every day.

Work ability examination

A local general practitioner is an attending physician who provides medical care to a patient during the period of his observation and treatment in a health care facility. When examining a patient, he solves not only diagnostic and treatment problems, but also determines the possibility of continuing his work activity. He is responsible for the examination of temporary disability and registration of patients for medical and social examination.

Anti-epidemic section of the work of the local service

The local doctor is responsible for carrying out basic anti-epidemic measures. The local therapist must be well versed not only in the issues of diagnosing infectious diseases, but also in matters of epidemiology, since the ability to collect an epidemiological history allows the doctor to recognize the disease in the early stages and take the necessary measures in a timely manner.

If an infectious disease is suspected, the local general practitioner must notify the management of the clinic, the infectious disease specialist and the authorities of the Federal Service for Surveillance on Consumer Rights Protection and Human Welfare. The patient must be urgently hospitalized, and within 24 hours an emergency notification about an infectious patient (form No. 058/u) must be filled out and submitted. If the patient is not hospitalized, everything necessary is done to prevent the spread of infection (maximum isolation, monitoring of contacts, disinfection). When a patient is hospitalized, the local physician monitors contacts in the outbreak for the entire incubation period of the disease with the preparation of the necessary documentation.

Preventative work

The local general practitioner pays great attention to preventive work aimed at preventing the occurrence of diseases and increasing the duration and quality of life. For this purpose, preventive examinations of the population are carried out to identify diseases in the early stages (target: tuberculosis, cancer, goiter, etc.) and mandatory preliminary and periodic examinations of workers (excluding exposure to harmful occupational factors).

Preliminary medical examinations upon entry to work are carried out in order to determine the suitability of the health status of the person being examined for the work assigned to him.

The purpose of periodic examinations is to dynamically monitor the health status of workers under conditions of exposure to occupational hazards. Prevention and timely detection of signs of general and occupational diseases that prevent continued work in these conditions, as well as the prevention of accidents. Timely implementation of preventive and rehabilitation measures.

The regulatory documents for this section of work are Order No. 90 of the Ministry of Health dated March 14, 1996 “On the procedure for conducting preliminary and periodic medical examinations of workers and medical regulations for admission to the profession,” Order No. 83 dated August 16, 2004 “On approval of lists of harmful and (or) hazardous production factors and work, during which preliminary and periodic medical examinations (examinations) are carried out, and the procedure for conducting these examinations (examinations).”

The following lists were approved by orders:

harmful, hazardous substances and production factors, work, the performance of which requires preliminary and periodic medical examinations of workers;
medical contraindications;
medical specialists participating in examinations;
necessary laboratory and functional studies;
general medical contraindications;
occupational diseases.

The frequency of periodic inspections is determined by the territorial bodies of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare together with the employer based on the specific sanitary, hygienic and epidemiological situation, but should not be less than once every two years, and for persons under 21 years of age not less than once a year. For workers employed in hazardous industries for 5 years or more, medical examinations are carried out by occupational pathology centers.

Medical examinations are carried out by medical institutions licensed for the specified type of activity.

The employer submits a name list of persons subject to inspection, previously agreed upon with the territorial bodies of the Federal Supervision Service, indicating workshops, hazardous work and factors to the medical institution 2 months before the start of the inspection.

The chief physician of the healthcare facility approves the composition of the medical commission, the chairman of which must be an occupational pathologist or a doctor of another specialty with training in occupational pathology; members of the commission must also have special training. The commission determines the types and volumes of necessary research, taking into account the specifics of production factors and medical contraindications to work in this specialty.

To undergo the examination, the employee presents a referral issued by the employer, a passport, an outpatient card, and the results of previous examinations.

The main person conducting the examinations is the local doctor. The examination data is entered into the medical record (form No. 025-u). Each doctor taking part in the examination gives his opinion on professional suitability and, if indicated, prescribes therapeutic and recreational measures.

The employee is informed of the results of the medical examination. If signs of an occupational disease are detected in an employee during a medical examination or upon treatment, he is sent by the attending physician, the head of the health care facility or an occupational pathologist in the prescribed manner to the occupational pathology center to clarify the diagnosis.

The final report based on the results of the periodic examination is drawn up by the responsible doctor together with representatives of the Federal Surveillance Service and is submitted to the employer within 30 days.

One of the sections of preventive work is vaccine prevention, which is carried out by the district service in accordance with the National Calendar of Preventive Vaccinations, approved by Order of the Ministry of Health No. 673 dated October 30, 2007. A card file is created for the entire population of the district, in which data on vaccinations is entered.

Health education and patient education work.

The sanitary and educational work of the local doctor is determined by the needs of improving the health of society. In it, the doctor, with the help of public health activists, must pay attention to the fight against weakness, overeating, smoking, excessive and unnecessary drug therapy, stress, etc.

The responsibilities of a local therapist include teaching patients with socially significant diseases and their relatives in specialized schools.

Medical examination of the population

The preventive section of the work of a local general practitioner includes clinical examination, which is an active method of continuous medical monitoring of the health status of the population for the purpose of early detection of diseases; timely registration; dynamic observation and complex treatment of patients; preventing the development and spread of diseases; maintaining ability to work.

The main purpose of medical examination healthy people are preserving and strengthening their health, ensuring proper physical and mental development, creating normal working and living conditions, preventing the development of diseases, and maintaining their ability to work.

The purpose of medical examination of patients– prevention of exacerbations and deterioration of the clinical course of diseases, reduction of morbidity with temporary disability and prevention of disability.

Clinical examination includes:

annual medical examination with a specified volume of laboratory and instrumental studies;
additional examination of those in need using all diagnostic methods;
identification of persons with risk factors contributing to the occurrence and progression of diseases;
detection of diseases at early stages;
development and implementation of a set of necessary medical and social measures and dynamic monitoring of the health status of the population.

Clinical examination is carried out in three stages:

Stage 1 – registration: selection of contingents for dispensary observation;

Stage 2 – carrying out the actual dispensary observation and treatment;

Stage 3 – assessment of the effectiveness and quality of medical examination (after three years of observation and treatment).

The formation of dispensary observation groups is carried out in an active (using medical examinations) and passive (by referral, after hospital treatment) way.

The priority groups for registration at the dispensary include disabled people and participants of the Second World War and other military operations, workers of leading industries, transport, agriculture, students of higher and secondary specialized educational institutions, workers of hazardous industries, women of reproductive age and others.

Based on the results of the registration stage, the following should be formed: clinical observation groups(health):

Group 1 – healthy (formed mainly from students, workers in harmful and dangerous industries, women of childbearing age, etc.).

Group 2 – practically healthy people who have suffered acute illnesses in the past or have a chronic disease in stable remission (there has been no exacerbation of the disease for five or more years).

Group 3 – patients with diseases in the stage of compensation, subcompensation, decompensation.

Healthy and practically healthy people should be observed in the prevention department; in the presence of diseases, they should be observed by specialist doctors in the profile of the disease.

Order of the Ministry of Health No. 770 approved instructions for medical examination of healthy people and persons with risk factors in outpatient clinics (Appendix No. 9). The scheme of dynamic observation of patients has been compiled for doctors of all specialties; it includes, in accordance with the nosological form, the frequency of observation, the required volume of laboratory and instrumental studies, examination by specialists, basic medical and health measures, and criteria for the effectiveness of clinical examination.

Preparation of documentation during medical examination

For each dispensary patient, an outpatient medical record (form No. 025-u) and a dispensary observation control card (form No. 030-u) are filled out.

Medical cards must be marked with letters or colors; each card must be marked with the letter “D” and the dispensary observation (health) group must be indicated. When registering, an introductory epicrisis is written (data substantiating the diagnosis, information about the previously conducted examination and treatment, its effectiveness, a plan of treatment and recreational measures is drawn up, repeated appearances are scheduled in accordance with Appendix No. 9 of Order of the Ministry of Health No. 770). After a year of observation, a staged epicrisis is drawn up, in which the attending physician reflects the detailed diagnosis, the dynamics of the condition, the implementation of the examination plan and treatment and recreational measures; A plan of treatment and recreational activities is drawn up for the new year. To facilitate the doctor’s work, unified typographical epicrisis forms are currently used.

For each dispensary patient, a dispensary observation control card is filled out, which is also marked as a medical record, and is used for operational monitoring of work with the dispensary group of patients. The card contains information about the registration of the patient, the timing of planned and actual appearances for dispensary examinations, which makes it possible to call the patient to the doctor on time. Form No. 030/u contains data on planned medical and recreational activities, and at the end of the observation year a note is made about their implementation.

One patient may have several control cards based on the number of etiologically unrelated diseases; they are marked “duplicate”. Control cards facilitate monitoring of patient visits and are stored in a box with 13 compartments (12 months and a cell for control cards of those who did not appear).

Quality indicators

number of dispensaries in the area, distribution by health groups, number of dispensaries per 1000 population;
percentage of dispensary observation coverage of patients by nosological forms from the number of registered patients in a given area (in the clinic):

Total dispensary patients with ulcerative disease

= —————————————————— × 100

Registered patients with ulcerative disease (form 071/у)

In 100% of cases, patients who have suffered acute pneumonia, follicular tonsillitis, acute glomerulonephritis, acute myocardial infarction, patients with rheumatic fever, systemic connective tissue diseases, chronic atrophic gastritis, diabetes mellitus, COPD, bronchial asthma, etc. should be registered at the dispensary;

timeliness of registration at the dispensary (the number of patients registered within a month from the date of diagnosis or discharge to work, out of the total number of newly identified patients);
completeness of the survey (number of people surveyed compared to the number of people in need of survey);
completeness of implementation of therapeutic and recreational measures in % (anti-relapse treatment, diet, sanatorium treatment, employment, planned hospitalization)

number of patients who received anti-relapse treatment

= ———————————————————————— × 100

number of patients who needed anti-relapse treatment

Performance indicators

(calculated in the group of patients observed for three or more years)

dynamics of the condition over the year of observation: improvement, no dynamics,
deterioration;
% of patients transferred to the second observation group due to recovery or persistent improvement of condition (there have been no exacerbations for at least five years);
temporary disability in cases and days (% change compared to the previous year);
primary disability (per 100,000 workers);
mortality from the underlying disease.

Additional medical examination

Since 2006, the country has been conducting additional clinical examination (DS) of citizens working in state and municipal institutions in the fields of education, healthcare, social protection, culture, physical culture and sports, and in research institutions. The procedure and scope of carrying out DD is regulated by order of the Ministry of Health of the Russian Federation No. 188 dated March 22, 2006. In 2006, DD was carried out for the above-mentioned contingents aged 35-55 years; since 2007, all workers are subject to DD. DD is carried out by medical specialists using established laboratory and functional tests in the following scope:

Examination by medical specialists:

therapist (precinct general practitioner, GP),
endocrinologist,
surgeon,
neurologist,
ophthalmologist,
urologist (for men),
obstetrician-gynecologist.

Laboratory and functional studies:

Clinical blood and urine tests,
Cholesterol, blood sugar,
Fluorography once a year,
Mammography (women 40-55 years old - once every 2 years) or ultrasound of the breast.

The local physician, taking into account the conclusions of medical specialists and the results of the examination, determines the health status of citizens who have undergone DD, and in order to plan further activities distributes into the following groups:

Group I – practically healthy citizens who do not need D-observation, with whom a conversation is held about a healthy lifestyle.

Group II – citizens at risk of developing diseases who need preventive measures. An individual prevention program is drawn up for them, carried out at a health care facility at their place of residence.

Group III – citizens who need additional examination to clarify (establish) the diagnosis (newly diagnosed chronic disease) or treatment on an outpatient basis (acute respiratory disease, influenza and other diseases, after treatment of which recovery occurs) “*”.

Group IV - citizens who need additional examination and treatment in a hospital setting, who are on the D-registration for a chronic disease “*”.

Group V – citizens with newly diagnosed diseases or those being observed for a chronic disease and who have indications for providing high-tech (expensive) medical care “*”.

“*” - additional examination in outpatient and inpatient settings is not included in the scope of DD.

The institution that carried out the DD not at the citizen’s place of residence transfers the “DD Registration Card” with the results of the examination to the health care facility at the citizen’s place of residence.

Based on information about the results of the DD, the local physician (GP), who carries out dynamic monitoring of the citizen’s health status, determines the required scope of further examination, refers him for further treatment and carries out D-monitoring for the chronic disease.

Medical examination of women of childbearing age with extragenital pathology, is carried out in accordance with the order of the Ministry of Health of the Russian Federation dated February 10, 2003 No. 50 “On improving obstetric and gynecological care in outpatient clinics” (Appendix 2, section 3 “Pregnancy and extragenital pathology”). The order contains a dynamic observation scheme indicating the duration of hospitalization.

Dispensary observation of patients with occupational diseases regulated by Order of the Ministry of Health of the Russian Federation No. 555 dated September 29, 1989 “On improving the system of medical examinations of workers and drivers of individual vehicles.” The general practitioner carries out observation in accordance with the approximate scheme given in Appendix No. 7 “Regulations on the procedure for medical examination of patients with occupational diseases.”

Disabled people and WWII participants are observed in accordance with the Federal Law of January 12, 1995 No. 5-FZ “On Veterans”.

Medical examination of persons exposed to radiation as a result of the disaster at the Chernobyl nuclear power plant, is carried out on the basis of the order of the Ministry of Health of the Russian Federation No. 293 dated October 3, 1997 “On improving the medical examination of persons exposed to radiation as a result of the disaster at the Chernobyl nuclear power plant.” This order regulates the frequency and scope of clinical examination of this category of persons.

Work of a local physician-therapist as part of the ATPC

In connection with the current unfavorable demographic situation in the country, the local therapist should pay special attention to the work to preserve the health of women of childbearing age, which is carried out as part of local obstetric-therapeutic-pediatric complexes (ATPC). The local ATPC includes 4-5 therapeutic, 2-3 pediatric and 1 obstetric department, united on a territorial basis. In all medical institutions, doctors work according to an agreed schedule at the same time. The local therapist (general practitioner) must know what somatic pathology adversely affects the reproductive function of a woman, her state of health during pregnancy, intrauterine development of the fetus and the condition of the child in the postnatal period. He is obliged to transmit information about the state of women’s health to the antenatal clinic and organize the health improvement of women of fertile age.

All women of fertile age with extragenital pathology should be under dispensary observation; the tactics for their management are determined by Order of the Ministry of Health No. 50 of February 10, 2003 “On improving obstetric and gynecological care in outpatient clinics” (Appendix 2, section 3 “Pregnancy and extragenital pathology").

On the basis of clinics for adults, there is an advisory and expert commission (AEC) for women of childbearing age, the purpose of which is to control the quality of medical examination of women and the implementation of the plan of treatment and health measures. All women who come under the supervision of clinic doctors (transferred for observation upon reaching 18 years of age from pediatric health care facilities, who have changed their place of residence, etc.) must, after further examination, be submitted to the CEC to clarify their health group and the plan of treatment and recreational measures.

An examination of healthy pregnant women in an adult clinic is carried out upon registration and at 30 weeks of pregnancy (when applying for maternity leave), the results of the examination are transferred to the antenatal clinic. The local service also provides postpartum patronage with a set of necessary medical and rehabilitation measures.

The local service, together with employees of family planning centers, should carry out work on timely, high-quality contraception, especially for women with extragenital pathology. If medical contraindications to pregnancy are identified, the issue is resolved jointly with doctors at antenatal clinics (at the pregnant women's health center) in accordance with the List of medical indications for artificial termination of pregnancy, approved by Order of the Ministry of Health No. 736 of 12/03/07 and social indications (RF Government Decree No. 485 dated 11.08.03 “On the list of social indications for artificial termination of pregnancy”).

Registration of patients for sanatorium-resort treatment

An important issue in the activities of a local doctor is the selection and referral of patients for sanatorium-resort treatment. The regulatory document for this section of work is Order of the Ministry of Health of the Russian Federation No. 256 dated November 22, 2004 “On the procedure for medical selection and referral of patients for sanatorium-resort treatment” with amendments approved by Order of the Ministry of Health No. 3 dated January 9, 2007. Medical selection and the referral of patients in need of sanatorium-resort treatment is carried out by the attending physician and the head of the department (if there is a benefit, the attending physician and the chairman of the VC).

If there are indications (healthy people cannot recommend treatment at a resort) and there are no contraindications for sanatorium-resort treatment, the doctor issues the patient a certificate (070/u-04) about the need for treatment, which is valid for 6 months, which is noted in the outpatient’s medical record. Beneficiaries are issued a certificate for obtaining a voucher by the VC, and disabled people - if there is a recommendation in the individual rehabilitation program issued by the ITU authorities.

In complex and conflict cases, upon the recommendation of the attending physician and the head of the department, a conclusion on the indications for sanatorium-resort treatment is issued by the Institutional Clinical Hospital.

Patients with concomitant diseases or age-related health problems for whom sanatorium-resort treatment is indicated, in cases where a trip to distant resorts can adversely affect their general health, should be sent to nearby sanatorium institutions.

When receiving a voucher (course), the patient is obliged to visit the attending physician no earlier than two months before the start of its validity period for the necessary additional examination. Attending physicians and heads of departments must be guided by the following mandatory list of diagnostic studies and consultations with specialists, the results of which must be reflected in the sanatorium-resort card (form 072/u-04):

clinical blood and urine analysis;
fluorography;
for diseases of the digestive system - x-ray examination (if more than 6 months have passed since the last examination), ultrasound, endoscopy;
in necessary cases, additional studies are carried out to clarify the diagnosis: biochemical, instrumental and others;
when sending women to the resort, a conclusion from an obstetrician-gynecologist is required; for pregnant women, an additional exchange card is required;
if there is a history of neuropsychiatric disorders, a psychiatrist’s conclusion;
in case of primary or concomitant diseases (urological, skin, blood, eyes and others) - the conclusion of relevant specialists.

Examination data and research results are entered into the outpatient card. The health resort card is certified by the head of the department. If a person entitled to a set of social services is registered for treatment, the sanatorium-resort card is certified by the attending physician, the head of the department or the chairman of the VC.

If contraindications to treatment are identified in the patient during the first five days of his stay at the resort, the VC of the resort (sanatorium) decides on the possibility of the patient’s further stay there, transfer to a hospital or transportation to his place of residence. When a patient makes a claim against a healthcare facility, all material costs are reimbursed by the attending physician.

Work on providing medications to patients

A responsible section of the work of a local therapist is the work of prescribing drug therapy and prescribing medications, including in the system of additional drug supply (DLO).

Medicines are prescribed by the doctor who is directly caring for the patient (the attending physician). In cases of a typical course of the disease, the prescription of drugs is carried out based on the severity and nature of the disease, in accordance with the standards of medical care and the list of vital and essential drugs approved by the Government of the Russian Federation, as well as the list of drugs dispensed to persons entitled to receive state social assistance.

The main regulatory documents regulating drug provision are orders of the Ministry of Health and Social Development No. 785 dated December 14, 2005 “On the procedure for dispensing medicines” and No. 110 dated February 12, 2007 “On the procedure for prescribing and prescribing medicines and medical products and specialized medical nutrition products.” Order No. 110 approved prescription forms and rules for filling them out.

Special prescription form for narcotic drugs and psychotropic substances is produced on pink paper with watermarks and has a serial number. It must be filled out legibly and clearly by the doctor; corrections are not allowed. The drug is prescribed in Latin, the amount of the drug is indicated in words, recommendations for use are indicated in Russian and must be specific. The prescription indicates the number of the outpatient’s medical card (number of “attachment” to the pharmacy institution, the full last name, first name, patronymic of the patient and the doctor. The prescription is signed by the doctor and certified by his personal seal, the chief physician of the health care facility (his deputy or head of the department) and certified by a round seal Health care facility. The prescription must have a stamp with the details of the health care facility. Only one drug is prescribed on the form (a narcotic or psychotropic drug included in List II of the List of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation. The validity of the prescription is 5 days.

Rules for the storage and accounting of narcotic drugs and psychotropic substances, estimated standards for the need for them, provisions for write-off and destruction are regulated by Order No. 330 of November 12, 1997 (as amended by Orders No. 2 of January 9, 2001 and No. 205 of May 16, 2005 G.).

On the prescription form (form No. 148-1/u-88) Schedule III psychotropic substances are prescribed; other drugs subject to subject-quantitative accounting, anabolic steroids. The prescription form has a series and number. Only one name of the drug can be written on the form; corrections are not allowed. The prescription contains the full last name, first name and patronymic of the patient, his age, address (or medical card number) and the full last name, first name and patronymic of the doctor. The prescription is signed by the doctor and certified with his personal seal and the seal of the health care facility “For prescriptions”. The prescription must be stamped with the details of the health care facility. The validity period of the prescription (10 days, 1 month) is indicated by striking through.

On recipe form No. 107/у All drugs are prescribed, with the exception of narcotic and psychotropic substances, drugs subject to subject-quantitative accounting, and anabolic steroids. No more than three drugs are prescribed on one form. Requirements for filling out a prescription are the same as in previous cases. The prescription must be stamped with the details of the health care facility. The prescription is signed by the doctor and certified with his personal seal. The validity period of the prescription (10 days, 2 months, year) is indicated by striking through.

Recipe form No. 148-1/u-04 is intended for prescribing drugs and medical products included in the lists of drugs sold free of charge or at a discount. The prescription form is issued in triplicate, each with a single series and number. When filling out the form, indicate the full last name, first name, patronymic of the patient, date of birth, SNILS, medical insurance policy number, address or medical card number, disease code according to ICD X. It is allowed to fill out a prescription using a computer. The prescription is signed by the doctor, certified by his personal seal and the seal of the healthcare facility “For prescriptions”. When a drug is prescribed, by decision of the medical commission (MC), a special stamp is placed on the back of the form. According to the decision of the High Commission, drugs are prescribed in cases of simultaneous prescription of five or more drugs; prescription of narcotic drugs, psychotropic substances; Medicines subject to subject-quantitative accounting; anabolic steroids.

Prescription of “preferential” drugs is carried out in accordance with the annually updated List of Medicines dispensed by prescription from a doctor (paramedic) when providing additional free medical care to certain categories of citizens entitled to receive state social assistance.” Currently, the current regulatory document is Order of the Ministry of Health of the Russian Federation No. 665 dated September 18, 2006.

Population groups:

Participants and disabled people of the Second World War and combat operations to defend the country.
Parents and wives of military personnel who died defending the country or performing other military service duties.
Citizens who worked during the siege in Leningrad, awarded the medal “For the Defense of Leningrad”, citizens awarded the badge “Resident of besieged Leningrad”.
Former minor prisoners of concentration camps and ghettos created by the Nazis during World War II.
Citizens from among former internationalist soldiers who took part in hostilities in Afghanistan and on the territory of other countries.
Disabled people, disabled children.
Citizens exposed to radiation as a result of the Chernobyl accident, the Techa River, Mayak Ave. and others

Disease categories(regional benefit): cerebral palsy, AIDS, HIV-infected, oncological diseases, acute intermittent porphyria, cystic fibrosis, hematological diseases, hematological malignancies, cytopenia, hereditary hemopathy, radiation sickness, tuberculosis, bronchial asthma, rheumatism, rheumatoid arthritis, SLE, ankylosing spondylitis, myocardial infarction (first 6 months), condition after valve replacement, diabetes, multiple sclerosis, Parkinson's disease, myopathy, etc.

Analysis of the activities of a local doctor

Performance indicators:

Seeking medical care at the office and at home;
Morbidity in the area: primary, general;
Infectious morbidity;
Incidence of illness with temporary disability, compliance with the terms of temporary disability;
Fluorographic examination coverage;
Efficiency of clinical examination (according to established criteria);
Hospitalization rate of patients;
Mortality at the site;
Preventive work: vaccinations, targeted examinations, sanitary education, etc.;
Incidence of tuberculosis and cancer pathology;

Each case is assessed by experts

sudden death;
deaths at home of people of working age;
discrepancies in diagnosis during hospitalization;
inconsistencies in terms of temporary disability of MES;
temporary disability for more than 120 days;
justified complaints from patients;
issuing preferential prescriptions through VK;
initial access to disability;
advanced forms of cancer, tuberculosis, diabetes.

Criteria for the effectiveness of the work of a local general practitioner

The assessment of the effectiveness of the work of a local general practitioner is carried out according to the criteria approved by Order of the Ministry of Health of the Russian Federation No. 282 of April 19, 2007 “On approval of criteria for assessing the effectiveness of the activities of a local general practitioner.”

When assessing work efficiency, the main accounting documents are:

outpatient medical card (025/у-04),
passport of the medical district (030/u-ter),
record of medical visits to APU, at home (039/u-02),
control card of dispensary observation (030/у-04),
outpatient card (025-12/у),
card of a citizen entitled to receive a set of social services for recording the dispensing of medicines (030-L/u).

Criteria for assessing performance:

stabilization or reduction in the level of hospitalization of the attached population;
reducing the frequency of emergency calls to the assigned population;
increasing the number of visits to the assigned population for preventive purposes;
complete coverage of treatment and preventive care for persons under dispensary observation;
complete coverage of preventive vaccinations of the assigned population against diphtheria (at least 90% in each age group), against hepatitis B (at least 90% under the age of 35 years), against rubella (at least 90% of women under 25 years of age), against influenza ( execution of the plan).
stabilization or reduction of the mortality rate of the population at home due to cardiovascular diseases, tuberculosis, diabetes;
reduction in the number of people who died at home from diseases of the circulatory system under the age of 60 and were not observed during the last year of life;
stabilization of the incidence of social diseases: tuberculosis, hypertension, diabetes, cancer.
complete coverage of dynamic medical monitoring of the health status of certain categories of citizens entitled to receive a set of social services, including drug provision, sanatorium-resort and rehabilitation treatment;
the validity of prescribing medications and compliance with the rules for discharge to patients, including those entitled to receive a set of social services.

Specific indicators of the criteria for assessing the effectiveness of the work of a local general practitioner are determined by the head of a health care institution, taking into account the size, density, age and sex composition of the population, morbidity levels, geographic and other features.

The performance indicators of local doctors are used to form the performance indicators of the clinic as a whole:

Key performance indicators of the clinic

Indicators allowing to assess the state of organization of medical care to the population:

the average number of visits to the clinic per resident living in the service area of the clinic;
locality of service to the population in the clinic and at home;
proportion of active home visits;
share of medical services provided in the compulsory health insurance (CHI) system (%).

Indicators allowing to evaluate the organization and results of preventive medical examinations of the population:

implementation of the plan for preventive examinations of the population;
morbidity according to preventive examinations per 100 (1000) examined persons.

Indicators of the quality and effectiveness of clinical examination:

coverage of the population with medical examinations by clinical observation groups;
indicator of the morbidity structure of persons under dispensary observation;
completeness of dispensary observation coverage;
indicator of compliance with the terms of dispensary examinations;
indicator of the completeness of medical and recreational activities;
clinical examination effectiveness indicators.

Indicators that allow you to evaluate the quality of the clinic’s work and the level of staff training: The quality of work of a clinic as a whole can be characterized by the dynamics of the morbidity rate of the population over several years, the percentage of coincidence of diagnoses between the clinic and the hospital, etc.

Job description of a general practitioner

[name of organization, enterprise, etc.]

This job description has been developed and approved in accordance with the provisions of the Unified Qualification Directory of Positions for Managers, Specialists and Employees, section “Qualification characteristics of positions of workers in the healthcare sector”, approved by order of the Ministry of Health and Social Development of the Russian Federation dated July 23, 2010 N 541n, and other legal acts regulating labor relations.

1. General provisions

1.1. The general practitioner belongs to the category of specialists and is directly subordinate to [name of the immediate supervisor].

1.2. A person who has a higher professional education in one of the specialties “General Medicine”, “Pediatrics” and postgraduate professional education (internship and (or) residency) in the specialty “Therapy” or professional retraining with postgraduate professional education in specialty "General Medical Practice (Family Medicine)", a specialist certificate in the specialty "Therapy", without any work experience requirements.

1.3. The general practitioner must know:

Constitution of the Russian Federation;

Laws and other regulatory legal acts of the Russian Federation in the field of healthcare;

The main provisions of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens, legislation on compulsory medical insurance, on the territorial program of state guarantees of free medical care (types of medical care provided to the population free of charge, medical care provided within the framework of the territorial program of compulsory medical insurance, medical care provided at the expense of budgets of all levels);

Principles of organizing therapeutic care in the Russian Federation, the work of hospital and polyclinic institutions, the organization of ambulance and emergency care for adults and children;

Questions about the connection between the disease and the profession;

Have an idea of the grounds for bringing a doctor to various types of liability (disciplinary, administrative, criminal);

Basic issues of normal and pathological anatomy, normal and pathological physiology, the relationship of the functional systems of the body and the levels of their regulation;

Basics of water-electrolyte metabolism, acid-base balance;

Possible types of their disorders and principles of treatment;

The hematopoiesis and hemostasis system, physiology and pathophysiology of the blood coagulation system, the basics of blood replacement therapy, indicators of homeostasis in normal and pathological conditions;

Clinical symptoms and pathogenesis of major therapeutic diseases in adults and children, their prevention, diagnosis and treatment, clinical symptoms of borderline conditions in a therapeutic clinic;

Fundamentals of pharmacotherapy in the clinic of internal diseases, pharmacodynamics and pharmacokinetics of the main groups of drugs, complications caused by the use of drugs, methods of their correction;

Fundamentals of immunobiology and body reactivity;

Organization of intensive care and resuscitation services in a therapeutic clinic, equipment of intensive care and resuscitation wards;

Basics of non-drug therapy, physiotherapy, physical therapy and medical supervision, indications and contraindications for spa treatment;

Organization of monitoring of side and undesirable effects of drugs, cases of lack of therapeutic effect in the Russian Federation;

Fundamentals of rational nutrition for healthy individuals, principles of diet therapy for therapeutic patients;

Anti-epidemic measures in case of outbreak of infection;

Issues of medical and social examination in internal diseases;

Issues of organizing dispensary observation of healthy and sick people;

Prevention issues;

Forms and methods of sanitary educational work;

Principles of organizing the civil defense medical service.

2. Job responsibilities

General practitioner:

2.1. Receives information about the disease.

2.2. Applies objective methods of examining the patient.

2.3. Identifies general and specific signs of the disease.

2.4. Performs a list of works and services for diagnosing the disease, assessing the patient’s condition and clinical situation in accordance with the standard of medical care.

2.5. Determines indications for hospitalization and organizes it.

2.6. Conducts differential diagnostics.

2.7. Justifies the clinical diagnosis, plan and tactics of patient management.

2.8. Determines the degree of disturbance of homeostasis and carries out all measures to normalize it.

2.9. Performs a list of works and services for the treatment of a disease, condition, clinical situation in accordance with the standard of medical care.

2.10. Identifies risk factors for the development of chronic non-communicable diseases.

2.11. Provides primary prevention in high-risk groups.

2.12. Conducts an examination of temporary disability, refers patients with signs of permanent disability for examination for a medical and social examination.

2.13. Carry out the necessary anti-epidemic measures when an infectious disease is detected.

2.14. Conducts medical examinations of healthy and sick people.

2.15. Draws up and sends an emergency notification to the Rospotrebnadzor institution when an infectious or occupational disease is detected.

2.16. Qualifiedly and timely carries out orders, instructions and instructions from the management of the institution, as well as regulatory legal acts related to his professional activities.

2.17. Complies with internal labor regulations, rules on labor protection and fire safety, sanitary and epidemiological regime, promptly takes measures, including timely informing management, to eliminate violations of safety regulations, fire safety and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors.

2.18. Systematically improves his skills.

2.19. [Other job responsibilities].

3. Rights

The general practitioner has the right:

3.1. For all social guarantees provided for by law.

3.2. Make proposals to senior management to improve their work.

3.3. Make decisions independently within your competence and organize their implementation.

3.4. Require the management of the organization to provide assistance in the performance of their professional duties and the exercise of rights.

3.5. Sign and endorse documents within your competence.

3.6. Receive information and documents necessary to perform your job duties.

3.7. Improve your professional qualifications.

3.8. [Other rights provided for labor legislation].

4. Responsibility

The general practitioner is responsible for:

4.1. For failure to perform or improper performance of their job duties as provided for in this job description - within the limits determined by the current labor legislation of the Russian Federation.

4.2. For causing material damage to the employer - within the limits determined by the current labor and civil legislation of the Russian Federation.

4.3. For offenses committed in the course of carrying out their activities - within the limits determined by the current administrative, criminal, and civil legislation of the Russian Federation.

The job description has been developed in accordance with [name, number and date of document]

Head of HR department

[initials, surname]

[signature]

[day, month, year]

Agreed:

[job title]

[initials, surname]

[signature]

[day, month, year]

I have read the instructions:

[initials, surname]

[signature]

[day, month, year]

We bring to your attention a standard example of a job description for a local physician, sample 2019/2020. should include the following sections: general regulations, job responsibilities of a local internist, rights of a local internist, responsibility of a local internist.

Job description of a local therapist belongs to the section " Qualification characteristics of positions of workers in the healthcare sector".

The job description of a local therapist should reflect the following points:

Job responsibilities of a local physician

1) Job responsibilities. Identifies and monitors risk factors for the development of chronic non-communicable diseases. Provides primary prevention in high-risk groups. Performs a list of works and services for diagnosing the disease, assessing the patient’s condition and clinical situation in accordance with the standard of medical care. Performs a list of works and services for the treatment of a disease, condition, clinical situation in accordance with the standard of medical care. Provides symptomatic care to cancer patients of clinical group IV in collaboration with an oncologist. Carries out examination of temporary disability of patients, presentation to a medical commission, referral of patients with signs of permanent disability for examination for medical and social examination. Issues conclusions on the need to refer the patient for medical reasons to sanatorium-resort treatment, draws up a sanatorium-resort card. Carries out organizational, methodological and practical work on medical examination of the population. Organizes vaccination of the population in accordance with the national calendar of preventive vaccinations and according to epidemic indications. Prepares and sends emergency notifications to Rospotrebnadzor institutions when an infectious or occupational disease is detected. Organizes and conducts events on sanitary and hygienic education (health schools, schools for patients with socially significant non-communicable diseases and people at high risk of their occurrence). Monitors and analyzes the main medical and statistical indicators of morbidity, disability and mortality in the service area in the prescribed manner. Maintains accounting and reporting documentation of the established form.

A local physician should know

2) When performing his duties, a local physician must know: Constitution of the Russian Federation; laws and other regulatory legal acts of the Russian Federation in the field of healthcare; Fundamentals of legislation on protecting the health of citizens; general issues of organizing therapeutic care in the Russian Federation; the work of medical and preventive institutions, the organization of ambulance and emergency care for adults and children; organization of the clinic’s work, continuity in its work with other institutions; organization of day hospital and hospital at home; basic issues of normal and pathological anatomy, normal and pathological physiology, the relationship of the functional systems of the body and the levels of their regulation; the basics of water-electrolyte metabolism, acid-base balance, possible types of their disorders and principles of treatment; hematopoiesis and hemostasis system, physiology and pathophysiology of the blood coagulation system, homeostasis indicators in normal and pathological conditions; basics of immunology and body reactivity; clinical symptoms and pathogenesis of major therapeutic diseases in adults and children, their prevention, diagnosis and treatment, clinical symptoms of borderline conditions in a therapeutic clinic; basics of pharmacotherapy in the clinic of internal diseases, pharmacodynamics and pharmacokinetics of the main groups of drugs, complications caused by the use of drugs, methods of their correction; the basics of non-drug therapy, physiotherapy, physical therapy and medical supervision, indications and contraindications for spa treatment; the basics of rational nutrition for healthy individuals, the principles of diet therapy for therapeutic patients; anti-epidemic measures in the event of a outbreak of infection; medical and social examination in internal diseases; dispensary observation of healthy and sick people, problems of prevention; forms and methods of sanitary educational work; demographic and social characteristics of the site; principles of organization of the civil defense medical service; issues of connection between the disease and the profession.

Requirements for the qualifications of a local therapist

3) Qualification requirements. Higher professional education in one of the specialties "General Medicine", "Pediatrics" and postgraduate professional education (internship and (or) residency) in the specialty "Therapy" or professional retraining with postgraduate professional education in the specialty "General Medical Practice (Family Medicine) ", a certificate of a specialist in the specialty "Therapy" without any work experience requirements.

Job description of a local general practitioner - sample 2019/2020. Job responsibilities of a local internist, rights of a local internist, responsibility of a local internist.

Officials responsibilities local general practitioner

1. Conduct outpatient visits to patients in accordance with the schedule approved by the administration of the clinic, regulating the flow of visitors by rationally distributing repeat patients.
2. Visit patients at home on the day the call is received.
3. Ensure timely diagnosis of diseases and qualified treatment of patients.
4. Provide emergency medical care to patients, regardless of their place of residence, in case of acute conditions, injuries, poisoning.
5. Conduct an examination of temporary disability in accordance with the current Regulations on it and promptly refer patients to CEC and MSEC in order to determine their ability to work and transfer to another job.
6. Timely hospitalize therapeutic patients with mandatory preliminary examination during planned hospitalization.
7. Consult patients with unclear forms of diseases with the head of the department, doctors of other specialties of the clinic and other health care institutions.
8. Use modern methods of prevention, diagnosis and treatment of patients in your work.
9. Carry out a set of measures for medical examination of the population of the site in accordance with the list of nosological forms subject to clinical observation by a general practitioner, with an analysis of the effectiveness and quality of medical examination.
10. Ensure the organization and implementation of preventive vaccinations for the population of the site.
11. Notify the management of the institution, the office of infectious diseases of the clinic, the state sanitary and epidemiological surveillance center about all cases of infectious diseases or suspicions of them, food and occupational poisoning, violations of the sanitary and anti-epidemic regime by infectious patients at home.
12. Conduct preventive examinations in accordance with the established procedure and according to the schedule approved by the administration of the clinic.
13. Observe the principles of deontology in your work.
14. Monitor and manage the work of the district nurse.
15. Systematically improve your qualifications and level of medical knowledge of the district nurse.
16. Conduct active and systematic sanitary and educational work among the population on issues of a healthy lifestyle and the prevention of diseases in the area.
17. Maintain medical records of outpatients, write prescriptions.
18. Ensure the correct maintenance of medical records by the local nurse.

Job responsibilities of a local nurse

1. Prepare workplaces before an outpatient appointment with a local therapist, checking the availability of the necessary medical supplies, equipment, documentation, checking the serviceability of equipment and office equipment.
2. Prepare and submit patient self-registration sheets and doctor’s appointment vouchers for the current week to the reception desk.
3. Before the start of the appointment, bring from the card storage medical records of outpatients, selected by the registrars in accordance with the self-registration sheets.
4. Monitor the timely receipt of laboratory and other test results and paste them into the medical records of outpatients.
5. Regulate the flow of visitors by fixing the appropriate time at self-registration places for repeat patients and issuing coupons to them.
6. Help patients, as directed by the doctor, prepare for examination during an outpatient appointment.
7. Measure patients’ blood pressure as directed by the local physician, conduct thermometry and other medical manipulations.
8. Report to the card storage about all cases of transfer of medical records of outpatients to other offices in order to make an appropriate entry in the replacement card.
9. Explain to patients the methods and procedures for preparing for laboratory, instrumental and instrumental studies.
10. Study, on the instructions of the doctor, the life and working conditions of dispensary Patients, keep records of them, and invite them to see the doctor.
11. Prepare preliminary materials for drawing up a Report on medical examination of the population of the site.
12. Perform, in accordance with the doctor’s prescription, medical manipulations at the site, collecting material for bacteriological research.
13. Carry out, as directed by the doctor, repeated visits to Patients at home in order to check their compliance with the prescribed regimen and treatment.
14. Equip the local therapist’s bag with the necessary tools and medications to provide medical care at home.
15. Carry out preventive vaccinations for the population under the guidance and supervision of a doctor.
16. Carry out, in accordance with the plan, sanitary and educational work among the population.
17. Systematically improve your qualifications by studying relevant literature, participating in conferences and seminars.
18. Draw up medical documentation under the supervision of a doctor: referrals for consultation and to auxiliary rooms, control cards of dispensary observation, statistical coupons, sanatorium and resort cards, extracts from medical records of outpatients, referrals to MSEC, temporary disability certificates, emergency notifications of an infectious disease , food poisoning, acute occupational poisoning, unusual reaction to vaccination, certificates of temporary incapacity for work, a work diary of nursing staff, a notebook for recording work at home by a local nurse, etc.

Job responsibilities of a receptionist

1. Meet patients at the reception desk, help navigate the services the patient needs.
2. Answer calls from patients, provide them with the necessary information about the services of the clinic.
3.If necessary, provide additional information and involve a consultant doctor in the conversation.
4. Draw patients’ attention to the demonstration stands and provide the necessary explanations.
5. Inform each patient about the capabilities of the hospital’s range of services.
6. Provide patients with all necessary documents (medical card, etc.) in the prescribed form.
7.Keep a file of medical records in the prescribed form.
8. Refer patients who wish to use paid hospital services to a consultant doctor.
9. Say goodbye to the patient, give him all the necessary documents.