List of documents for the passage of MSE. What is a referral to ITU? What medical and preventive organizations issue it and how to get it? Application Form 088

“Referral for medical and social examination by an organization providing medical and preventive care”

The line "Date of issue" indicates the date of issue of the "Referral for medical and social examination by an organization providing medical and preventive care" to a citizen sent for a medical and social examination or his legal representative.

On line 1 the surname, name, patronymic of the citizen sent for medical and social examination are indicated in full.

On line 2“Date of birth” indicates the day, month and year of birth.

On line 3 the gender of the citizen is indicated in abbreviated form: “m” or “g”.

Line 4“Last name, first name, patronymic of the legal representative of a citizen” is filled in in full if there is a legal representative.

On line 5“Address of the place of residence of a citizen” in the absence of a place of residence, the address of stay, actual residence on the territory of the Russian Federation is indicated.

On line 6“Not a disabled person, disabled person of the first, second group, category “disabled child” of the group” indicates the disability group based on the certificate of the institution of medical and social expertise on the established disability group that the disabled person has or emphasizes “not a disabled person” if the patient is sent for the first time.

Line 7"The degree of limitation of the ability to work" is excluded by the Decree of the Government of the Russian Federation of December 30, 2009 No. N 1121

Line 8“The degree of loss of professional ability to work as a percentage” is filled in during a re-examination on the basis of a certificate of a medical and social examination institution that a citizen has on determining the degree of loss of professional ability to work.

On line 9 it is emphasized whether a citizen is first or re-sent to the ITU.

On line 10“Who works at the time of sending for a medical and social examination” should indicate the position, profession, specialty, qualifications and length of service in the specified position, profession, specialty, qualifications; in relation to non-working citizens, make an entry: “does not work”.

On line 11“Name and address of the organization in which the citizen works” indicates the name of the organization with the address in which the person being sent works on the day the sick leave is opened. If a citizen does not work, an appropriate entry is made about this.

On line 12“Conditions and nature of the work performed” information is recorded from the words of the patient, if necessary, requested from the place of work in the form of production characteristics (duration of the working day, shift; manual labor, machine-manual, mental, conveyor: position at work (in percent: sitting , standing, variable, walking); degree of physical stress: permanent (mild, moderate, severe) and temporarily (mild, moderate, severe); degree of neuropsychic stress: permanent (mild, moderate, severe) and temporarily (mild, moderate , heavy); administrative work (large, medium, small volume), indicate the number of subordinates; the presence of unfavorable working conditions (work in a hot shop, in the cold, increased dust and gas pollution, exposure to chemicals, at height, with vibration) .

On line 13“Main profession (specialty)” indicates a profession obtained through special education (for example, an engineer, teacher, construction technician), or a profession in which there is the longest work experience and (or) the highest qualification (for example, a repairman of the 5th category and etc.).

On line 14“Qualification in the main profession (class, category, category, rank)” should indicate the qualification that the patient had on the day the sick leave was opened.

Lines 15, 16. 17 filled out for citizens who are studying at an educational institution at the time of being sent for a medical and social examination (full-time or part-time department). Line 15 indicates the name and address of the educational institution, line 16 indicates the indicated group, class, course, line 17 indicates the profession (specialty) that a citizen sent for a medical and social examination will receive upon graduation from an educational institution.

On line 18“Observed in organizations providing medical and preventive care since _____ year” indicates the date of initial filling out of the patient's outpatient card in a medical institution.

On line 19 during the initial registration of a referral for a medical and social examination, information is provided in detail about the onset of the disease (the nature of the injury, injury), the characteristics of the course, exacerbations (indicate the frequency and duration of exacerbations for the 12 months preceding the referral of the patient for a medical and social examination), information about the nature of the treatment (outpatient or inpatient with indication of the profile of the department), types of treatment: therapeutic, surgical, physiotherapy, etc. When making a referral for re-examination, information is indicated on the course of the disease for the period that has elapsed since the date the disability group was established, new cases identified during this period are described in detail diseases that lead to permanent impairment of body functions.

Line 20“Anamnesis of life” is filled in at the primary referral. The diseases transferred in the past, injuries, poisonings, operations, diseases for which heredity is burdened are listed. In relation to the child, it is additionally indicated how the mother's pregnancy and childbirth proceeded, the terms for the formation of psychomotor skills, self-service, cognitive-playing activities, skills of neatness and self-care, how the development proceeded (by age, lagging behind, ahead of schedule).

On line 21“Frequency and duration of temporary disability for the last 12 months” in the columns “Date (day, month, year) of the beginning of temporary disability” and “Date (day, month, year) of the end of temporary disability” indicate the dates of opening and closing of sick leave sheets, in the column “number of days (months and days) of temporary incapacity for work” indicates the total number of days of temporary incapacity for work. If the patient does not work, then this section indicates the frequency of his requests for medical care to a medical institution and the diagnosis of diseases for which the patient applied to a medical facility. The column "Diagnosis" indicates the diagnosis of the disease, for which the patient in the relevant period was recognized as temporarily disabled or sought medical help.

On line 22“The results of the measures taken for medical rehabilitation in accordance with the individual rehabilitation program for a disabled person” indicates information on measures to restore the patient’s ability to work, specific types of restorative therapy, reconstructive surgery, spa treatment, technical means of rehabilitation, including prosthetics and orthotics, as well as the period in which they were provided; lists the functions of the body that could be compensated or restored in whole or in part, or a note is made that there are no positive results.

On line 23“The state of a citizen when referring to a medical and social examination (complaints, examination data by the attending physician and doctors of other specialties are indicated) when describing the objective status, each specialist describes in detail and consistently the patient’s complaints, primarily related to the underlying disease, then others, with exhaustive completeness the data of an objective examination of the patient by specialists are reflected, while the specialty of the doctor (therapist, surgeon, neurologist, etc.) is indicated.

In necessary cases, for records of the patient's condition, the results of the examination, specialists can use an insert for the referral of an arbitrary form, which must be sealed and signed by the chairman of the medical commission and members of the commission.

On line 24 the results of laboratory, radiological, endoscopic, ultrasound, psychological, functional and other types of studies are indicated.

On line 25 the body weight of a citizen in kg, height in meters, body mass index are indicated. The latter is calculated by the formula:

BMI = Weight (kg) / Height (in meters) squared

Preobesity 25–29.9

Obesity I degree 30–34.9

Obesity II degree 35–39.9

Obesity III degree 40 or more

A person's height is measured using a stadiometer. Normally, the height of men ranges from 160-180 cm, women 155-170 cm. Body weight is determined using medical scales.

On line 26 an assessment of physical development is given - normal, deviation (lack of body weight, excess body weight, short stature, high stature) - the necessary is underlined. Physical development is a set of morphological functional features of the body that determine the reserve of its physical strength, endurance and performance.

On line 27“Assessment of psychophysiological endurance: norm, deviation” is underlined. Psychophysiological endurance is the ability of a person to maintain any activity for a long time without reducing the effectiveness of its implementation, i.e. in a broad sense - performance. Psychophysiological endurance is determined by the degree of physical development, the state of the functional systems of the body, personality traits, temperament, the level of motivation to perform activities, and other factors. Psychophysiological stability is assessed by a psychologist based on an analysis of the dynamics of psychophysiological and physiological indicators in the process of performing psychological tests, sensory, sensorimotor and physical stress, as well as knowledge that simulates various types of household, professional and other activities. At the same time, it is not just the level of development or the state of certain functions that is assessed, but, first of all, their characteristics such as stability and the ability to maintain activity at a certain level for a long time.

On line 28“Assessment of emotional stability: norm, deviation” is underlined. Emotional stability is a trait that expresses the preservation of organized behavior in normal and stressful situations and is characterized by maturity, excellent adaptation, the absence of great tension, anxiety, a tendency to leadership, sociability; emotional instability - extreme nervousness, instability, poor adaptation, a tendency to quickly change moods, feelings of guilt and anxiety, anxiety, depressive reactions, absent-mindedness, instability in stressful situations, impulsiveness, unevenness in relationships with people, variability of interests, self-doubt, pronounced sensitivity, impressionability, propensity to irritants. Emotional stability is assessed by a psychologist using various projective techniques, questionnaires and scales.

On line 29"Diagnosis when referring to a medical and social examination" in paragraph "a" the code of the underlying disease according to ICD-10 is indicated; in paragraph “b” a detailed diagnosis is indicated, reflecting the nosological form of the disease in accordance with ICD-10, etiology, course features, stage, degree of functional disorders. When several diseases are combined, the main disease is indicated, which determines the presence of signs of disability; in paragraph “c” “comorbidities” indicate those diseases that are not decisive in the assessment of disability; in paragraph “c” the complications caused by the underlying disease are indicated.

On line 30“Clinical prognosis: favorable, relatively favorable, doubtful (uncertain), unfavorable” is underlined. Clinical prognosis - a medical assessment of the outcome of the disease, taking into account the nature of the disease and its course, stage, severity of symptoms, the degree of dysfunction of the affected organs and systems and the state of their compensation, as well as the effectiveness of adequate treatment. The prognosis can be: favorable - complete recovery or compensation of functions impaired as a result of illness, injury or injury, leading to disability; relatively favorable - incomplete recovery with residual manifestations, reduction, stabilization or partial compensation of impaired functions leading to disability, in case of a chronic disease - slowing down the progression of the disease, prolongation of remission periods, etc., doubtful - unclear course of the disease, unfavorable - impossibility of stabilization state of health, stopping the progression of the pathological process and reducing the degree of violation of the functions of the body, leading to limitation of life. In order to predict the degree of recovery of impaired functions, it is possible to use various tests and scales.

On line 31“Rehabilitation potential: high, fair, low” is underlined. Rehabilitation potential is a set of preserved physical, psychophysiological, mental abilities and inclinations that allow a person to compensate or eliminate, to one degree or another, the limitations of life activity that have formed as a result of an illness or defect. High rehabilitation potential - full restoration of health, all types of life that are usual for a person, working capacity and social status. Satisfactory potential - incomplete recovery with the preservation of a moderately pronounced dysfunction, the performance of the main activities with limited labor or with the help of technical aids. Low rehabilitation potential - progressive course of the disease, severe dysfunction; a significant limitation in the performance of most activities, expressed by a decrease in working capacity and the ability to social integration; the need for social support and constant material assistance. The rehabilitation potential is assessed by the attending physician, who directs the citizen to a medical and social examination.

On line 32“Rehabilitation prognosis: favorable, relatively favorable, doubtful (uncertain), unfavorable” is underlined. Rehabilitation prognosis - the estimated probability of realizing the rehabilitation potential and the estimated level of integration of the disabled person into society. The rehabilitation forecast is determined not only by the level and content of the rehabilitation potential, but also by the real possibilities of using modern rehabilitation technologies, means and methods for its implementation. The rehabilitation prognosis is assessed as: favorable - with the possibility of complete restoration of impaired body functions and categories of disability, full social, including professional integration of a disabled person; relatively favorable - the possibility of partial restoration of impaired body functions and categories of disability, with a decrease in the degree of their limitations or stabilization, with an expansion of the ability to integrate and move from full to partial social support; doubtful (uncertain) - unclear forecast; unfavorable - the impossibility of restoring or compensating for impaired body functions and categories of life restrictions. The rehabilitation prognosis is assessed by the attending physician, who directs the citizen to a medical and social examination.

On line 33 the purpose of the referral for a medical and social examination is indicated (the necessary is underlined): to establish disability, the degree of limitation of the ability to work, the degree of loss of professional ability as a percentage, to develop (correct) an individual rehabilitation program for a disabled person (a program for the rehabilitation of a victim of an accident at work and occupational disease), for another (specify).

On line 34“Recommended medical rehabilitation measures for the formation or correction of an individual rehabilitation program for a disabled person, a rehabilitation program for a victim of an accident at work and an occupational disease” indicates specific types of rehabilitation therapy (including drug provision in the treatment of a disease that caused disability), reconstructive surgery, technical means of medical rehabilitation, including prosthetics and orthotics, a conclusion on sanatorium treatment with a prescription for the profile, frequency, duration and season of recommended treatment, on the need for special medical care for persons injured as a result of accidents at work and occupational diseases, about the need for medicines for the treatment of the consequences of accidents at work and occupational diseases, other types of medical rehabilitation.

The direction is signed by the chairman of the medical commission, members of the commission with a transcript of the signatures and sealed with the seal of the medical institution.

Responsibility for the correctness of filling out Form No. 088 / y-06 “Referral for medical and social examination by an organization providing medical and preventive care” rests with the chairman of the medical commission of the medical institution, or with the head physician.

The form must be submitted to the Bureau of Medical and Social Expertise no later than 1 month from the date of its issuance.

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Filling out the document using a computer allows you to increase, if necessary, the number of lines in the paragraphs of the form, to avoid the use of inserts

In the work of the bureau of medical and social expertise, it is of great importance that the doctor of the health facility correctly fill out the form No. 088 / y-06 "Referral for medical and social expertise by an organization providing medical and preventive care", approved by order of the Ministry of Health and Social Development of Russia dated January 31, 2007 No. 77.

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Correct completion of the form No. 088 / y-06

After the cancellation of registration form No. 088 / y-97 "Referral for medical and social examination" and the instructions regulating the procedure for filling it out, approved by the Ministry of Health of Russia dated December 15, 1999 No. 06-23 / 6-20, the corresponding instructions for filling out a new registration form No. 088 / y-06 "Submission for medical and social examination by an organization providing medical and preventive care" (hereinafter - form No. 088 / y-06) was not issued.

now >>

Meanwhile, despite the fact that each item of the form No. 088 / y-06 is accompanied by explanations, this is often not enough. The existing stereotypes of the activities of employees (hereinafter referred to as ITU) sometimes become the reason for making unreasonable demands when receiving documents from citizens for examination at the ITU bureau and a reason for refusing to register documents.

Most of our patients, having received the form No. 088 / y-06, were examined at the place of residence (registration). An analysis of the actions of specialists from individual ITU bureaus in various regions of Russia showed that their requirements for filling out form No. 088 / y-06 reflect the desire to follow the canceled instructions.

So, it is often indicated that it is necessary to stamp the institution on the title page of the document. Also, employees of some ITU bureaus require, as a mandatory requirement, that each of the specialists (in addition to the attending physician) fill out clause 23 "State of a citizen when sent for a medical and social examination" - indicating the data of the examination and diagnosis.

Meanwhile, when filling out clause 24 "Results of additional research methods", it is not required that each specialist doctor personally enter the results of laboratory, radiological, endoscopic, functional, ultrasound, cytological, neurofunctional and other studies carried out on his instructions, although the results of these studies depends .

In our opinion, the data of studies and examinations conducted by doctors of other specialties can be transferred to form No. 088 / y-06 from the medical history by the attending physician. Nevertheless, we have a considerable number of examples when referrals to the ITU were not accepted for implementation, since paragraph 23 lacked the signatures of the relevant specialists and their personal seals.

Filling out the registration form No. 088 / y-06 on a computer

Filling out a document using a computer allows you to:

1. increase, if necessary, the number of lines in form items;
2. avoid using inserts (stretch text);
3. save direction format;
4. do not certify with signatures and seals additional insert sheets.

Design features
Number of document form copies	For each patient, form No. 088 / y-06 is drawn up in two copies, one of them is issued to the patient, the second remains in the medical history or in the outpatient card. This seems to be justified, since form No. 088/u-06 is the final document containing information about the specialists responsible for examination and treatment, military medical and labor examinations. Item 23 of form No. 088/-06, like all other items, is filled in by the attending physician in our institution based on the data available in the medical history. After that, the completed form is submitted to the medical commission along with the medical history for a final decision.
Signatures	The document is signed by the chairman and members of the medical commission.
Stamps	As for the stamp in the upper left corner of the document with the name of the medical institution, all the necessary information is contained in the "header" of the direction - "Name and address of the organization providing medical and preventive care", therefore, in our opinion, setting the stamp is an unnecessary duplication of this information.

ITU denials

In order to prevent in the conduct of ITU, improve its results, which depends, among other things, on the correct filling out of form No. 088 / y-06, the requirements for its execution should be logical, and the understanding of the content of each paragraph should be the same for all performers. This is all the more necessary, since at present there is no officially announced procedure for filling out this document.

The current order of the Ministry of Health and Social Development of Russia dated 08/01/2007 No. 514 "On the Procedure for issuing sick leave certificates by medical organizations" is only the basis for issuing form No. 088 / y-06 and applies mainly to working citizens. In relation to non-working persons, pensioners who repeatedly apply to confirm their disability group, there is no fundamental document.

At the Main Military Clinical Hospital named after N.N. Burdenko (hereinafter referred to as the hospital) has been operating a medical information system (MIS) for more than 25 years. It is an integral part of the structures that ensure the clinical and economic activities of the institution. The use of modern information technologies is one of the priorities of the hospital and allows to increase the efficiency of processing and obtaining information in the process of diagnosing and treating patients, save time spent by staff on maintaining records and preparing reporting materials.

In the process of building such a system, various options for using computer technology were tested. As the most appropriate for the tasks set, a variant of the implementation of the system based on personal computers united in local networks was chosen.

For the past 15 years, the hospital has been using personal computers to refer patients to the ITU, which are equipped with all medical and diagnostic departments. Information is concentrated in the case history, where data from related specialists are included. Such opportunities allowed to increase the efficiency of processing medical information, and the quality of work improved.

Refusals to servicemen in the form No. 088 / y-06

In addition to the above, I would like to draw your attention to the fact that some ITU bureaus refuse to accept documents for examination by servicemen who have not yet been dismissed from service, but who have passed an examination by a military medical commission. This is a violation of the Federal Law of March 28, 1998 No. 52-FZ "On Compulsory State Insurance of Life and Health of Military Personnel, Citizens Called for Military Training, Individuals and Commanders of the Internal Affairs Bodies of the Russian Federation, the State Fire Service, and Bodies for Controlling the Turnover narcotic drugs and psychotropic substances, employees of institutions and bodies of the penitentiary system.

At the time when the above-mentioned Federal Law was adopted, the letter of the Ministry of Labor of Russia dated November 10, 1997 No. 5546-AO was in force, according to which no examination of military personnel who were not dismissed from service was carried out in ITU institutions. Since the letter of the Ministry of Labor of Russia did not comply with the law, this document was withdrawn by letter of the Ministry of Health and Social Development of Russia dated 07.02.2006 No. 544-VS. We consider it necessary to include the text of this letter in the appendix, since, apparently, the employees of the ITU bureau are not aware of it in all regions of Russia. For this reason, it is necessary to issue a copy of this letter to those patients who were refused acceptance of documents for examination at the ITU Bureau.

Application

Letter of the Ministry of Health and Social Development of Russia dated February 7, 2006 No. 544-VS “On the withdrawal of the letter of the Ministry of Labor of Russia dated November 10, 1997 No. 5546-AO”

The Ministry of Health and Social Development of the Russian Federation, in connection with numerous appeals regarding the application of the letter of the Ministry of Labor of Russia dated November 10, 1997 No. 5546-AO, according to which the examination of military personnel in institutions of medical and social expertise, reports the following.

After the introduction of this letter into the practice of the activities of institutions of medical and social expertise, the Federal Law of March 28, 1998 No. 52-FZ "On Compulsory State Insurance of Life and Health of Military Personnel, Citizens Called for Military Training, Individuals and Commanders of Internal Affairs Bodies" was adopted. affairs of the Russian Federation, employees of institutions and bodies of the penitentiary system and employees of the federal tax police" according to which an insured event in the implementation of compulsory state insurance is, among other things, the establishment of a disability for the insured person during the period of military service, service, military training or before the expiration of one years after dismissal from military service, from service, after the end of military training due to injury (wounds, injuries, concussions) or diseases received during military service, service, military training (Article 4).

According to paragraph 3 of the List of documents required to make a decision on the payment of the sum insured to military personnel insured under compulsory state life and health insurance, citizens called up for military training, private and commanding personnel of the internal affairs bodies of the Russian Federation, the state fire service, bodies for monitoring turnover of narcotic drugs and psychotropic substances, employees of institutions and bodies of the penitentiary system and employees of the federal tax police, approved by Decree of the Government of the Russian Federation of July 29, 1998 No. 855, in the event that the insured person is found to have a disability during the period of military service, service, military dues, the insured person provides a copy of the certificate confirming the fact of the establishment of disability to the insured person, issued by the institution of medical and social expertise.

The Federal Law of November 24, 1995 No. 181-FZ "On the Social Protection of Disabled Persons in the Russian Federation" (with further amendments and additions) and the regulatory legal documents issued for the purpose of its implementation also do not see restrictions for military personnel to undergo a medical and social examination.

Thus, the letter of the Ministry of Labor of Russia dated November 10, 1997 No. 5546-AO does not comply with the changed legislation, under which military personnel have the right to undergo an examination in federal state institutions of medical and social expertise.

In this regard, the Ministry of Health and Social Development of the Russian Federation withdraws the letter of the Ministry of Labor of Russia dated November 10, 1997 No. 5546-AO.

Bring this letter to all federal state institutions of medical and social expertise.

IN AND. Starodubov, Deputy Minister

The referral to the commission is a regular form, pink, with paragraphs that explain in detail who is sent to the commission and for what reason.

In most situations, it is issued by the local therapist of the district clinic based on the results of the observation of the patient. It is also issued:

• pension provision authority;
• state structures providing social protection.

Such a referral is issued only after a thorough analysis of the conducted medical studies, on the basis of which conclusions were drawn about the presence of data suggesting a persistent health disorder.

Only in such a situation is a referral issued for a medical and social examination in a specialized form developed by the Ministry of Health and Social Development of the Russian Federation.

A similar form 088 / y-06 issued in a medical institution contains information:

Official form only, of the established sample, can become the basis for the start of the ITU. The form is attached to the written application of the citizen himself or his official representative.

Depending on the state of health, MSE can be carried out in a municipal medical institution, in a hospital or, if such a physiological need arises, directly at the place of residence of a potential disabled person.

Is there a mandatory order?

At the moment, the procedure for referral to a medical and social examination depends on the basis that has become the basis for the potential recognition of a citizen in need of social protection. And also the reason for considering the possibility of recognizing the fact of reducing the ability to work. Paper can be issued:

1. For any period of temporary disability, if there is a clearly unfavorable clinical prognosis
2. If the prognosis is favorable, but there is a confirmed fact of continuous disability for the same disease for a period not exceeding 10-12 months
3. If it becomes necessary to determine labor recommendations in the event of a worsening clinical prognosis for a working disabled person

In each case indicated, the organization sending for the examination must prepare and submit a package of accompanying documents. This package must include:

• Inspection certificate
• Book of minutes, in which all meetings are entered
• Coupon in form 7p, which indicates the statistics of surveys and acts drawn up on the basis of examinations
• Bureau conclusion

The received package of documents, with the consent of the citizen, or his legal representative, is submitted for consideration by the commission, whose specialists decide on the recognition or non-recognition of the fact of the need to provide social assistance and the recognition of the fact of a decrease in the level of working capacity.

The results of the meeting are transmitted to the sending organization.

The documents that become the basis are prepared based on the results of a medical examination of a citizen, including sheets of temporary disability (sick leave).

Who sends for medical and social examination?

In other words, how to get?

It can be issued based on the results of a medical examination. The attending physician can refer her to it if the extension of the sick leave is no longer possible, and it is not possible to eliminate the cause of the sick leave.

Also the patient has the right to submit the application to the local therapist. They don't have the right to refuse. The beginning of the work of the commission is a statement written by the patient in the name of the head of the medical institution.

Specialized medical institutions, regardless of their departmental affiliation, have the right to send for examination.

The attending physician must complete the form. There must be the signatures of all the doctors of the medical institution who took part in the examination of the patient's health status.

You can get such a document with equal success at the place of permanent registration or at the place of actual residence when attaching a health insurance policy to a specific medical institution.

With temporary disability

In the event that a referral for an examination arises upon the fact of a stable persistence of poor health that is ready to become a basis for recognizing disability, a medical institution may send a “sick leave” leaflet for the same diagnosis when repeating the discharge.

In most cases, a temporary disability certificate is issued for up to 10 days, and the certificate is extended up to 30 days. In some situations, the medical commission has the right to extend this document for up to 10 months.

In an exceptional situation for up to 12 months, but not more. After 12 months, the patient must be sent for an examination, which determines the degree of his ability to work.

The commission determines whether the sick leave can be further extended or there will be no final recovery. Then there is disability. The patient has the right to challenge the decision. To do this, he will need to send an application to a higher authority.

If he was refused at the level of an application written in the name of the head of the head of the department of the polyclinic, in the name of the head physician. When the head physician refuses, more precisely, the commission convened on his initiative, addressed to the head of the municipal health department.

IN In most cases, the commission assembled at this level does not refuse to recognize the fact of disability.

The sick leave in such a situation is closed by the date preceding the date, it contains a record of the decision made by the commission. The days of the examination are not included in the sheet, are not paid, but are not absenteeism.

The clinic does not give a document

In some situations, the patient of the medical institution may be refused to conduct. In such a situation, it is important for a patient to take into account that the official order of the Ministry of Health with number 535, issued back in 2005, obliges any doctor to accept a citizen's application for an examination and issue him an appropriate one.

In that case, when the local therapist refuses the applicant, it is recommended to apply with a statement to the head of the department or the head physician of the clinic. The next, and almost always the last resort, is the health department of the local government.

In case of refusal at the level of the district polyclinic, the patient, who assumes that he needs to undergo an examination, will need to independently prepare a complete package of documents showing the state of his health. This may include a notarized copy of a medical record and other documents showing the presence of a diagnosis.

In the absence of such documents, representatives of the health department can send the applicant for a medical examination.

To those who apply for the passage of the ITU, it is important to control that in his medical record each representative of the medical institution makes an entry about the refusal with justification in this document, which is an anamnesis of the health status of the applicant for all years of observation. Without appropriate records in the outpatient card, higher levels will not consider the application.

In conclusion, it is worth noting that anyone can declare the need to recognize their own health problems and the possibility of recognizing the need for social assistance, assuming a deterioration in their own health. This is the right of every citizen of the country.

Moreover, a citizen can declare his right any number of times, requiring mandatory written registration in the outpatient card of a refusal to apply to higher structures.

Important update!

What does this paper look like?

If a person received a referral at a polyclinic or other medical organization, then the appearance and shape of this paper are subject to the rules. They are formulated in order No. 77 of the Ministry of Health and Social Development of the Russian Federation:

1. Already in the direction itself, the results of previous examinations and studies, the estimated severity of the established disease and the disability that it may entail, as a percentage, are necessarily entered.
2. The results of rehabilitation measures and the actual purpose pursued by the issuance of the referral are also indicated in such a paper.

Directions issued by authorized pension and social security institutions are somewhat different in appearance due to the fact that they are subject to another regulatory act - order of the Ministry of Health and Social Development of the Russian Federation No. 874.

The differences are as follows:

1. The restrictions that the patient is forced to comply with, in this case, are considered not as a fact, and not from the point of view of working capacity, but from the standpoint of whether a person needs social assistance and protection.
2. The purpose of receiving the direction, as in the previous case, is written necessarily.

The procedure for registration for medical and social examination

The registration procedure for ITU consists of several stages:

Clarifications

Who directs?

Direction is issued:

• Medical institutions providing medical and preventive care (polyclinics, hospitals, including psychiatric ones).
• Organizations for the social support of citizens.
• pension funds.

Who issues the document?

The attending physician, the therapist of the local polyclinic - this is who most often directs citizens to undergo the ITU, based on studies of their health status or a sick leave that has been going on for about 10-12 months. But, if there is a corresponding desire, the patient can start this process on his own.

Paper of any other sample cannot be considered as a valid beginning of the procedure. An officially issued form in accordance with all regulatory standards is sent to the ITU center when an application is submitted by a citizen or his authorized representative.

Advice! For those situations when a citizen, due to his serious condition, does not have the physical ability to arrive at the institution and undergo an examination, the legislation provides for the possibility of undergoing a medical and social examination in a hospital or at home.

Disability procedure

There are situations when an employee took a sick leave - and everything prolongs and prolongs it, and there are no positive changes in the condition of such a patient. In case of repeated repetition of a leaflet with an unchanged diagnosis, an employee of a medical organization is authorized to issue a referral to the ITU for the patient.

As you know, the standard validity of the sick leave is ten days. By decision of a council of doctors, it can be extended for up to thirty days, and sometimes up to 10 months, but not more than a year.

If within a year the patient's ability to work has not recovered, then the attending physician is obliged to send him for examination. Already the ITU commission will decide whether a further extension of the sick leave is possible, or final rehabilitation is impossible, as a result of which the citizen acquires the status of a disabled person.

If a person was not satisfied with the results of the commission, then he has the opportunity by submitting an application to the appropriate higher authority. The statistics of this practice shows that at the highest level, the commission rarely refuses to recognize a citizen as a disabled person.

When this is issued, the infinitely extended sick leave is finally closed on the date preceding the day of the examination, and the verdict of the commission is also entered. All the days on which the patient passed the ITU are not considered absenteeism at work, however, they are not paid.

What to do if the clinic refuses to pass the examination?

For various reasons, health care institutions may refuse to issue a referral to the ITU. However, this does not mean at all that it will not be possible to pass the examination. In this case, it is not so difficult to protect your rights.

The fact is that for a long time, since 2005, the order of the Ministry of Health of the Russian Federation No. 535, deprived doctors of the opportunity to decide whether to give a referral or not. According to him, an employee of a medical institution must accept an application for ITU from a citizen, and then issue a referral. This document is already considered invalid, but this requirement is still relevant.

And if the therapist refuses to accept the application, it is quite possible to apply with a similar requirement, say, to the head physician of the clinic. In extreme cases, the local government has such a body as the Department of Health.

Important! If a citizen applied for a referral to the ITU, and he was refused, then you need to insist and make sure that the doctor of the appropriate authority writes about his refusal in the outpatient card of the patient (which contains summarized data from all studies and observations for many years).

The reason for this is that without a documented fixation of the refusal of a medical worker, it is impossible to appeal his current decision and further attempts to achieve his own at a higher level.

Conclusion

Health is a great value for every person. Recognizing the presence of serious illnesses is a difficult step for any person and a test for his environment.

And that is why citizens of the Russian Federation have the right to apply for specialized medical expertise as many times as they need. Defending your rights and needs for social protection is not only possible, but moreover, it is necessary.

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