Sinusitis

Procedure for patient care in a children's clinic. Children's clinic, tasks, structure

Children's clinic is the main healthcare organization providing medical care to children when visiting a clinic, at home, or in educational institutions in the service area.

Children's clinics are divided into:

– by capacity, determined by the number of visits per shift: 5 categories of clinics (from 1st - 800 visits per day to 5th - 150 visits per day)

– organizational principle: independent and combined with the hospital.

Principles provision of outpatient medical care to the children's population:

– preventive orientation;

– accessibility;

– widespread use of the dispensary method;

– active patronage system;

– continuity in the work of doctors providing medical care to children;

– phasing;

– hygienic education and training of both parents and children;

– local-territorial service;

– social orientation.

The following are distinguished: tasks children's clinic:

1. Providing medical care to children in the clinic and at home.

2. Organization and implementation of a set of preventive measures, including dynamic monitoring of healthy and sick children.

3. Organization and implementation of treatment and preventive work in kindergartens and schools.

4. Organization and implementation of anti-epidemic measures (together with the Center for State Examination).

5. Organization and conduct of events for hygienic education and training of the population, promotion of a healthy lifestyle.

6. Improving the organizational forms and methods of work of the clinic, aimed at improving the quality and efficiency of diagnostic and treatment work and medical rehabilitation, introducing hospital-replacing technologies into practice.

7. Analysis of the health status of the children's population.

Structure The children's clinic is represented by the following functional divisions:

1. Guide.

2. Filter boxes for receiving sick children who have a separate entrance from the inside and exit to the outside (Meltzer-Soloviev box).

3. Registration.

4. Medical departments or offices of pediatricians and medical specialists, an office for providing medical care to adolescents.

5. Healthy child's office(where they teach parents the rules of care, feeding features, massage techniques, gymnastics complexes) 1 position per 10,000 people.

6. Vaccination room.

7. Office (department) of medical care for organized children ( 1 position per 600 preschool children or per 2000 schoolchildren).

8. Teenager's office(the position of a doctor in a teenage office is being introduced based on 1,500 children aged 15–17 years).

9. Clinical laboratory.

10. Diagnostic rooms.

11. Department of medical rehabilitation.

12. Social and legal office (1 position per 20,000 people)

13. Central sterilization department.

14. Administrative and economic part.

The area of operation of the clinic and its work schedule are established by the health authorities of the administrative territory. The district-territorial principle of the clinic’s operation ensures that the entire service area is divided into separate areas, where medical care for the children’s population is provided by a local pediatrician and a local nurse.

In accordance with the resolution of the Council of Ministers of the Republic of Belarus

dated June 20, 2007 No. 811 “On approval of state minimum standards for public services” 1 position of a local pediatrician is calculated for 800 children. 1.5 nurse positions are being introduced per site (0.5 for patronage work). Enrollment in medical care is carried out at the place of residence in accordance with Art. 14 of the Law of the Republic of Belarus “On Health Care”.

During the working day, time is allocated to receive patients at the clinic (3 hours) and home call service ( 3 hours). The distribution of time may be different depending on the epidemic situation, the distance of the site from the clinic, and the age composition of the child population of the site. In one hour of work, a pediatrician must see 4 patients for an initial or repeat appointment (15 minutes per

patient) or 6 people for a preventive examination (10 minutes per 1 child). Load standards for servicing calls are 2 calls per 1 hour.

The single pediatrician system, in which a pediatrician monitors a child from birth to 18 years of age, ensures continuity of monitoring at all stages of development. Appointments with a local doctor at the clinic are organized on a staggered schedule so that parents can choose a time that is convenient for them. The children's clinic receives healthy, convalescent children and children suffering from chronic diseases. Patients with acute infectious diseases and those who fall ill for the first time in the acute period of the disease are served at home.

Within a week, the pediatrician identified:

Reception of sick children in the period of convalescence (Monday, Wednesday, Friday). If children come to the appointment with infectious diseases accompanied by a rash or diarrhea, they are sent to filter boxes. The nurse calls the local pediatrician or infectious disease specialist. In boxing, the doctor examines the child, decides on hospitalization or prescribes treatment at home.

Admission of children who do not have acute illnesses is carried out in Tuesday and Thursday. The pediatrician sees healthy young children and children under 6 years old on Tuesdays, Healthy Children's Day .

Sick children who are registered at the dispensary visit the pediatrician at the invitation of the nurse on Thursdays.

Treatment of children in the clinic is carried out as a continuation of the patient’s treatment begun at home, or as an active rehabilitation process after discharge from the hospital. The children's clinic provides health care to children in educational institutions in the service area.

Each children's clinic organizes the work of specialist doctors: otolaryngologist, ophthalmologist, neurologist, surgeon, dentist, cardio-rheumatologist. Positions of other specialists (pulmonologist, allergist, hematologist, urologist, nephrologist, endocrinologist, gastroenterologist, gynecologist) are added to the staff of the advisory children's clinic of the city (region) or to the staff of the advisory offices of children's hospitals. Certain profiles of specialized care are provided in dispensaries (psychoneurological, oncological, anti-tuberculosis, audiological, dermatovenerological, endocrinological, etc.).

Indicators:

1. Characteristics of the child population in the area where the clinic operates:

a) age composition of children at the end of the year:

b) average number of children in one area:

c) average number of children in the first year of life in the area:

In order to improve the provision of medical care to the child population in outpatient clinics in the city of Moscow, I order:

1. To the heads of health departments of administrative districts, chief doctors of children's treatment and preventive institutions of urban subordination:

1.1. Organize the reception of patients in subordinate children's outpatient clinics in the following mode:

children's city clinics, outpatient departments of city clinics and hospitals:

– working days – from 8.30 to 19.00;

– Friday – from 8.30 to 18.00;

– on Saturday – from 9.00 to 15.00;

– on Sundays and holidays (servicing home calls by local pediatricians and providing pre-hospital medical care in the clinic by a nurse) – from 9.00 to 15.00;

– receiving calls daily from 9.00 to 14.00;

trauma centers of children's city clinics - daily from 8.30 to 22.00;

children's dental clinics, dental departments and offices of children's city clinics:

– weekdays – from 8.00 to 20.00 (children’s dental clinics);

– weekdays – from 9.00 to 19.00 (dental departments and offices of children’s city clinics);

- on Saturdays, Sundays and holidays - from 9.00 to 15.00 on the basis of at least two subordinate medical and preventive institutions (Zelenograd - on the basis of one medical and preventive institution).

1.2. Organize the operation of milk distribution points at children's city clinics daily from 6.30 to 12.00.

1.3. Provide timely round-the-clock medical care to children at home by medical workers from departments of round-the-clock medical care for children at home.

3. To the heads of health departments of administrative districts, chief doctors of children's treatment and preventive institutions of urban subordination:

3.1. Establish the following schedule for the reception of medical specialists: one day - preventive examinations of children in the first year of life and children under 3 years of age, one day - targeted medical examination of children in organized groups, the remaining days - reception of the assigned population.

3.2. Eliminate the distraction of medical specialists during reception hours to participate in meetings, scientific and practical events (conferences, congresses).

3.3. Organize reception of disabled children and children suffering from chronic diseases on a working Saturday every month.

3.4. Establish the following procedure for making an appointment with a specialist doctor:

– for the initial appointment – by appointment 14 days in advance by visiting the reception in person or by telephone (at least 2 lines) in accordance with clause 1.1 of this order;

– for a repeat appointment – by a specialist doctor during the initial visit;

– record data in the pre-registration log indicating the date and time of reception;

– in the absence of a medical specialist, the administration of the medical institution is obliged to organize the reception of the child population in nearby medical institutions.

3.5. Organize the provision of emergency medical care to patients and their hospitalization, regardless of place of residence and availability of documents out of turn.

3.6. Carry out reception of children with acute pathology in the filter room of the clinic.

3.7. Do not allow medical specialists to complete their appointments until the necessary medical care has been provided to all patients requiring an appointment.

3.8. Provide:

3.8.1. Completion of preventive examinations for children in the first year of life no later than five days after they reach 1, 3, 6, 9 months and 1 year in accordance with the order of the Ministry of Health and Social Development of the Russian Federation dated April 28, 2007 N 307.

3.8.2. Conducting consultations with medical specialists (as indicated) for sick children at home as prescribed by local pediatricians after examination by the heads of pediatric departments.

3.8.3. Carrying out clinical examination of disabled children with severe motor impairments at home.

3.9. Establish the following recording order for conducting instrumental research methods:

– registration for neurosonography (NSG), rheoencephalography (REG), electroneuromyography (EMG), Doppler ultrasound (USDG) of cerebral vessels, echoencephalography (M-ECHO) is carried out by a neurologist at an appointment if indicated;

– registration for echocardiography is carried out by a cardiologist at an appointment if indicated;

– registration for electrocardiography, ultrasound examination, examination of external respiration function is carried out by a pediatrician or medical specialists at the appointment;

– X-ray examination is carried out as prescribed by a pediatrician or medical specialists on an urgent and planned basis.

3.10. Ensure maximum use of the potential of district consultation and diagnostic centers.

3.10.1. Establish the following procedure for referring children to district consultation and diagnostic centers:

– a child sent to the district consultative and diagnostic center must have a referral from a local pediatrician or medical specialist;

– registration at the district consultative and diagnostic centers is carried out at the reception desk in person or by telephone during the working day.

3.10.2. Refer children to city consultative and diagnostic centers according to directions certified by the clinic administration.

3.11. Constantly monitor the organization of patient reception and take timely measures to minimize the waiting time for patients and resolve emerging conflict situations.

5.1. Establish staffing standards for medical personnel in children's city clinics (outpatient departments), provided for by Order of the Ministry of Health of the Russian Federation dated October 16, 2001 N 371, as amended by Order of the Ministry of Health and Social Development of the Russian Federation dated 04/28/2006 N 320.

6. Consider as invalid paragraphs 1.1, 1.2, 1.3 of the order of the Health Committee dated December 22, 1997 N 697 “On the operating hours of outpatient clinics for children and obstetrics”, order of the Health Committee dated 02/03/2000 N 42 “On the operating hours of children’s dental clinics” .

7. Entrust control over the implementation of this order to the Deputy Head of the Department of Health I.A. Leshkevich.

Head of the Department of Health A.P. Seltsovsky

The medical work of a local pediatrician has its own characteristics and is divided into:

Providing medical care to acutely ill children at home;

Aftercare of convalescent children;

Treatment of dispensary patients.

The children's contingent, which determines the main treatment load at the site, includes: children with respiratory diseases, children with infectious diseases (so-called childhood infections), children with acute intestinal diseases.

All children who become ill with acute diseases must be examined by a local pediatrician at home. All children who were in contact with infectious patients during the quarantine period are also served at home; disabled children; children discharged from the hospital (on the first or second day after discharge); children with health problems that prevent them from visiting the clinic. Calls received at the children's clinic by telephone, personally from parents, from ambulance stations, hospitals are recorded in the station's call log, and a statistical coupon is immediately issued for each child.

The local pediatrician visits patients at home on the day the call is received. Young children are served first, then those with high fevers, and then children with less urgent reasons for making house calls. During the first home visit to a sick child, the doctor should assess the severity of the condition. Further, in the absence of indications for emergency measures, the doctor must make a preliminary diagnosis, decide on the possibility of outpatient treatment or the need for emergency hospitalization, outline tactics for managing the patient, prescribe the necessary therapeutic and diagnostic measures, and conduct an examination of temporary disability.

It is necessary to especially emphasize the need to comply with deontological principles in the work of a local doctor when servicing calls at home. An attentive, unhurried attitude towards a sick child and his relatives, friendly contact with them allows parents to avoid mistrust not only of the local doctor, but also of the medical personnel of subsequent stages of treatment, and prevent possible conflict situations. The culture of his behavior is also of great importance for the reputation of a doctor.

When treating a sick child at home, it is very important to organize continuous monitoring of him. This is achieved by a system of initial, repeated and active visits to the local doctor. The frequency and intervals of visits are regulated by the doctor depending on the age, severity of the condition and the nature of the disease of the observed child.

Infants treated at home are osmated daily. Children over 1 year of age are examined depending on the severity of the condition. As a rule, when treating at home, the local pediatrician has to make active visits to children with acute respiratory viral infections, influenza, sore throat, bronchitis 2-3 times, with childhood infections 4-6 times, with pneumonia 6-8 times. Patients left at home are prescribed treatment and the necessary examination. Consultations with specialists (otorhinolaryngologist, neurologist, surgeon, rheumatologist) at home are necessary in cases where the local pediatrician finds it difficult to make a diagnosis and decide on further treatment of the patient.

As the child recovers, active follow-up at home can be replaced by inviting the child to the clinic. The mandatory conditions for inviting convalescents to the clinic are:

Persistent positive dynamics in the clinical picture of the disease
vania;

Possibility of visiting a clinic without the risk of worsening your condition
nia;

No risk of infection for clinic visitors who have recovered
a weeping child;

The need for rehabilitation measures, possible
only in a clinic setting (physiotherapy, exercise therapy, etc.).

Scheme 2. Calling a local doctor to the home of a sick child (entry in form No. 112/u)

Nature of the call (initial, repeated, active visit)

Sick day

Measurement data of body temperature, number of respirations, pulse

Complaints and their details. A brief history of the disease (duration of the disease, what is associated with the onset of the disease, the dynamics of the main symptoms, the treatment performed and its effectiveness, the presence of background pathology). Assessment of the severity of the condition and its justification Objective status (with an emphasis on identified pathological changes in organs and systems, local status, assessment of the severity of functional disorders) Diagnosis (preliminary diashosis at the initial examination, final detailed clinical diashosis within three days after the initial examination) . When issuing a certificate of temporary disability to care for a sick child, indicate: to whom the sick leave was issued; last name, first name, patronymic of the caregiver, age in years, place of work, date of issue of sick leave

Prescription regimen, diet, drug treatment (indicating the form of the drug, dose, frequency of administration, route of administration), non-drug treatment, physical therapy Examination and consultations with specialists. Further tactics of patient management (active visits, attendance at the doctor, referral to the hospital)

When registering an active visit to a sick child at home, the record must contain information about the dynamics of complaints, objective status, and prescribed treatment.

In addition to treating children at home, the medical work of a pediatrician includes holding appointments in a clinic. Treatment of children in a clinic should be a logical continuation of treatment begun at home or in a hospital.

According to the list of population groups and categories of diseases, for outpatient treatment of which medicines and medical products are dispensed free of charge according to doctor’s prescriptions (order of the Ministry of Health and MP of the Russian Federation dated 08.23.94 No. 180, additions to the order of the Ministry of Health and SR of the Russian Federation No. 296 dated 02.12.04 and No. 321 dated December 24, 2004), all medicines are received free of charge by children of the first year of life, children from large families up to 6 years of age, disabled children under the age of 18, all children and adolescents registered as “Chernobyl Children” .

Regardless of the “Disabled Child” status, they receive free of charge:

Children with tuberculin test variation and local forms
tuberculosis - anti-tuberculosis drugs;

Children with cystic fibrosis - enzymes;

Children with bronchial asthma - means for treating this problem
levania;

Children with rheumatism and collagenosis - glucocorticoid medications
drugs, cytostatics, colloidal gold preparations, non-steroidal pro
anti-inflammatory drugs, antibiotics, antihistamines
drugs, coronary lytics, diuretics, calcium antagonists, drugs
potassium, chondroprotectors;

Children with hematological diseases - cytostatics, immuno-
depressants, immunocorrectors, glucocorticoid and non-steroidal
hormones, antibiotics and other drugs to treat these diseases
prevention and correction of complications, their treatment;

Children with seizure syndrome - anticonvulsants;

Children with diabetes - all antidiabetic drugs,
ethanol, syringes, diagnostic tools;

Children with cancer - everything they need
medicinals;

Children with endocrine diseases - hormonal drugs;

Children with helminthiasis - all drugs prescribed by the doctor - gel
mintologist.

The accounting and reporting form for issuing a prescription for free medicines is form No. 148-1/u-04 (Order of the Ministry of Health and Social Development of the Russian Federation No. 257 of November 22, 2004 in addition to Order No. 328 of August 23, 1999). According to the same

The order introduced accounting form No. 305/u-1 “Recording register of prescription forms”. According to a prescription written by the attending physician (with a copy of the prescription recorded in the child’s development history), medications are dispensed by the attached pharmacy or senior nurses of the health care facility. After the medicine is dispensed, the prescription is withdrawn. The prescription is written according to the general rules for issuing prescriptions, necessarily in 2 copies, the second copy is stored in the clinic.

Organizational and methodological offices are called upon to control the provision of primary health care to citizens entitled to receive a set of social services in medical institutions. If the “List of Medicines for Citizens Eligible to Receive a Set of Social Services” does not contain any medicines necessary for a child from this category, they are prescribed to him by the decision of a clinical expert commission and approved by the head of a primary care medical institution.

Young children with various somatic diseases - anemia, rickets, malnutrition and others are sent to a general appointment. For the appointment of children who are registered at the dispensary for chronic pathology, a separate appointment day is allocated in clinics

When deciding on hospitalization, the severity and nature of the disease, the age of the child, the characteristics of his reaction to treatment, social and living conditions are taken into account. In case of emergency hospitalization, the doctor calls an ambulance for transportation and transfers the patient from hand to hand.

A referral for inpatient treatment is issued by a local doctor for an acute or chronic illness that requires inpatient treatment or observation, both planned and emergency.

Indications for emergency hospitalization include:

Acute surgical situations (appendicitis or suspected
appendicitis, acute abdomen syndrome, strangulated hernia, trauma, etc.);

Poisoning (food, medication, household);

Severe diseases accompanied by disorders
activities of vital organs (respiratory and cardiovascular
vascular insufficiency, hyperthermia, convulsive syndrome, etc.);

Acute diseases in children in the neonatal period;

Infectious diseases requiring hospitalization
tion departments according to the severity of the condition.

Children hospitalized urgently, as a rule, require urgent assistance already at the prehospital stage, which is important for the upcoming

for transporting the patient. Information about emergency measures taken (volume, time of implementation, etc.) should be reflected in the referral for hospitalization

Children with chronic diseases are routinely sent to hospital for examination and treatment if it is impossible to carry out therapeutic and diagnostic measures on an outpatient basis. When referred for planned hospitalization, contacts with an infectious patient are indicated in the accompanying documents to prevent the occurrence of nosocomial infections. Children routinely sent for hospitalization should be examined as fully as possible in an outpatient setting. In the referral for hospitalization (or in the attached extract from the child’s developmental history), data from the anamnesis, features of the course of the disease, background diseases (including manifestations of medication and food allergies), the results of the outpatient examination, the nature and results of outpatient treatment are indicated. Children of risk group V from socially disadvantaged families, especially young children, are subject to mandatory hospitalization for any acute or exacerbation of a chronic disease.

The referral for hospitalization indicates the time of call and arrival of the ambulance. The emergency doctor issues a tear-off coupon for the hospitalized child, a duplicate of which is sent to the children's clinic.

During hospitalization, the doctor must:

Determine indications (emergency, planned hospitalization);

Determine the profile of the hospital in accordance with the character and
severity of the disease, its complications (somatic department, in
infectious diseases, intensive care, specialized),

Determine the type of transportation, its risk, the need for support
driving a patient by medical personnel;

Complete a referral, indicating the place of hospitalization (hospital,
department), patient's passport data, diagnosis, epidemiological environment.

In addition, the referral must include the insurance policy number, the date of referral and the doctor’s signature.

The responsibilities of the local pediatrician also include monitoring of hospitalization, which should be carried out within the first 24 hours after referral to the hospital. For young children discharged from the hospital or who left without permission, “assets” are transferred to the children’s clinic for observation and follow-up treatment by their local pediatrician until full recovery.

Currently, an alternative to inpatient treatment for children is day hospitals at children's hospitals or short-stay hospitals at children's clinics and diagnostic centers. Day hospital beds in municipal health care institutions are organized for the hospitalization of patients with acute and chronic diseases, whose condition does not require round-the-clock monitoring and treatment, but for whom therapeutic and diagnostic care is indicated during the day. Such units operate in the compulsory health insurance system. The management of the day hospital is carried out by the chief physician, the direct organization and quality control of diagnostics and treatment is carried out by the deputy chief physician for medical affairs, senior nurses, and heads of departments in which the day hospital beds are deployed. The number of medical personnel is determined according to the current staffing standards provided for the relevant department profile. The day hospital operates one shift, six days a week. The selection of patients for examination and treatment in a day hospital is carried out by local doctors, specialists from city specialized services and heads of hospital departments. Contraindications to referral to a day hospital are acute illnesses that require round-the-clock medical supervision.

If the course of the disease worsens and round-the-clock medical supervision is necessary, the patient in the day hospital is immediately transferred to the appropriate departments of the hospital for a round-the-clock stay. For a patient in need of treatment in a day hospital, a medical history is created with information from the anamnesis, medical history and previous examination and treatment entered into it. The medical history has a special marking. Working (student) patients undergoing treatment in a day hospital are issued certificates of incapacity for work (certificates) on a general basis. When a patient is discharged from a day hospital, all information is transferred to the doctor who referred the patient for treatment, with the necessary recommendations.

In addition to preventive work, medical specialists receive sick children according to a schedule, carry out clinical examinations, consultative assistance (in the clinic and at home), analyze morbidity, develop measures to reduce it, conduct advanced training for medical staff of clinics and health education of the population.

The quality and effectiveness of specialized assistance depend on the level of equipment of the institution and on the qualifications of specialists. In recent years, regional and city diagnostic centers equipped with modern equipment have provided great assistance in examining children.

When treating a child at home, the local doctor needs to remember several rules

Regime, diet and caring for a sick child most often become
key factors contributing to recovery.

The role of the family in the treatment and care of the child is a priority.

Drug treatment must be justified and rational
cash

Caution in doctor's prescriptions should not extend
only for potent drugs, but also for routine medications (an
typyretics, antibiotics)

Approximate dosages should be strictly avoided

Pa6oia with prescription reference books, even in full view of the patient and
his relatives should become the norm.

The period of a child’s stay in “sickness mode” should be extended
to be injured and during the period of convalescence.

The rehabilitation period cannot be shorter than the period
climb.

Children who have been ill are allowed into children's groups only with a certificate stating that they are healthy, which is issued by a local doctor. Children who have been ill attending a preschool institution or school are issued a “Certificate of temporary disability of students, students of vocational schools about illnesses, quarantine of a child attending a preschool institution, school."

For children attending preschool institutions, certificates are issued not only after illness, but also if the child is absent from kindergarten for more than 3 days for social reasons. The certificate indicates the diagnosis, duration of the disease, information about the absence of contacts with infectious patients, data on the treatment performed, recommendations on the individual regimen of the convalescent child for the first 10-14 days

For schoolchildren who have recovered from an acute illness, the certificate includes recommendations on limiting physical activity during physical education classes, measures for the social rehabilitation of children (school schedule, exemption from certain types of activities, etc.). In children's institutions, certificates of diseases suffered by children are filed in the medical documentation of the child.

The most advanced rehabilitation measures are carried out by doctors from children's institutions, taking into account the recommendations of local pediatricians.

Registered with the Ministry of Justice of the Russian Federation on June 27, 2012.
Registration No. 24726

In accordance with Article 32 of the Federal Law of November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724) I order:

1. Approve the attached Regulations on the organization of primary health care.

2. To recognize as invalid:

Order of the Ministry of Health and Social Development of the Russian Federation dated July 29, 2005 N 487 “On approval of the procedure for organizing the provision of primary health care” (registered by the Ministry of Justice of the Russian Federation on August 30, 2005 N 6954);

Order of the Ministry of Health and Social Development of the Russian Federation dated August 4, 2006 N 584 “On the procedure for organizing medical care for the population on a local basis” (registered by the Ministry of Justice of the Russian Federation on September 4, 2006 N 8200).

I. about Minister T. Golikov

Note ed.: the order was published in the "Bulletin of normative acts of federal executive authorities", N 52, 12/24/2012.

Appendix to the Order

Regulations on the organization of primary health care for the adult population

1. These Regulations establish the rules for organizing the provision of primary health care to the adult population on the territory of the Russian Federation.

2. The organization of primary health care is carried out in medical and other organizations of the state, municipal and private healthcare systems, including individual entrepreneurs who have a license for medical activities, obtained in the manner established by the legislation of the Russian Federation (hereinafter referred to as medical organizations) .

The organization of primary health care is carried out by medical organizations and their structural divisions in accordance with Appendices No. 1 - 27 to this Regulation.

3. Employees of organizations included in the list of organizations of certain industries with particularly hazardous working conditions approved by the Government of the Russian Federation, and the population of closed administrative-territorial entities, territories with physical, chemical and biological factors hazardous to human health, included in the list approved by the Government of the Russian Federation territories, primary health care is carried out taking into account the specifics of organizing the provision of medical care established by the Government of the Russian Federation.

4. Primary health care in medical organizations can be provided to the population:

A) as free - within the framework of the Program of State Guarantees for the free provision of medical care to citizens of the Russian Federation at the expense of compulsory health insurance and funds from the relevant budgets, as well as in other cases established by the legislation of the Russian Federation;

B) as paid medical care - at the expense of citizens and organizations.

5. Primary health care is the basis of the medical care system and includes measures for the prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, monitoring the course of pregnancy, promoting a healthy lifestyle, including reducing the level of risk factors for diseases, and health and hygiene education.

6. Primary health care is provided in planned and emergency forms.

7. Primary health care is provided:

1) outpatient, including:
in a medical organization providing primary health care, or its division, at the patient’s place of residence (stay) - in case of acute diseases, exacerbations of chronic diseases in the event of a call from a medical worker or when he visits the patient in order to monitor his condition, the course of the disease and timely appointment (correction) of the necessary examination and (or) treatment (active visit), when patronizing certain groups of the population when an epidemic of an infectious disease is identified or threatened, patients with an infectious disease, persons in contact with them and persons suspected of an infectious disease, including through door-to-door (door-to-door) visits, inspections of workers and students;
at the place of departure of the mobile medical team, including to provide medical care to residents of settlements with predominantly people over working age, or located at a considerable distance from the medical organization and (or) with poor transport accessibility, taking into account climatic and geographical conditions.

2) in a day hospital, including a hospital at home.

8. In order to increase the efficiency of providing primary health care for sudden acute diseases, conditions, exacerbation of chronic diseases that are not life-threatening to the patient and do not require emergency medical care, an emergency medical care department (office) may be organized within the structure of medical organizations, providing its activities in accordance with Appendix No. 5 to these Regulations.

Taking into account the formation of contingents of citizens temporarily (seasonally) living in the territory of a populated area (including in summer cottages and gardening communities), an emergency medical care department (office) can be organized in close proximity to the place of temporary (seasonal) residence.

9. Primary health care is provided in accordance with established procedures for the provision of certain types (by profile) of medical care and standards of medical care.

10. Primary health care includes the following types:

Primary pre-hospital health care, which is provided by paramedics, midwives, and other medical workers with secondary medical education in paramedic health centers, paramedic-obstetric centers, medical outpatient clinics, health centers, clinics, outpatient departments of medical organizations, departments (offices) of medical prevention, health centers;
primary medical health care, which is provided by general practitioners, local physicians, general practitioners (family doctors) of outpatient clinics, health centers, clinics, outpatient departments of medical organizations, offices of general practitioners (family doctors), health centers and departments (offices) of medical prevention;
primary specialized health care, which is provided by medical specialists of various profiles in polyclinics, outpatient departments of medical organizations, including those providing specialized, including high-tech, medical care.

11. In small settlements and (or) located at a considerable distance from a medical organization or its subdivision, including temporary (seasonal), medical organizations providing primary health care on a territorial-precinct basis, in the service territory of which such populated areas, organize the provision of first aid to the population before the arrival of medical workers in case of sudden, life-threatening acute diseases, conditions, exacerbations of chronic diseases, injuries, poisonings with the involvement of one of the households.

Organization of first aid includes the formation of a first aid kit, its replenishment as needed, training in first aid skills, provision of first aid providers, as well as persons at high risk of developing sudden cardiac death, acute coronary syndrome and other life-threatening conditions, and members of their families, manuals and first aid instructions for the most common life-threatening conditions that are the main cause of mortality (including sudden cardiac death, acute coronary syndrome, acute cerebrovascular accident), containing information about the characteristic manifestations of these conditions and necessary measures to eliminate them before the arrival of medical workers.

12. Primary pre-medical and primary medical health care are organized on a territorial-precinct basis.

13. The territorial-area principle of organizing the provision of primary health care is to form groups of the service population based on residence (stay) in a certain territory or on the basis of work (training) in certain organizations and (or) their divisions.

14. The distribution of the population among areas is carried out by the heads of medical organizations providing primary health care, 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.

15. In order to ensure the right of citizens to choose a doctor and a medical organization, it is allowed to assign citizens living or working outside the service area of a medical organization to local physicians, general practitioners (family doctors), for medical observation and treatment, taking into account the recommended number of assigned citizens established by paragraph 18 of these Regulations.

16. In medical organizations, areas can be organized:

Paramedic;
therapeutic (including workshop)
general practitioner (family doctor);
complex (a site is formed from the population of a medical organization site with an insufficient number of attached population (small-staffed site) or the population served by a general practitioner at a medical outpatient clinic and the population served by paramedic-obstetric stations (paramedic health centers);
obstetric;
attributed.

17. Services to the population at the sites are carried out:

Paramedic of a paramedic health center, paramedic and obstetric station;
a local therapist, a local therapist at a workshop medical site, a local nurse at a therapeutic (including workshop) site;
general practitioner (family doctor), assistant general practitioner, nurse of a general practitioner at the site of a general practitioner (family doctor);

At the paramedic station there are 1,300 adults aged 18 years and older;
at a therapeutic site - 1,700 adults aged 18 years and older (for a therapeutic site located in a rural area - 1,300 adults);
at the general practitioner's site - 1,200 adults aged 18 years and older;
at the family doctor's site - 1,500 adults and children;
on a complex site - 2000 or more adults and children.

19. In the regions of the Far North and equivalent areas, high-mountainous, desert, arid and other areas (locals) with severe climatic conditions, with long-term seasonal isolation, as well as in areas with low population density, areas can be formed with a smaller number of attached of the population, while maintaining the full-time positions of local therapists, local pediatricians, general practitioners (family doctors), local nurses, general practitioner nurses, paramedics (obstetricians) in full.

20. Depending on the specific conditions for the provision of primary health care to the population, in order to ensure its accessibility, permanent medical teams can be formed, consisting of a local physician, paramedics, obstetricians and nurses, with the distribution of functional responsibilities among them according to their competence, based on from the established staffing standards intended to calculate the number of positions provided for the medical organization to perform the functions assigned to it.

21. Primary specialized health care is organized in accordance with the needs of the population for its provision, taking into account morbidity and mortality, the sex and age composition of the population, its density, as well as other indicators characterizing the health of the population.

Primary specialized health care is provided by referral from medical workers providing primary pre-medical and primary medical care, as well as when the patient independently contacts a medical organization.

22. To provide medical care to patients with acute chronic diseases and their exacerbations who require inpatient treatment, but are not referred to a medical organization for the provision of inpatient medical care, a hospital at home can be organized, provided that the patient’s health condition and his home conditions allow the organization medical assistance and home care.

The selection of patients for inpatient treatment at home is carried out on the recommendation of local therapists, general practitioners (family doctors) and medical specialists.

When organizing a hospital at home, the patient is monitored daily by a medical specialist and a nurse, laboratory diagnostic examinations, drug therapy, various procedures are carried out, as well as consultations with medical specialists on the profile of the disease.

On Saturdays, Sundays and holidays, monitoring of patients can be carried out by doctors and nurses on duty, as well as emergency medical services. If the course of the disease worsens, the patient should be immediately transferred to a 24-hour hospital.

Appendix No. 1 to the Regulations

Rules for organizing the activities of the clinic

1. These Rules determine the procedure for organizing the activities of the clinic.

2. The clinic is an independent medical organization, or a structural unit of a medical organization (its structural unit) providing primary health care, and is organized to provide primary pre-medical health care, primary medical health care, primary specialized health care , as well as palliative medical care to the population.

3. The management of the clinic is carried out by the chief physician, to whose position specialists are appointed who meet the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009 No. 14292), as well as by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247).

5. Specialists who meet the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292) are appointed to the position of paramedic at the clinic. ), specializing in paramedic.

6. A specialist who meets the qualification characteristics of positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), with a specialty of "Paramedic", is appointed to the position of a nurse in a polyclinic. "Midwife" or "Nurse".

7. The structure of the clinic and staffing levels are established by the chief physician of the clinic or the head of the medical organization (its structural unit) of which it is a part, based on the volume of diagnostic and treatment work carried out, taking into account the recommended staffing standards established by Appendix No. 2 to the Regulations on the organization the provision of primary health care to the adult population, approved by this order, the level and structure of morbidity and mortality, the sex and age composition of the population, its density, as well as other indicators characterizing the health of the population.

8. To organize the work of the clinic, it is recommended to include the following divisions in its structure:

Registry;
department (office) of first aid;
department of general medical (family) practice;
department (office) of primary specialized health care;
departments of primary specialized health care (traumatological and orthopedic, surgical, therapeutic, otorhinolaryngological, ophthalmological, neurological and others);

emergency medical care department (office);
department (office) of functional diagnostics;
dental department (office);
treatment room;
examination room;
fluorography room;
trust office;
room for crisis conditions and medical and psychological relief;
medical aid room for smoking cessation;
department (office) of radiation diagnostics;
clinical laboratory;
biochemical laboratory;
microbiological laboratory;

health center;
premises (classrooms, auditoriums) for group prevention (health schools);
day hospital;
information and analytical department or medical statistics office;
organizational and methodological office (department);
administrative and economic divisions.

9. The equipment of departments and offices is carried out in accordance with the established procedures for the provision of certain types (by profile) of medical care.

10. If there is no effect from the treatment on an outpatient basis and (or) in the absence of the possibility of conducting additional examinations for medical reasons, a local therapist, a local therapist of a workshop area, a general practitioner, a family doctor in agreement with a specialist doctor according to the patient’s disease profile, he is referred to a medical organization for additional examinations and (or) treatment, including in an inpatient setting.

11. The main objectives of the clinic are:

Providing primary (pre-hospital, medical, specialized) health care, including emergency care to patients living in the service area and (or) assigned to service, in case of acute diseases, injuries, poisoning and other emergency conditions;
carrying out preventive measures to prevent and reduce morbidity, identifying early and latent forms of diseases, socially significant diseases and risk factors;
carrying out medical examination of the population;
diagnosis and treatment of various diseases and conditions;
restorative treatment and rehabilitation;
clinical expert activities to assess the quality and effectiveness of treatment and diagnostic measures, including examination of temporary disability and referral of citizens for medical and social examination;
dispensary monitoring of the health status of persons suffering from chronic diseases, including certain categories of citizens entitled to receive a set of social services, functional disorders, and other conditions in order to timely identify (prevent) complications, exacerbations of diseases, other pathological conditions, their prevention and implementation of medical rehabilitation;
organization of additional free medical care, including necessary medicines, for certain categories of citizens;
identification of medical indications and referral to medical organizations to receive specialized types of medical care;

conducting all types of medical examinations (preventive, preliminary, periodic);
establishing medical indications for sanatorium-resort treatment, including in relation to certain categories of citizens entitled to receive a set of social services;
carrying out anti-epidemic measures, including vaccination, in accordance with the national calendar of preventive vaccinations and according to epidemic indications, identifying patients with infectious diseases, dynamic monitoring of persons in contact with patients with infectious diseases at the place of residence, study, work and convalescents, as well as transmission in accordance with the established procedure, information on identified cases of infectious diseases;
providing medical consultations;
providing medical support for the preparation of young men for military service;
examination of temporary incapacity for work, issuance and extension of certificates of incapacity for work;
organizing and conducting events to promote a healthy lifestyle, including issues of rational nutrition, increasing physical activity, preventing the consumption of psychoactive substances, including alcohol, tobacco, and narcotic substances;
identification of smokers and people who consume alcohol in excess, as well as people at high risk of developing diseases associated with smoking, alcohol and poisoning with alcohol substitutes;
provision of medical assistance to quit smoking and alcohol abuse, including referral for consultation and treatment to specialized specialized medical organizations;
organizing informing the population about the need and possibility of identifying risk factors and assessing the degree of risk of developing chronic non-communicable diseases, their drug and non-drug correction and prevention, as well as counseling on maintaining a healthy lifestyle in departments (offices) of medical prevention and health centers;
carrying out recreational activities, medicinal and non-medicinal correction of risk factors, providing reminders, dispensary observation of people at high risk of developing a chronic non-infectious disease and its complications, referring, if necessary, people with a high risk of developing a chronic non-infectious disease for consultation with a specialist;
advanced training of doctors and workers with secondary medical education;

interaction with medical organizations, Rospotrebnadzor, Roszdravnadzor, and other organizations on the provision of primary health care and palliative care.

12. The work of the clinic should be organized according to a shift schedule, ensuring the provision of medical care throughout the day, and also provide for the provision of emergency medical care on weekends and holidays.

Appendix No. 3 to the Regulations

Rules for organizing the activities of the first-aid room (department) of a polyclinic (medical outpatient clinic, general medical practice center (family medicine))

1. These Rules stop the procedure for organizing the activities of the office (department) of pre-medical care of a polyclinic (medical outpatient clinic, center of general medical practice (family medicine)) (hereinafter referred to as the Office).

2. The office is organized as a structural unit of a clinic, outpatient clinic or general medical practice (family medicine) center (hereinafter referred to as a medical organization).

3. Medical care in the Office is provided by medical workers with secondary medical education from among the most experienced employees, as well as nurses with higher medical education.

4. Organization of work in the Office can be carried out both on an ongoing basis by medical workers of the Office, and on a functional basis by medical workers of other divisions of the medical organization in accordance with the schedule approved by the head of the medical organization.

5. The management of the Cabinet is carried out by the head of one of the departments of the medical organization authorized by the head of the medical organization.

7. The main tasks of the first aid office (department) are:

Reception of patients to decide on the urgency of referral to a doctor;
referral for laboratory and other tests of patients who do not need a doctor’s appointment on the day of treatment;
carrying out anthropometry, measuring blood and eye pressure, body temperature, visual and hearing acuity, other diagnostic manipulations, the implementation of which is within the competence of workers with secondary medical education, filling out the passport part of the delivery sheet for medical and social examination, sanitary and resort card, laboratory data and other functional diagnostic studies before referral for medical and social examination, for sanatorium-resort treatment, preparation of certificates, extracts from individual outpatient records and other medical documentation, the preparation and maintenance of which is within the competence of workers with secondary medical education;
registration of sheets and certificates of temporary disability, confirmation with appropriate seals of certificates, directions, prescriptions and extracts from medical records issued to patients, strict accounting and registration in special journals of sheets, certificates of temporary disability and prescription forms;
participation in the organization and conduct of preventive medical examinations.

8. The office is provided with the necessary medical equipment, instruments and medical documentation forms.

Appendix No. 4 to the Regulations

Rules for organizing the activities of a clinic registry (medical outpatient clinic, general medical practice center (family medicine))

1. These Rules establish the procedure for organizing the activities of the registry of a polyclinic (medical outpatient clinic, center of general medical practice (family medicine)) (hereinafter referred to as the medical organization).

2. The registry is a structural unit that ensures the formation and distribution of patient flows, timely recording and registration of patients for appointments with a doctor, including the use of information technology.

3. Direct supervision of the work of the registry of a medical organization is carried out by the head of the registry, appointed and dismissed by the head of the medical organization.

4. The main tasks of the registry of a medical organization are:

Organization of unhindered and immediate pre-registration of patients for an appointment with a doctor, including in an automated mode, in a medical prevention room, in a first-aid room (both when they contact a clinic directly or by telephone);
organization and implementation of registration of doctors' house calls at the patient's place of residence (stay);
ensuring regulation of the intensity of population flow in order to create a uniform workload of doctors and distribute it according to the types of care provided;
systematic storage of patient medical records, ensuring timely selection and delivery of medical records to doctors’ offices.

5. To carry out its tasks, the registry organizes and carries out:

Informing the population about appointment times for doctors of all specialties, operating hours of laboratories, offices, health centers, day hospitals and other departments of the medical organization, including Saturday and Sunday, indicating appointment hours, location and room numbers;
informing about the rules for calling a doctor at home, about the procedure for making an appointment with doctors, about the time and place of reception of the population by the head of the medical organization and his deputies; addresses of the nearest pharmacies, the nearest health center in whose area of responsibility this medical organization is located;
informing about the rules of preparation for research (fluoroscopy, radiography, blood tests, gastric juice, etc.);
making appointments with doctors of a medical organization and registering calls from doctors at the patient’s place of residence (stay), timely transfer of information about registered calls to doctors;
referral in accordance with the established procedure to those who applied to the clinic for preventive examinations and examinations*;
selection of medical records of outpatients who made an appointment or called a doctor to their home;
delivery of patient medical records to doctors' offices;
registration of sheets (certificates) of temporary incapacity for work, confirmation with appropriate stamps of certificates, directions, prescriptions and extracts from medical records issued to patients, strict accounting and registration in special journals of sheets, certificates of temporary incapacity for work and prescription forms;
sorting and entering into medical documentation the results of laboratory, instrumental and other examinations.

6. It is recommended that the registry office of a medical organization include a information desk, a self-recording room (table), workstations for receiving and registering doctor’s house calls, a room for storing and selecting medical documentation, a room for processing medical documents, and a medical archive.

*for all citizens who first contact a medical organization, a checklist of risk factors for chronic non-communicable diseases is created, which are sent (with their consent) to identify risk factors and the degree of risk to a medical prevention office or a health center; persons are sent to the same units already have this control sheet and wish to receive medical assistance to correct risk factors and/or additional advice on maintaining a healthy lifestyle

Appendix No. 5 to the Regulations

Rules for organizing the activities of the department (office) of emergency medical care of a polyclinic (medical outpatient clinic, center of general medical practice (family medicine))

1. These Rules establish the procedure for organizing the activities of the emergency medical care department (office) of a polyclinic (medical outpatient clinic, general medical practice center (family medicine)).

2. The department (office) of emergency medical care is a structural unit of a polyclinic (medical outpatient clinic, center of general medical practice (family medicine)) and is organized to provide medical care for sudden acute diseases, conditions, exacerbation of chronic diseases that are not life-threatening and do not require emergency medical care (hereinafter referred to as emergency conditions).

3. Providing emergency medical care to persons who apply with signs of emergency conditions can be provided on an outpatient basis or at home when a medical professional is called.

4. Emergency medical care can be provided as primary pre-medical health care by paramedics, as well as as primary medical care by medical specialists.

5. The staffing level of medical and other personnel in the emergency medical care department (office) is established by the head of the medical organization to which he is a part.

Medical care in the emergency medical care department (office) can be provided by medical workers of the emergency medical department (office) or medical workers from other departments of the medical organization in accordance with the duty schedule approved by its head.

6. Emergency medical care for persons who contact a medical organization with signs of emergency conditions is provided immediately by the registrar.

7. Emergency medical care at home is provided within no more than 2 hours after receipt of an application from a patient or other person for emergency medical care at home.

8. If there is no effect from the medical care provided, the patient’s condition worsens and life-threatening conditions arise, medical workers take measures to eliminate them using a stationary or portable emergency medical care unit and organize a call for an ambulance team or transportation of the patient to a medical organization, providing specialized medical care, accompanied by a medical professional.

9. After providing emergency medical care to the patient and eliminating or reducing the manifestations of the emergency condition, the patient is sent to a doctor or information about the patient is transferred to the local doctor to visit the patient in order to monitor his condition, the course of the disease and timely order (correction) of the necessary examination and (or ) treatment (active visit) during the day.

Appendix No. 6 to the Regulations

Rules for organizing the activities of a general practitioner (family doctor) office

1. These Rules establish the procedure for organizing the activities of the office of a general practitioner (family doctor).

2. The office of a general practitioner (family doctor) (hereinafter referred to as the Office) is a structural unit of a medical organization (its structural unit) providing primary health care and palliative care.

3. The office is organized to provide primary medical care and palliative medical care to the population.

4. The provision of medical care in the Office is carried out on the basis of interaction between general practitioners (family doctors) and medical specialists in the profile of the patient’s disease (cardiologists, rheumatologists, endocrinologists, gastroenterologists, etc.) who carry out their activities in a medical organization, the structure of which includes the Cabinet, as well as other medical organizations.

5. The structure of the Cabinet and staffing levels are established by the head of the medical organization in which the Cabinet is created, based on the volume of diagnostic and treatment work carried out, the number, age and gender composition of the population served, indicators of the level and structure of morbidity and mortality of the population, and other indicators characterizing the health of the population.

6. The main tasks of the Cabinet are:

Providing primary medical care in accordance with established procedures for the provision of certain types (by profile) of medical care and standards of medical care, including in a day hospital;

carrying out dispensary observation of patients with chronic diseases with the necessary examination, treatment and rehabilitation;

providing medical assistance to smokers and excessive alcohol drinkers to quit smoking and alcohol abuse, including referring them for consultation and correction of risk factors for the development of diseases to medical prevention departments (offices), health centers and, if necessary, to specialized specialized medical organizations;
organizing and conducting activities for sanitary and hygienic education, including activities to improve public health;
organizing and conducting health schools, schools for patients with socially significant non-communicable diseases and diseases that are the main causes of mortality and disability of the population, as well as for persons at high risk of their occurrence;
elimination of life-threatening conditions with subsequent organization of medical evacuation to medical organizations or their units providing specialized medical care accompanied by a medical worker or emergency medical team;
provision of emergency medical care to patients with sudden acute diseases, conditions, exacerbation of chronic diseases that are not life-threatening and do not require emergency medical care, followed by referral to a medical specialist from a medical organization providing primary health care at the patient’s place of residence, and subsequent visit to the patient in order to monitor his condition, the course of the disease and timely appointment (correction) of the necessary examination and (or) treatment (active visit) if there are medical indications;
training the population in first aid, as well as individual and/or group training of persons at high risk of developing life-threatening conditions and their family members in the rules of first aid for these conditions;
referral of patients to medical organizations for the provision of primary specialized health care and specialized, including high-tech, medical care in cases provided for by the procedures for providing certain types (by profile) of medical care;

formation of risk groups;

organization and provision of palliative care to patients, including patients with cancer, who need narcotic and potent medications in accordance with the recommendations of medical specialists;
carrying out examination of temporary disability, referral for medical and social examination;

conducting preliminary or periodic medical examinations of workers and vehicle drivers;

interaction with medical organizations, territorial bodies of Rospotrebnadzor and Roszdravnadzor, other organizations on the provision of primary pre-medical health care.

10. To ensure its activities, the Cabinet uses the capabilities of the structural divisions of the medical organization within which it is formed.

Appendix No. 7 to the Regulations

Rules for organizing the activities of the department (office) of medical prevention

1. These rules establish the procedure for organizing the activities of the prevention department (office) (hereinafter referred to as the Department).

2. The department is organized in a medical organization (its structural unit) providing primary health care.

3. The prevention department includes the following structural divisions:

Anamnesis room;
functional (instrumental) research room;
healthy lifestyle promotion room;
office for centralized recording of annual medical examinations;
medical aid room for smoking cessation.

4. When organizing the activities of the Department, it is recommended to provide for the possibility of conducting the necessary diagnostic studies directly in the Department.

5. The department is headed by a director who reports directly to the chief physician of the medical organization (the head of its structural unit) providing primary health care.

6. The main functions of the Department are:

Participation in the organization and conduct of medical examinations;
participation in the organization and conduct of preventive medical examinations;
early detection of diseases and persons with risk factors for developing diseases;
control and recording of annual medical examination of the population;
preparation and transfer to doctors of medical documentation for patients and persons with an increased risk of diseases for additional medical examination, clinical observation and treatment and recreational activities;
sanitary and hygienic education and promotion of a healthy lifestyle (fight against smoking, alcoholism, excess nutrition, physical inactivity, etc.).

Appendix No. 8 to the Regulations

Rules for organizing the activities of a mobile medical team

1. These Rules establish the procedure for organizing the activities of a mobile medical team.

2. A mobile medical team is organized within the structure of a medical organization (its structural unit) providing primary health care to provide primary health care to the population, including residents of settlements with a predominant population of people over working age or located at a considerable distance from a medical organization and (or) with poor transport accessibility, taking into account climatic and geographical conditions.

3. The composition of the mobile medical team is formed by the head of the medical organization (its structural unit) from among doctors and medical workers with secondary medical education, based on the purpose of its formation and assigned tasks, taking into account existing medical organizations providing primary health care, medical demographic characteristics of the service area of the medical organization, its personnel and technical potential, as well as the gender, age, social structure of the population and its needs for certain types (by profile) of medical care (including issues of individual and group prevention of non-communicable diseases, training the population in the rules of first aid, counseling on maintaining a healthy lifestyle).

The mobile medical team may, by agreement, include medical workers from other medical organizations.

4. The work of the mobile medical team is carried out in accordance with the plan approved by the head of the medical organization within which it is organized.

5. The leadership of the mobile medical team is assigned by the head of the medical organization in which it is organized, to one of the doctors of the mobile medical team from among those with experience in medical and organizational work.

6. The mobile medical team is provided with vehicles, including special ones, equipped with medical equipment, consumables, medicines necessary to provide medical care to the population in accordance with paragraph 2 of these Rules, teaching aids and sanitary education literature.

7. Support and control of the activities of mobile medical teams is carried out by the head of the medical organization within which they were created.

Appendix No. 9 to the Regulations

Rules for organizing the activities of a day hospital

1. These Rules establish the procedure for organizing the activities of a day hospital of a medical organization (division of a medical organization) providing primary health care.

2. A day hospital is a structural unit of a medical organization (its structural unit) providing primary health care, and is organized to carry out therapeutic and diagnostic measures for diseases and conditions that do not require round-the-clock medical supervision.

3. The structure and staffing levels of a day hospital are established by the head of the medical organization within which it was created, based on the volume of diagnostic and treatment work carried out and the number of the population served and taking into account the recommended staffing standards in accordance with Appendix No. 10 to the Regulations on the organization of primary health care - sanitary care for the adult population approved by this order.

5. Medical care in a day hospital can be provided by medical workers of a day hospital, or medical workers of other departments of a medical organization in accordance with the duty schedule approved by its head.

6. To organize the work of a day hospital, it is recommended that its structure include:

Chambers;
procedural (manipulative);
nurse's post;
office of the head of the day hospital;
room for patients to eat;
doctors' offices;
staff room;
room for temporary storage of equipment;
staff bathroom;
bathroom for patients;
sanitary room.

7. The equipment of the day hospital is carried out in accordance with the standard of equipment for the day hospital in accordance with Appendix No. 11 to the Regulations on the organization of primary health care for the adult population, approved by this order.

8. The number of beds and operating hours of the day hospital are determined by the head of the medical organization, taking into account the capacity of the medical organization (its structural unit) and the volume of medical activities carried out (in 1 or 2 shifts).

9. The day hospital performs the following functions:

Providing medical care to patients who do not require round-the-clock medical supervision in accordance with approved standards of medical care;
treatment of patients discharged from the hospital under the supervision of a doctor of a medical organization after surgical interventions, if it is necessary to carry out therapeutic measures that require observation by medical personnel for several hours in a medical organization;
introduction into practice of modern methods of diagnosis, treatment and rehabilitation of patients;
maintaining accounting and reporting documentation, providing reports on activities in the prescribed manner, the maintenance of which is provided for by law;
participation in activities to improve the qualifications of doctors and medical workers with secondary medical education.

10. If there is no effect from the treatment in a day hospital or if there are indications for round-the-clock medical observation and treatment, as well as in the absence of the possibility of conducting additional examinations for medical reasons, the patient is sent for additional examinations and (or) treatment, including inpatient conditions.

Appendix No. 12 to the Regulations

Rules for organizing the activities of a medical outpatient clinic

1. These Rules determine the procedure for organizing the activities of a medical outpatient clinic.

2. A medical outpatient clinic is organized to provide primary medical care (hereinafter referred to as primary medical care), as well as primary pre-medical health care (hereinafter referred to as pre-medical care) as part of the provision of emergency medical care to the population.

A medical outpatient clinic is an independent medical organization or a structural unit of a medical organization (its structural unit).

3. The provision of primary medical care in a medical outpatient clinic is carried out by local physicians, general practitioners of a workshop medical district, general practitioners (family doctors) and medical specialists on a territorial-precinct basis.

4. A specialist who meets the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009, is appointed to the position of head of a medical outpatient clinic. No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292), as well as by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247).

6. Specialists who meet the qualification characteristics of positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position “Paramedic” are appointed to the position of paramedic in a medical outpatient clinic. .

7. A specialist is appointed to the position of midwife in a medical outpatient clinic who meets the qualification characteristics of positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position “Midwife”.

8. A specialist who meets the qualification characteristics of positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), is appointed to the position of nurse ".

9. The medical outpatient clinic is provided with class A ambulances.

10. The structure of the medical outpatient clinic and the staffing level are established by the head of the medical organization, the structure of which includes the medical outpatient clinic, based on the volume of diagnostic and treatment work carried out, the number of the population served and taking into account the recommended staffing standards in accordance with Appendix No. 13 to the Regulations on the organization of primary healthcare sanitary care for the adult population approved by this order.

11. To organize the work of a medical outpatient clinic, it is recommended to provide the following premises in its structure:

Registry;
procedural;
doctors' offices;
medical prevention room;
staff room;
staff bathroom;
bathroom for patients;
clinical laboratory;
biochemical laboratory;
sanitary room.

12. In order to improve the provision of medical care, a pre-medical care office (department), an emergency medical care office (department), a day hospital, including a hospital at home, can be organized in a medical outpatient clinic.

13. The provision of medical care in a medical outpatient clinic is carried out on the basis of interaction between local general practitioners, local general practitioners of the workshop medical district, general practitioners (family doctors) and specialist doctors in the profile of the patient’s disease (cardiologists, rheumatologists, doctors -endocrinologists, gastroenterologists and others) operating in a medical outpatient clinic or in a medical organization that includes a medical outpatient clinic, as well as other medical organizations.

14. The equipment of the medical outpatient clinic is carried out in accordance with the equipment standard established by Appendix No. 14 to the Regulations on the organization of primary health care for the adult population, established by this order.

15. The main tasks of a medical outpatient clinic are:

Diagnosis and treatment of acute diseases, chronic diseases and their exacerbations, injuries, poisoning and other conditions;
carrying out dispensary observation of patients with chronic diseases;
implementation of medical rehabilitation measures;
elimination of life-threatening conditions with subsequent organization of medical evacuation to medical organizations providing specialized medical care accompanied by a medical worker from an outpatient clinic or an emergency medical team;
provision of emergency medical care to patients in case of sudden acute diseases, conditions, exacerbation of chronic diseases that are not life-threatening and do not require emergency medical care, with subsequent referral to a specialist doctor of the medical organization in whose area of responsibility this medical outpatient clinic is located;
visiting a patient in cases provided for in the procedures for providing medical care in order to monitor his condition, the course of the disease and timely appointment (correction) of the necessary examination and (or) treatment (active visit);
referral of patients to medical organizations for the provision of primary specialized health care, specialized, including high-tech, medical care in cases provided for by the procedures for providing certain types of medical care (by profile);

active detection of malignant neoplasms and precancerous diseases and referral of patients with suspected malignant neoplasms to primary oncology clinics;
implementation of activities to promote a healthy lifestyle;
implementation of measures for medical prevention, including the organization and conduct of events for sanitary and hygienic education and promotion of public health, health schools for patients with socially significant non-communicable diseases and people at high risk of their occurrence, the formation of risk groups for the development of diseases, including training the population in the rules of providing first aid assistance, referral for consultation on maintaining a healthy lifestyle;
implementation of sanitary-hygienic and anti-epidemic measures;
identification of smokers and people who consume alcohol in excess, with a high risk of developing diseases associated with smoking, alcohol and poisoning with alcohol substitutes;
providing medical assistance to persons who smoke and consume alcohol in excess, to quit smoking and abuse alcohol, including referring them for consultation and treatment to medical prevention departments, health centers and specialized medical organizations;
interaction with a medical organization, the structure of which includes a medical outpatient clinic, territorial bodies of Rospotrebnadzor and Roszdravnadzor on the provision of primary health care.

16. The work of a medical outpatient clinic should be organized according to a shift schedule, ensuring the provision of medical care throughout the day, and also provide for the provision of emergency medical care on weekends and holidays.

Appendix No. 15 to the Regulations

Rules for organizing the activities of a paramedic-midwife station

1. These Rules determine the procedure for organizing the activities of a paramedic-midwife station.

2. FAP is organized to provide primary pre-medical health care (hereinafter referred to as pre-hospital medical care) and palliative medical care to the population in rural areas.

In the presence of water and other barriers, distance from the nearest medical organization, low population density in the region (3 times lower than the Russian average), the number of the population served can be adjusted relative to the recommended number of the population served by the FAP.

4. A specialist who meets the qualification characteristics of positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), is appointed to the position of head of the medical and obstetric center - paramedic. "Paramedic."

5. A specialist who meets the qualification characteristics of positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), is appointed to the position of midwife ".

" Nurse".

7. The structure of the medical and midwifery station and the staffing level are established by the head of the medical organization, the structure of which includes the medical and midwifery station, based on the volume of diagnostic and treatment work carried out, taking into account the level and structure of morbidity and mortality, the age and gender composition of the population, its density, and other indicators and taking into account the recommended staffing standards in accordance with Appendix No. 16 to the Regulations on the organization of primary health care for the adult population, approved by this order.

8. To organize the work of a paramedic-midwife station, it is recommended to provide the following premises in its structure:

Procedural;
room for paramedic and midwife;
emergency room for childbirth;
room for temporary stay of patients;
staff bathroom;
bathroom for patients;
sanitary room.

9. To provide emergency pre-hospital medical care for sudden, life-threatening acute diseases, conditions, exacerbations of chronic diseases, injuries, poisonings (hereinafter referred to as life-threatening conditions and (or) diseases), instructions are placed in the FAP in places accessible to medical personnel, including sequence of actions for diagnosing life-threatening conditions and (or) diseases and providing medical care for them using packages containing the necessary medicines and medical products, the stocks of which are replenished as needed.

10. The equipment of the FAP is carried out in accordance with the equipment standard established by Appendix No. 17 to the Regulations on the organization of primary health care for the adult population, established by this order. The FAP is provided with a Class A ambulance.

11. The main tasks of the FAP are:

Appendix No. 18 to the Regulations

Rules for organizing the activities of a paramedic health center of a medical organization

1. These Rules determine the procedure for organizing the activities of a paramedic health center of a medical organization.

2. A paramedic health center of a medical organization (hereinafter referred to as a paramedic health post) is a structural unit of a medical organization and is organized to provide primary pre-hospital health care (hereinafter referred to as pre-hospital medical care) and palliative medical care to the population in rural settlements with a small population and (or ) located at a considerable distance from medical organizations, including medical and obstetric centers, or in the presence of water, mountain and other barriers, as well as in the case of predominantly (more than 40%) people living in them over working age.

3. A specialist who meets the qualification characteristics of positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position “Paramedic” is appointed to the position of paramedic at a paramedic health center.

A specialist is appointed to the position of nurse at a paramedic health center who meets the qualification characteristics of positions for workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position “Nurse”.

4. The staffing level of medical and other personnel of a paramedic health center is established by the head of the medical organization of which he is a part, in accordance with the recommended staffing standards for a paramedic health center of a medical organization, established by Appendix No. 19 to the Regulations on the organization of primary health care for the adult population, approved by this order.

5. To organize a paramedic health center, it is recommended that its structure include:

Procedural;
paramedic's office;
bathroom

6. The equipment of the paramedic health center is carried out in accordance with the standard established by Appendix No. 20 to the Regulations on the organization of primary health care for the adult population, approved by this order.

7. To provide emergency pre-hospital medical care for sudden, life-threatening acute diseases, conditions, exacerbations of chronic diseases, injuries, poisonings (hereinafter referred to as life-threatening conditions), instructions are posted at the paramedic health center in places accessible to medical workers, including the sequence of diagnostic actions life-threatening conditions and (or) diseases and the provision of medical care for them, including the use of packages containing necessary medicines and medical products, the stocks of which are replenished as needed.

8. The main tasks of the paramedic health center are:

Diagnosis and treatment of uncomplicated acute, exacerbations of chronic diseases and other conditions, injuries, poisonings;
implementation of prevention of infectious and non-infectious diseases;
identification of smokers and people who consume alcohol in excess, with a high risk of developing diseases associated with smoking, alcohol and poisoning with alcohol substitutes;
providing assistance to smokers and people who consume alcohol excessively in the prevention and cessation of smoking and alcohol abuse, including referring them for consultation and treatment to medical prevention departments (offices), health centers and specialized medical organizations;
implementation of activities to promote a healthy lifestyle;
referring patients to medical organizations to provide primary (medical, specialized) health care or specialized medical care in cases provided for by the procedures for providing medical care by profile, organizing appointments with medical specialists;
elimination of life-threatening conditions with subsequent organization of medical evacuation to medical organizations providing specialized medical care, accompanied by a medical worker from a paramedic health center or an emergency medical team;
identification of precancerous diseases and malignant neoplasms of visual localizations and referral of patients with suspected malignancy and precancerous diseases to the primary oncology office of a medical organization;
organization and provision of palliative care to patients, including patients with cancer, who need narcotic and potent medications in accordance with the recommendations of medical specialists;
implementation of sanitary-hygienic and anti-epidemic measures;

implementation of measures to protect the family, motherhood, paternity and childhood;
examination of temporary disability;
interaction with a medical organization, the structure of which includes a paramedic health center, territorial bodies of Rospotrebnadzor and Roszdravnadzor on the provision of primary pre-medical health care.

Appendix No. 21 to the Regulations

Rules for organizing the activities of the Center (Department) of General Medical Practice (Family Medicine)

1. These Rules establish the procedure for organizing the activities of the Center (Department) of General Medical Practice (Family Medicine).

2. The Center (Department) of General Medical Practice (Family Medicine) (hereinafter referred to as the Center) is organized as an independent medical organization or as a structural unit of a medical organization (its structural unit) providing primary health care, and is organized to provide primary medical care. sanitary care (hereinafter referred to as medical medical care), primary pre-medical health care (hereinafter referred to as pre-hospital medical care) as part of the provision of emergency medical care, as well as palliative medical care.

3. The provision of medical care at the Center is carried out on the basis of interaction between general practitioners (family doctors) and medical specialists in the profile of the patient’s disease (cardiologists, rheumatologists, endocrinologists, gastroenterologists, etc.) who carry out their activities in the medical organization that includes the Center, as well as other medical organizations.

4. The structure of the Center and staffing levels are established by the head of the Center or the head of the medical organization within which it was created, based on the volume of diagnostic and treatment work carried out, the number, age and sex composition of the population served, indicators of the level and structure of morbidity and mortality of the population, other indicators characterizing public health, and taking into account the recommended staffing standards in accordance with Appendix No. 22 to the Regulations on the organization of primary health care for the adult population, approved by this order.

5. The center is headed by the chief physician (head), to whose position a specialist is appointed who meets the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on 9 July 2009, No. 14292), in the specialty "General Medicine", "Pediatrics", "General Medical Practice (Family Medicine)" and the qualification characteristics of positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n ( registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247).

6. A specialist who meets the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by Order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292) is appointed to the position of a doctor of the Center ), in the specialty "General medical practice (family medicine)" and the qualification characteristics of positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position " General practitioner (family doctor)."

7. A specialist is appointed to the position of a nurse at the Center who meets the qualification characteristics of positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position “Nurse” .

8. Specialists who meet the qualification characteristics of positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position “Paramedic” are appointed to the position of paramedic of the Center.

9. To organize the work of the Center, it is recommended that its structure include:

Registry;
consultation and treatment department, which may include:
general practitioner (family doctor) offices),
gynecological (examination) room,
dental office,
manipulative,
children's vaccination office,
procedural,
dressing room,
physiotherapy room;
day hospital department;
department (office) of medical prevention;
clinical diagnostic laboratory;
baby food station.

10. In order to improve the provision of medical care, the Center (Department) can organize a pre-medical care room (department), an emergency medical care room (department), a day hospital, including a home hospital, a medical care room for smoking cessation.

11. The Center performs the following functions:

Provision of medical medical care in accordance with established procedures for the provision of certain types (by profile) of medical care and standards of medical care, including:
informing the population about the need and possibility of identifying risk factors and assessing the degree of risk of developing chronic non-communicable diseases, their drug and non-drug correction and prevention, as well as counseling on maintaining a healthy lifestyle in the Center’s divisions, departments (offices) of medical prevention and health centers;
identification of smoking and excessive alcohol consumption of persons at high risk of developing diseases associated with smoking, alcohol and poisoning with alcohol substitutes;
providing medical assistance to smokers and people who drink alcohol excessively to quit smoking and alcohol abuse, including referring them for consultation and treatment to health centers and specialized specialized medical organizations;
conducting preventive examinations, individual and group preventive counseling and examinations;
training in health schools, in schools for patients and people at high risk of developing non-communicable diseases, including training at-risk groups in first aid rules for sudden cardiac arrest, acute coronary syndrome, acute cerebrovascular accident and other life-threatening conditions that are the main causes of mortality in the population outside medical organizations;
carrying out recreational activities, medicinal and non-medicinal correction of risk factors for diseases, dispensary observation of people at high risk of developing a chronic non-infectious disease and its complications, referral, if there are medical indications, of people with a very high risk of a chronic non-infectious disease for consultation with a specialist in the profile of the threatened disease or its complications;
implementation of measures to promote a healthy lifestyle, prevention of chronic non-communicable diseases among the population of the service territory (zone);
implementation of the prevention of infectious diseases;
implementation of medical rehabilitation measures;
carrying out dispensary monitoring of the health status of patients with the necessary examination, treatment and rehabilitation;
organizing and conducting sanitary and hygienic education activities, including health promotion activities;
elimination of life-threatening conditions with subsequent organization of medical evacuation to medical organizations or their units that provide specialized medical care accompanied by a medical worker or an emergency medical team;
provision of emergency medical care to patients with sudden acute diseases, conditions, exacerbation of chronic diseases that are not life-threatening and do not require emergency medical care, followed by referral to a medical specialist from a medical organization providing medical care at the patient’s place of residence, followed by a visit to the patient in cases provided for by the procedures for the provision of medical care in order to monitor his condition, the course of the disease and timely appointment (correction) of the necessary examination and (or) treatment (active visit);
organization of hospital care at home;
training the population in first aid;
referral of patients to medical organizations for the provision of primary specialized health care, specialized, including high-tech, medical care in cases provided for by the procedures for providing certain types (by profile) of medical care;
identification of malignant neoplasms and precancerous diseases and referral of identified cancer patients and patients with suspected malignant neoplasms to primary oncology clinics;
formation of risk groups;
carrying out clinical monitoring of precancerous diseases;
organization and provision of palliative care to patients, including patients with cancer, who need narcotic and potent medications in accordance with the recommendations of medical specialists;
carrying out examination of temporary disability, referral for medical and social examination.
implementation of sanitary-hygienic and anti-epidemic measures;
conducting preliminary or periodic medical examinations of employees;
implementation of measures to protect the family, motherhood, paternity and childhood,
sanitary and hygienic education of the population;
interaction with medical organizations, territorial bodies of Rospotrebnadzor and Roszdravnadzor, other institutions and organizations on the provision of pre-medical care;
organization independently or jointly with social protection authorities of medical and social medical care for disabled people and chronically ill people.

12. To ensure its activities, the Center uses the capabilities of the structural divisions of the medical organization within which it was created.

Appendix No. 24 to the Regulations

Rules for organizing the activities of the health center

1. These Rules determine the procedure for organizing the activities of a health center, which is created to provide primary medical care to the adult population, as well as primary pre-medical health care aimed at implementing measures to promote a healthy lifestyle, including reducing the consumption of alcohol and tobacco.

2. The health center is a structural unit of a medical organization (its structural unit).

3. The management of the health center is carried out by the manager, who is appointed to the position and dismissed by the head of the medical organization.

Specialists who meet the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292) are appointed to the position of head of the health center. who have appropriate training in healthy lifestyle issues and medical prevention.

4. Specialists who meet the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292), in the specialties “health care organization and public health”, “therapy”, “pediatrics”, “hygienic education”, “general medical practice (family medicine)”, “allergology and immunology”, “regenerative medicine”, “dietology” , “therapeutic physical education and sports medicine”, “cardiology”, “pulmonology”, “gastroenterology”, “psychiatry-narcology”, “preventive dentistry”, “medical psychology” and having appropriate training on healthy lifestyle issues and medical prevention.

5. A specialist is appointed to the position of a nurse at a health center who meets the qualification characteristics of positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), in the specialty "instructor in hygienic education", "nurse" with appropriate training in healthy lifestyle issues and medical prevention.

6. A specialist is appointed to the position of hygienist at a dental health center who meets the qualification characteristics of positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), in the specialty “preventive dentistry” ".

7. A specialist is appointed to the position of nurse to work in the ophthalmology office of the health center, corresponding to the qualification characteristics of positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), in the specialty "medical optometrist-optometrist" or in the specialty "nurse", who has undergone additional professional training in the specialty "medical optics" and has appropriate training in healthy lifestyle issues and medical prevention.

8. The structure of the health center and staffing levels are established by the head of the medical organization, the structure of which includes the health center, based on the volume of work performed, the size of the population served and taking into account the recommended staffing standards in accordance with Appendix No. 25 to the Regulations on the organization of primary health care for adults to the population approved by this order.

9. To organize the work of a health center, it is recommended that its structure include:

Doctors' offices;
dental hygienist's office;
ophthalmology office;
testing room on a hardware and software complex;
instrumental and laboratory examination rooms;
physical therapy room (hall);
classrooms (auditoriums) of health schools.

10. In order to improve the provision of medical care, a prevention room (department) can be organized at the Health Center.

11. The equipment of the Health Center is carried out in accordance with the equipment standard established by Appendix No. 26 to the Regulations on the organization of primary health care for the adult population, established by this order

12. The main objectives of the Health Center are:

A comprehensive medical examination, including measurement of anthropometric data, screening assessment of the level of psychophysiological and somatic health, functional and adaptive reserves of the body, express assessment of cardiac activity, vascular system, basic hemodynamic parameters, express analysis of laboratory markers of socially significant diseases and atherosclerosis, assessment of complex indicators of the function of the respiratory system, organ of vision, identification of pathological changes in teeth, periodontal diseases and oral mucosa, based on the results of which an assessment of the functional and adaptive reserves of the body is carried out, a prognosis of health status and an assessment of the degree of risk of developing diseases and their complications, including the risk of developing cardiovascular diseases, development of an individual program for maintaining a healthy lifestyle, health and preventive measures;
medical assistance in stopping the consumption of alcohol, tobacco, reducing excess body weight, organizing a balanced diet, correcting hyperlipidemia and dyslipidemia, optimizing physical activity;
dynamic monitoring of patients at high risk of developing non-communicable diseases, teaching them effective methods of disease prevention, taking into account age-related characteristics;
group training in health schools, lectures, conversations and individual counseling on maintaining a healthy lifestyle, hygienic skills, maintaining and promoting health, including recommendations on balanced nutrition, physical activity, physical education and sports, sleep patterns, living conditions, and work ( study) and recreation, mental hygiene and stress management, prevention and correction of behavioral risk factors for non-communicable diseases, responsible attitude towards one’s health and the health of one’s loved ones, principles of a responsible attitude towards the health of one’s children;
informing about environmental factors harmful and dangerous to human health, risk factors for the development of diseases, as well as teaching the population to maintain a healthy lifestyle, reducing the level of correctable risk factors, motivating them to give up bad habits;
development of action plans to promote a healthy lifestyle among the population, including with the participation of medical and other organizations, their coordination and implementation;
providing methodological and practical assistance to doctors and specialists with secondary medical education from medical organizations and their departments in implementing activities to promote a healthy lifestyle and conduct health schools;
training medical workers of medical organizations in methods of conducting activities to promote a healthy lifestyle, conducting health schools;
analysis of the dynamics of morbidity and mortality of the population from chronic non-communicable diseases in the service territory, participation in studies of the level and dynamics of prevalence indicators of the main risk factors for chronic non-communicable diseases;
maintaining medical records in the prescribed manner and submitting reports;
interaction with medical organizations, Rospotrebnadzor, Roszdravnadzor, and other organizations on the issues of promoting a healthy lifestyle, organizing and conducting medical prevention of chronic non-communicable diseases, including issues of training the population in the rules of first aid for diseases (conditions) that are the main cause of mortality outside medical organizations.

INTERNAL RULES

KGBUZ "Children's City Clinic No. 24"

Ministry of Health of the Khabarovsk Territory

1.General provisions

These Rules have been developed in accordance with the Federal Law of November 21, 2011. No. 323 “On the basics of protecting the health of citizens in the Russian Federation”, Territorial program for the provision of free medical care to citizens in the Khabarovsk Territory for 2017 and for the planning period of 2018 and 2019 (approved by Decree of the Government of the Khabarovsk Territory dated December 29, 2016 No. 50 -pr), order of the Ministry of Health and Social Development of the Russian Federation No. 366n dated April 16, 2012 “On approval of the procedure for providing pediatric care”, other federal laws and federal regulatory legal acts, laws and other regulatory legal acts of the Khabarovsk Territory, local regulatory acts.

Medical care for the children in the service area is provided on a territorial basis.

Primary health care is provided in the following settings:

Outpatient (in conditions that do not provide round-the-clock medical observation and treatment), including at home when a medical professional is called;

– in a day hospital (in conditions that provide medical supervision and treatment during the daytime, but do not require round-the-clock medical supervision and treatment).

Primary health care includes measures for the prevention, treatment of diseases and certain conditions, medical rehabilitation, promotion of a healthy lifestyle and sanitary and hygienic education of the child population.

Primary health care includes:

– primary pre-medical health care;

– primary medical health care;

– primary specialized health care.

Primary health care for the children's population in case of childhood illnesses on an outpatient basis is provided by local pediatricians, specialist doctors, and relevant nursing personnel in planned and emergency forms.

If there are medical indications, local pediatricians and medical staff of educational institutions refer children for consultations to doctors - specialists of medical organizations in the specialties provided for by the Nomenclature of Specialties of Specialists with Higher and Postgraduate Medical and Pharmaceutical Education in the Healthcare Sphere of the Russian Federation, approved by order of the Ministry of Health and Social Development of Russia dated April 23 .2009 No. 210n, as amended by order of the Ministry of Health and Social Development of Russia dated 02/09/2011.

Each time a patient seeks medical help at a clinic, the patient is required to present an identification document (passport) and a valid medical insurance policy to the institution’s reception desk. (Subclause 2, Clause 2, Article 16 of the Federal Law of the Russian Federation of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation”). The registry employee, together with the operator of the medical statistics department, checks the validity of the presented policy, as well as the presence in the regional register of insured persons of a mark indicating that the citizen is attached to the Children's City Clinic No. sanitary assistance. The absence of a medical insurance policy, the patient’s refusal to present it, as well as the lack of attachment to the KGBUZ DGP 24 for the provision of medical care may be grounds for a temporary refusal to provide planned medical care until the patient fulfills the above conditions, but is not a basis for refusal to provide urgent medical care for illness.

Citizens living in the service area of the institution and wishing to be served in the institution, but not attached to the KGBUZ DGP 24, must contact the head physician of the institution with an application for choosing a medical organization. When submitting an application, the originals of the following documents are presented:

Birth certificate;

Identity document of the child’s legal representative;

Compulsory medical insurance policy for the child;

For citizens of the Russian Federation aged fourteen years and older: a passport of a citizen of the Russian Federation or a temporary identity card of a citizen of the Russian Federation, issued for the period of registration of the passport;

Compulsory health insurance policy;

After submitting an application for attachment to the service of the selected medical organization, the manager considers the possibility of attaching the patient within one month. This takes into account: the patient’s place of residence, the number of people served, and the territorial principle of service. The head of the medical organization that accepted the application informs the citizen (his representative) in writing or orally (in person or by post, telephone, electronic communication) about the result of the consideration about the citizen’s acceptance for medical care.

In accordance with current legislation, a citizen chooses a medical organization to provide primary health care, including on a territorial-precinct basis, no more than once a year.

If the review of a citizen’s application for admission to the clinic’s services is positive, the citizen provides the head of the pediatric department with:

– a certificate of dismissal from the health care facility where the citizen was previously served (preferably, but not required);

– an outpatient card/history of the child’s development (or a detailed extract) from the health care facility where the citizen was previously served.

Attachment of citizens living outside the service area structural divisions of the institution, for medical care (temporary/permanent) is carried out in accordance with the Order of the Ministry of Health and Social Development of the Russian Federation dated 08/04/2006. No. 584 “On the Procedure for organizing medical care for the population on a local basis” and Order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2012 N 406n “On approval of the Procedure for a citizen to choose a medical organization when providing him with medical care within the framework of the program of state guarantees of free provision medical care for citizens”, taking into account the consent of the local pediatrician and compliance with the principle of accessibility of medical care.

Medical card.

2.1. The patient's medical record is the property of the clinic and must be kept in the registry.

It is not permitted to unauthorizedly remove a medical record from the clinic without the consent of the head of the pediatric department or the deputy chief physician for medical affairs! (in accordance with clause 3.2. Order of the Ministry of Health of the Russian Federation No. 291 and the Federal Social Insurance Fund of the Russian Federation No. 167 dated 06.10.1998 “On approval of the instructions on the procedure for monitoring the organization of examination of temporary disability” and Letter of the Ministry of Health and Social Development of the Russian Federation dated 04.04.2005 No. 734/MZ -14).

2.2. In the event of a patient’s temporary or permanent departure to another area of residence not served by the State Budgetary Institution of Public Health No. 24, as well as when the patient is detached from the clinic, the medical registrar issues Form 112 (outpatient medical card) to the patient (or his legal representative) in person, and makes an entry in the register of departed patients.

2.3. At the request of the patient, addressed to the head of the institution, he may be issued a photocopy of the outpatient card within up to 7 working days from the date of submission of the application.

2.4. When a patient is referred for an appointment with a doctor, a medical card is not given to the patient, but is transferred to the office by the registrar.

The procedure for organizing the reception of patients in the clinic, conducting laboratory and instrumental examinations, and physiotherapy.

3.1. The procedure for organizing the reception of patients in an outpatient clinic provides for:

Availability of a waiting list for scheduled patients to see a doctor, individual diagnostic tests, and advice from specialists (the waiting period should not exceed 10 working days);

– receiving patients by appointment, including by telephone at the reception (477 860 – multi-channel).

- extraordinary provision of outpatient care for emergency and urgent indications without prior appointment is implemented in the following order : the patient contacts the receptionist, states complaints indicating the need for emergency or emergency medical care (body temperature above 38 C at the time of application, repeated vomiting, general poor condition of the patient), the receptionist takes the patient to a separate room and invites the pediatrician conducting the appointment , to examine the patient, or the registrar takes the patient directly to the doctor’s office conducting the appointment and informs the doctor about the need to provide emergency assistance to the patient.

– in the event of an appeal from several citizens entitled to emergency medical care (children of the first year of life, disabled children, orphans), planned assistance is provided in the order in which requests are received. Extraordinary provision of medical care is carried out if citizens have medical indications and a document confirming their membership in a preferential category of citizens.

3.2. For conditions that do not require urgent medical intervention, the patient goes to the facility’s reception desk, receives an outpatient card, and is sent to see a doctor.

3.3. The waiting time for an appointment by appointment is 30 minutes from the appointed time, except in cases where the doctor is involved in providing emergency or emergency care to another patient.

3.4. If there are indications for a consultative examination by a specialist, the child is sent for consultation to a specialist with a referral from the local pediatrician.

3.5. If there are indications for inpatient treatment, the patient receives from the local pediatrician a referral for hospitalization, an extract from the outpatient card, a certificate of no contact with infectious patients, information about vaccinations and the Mantoux test. For planned hospitalization, the deadline for providing these documents may be 3 working days.

3.6. The scope of diagnostic and therapeutic measures for a citizen is determined by the attending physician in accordance with the procedures and standards of medical care. Preventive, sanitary and hygienic, anti-epidemic measures are prescribed and carried out if there are appropriate medical indications. In case of life-threatening conditions or the impossibility of providing medical care in a clinic, the patient is sent to the next stage of medical care.

Planned hospitalization is carried out in the order of priority, hospitalization of acute patients is carried out on the day of referral to the hospital.

3.7. Doctors - specialists, local pediatricians, pediatricians conduct appointments by appointment, strictly in the direction of the local pediatrician. Pre-registration is carried out at the clinic's reception desk when the patient appears in person from 8.00 to 19.00, by phone - after 15.00 (registration can be made by a local medical worker at the appointment), as well as by self-registration through the portals: http://www.gosuslugi. ru/; https://uslugi27.ru.

3.8. Citizens referred by attending physicians from other medical organizations for consultations with specialists of the Children's Clinic No. 24 and for laboratory and functional tests are not assigned to the institution. Consultations with doctors and studies are carried out strictly in accordance with the direction of the attending physician of the health care facility to which the citizen is assigned and, if there is an agreement between institutions, in the order of scheduled appointments. In this case, the presentation by the citizen of the appropriate referral and compulsory medical insurance policy is mandatory.

3.9. When a patient assigned for medical support to the Children's Clinic No. 24 seeks to follow recommendations for treatment, examination and rehabilitation, including: injection of medications at home, physiotherapeutic procedures, prescribed in other medical institutions, the decision to perform them is made by the attending physician to whom the patient is assigned. Injections of medications at home are carried out only as prescribed by a doctor of the Children's Clinic No. 24, for children under 6 months of age, while the first injection of the drug must be made in the treatment room of the clinic in order to prevent the development of a sudden adverse reaction to the administered substance and timely providing appropriate medical care. Injections to a child over 6 months old are carried out as prescribed by doctors of the Children's Clinic No. 24 in the treatment room of the clinic, with the exception of cases of prescribing antibacterial drugs for the treatment of an acute disease in a hospital at home.

Physiotherapeutic procedures prescribed by a doctor from another medical institution are dispensed as scheduled and in compliance with the order of patients, after examination by a physiotherapist of the KSBUZ DGP 24.

3.10. If the patient needs a laboratory or instrumental examination, the attending physician will issue a referral: for tests, ECG, EEG, ultrasound examination.

Biochemical blood tests are carried out by appointment at the reception desk; the waiting period for an appointment does not exceed 10 working days.

General blood test, Wasserman reaction, blood for sugar, feces for worm eggs, coprogram - daily from 9.00 - 10.30 upon referral from a doctor, without an appointment.

Scraping for pinworms, bacteriological examination of urine, swab from the throat and nose for flora and sensitivity to antibiotics, swab from the throat and nose for diphtheria, examination for meningococcal infection and whooping cough, examination for the dys.group, examination for opportunistic flora is carried out on Monday , Wednesday, Friday from 8.30 to 9.30 without an appointment, if required by SanPin, by appointment - if the examination is planned, for preventive purposes or as part of dispensary observation.

3.11. The issue of the need to draw blood for research from a non-transportable or seriously ill patient at home is resolved through the head of the clinical diagnostic laboratory with a referral from the attending physician.

3.12. Citizens in need of routine medical care must strictly adhere to the visiting time specified in the preliminary appointment or coupon. The patient must appear for the appointment in a timely manner, 15-20 minutes in advance, and warn about the impossibility of appearing for a valid reason.

Citizens who are late for an appointment will be provided with medical assistance after the end of the appointment and only in agreement with the doctor, if there is free time in the schedule. To change the appointment time, the patient must contact the reception desk.

Citizens who do not come for an appointment on the specified day do not have the right to an extraordinary visit without an appointment; the next appointment will be carried out according to the newly created appointment and subject to the order of patients.

3.13. Examination of a child under 15 years of age is carried out only in the presence of a legal representative (mother, father, guardian, trustee). Grandparents are not the child's legal representatives. If a child under the age of 15 self-appears for an appointment with a doctor without legal representatives, routine medical care may be denied.

Issuance and registration of certificates of incapacity for work.

If it is necessary to organize care for a sick child, the mother or other relative who directly provides care receives a certificate of incapacity for work.

The clinic has organized a centralized issuance of certificates of incapacity for work in the direction of the local pediatrician in office No. 1 according to the schedule: Monday-Friday from 9-00 to 17-00, technical break from 12-00 to 12-30). A sick leave certificate is issued to one of the family members (guardian, trustee, other relative) who is actually providing care, upon presentation of an identity document.

The certificate of incapacity for work closed by the doctor after 17-00 must be signed in the child’s card (F112u) by the administrator on duty.

Procedure for calling a doctor at home

5.1. A doctor can be called to your home in person at the reception desk or by phone: 477 860 on weekdays (Monday-Friday) from 8.00 to 14.00, on Saturday from 9.00 to 12.00, day off is Sunday.

5.2. The call is serviced on the same day. The waiting time for a medical worker to provide medical care at home should not exceed eight hours from the moment the call is registered, with the exception of children of the first year of life and children at medical and biological risk, when the waiting time should not exceed four hours provided that a pediatrician is serving one pediatric area, when a pediatrician serves more than one pediatric area, the call service time may be increased.

5.3. The basis for calling a pediatrician at home is: an acute illness in a child at any age (the first 3 days of illness), the impossibility of transporting the patient to the clinic due to his condition.

5.4. When calling a pediatrician at home the patient is obliged:

– present, at the doctor’s request, a compulsory medical insurance policy, an outpatient medical card (if it is in hand), an identification document of the child’s representative (passport);

– provide conditions for the work of a pediatrician (provide unhindered access to the apartment, cover the floor, carpets, prepare a clean spoon, towel, remove pets from the premises)

– if the outpatient card (f. 112) is at the patient’s home, the doctor servicing the call is not obliged to make entries in it at the patient’s home. Entries are entered into the outpatient record when it is in the clinic, including the patient’s electronic medical record.

5.5. On call, the local pediatrician sets the date for the patient’s next visit to the clinic or plans an active visit to the sick child at home. If there are indications, the doctor writes out directions for laboratory and instrumental examination. Various types of certificates (about a past illness, about the possibility of playing sports, about observation in a clinic, etc.) when calling a doctor at home are not issued. Certificates are issued at an outpatient appointment when the patient appears at the clinic.

5.6. When calling a doctor to the home of a child under 15 years of age, the presence of the child’s legal representative is required. In the absence of a legal representative, examination of the child and provision of medical care is carried out only in the presence of symptoms and conditions that threaten the patient’s life.

5.7. Active visits by a medical worker (doctor, nurse) to a patient at home are carried out for:

planned patronage of children under two years of age,

pregnant women;

patronage of chronic, dispensary patients and disabled people;

active patronage of patients;

organization of preventive and preventative measures on the initiative of medical workers.

The frequency and schedule of active home health visits and patronage are determined by the attending physician depending on the patient’s age, the patient’s condition and the local pediatrician’s call load.

The procedure for providing medical care in a day hospital

The day hospital of the clinic operates according to a schedule on weekdays, weekends – Saturday, Sunday.

The day hospital provides medical care to children who do not require round-the-clock supervision, in a volume similar to a round-the-clock hospital. In the day hospital, medication is provided in accordance with the Territorial Program of State Guarantees of the Khabarovsk Territory at the expense of the clinic.

The selection of patients for the day hospital is carried out by the local pediatrician. If there are indications for treatment, the patient receives a referral from the local pediatrician to the day hospital and goes to the pediatrician at the day hospital. The date of admission to the hospital is planned. In the day hospital, according to indications, the child undergoes laboratory, ultrasound, and ECG examinations, and treatment is prescribed in accordance with the established diagnosis and within the framework of treatment standards. After completing their stay in the day hospital, patients receive from the day hospital doctor a discharge summary with recommendations for further treatment, which is provided to the local pediatrician and pasted into the outpatient card.

The procedure for providing medical care to children in a hospital

at home

A hospital at home is intended to provide qualified medical care to patients in need of inpatient treatment, if the patient’s condition and home conditions (social, material, moral) allow organizing the necessary care for the child at home. The decision on hospital treatment at home is made by the attending physician.

Selection criteria:

– no need for round-the-clock medical supervision;

– the ability to conduct examinations and treatment at home to receive a course of therapy under the supervision of the medical staff of the clinic;

The local pediatrician decides to conduct examinations and draws up a list of prescriptions for the patient in accordance with the standards of therapy. The mother receives medications from the head nurse of the clinic or from the local pediatrician; a note is made on the prescription sheet that the medications have been received and the date of receipt of the medications is indicated, signed by the mother. The child is observed at home until his condition improves by a local pediatrician, and then a decision is made on the possibility of transferring him to outpatient treatment until recovery.

Rights and responsibilities of patients

The rights and obligations of patients are approved in accordance with the Federal Law of the Russian Federation “On the fundamentals of protecting the health of citizens in the Russian Federation” Federal Law No. 323-FZ dated November 21, 2011.

When seeking and receiving medical care the patient has the right to:

– respectful and humane attitude on the part of medical workers and other persons involved in the provision of medical care;

– information about the last name, first name, patronymic, position and qualifications of his attending physician and other persons directly involved in the provision of medical care to him;

– examination, treatment and stay in a health care institution in conditions that meet sanitary, hygienic and anti-epidemic requirements;

– relief of pain associated with the disease and (or) medical intervention, using available methods and means;

– transfer to another attending physician with the permission of the head of the institution subject to the consent of another doctor;

– appealing the diagnosis, the methods of examination and treatment used;

– voluntary informed consent of the patient to medical intervention in accordance with legislative acts;

– refusal to provide (terminate) medical care, hospitalization, except for cases provided for by legislative acts; if the patient refuses medical intervention is obliged to express his will in writing, in accordance with the order of the Ministry of Health

Russian Federation dated December 20, 2012 N 1177n “On approval of the procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types of medical interventions, forms of informed voluntary consent to medical intervention and forms of refusal of medical intervention”;

– filing a complaint with officials of the health care institution in which he receives medical care, as well as with officials of government bodies or in court;

– keeping by medical workers secret information about the fact of his application for medical help, state of health, diagnosis and other information obtained during his examination and treatment, except for cases provided for by legislative acts;

– obtaining, in a form accessible to him, complete information about the state of the child’s health, the methods of diagnosis and treatment used.

The patient is obliged:

– comply with the internal regulations of the clinic;

– treat the institution’s property with care; in the event of loss or damage to the property of the clinic, the administration of the KSBUZ DGP 24 reserves the right to contact law enforcement agencies with an application for compensation for the damage caused;

– treat medical workers and other persons involved in the provision of medical care with respect; insulting a medical worker entails administrative liability in accordance with Article 5.61 of the Code of the Russian Federation on Administrative Offenses. The police are called immediately.

– treat other patients with respect, respect the order, let through persons entitled to priority service in accordance with the legislation of the Russian Federation;

– provide the person providing medical care with reliable information about the child’s health status, including contraindications to the use of medications, previously suffered and hereditary diseases;

– comply with medical instructions;

– cooperate with the doctor at all stages of medical care;

– comply with sanitary and hygienic standards: (entrance to surgical, procedural rooms, in shoe covers, leave outerwear in the wardrobe), Entry into offices in outerwear is strictly prohibited;

– comply with the rules for banning smoking in medical institutions;

– observe the operating hours of the medical institution; fire safety requirements;

– have the results of fluorography of the chest organs with you and present them at the request of the medical staff of the clinic;

– formalize refusal or consent to medical intervention;

– if sources of fire or other threats are detected, immediately report this to the administrator on duty and the clinic staff;

In the premises of a medical institution it is prohibited:

– wear outerwear;

- talk loudly, make noise;

– use a cell phone at the reception;

– drink alcoholic beverages, use narcotic and toxic drugs;

– appearing in a state of alcoholic or drug intoxication

The procedure for resolving conflicts between the patient and the clinic

The procedure for considering complaints and appeals is determined in accordance with the Federal Law of the Russian Federation “On the procedure for considering appeals from citizens of the Russian Federation” dated May 2, 2006. No. 59-FZ.

9.1 In case of conflict situations, the patient (his legal representative) has the right, when visiting the clinic, to directly contact the administration of the clinic or the administrator on duty according to the schedule of reception of citizens, an appeal in writing is possible.

9.2 Upon personal reception, the citizen presents a document proving his identity. The content of the oral appeal is entered into the register of citizens' appeals. If the facts and circumstances stated in the oral appeal are obvious and do not require additional verification, the response to the appeal, with the consent of the citizen, can be given orally during a personal reception, which is recorded in the citizen’s reception log. In other cases, a written response is made on the merits of the questions raised in the appeal.

9.3 A written appeal accepted during a personal reception is subject to registration and consideration in the manner established by federal legislation.

9.4 If the appeal contains issues the solution of which is not within the competence of the official, the citizen is given an explanation of where and in what order he should apply.

9.5 A citizen in his written appeal must indicate the name of the institution to which he is sending the written appeal, the surname, first name, patronymic of the relevant official, as well as his surname, first name, patronymic (the latter - if available), postal address to which a response has been sent, a notice of redirection of the appeal, sets out the essence of the proposal, statement or complaint, puts a personal signature and date.

9.6 If necessary, in support of his arguments, the citizen attaches documents and materials or copies thereof to the written appeal.

9.7 A written appeal received by the administration of the clinic or other authorities is considered within 30 days from the date of its registration in the manner established by federal legislation.

9.8 The response to a written appeal received by the administration of the clinic is sent to the postal address specified in the appeal, or delivered personally to the applicant.

The procedure for obtaining information about the patient’s health status

10.1 Information about the child’s health status is provided to the patient or his legally legal representative (mother, father of a child under 15 years old), or an authorized representative (a notarized power of attorney must be provided) in an accessible form that meets the requirements of medical ethics and deontology by the attending physician, head of department or others officials of a medical organization. Grandparents and other relatives of the child are not his legal representatives.

The information should contain information about the results of the examination, the presence of the disease, diagnosis and prognosis, methods of examination and treatment, associated risks, possible options for medical intervention and their consequences, as well as the results of treatment and possible complications. Information about the patient's health status is communicated to members of his family, unless the patient has prohibited telling them about it or has not designated a person to whom such information should be conveyed.

10.2 In relation to minors and persons recognized as legally incompetent, information about the patient’s health status is provided to their legal representative.

10.3 If the patient refuses to receive information about his or her health status, a corresponding entry is made in the medical documentation.

10.4 The information contained in the medical documentation constitutes a medical secret and can be provided without the patient’s consent only on the grounds provided for by legislative acts.

The procedure for issuing certificates and extracts from medical records to the patient or other persons.

11.1 The procedure for issuing documents certifying temporary disability, as well as extracts from medical records, is approved by the Ministry of Health of the Russian Federation.

11.2 Documents certifying the patient’s temporary incapacity for work are a certificate of incapacity for work in the established form, a certificate of temporary incapacity for work (Form-095-u - for students), a certificate of release from official duties. Documents certifying temporary disability, as well as extracts from medical records, are issued by the attending physician.

11.3. The issuance and extension of a document certifying temporary disability is carried out by a doctor after a personal examination of the patient and is confirmed by an entry in the medical documentation justifying the temporary release from work. In case of illness of a child, pupils, students of secondary, special and higher educational institutions, a certificate of the established form is issued to exempt them from study.

11.4. Certificates and extracts from the outpatient card are issued according to the sample and within the time limits established by regulations: Order of the Ministry of Health of Russia dated December 15, 2014. No. 834n “On approval of unified forms of medical documentation used in medical organizations providing medical care on an outpatient basis, and procedures for filling them out,” order of the USSR Ministry of Health dated 10/04/80. No. 1030 “On approval of forms of primary medical documentation of healthcare institutions”; Order of the Ministry of Health and Social Development of the Russian Federation dated May 2, 2012 N 441n “On approval of the Procedure for issuing certificates and medical reports by medical organizations.” It is not allowed to issue certificates of an unspecified type.

11.5 Deadlines for issuing certificates and opinions.

1) certificate of contact with infectious patients, presence of form 20, acute diseases - on the day of application;

2) certificate of visit to a doctor - on the day of the visit;

3) certificate of previous illness - on the day of discharge;

4) Certificate for obtaining a voucher to a sanatorium – 3 working days;

5) Sanatorium-resort card – 5 working days;

6) Certificate of observation at the KSBUZ DGP 24 - on the day of application

7) Statement of health (VK protocol) – 5 working days;

8) History of the child’s development (form 026U for admission to an educational institution) - from 7 to 10 days, depending on the workload of the local medical worker;

9) Certificate in form 086/у (medical professional opinion) – 3 working days, provided that the certificate is filled out by specialized specialists;

10) Referral to medical examination - from 7 to 10 working days if there are reports from specialists, laboratory examination, depending on the workload of the local medical worker;

11) Referral to primary care – from 7 to 10 working days, depending on the workload of the local medical worker.

11.6 For unjustified issuance or incorrect execution of a certificate of incapacity for work (certificate), doctors who are granted the right to issue them are held accountable in the manner prescribed by law.

11.7 Certificates of incapacity for work and certificates of temporary incapacity for work received by the patient must be certified with seals of the established form in the clinic.

Working hours of the clinic and its officials

12.1 The work schedule of the clinic and its officials is determined by the internal labor regulations of the clinic, taking into account the restrictions established by the Labor Code of the Russian Federation.

12.2 The operating hours of the clinic and its officials determine the start and end times of the working day, as well as working days and weekends, lunch and other breaks, the sequence of alternating work in shifts, as well as the working hours of officials. Information about the operating hours of a medical organization is located in the lobby of the clinic, on the doors of the offices and on the institution’s website: www.site

12.3 Individual standards for staff workload (work schedule) are established by the chief physician in accordance with standard job descriptions for clinic staff and in agreement with trade union bodies. The schedule and mode of work are approved by the chief physician.

12.4 Reception of the population (patients and their relatives) by the chief physician or his deputies is carried out at established hours. Information about reception hours can be found on the stand in the hall on the first floor and on the clinic’s website, on the doors of the offices.

Information on the list of types of paid medical services and the procedure for their provision

13.1 The list of paid types of medical care and services provided to the population, as well as the procedure and conditions for their provision to the population, are determined by the Regulations on the provision of paid services of the Khabarovsk State Budgetary Healthcare Institution No. 24 and the Decree of the Government of the Russian Federation No. 1006 “On approval of the rules for the provision of paid medical services by medical organizations.”

13.2 The cost of paid medical services is determined by calculation, taking into account all costs associated with the provision of these services.

13.3 Information about paid types of medical care and services provided to the population by the clinic, as well as the procedure and conditions for their provision to the population, is posted on the information stand on the 2nd floor and in the accounting department.

13.4 The institution informs citizens in an accessible form about the list of paid medical services, indicating their cost, conditions for the provision of services, including information about benefits for certain categories of citizens.

13.5 Payments to patients for the provision of paid medical services are carried out only using a cash register with the issuance of a cash receipt to the patient and the execution of an agreement for the provision of paid services in the accounting department on weekdays from 9.15 to 16.30. Other methods of payment for medical services are illegal.

13.6 Payment for medical services is made on the day the patient applies to receive the service, during the hours allocated for the provision of paid services or by appointment, but does not provide rights of priority service to the detriment of citizens receiving free medical care under the Territorial State Guarantees Program.