Referring children to sanatorium-resort treatment. Sanatorium-resort care Sanatorium-resort treatment is aimed at

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” (Collection of 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 for sanatorium-resort treatment I order:

1. Approve:

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

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

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

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

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

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

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

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

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

Minister M. Zurabov

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

Appendix No. 1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The number of certificates issued to obtain a voucher;

Number of health resort cards issued;

Number of return coupons for sanatorium and resort cards.

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

a) clinical blood test and urine test;

b) electrocardiographic examination;

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

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

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

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

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

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

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

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

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

Registration of children in need of sanatorium-resort treatment;

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

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

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

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

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

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

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

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

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

Voucher;

Sanatorium-resort card for children;

Compulsory health insurance policy;

Analysis for enterobiasis;

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

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

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

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

III. Procedure for admission and discharge of patients

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

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

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

3.4. Upon completion of the course of sanatorium-resort treatment, the patient is given a return voucher for the sanatorium-resort card and a sanatorium booklet with data on the treatment carried out in the SKO, 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 patient’s place of residence after completion of the course of follow-up treatment.

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

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

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

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

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

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

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

Presence of contraindications for treatment;

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

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

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

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

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

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

Appendix No. 5

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

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

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

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

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

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

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

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

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

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

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

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

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

The items “Preferred treatment location” and “Recommended treatment seasons” are optional.

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

Appendix No. 6

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

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

Sanatorium-resort card;

Return coupon.

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

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

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

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

In paragraph “N of the medical history or outpatient card”, the registration number of these documents, established by the medical institution, is indicated.

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

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

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

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

In the paragraph “Insurance number of an individual personal account (SNILS)” the insurance number of an individual personal account is indicated on the document certifying the right to receive a set of social services. The “Accompaniment” item is filled in if the patient is a citizen with a third-degree disability in the ability to work.

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

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

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

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

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

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

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

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

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

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

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

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

Appendix No. 7

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

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

The health resort card form consists of:

Sanatorium-resort card;

Return coupon.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Resorts and sanatoriums

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

The sanatorium is designed to treat patients primarily with natural remedies in combination with physiotherapy, exercise therapy, and therapeutic nutrition in conditions of active recreation and a specially organized regime. Drug treatment and bed rest are not typical for the sanatorium, although they can be prescribed. Patients with a wide variety of diseases are treated in sanatoriums. In this regard, there are sanatoriums with diseases of the circulatory system, 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-resort treatment is the sanatorium regime, which provides the most favorable conditions for treatment and relaxation. Patients are provided with treatment in mud baths, solariums, swimming pools, etc. At most resorts, along with sanatorium treatment, outpatient treatment is also provided for patients coming on course vouchers.

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

The procedure for referral to sanatorium-resort treatment

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

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

Upon arrival at the sanatorium, the patient submits a sanatorium-resort card, which is filled out at the clinic at the place of residence: a clinical blood and urine test no more than 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 properly issued and certified by the seal of the institution that issued it. In addition to the voucher and sanatorium-resort card, upon admission to the sanatorium you must have a passport, and for children under 16 years of age a birth certificate or a copy thereof. Military personnel present an identification card, and military pensioners - a pension certificate, where in the section for special marks it must be indicated that the pensioner enjoys the right to sanatorium-resort treatment in sanatoriums of the Ministry of Defense of the Russian Federation.

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

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

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

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

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

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

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

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

New requirements

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

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

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

(8) Order of the Ministry of Health of the Russian Federation dated 08/05/2003 No. 330 “On measures to improve clinical nutrition in medical and preventive institutions of the Russian Federation” (registered by the Ministry of Justice of the Russian Federation on September 12, 2003, registration No. 5073), as amended, introduced by orders of the Ministry of Health and Social Development of the Russian Federation dated October 7, 2005 No. 624 (registered by the Ministry of Justice of the Russian Federation on November 1, 2005, registration No. 7134), dated January 10, 2006 No. 2 (registered by the Ministry of Justice of the Russian Federation January 24, 2006, registration No. 7411), dated April 26, 2006 No. 316 (registered by the Ministry of Justice of the Russian Federation on May 26, 2006, registration No. 7878) and by order of the Ministry of Health of the Russian Federation dated June 21, 2013 No. 395n (registered by the Ministry of Justice of the Russian Federation on July 5, 2013, registration No. 28 995).

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

Six standard diets

Cancellation of old norms

features of the application of regulatory documents

Purpose of diets

Specialty Products - Order Requirement

Vitamins in the diet

Individual therapeutic nutrition program

Drawing up an individual program

Summary

Rice. 1. Standard diets used in health resort organizations

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

Table 1. Prescribing diets (part 1)

Table 1.2. Prescribing diets (part 2)

Layout card No. 5.4

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

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

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