Preventive examination and medical examination are a set of measures that are carried out in medical organizations. According to the order of the Ministry of Health of the Russian Federation dated March 13, 2019 No. 124N, both working and non-working citizens, as well as full-time students studying in educational organizations over the age of 18 years, undergo medical examination and medical examination. Based on the results of these medical measures, doctors determine patient health groups and dispensary observation groups.

How does a medical examination differ from a medical examination?

A preventive examination is carried out for the timely detection of diseases and risk factors for their development, as well as to identify non-medical use of narcotic drugs and psychotropic substances. Clinical examination is a broader set of activities. It includes a medical examination, as well as additional examination methods that are carried out to assess the condition of certain groups of the population.

How often do you need to undergo a medical examination and medical examination?

A medical examination is carried out annually as an independent event, as part of a medical examination or during the first medical examination of the current year. Medical examinations for persons aged 18 to 39 years inclusive are carried out once every three years. According to the new rules, citizens over the age of 40 can undergo it annually.

What procedures include medical examination and medical examination?

The annual medical examination for citizens aged 18 years and older includes the following activities:

• questionnaires to identify complaints, symptoms, determine risk factors for diseases, etc.;
• calculation of body mass index;
• blood pressure measurement;
• study of the level of total cholesterol in the blood;
• determination of blood glucose levels.

Adult citizens over the age of 18 also undergo fluorographic examination of the lungs or chest x-ray once every two years. In patients aged 18 to 39 years inclusive, once a year the doctor determines the relative cardiovascular risk; women in this age group are examined by a paramedic (midwife) or obstetrician-gynecologist.

Citizens over the age of 35 years old undergo additional electrocardiography every year during medical examinations, and for those over 40 years old, intraocular pressure is measured.

In patients aged 40 to 64 years inclusive, the absolute cardiovascular risk is determined annually, and after the age of 65, the risk of developing osteoporosis, depression, heart failure, uncorrected hearing and vision impairment.

Clinical examination is carried out in two stages. At the first stage, for citizens aged 18 to 39 years inclusive, once every three years a medical examination, cancer screening, brief preventive consultation by a general practitioner, and an examination by this doctor are carried out. Citizens aged 40 to 64 years inclusive and patients aged 65 years and older once a year, in addition to these procedures, also undergo a general blood test.

At the second stage of clinical examination, patients are offered to undergo additional examinations by specialized doctors, and their diagnoses are clarified. A list of possible procedures is given in

Preventive medical examination, just read it carefully! Prophylactic! This is why it exists to identify diseases in the early stages and prevent its development.

Preventive medical examination is a term enshrined in law and obliges employers to provide the procedure and make sure that they are hiring a healthy person. A professional examination is part of the employment procedure and is carried out both at the beginning of work and annually.

For which professions is a medical examination required?

1. Professions involving high physical activity.
2. Specialists whose work is associated with harmful and dangerous conditions.
3. Branches of production that require special selection for certain physical qualities.
4. Professions in which work is related to serving the population.

It is also legally established that a medical examination is mandatory for children entering kindergarten, school, higher education institutions, when a person wants to obtain a driver’s license.

Where to get a preventive medical examination

The question is very ambiguous and in order to answer it you need to know a number of circumstances, for example, why are you undergoing a medical examination? If for the purpose of prevention and for self-soothing, then you are free to choose any clinic to your liking.

If for employment, then you should ask the employer if he has an agreement with a medical institution where it is necessary to undergo this procedure.

List of doctors for medical examination

The question also requires clarification. If the purpose of your medical examination is prevention and taking care of your health, then we start with a therapist, and then follow specialized specialists, for example, a cardiologist, gynecologist, urologist, ophthalmologist, dentist. Their list depends on your health status, gender and age.

Therapists usually advise that in the current situation with the environment and the spread of certain diseases, it is imperative to do a number of special studies, such as mammography for women, ultrasound examination of the prostate for men, chest fluorography, ultrasound of the thyroid gland.

Let's return to the medical examination when it is necessary for employment or is taken during the course of work to determine the possibility of working in a certain specialty. Then the list of doctors and medical studies is approved by various orders and is strictly defined, it must be followed.

Yulia Egorova talks about the new rules for medical examinations

The law obliges

Recently, in connection with the active social policy of our state, such a form of health care as a preventive medical examination is becoming increasingly relevant.

The Labor Code defines groups of people for whom medical examination is mandatory.

Labor Code of the Russian Federation Art. 213 (extract):

Workers engaged in heavy work and work with hazardous working conditions<…>undergo mandatory preliminary (upon entry to work) and periodic medical examinations to determine the suitability of these workers to perform the assigned work and prevent occupational diseases.

Workers<…>medical and preventive care and children's institutions<…>undergo the specified medical examinations (examinations) in order to protect public health and prevent the occurrence and spread of diseases.

An important point reflected in Article 213 of the Labor Code is that carrying out preventive examinations of these groups of workers is the responsibility of the employer and is carried out at his expense, during working hours and with the preservation of wages. The state supports this using the “carrot and stick” method. Gingerbread is a preferential taxation of amounts spent by the employer on conducting medical examinations. Whip is an administrative liability under Article 5.27 of the Code of Administrative Offenses of the Russian Federation for officials guilty of violating labor laws.

What to do with the mandatory medical examination if, according to the law, medical examinations and interventions cannot be carried out without consent, and even more so against the will of the patient?

Preventive examination is mandatory only for certain groups of workers in order to protect public health. Employment in such responsible work can only be voluntary, and consent to preliminary and periodic medical examinations is assumed to be automatic upon signing an employment contract, which most often includes a clause on undergoing examinations as an essential condition.

What has changed in the medical examination?

Until 2012, medical examinations were regulated by several orders, some of which were issued back in Soviet times. Since January 2012, Order of the Ministry of Health and Social Development of Russia No. 302n dated April 12, 2011 “On approval of lists of harmful and (or) hazardous production factors and work...” came into force. At the moment, this order and its annexes are the main regulatory framework for carrying out preventive examinations, and previously existing orders have been canceled since 2012.

Compared to the old procedure for conducting medical examinations Several fundamental differences emerged.

1. Now only an occupational pathologist should head the medical commission, and the commission’s medical specialists need advanced training in the field of occupational pathology.

2. The principles for compiling lists of workers sent for medical examinations have changed. If previously employees were included in the list depending on their position, now an employee can be added to this list only on the basis of certification of the workplace, which must be carried out in accordance with another order of the Ministry of Health and Social Development of Russia (No. 342n dated April 26, 2011 “On approval of the Procedure for certification jobs according to working conditions"). That is, even if a person works at a uranium mine, but the employment contract does not indicate a workplace certification card, then he does not need to undergo a medical examination, and he has no medical contraindications to work.

3. A psychiatrist and a narcologist are included in the medical commission; their examination is now mandatory for everyone undergoing a medical examination, and not just for those who are hired or have access to drugs, as was previously the case.

These innovations can generally be considered positive, especially if medical examinations of employees are not reduced to a formality, as, unfortunately, sometimes happens. The emphasis on occupational pathology increases the preventive value of medical examination, and preventing persons with alcohol or drug addiction from dangerous work will certainly reduce the level of injuries in the workplace.

Health passport

The so-called “health passport” is also gradually being introduced into practice - a document of the established form, a sample of which can be found at the link medexx.ru. The passport contains information about employees undergoing medical examinations; during the examination, it is kept in the medical organization, and after it is given to the employee.

The introduction of health passports does not cancel personal medical records. The procedure for issuing a medical book is regulated by Rospotrebnadzor Order No. 402 of May 20, 2002 “On a personal medical book and sanitary passport,” which continues to be in effect. In addition, the lists of workers required to have a health passport and a medical book are somewhat inconsistent, and employees of children's health care institutions are required to have both. Of course, in this case, you can undergo an annual medical examination, recording the examination results in both documents. You can learn more about medical books and who needs them on the website of the Moscow Center for Hygiene and Epidemiology http://www.mossanexpert.ru

Organization of medical examination of employees

According to the order, now only a medical institution that has received the appropriate license can provide medical examination services. At the same time, the institution must have a permanent medical commission under the leadership of an occupational pathologist. Therefore, the natural desire for every health worker to undergo a medical examination directly at the place of work, unfortunately, is not feasible if the establishment does not have the appropriate license.

The same is true with analyses. For an organization performing a medical examination, there is no regulatory document prohibiting the use of the results of tests and examinations performed in other medical institutions. But, given that this is a paid service, it is unprofitable and quite risky for medical institutions to accept third-party results, since they can be falsified. Unfortunately, it is also impossible to undergo a medical examination privately - where you prefer, because the employer must organize a centralized medical examination and provide the medical organization with a list of employees, data on the certification of workplaces and harmful factors of production. Moreover, the medical organization must summarize the results no later than a month after the completion of the periodic medical examination. Then, together with the territorial bodies of the federal executive body authorized to exercise state control and supervision in the field of ensuring the sanitary and epidemiological well-being of the population, and representatives of the employer, the medical institution draws up a final act.

Our medical examination or medical examination of doctors

Let's talk about the features of medical examinations for health workers. According to paragraph 17 of Appendix No. 2 to Order No. 302n, medical personnel of all medical institutions must undergo a preventive medical examination annually. The “program” of the medical examination is presented in Table 1.

* The inclusion of a dermatovenerologist and an otorhinolaryngologist in the medical examination commission for medical workers is based on frequent professional contact with various types of allergens. On the recommendation of these specialists, further examination may be prescribed in the form of specific allergy diagnostics, examination of external respiration function and consultation with an allergist. ** Appendix No. 1 to Order No. 302n also indicates additional medical contraindications for work associated with unfavorable factors, such as hypochromic anemia, benign neoplasms, microcirculation disorders of any nature.

The result of the medical examination

If the examinee does not have any health problems, the occupational pathologist makes a conclusion about suitability for the work performed. But what if a medical examination reveals any diseases? The full list of contraindications is quite extensive and is contained in paragraph 48 of Appendix No. 3 to Order No. 302n.

It must be said that many of the points when applied to medical workers are controversial. For example, how stable angina pectoris, post-infarction cardiosclerosis, drug-compensated epilepsy, widespread ichthyosis, or even early stage cancer can interfere with the performance of a therapist’s duties is personally unclear to me.

Of course, for emergency work in the ambulance, operating room, emergency department and similar areas, good health is necessary, but for routine appointments and consultative work, such requirements seem to me to be excessive. If all the contraindications listed in this list are observed in detail, medicine risks losing a large number of older specialists, whose knowledge and experience are of great value, despite the non-ideal state of their health.

Mandatory participation in a medical examination by an occupational pathologist involves identifying the connection between detected diseases and professional activities. If an occupational disease is suspected, the medical organization issues the employee a referral to an occupational pathology center or a specialized medical institution that has the right to conduct research regarding the connection of the disease with the profession. Such a medical institution also draws up and sends, in the approved manner, a notice of establishing a preliminary diagnosis of an occupational disease to the territorial body of the federal executive authorities authorized to exercise state control and supervision in the field of ensuring sanitary and epidemiological well-being.

The employer, if medical contraindications are discovered, is obliged to remove the employee from the work he is performing or provide him with another one that is not contraindicated for him due to health reasons. At the same time, at the first stage, the employer is obliged to offer the employee available vacant positions, and then, by the decision of the employee himself, an additional agreement to the employment contract on the transfer is drawn up or, in case of refusal, the removal procedure provided for in Article 76 of the Labor Code of the Russian Federation is applied. In this case, wages for the period of release from work duties are not accrued, but the place of work and position are retained. If the period for which the employer is forced to suspend an employee for medical reasons exceeds four months, then the employee is subject to dismissal under Art. 77 Labor Code of the Russian Federation.

Some difficulties when undergoing a medical examination may arise for employees who have a disability for any reason. Along with the referral for a medical examination, it is better for them to provide the conclusion of the next medical and sanitary examination, so that the commission can make a decision on admission to work.

There is something to strive for

Much attention is paid to the legal regulation of preventive medical examinations: clear rules for their conduct are defined, a list of works is given that require a medical examination, outdated orders are canceled, and centralized control over the conduct of examinations is introduced. However, perfection has not yet been achieved. The most reasonable thing would probably be to issue a separate order on preventive examinations of medical personnel and somewhat soften the list of contraindications for working in medicine.

In this article we will look at what a medical examination is, who needs it, for what purposes, at whose expense it is done, how often it needs to be done, and what is mandatory.

What is a medical examination?

A medical examination is the passage of a medical commission depending on the location of the requirement or for health prevention.

Who needs a medical examination?

The majority of the officially working population knows first-hand what a medical examination is, because... When hiring, in most cases, the employer requests from the employee a medical book with access to work. Not always and not everyone likes it, but it is a necessity that cannot be avoided, and for your health it would not be a bad idea to check if everything is okay with the body.

In the Russian Federation there is a “Health” project, which is aimed at preserving the health of the working population. The most important measure to maintain health is regular examination of people upon hiring and further regular examinations.

Purposes of the physical examination

Of all the reasons for a medical examination, several are the main ones:

. Prof.'s definition suitability of employees to perform assigned work tasks;

Ensuring labor safety;

Identification of persons with occupational diseases or suspected of such diseases, prevention and timely identification of initial signs of occupational diseases;

Detection of any diseases not related to work, but in which a person’s condition may worsen;

Sanitary and hygienic measures designed to identify and eliminate the causes of occupational diseases;

Regular monitoring of the health of workers in hazardous work;

Timely prevention and rehabilitation of workers to preserve their health;

Avoiding workplace accidents.

Employees are required to undergo a medical examination when working:

. in hazardous production;

In hazardous production;

Security guards;

Railway workers;

Drivers;

Social service workers;

Workers of children's and preschool institutions.

Medical examinations are required by law, and persons who do not pass the examination are not allowed to work. The employer is responsible for undergoing a medical examination. Typically, the employer enters into an agreement with one of the health examination clinics, and all employees are examined in one place. Inspections are divided into two categories:

. preliminary;

Periodic.

Preliminary examination is when entering a job to determine professional suitability. Periodic examination is to identify and prevent diseases acquired at work, and not only.

At whose expense is the medical examination done?

All activities related to undergoing medical examinations are undertaken by the employer; this is prescribed by the law of the Russian Federation. If an employee has not been cleared by a health examination doctor to work, the employer must not allow him to enter the workplace.

Frequency of medical examinations

The frequency of medical examinations is prescribed by law and is carried out once every two years, and for persons under 21 years of age annually. Inspections may also be extraordinary at the request of workers or during an epidemic.

People working in hazardous and hazardous industries undergo a medical examination in special medical examination centers by specialists called occupational examination doctors. What is included in the mandatory tests during a medical examination Mandatory tests include:

. general blood test;

General urine test;

Fluorography.

A blood test reveals the presence of inflammatory processes in the body, anemia, and various blood diseases. If any deviations are detected, a person may become more fatigued, which leads to a decrease in performance. Urinalysis reveals diseases of the kidneys and urinary system. An ECG checks the heart for various abnormalities.

Specialists who are required:

. therapist;

Surgeon;

Gynecologist;

Neuropathologist.

The surgeon will determine the size of the liver and spleen and other abdominal organs, and also check for the presence of varicose veins. In men, this also includes the prostate. A neurologist checks for abnormalities related to the nervous system. A gynecologist is mandatory for women. The therapist measures blood pressure and identifies signs of hypertension, and also gives a conclusion and permission to work after passing all the specialists and passing all the tests.

To live a full and happy life, we need good health. This is the only way you can realize yourself in the profession and create a full-fledged family.

In order for everything to be as we planned, we simply must monitor our health, namely, undergo regular medical examinations. Today, every employee of an enterprise is required to undergo a medical examination every year, and the employer is obliged to monitor changes in indicators. Please note that any restriction by an employer on visiting a doctor is considered illegal.

What is a medical examination (medical examination)?

Medical examination; This is a set of medical interventions for the purpose of pathologies or diseases. Medical examination; - This is a preventive medical examination. They are:

• preventive;


• preliminary;


• periodic;


• pre-shift.

All employees are required to undergo a medical examination before starting work. To do this, you need to get a referral from the HR department and come with your passport or medical book to the desired medical institution. Next, you need to undergo a medical examination, obtain a conclusion from a doctor, and bring it to the HR department of the enterprise.

The number of medical examinations per year is determined by law depending on the type of production, but this must occur at least once a year.

Entrepreneurs and legal entities are obliged to ensure that their employees undergo medical examinations on time and regularly. If the employee refuses to do this, he is not allowed to work. All results of medical examinations must be recorded in a medical record.

Regular medical examinations and their correct indicators ensure constant monitoring of the health of workers, which means timely detection and treatment of diseases.