Information on the procedure and rules for obtaining vouchers to sanatorium and resort organizations of the Ministry of Defense of the Russian Federation. The procedure for selecting and referring patients for sanatorium-resort treatment The procedure for medical selection for sanatorium-resort treatment

In accordance with articles 5.2.11. and 5.2.101. Regulations on the Ministry of Health and social development of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 2004 N 321 (Collection of Legislation of the Russian Federation, 2004, N 28, Art. 2898), Article 6.2. Federal Law dated July 17, 1999 N 178-FZ “On State Social Assistance” (Collection of Legislation of the Russian Federation, 1999, N 29, Art. 399; 2004, N 35, Art. 3607) and in order to improve the procedure medical selection and referral of patients to Spa treatment I order:

1. Approve:

1.1 The procedure for medical selection and referral of patients for sanatorium treatment (Appendix No. 1).

1.2. Form N 070/у-04 “Certificate for obtaining a voucher” (Appendix No. 2).

1.3. Form N 072/у-04 “Sanatorium-Resort Card” (Appendix No. 3).

1.4. Form N 076/у-04 “Sanatorium-resort card for children” (Appendix No. 4).

1.5. Instructions for filling out form N 070/у-04 “Certificate for obtaining a voucher” (Appendix No. 5).

1.6. Instructions for filling out form N 072/у-04 “Sanatorium-Resort Card” (Appendix No. 6).

1.7. Instructions for filling out form N 076/u-04 “Sanatorium and resort card for children” (Appendix No. 7).

2. Recognize the order of the Ministry of Health of the Russian Federation dated June 14, 2001 N 215 “On the referral of patients to sanatorium-resort and outpatient-resort treatment” as invalid*.

3. Control over the implementation of this order is entrusted to the Deputy Minister of Health and Social Development of the Russian Federation V.I. Starodubova.

Minister M. Zurabov

____________
* Registered with the Ministry of Justice of Russia on July 10, 2001, registration N 2800.

Appendix No. 1

The procedure for medical selection and referral of patients for sanatorium treatment

I. The procedure for medical selection and referral to sanatorium-resort treatment for adults (except for patients with tuberculosis)

1.1. This Procedure defines the basic principles of medical selection and referral of patients for sanatorium treatment.

1.2. Medical selection and referral of patients in need of sanatorium-resort treatment is carried out by the attending physician and the head of the department, and where there is no head of department, the chief physician (deputy chief physician) of the medical institution (outpatient clinic (at the place of residence) or medical and sanitary unit (at the place of work, study) of the patient when sending him for preventive sanatorium treatment and hospital institution when sending the patient for follow-up treatment).

1.3. The attending physician determines the medical indications for spa treatment and the absence of contraindications for its implementation, primarily for the use of natural climatic factors, based on an analysis of the patient’s objective condition, the results of previous treatment (outpatient, inpatient), laboratory, functional, radiological and other data research.

In complex and conflict situations, upon the recommendation of the attending physician and the head of the department, a conclusion on the indications for sanatorium-resort treatment is issued by the medical commission (hereinafter referred to as the MC) of the medical institution.

Sanatorium-resort treatment, in accordance with the doctor’s recommendation and the patient’s application, can also be provided on an outpatient basis (hereinafter referred to as sanatorium-resort treatment).

1.4. When deciding on the choice of a resort, in addition to the disease for which sanatorium-resort treatment is recommended for the patient, one should take into account the presence of concomitant diseases, travel conditions to the resort, contrasting climatic and geographical conditions, features of natural healing factors and other treatment conditions at the recommended resorts.

Patients who are indicated for sanatorium-resort treatment, but are burdened with concomitant diseases, or with age-related health problems, in cases where a trip to remote resorts can have a harmful effect on general condition health, should be sent to nearby sanatorium-resort institutions, organizations (hereinafter - SKO) of the required profile.

1.5. In the presence of medical indications and there are no contraindications for sanatorium-resort treatment, the patient is given a certificate for obtaining a voucher in form N 070/u-04 (hereinafter referred to as a certificate for obtaining a voucher) (Appendix No. 2) with a recommendation for sanatorium-resort treatment, about which the attending physician preventive institution makes an appropriate entry in the medical record of the outpatient. The certificate is valid for 6 months.

1.6. The certificate must be completed by the attending physician in all mandatory sections using the information on back side certificates

The darkened field of the certificate is filled out and marked with the letter “L” in the organizational and methodological office of the medical institution (hereinafter referred to as the organizational and methodological office) only for citizens entitled to receive the kit social services.

The certificate is of a preliminary informational nature and is presented to patients along with an application for a voucher for sanatorium treatment at the place where the voucher was provided, where it is stored for three years.

1.7. Having received a voucher, the patient is obliged, no earlier than 2 months before the start of its validity, to visit the attending physician who issued him a certificate to receive the voucher, in order to conduct the necessary additional examination. If the SCO profile specified in the voucher corresponds to the previous recommendation, the attending physician fills out and issues to the patient a sanatorium-resort card in form N 072/u-04 (hereinafter health resort card) (Appendix No. 3) of the established form, signed by him and the head of the department.

The darkened field of the sanatorium-resort card is filled out and marked with the letter “L” in the organizational and methodological office only for citizens entitled to receive a set of social services.

About the issuance of a sanatorium-resort card, the attending physician of a medical institution makes an appropriate entry in the medical record of the outpatient (in the medical history when referred for follow-up treatment).

1.8. The organizational and methodological office monitors the timely provision of sanatorium and resort treatment and keeps records of the following documents issued to citizens entitled to receive a set of social services:

The number of certificates issued to obtain a voucher;

Number of health resort cards issued;

Number of return coupons for sanatorium and resort cards.

1.9. Attending physicians and heads of departments should be guided by the following mandatory list diagnostic studies and consultations with specialists, the results of which must be reflected in the sanatorium-resort card:

A) clinical analysis blood and urine analysis;

b) electrocardiographic examination;

V) X-ray examination organs chest(fluorography);

d) for diseases of the digestive organs - their fluoroscopic examination (if since the last X-ray examination more than 6 months have passed) or ultrasound, endoscopy;

e) in necessary cases are carried out additional research: determination of residual blood nitrogen, fundus examination, gastric juice, liver, allergy tests, etc.;

f) when sending women to sanatorium-resort treatment for any disease, a conclusion from an obstetrician-gynecologist is required, and for pregnant women - an additional exchange card;

g) a certificate from a psychoneurological dispensary if the patient has a history of neuropsychiatric disorders;

h) with the main or concomitant diseases(urological, skin, blood, eyes, etc.) - conclusion of relevant specialists.

II. The procedure for medical selection and referral of children to sanatorium-resort treatment

2.1. Medical selection of children for treatment in health resort organizations carried out by treatment and preventive institutions, which must provide:

Registration of children in need of sanatorium-resort treatment;

Monitoring the completeness of examination of patients before referral to sanatorium-resort treatment and the quality of medical documentation;

Accounting for defects in selection, referral of children to sanatorium-resort treatment and analysis of its effectiveness.

2.2. The need to refer a child to sanatorium-resort treatment

determined by the attending physician of the medical institution with the issuance of a certificate for obtaining a voucher for the child (to be provided at the place of request) and a sanatorium-resort card for children in form N 076/u-04 (hereinafter referred to as the sanatorium-resort card for children) (Appendix N 4).

In the organizational and methodological office, mark with the letter “L” and fill out the darkened field of the certificate for obtaining a voucher and a sanatorium-resort card for children, only for children from among citizens entitled to receive a set of social services.

2.3. Referral of children to sanatorium-resort treatment is carried out in a manner similar to that for adult patients.

2.4. Medical selection of adult patients sent together with children to sanatoriums for children with parents is carried out in the manner established in sections I and III of this Procedure. When determining the CODE profile, the child’s illness and the absence of contraindications for sanatorium-resort treatment for his accompanying person are taken into account.

2.5. Before sending a child for sanatorium-resort treatment, the attending physician organizes his clinical and laboratory examination depending on the nature of the disease, as well as the sanitation of chronic foci of infection, anthelmintic or anti-giardiasis treatment.

2.6. When referring a child for sanatorium treatment, you must have the following documents:

Voucher;

Sanatorium-resort card for children;

Compulsory health insurance policy;

Analysis for enterobiasis;

Conclusion from a dermatologist confirming the absence of contagious skin diseases;

A certificate from a pediatrician or epidemiologist confirming that the child has no contact with infectious patients at the place of residence, in kindergarten or school.

2.7. At the end of the sanatorium-resort treatment, the child is issued a return coupon of the sanatorium-resort card for submission to the medical institution that issued the sanatorium-resort card, as well as a sanatorium booklet with data on the treatment carried out in SKO, its effectiveness, medical recommendations.

This documentation is handed over to the parents or accompanying person.

III. Procedure for admission and discharge of patients

3.1. Upon arrival at the SKO, the patient presents a voucher and a sanatorium-resort card, which is stored in the SKO for three years. In addition, the patient is recommended to have a compulsory health insurance policy.

3.2. After initial examination The attending physician of the SKO issues a sanatorium book to the patient, in which the prescribed healing procedures and other appointments. The patient presents it to medical units Standard deviation for marking the treatment or examination performed.

3.3. When providing health resort assistance, types and volumes medical services are provided in accordance with the standards recommended by the Ministry of Health and Social Development of the Russian Federation.

3.4. Upon completion of the course of sanatorium-resort treatment, the patient is given a return coupon of the sanatorium-resort card and a sanatorium book with data on the treatment carried out in SKO, its effectiveness, recommendations for healthy image life, which the patient is obliged to submit to the medical institution that issued the sanatorium-resort card or to the outpatient clinic at the patient’s place of residence after completing the course of follow-up treatment.

3.5. Return coupons for sanatorium-resort cards are filed in the medical record of an outpatient patient and are stored in a medical institution for three years.

3.6. Documents certifying the temporary disability of citizens due to acute illness, injury or exacerbation of a chronic disease that arose during the period of their stay at a sanatorium-resort treatment, are issued, as a rule, by medical institutions at the patient’s place of stay, in accordance with current regulatory legal documents.

IV. The procedure for identifying and evacuating patients who are contraindicated for sanatorium treatment

4.1. Staying in a medical facility, which entails a deterioration in the patient’s health, is considered contraindicated for him.

4.2. When determining a contraindication to sanatorium-resort treatment, doctors of a medical institution and health care institution must be guided by contraindications approved in the established manner, excluding the referral of patients to sanatorium-resort treatment, taking into account in each individual case not only the form and stage of the disease, but also the degree of danger of the stay at a resort or sanatorium for him, as well as for those around him.

4.3. Contraindications for the referral and stay of a patient in a medical treatment facility are established by the attending physician, and in conflict cases - by the Institutional Institution of the medical institution, the medical treatment facility.

The attending physician or the Institutional Inspectorate of the medical institution, SKO determines:

Presence of contraindications for treatment;

The possibility of leaving the patient in the SKO for balneological, climatic, medicinal or other treatment;

The need to transfer the patient to a hospital or transport with an accompanying person at the place of residence;

The need to provide assistance in purchasing travel tickets, etc.

4.4. The period for identifying a contraindication for a patient’s stay in a medical facility, as a rule, should not exceed 5 days from the moment of his admission.

4.5. If a patient has contraindications to the HC, the SKO draws up a report on the patient’s contraindication to sanatorium-resort treatment in 3 copies: one of which is sent to the health care authority of a constituent entity of the Russian Federation, the second to the medical institution that issued the sanatorium-resort card for review. on VK, and the third copy of the act remains in SKO.

4.6. Health authorities of the constituent entities of the Russian Federation annually analyze the selection and referral of patients for sanatorium-resort treatment and, if necessary, take appropriate measures.

Appendix No. 5

Instructions for filling out form N 070/у-04 "Certificate for obtaining a voucher"

The certificate for obtaining a voucher is of a preliminary informational nature, does not replace a sanatorium-resort card and does not give the right to enter the SKO for sanatorium-resort treatment, which can also be provided on an outpatient basis.

A certificate for obtaining a voucher is filled out by attending physicians of medical institutions providing outpatient care.

The darkened field of the certificate for obtaining a voucher (items 6-13) is filled out and marked with the letter “L” in the organizational and methodological office only for citizens entitled to receive a set of social services.

On title page on the certificate for obtaining a voucher, the full name of the medical institution is indicated in accordance with the registration document.

The certificate number for obtaining a voucher is the individual registration number of the certificate for obtaining a voucher, established by the medical institution.

In the item “Region of residence” the code of the subject of the Russian Federation in which the patient lives is indicated, in accordance with the list of subjects of the Russian Federation located on the reverse side of the certificate for obtaining a voucher.

The item “Nearest region” is filled in only if the patient lives in a territory located near the border of another subject of the Russian Federation, indicating the code of this subject of the Russian Federation.

In the paragraphs “Climate in the place of residence” and “Climatic factors in the place of residence”, digital codes are indicated in accordance with the list of climates in the place of residence given on the back of the certificate for obtaining a voucher.

The “Diagnosis” item is filled out in accordance with ICD-10 ( International classification diseases) according to medical documentation about the forms, stages, nature of the disease.

In the paragraph “Disease for the treatment of which the patient is sent to a sanatorium,” the diagnosis of the disease for the treatment of which the patient is sent to a sanatorium is indicated.

The paragraph “Main disease or disease causing disability” indicates the diagnosis of the main disease, and for disabled people and disabled children - the diagnosis of the disease causing disability.

In the “Concomitant diseases” section, diagnoses of concomitant diseases are indicated.

Items " Preferred location treatment" and "Recommended treatment seasons" are not required to be filled out.

The certificate is certified by the signatures of the attending physician, the head of the department or the chairman of the Institution and the round seal of the medical institution.

Appendix No. 6

Instructions for filling out form N 072/u-04 “Sanatorium-resort card”

A sanatorium-resort card is issued by the attending physician upon presentation by the patient of a voucher for sanatorium-resort treatment, which can also be provided on an outpatient basis (hereinafter referred to as sanatorium-resort treatment).

Sanatorium-resort card;

Return coupon.

The sanatorium-resort card is filled out by attending physicians of medical institutions providing outpatient care.

The darkened field of the sanatorium-resort card (items 8-11) is filled out and marked with the letter “L” in the organizational and methodological office only for citizens entitled to receive a set of social services.

On the title page of the sanatorium-resort card, the full name of the medical institution is indicated, in accordance with the registration document.

Last name, first name, patronymic, gender, date of birth, address of permanent residence in the Russian Federation are filled in in accordance with the citizen’s identity document.

In paragraph "N of the medical history or outpatient card"indicate the registration number of these documents, established by the medical institution.

In the paragraph "Identification number in the compulsory medical insurance system" for medical insurance compulsory medical insurance policy the identification number is indicated in accordance with the form of the submitted policy, where twelve characters are determined for the series and policy number.

The “Benefit Code” item is filled out in accordance with Chapter 2 of the Federal Law of July 17, 1999 N 178-FZ “On State Social Assistance”. A list of categories of citizens entitled to receive a set of social services, indicating the codes, is given on the back of the certificate for obtaining a voucher. The specified item is filled in by placing zeros before the first significant digit.

Example: if a citizen who has the right to receive a set of social services belongs to the second category, “002” is entered in the “Benefit Code” item.

In the paragraph “Document certifying the right to receive a set of social services,” an entry is made according to the details of the submitted document (number, series, date).

In the paragraph “Insurance number of an individual personal account (SNILS)” the insurance number of an individual personal account is indicated on the document certifying the right to receive a set of social services. The “Accompaniment” item is filled in if the patient is one of the citizens with limited ability to labor activity III degree.

The items “Place of work, study” and “Position held, profession” are filled out from the patient’s words.

The item “Complaints, duration of illness, medical history, previous treatment, including sanatorium-resort treatment” is filled out on the basis of medical documentation and from the patient’s words.

The item “Data of clinical, laboratory, radiological and other studies” is filled in on the basis medical documents with the obligatory indication of the date of the study.

The “Diagnosis” item is filled out in accordance with ICD-10, according to medical documentation about the forms, stages, and nature of the disease.

The return coupon is filled out by the attending physician of the sanatorium-resort organization for presentation to patients at the medical institution that issued the sanatorium-resort card (after completion of the course of follow-up treatment - to the outpatient clinic at the place of residence).

Last name, first name, patronymic are filled in in accordance with the citizen’s identity document recognized on the territory of the Russian Federation.

The item “Diagnosis upon admission” is filled out in accordance with ICD-10 according to the information specified in the sanatorium card.

The subparagraph “Disease for the treatment of which the patient is sent to a sanatorium” indicates the diagnosis of the disease for the treatment of which the patient is sent to a sanatorium.

The subparagraph “Main disease or disease causing disability” indicates the diagnosis of the main disease, and for disabled people - the diagnosis of the disease causing disability.

The subparagraph “Concomitant diseases” indicates diagnoses of concomitant diseases.

The subparagraph “Main disease or disease causing disability” indicates the diagnosis of the main disease, and for disabled people - the diagnosis of the disease causing disability.

The subparagraph “Concomitant diseases” indicates diagnoses of concomitant diseases.

Appendix No. 7

Instructions for filling out form N 076/u-04 "Sanatorium-resort card for children"

A sanatorium-resort card for children is issued by the attending physician upon presentation to the patient of a voucher for sanatorium-resort treatment, which can also be provided on an outpatient basis (hereinafter referred to as sanatorium-resort treatment).

The health resort card form consists of:

Sanatorium-resort card;

Return coupon.

The sanatorium-resort card is filled out by attending physicians of medical institutions providing outpatient care to children.

The darkened field of the sanatorium-resort card (items 8-11) is filled out and marked with the letter “L” in the organizational and methodological office only for children from among citizens entitled to receive a set of social services.

On the title page of the sanatorium-resort card, the full name of the medical and preventive institution is indicated in accordance with the registration document.

The health resort card number is the individual registration number of the health resort card established by the health care institution.

Last name, first name, patronymic, gender, date of birth, address of permanent residence in the Russian Federation are filled in in accordance with the citizen’s identity document.

In paragraph “N of the history of development (disease)” the registration number of this document, established by the medical institution, is indicated.

In the paragraph “Identification number in the compulsory medical insurance system” for the compulsory medical insurance policy, the identification number is indicated in accordance with the form of the submitted policy, where twelve characters are determined for the series and policy number.

Example: if a citizen who has the right to receive a set of social services belongs to the second category, “002” is entered in the “Benefit Code” item.

In the paragraph “Document certifying the right to receive a set of social services,” an entry is made according to the details of the submitted document (number, series, date).

The “Accompaniment” item is filled in if the patient is a disabled child.

The items “Educational institution” and “Parents’ place of work” are filled in from the words of the person accompanying the child.

Items "Anamnesis", "Heredity", " Preventive vaccinations", "Anamnesis of the present illness", "Have you used sanatorium-resort treatment before", "Name of the previously visited sanatorium-resort organization, date of visit", "Data of clinical, laboratory, radiological and other studies (dates)" are filled in based on the history data development (illness) of the child and other medical documentation.

The “Diagnosis” item is filled out in accordance with ICD-10 based on information from medical documentation about the forms, stages, and nature of the disease.

The subparagraph “Disease for the treatment of which the patient is sent to a sanatorium” indicates the diagnosis of the disease for the treatment of which the patient is sent to a sanatorium.

The subparagraph “Concomitant diseases” indicates diagnoses of concomitant diseases.

The sanatorium-resort card is certified by the signatures of the attending physician, the head of the department or the chairman of the Institution and the round seal of the medical institution.

The return coupon is filled out by the attending physician of the sanatorium-resort organization for presentation to the medical institution that issued the sanatorium-resort card.

The full name of the sanatorium and resort organization is indicated on the title page of the return coupon in accordance with the registration document.

The child's last name, first name and patronymic are filled in in accordance with the citizen's identity document recognized on the territory of the Russian Federation.

The item “Diagnosis upon discharge from the sanatorium” is filled out in accordance with ICD-10 according to the medical documentation of the sanatorium organization about the forms, stages, and nature of the course of the disease.

The subparagraph “Main disease or disease causing disability” indicates the diagnosis of the main disease, and for disabled children - the diagnosis of the disease causing disability.

The subparagraph “Concomitant diseases” indicates diagnoses of concomitant diseases.

In the section “Treatment carried out”, information from the sanatorium book is indicated. If the types of treatment or number of procedures did not meet the corresponding recommended standard of sanatorium-resort care, the attending physician makes a note indicating the reasons in the paragraph “Reasons for deviation from the standard of sanatorium-resort care.”

The “Epicrisis” item indicates information about the treatment received by the patient in a sanatorium-resort organization and his condition at the time of discharge based on the data of the sanatorium book, medical documentation and the objective condition of the patient.

The items “Treatment results”, “Presence of exacerbations that required cancellation of procedures” and “Recommendations for further treatment” are filled out based on the data specified in the “Epicrisis” item.

If there is contact with infectious patients during a stay in a sanatorium-resort organization, a mark is made in the paragraph “Contacts with patients infectious diseases" indicating the date and diagnosis of the disease.

The item “Transferred intercurrent diseases and exacerbation of the main and concomitant diseases” is filled out on the basis of medical documentation data.

The return coupon is certified by the signatures of the attending physician, the chief physician and the round seal of the sanatorium-resort organization.

Appendix No. 1. The procedure for medical selection and referral of patients for sanatorium-resort treatment Appendix No. 2. Form N 070/u-04 “Certificate for obtaining a voucher” Appendix No. 3. Form N 072/u-04 “Sanatorium-resort card” ( no longer valid) Appendix No. 4. Form N 076/u-04 “Sanatorium-resort card for children” (no longer valid) Appendix No. 5. Instructions for filling out form N 070/u-04 “Certificate for obtaining a voucher” (no longer valid) Appendix No. 6. Instructions for filling out form N 072/u-04 “Sanatorium and resort card” (no longer valid) Appendix No. 7. Instructions for filling out form N 076/u-04 “Health resort card for children” (no longer valid)

Order of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004 N 256
"On the procedure for medical selection and referral of patients for sanatorium-resort treatment"

With changes and additions from:

3. Control over the implementation of this order is entrusted to the Deputy Minister of Health and Social Development of the Russian Federation V.I. Skvortsov.

M.Yu. Zurabov

_____________________________

* Registered with the Ministry of Justice of Russia on July 10, 2001 registration N 2800

Registration No. 6189

Medical selection and referral of patients in need of sanatorium-resort treatment is carried out by the attending physician and the head of the department, or in his absence, the chief physician (his deputy) of the medical institution (outpatient clinic (at the place of residence) or medical unit ( at the place of work, study).

The doctor determines the medical indications for spa treatment and the absence of contraindications for its implementation based on an analysis of the patient’s objective condition and the results of previous treatment, data from laboratory, functional, radiological and other studies. In complex and conflict situations, a conclusion on the indications for sanatorium-resort treatment is issued by the medical commission of the medical institution.

The features of medical selection and referral for sanatorium-resort treatment of children, as well as the procedure for admission and discharge of patients are established.

Document forms N 070/u-04 “Certificate for obtaining a voucher”, N 072/u-04 “Sanatorium-resort card”, N 076/u-04 “Sanatorium-resort card for children” and the procedure for filling them out are provided.

Order of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004 N 256 “On the procedure for medical selection and referral of patients for sanatorium treatment”

Registration No. 6189

This order comes into force 10 days after the day of its official publication

(as amended by Orders of the Ministry of Health and Social Development of the Russian Federation dated January 09, 2007 N 3,

From December 24, 2007 N 794)

I. The procedure for medical selection and referral to sanatorium-resort treatment for adults

(except for patients with tuberculosis)

1.1. This Procedure defines the basic principles of medical selection and referral of patients for sanatorium treatment.

1.2. Medical selection and referral of patients in need of sanatorium-resort treatment (with the exception of citizens specified in paragraph two of this paragraph) is carried out by the attending physician and the head of the department, and where there is no head of the department, the chief physician (deputy chief physician) of the treatment and prophylactic institution (an outpatient clinic (at the place of residence) or a medical unit (at the place of work, study) of the patient when sending him to preventive sanatorium-resort treatment and a hospital institution when sending the patient for follow-up treatment).

Medical selection and referral for sanatorium-resort treatment of citizens entitled to receive state social assistance in the form of a set of social services is carried out by the attending physician and the medical commission (hereinafter referred to as the MC) of the medical institution at the place of residence.

(as amended by Order of the Ministry of Health and Social Development of the Russian Federation dated January 09, 2007 N 3)

The VC of a medical treatment institution, upon the recommendation of the attending physician and the head of the department, issues a conclusion on the indications or contraindications of sanatorium-resort treatment to citizens entitled to receive state social assistance in the form of a set of social services.

(paragraph introduced by Order of the Ministry of Health and Social Development of the Russian Federation dated 01/09/2007 N 3)

Patients who are indicated for sanatorium-resort treatment, but are burdened with concomitant diseases, or with health problems of an age-related nature, in cases where a trip to distant resorts can adversely affect their general health, should be sent to nearby sanatorium-resort institutions, organizations (hereinafter - RMS) of the required profile.

1.5. If there are medical indications and there are no contraindications for sanatorium-resort treatment, the patient is given a certificate for obtaining a voucher in the form N 070/u-04 (hereinafter referred to as a certificate for obtaining a voucher) (Appendix No. 2) with a recommendation for sanatorium-resort treatment, about which The attending physician of the medical institution makes an appropriate entry in the medical record of the outpatient.

(as amended by Order of the Ministry of Health and Social Development of the Russian Federation dated January 09, 2007 N 3)

Citizens who have the right to receive state social assistance in the form of a set of social services are issued a certificate for receiving a voucher based on the conclusion of the VC of the medical institution.

(paragraph introduced by Order of the Ministry of Health and Social Development of the Russian Federation dated January 9, 2007 N 3, as amended by Order of the Ministry of Health and Social Development of the Russian Federation dated December 24, 2007 N 794)

The validity period of the certificate for obtaining a voucher is 6 months.

(paragraph introduced by Order of the Ministry of Health and Social Development of the Russian Federation dated 01/09/2007 N 3)

1.6. The certificate must be completed by the attending physician in all required sections using the information on the back of the certificate.

1.7. Having received a voucher, the patient is obliged, no earlier than 2 months before the start of its validity, to visit the attending physician who issued him a certificate to receive the voucher, in order to conduct the necessary additional examination. If the SCO profile specified in the voucher corresponds to the previous recommendation, the attending physician fills out and issues to the patient a sanatorium-resort card in the form N 072/u-04 (hereinafter referred to as the sanatorium-resort card) (Appendix No. 3) of the established form, signed by him and head of the department.

The number of certificates issued to obtain a voucher;

Number of health resort cards issued;

Number of return coupons for sanatorium and resort cards.

1.9. Attending physicians, heads of departments and medical institutions of medical institutions must be guided by the following mandatory list of diagnostic studies and consultations with specialists, the results of which must be reflected in the sanatorium-resort card:

(as amended by Order of the Ministry of Health and Social Development of the Russian Federation dated January 09, 2007 N 3)

A) clinical blood test and urine test;

B) electrocardiographic examination;

C) X-ray examination of the chest organs (fluorography);

D) for diseases of the digestive organs - their X-ray examination (if more than 6 months have passed since the last X-ray examination) or ultrasound, endoscopy;

D) if necessary, additional studies are carried out: determination of residual blood nitrogen, examination of the fundus, gastric juice, liver tests, allergy tests, etc.;

E) when sending women to sanatorium-resort treatment for any disease, a conclusion from an obstetrician-gynecologist is required, and for pregnant women - an additional exchange card;

G) certificate-conclusion from a psychoneurological dispensary if the patient has a history of neuropsychiatric disorders;

H) in case of main or concomitant diseases (urological, skin, blood, eyes, etc.) - the conclusion of relevant specialists.

1.10. The chief doctors of treatment and preventive institutions monitor the implementation of this Procedure and the organization of medical selection and referral of patients (adults and children) to sanatorium-resort treatment.

II. The procedure for medical selection and referral of children to sanatorium-resort treatment

2.1. Medical selection of children for treatment in sanatorium-resort organizations is carried out by treatment and preventive institutions, which must provide:

Registration of children in need of sanatorium-resort treatment;

Monitoring the completeness of examination of patients before referral to sanatorium-resort treatment and the quality of medical documentation;

Accounting for defects in selection, referral of children to sanatorium-resort treatment and analysis of its effectiveness.

2.2. The need to refer a child for sanatorium-resort treatment is determined by the attending physician and the head of the department of the medical-prophylactic institution, and for children entitled to receive state social assistance in the form of a set of social services, by the attending physician and the Institution of Internal Affairs of the medical-prophylactic institution at the place of residence with the issuance of a certificate for obtaining a voucher for a child (to be provided at the place of request) and a sanatorium and resort card for children in form N 076/u-04 (hereinafter referred to as a sanatorium and resort card for children) (Appendix No. 4).

(as amended by Order of the Ministry of Health and Social Development of the Russian Federation dated January 09, 2007 N 3)

In the organizational and methodological office of the medical institution, mark with the letter “L” and fill out the darkened field of the certificate to receive a voucher and a sanatorium-resort card for children only for children from among citizens entitled to receive a set of social services.

(as amended by Order of the Ministry of Health and Social Development of the Russian Federation dated January 09, 2007 N 3)

2.3. Referral of children to sanatorium-resort treatment is carried out in a manner similar to that for adult patients.

2.6. When referring a child for sanatorium treatment, you must have the following documents:

Voucher;

Sanatorium-resort card for children;

Compulsory health insurance policy;

Analysis for enterobiasis;

Conclusion from a dermatologist confirming the absence of contagious skin diseases;

A certificate from a pediatrician or epidemiologist confirming that the child has no contact with infectious patients at the place of residence, kindergarten or school.

2.7. At the end of the sanatorium-resort treatment, the child is issued a return coupon of the sanatorium-resort card for submission to the medical institution that issued the sanatorium-resort card, as well as a sanatorium book with data on the treatment carried out in the SKO, its effectiveness, and medical recommendations.

This documentation is handed over to the parents or accompanying person.

III. Procedure for admission and discharge of patients

3.2. After the initial examination, the attending physician of the SKO gives the patient a sanatorium book, in which the prescribed medical procedures and other appointments are recorded. The patient presents it to the medical departments of the SKO to mark the treatment or examination performed.

3.3. When providing health resort care, the types and volumes of medical services are provided in accordance with the standards recommended by the Ministry of Health and Social Development of the Russian Federation.

3.4. Upon completion of the course of sanatorium-resort treatment, the patient is given a return coupon for the sanatorium-resort card and a sanatorium booklet with data on the treatment carried out in SKO, its effectiveness, and recommendations for a healthy lifestyle. The patient must submit the return coupon of the sanatorium-resort card to the medical institution that issued the sanatorium-resort card or to the outpatient clinic at the patient’s place of residence after completing the course of follow-up treatment.

(as amended by Order of the Ministry of Health and Social Development of the Russian Federation dated January 09, 2007 N 3)

3.5. Return coupons for sanatorium-resort cards are filed in the medical record of an outpatient patient and are stored in a medical institution for three years.

3.6. Documents certifying the temporary disability of citizens caused by an acute illness, injury or exacerbation of a chronic disease that arose while they were undergoing sanatorium-resort treatment are issued, as a rule, by medical institutions at the patient’s place of stay in accordance with current regulatory legal documents.

IV. The procedure for identifying and evacuating patients who are contraindicated for sanatorium treatment

4.1. Staying in a medical facility, which entails a deterioration in the patient’s health, is considered contraindicated for him.

4.2. When determining a contraindication to sanatorium-resort treatment, doctors of medical institutions and health care institutions must be guided by contraindications approved in the established manner, excluding the referral of patients to sanatorium-resort treatment, taking into account in each individual case not only the form and stage of the disease, but also the degree of danger of staying at resort or sanatorium for him, as well as for those around him.

The attending physician or the Institutional Inspectorate of the medical institution, SKO determines:

Presence of contraindications for treatment;

The possibility of leaving the patient in the SKO for balneological, climatic, medicinal or other treatment;

The need to transfer the patient to a hospital or transport with an accompanying person at the place of residence;

The need to provide assistance in purchasing travel tickets, etc.

4.4. The period for identifying a contraindication for a patient’s stay in a medical facility, as a rule, should not exceed 5 days from the moment of his admission.

4.5. If a patient has contraindications to the HC, the SKO draws up a report on the patient’s contraindication to sanatorium-resort treatment in 3 copies, one of which is sent to the health care authority of a constituent entity of the Russian Federation, the second to the medical institution that issued the sanatorium-resort card for review. on VK, and the third copy of the act remains in SKO.

According to the order of the Ministry of Health and Social Development of the Russian Federation dated November 22, 2004 No. 256 “On the procedure for medical selection and referral of patients for sanatorium-resort treatment,” medical selection and referral for sanatorium-resort treatment of citizens is carried out by the attending physician and the head of the department or a medical commission (for citizens entitled to receive state social assistance in the form of a set of social services) of a treatment and preventive institution at their place of residence.

If there are indications and no contraindications for referral to sanatorium-resort treatment, the patient is issued a certificate to receive a voucher for sanatorium-resort treatment" (form No. 070/u). Medical indications and contraindications for sanatorium-resort treatment are determined by Order of the Ministry of Health of Russia dated 05.05.2016 No. 281n “On approval of lists of medical indications and contraindications for sanatorium-resort treatment.” If the patient has diseases included in the list of medical indications for sanatorium-resort treatment of the child population, on the basis of a certificate for obtaining a voucher for sanatorium-resort treatment (form No. 070/u), an application is made in the sanatorium-resort treatment monitoring subsystem of the Russian Ministry of Health.

In accordance with the letter of the Ministry of Health and Social Development of the Russian Federation dated May 29, 2009 No. 14-5/10/2-4265 “On sending children for sanatorium-resort treatment to sanatorium-resort institutions under the jurisdiction of the Ministry of Health and Social Development of Russia” to sanatorium-resort Institutions under the jurisdiction of the Ministry of Health of the Russian Federation send children from 4 to 14 years of age inclusive, including accompanied by a legal representative, from 15 to 18 years of age unaccompanied, unless the need for accompaniment is due to medical indications. Children aged 2 years and older are sent to sanatorium-resort institutions with a psychoneurological profile, accompanied by a legal representative.

When contacting the Moscow City Health Department regarding referral of a child for sanatorium-resort treatment in a sanatorium under the jurisdiction of the Ministry of Health of the Russian Federation, the following documents must be provided:

application from the legal representative of a minor to send the child to a sanatorium-resort treatment;
statement from the legal representative of the minor regarding consent to the processing of personal data;
a copy of the passport of the legal representative of the minor with information on registration at the place of residence;
a copy of the child's birth certificate;
a copy of the compulsory health insurance policy;
a document confirming the child’s registration in the city of Moscow;
a copy of the certificate for obtaining a voucher for sanatorium treatment (form No. 070/u);
copy of SNILS (if available).

The structure of Moscow city healthcare includes sanatoriums for children: general, bronchopulmonary, orthopedic, cardio-rheumatological, nephrological and gastroenterological profiles. All sanatoriums provide for the stay of children throughout the year.

In accordance with the order of the Ministry of Health and Social Development of Russia dated November 22, 2004 No. 256 “On the procedure for medical selection and referral of patients for sanatorium-resort treatment,” medical selection and referral of patients in need of sanatorium-resort treatment are carried out by the attending physician and the head of the department. The presence of medical indications for sanatorium-resort treatment and the absence of contraindications for its implementation is within the competence of the attending physician and is determined in accordance with the order of the Ministry of Health of Russia dated 05.05.2016 No. 281n “On approval of lists of medical indications and contraindications for sanatorium-resort treatment.” The decision is made based on an analysis of the patient’s objective condition, the results of previous treatment (outpatient, inpatient), data from laboratory, functional, radiological and other studies. If there are indications and there are no contraindications for treatment, the following will be issued to the sanatorium: a voucher to the sanatorium; sanatorium-resort card for children (registration form N 076/u) and a certificate from a pediatrician or epidemiologist confirming the absence of contact with patients with infectious diseases (for those attending educational institutions, a certificate of no contact with patients with infectious diseases from educational institution(kindergartens, schools).

In addition, the following documents of the child must be submitted to the sanatorium: birth certificate and compulsory health insurance policy (it is advisable to provide a photocopy of these documents).

Considering individual characteristics child, as well as the profile (specialization) of the sanatorium; in some cases, the decision on the possibility of a child’s stay is decided by a commission at the sanatorium.

In accordance with Article 37 of the Federal Law dated November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (as amended on July 3, 2016), sanatorium-resort treatment must be organized in accordance with the Order of the Russian Ministry of Health dated May 5, 2016 No. 279n “On approval of the Procedure for organizing sanatorium and resort treatment” (registered with the Ministry of Justice of Russia on June 21, 2016 No. 42,580). This order approved by the authorized federal executive body - the Ministry of Health of the Russian Federation. The procedure for organizing sanatorium-resort treatment is mandatory for execution on the territory of the Russian Federation. Spa treatment includes medical care carried out medical organizations(sanatorium and resort organizations) for preventive, therapeutic and rehabilitation purposes.

Sanatorium-resort treatment is aimed at activating the body’s protective and adaptive reactions in order to prevent diseases, improve health, restore and/or compensate for body functions impaired due to injuries, operations and chronic diseases, to reduce the number of exacerbations, lengthen the period of remission, slow down the development of diseases and prevent disability as one of the stages of medical rehabilitation.

When organizing spa treatment, nutritional therapy is part of complex therapy.

Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (as amended on July 3, 2016), Article 39 “Therapeutic nutrition”:

"1. Therapeutic nutrition is nutrition that ensures the satisfaction of the physiological needs of the human body in nutrients and energy, taking into account the mechanisms of development of the disease, the characteristics of the course of the main and concomitantdiseases and performing preventive and therapeutic tasks.”

Medical nutrition must be organized in accordance with the standards therapeutic nutrition and the requirements of Russian legislation for the organization of dietary therapeutic and dietary preventive nutrition.

New requirements

Order of the Ministry of Health of Russia dated 05.05.2016 No. 279n “On approval of the Procedure for organizing sanatorium and resort treatment” (registered with the Ministry of Justice of Russia on 06.21.2016 No. 42 580), paragraph 18:

“The organization of therapeutic nutrition is one of the main therapeutic measures(8) when providing sanatorium-resort treatment in sanatoriums, sanatoriums for children, including for children with parents, sanatoriums and year-round sanatorium-improving camps.

Medical nutrition is carried out in compliance with established standards (9).

(8) Order of the Ministry of Health of the Russian Federation dated 05.08.2003 No. 330 “On measures to improve therapeutic nutrition in medical preventive institutions Russian Federation" (registered by the Ministry of Justice of the Russian Federation on September 12, 2003, registration No. 5073), as amended by orders of the Ministry of Health and Social Development of the Russian Federation dated October 7, 2005 No. 624 (registered by the Ministry of Justice of the Russian Federation on November 1 2005, registration No. 7134), dated January 10, 2006 No. 2 (registered by the Ministry of Justice of the Russian Federation on January 24, 2006, registration No. 7411), dated April 26, 2006 No. 316 (registered by the Ministry of Justice of the Russian Federation May 26, 2006, registration No. 7878) and by order of the Ministry of Health of the Russian Federation dated June 21, 2013 No. 395n (registered by the Ministry of Justice of the Russian Federation on July 5, 2013, registration No. 28 995).

(9) Order of the Ministry of Health of the Russian Federation dated June 21, 2013 No. 395n “On approval of clinical nutrition standards” (registered by the Ministry of Justice of the Russian Federation on July 5, 2013, registration No. 28 995).”

Six standard diets

Cancellation of old norms

features of the application of regulatory documents

Purpose of diets

Specialty Products - Order Requirement

Vitamins in the diet

Individual therapeutic nutrition program

Drawing up an individual program

Summary

Rice. 1. Standard diets used in sanatorium-resort organizations

Rice. 2. Modern chronological classification of law enforcement and by-laws on the organization of medical nutrition in sanatorium and resort organizations

Table 1. Prescribing diets (part 1)

Table 1.2. Prescribing diets (part 2)

Layout card No. 5.4

Name of the dish: cottage cheese casserole with sugar with the addition of a dry protein composite mixture (SBKS) 9 g
Indicated for diets: OVD, ShchD, VBD, VKD, NKD
Weight ready-made dish(g): 110

Table 2. Protein correction of standard diets (in accordance with the norms of therapeutic nutrition approved by order of the Ministry of Health of the Russian Federation No. 395n)

Table 3. Fortification of the therapeutic diet (in accordance with the norms of therapeutic nutrition approved by order of the Ministry of Health of the Russian Federation No. 395n)