The order of medical selection and referral to sanatorium-and-spa treatment. The procedure for the selection and referral of patients for sanatorium-resort treatment Grounds for sanatorium-resort treatment

(as amended by the Orders of the Ministry of Health and Social Development of the Russian Federation dated 09.01.2007 N 3,

dated December 24, 2007 N 794)

I. The order of medical selection and referral to sanatorium-and-spa treatment for adults

(except for tuberculosis patients)

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

1.2. Medical selection and referral of patients in need of sanatorium 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 head physician (deputy head physician) of the medical and prophylactic institution (outpatient institution (at the place of residence) or medical unit (at the place of work, study) of the patient when referring him to preventive sanatorium treatment and hospital institution when referring the patient for aftercare).

Medical selection and referral to 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.

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

In difficult and conflict situations, on the recommendation of the attending physician and the head of the department, a conclusion on the indications for sanatorium treatment is issued by the VC of the medical institution.

(as amended by the Order of the Ministry of Health and Social Development of the Russian Federation dated 09.01.2007 N 3)

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

(the paragraph was introduced by the Order of the Ministry of Health and Social Development of the Russian Federation of 09.01.2007 N 3)

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

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

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

1.5. If there are medical indications and there are no contraindications for sanatorium-resort treatment, the patient is given a certificate for obtaining a voucher in the form N 070 / y-04 (hereinafter referred to as a certificate for obtaining a voucher) (Appendix N 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 the Order of the Ministry of Health and Social Development of the Russian Federation dated 09.01.2007 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 obtaining a voucher based on the conclusion of the VK of the medical institution.

(The paragraph was introduced by the Order of the Ministry of Health and Social Development of the Russian Federation of 09.01.2007 N 3, as amended by the Order of the Ministry of Health and Social Development of the Russian Federation of 24.12.2007 N 794)

Validity of the certificate for obtaining a ticket is 6 months.

(the paragraph was introduced by the Order of the Ministry of Health and Social Development of the Russian Federation of 09.01.2007 N 3)

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

The darkened reference field is filled in 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 who are entitled to receive a set of social services.

The certificate is of a preliminary informational nature and is submitted to the patient 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 not earlier than 2 months before the start of its validity to come to the attending physician who issued him a certificate for obtaining a voucher, in order to conduct the necessary additional examination. If the SCO profile specified in the voucher corresponds to this recommendation before, the attending physician fills in and issues to the patient a sanatorium-resort card in the form N 072 / y-04 (hereinafter referred to as the sanatorium-resort card) (Appendix N 3) of the established form, signed by him and department head.

The darkened field of the sanatorium card is filled in and marked with the letter "L" in the organizational and methodological office only for citizens who are entitled to receive a set of social services.

The attending physician of the medical institution makes an appropriate entry in the medical record of the outpatient (in the case history when referring for follow-up care) about the issuance of a sanatorium-and-spa card.

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

The number of issued certificates for obtaining a ticket;

Number of health resort cards issued;

The number of return coupons for sanatorium cards.

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

(as amended by the Order of the Ministry of Health and Social Development of the Russian Federation dated 09.01.2007 N 3)

A) clinical blood analysis and urinalysis;

B) electrocardiographic examination;

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

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

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

E) when referring women to sanatorium-and-spa treatment for any disease, the conclusion of an obstetrician-gynecologist is mandatory, and for pregnant women - an additional exchange card;

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

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

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

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

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

Accounting for children in need of sanatorium treatment;

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

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

2.2. The need to send a child to a sanatorium-and-spa treatment is determined by the attending physician and the head of the department of the medical institution, and for children who are entitled to receive state social assistance in the form of a set of social services, by the attending physician and the VC of the medical institution at the place of residence with a certificate for obtaining a voucher for a child (to be provided at the place of demand) and a sanatorium-resort card for children in the form N 076 / y-04 (hereinafter referred to as a sanatorium-resort card for children) (Appendix N 4).

(as amended by the Order of the Ministry of Health and Social Development of the Russian Federation dated 09.01.2007 N 3)

In the organizational and methodological office of the medical institution, it is marked with the letter "L" and a darkened reference field is filled in for obtaining a voucher and a sanatorium card for children only for children from among citizens entitled to receive a set of social services.

(as amended by the Order of the Ministry of Health and Social Development of the Russian Federation dated 09.01.2007 N 3)

2.3. Referral of children to sanatorium treatment is carried out in the same manner as for adult patients.

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

2.5. Before sending a child to a spa treatment, the attending physician organizes his clinical and laboratory examination, depending on the nature of the disease, as well as the rehabilitation of chronic foci of infection, antihelminthic or antigiardia treatment.

2.6. When referring a child to a sanatorium-resort treatment, the following documents must be presented:

a voucher;

Sanatorium-resort card for children;

Compulsory health insurance policy;

Analysis for enterobiasis;

The conclusion of a dermatologist about the absence of contagious skin diseases;

A certificate from a pediatrician or epidemiologist about the absence of contact between the child and infectious patients at the place of residence, in kindergarten or school.

2.7. At the end of the sanatorium-and-spa treatment, a return coupon of the sanatorium-and-spa card is issued for the child to be presented to the medical institution that issued the sanatorium-and-spa card, as well as a sanatorium book with data on the treatment performed in the North Kazakhstan Region, its effectiveness, and medical recommendations.

This documentation is handed out to parents or an accompanying person.

III. The order of admission and discharge of patients

3.1. Upon arrival in the North Kazakhstan region, the patient presents a voucher and a sanatorium-and-spa card, which is stored in the North Kazakhstan region for three years. In addition, the patient is recommended to have a compulsory health insurance policy with him.

3.2. After the initial examination, the attending physician of the NKR issues a sanatorium book to the patient, in which the prescribed medical procedures and other appointments are recorded. The patient presents it in the medical units of the North Kazakhstan region to mark the treatment or examination.

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 issued a return coupon of the sanatorium-resort card and a sanatorium book with data on the treatment performed in the North Kazakhstan region, its effectiveness, and recommendations for a healthy lifestyle. The return coupon of the sanatorium card of the patient must be submitted to the medical institution that issued the sanatorium card or to the outpatient institution at the place of residence of the patient after completion of the aftercare course.

(as amended by the Order of the Ministry of Health and Social Development of the Russian Federation dated 09.01.2007 N 3)

3.5. Reverse coupons of sanatorium-and-spa cards are filed into the medical record of an outpatient and stored in a medical institution for three years.

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

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

4.1. Staying in the SKO, which entails a deterioration in the patient's health, is considered contraindicated for him.

4.2. When determining contraindications to sanatorium-and-spa treatment, physicians of a medical institution and a health resort should be guided by duly approved contraindications that preclude referral of patients to sanatorium-and-spa 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 others.

4.3. The contraindication of the direction and stay of the patient in the NKR is established by the attending physician, and in conflict cases - by the VC of the medical institution, NKR.

The attending physician or VC of a medical and preventive institution, RCO determines:

Presence of contraindications for treatment;

The possibility of leaving the patient in the North Kazakhstan region for balneological, climatic, medical or other treatment;

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

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

4.4. The term for identifying contraindications for a patient's stay in the SKO, as a rule, should not exceed 5 days from the moment of his admission.

4.5. In the event that a patient has contraindications, the VK SKO draws up an act of contraindication to the patient of sanatorium-and-spa treatment in 3 copies, one of which is sent to the health management body of the constituent entity of the Russian Federation, the second - to the address of the medical institution that issued the sanatorium-and-spa card, for analysis on VK, and the third copy of the act remains in the North Kazakhstan region.

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

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 (Collected Legislation of the Russian Federation, 2004, N 28, Art. 2898), article 6.2. Federal Law of 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 to sanatorium-and-spa treatment I order:

1. Approve:

1.1 The order of medical selection and referral of patients for sanatorium treatment (Appendix N 1).

1.2. Form N 070 / y-04 "Certificate for obtaining a ticket" (Appendix N 2).

1.3. Form N 072 / y-04 "Sanatorium card" (Appendix N 3).

1.4. Form N 076 / y-04 "Sanatorium card for children" (Appendix N 4).

1.5. Instructions for filling out the form N 070 / y-04 "Help for obtaining a ticket" (Appendix N 5).

1.6. Instructions for filling out the form N 072 / y-04 "Sanatorium card" (Appendix N 6).

1.7. Instructions for filling out the form N 076 / y-04 "Sanatorium card for children" (Appendix N 7).

2. Recognize invalid 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" *.

3. To impose control over the execution of this order on 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 number 2800.

Appendix No. 1

The order of medical selection and referral of patients for sanatorium-and-spa treatment

I. The order of medical selection and referral to sanatorium treatment of adults (except for patients with tuberculosis)

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

1.2. Medical selection and referral of patients in need of sanatorium treatment is carried out by the attending physician and the head of the department, and where there is no head of the department, the head physician (deputy head physician) of the medical institution (outpatient clinic (at the place of residence) or medical unit (at the place of work, study) of the patient when he is sent for preventive sanatorium treatment and a hospital institution when the patient is sent for aftercare).

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

1.7. Having received a voucher, the patient is obliged not earlier than 2 months before the start of its validity to come to the attending physician who issued him a certificate for obtaining a voucher, in order to conduct the necessary additional examination. If the SCO profile specified in the voucher corresponds to this recommendation before, the attending physician fills out and issues to the patient a sanatorium-resort card in the form N 072 / y-04 (hereinafter referred to as the sanatorium-resort card) (Appendix N 3) of the established sample, signed by him and the head department.

The number of issued certificates for obtaining a ticket;

Number of health resort cards issued;

The number of return coupons for sanatorium cards.

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

a) clinical blood analysis and urinalysis;

b) electrocardiographic examination;

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

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

f) when referring women to sanatorium-resort treatment for any disease, the conclusion of an obstetrician-gynecologist is mandatory, and for pregnant women - an additional exchange card;

g) a certificate-conclusion of a psycho-neurological dispensary if the patient has a history of neuropsychiatric disorders;

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

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

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

Accounting for children in need of sanatorium treatment;

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

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

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

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

In the organizational and methodological office, it is marked with the letter "L" and a darkened reference field is filled in for obtaining a voucher and a sanatorium card for children, only for children from among citizens entitled to receive a set of social services.

2.3. Referral of children to sanatorium treatment is carried out in the same manner as for adult patients.

2.6. When referring a child to a sanatorium-resort treatment, the following documents must be presented:

a voucher;

Sanatorium-resort card for children;

Compulsory health insurance policy;

Analysis for enterobiasis;

The conclusion of a dermatologist about the absence of contagious skin diseases;

A certificate from a pediatrician or epidemiologist about the absence of contact between the child and infectious patients at the place of residence, in kindergarten or school.

This documentation is handed out to parents or an accompanying person.

III. The order of admission and discharge of patients

3.4. Upon completion of the course of sanatorium-resort treatment, the patient is issued a return coupon of the sanatorium-resort card and a sanatorium book with data on the treatment performed in the North Kazakhstan region, its effectiveness, recommendations for a healthy lifestyle, which the patient must submit to the medical institution that issued the sanatorium-resort card or to an outpatient clinic at the place of residence of the patient after completion of the aftercare course.

3.5. Reverse coupons of sanatorium-and-spa cards are filed into the medical record of an outpatient and stored in a medical institution for three years.

3.6. Documents certifying temporary incapacity for work of citizens due to an acute illness, injury or exacerbation of a chronic disease that occurred during their stay at a sanatorium-and-spa treatment are issued, as a rule, by medical institutions at the place of stay of the patient, in accordance with the current regulatory legal documents.

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

4.1. Staying in the SKO, which entails a deterioration in the patient's health, is considered contraindicated for him.

4.2. When determining contraindications to sanatorium-and-spa treatment, doctors of a medical institution and a medical institution should be guided by duly approved contraindications that exclude the referral of patients to sanatorium-and-spa 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 a resort or in a sanatorium for him, as well as for others.

4.3. The contraindication of the direction and stay of the patient in the NKR is established by the attending physician, and in conflict cases - by the VC of the medical institution, NKR.

The attending physician or VC of a medical and preventive institution, RCO determines:

Presence of contraindications for treatment;

The possibility of leaving the patient in the North Kazakhstan region for balneological, climatic, medical or other treatment;

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

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

4.4. The term for identifying contraindications for a patient's stay in the SKO, as a rule, should not exceed 5 days from the moment of his admission.

4.5. In the event that a patient has contraindications, the VK SKR draws up an act of contraindication to the patient of sanatorium-and-spa treatment in 3 copies: one of which is sent to the health management body of the subject of the Russian Federation, the second - to the address of the medical institution that issued the sanatorium-and-spa card, for analysis on VK, and the third copy of the act remains in the North Kazakhstan region.

Appendix No. 5

Instructions for filling out the form N 070 / y-04 "Help for obtaining a ticket"

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

The certificate for obtaining a permit is filled in by the attending physicians of medical institutions providing outpatient care.

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

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

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

In the paragraph "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 back of the certificate for obtaining a ticket.

The item "Nearest region" is filled in only if the patient lives in the 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" numerical 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 ticket.

The item "Diagnosis" is filled in in accordance with ICD-10 (International Classification of Diseases) according to medical documentation about the forms, stages, nature of the course of the disease.

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

In the paragraph "Main disease or disease that causes disability" the diagnosis of the underlying disease is indicated, and for disabled people and children with disabilities - the diagnosis of the disease that causes disability.

Under "Concomitant diseases" diagnoses of concomitant diseases are indicated.

Items "Preferred place of treatment" and "Recommended seasons of treatment" are optional.

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

Appendix No. 6

Instructions for filling out the form N 072 / y-04 "Sanatorium card"

The 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 ticket.

The sanatorium card is filled in by the attending physicians of medical institutions providing outpatient care.

The darkened field of the sanatorium card (items 8-11) is filled in and marked with the letter "L" in the organizational and methodological office only for citizens who are 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 affixed, 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 identity document of the citizen.

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

In the paragraph "Identification number in the compulsory medical insurance system" under 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 number of the policy.

The item "Benefit Code" is filled in in accordance with Chapter 2 of the Federal Law of July 17, 1999 N 178-FZ "On State Social Assistance". The 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 ticket. The specified item is filled in by putting zeros up to 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 item "Benefit Code".

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 according to a document certifying the right to receive a set of social services. The "Accompaniment" item is filled in if the patient belongs to citizens who have a III degree disability in their ability to work.

Items "Place of work, study" and "Position held, profession" are filled in according to the patient.

The item "Complaints, duration of the disease, history, previous treatment, including spa treatment" is filled in on the basis of medical documentation and according to the patient.

The item "Data of clinical, laboratory, X-ray and other studies" is filled in on the basis of medical documents with the obligatory indication of the date of the study.

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

The return coupon is filled in by the attending physician of the sanatorium-resort organization to present it to patients at the medical institution that issued the sanatorium-resort card (after completion of the aftercare course - to the outpatient institution at the place of residence).

Surname, name, patronymic are filled in in accordance with the document proving the identity of a citizen, recognized in the territory of the Russian Federation.

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

The subparagraph "Disease for which treatment 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 underlying disease, and for disabled people, the diagnosis of the disease that causes disability.

In the subparagraph "Concomitant diseases" diagnoses of concomitant diseases are indicated.

The subparagraph "Main disease or disease causing disability" indicates the diagnosis of the underlying disease, and for disabled people, the diagnosis of the disease that causes disability.

In the subparagraph "Concomitant diseases" diagnoses of concomitant diseases are indicated.

Appendix No. 7

Instructions for filling out the form N 076 / y-04 "Sanatorium and resort card for children"

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

The form of the sanatorium-resort card consists of:

Sanatorium-resort card;

Return ticket.

The sanatorium-resort card is filled in by the attending physicians of medical institutions providing outpatient care for children.

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

On the title page of the health resort card, the full name of the medical institution is affixed in accordance with the registration document.

The number of the sanatorium-resort card is an individual registration number of the sanatorium-resort card, established by the medical 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 identity document of the citizen.

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

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 item "Benefit Code".

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 item "Accompaniment" is filled in if the patient is a disabled child.

The items "Educational institution" and "Place of work of parents" are filled in according to the words of the person accompanying the child.

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

The item "Diagnosis" is filled in in accordance with ICD-10 according to the medical documentation on the forms, stages, nature of the course of diseases.

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

In the subparagraph "Concomitant diseases" diagnoses of concomitant diseases are indicated.

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

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

On the title page of the return coupon, the full name of the sanatorium and resort organization is affixed in accordance with the registration document.

The surname, name, patronymic of the child are filled in in accordance with the document proving the identity of the citizen, recognized in the territory of the Russian Federation.

The item "Diagnosis upon discharge from the sanatorium" is filled in in accordance with ICD-10 according to the medical documentation of the sanatorium-resort organization on the forms, stages, nature of the course of the disease.

The subparagraph "Main disease or disease causing disability" indicates the diagnosis of the underlying disease, and for disabled children, the diagnosis of the disease that causes disability.

In the subparagraph "Concomitant diseases" diagnoses of concomitant diseases are indicated.

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

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".

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

The item "Past intercurrent diseases and exacerbation of the underlying and concomitant diseases" is filled in on the basis of medical records.

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

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

The resort stationary medical and preventive institution is sanatorium. Most sanatoriums are organized in resort areas in order to maximize the use of the natural features of the area.

Resorts and sanatoriums

Resort- the area, the natural features of which allow you to effectively deal with the treatment and prevention of diseases. According to the nature of these features, resorts are divided into three groups: (waters of mineral springs), mud (therapeutic mud) and climatic (seaside, mountain, plain, forest and steppe). For resorts, three zones of sanitary protection have been established, within which it is prohibited. An important role is given to local resorts, which are most often intended for patients who, after treatment, for health reasons, are contraindicated in climate change.

The sanatorium is intended for the treatment of patients mainly with natural remedies in combination with physiotherapy, exercise therapy, and therapeutic nutrition in conditions of active recreation and a specially organized regimen. Drug treatment and bed rest are not typical for a sanatorium, although they can be prescribed. Patients with a variety of diseases are treated in sanatoriums. In this regard, there are sanatoriums with diseases of the circulatory organs, digestive organs, gynecological diseases, etc. Depending on the age of the patients, sanatoriums are divided into children's, adolescent and adult.

The basis of sanatorium treatment is the sanatorium regime, which provides the most favorable conditions for treatment and rest. Patients are provided with treatment in mud baths, solariums, swimming pools, etc. In most resorts, along with sanatorium treatment, outpatient treatment is also carried out for patients who come on course vouchers.

Sanatoriums-dispensaries are also widely used - medical and preventive institutions organized at industrial enterprises, maintained at the expense of state insurance funds. The workers of this enterprise, on the recommendation of the attending physician, are given the opportunity to undergo treatment in a dispensary within 24 days after work, where they are delivered by special transport. In addition, sanatorium institutions include resort clinics, hydropathic clinics, mud baths, etc.

The order of referral to sanatorium-resort treatment

The effectiveness of spa treatment depends on the correct direction of patients to the resort and the sanatorium.

For the possibility of spa treatment, you must contact the doctor of the clinic at the place of residence. The doctor gives a referral to the sanatorium selection committee (SOK), which determines the need for sanatorium treatment, the profile of the sanatorium and the season for treatment. After receiving the conclusion of the SOK, it is necessary to write an application for a voucher addressed to the chairman of the commission (authorized) for social insurance at the place of work. Pensioners apply to the social security authorities (district departments of social protection of the population) at their place of residence. The Social Insurance Commission must consider the application and make a decision within 10 days. In case of disagreement with the decision of the commission, it is possible to appeal against its decision through the department (branch of the department) of the social protection institution. In addition to resolving the issue of allocating a voucher, the social insurance commission has the right to resolve the issue of paying 50% of the cost of travel to the sanatorium and back, depending on the patient's earnings and marital status. Permits are issued only for the period of vacation of the employee. Participants of the Great Patriotic War and persons equated to them are entitled to receive a ticket free of charge.

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 a month old, an ECG no more than a month old, an X-ray examination (FLG or chest X-ray) no more than six months ago, for women, the conclusion of a gynecologist, regardless of the diagnosis of the disease, the 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 duly issued and certified by the seal of the institution that issued it. In addition to a voucher and a sanatorium card, when entering a sanatorium, you must have a passport, children under 16 years of age have a birth certificate or a copy of it. Military personnel present an identity card, and military pensioners - a pension certificate, where in the section for special marks it should be indicated that the pensioner enjoys the right to sanatorium treatment in sanatoriums of the Ministry of Defense of the Russian Federation.

In the sanatorium book issued to the patient in his hands, the doctor of the sanatorium notes the change in the patient's state of health, the treatment and research carried out, and at the end of the voucher period - the results of treatment and recommendations on the mode of work and therapeutic measures. Upon returning from the sanatorium, the patient presents the sanatorium book to the attending physician, who transfers all the necessary information to the outpatient card for the development of further therapeutic and preventive measures.

The effectiveness of sanatorium-and-spa treatment is evidenced by the long-term absence of exacerbations of the underlying disease, stable recovery, improvement in the general state of health and well-being of the patient.

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The selection of persons in need of sanatorium treatment is carried out by the attending physician and the head of the department of the medical institution (hospital, polyclinic, antenatal clinic, dispensary, medical unit) in which the patient is treated. In their work, they are guided by the “Procedure for medical selection and referral of patients to sanatorium treatment”, approved by Order of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004 No. 256.

When deciding whether to send patients to a sanatorium, the attending physician must take into account the requirements of the Guidelines (“Medical indications and contraindications for sanatorium treatment of adults and adolescents”) approved by the Ministry of Health of the Russian Federation on December 22, 1999 No. 99/227. They also define general contraindications that exclude the direction of sick adults and adolescents to resorts and local sanatoriums.

These include the following states:
1. All diseases in the acute stage, chronic diseases in the acute stage and complicated by an acute purulent process.
2. Acute infectious diseases before the end of the isolation period.
3. All sexually transmitted diseases in acute and contagious form.
4. All blood diseases in the acute stage and the stage of exacerbation.
5. Cachexia of any origin.
6. Malignant neoplasms (after radical treatment with a generally satisfactory condition, no metastasis, normal peripheral blood counts, patients can only be referred to local sanatoriums for general strengthening treatment).
7. All diseases and conditions requiring inpatient 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 to be treated in specialized sanatoriums for spinal patients) .
8. Echinococcus of any localization.
9. Frequent or profuse bleeding.
10. Pregnancy at all times - for balneological and mud resorts, and for climatic resorts - starting from the 26th week.
In addition, during all periods of pregnancy, it is impossible to send residents of the plains to mountain resorts located at an altitude of more than 1000 m above sea level.
11. All forms of tuberculosis in the active stage - for any resorts and sanatoriums of a non-tuberculosis profile.

When deciding on the advisability of treatment at resorts, it is necessary to take into account the patient's concomitant diseases, which should not be a contraindication for referral to this sanatorium, the contrast of climatic and geographical conditions, the features of the hydro-mineral resources of the resort and the severity of the move for the patient. In the presence of a serious illness or short periods of rehabilitation, the direction of patients is shown mainly to local sanatoriums.

If there are indications and no contraindications for sanatorium treatment, the patient is issued a certificate for obtaining a voucher (form 070 / y-04), approved by Order of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004 No. 256 (Appendix 2), in which it should be indicated using the code region of residence and, if necessary, the nearest region; climate and climatic factors in the place of residence; diagnosis, which is the basis for referral to a sanatorium, diagnosis - the cause of disability (if any), concomitant diseases; recommended treatment, preferred treatment site and recommended seasons. For persons entitled to receive a package of social services, the darkened field (clauses 8-13) of the certificate is filled in and marked with the letter “L”. The certificate is valid for 6 months from the date of issue. The certificate is a medical basis for obtaining a voucher, is preliminary informational in nature and is issued to the patient for presentation at the place where the voucher was provided, where it is stored for three years.

Having received a voucher, the patient is obliged not earlier than 2 months before the start of its validity to come to the attending physician who issued the certificate for obtaining a voucher to conduct the necessary examination, which includes a clinical blood and urine test, ECG, X-ray examination of the chest organs (FLG) , consultation of an obstetrician-gynecologist (for women). In necessary cases, special studies and consultations of specialists are carried out to clarify the diagnosis of the underlying and concomitant diseases.

Based on the medical examination data, the attending physician fills in and issues to the patient a sanatorium-resort card (form 072 / y-04), approved by order of the Ministry of Health of the Russian Federation of November 22, 2004 No. 256 (Appendix 3), signed by him and the head of the department. It reflects complaints, anamnesis, examination data of specialists, results of analyzes and instrumental studies, a diagnosis - for the treatment of which they are sent to a sanatorium, the cause of disability (if any), concomitant diseases. For persons entitled to receive a package of social services, the darkened field (clauses 8-13) of the sanatorium card (clauses 6-11) is filled in and marked with the letter "L".

When a patient enters a sanatorium, he presents a completed voucher, passport, compulsory medical insurance policy and a sanatorium card. Based on the initial and subsequent in-depth examination, the doctor fills in the medical history and issues a spa book, in which he notes the order and sequence of the procedures, the necessary motor regimen and diet.

Upon completion of the course of sanatorium-resort treatment, the patient is issued a return coupon of the sanatorium-resort card and a sanatorium book with data on the treatment carried out in the sanatorium-resort organization, its effectiveness, recommendations on the mode of work, nutrition and rest for presentation to the medical institution that issued the sanatorium - a resort card or an outpatient clinic at the place of residence of the patient after completion of the aftercare course. Reverse coupons of sanatorium-and-spa cards are filed into the medical card of an outpatient.

The terms of sanatorium treatment in accordance with the letter of the Ministry of Health of Russia dated 08.10.1997 No. 2510 / 7551-97-23 are 24 calendar days in sanatoriums of all-Russian significance, and 21 calendar days in local sanatoriums.

For the treatment of certain categories of patients, longer periods of treatment have been established in highly specialized sanatorium-resort institutions (in accordance with the Decree of the Executive Committee of the Council of the Federation of Independent Trade Unions of Russia dated 06/16/1992 No. 6-7, agreed with the Ministry of Health and Medical Industry of the Russian Federation): in sanatoriums (departments) for the treatment of patients with diseases and consequences of spinal cord injuries - 45 days; with inflammatory diseases of the kidneys - 36 days; with occupational respiratory diseases - 45 days; with occupational lung diseases (pneumoconiosis, silicosis) - 30 days.

Martsyash A.A., Lastochkina L.A., Nesterov Yu.I.