Sanatorium-resort card for children and adults. How to apply for a health resort card in a clinic. How to download the form of a spa card for free Form 072 y 04 sanatorium resort

Sanatorium-resort card is a document that must be issued before a trip to a sanatorium, dispensary or other medical and recreational institution. Such a documentis a guarantee that a person has no contraindications to undergoing a course of treatment, as well as a correctly chosen profile of the sanatorium (in accordance with complaints or diagnoses).

Registration procedurehealth resort card

It is issued free of charge at the clinic at the place of residence or in any other medical institution but for a fee. To do this, you need to come to the therapist, taking with you an outpatient card and a ticket to the sanatorium. The doctor directs the patient for examinations by narrow specialists and testing.

Yes, you must submit general analyzes blood and urine, electrocardiogram, fluorography, and women still in without fail you need to go to the gynecologist and take tests for microflora.

If a person has complaints or goes to a sanatorium in connection with a certain diagnosis, he is sent to narrow specialist and additional examinations. The list of doctors is approved by the therapist.

Filling ordersanatorium card

After the patient goes around all the doctors and passes the tests, he again returns to the therapist. He fills out the card.

According to the patient, the doctor writes down the basic data about him:

place of residence and work

job title

passport data

insurance policy number

available benefits, etc.

Based on the voucher provided, the doctor enters its number and the name of the institution where the patient is going.

All these data are common to all patients, regardless of the state of health and the purpose of the trip to the sanatorium.

However, despite the fact that there is an approved sample document, there is no single form for filling it out. And the differences in filling out the certificate in one case or another are due precisely to the anamnesis, the main complaints and the diagnoses made to the patients. After all, it is in connection with them that people go for treatment and recreation, choose the profile of a medical institution.

Patient categories and samplescertificates of form 072

We have already considered general information, which is recorded in the certificate, regardless of the purpose for which and where the person is sent. Now let's consider special cases.

All people who go to the resort are divided into 3 groups.

Healthy people

As a rule, these are young people who are practically healthy. They have no complaints or chronic diseases, and they go to a sanatorium in order to relax.

Therefore, in the document, the therapist will write that the person has no complaints, and research results are positive.

However, the doctor must indicate the diagnosis in connection with which the person goes to the sanatorium. Usually indicate chronic gastritis How common disease which occurs even in healthy young people.

People who suffer from a chronic illness

This category includes people young age who have a single disease. As a rule, the diagnosis is associated with the gastrointestinal tract or lungs. These patients go to the resort with the aim not only to relax, but also to heal. Therefore, the profile of the institution should correspond to the main diagnosis.

In the certificate, the therapist indicates what the patient is complaining about, as well as the results of the tests and general data.

Aged people

Patients in this group were diagnosed with several chronic diseases at the same time. As a rule, these are violations of the work of cardio-vascular system. Therefore, the goal of these patients- improve your health, undergo a preventive and therapeutic course.

Therapist in help 072 indicates that the patient has complaints of pain in the heart, high blood pressure.

It is important that all information is correctly indicated in the document, as well as seals and stamps are affixed.

When the health resort card is filled out and certified with seals, a person can go for treatment. In the sanatorium he gives her medical staff, and he, in turn, fills the card from the back. Upon completion of the course of treatment, the completed document is issued to the person. When he returns home, you need to provide a certificate to the institution that issued him.

A sanatorium-resort card for adults (certificate form 072/y-04) is issued by the attending physician upon presentation by the patient of a voucher for sanatorium-and-spa treatment.

Sanatorium-resort card issued by the attending physician upon presentation by the patient of a voucher for sanatorium treatment. Certificate of form No. 072 / y-04 indicates the absence of contraindications for the implementation of spa treatment, Firstly, for use in the treatment of natural climatic factors. The sanatorium card reflects data on the objective condition of the patient, data on the results of previous treatment (outpatient, inpatient), data on laboratory, functional, radiological and other studies.

In general, the health resort card must be filled in by the attending physician, in accordance with the instructions for filling out the form No. 072 / y-04. The columns of the document should contain the following data:

The front side of the document.

On the front of the form must be entered OGRN code polyclinic (this number must correspond to the number of the polyclinic on the round seal placed on reverse side form).

No. of the Sanatorium-resort card: three or four digit number (eg 348/09) and date of issue of the certificate (eg May 10, 2009). The number can be fractional, indicating the year the certificate was issued for the fraction.

1. Attending physician: Physician's name.

2. Issued: your full name.

3. Gender: your gender is ticked.

4. Date of birth: your date of birth.

5. Address: your permanent address and telephone number.

6. No. of medical history or outpatient card: four-digit number (ex. 1349)

7. Identification number in the CHI system: your number, if any. (e.g. 880003 0063870120)

8. Benefit code: the benefit code must be indicated if you have this benefit. (this item is relevant only for people with disabilities: 081 - group 3, 082 - group 2, 083 - group 1)

9. Document certifying the right to receive a set of social services: the corresponding document (series, number and date), if any, must be entered. (this item is relevant only for disabled people, e.g. 002 005162 dated 03/17/2004)

10. SNILS: your insurance number, if any. (ex. 033-062-545-07)

11. Escort: ticked if you require accompaniment (this item is relevant only for people with disabilities).

12. Place of work, study: usually the place of work or study is indicated if you study or work, if you do not work, then it should be written “does not work”.

13. Position, profession: the position (profession) is usually indicated, if any.

Reverse side of the document.

It is not possible to describe the general pattern that the content of the reverse side of the document should correspond to, so we will consider three filling options for three conditional groups citizens:

1. Group. Young people who do not have any diseases, and bought a ticket to the sanatorium only for the purpose of relaxing, provide a certificate of the following content: (filling example)

14. Complaints, duration of the disease, history, previous treatment, including spa treatment: should be entered: no complaints, no pulm-wheezing, cor-rhythm. HR-75 bpm min. ; AD-120/80 mm Hg

Because V this option there are no significant diseases, then, as a rule, the code of chronic gastritis (K29.3) is indicated. This disease occurs quite often even in very young and practically healthy people. Paragraphs 16.2 and 16.3 are usually left blank.

18. Treatment:

19. Course duration:

20. Voucher number:

14. Complaints, duration of the disease, history, previous treatment, including sanatorium treatment: must be entered: complaints about periodic pain in the epigastric region more often on an empty stomach., no pulm-rales, cor-rhythm. HR-75 bpm min. ; AD-120/80 mm Hg The abdomen is soft, slightly painful in the epigastric region. Stool and urine in N.

15. Data from clinical, laboratory, radiological and other studies: the dates and types of examinations carried out should be entered. For example: 06.08.08 Gen. an. blood: Hb-150; ER-4.6;.CP-0.89; Leu-5.2; P-1; S-63; E-2; B-1; L-29; M-4; ESR-3 mm/h. 06.08.08 General an. urine: color - sol.zh.; p-1021; sugar, white - abs; Lei- 0-1 in p / sp. Fluorography dated 11.07.08: no pathology. ECG from 08/01/08: Rhythm syn. Heart rate 74 beats / min. norm-e floor-e EOS.

16. Diagnosis. 16.1 Disease, for the treatment of which is sent to a sanatorium: because in this option, we consider treatment in a sanatorium specialized in the treatment gastrointestinal diseases, then this paragraph should naturally indicate the code of chronic gastritis (K29.3). If you have any other chronic diseases, then their codes should be indicated in paragraph 16.3. (eg chronic bronchitis J41.0) - Section 16.2 should not be filled out.

If you are going to a sanatorium where broncho-pulmonary diseases are treated, to treat chronic bronchitis that has bothered you during the cold season, The following filling option is possible:

14. Complaints, duration of the disease, history, previous treatment, including spa treatment: should be entered: complaints of coughing mainly in the cold season, pulm-breathing with a hard tone, no wheezing, cor-rhythm. HR-75 bpm min. ; AD-120/80 mm Hg

15. Data from clinical, laboratory, radiological and other studies: dates and types of examinations carried out should be entered here. For example: 06.08.08 Gen. an. blood: Hb-150; ER-4.6;.CP-0.89; Leu-5.2; P-1; S-63; E-2; B-1; L-29; M-4; ESR-3 mm/h. 06.08.08 General an. urine: color - sol.zh.; p-1021; sugar, white - abs; Lei- 0-1 in p / sp. Fluorography dated 11.07.08: no pathology. ECG from 08/01/08: Rhythm syn. Heart rate 74 beats / min. norm-e floor-e EOS.

16. Diagnosis. 16.1 Disease, for the treatment of which is sent to a sanatorium: because in this version, we are considering treatment in a sanatorium specializing in the treatment of broncho-pulmonary diseases, then this paragraph should naturally indicate the code chronic bronchitis(J41.0). If it is assumed that there are any other chronic diseases, then their codes should be indicated in paragraph 16.3. (eg chronic gastritis K29.3) - Section 16.2 is usually left blank.

17. Name health resort organization: must correspond to the name of the sanatorium-resort organization in the voucher you purchased.

18. Treatment: most often it is about spa treatment, so the corresponding item should be checked.

19. Course duration: must correspond to the number of days of spa treatment indicated in the voucher you purchased.

20. Voucher number: must match the ticket number you purchased.

Below should be the signature of the attending physician and the head of the department (usually in different pens).

14. Complaints, duration of the disease, history, previous treatment, including sanatorium-and-spa treatment: should be entered: complaints of recurrent pain in the heart, which occur more often on the background of physical activity, an increase in blood pressure to 160/80 mm Hg ., general weakness. , Ob-but: pulm-breathing with a hard tone, no wheezing, cor-rhythm. HR-60 bpm min. ; AD-140/90 mm Hg

15. Data from clinical, laboratory, radiological and other studies: the dates and types of examinations carried out should be entered. For example: 06.08.08 Gen. an. blood: Hb-120; Er-4,2;.; Leu-5.2; P-1; S-63; E-2; B-1; L-29; M-4; ESR-10 mm/h. 06.08.08 General an. urine: color - sol.zh.; p-1021; sugar, white - abs; Lei- 1-2 in p / sp. Fluorography from 11.07.08: Emphysema, pneumosclerosis. ECG from 08/01/08: Rhythm syn. Heart rate 62 beats / min. EOS deviation to the left, LV hypertrophy, diffuse changes myocardium.

16. Diagnosis. 16.1 Disease, for the treatment of which is sent to a sanatorium: because in this option, we consider treatment in a sanatorium specialized in the treatment cardiovascular disease, then in this paragraph, of course, the code for atherosclerotic heart disease (I25.1) should be indicated. If there are any other chronic diseases, then their codes should be indicated in paragraph 16.3. (usually these include: chronic gastritis K29.3, cerebral atherosclerosis I67.2, chronic cholecystitis K81.1 etc.). Item 16.2: this item usually contains the code of the disease for which the disability was obtained (usually this is I25.1). If there is no disability, then this item will be empty.

17. Name of the health resort organization: must correspond to the name of the sanatorium-resort organization in the voucher you purchased.

18. Treatment: most often we are talking about spa treatment, so the corresponding item should be ticked.

19. Course duration: must correspond to the number of days of spa treatment indicated in the voucher you purchased.

20. Voucher number: must match the ticket number you purchased. Below should be the signature of the attending physician and the head of the department (usually in different pens).

This is how the health resort card should look like, filled out in accordance with the instructions for the above-mentioned 3rd group of citizens.

* Always check the correctness of the indication of personal data in your spa card.

The main codes of diseases that are often used to fill out certificates 070 / y-04 and 072 / y-04

1.I10. Essential (primary) hypertension

2. I11.9 Hypertensive heart disease without (congestive) heart failure.

3. I20 Angina pectoris (angina pectoris)

4. I25.10 Atherosclerotic heart disease with hypertension

5. I25.1 Atherosclerotic heart disease

6. I67.1 Cerebral atherosclerosis

7 J40.0 Chronic simple bronchitis

8. J45.0 Asthma with a predominance of an allergic component.

9. J45.1 Non-allergic asthma.

10. J45.8 Mixed asthma.

11. K29.3 Chronic superficial gastritis.

12. K29.4 Chronic atrophic gastritis.

13. K81.1 Chronic cholecystitis.

It is not possible to describe the general pattern that the content of the reverse side of the document should correspond to, therefore we will consider three filling options for three conditional groups of citizens: 1. Group. Young people who do not have any diseases, and bought a ticket to a sanatorium only for the purpose of relaxing, provide a certificate of the following content: (filling example) 14. Complaints, duration of the disease, history, previous treatment, including sanatorium treatment: must be inscribed: no complaints, no pulm-wheezing, cor-rhythm. HR-75 bpm min. ; AD-120/80 mm Hg 15. Data from clinical, laboratory, X-ray and other studies: the dates and types of studies performed must be entered. For example: 06.08.08 Gen. an. blood: Hb-150; ER-4.6;.CP-0.89; Leu-5.2; P-1; S-63; E-2; B-1; L-29; M-4; ESR-3 mm/h. 06.08.08 General an.

Sanatorium-resort card

Attention

Lei- 1-2 in p / sp. Fluorography from 11.07.08: Emphysema, pneumosclerosis. ECG from 08/01/08: Rhythm syn. Heart rate 62 beats / min. EOS deviation to the left, LV hypertrophy, diffuse changes in the myocardium. 16. Diagnosis. 16.1 Disease, for the treatment of which one is sent to a sanatorium: because

in this version, we consider treatment in a sanatorium specializing in the treatment of cardiovascular diseases, then in this paragraph, of course, the code for atherosclerotic heart disease should be indicated (

Important

I25.1). If there are any other chronic diseases, then their codes should be indicated in paragraph 16.3. (usually these include: chronic gastritis K29.3, cerebral atherosclerosis I67.2, chronic cholecystitis K81.1, etc.). Item 16.2: this item usually contains the code of the disease for which the disability was obtained (usually this is I25.1). If there is no disability, then this item will be empty.

17.

Filling out a health resort card: form 072 / y-04

taxpayer identification number assigned to the organization ( individual entrepreneur) that issued the document;
type of service;
the cost of the service in monetary terms;
the amount of payment made in cash and (or) using a payment card;
date of calculation and preparation of the document;
position, surname, name and patronymic of the person responsible for the transaction and the correctness of its execution, his personal signature, seal of the organization (individual entrepreneur);
other details that characterize the specifics of the service provided and with which the organization (individual entrepreneur) has the right to supplement the document.

It should be noted that some categories of citizens have the right to receive a ticket for free.

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Info

This is how the health resort card should look like, filled out in accordance with the instructions for the above-mentioned 2nd group of citizens. 3.Group. Elderly people who, as they themselves put it, have a “bouquet of diseases”. Relatives bought them a ticket to a sanatorium, but without a sanatorium-resort card they may not be accommodated in this sanatorium.
There is either no desire or no time to receive a sanatorium-and-spa card in your clinic.
If the patient has diseases of the skin, eyes, blood and genitourinary system, then the doctor fixes in the form of the conclusion of the relevant specialists. The card issued by the doctor is valid for 2 months. If you arrange it on the spot in the sanatorium, then keep in mind that you will have to wait a few days until it is processed.
There will be no treatment during paper preparation. Advice. Carefully approach the selection of the profile of the sanatorium-resort institution. Very often, many do not know what their diagnosis is, and when they receive the results of research in a sanatorium, it turns out that his profile is not suitable for treating an existing disease.

The procedure for filling out the registration form No. 072 / y-04 Let's consider schematically the process of filling out the form for rest and treatment.

Form 072 / y-04 - health resort card for adults

In column number 2 - your full name.
In column number 3 - your gender.
In column number 4 - the date of your birth.
In column No. 5 - place of residence and contact phone number.
In column No. 6 - the number of the medical card / medical history (consists of 4 digits).
In column No. 7 - your identification number (if you have one).
Column number 8 indicates the benefit code, if you have one.
Column No. 9 indicates a document confirming the right to receive social assistance.
In column No. 10 - insurance number.
The item "accompaniment" is noted only if necessary.
Column No. 11 indicates the place of work / study
In column number 12 - the position you hold.

medical terms

400 bad request

The paragraph "Epicrisis" 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 patient's objective condition. The items “Results of treatment”, “Presence of exacerbations that required cancellation of procedures” and “Recommendations for further treatment” are filled in based on the data specified in the item “Epicrisis”. The return coupon is certified by the signatures of the attending physician, the head physician and the round seal of the sanatorium-resort organization.

(name of the medical organization) (address, phone) ^ Accounting documentation Form No. 070/u Approved by order of the Ministry of Health and Social Development of Russia dated 2020

Sanatorium and resort card: form 072 / y

Complaints, duration of the disease, history, previous treatment, including spa treatment: should be entered: complaints of recurrent pain in the epigastric region more often on an empty stomach, no pulm-wheezing, cor-rhythm. HR-75 bpm min. ; AD-120/80 mm Hg The abdomen is soft, slightly painful in the epigastric region. Stool and urine in N. 15. Data from clinical, laboratory, radiological and other studies: the dates and types of studies performed should be entered. For example: 06.08.08 Gen. an. blood: Hb-150; ER-4.6;.CP-0.89; Leu-5.2; P-1; S-63; E-2; B-1; L-29; M-4; ESR-3 mm/h. 06.08.08 General an. urine: color - sol.zh.; p-1021; sugar, white - abs; Lei- 0-1 in p / sp. Fluorography dated 11.07.08: no pathology. ECG from 08/01/08: Rhythm syn. Heart rate 74 beats / min. norm-e floor-e EOS. 16. Diagnosis. 16.1 Disease, for the treatment of which one is sent to a sanatorium: because

In order to undergo treatment in sanatorium-resort institutions, the patient should issue a sanatorium-resort card (form 072 / y), which is issued medical organizations, which provide medical care exclusively in outpatient settings. This card must be completed medical workers only upon presentation by the patient of a voucher for sanatorium treatment. This certificate confirms that the patient has no contraindications for the treatment. The card reflects the state of health of the patient, includes the conclusions of possible previous treatments, as well as laboratory, radiological, functional, etc.
A few words should be said about the content of the diagnoses. They are indicated in the form in the form of a special font, universal for all countries. This makes the form valid for any country. Besides, medical uniform, which gives the basis for rest and treatment in specialized resort institutions, without fail contains the following information: It is very important to find out the true state of your health before spa procedures

examinations that the patient underwent and their results;
main diagnosis;
test results;
concomitant diseases: name and condition.

In order to receive a sanatorium-and-spa card, it is necessary not later than 10 days after receiving the voucher to visit a doctor and undergo an examination prescribed by him.
If necessary, pass rehabilitation period or continuation of treatment, the attending physician may recommend to his patients a stay in specialized sanatoriums, medical resorts. To issue a voucher to medical institutions, the local therapist (attending physician) draws up a special medical certificate - a sanatorium-and-spa card of the patient. Form and sample card Sample sanatorium-resort card The document reflects the doctor's recommendations for the rehabilitation and treatment of the patient using certain climatic and natural factors, the season sanatorium treatment, as well as the absence of contraindications. According to the requirements of the legislation of the Russian Federation, the document has the form 072 / y-04. You can get a health resort card in district polyclinic.

If it is necessary to undergo a rehabilitation period or continue treatment, the attending physician may recommend a stay in specialized sanatoriums and medical resorts to their patients. To issue a voucher to medical institutions, the local therapist (attending physician) draws up a special medical certificate - a sanatorium-and-spa card of the patient.

According to the requirements of the legislation of the Russian Federation, the document has the form 072 / y-04. You can get a sanatorium-resort card at the district clinic. The therapist will send the patient to take several tests and undergo elementary studies, on the basis of which he will draw up a document for obtaining a ticket.

Composition and completion of the form

The form of the sanatorium-resort card consists of the front and back parts. The main page displays:

details of the institution that issued the document;
specialty, position and full name of the doctor;
information about the patient (full name, registration address, outpatient card number, compulsory medical insurance and SNILS numbers);
benefits marks are indicated by the letter "L";
information about the absence / presence of a disability in a patient, whether he needs to be accompanied when going to a sanatorium-and-spa treatment;
detailed recommendations regarding the methods and methods of treatment, according to the established diagnosis of the patient.

The reverse side of the card (reverse coupon) must be filled in by the institution that provided services for sanatorium treatment, or upon the return of the patient - by the clinic at the place of residence of the citizen. The completed form 072 / y-04 must be certified by the signature of the doctor and members of the medical commission, as well as the stamp of the medical institution.

Treatment: most often we are talking about spa treatment, so the corresponding item should be ticked. 19. Duration of the course: must correspond to the number of days of spa treatment indicated in the purchased voucher. 20. Voucher number: must match the number of the purchased voucher. The signature of two doctors (the attending physician and the head of the department) must be placed below. This is how the health resort card should be filled out for the above-mentioned 2nd group of citizens. 3.Group. Elderly persons suffering from numerous chronic diseases, serving for sanatorium-and-spa treatment in order to receive effective treatment and improve significantly. Most people in this conditional group go to the so-called "general profile" sanatoriums, which, as a rule, specialize in the treatment of cardiovascular diseases.

Sanatorium-resort card

What you need for a health resort card Going to the clinic, do not forget to bring personal documents (passport and medical insurance policy). For a spa card, you need to take them to get a coupon for a visit to the doctor. If you are going to undergo a commission on the territory of a sanatorium, check in advance whether it is possible to obtain the necessary certificate so as not to waste precious time solving issues and looking for specialists at the last moment.
Not all sanatoriums conduct surveys on their territory, so it’s better to find out everything in advance so that you don’t “sit in a puddle” later. Health resort card form When all the important examinations have been completed and the test results have been received, you will have to visit your doctor again. Based on the data received, he will personally fill in the form of the sanatorium-resort card form 072 / y-04.

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Complaints, duration of the disease, history, previous treatment, including spa treatment: should be entered: complaints of recurrent pain in the epigastric region more often on an empty stomach, no pulm-wheezing, cor-rhythm. HR-75 bpm min. ; AD-120/80 mm Hg The abdomen is soft, slightly painful in the epigastric region. Stool and urine in N. 15. Data from clinical, laboratory, radiological and other studies: the dates and types of studies performed should be entered.
For example: 06.08.08 Gen. an. blood: Hb-150; ER-4.6;.CP-0.89; Leu-5.2; P-1; S-63; E-2; B-1; L-29; M-4; ESR-3 mm/h. 06.08.08 General an. urine: color - sol.zh.; p-1021; sugar, white - abs; Lei- 0-1 in p / sp. Fluorography dated 11.07.08: no pathology. ECG from 08/01/08: Rhythm syn. Heart rate 74 beats / min. norm-e floor-e EOS. 16. Diagnosis. 16.1 Disease, for the treatment of which one is sent to a sanatorium: because

For example, if a patient suffers diabetes- you need an analysis for sugar in the blood and the conclusion of an endocrinologist. There is cholelithiasis - ultrasound of the gallbladder is necessary. treated for oncological disease- there must be recommendations from an oncologist.
The form of the health resort card consists of the card itself and the return coupon. The card indicates the surname, name, patronymic of the patient, gender, date of birth, address of permanent residence. In accordance with the submitted compulsory medical insurance policy, the patient's identification number in the CHI system is indicated.
If the patient is eligible for a kit social services, then the codes of these benefits, as well as the documents on the basis of which these benefits are provided, are indicated in the sanatorium card. According to the patient, data on the place of work, study, profession and position are indicated.

Sanatorium-resort card 072/u-04

A sanatorium-resort card for adults (certificate form 072/y-04) is issued by the attending physician upon presentation by the patient of a voucher for sanatorium-and-spa treatment. The sanatorium-resort card is issued by the attending physician upon presentation by the patient of a voucher for sanatorium-and-spa treatment. Reference form No. 072 / y-04 indicates the absence of contraindications for the implementation of sanatorium treatment, primarily for use in the treatment of natural climatic factors.

The sanatorium card reflects data on the objective condition of the patient, data on the results of previous treatment (outpatient, inpatient), data on laboratory, functional, radiological and other studies. In general, the health resort card must be filled in by the attending physician, in accordance with the instructions for filling out the form No. 072 / y-04.

Form 072 / y-04 - health resort card for adults

Therefore, we will consider this particular filling option: 14. Complaints, duration of the disease, history, previous treatment, including sanatorium treatment: should be entered: complaints of recurrent pain in the heart, which occur more often against the background of physical activity, increased blood pressure up to 160/80 mm Hg, general weakness. , Ob-but: pulm-breathing with a hard tone, no wheezing, cor-rhythm. HR-60 bpm min. ; AD-140/90 mm Hg 15. Data from clinical, laboratory, X-ray and other studies: the dates and types of studies performed must be entered. For example: 06.11.10 Tot. an. blood: Hb-120; Er-4,2;.; Leu-5.2; P-1; S-63; E-2; B-1; L-29; M-4; ESR-10 mm/h. 06.11.10 General an. urine: col. - sol.zh.; p-1021; sugar, white - abs; Lei- 1-2 in p / sp. Fluorography from 11.08.10: Emphysema, pneumosclerosis. ECG from 11/01/10: Rhythm syn. Heart rate 62 beats / min.

Info

17.

Filling out a health resort card: form 072 / y-04

A few words should be said about the content of the diagnoses. They are indicated in the form in the form of a special font, universal for all countries. This makes the form valid for any country. In addition, the medical form, which provides the basis for rest and treatment in specialized spa facilities, must contain the following information: It is very important to find out the true state of your health before spa procedures

examinations that the patient underwent and their results;
main diagnosis;
test results;
concomitant diseases: name and condition.

In order to receive a sanatorium-and-spa card, it is necessary not later than 10 days after receiving the voucher to visit a doctor and undergo an examination prescribed by him.
Lei- 0-1 in p / sp. Fluorography dated 11.07.08: no pathology. ECG from 08/01/08: Rhythm syn. Heart rate 74 beats / min. norm-e floor-e EOS. 16. Diagnosis. 16.1 Disease, for the treatment of which one is sent to a sanatorium: because in this variant, there are no significant diseases, then, as a rule, the code of chronic gastritis (K29.3) is indicated. This disease occurs quite often even in very young and practically healthy people. Paragraphs 16.2 and 16.3 are usually left blank. 17. The name of the sanatorium-resort organization: must match the name of the sanatorium-resort organization in the voucher you purchased. 18. Treatment: most often we are talking about spa treatment, so the corresponding item should be ticked. 19. Duration of the course: must correspond to the number of days of spa treatment indicated in the voucher you purchased. 20.

Attention

Hb-150; ER-4.6;.CP-0.89; Leu-5.2; P-1; S-63; E-2; B-1; L-29; M-4; ESR-3 mm/h. 06.11.10 General an. urine: col. - sol.zh.; p-1021; sugar, white - abs; Lei- 0-1 in p / sp. Fluorography dated 11.08.10: no pathology. ECG from 11/01/10: Rhythm syn. Heart rate 74 beats / min. norm-e floor-e EOS. 16. Diagnosis. 16.1 Disease, for the treatment of which one is sent to a sanatorium: because

in this version, we are considering treatment in a sanatorium that specializes in the treatment of broncho-pulmonary diseases, then this paragraph should naturally indicate the code of chronic bronchitis (J41.0). If it is assumed that there are any other chronic diseases, then their codes should be indicated in paragraph 16.3. (eg chronic gastritis K29.3) - Section 16.2 is usually left blank. 17. Name of the sanatorium-resort organization: must match the name of the sanatorium-resort organization in the purchased voucher. 18.

Sanatorium resort card form 072u 04 sample filling for women

The columns of the document must contain the following data: The front side of the document. On the front side of the form, the OGRN Code of the polyclinic must be entered (this number must correspond to the number of the polyclinic on the round seal on the back of the form). Health resort card number: three or four digit number (eg 348/09) and date of issue of the certificate (eg May 10, 2009). The number can be fractional, indicating the year the certificate was issued for the fraction. 1. Attending physician: full name of the physician. 2. Issued: your full name. 3. Gender: Your gender is ticked. 4. Date of birth: your date of birth. 5. Address: your permanent address and telephone number. 6. Medical history or outpatient card number: four-digit number (eg 1349) 7. MHI identification number: your number, if you have one.
(eg 880003 0063870120) 8. Benefit Code: You must enter the benefit code if you have this benefit.