Referring children to sanatorium-resort treatment. The procedure for medical selection and referral to sanatorium-resort treatment The procedure for providing medical care at sanatorium-resorts

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” (Collected Legislation of the Russian Federation, 1999, N 29, Art. 399; 2004, N 35, Art. 3607) and in order to improve the procedure for medical selection and referral of patients on 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 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. 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 a set of 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 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 the head department.

Shaded field health resort card is filled out and marked with the letter “L” in the organizational and methodological office only for citizens who have the right 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;

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;

e) in necessary cases additional studies are carried out: 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”, the registration number of these documents, established by the medical institution, is indicated.

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.

Items " Educational institution" and "Place of work of parents" are filled in according to 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 note is made in the paragraph “Contacts with patients with 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.

^ The procedure for providing health resort services medical care

1. Sanatorium-resort treatment is provided to patients within the framework of sanatorium-resort medical care in state, municipal, departmental and other forms of ownership of sanatorium-resort institutions and clinics that are part of medical scientific organizations licensed to provide services in the type of activity “sanatorium-resort” resort care", which provides for the performance of work (services) to provide sanatorium-resort medical care to citizens in accordance with the list of works (services) in the implementation of medical activities, approved by the Ministry of Health and Social Development of the Russian Federation, mainly using natural healing factors (mineral waters , therapeutic mud, climate, etc.) in combination with physiotherapy, physical therapy, therapeutic nutrition and others medicinal products.

The main objectives of sanatorium-resort treatment are: activation of the body’s protective and adaptive reactions for the purpose of primary prevention of diseases, restoration and compensation of impaired functions in chronic diseases, reducing the number of exacerbations, lengthening the period of remission, slowing the progression of diseases (secondary prevention) and preventing disability.

2. The provision of sanatorium and resort care to patients is carried out in accordance with the standards of medical care and regulatory legal acts of the federal executive body in the field of health care,

Relevant executive authorities of the constituent entity of the Russian Federation and local government bodies.

3. The procedure for organizing sanatorium-resort care includes two main stages - selection of patients for sanatorium-resort treatment and sanatorium-resort treatment in the conditions of sanatorium-resort institutions.

4. The effectiveness of ongoing medical and recreational activities, the duration and durability of the results of sanatorium-resort treatment largely depends on compliance with the rules for selecting and referring patients to this type of treatment.

5. Medical selection of patients for sanatorium-resort treatment is carried out by clinical expert commissions of medical institutions. When deciding whether spa treatment is indicated, the medical commission is obliged to take into account the nature of both the underlying and concomitant diseases; their compliance with natural healing factors (landscape, climate, mineral waters, mud); contrast of climatic and geographical conditions; range of distances (from the patient’s permanent place of residence to the resort); the severity of the disease, the possibility of their seasonal exacerbation (spring-autumn for gastric ulcers and duodenum, vegetative-vascular disorders, respiratory diseases, kidney diseases in the cold season, etc.).

Patients with more severe forms of illness, for whom long-distance travel is contraindicated for health reasons, are sent to local nearby sanatoriums. In territories (territories, regions) with resorts

Of federal significance, it is allowed to refer patients with severe forms of diseases (for follow-up treatment, medical rehabilitation) from among local residents, who are indicated for treatment in local and suburban sanatoriums.

6. A list of medical indications and contraindications for adults, adolescents and children is developed by research institutes of balneology and physiotherapy.

Recommendations are given for the examination of patients on site with mandatory study of them general condition, conducting blood tests, urine tests, electrocardiography, X-ray examination of the chest organs (fluorography); for diseases of the digestive system - fluoroscopy of the stomach or endoscopic examination(esophagogastro-duodenofibroscopy), ultrasound of organs abdominal cavity; liver (blood content of bilirubin, protein fractions, transaminase activity, glucose), intestines (stool analysis, sigmoidoscopy); for respiratory diseases - sputum analysis, spiro-, fluorography; for allergic diseases - skin allergy diagnostic tests, studying indicators of the state of the immune system, etc.

All women sent to the resort must first be examined by a gynecologist. In the presence of gynecological diseases, the complex of special examinations includes determining the “hormonal profile” of patients; in case of infertility, patency indicators fallopian tubes.

If patients have neuropsychiatric diseases, a conclusion from a psychoneurological dispensary is necessary.

For nephro-urological diseases - research functional state kidneys, X-ray, ultrasound and other examinations.

Carrying out a thorough examination of patients makes it possible to clarify the nature of the underlying and concomitant diseases: their form, severity and activity of the process. If disease activity is detected, the doctor must conduct a preliminary course of treatment. To avoid exacerbation of the disease, anti-relapse treatment is prescribed at the resort; in the presence of foci of local infection (in carious teeth, palatine tonsils, paranasal sinuses nose, gallbladder, etc.) their sanitation is carried out - health measures with the help of medicinal or non-medicinal means before going to the resort.

7. When selecting patients for spa treatment, it is important to take into account the weather lability (meteosensitivity) of patients and the peculiarities of their adaptation to new climatic conditions. The greatest meteosensitivity is observed in patients with diseases of cardio-vascular system, nonspecific respiratory diseases, both in adolescents and the elderly. Therefore, sending them to remotely located resorts should be treated with caution.

When selecting patients for sanatorium-resort treatment, it is necessary to take into account the peculiarities of patients’ adaptation to contrasting climatic and geographical conditions (seaside or mountain resorts). In persons with increased meteotropicity longer period adaptation to the characteristics of resorts with contrasting climatic and geographical conditions, especially during the transitional season (spring, autumn); it may be complicated by negative meteorological reactions. Therefore, sending such patients to resorts with sharply changing meteorological conditions (temperature fluctuations, atmospheric pressure) in transitional seasons of the year is impractical. They should be sent to resorts close to their permanent place of residence.

The need to refer a patient for sanatorium-resort treatment is determined by the attending physician and the head of the department, and where there is no head of the department - by the deputy chief physician for medical work or the chief physician of a medical institution.

8. The procedure for obtaining free vouchers for sanatorium and resort treatment.

Citizens of Russia who have the right to state aid(public service) in the form of a set of social services (Federal Law No. 122-FZ of August 22, 2004), can receive a voucher paid for from the federal budget.

Vouchers are provided if there are medical indications to sanatorium and resort organizations located on the territory of the Russian Federation and included in the List approved by the Ministry of Health and Social Development of the Russian Federation.

The public service is provided primarily to low-income families, large families, single-parent families, and participants in the liquidation of the Chernobyl accident; children left without parental care.

Documents provided by the recipient of public services:

1. Application in any form;

2. Certificate for obtaining a voucher - form No. 070/у-04 (Appendix 3);

3. The applicant’s passport (for children under 14 years of age - birth certificate);

4. Passport of one of the parents (in the case of the “Mother and Child” package);

5.Passport of the accompanying person (if accompanied by another person);

6. Certificate of disability (if available);

If there are grounds for priority receipt of a voucher, photocopies of the relevant documents are attached to the application (low-income family, large family, single-parent family, parental participation in the liquidation of the Chernobyl accident; a child left without parental care).

Documents are provided in one copy in person.

To obtain a voucher, you need to contact the attending physician of the medical institution at your place

Residence. If there are medical indications and there are no contraindications for sanatorium-resort treatment, the doctor will fill out a certificate for obtaining a voucher in form No. 070/u-04 (in accordance with Order of the Ministry of Health and Social Development of Russia dated November 22, 2004 No. 256). The certificate for obtaining a voucher must contain the following information: name of the resort, profile of the sanatorium, recommended season (valid for 6 months). With this certificate and an application for a voucher, you must contact the regional office of the Social Insurance Fund of the Russian Federation. In addition, to receive a voucher for sanatorium-resort treatment, it is necessary to provide: documents confirming the inclusion of a citizen in the appropriate preferential category (certificate, ITU certificate of disability, etc.), passport. Within two weeks, the Foundation will inform you about the possibility of providing a sanatorium-resort voucher that corresponds to the declared treatment profile, indicating the date of arrival.

The sanatorium-resort voucher is issued in completed form with the seal of the executive body of the Foundation and with the note “Paid for from the federal budget and cannot be sold.”

After receiving a sanatorium-resort voucher, but not earlier than 2 months before the start of its validity period, you need to obtain a sanatorium-resort card (registration form 072/u-04, for children - 076/u-04, approved by order of the Ministry of Health and Social Development of Russia dated November 22 .2004 No. 256) at the clinic that issued a certificate for obtaining a voucher. After the end of the sanatorium-resort treatment (no later than 30 days), you must return the return voucher to the clinic, and the sanatorium will return the tear-off voucher to the Social Insurance Fund of the Russian Federation.

9. Aftercare in a sanatorium.

The federal budget also pays for aftercare in a sanatorium. Since 2006, the list of diseases for which patients are treated in sanatoriums immediately after hospital treatment has expanded significantly. It includes patients who have had acute myocardial infarction, acute disorder cerebral circulation, operations on the heart and great vessels, operations for pancreatitis (pancreatic necrosis), peptic ulcer of the stomach, duodenum and removal of the gallbladder, as well as after treated unstable angina and diabetes mellitus, working pregnant women.

Patients after surgery or conservative treatment immediately after discharge from the hospital, they are sent to sanatoriums included in the “List of sanatorium and resort institutions to which vouchers for sanatorium and resort treatment are provided to citizens entitled to receive state social assistance” (approved by order of the Ministry of Health and Social Development of Russia dated July 22, 2009 No. 540n “On approval of the list of sanatorium and resort institutions to which vouchers for sanatorium and resort treatment are provided to citizens entitled to receive state social assistance" (as amended by the order of the Ministry of Health and Social Development of Russia dated October 29, 2009 No. 854n).

The main selection criterion is the optimal price/quality ratio. That is, the health resort is obliged, for state compensation, to provide privileged patients with fairly comfortable living conditions and comprehensive treatment in accordance with the diagnosis (Federal Law of the Russian Federation dated December 10, 2006 No. 234-FZ).

When receiving a budget voucher, patients are issued special coupons (personal directions) for travel to the place of treatment to receive medical care (filled out by the executive authority of the constituent entity of the Russian Federation in the field of healthcare) to citizens entitled to a set of social services.

10. The Administrative Regulations for the provision of public services for the referral of citizens (children and citizens 18 years of age and older) for sanatorium treatment and rehabilitation also provide grounds for refusal to provide public services: medical contraindications for sanatorium treatment; corrections in the application or documents attached to the application that do not allow an unambiguous interpretation of their content; Providing false information; absence full list documents necessary to resolve the issue of sending a citizen for sanatorium treatment; lack of sanatorium vouchers to the health resorts specified in the application; lack of sanatorium vouchers for the period specified in the application; lack of vouchers.

11. The procedure for obtaining preferential vouchers.

In sanatoriums, sanatoriums, holiday homes, student winter and summer camps you can get discounted vouchers through trade union committees of enterprises and state universities. To obtain such a voucher, you must take a certificate from a doctor to obtain a voucher and submit it to the trade union committee with an application in the established form. After receiving the voucher, you must issue a sanatorium-resort card; within ten days after the end of check-in at the sanatorium, provide the trade union committee with a return voucher for the voucher.

In departments and large associations, employees and their children are provided with discounted vouchers to departmental sanatoriums, dispensaries and children's health camps.

Discount vouchers can also be obtained through various funds, for example, the Family World Rehabilitation and Support Foundation, one of whose tasks is to organize recreation for children from large families.

12. Purchasing paid vouchers.

You can purchase (or order) a voucher by contacting the sanatorium directly through the voucher sales departments or through travel companies that are members of the Russian Union of Travel Industry and work with sanatoriums under direct contracts.

13. General contraindications that exclude sending patients (adults and adolescents) to resorts and local sanatoriums:

● All diseases in the acute stage, chronic diseases in the acute stage and complicated by acute purulent process.

●Acute infectious diseases before the end of the isolation period.

●Everything venereal diseases in an acute and contagious form.

●All blood diseases in the acute stage and in the acute stage.

●Cachexia of any origin.

● Malignant neoplasms.

Note. Patients after radical treatment for malignant neoplasms (surgical, radiant energy, chemotherapy) with a generally satisfactory condition, absence of metastasis, normal indicators peripheral blood can only be sent to local sanatoriums for restorative treatment.

● All diseases and conditions requiring hospital treatment, including surgical intervention, all diseases in which patients are not capable of independent movement and self-care require constant special care (except for persons subject to treatment in specialized sanatoriums for spinal patients).

● Echinococcus of any localization.

●Frequently repeated or heavy bleeding.

● Pregnancy at all times at balneological and mud resorts, and at climatic resorts, starting at 26 weeks.

● All forms of pulmonary tuberculosis in the active stage - for any non-tuberculosis resorts and sanatoriums.

14. The procedure for sending children to sanatoriums is regulated by the Order of the Ministry of Health and Social Development of the Russian Federation dated November 22, 2004 “On the procedure for selecting and referring patients for sanatorium treatment (as amended by the Order of the Ministry of Health and Social Development of the Russian Federation dated January 9, 2007 No. 3). The procedure for sending children with their parents to sanatoriums, vouchers to which are provided free of charge, is regulated by Order of the Ministry of Health and Social Development of Russia dated March 27, 2009 No. 138n “On the procedure for organizing work on distributing vouchers and referring patients from institutions providing specialized, including high-tech, medical care to treatment in sanatorium-resort institutions under the jurisdiction of the Ministry of Health and Social Development of Russia.”

Referral of children aged 3 to 18 years to sanatorium-resort treatment is carried out based on the results of medical selection, which is carried out by treatment and preventive institutions (HCI) at the child’s place of residence. If there are medical indications and there are no contraindications for sanatorium-resort treatment in a child, the attending physician of the healthcare facility issues a certificate for obtaining a voucher for sanatorium-resort treatment and a completed sanatorium-resort card. Based on these documents, the executive authority of the constituent entity of the Russian Federation in the field of healthcare makes a decision to send the child to a sanatorium of the Federal Service for Healthcare and issues an appropriate voucher. If there are contraindications for sanatorium-resort treatment, a decision is made to return the documents to the health care facility with a reasoned justification for the refusal.

Before going to the child’s resort, the attending physician will organize a clinical and laboratory examination depending on the nature of the disease, as well as the sanitation of chronic foci of infection, anthelmintic or antigiardiasis treatment.

The child must have the following documents:

Sanatorium-resort card for children (Form No. 076/у-04).
Compulsory health insurance policy.
Results of 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.

The organization of children's recreation and treatment is regulated by the annual Decree of the Government of the Russian Federation “On ensuring the recreation, health and employment of children.”

Almost all working parents have the right to receive a voucher to a children's sanatorium or country camp for children aged 4 to 15 years inclusive, paid for with the participation of the Social Insurance Fund. By Resolution No. 144 of 03/05/2007, the Government of Russia instructed the Social Insurance Fund of the Russian Federation to provide for the children of insured citizens full or partial payment for the cost of vouchers to sanatorium-resort and health-improving organizations located on the territory of the Russian Federation, opened in the prescribed manner:

Children's sanatoriums – for children aged 4 to 15 years and year-round sanatorium camps for children school age up to 15 years (inclusive) with a period of stay of 21–24 days at the rate of up to 500 rubles. per child per day. The maximum amount of payment for the cost of a voucher per child per day in the specified organizations located in regions and localities in which regional coefficients are applied in accordance with the established procedure wages, is determined taking into account these regional coefficients;

Country stationary children's health camps (with a stay of at least 7 days during the spring, autumn, winter school holidays and no more than 24 days during the summer school holidays) - for school-age children under 15 years old in the amount of up to 50% of the average cost vouchers (up to 100% of the average cost of a voucher for children of employees of budgetary organizations).

15. General contraindications that exclude sending children to sanatorium-resort treatment:

●All diseases in acute period.

●Somatic diseases requiring treatment in a hospital setting.

●Transmitted infectious diseases before the end of the isolation period.

●Bacillus carriage of diphtheria and intestinal infectious diseases.

●Malignant neoplasms, pernicious anemia, leukemia (except for specialized sanatoriums).

●Amyloidosis internal organs.

●Tuberculosis of the lungs and other organs.

●Convulsive seizures and their equivalents, mental retardation(except for specialized sanatoriums for children with cerebral palsy), pathological personality development with severe behavioral disorders and social adaptation.

●The presence of concomitant diseases in children that are contraindicated for this resort or sanatorium.

●Patients requiring constant individual care.

● Mental illness.

Sanatorium-resort treatment, as a stage of medical rehabilitation, can be provided to sick and disabled people with consequences of injuries, operations, chronic diseases within the framework of specialized medical care in state and municipal specialized sanatorium and resort healthcare institutions that have the appropriate license to provide medical care to people with disabilities. The main objective of sanatorium-resort treatment is the complete or partial restoration of impaired functions or compensation for lost functions of the affected organ or body system.

2. The provision of sanatorium and resort care to sick and disabled people is carried out in accordance with the standards of medical care and regulatory legal acts of the federal executive body in the field of healthcare, the relevant executive bodies of the constituent entity of the Russian Federation and the local government body.

3. The following are sent to the sanatorium-resort stage of medical rehabilitation, in the presence of appropriate medical indications and the absence of contraindications:

Citizens entitled to receive state social assistance in the form of a set of social services, in accordance with the established procedure;

Insured persons who have suffered health damage due to industrial accidents and occupational diseases, in accordance with the established procedure;

Citizens (adults and children) who need sanatorium-resort treatment in sanatorium-resort institutions administered by the Ministry of Health and Social Development of Russia, in accordance with the established procedure;

4. Sick and disabled people are sent to sanatorium-resort institutions, provided full examination, ability for independent movement and self-care, no need for bed rest and individual care from middle and junior medical personnel.

5. The selection of patients and disabled people and referral to the sanatorium-resort stage of medical rehabilitation is carried out in the manner approved by 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 to sanatorium-resort treatment”, taking into account the established indications and contraindications.

6. Upon admission of sick and disabled people to sanatorium-resort institutions, based on the results of the previous stages of treatment, a comprehensive individual program of medical rehabilitation is drawn up using natural and preformed physical factors, which reflects the initial state of impaired (lost) functions, existing disabilities, as well as specific volumes and methods of carrying out rehabilitation measures.

The duration of medical rehabilitation is determined by the standards of medical care.

7. In cases of exacerbation of the disease or the emergence of a new pathological process requiring the provision of specialized medical care, the patient is transferred to the appropriate healthcare institution in the prescribed manner.

8. Upon completion of the course of sanatorium-resort medical rehabilitation, the effectiveness of the rehabilitation measures taken is assessed, after which the need, timing and stage of a repeated course of medical rehabilitation in a sanatorium are determined. The recommendations issued are implemented by specialists from the medical institution at the patient’s place of residence (work).

Medical care for the improvement of risk groups is provided to patients with risk factors that contribute to the occurrence and development of diseases, as part of sanatorium and resort care in state and municipal sanatorium and resort institutions that have the appropriate license.

The main task of improving the health of people at risk is primary prevention diseases using diagnostic and health technologies of resort medicine.

2. The provision of sanatorium and resort health care to patients is carried out in accordance with the standards of medical care and regulatory legal acts of the federal executive body in the field of healthcare, the relevant executive bodies of the constituent entity of the Russian Federation and the local government body.

3. In order to provide accessible and high-quality medical care for the improvement of risk groups, the health authorities of the constituent entities of the Russian Federation are developing an appropriate procedure for the provision of medical care, taking into account the stage of medical care, regional needs, structure, capacity, level of equipment and availability of qualified personnel of the relevant medical institutions .

4. The following are sent to the sanatorium-resort stage of recovery:

Insured employees engaged in work with harmful and (or) hazardous production factors, in accordance with the established procedure;

Children of insured citizens when sent to children's sanatoriums and year-round sanatorium camps in accordance with the established procedure;

5. Persons (adults and children) who have risk factors that contribute to the occurrence and development of diseases are sent to the sanatorium-resort stage of recovery if there are established medical indications and there are no contraindications.

6. Medical selection and referral to the sanatorium-resort stage of health improvement of workers engaged in work with harmful and (or) dangerous production factors is carried out by a medical commission of a medical organization that carries out preliminary and periodic medical examinations, based on the results of periodic medical examinations. Recommendations for sanatorium-resort treatment are indicated in the final report of the medical commission in accordance with the established rules.

7. Medical selection and referral to the sanatorium-resort stage of health improvement of children of insured citizens is carried out in the manner approved by 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 to sanatorium-resort treatment.”

8. When a patient is admitted for health improvement, depending on the risk factors identified for him, the attending physician of the sanatorium-resort institution draws up a comprehensive individual health program, which reflects the volume and methods of health-improving activities.

The duration of recovery is determined by the standards of medical care.

9. Upon completion of the course of rehabilitation, the patient is sent to an outpatient clinic at the place of residence (work, stay) for further dispensary observation.

Appendix No. 15.1

To the Procedure for the provision of sanatorium and resort medical care, approved by order of the Ministry of Health and Social Development of the Russian Federation

From ______________, 2010 No. ______

1. A sanatorium is a medical and preventive institution designed to treat patients primarily with natural healing factors (climate, mineral waters, therapeutic mud, etc.) in combination with physiotherapy, physical therapy, therapeutic nutrition and other means, subject to mandatory compliance with the established sanatorium regime providing complete treatment and rest for patients.

2. The sanatorium is organized as an independent treatment and preventive health resort health care organization and operates on the basis of a license to carry out medical activities granted in accordance with the legislation of the Russian Federation.

3. The founder of the sanatorium, based on the form of ownership, can be a federal executive body, an executive body of a constituent entity of the Russian Federation, a local government body, a public organization (association), legal entities or individuals.

4. The activities of the sanatorium are carried out in accordance with the legislative acts of the Russian Federation, regulatory legal acts of executive authorities of constituent entities of the Russian Federation or local governments, regulatory legal acts of the Ministry of Health and Social Development of the Russian Federation, regulatory legal acts or legal acts of the founders, these Regulations and constituent documents .

5. The main activity of the sanatorium is the implementation of medical activities, which involves the performance of work (services) to provide sanatorium-resort medical care to citizens in accordance with the list of works (services) in the implementation of medical activities, approved by the Ministry of Health and Social Development of the Russian Federation, mainly using natural healing factors (mineral waters, therapeutic mud, climate, etc.) in combination with physiotherapy, physical therapy, therapeutic nutrition and other therapeutic agents.

6. Sanatoriums are organized in specially constructed or adapted buildings that meet the sanitary and hygienic requirements of state sanitary inspection bodies and standards approved by the State Committee for Construction.

7. Sanatoriums are organized at resorts or health resorts. Outside the resorts, a local suburban sanatorium can be organized. The local sanatorium is intended to treat patients for whom change is contraindicated for health reasons. climatic conditions stays and trips to remote resorts, as well as to provide outpatient resort care to patients without changing their permanent place of residence or stopping their work activities.

8. The sanatorium is not intended for the treatment of patients who are not capable of independent movement and self-care, and who require constant special care (except for persons subject to treatment in specialized sanatoriums for spinal patients).

9. A sanatorium may be intended to provide sanatorium-resort medical care to adults (sanatorium), children (sanatorium for children), adults and children (sanatorium for children with parents).

10. A sanatorium can be single-profile (for the treatment of patients with similar diseases) and multi-profile (with two or more specialized departments).

The medical profile (specialization) of the sanatorium (its departments and beds) is established depending on the presence of certain natural healing factors and a license for medical activities, as well as the needs of the population for types of sanatorium care based on the classes (groups) of diseases that are treated in this sanatorium.

11. Depending on the period of operation, the sanatorium can be year-round or seasonal.

12. The management of the sanatorium is carried out by the head (director, chief physician) of the sanatorium, appointed to the position and dismissed by the founder, in the prescribed manner. The management of the medical activities of the sanatorium is carried out by the chief physician (deputy chief physician for medical affairs) - a specialist with a higher professional medical education, postgraduate or additional professional medical education and work experience in the specialty for at least 5 years. The head doctor of the sanatorium is appointed and dismissed by the founder. The deputy chief physician for medical affairs is appointed and dismissed by the head of the sanatorium.

13. The structure of the sanatorium is approved by the head of the sanatorium depending on the needs of the population for types of sanatorium and resort assistance in accordance with the recommended approximate structure:

Reception department;

Functional and diagnostic department:

Clinical diagnostic laboratory;

Department (offices) of functional diagnostics;

Ultrasound diagnostic room;

Medical departments (including specialized departments, beds);

Hydrotherapy (hydrotherapy, balneotherapy);

Thermotherapy;

Physiotherapy;

Barotherapy;

Kinesitherapy;

Manual therapy;

Reflexology;

Herbal medicine;

Psychotherapy;

Doctors' offices;

Administrative and economic divisions and services:

Administration;

Food department;

Accounting;

Human Resources Department;

Purchase department;

Pharmacy;

Technical Services.

The sanatorium can organize other departments and rooms depending on medical profile sanatorium.

The equipment of diagnostic and treatment rooms, utility and utility rooms is determined depending on the profile and capacity of the sanatorium,

14. To provide sanatorium-resort medical care, a staff of medical, paramedical and junior medical personnel is formed in the sanatorium in accordance with the recommended staffing levels.

15. To ensure the activities of the sanatorium, administrative, financial, economic, technical personnel, personnel for conducting educational, cultural events, ensuring the protection of public order, and preventing and eliminating possible emergency situations are also formed.

The staff of the sanatorium is approved by the head of the sanatorium, depending on the need and volume of work performed, taking into account the current standards of working time and workload.

16. The sanatorium exists with funds from the federal, regional or local budget or with funds received from the sale of vouchers.

17. The sanatorium provides health resort and rehabilitation treatment(follow-up treatment) for patients immediately after inpatient and outpatient treatment, medical rehabilitation of sick and disabled people with consequences of injuries, operations, chronic diseases, including persons injured as a result of industrial accidents and occupational diseases, rehabilitation of practically healthy individuals and people at risk (hereinafter – sanatorium-resort treatment), as well as measures to promote a healthy lifestyle among sanatorium patients, the introduction of new health, rehabilitation and preventive technologies, internal quality control of sanatorium-resort treatment, its compliance with the recommended standards of sanatorium-resort care, maintaining medical records and reports documentation in the prescribed manner, analysis of the work of the sanatorium, organization of promotion professional qualifications medical and paramedical personnel.

18. Selection and referral for sanatorium-resort treatment of citizens, determination of medical indications and contraindications for sanatorium-resort treatment, the volume and conditions for the provision of sanatorium-resort care, as well as the duration of stay in the sanatorium, depending on the disease, are carried out in the prescribed manner.

19. Sanatorium-resort treatment can be provided to citizens with accommodation and meals in a sanatorium (sanatorium-resort care) or without accommodation, without accommodation and meals in a sanatorium (outpatient-resort care).

20. To carry out the tasks provided for by these regulations, the sanatorium is entrusted with:

A) ensuring correct diagnosis and qualified treatment of patients in accordance with modern requirements medical science and approved medical technologies, developed and recommended by specialized research institutions of the Ministry of Health and Social Development and approved for use by Roszdravnadzor;

B) organization of appropriate cultural and everyday services for patients;

B) carrying out preventive measures and sanitary educational work, both among patients and among service personnel;

D) study of the immediate results of sanatorium-resort treatment of patients;

E) providing measures to improve the professional qualifications of medical, nursing and service personnel.

21. Works (services) of the sanatorium to provide sanatorium-resort or outpatient-resort care are formalized accordingly sanatorium-resort voucher or coursework.

22. Internal regulations and job responsibilities of employees are established by the head of the sanatorium.

23. Fire safety and sanitary and epidemiological measures are provided by the administration of the sanatorium in accordance with the regulations in force in these areas of activity.

(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)

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.

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.

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.

It occupies a major place in the system of treatment and preventive measures, primarily in the rehabilitation of patients.

The resort inpatient treatment and prevention facility is sanatorium. Most sanatoriums are organized in resort areas in order to make maximum use of the natural features of the area.

Resorts and sanatoriums

Resort- an area whose natural features make it possible to effectively treat and prevent diseases. Based on the nature of these features, resorts are divided into three groups: (mineral spring waters), mud (therapeutic mud) and climatic (seaside, mountain, plain, forest and steppe). Three sanitary protection zones have been established for resorts, within which it is prohibited. Important role allocated to local resorts, most often intended for patients for whom, after treatment, climate change is contraindicated for health reasons.

The sanatorium is intended for the treatment of patients primarily with natural remedies in combination with physiotherapy, physical therapy, and therapeutic nutrition in conditions of active recreation and specially organized regime. Drug treatment And bed rest are not typical for the sanatorium, although they can be prescribed. Patients with the most severe illnesses are treated in sanatoriums. various diseases. In this regard, there are sanatoriums with diseases of the circulatory system, digestive system, gynecological diseases etc. Depending on the age of the patients, sanatoriums are divided into children's, adolescent and adult.

The basis of spa treatment is the sanatorium regime, which provides the most favorable conditions treatment and rest. Patients are provided with treatment in mud baths, solariums, swimming pools, etc. At most resorts, along with sanatorium treatment, ambulatory treatment patients coming on course vouchers.

Sanatoriums-preventoriums are also widely used - medical and preventive institutions organized at industrial enterprises, maintained at the expense of state insurance funds. Workers of this enterprise, on the recommendation of the attending physician, have the opportunity, without interruption from work, to undergo treatment at a dispensary for 24 days after work, where they are delivered by special transport. In addition, sanatorium institutions include resort clinics, hydropathic baths, mud baths, etc.

The procedure for referral to sanatorium-resort treatment

The effectiveness of sanatorium-resort treatment depends on the correct referral of patients to the resort and sanatorium.

To be able to receive sanatorium-resort treatment, you must contact a doctor at the clinic at your place of residence. The doctor gives a referral to the sanatorium selection commission (SSC), which determines the need for sanatorium treatment, the profile of the sanatorium and the time of year for treatment. After receiving the conclusion of the SOC, you must write an application for a voucher addressed to the chairman of the commission (commissioner) for social insurance at the place of work. Pensioners contact social security authorities (district offices social protection population) at place of residence. The Social Insurance Commission must review the application and make a decision within 10 days. If you disagree with the decision of the commission, you can appeal its decision through the department (branch department) of the social protection institution. In addition to deciding on the allocation of a voucher, the social insurance commission has the right to decide on the payment of 50% of the cost of travel to the sanatorium and back, depending on the patient’s earnings and marital status. Vouchers are issued only during the employee's vacation period. Participants of the Great Patriotic War and persons equivalent to them have the right to receive a free voucher.

Upon arrival at the sanatorium, the patient submits a sanatorium-resort card, which is filled out at the clinic at the place of residence: a clinical blood and urine test no more than month period prescription, ECG is no more than a month old, x-ray examination(FLG or chest X-ray) no more than six months ago, for women, a gynecologist’s conclusion regardless of the diagnosis of the disease, conclusions of other specialists depending on the profile of the disease. Registration and issuance of medical documents and vouchers is carried out 15-20 days before the start of the voucher period. The voucher must be properly issued and certified by the seal of the institution that issued it. In addition to the voucher and sanatorium-resort card, upon admission to the sanatorium you must have a passport, and for children under 16 years of age a birth certificate or a copy thereof. Military personnel present an identification card, and military pensioners - a pension certificate, where in the section for special marks it must be indicated that the pensioner enjoys the right to sanatorium-resort treatment in sanatoriums of the Ministry of Defense of the Russian Federation.

In the sanatorium book, handed out to the patient, the sanatorium doctor notes the change in the patient’s well-being, the treatment and research performed, and at the end of the stay, the results of treatment and recommendations on the work schedule and therapeutic measures. Upon returning from the sanatorium, the patient presents the sanatorium book to the attending physician, who necessary information transfers to outpatient card for the development of further treatment and preventive measures.

The effectiveness of sanatorium-resort treatment is evidenced by the long-term absence of exacerbations of the underlying disease, stable restoration of ability to work, and improvement in the general health and well-being of the patient.

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 procedure was 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. Sanatorium-resort treatment includes medical care provided by medical organizations (sanatorium-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 prevention of 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 August 5, 2003 No. 330 “On measures to improve clinical nutrition in therapeutic and preventive institutions of the 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 1 November 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 Federation on 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)