Permanent disability is a long-term or permanent loss of ability to work resulting from a chronic disease or injury that leads to a significant impairment of body functions. Adopted in November 1995 The Federal Law “Social Protection of Disabled Persons of the Russian Federation” defined a new concept of disability, defining such fundamental concepts as “disabled person”, “disability”, “medical and social examination”, etc.

Disabled person- a person who has a health impairment with a persistent disorder of body functions caused by diseases, consequences of injuries or defects leading to limitation of life activity and causing the need for social protection.

Medical and social examination (MSE)- this is the determination, in the prescribed manner, of the needs of the examined person for social protection measures, including rehabilitation, based on an assessment of the limitations in life activity caused by a persistent disorder of body functions.

MSA is carried out by the State Service for Medical and Social Expertise, which is part of the system of social protection bodies of the Russian Federation. ITU establishes the cause and group of disability, the degree of disability, determines the types, volume and timing of rehabilitation, social protection measures, and provides recommendations for employment

Limitation of life activities is a complete or partial loss of a person’s ability or ability to perform self-care, move independently, navigate, communicate, control one’s behavior, learn and engage in work.

Classification of parameters of disability is carried out according to three degrees:

1. 
   mild functional impairment
2. 
   moderately severe functional impairment
3. 
   significant functional impairment.

Recognition of a person as disabled is carried out during MSA, based on a comprehensive assessment of his state of health and the degree of disability.

The basis for recognizing a person as disabled is:

1. 
   impairment of health with persistent impairment of body functions caused by diseases, injuries or defects
2. 
   disability
3. 
   the need to implement social protection measures for citizens.

The presence of one of these signs is not sufficient to recognize a citizen as disabled.

Group 2 - social failure. requiring social protection due to health impairment, with a persistently expressed disorder of body functions as a result of disease, injury or defect, leading to a pronounced limitation of one of the categories of life activity - 2nd degree. These patients do not need outside care, but all types of work are contraindicated for them for a long period

3 group - social insufficiency. requiring social protection due to health impairment, as a result of illness, with a moderately severe disorder of body functions as a result of illness, injury or defect leading to a slightly pronounced limitation of one of the categories of life activity - 1st degree. These patients have a significantly reduced ability to work, and their health requires changes in working conditions.

The criteria for determining disability, without pre-certification periods, are:

1. 
   the impossibility of eliminating and reducing the social insufficiency of a disabled person due to long-term limitation of his life activity (with a period of observation of at least 5 years) caused by health problems with persistent irreversible morphological changes and dysfunctions of the body.
2. 
   Ineffectiveness of rehabilitation measures, which leads to the need for constant social protection.
3. 
   Other criteria provided for by current legislation

In each case of disability, its cause must be indicated. The following formulations of causes of disability are provided: general disease, prof. illness, work injury (work injury), disability since childhood, disability before starting work, injury (concussion, injury) received while performing military service duties. The assigned pension and other benefits provided for various categories of disabled people depend on the causes of disability.

The ITU public service institutions include: the ITU Bureau and the ITU Main Bureau

The formation of a network of ITU bureaus is carried out based on the population living in the territory, as a rule, one institution per 70-90 thousand people.

City emergency medical service;

Central (city, district);

Regional, including children's (regional, republican, district).
1.1.2. Specialized hospitals, including:

Rehabilitation treatment, including children's;

Gynecological;

Geriatric;

Infectious, including children's;

Narcological;

Oncological;

Ophthalmological;

Psychoneurological, including children's;

Psychiatric, including children's;

Psychiatric (inpatient) specialized type;

Psychiatric (inpatient) specialized type with intensive observation;

Tuberculosis, including children's.
1.1.3. Hospital.

1.1.4. Medical and sanitary part, including the central one.

1.1.5. Nursing home (hospital).

1.1.6. Hospice.

1.1.7. Leper colony.
1.2. Dispensaries:

Medical and physical education;

Cardiological;

Dermatovenerological;

Mammological;

Narcological;

Oncological;

Ophthalmological;

Antituberculosis;

Neuropsychiatric;

Endocrinological.
1.3. Outpatient clinics

1.3.1. Outpatient clinic.

1.3.2. Clinics, including:

Urban, including children's;

Central District;

Dental, including children's;

Consultative and diagnostic, including for children;

Psychotherapeutic;

Physiotherapeutic.
1.4. Centers, including scientific and practical ones:

Rehabilitation therapy for internationalist soldiers;

Regenerative medicine and rehabilitation;

Geriatric;

Diabetology;

Drug rehabilitation;

Occupational pathology;

On the prevention and control of AIDS and infectious diseases;

Clinical and diagnostic;

Speech pathology and neurorehabilitation;

Rehabilitation;

Medical and social rehabilitation;

General medical (family) practice;

Consultative and diagnostic, including for children;

Hearing rehabilitation;

Physiotherapy and sports medicine;

Manual therapy;

Therapeutic and preventive nutrition;

Specialized types of medical care;

Psychophysiological diagnostics.
1.5. Emergency medical facilities

and blood transfusion facilities

1.5.1. Emergency medical station.

1.5.2. Blood transfusion station.

1.5.3. Blood Center.

1.6. Institutions for maternal and child health care

1.6.1. Perinatal center.

1.6.2. Maternity hospital.

1.6.3. Women's consultation.

1.6.4. Family Planning and Reproduction Center.

1.6.5. Center for Adolescent Reproductive Health.

1.6.6. Children's home, including a specialized one.

1.6.7. Dairy kitchen.
1.7. Sanatorium-resort institutions

1.7.1. Balneological hospital.

1.7.2. Mud bath.

1.7.3. Resort clinic.

1.7.4. A sanatorium, including for children, as well as for children with their parents.

1.7.5. Sanatorium-preventorium.

1.7.6. Sanatorium health camp year-round.
2. Special types of healthcare institutions

2.1. Centers:

Medical prevention;

Disaster medicine (federal, regional, territorial);

Medical mobilization reserves "Reserve" (republican, regional, regional, city);

Licensing of medical and pharmaceutical activities (republican, regional, regional);

Quality control and certification of medicines;

Medical information and analytical;

Information and methodological on examination, accounting and analysis of the circulation of medical products.
2.2. Bureau:

Medical statistics;

Pathological;

Forensic medical examination.

2.3. Control and analytical laboratory.

2.4. Military medical commission, including the central one.

2.5. Bacteriological laboratory for the diagnosis of tuberculosis.
3. Health care institutions for supervision

in the field of consumer rights protection and human well-being

3.1. Centers for Hygiene and Epidemiology.

3.2. Centers for state sanitary and epidemiological surveillance.

3.3. Anti-plague center (station).

3.4. Disinfection center (station).

3.5. Center for Hygienic Education of the Population.

4. Pharmacies

4.1. Pharmacy.

4.2. Pharmacy point.

4.3. Pharmacy kiosk.

4.4. Pharmacy store.

Notes:

1. Medical and preventive institutions (hospitals, dispensaries, maternity hospitals and other institutions) used for teaching purposes by higher medical educational institutions (faculties) or for scientific purposes by medical research organizations are clinical institutions.

2.Health care institutions provided for in subsection 1.1 “Hospital institutions” of this Nomenclature may include a polyclinic (outpatient clinic).

3. If there are two or more healthcare institutions of the same name, subordinate to one state or municipal authority, each of them is assigned a serial number.

4.Medical and midwifery stations (FAP) are structural divisions of healthcare institutions.

5. Health centers (medical, paramedic) are structural divisions of healthcare institutions or organizations and are intended to provide first aid to workers, employees and students.

6.Sanitary aviation may be part of a regional, regional, republican hospital or health care institution for disaster medicine and acts as its department.

7. Clinics are medical and preventive institutions (hospitals, maternity hospitals and other health care institutions), which are part of higher medical educational institutions, medical scientific organizations or subordinate to medical universities and scientific organizations, are their structural divisions.

8. Specialized orphanages for children include:

With organic damage to the central nervous system with mental disorders;

With organic damage to the central nervous system, including cerebral palsy, without mental impairment;

With dysfunction of the musculoskeletal system and other defects of physical development without mental impairment;

With hearing and speech impairments (deaf, deaf, hard of hearing);

With speech disorders (stuttering, alalia and other speech disorders);

With visual impairments (blind, visually impaired);

- with tuberculosis intoxication, minor and subsiding forms of tuberculosis;

Sanatorium.

9. The center for medical and social rehabilitation includes:

Department of permanent residence for adolescents and adults with disabilities with severe forms of cerebral palsy who cannot move independently and do not care for themselves.

10. The full name of the healthcare institution provided for by this Nomenclature may contain information about departmental affiliation (Roszdrav, Ministry of Internal Affairs of Russia, etc.) and functional affiliation (clinical).

Educational edition

Shkor Nadezhda Mikhailovna
Economics and Health Management

The examination of disability allows, taking into account medical and social criteria, to assess the ability of a given person to perform his professional duties. At the same time, it is necessary to distinguish between the concepts of ability to work and incapacity to work, to determine their medical and social criteria.

Work ability

is a state of the body in which the totality of physical and spiritual capabilities allows a person to perform work of a certain volume and quality. There are two types of its violation: temporary and permanent disability. Their differentiation is based on clinical and labor prognosis, i.e. medical and social criteria.

Medical criterion

– an accurate diagnosis in accordance with the accepted classification, reflecting the stage of development, the clinical variant and severity of the disease, the phase of the disease, in case of exacerbation - the severity of the exacerbation, the degree of functional impairment, complications; associated diseases.

Social criterion

– the nature and working conditions of the patient, which determine the labor prognosis for a specific disease. The attending physician must find out and record in the medical documentation the nature and working conditions of the patient: the presence of unfavorable working conditions and occupational hazards, organization, frequency and rhythm of work, load on individual organs and systems, body position during work, production duties and skills, qualifications.

However, the presence of a disease is not always accompanied by disability. Thus, in the presence of the same diagnosis, the issue of patients’ ability to work is resolved differently: with pustular lesions of the hands, a cook is unable to work, an accountant can perform his professional duties. Thus, in the presence of an illness, a person can be able to work if the disease does not interfere with the performance of professional work, and disabled if performing the work is difficult or impossible.

The cause of disability is not always the illness of the patient himself; the reason may be the removal from work of a healthy employee, for example, due to quarantine.

Medical and social criteria must always be clearly defined and reflected in medical documentation in accordance with the requirements of current legislation in the field of social insurance of citizens.

Thus, disability should be understood as a condition caused by illness, injury, its consequences or other reasons, when the performance of professional activities - in whole or in part, for a limited time or permanently - is impossible. Based on duration, temporary (T) and permanent disability are distinguished.

Temporary disability

– the impossibility of an employee to perform work duties due to medical reasons, as well as social factors provided for by current legislation, which are temporary, reversible, when recovery or improvement of condition and restoration of working capacity are expected in the near future. VN can be full or partial.

Full VN– the employee’s inability to work for a certain period and the need for treatment and adherence to the regime.

Partial VN- a state of the body when an employee, due to illness (injury), cannot perform his usual professional activity, but without harm to health can perform another, with a different volume and regime.

Temporary disability may result from

• diseases and injuries, poisoning (other consequences of external causes);
• after-care in sanatorium-resort institutions;
• caring for a sick family member;
• quarantine;
• pregnancy and childbirth;
• adoption of a child;
• prosthetics in a hospital setting.

VN solves problems VN examination- a type of medical examination, the main purpose of which is to assess the patient’s health status, the validity of the diagnosis, the quality and effectiveness of the examination and treatment, the ability to carry out professional activities, as well as determining the degree and timing of VN, including timely referral to medical examination, etc.

LN is issued insured disabled citizens of the Russian Federation, as well as foreign citizens permanently or temporarily residing in the territory of the Russian Federation, stateless persons, including persons whose illness or injury occurred within 30 calendar days from the date of termination of work under an employment contract, performance of official or other activities, or during the period from the date of conclusion of the employment contract until the day of its cancellation;

citizens recognized as unemployed and registered with the territorial bodies of the Federal Service for Labor and Employment in the event of illness, injury, pregnancy and childbirth.

The right to issue LN

if they have a license for medical activities, including work on the examination of VN, they have:

• attending physicians of medical organizations (MO) of public and private healthcare;
• attending physicians at clinics of research institutions (institutes) - research institutes, including prosthetics and prosthetics clinics;
• paramedics and dentists of the Moscow Region - in cases established by the authorized federal executive body.

They do not have the right to issue personal income tax

medical workers of institutions:

• ambulance;
• blood transfusions;
• medical organizations of a special type (centers for medical prevention, disaster medicine, forensic medical examination bureaus);
• healthcare institutions for supervision in the field of consumer rights protection and human well-being;
• hospital admission departments;
• balneological hospitals and mud baths.

LN is not issued citizens not subject to social insurance:

• military personnel;
• police officers;
• employees of the FSB, FSO, Federal Penitentiary Service, drug control;
• pupils, students, graduate students, doctoral students;
• individual entrepreneurs, notaries, lawyers who have not concluded a voluntary social insurance agreement;
• persons under arrest and during forensic medical examinations,
• able-bodied workers sent from periodic medical examinations to inpatient and outpatient examinations to determine the cause of the disease and establish its connection with occupational hazards;
• conscripts sent by military registration and enlistment offices for examination to determine suitability for military service;
• able to work for the period of examination and consultation;
• when on leave without pay, maternity leave, leave to care for a child under 3 years of age. If the VN persists, the LN is issued from the date of the end of the specified vacations.

Monitoring of compliance with the Procedure for the issuance and registration of personal income tax is carried out by the FSS of the Russian Federation.

Legal framework of EWH

EWH is carried out in accordance with the Constitution of the Russian Federation; Federal Law No. 323-FZ dated November 21, 2011 “On the fundamentals of protecting the health of citizens in the Russian Federation”; Federal Law No. 165-FZ dated July 16, 1999 “On the fundamentals of compulsory social insurance” (as amended on July 11, 2011); Federal Law No. 255-FZ dated December 29, 2006 “On compulsory social insurance in case of temporary disability and in connection with maternity” (as amended on December 29, 2012).

Since 2011, the examination of VN has been carried out in accordance with the order of the Ministry of Health and Social Development of the Russian Federation (hereinafter referred to as the Ministry of Health and Social Development of the Russian Federation) dated June 29, 2011 No. 624n “On approval of the procedure for issuing certificates of incapacity for work”; by order of the Ministry of Health and Social Development of the Russian Federation dated January 24, 2012 No. 31n “On amendments to the Procedure for issuing certificates of incapacity for work, approved by order of the Ministry of Health and Social Development of the Russian Federation dated June 29, 2011 No. 624n”; by order of the Ministry of Health of the Russian Federation dated December 27, 2011 No. 1687n “On the medical criteria for birth, the form of the birth document and the procedure for its issuance.”

Documents certifying temporary disability

The document certifying the VN is a certificate of incapacity for work (LS) - a document of strict accountability that serves as the basis for the release of the insured person from work, the assignment and payment of benefits for VN, pregnancy and childbirth at the expense of the Social Insurance Fund (SIF).

The form of the LN form was approved by order of the Ministry of Health and Social Development of the Russian Federation No. 347n dated April 26, 2011 “On approval of the form of the certificate of incapacity for work.”

In case of illness of students and pupils, a certificate of form 095u is issued to exempt them from study. If a student falls ill during a paid internship, a personal injury certificate is issued until its completion; if the student continues to be incapacitated, a certificate of form 095-u is issued.

If a student’s LT during practical training is due to an industrial injury or occupational disease, the LT is issued for the entire period of incapacity;

Organization and procedureexaminations of temporary disability in medical organizations

The procedure for organizing and conducting departmental quality control is established by the authorized federal executive body. Internal control of the quality and safety of medical activities, including the examination of temporary disability, is carried out at several levels: 1st level - examination of the attending physician and the head of the department; Level 2 – examination of the deputy chief physician for EVN; Level 3 – VC examination.

The organization and procedure for conducting EWH are based on the functions of each of the listed levels.

Functional responsibilities of participants in the examination of temporary disability

In case of incapacity for work, a PL is issued attending physician– a doctor providing medical care to a patient during the period of his observation and treatment in the Moscow Region. When examining a patient, he solves not only diagnostic and treatment problems, but also determines the possibility of continuing his work activity.

When carrying out EWH attending physician

• determines signs of temporary disability based on an assessment of health status, nature and working conditions, social factors;
• records in the medical documentation complaints, anamnesis, objective data confirming the diagnosis and disability; prescribes necessary examinations and consultations; formulates a diagnosis indicating the degree of severity, functional disorders, complications;
• recommends medical and health measures, type of medical and protective regime;
• determines the timing of VL taking into account the characteristics of the disease (main and concomitant);
• issues a LN (certificate), orders a second visit to the doctor with a note about this in the medical record;
• reflects the dynamics of the disease during subsequent examinations, the effectiveness of the treatment, and justifies the extension of the period of disability;
• promptly (no later than the 15th day) refers the patient to resolve the issue of extending LN beyond 15 days, resolve the issue of further treatment and other expert issues.

When referred to the VK, an epicrisis is drawn up. The epicrisis should reflect: the duration of treatment, starting from the first day of incapacity, regardless of where and in which medical institution the treatment was started; the number of the medical condition; the diagnosis; the treatment performed and its effectiveness; the patient’s complaints and his condition at the time of presentation to the IC; clinical and labor forecast; the purpose of referral to VC (extension of treatment - indicate the extension period and what regimen the treatment will be continued; approval of the submission to the ITU, determination of work ability or professional suitability, granting academic leave, employment, etc.).

• In case of violation of the regime, makes an appropriate entry in the medical record and medical record, indicating the type and date of the violation.
• Upon restoration of working capacity and discharge to work, it reflects the objective status in the medical documentation and justifies the closure of the FN.
• Identifies signs of permanent disability, promptly organizes the patient’s referral to VC and registration for medical examination.
• Carry out clinical examination of long-term and frequently ill patients (those with 4 or more cases and 40 or more days of disability per year for one disease or 6 or more cases and 60 or more days taking into account all diseases).
• Analyzes the causes of morbidity with temporary disability and primary disability, takes part in the development of measures to reduce them.
• Constantly improves knowledge of VN examination issues.

Head of department

• carries out constant monitoring of the performance by attending physicians of the functions of organizing and conducting the treatment and diagnostic process and EVI, issuing and correct execution of documents certifying VN, timely referral of patients to VC and MSE, as well as the correct execution of documentation;
• conducts an expert assessment of the quality of medical care for patients at different stages of treatment with a mandatory personal examination and recording in primary medical documents, and also carries out an expert assessment of medical documentation at the end of the VN period or when transferring the patient to another stage of treatment;
• controls the timely improvement of the qualifications of attending physicians on issues of electronic medical equipment;
• monthly analyzes the causes and timing of VN, patients’ initial disability, and clinical and expert errors of the department’s attending physicians.

Deputy Chief Physician for Examination of Temporary Disability

• carries out selective control (according to medical documentation or after personal examination of patients) over the performance of doctors’ work on diagnosis, treatment, rehabilitation and EVN;
• takes part in solving complex clinical and expert issues;

analyzes clinical and expert errors, reports at medical conferences the results of the analysis and measures taken to reduce the incidence of temporary disability;

• interacts with the ITU bureau, takes into account and analyzes discrepancies in expert decisions, errors and violations of the procedure for referring a patient to ITU, and regularly reports at medical conferences;
• considers claims and complaints from medical insurance organizations, territorial executive bodies of the Social Insurance Fund, patient complaints on issues of quality of medical care and electronic medical equipment;
• organizes training for attending physicians on EVN issues.

Head of the Ministry of Defense

• is responsible for electronic warfare in the Ministry of Defense, issues orders on issues of its organization and implementation;
• approves the composition of the VC, regulations on the structure and organization of work of the VC and its subcommittees;
• appoints persons responsible for recording, receiving, storing and using document forms certifying citizens’ VN, creates conditions for their registration and issuance, and controls their work;
• applies disciplinary and material measures to employees who have made clinical and expert errors, violation of the procedure for conducting EVI, rules of storage, recording, execution and issuance of documents certifying EI, if necessary, in the manner established by current legislation, sends materials to the investigative authorities to resolve issues on bringing the perpetrators to criminal liability.

Medical commission

• conducts an expert assessment of the quality and effectiveness of the diagnostic and treatment process;
• extends certificates of incapacity for work for VN over 15 days;
• resolves EWH issues in complex and conflict situations;
• recommends referral of patients to medical examination;
• gives recommendations on employment for medical reasons;
• registers individuals for specialized treatment at research institute clinics, for sanatorium-resort treatment in case of severe work injury and in other cases provided for by law;
• issues a conclusion on granting academic leave for health reasons to students of secondary and higher educational institutions.

Registration of a certificate of incapacity for work

Entries in LN are made in Russian in printed capital letters in black ink or using printing devices. It is allowed to use helium , capillary or fountain pen. The use of a ballpoint pen is not permitted. Entries must not extend beyond cell boundaries.

The seals of the Ministry of Defense and ITU institutions may protrude beyond the specially designated space, but should not fall into the cells of the information field of the LN form. The imprint of the seal of the Ministry of Defense of the organization must correspond to the name specified in its charter.

In order to maintain medical confidentiality, in agreement with the patient, when registering a medical document in some specialized medical organizations (psychiatric, drug treatment organizations, centers for the prevention and control of AIDS and infectious diseases, etc.), special seals or stamps may be used without indicating the organization’s profile, and in The column “doctor’s specialty” indicates the specialty of the general practitioner - therapist, pediatrician, family doctor, dentist, paramedic, etc. In such cases, special stamps and seals of the institution are used without indicating its profile.

If there are errors in filling out the LN, it is considered damaged and a duplicate is issued in its place.

A prerequisite for registration of the LN is to fill out all cells, starting from the first.

The line “name of medical organization” indicates the full or abbreviated name of the organization (person) licensed to carry out medical activities, including work (services) under EWH;

The line “address of the medical organization” indicates the address (name of urban or rural settlement, street, house number, building, apartment (office), corresponding to the address of the actual issuance of medical information and the implementation of medical activities in accordance with the license for medical activities. The specified data is entered at intervals of one cell, the building number is indicated through a “/” sign in the cell after the house number, the apartment (office) number is indicated through a space of one cell after the house or building number (for example, |Ч|И|Т|А||у|л|| S|E|R|O|B|A|||5|/|3|.

In the “Full Name” line, the surname, first name and patronymic (patronymic is indicated if available) of the temporarily disabled citizen are indicated in the appropriate cells in accordance with the identity document.

The place of work (name of the organization) is indicated according to the citizen: full or abbreviated name of the organization (separate unit); surname and initials of the policyholder - an individual (with an interval of one cell between the surname and initials);

The surname of the medical worker who issued the drug and his initials are indicated with a space of one cell between the surname and initials.

In order to maintain medical confidentiality, Order No. 624 of the Ministry of Health defines codes for causes of disability with additional codes and change codes.

Causes of disability	Codes
disease	01
injury	02
quarantine	03
accident at work or its consequences	04
maternity leave	05
prosthetics in hospital	06
occupational disease and its complications	07
aftercare in a sanatorium	08
caring for a sick family member	09
other condition (poisoning, manipulation, etc.)	10
tuberculosis disease	11
in case of a child’s illness included in the list of diseases determined by the Ministry of Health and Social Development of Russia	12
disabled child	13
post-vaccination complication or malignant neoplasm in a child	*14
HIV-infected child	*15
*Codes 14 and 15 are entered only with the consent of the insured person

Additional codes

In the line “date 1” the date of change in the cause of disability, the expected date of birth, the start date of the trip for treatment or follow-up treatment in sanatoriums or clinics of the research institute are entered.

In the line “date 2” the end date of the voucher for treatment (follow-up treatment) is entered.

When work ability is restored, the labor permit is closed the next day after the inspection; in the “Start work” line, the date of work ability restoration is indicated in the cells. In other cases, when registering LN, the codes of the “Other” section are used:

in case of continuing disability, a continuation of the LN is issued	31
when establishing disability	32
when changing the disability group	33
in case of death	34
in case of refusal to conduct a medical and social examination	35
in the case when a citizen, after issuing or extending a certificate of incapacity for work, did not appear for an appointment, but at the next visit was recognized as able to work	36
in case of referral for follow-up treatment immediately after inpatient treatment	37
For codes 32, 33, 34 and 36, the date of establishment, change of disability group, date of death of the citizen, date of appearance as able-bodied is entered

In the “Main” line, a “V” mark is made if the personal identification document was issued for presentation at the main place of work (including when working for one employer, which is due to the technical features of the program).

In the line “Part-time”, a “V” mark is made if the personal identification document is issued for presentation at the place of work on an external part-time basis and the number of the personal identification document issued for presentation at the main place of work is indicated (Fig. No. 1/1, 1/2).

Example: A patient has been working for two employers for several years. Temporarily disabled due to an acute illness from January 17 to January 23, discharged to work from January 24. Certificate of incapacity for work at the main place of work No. 001234567891.

If, at the time of the onset of LT, maternity leave, a citizen is working for several employers, and in the two previous years he was employed by the same employers, several LT are issued (for each place of work).

If a citizen, at the time of the onset of VN, maternity leave, works for several employers and was employed by other employers in the two previous years, one LN is issued for presentation at one of the last places of work of the citizen’s choice.

If a citizen at the time of the onset of maternity leave works for several employers, and in the two previous years was employed by these and other employers,

either several LNs are issued (for each place of work), or one LN is issued for presentation at one of the last places of work of the citizen’s choice.

If there is information that a citizen is recognized as unemployed in the prescribed manner, a “V” mark is made in the line “Registered with state employment service institutions”; if this mark is marked, the lines and “(place of work - name of organization)”, “Primary”, “Part-time” - are not filled in.

Registration of a duplicate of LN

If the LN is damaged or lost, by decision of the VC, a duplicate LN is issued.

If you lose personal income, you must provide a certificate from your place of work stating that benefits were not paid for a given period of time. The entire period of the temporary residence permit is entered in one line in the “Exemption from work” column; data on the issuance of a duplicate is entered into the patient’s medical record. If there are errors in filling out the LN, it is considered damaged and a “duplicate” is issued in its place.

The procedure for issuing a certificate of incapacity for work in various clinical situations

The procedure for issuing a certificate of incapacity for work in case of illnesses, occupational diseases, injuries, including those received as a result of an industrial accident, poisoning (some other consequences of external causes)

For outpatient treatment of diseases (injuries) associated with VN, the attending physician issues (extends) alone for a period of up to 15 calendar days inclusive (Fig. No. 2).

Example: A patient was unable to work due to ARVI from January 27 to January 31, but upon examination on January 31, his ability to work was restored.

The period of one-time release from work depends on the diagnosis (taking into account the approximate terms of the VN and the frequency of assessing the dynamics of the patient’s condition).

If the time limit for the LT exceeds 15 calendar days, the LT is extended by decision of the VC for a period of no more than 15 days (Fig. No. 3).

Example: A patient is incapacitated due to acute respiratory viral infection from January 27 to February 10, upon examination on February 10, the incapacity remains, he is referred to the VA.

The paramedic and dentist issue and extend the medical license for up to 10 days. If LN persists for more than 10 days, further extension of LN should be carried out by decision of the Military Commission of the Moscow Region (without the participation of paramedical workers).

Date of issue of the certificate of incapacity for work.

The LN is issued at the request of the patient on the day of his application to the Moscow Region or on the day the LN is closed. The registration of LN for the assignment and payment of benefits is carried out by the Moscow Region on the day of its closure. In outpatient treatment, LD is issued when the fact of incapacity for work is established.

Upon discharge from the hospital, LN is issued for the entire period of inpatient treatment on the day of discharge (Fig. No. 4), for non-residents with continued disability - taking into account the days of travel to their place of residence.

Example: The patient was treated in a hospital from 02.02 to 16.02. Upon discharge, the patient’s ability to work was restored.

If the disability continues, the hospital has the right to extend the LN for up to 10 days. In case of restoration of working capacity, the medical facility is closed by hospital doctors.

In case of long-term treatment, the medical organization issues a new

LN (continued) and at the same time draws up the previous LN for the assignment and payment of VN benefits.

The document, as a rule, is issued and closed in one MO. But, if the patient is sent to continue treatment to another medical organization, the closure of the LN must be performed by the organization to which the patient is referred. A situation is possible when a citizen who is unable to work on the day of discharge from the hospital is sent to continue treatment in another municipality where the citizen is already able to work. In this case, the MO to which the citizen was sent must fill out the line “Get to work” in the LN and close it.

When the fact of incapacity for work is established, the issuance of a medical document is made on the basis of a doctor’s entry in the medical documentation justifying temporary release from work, upon presentation of a document confirming the patient’s identity. The extension of LN is carried out by a doctor after a personal examination and is confirmed by an entry in the medical record of an outpatient (inpatient) patient.

For outpatient treatment, the extension of the certificate of incapacity for work is carried out from the day following the day the citizen is examined by a doctor. Each extension of a certificate of incapacity for work is recorded in separate rows of the “Exemption from work” table.

Extension of the LN is carried out taking into account the approximate terms of the VN, the permissible deviation from which should not exceed 30%. In the period between meetings of the VC, the extension of the LN is carried out by the attending physician under the supervision of the head of the department, who, when examining the patient, only signs the examination record in the medical record.

Information about the medical document, indicating the number, dates of issue and renewal, re-attendance for appointments, discharge to work, referral of the patient to another medical institution is entered into the medical documentation. If there is no record in the medical documentation substantiating the VN, the LV is considered to have been issued without justification.

In accordance with Article 59 of Federal Law No. 323-FZ, if there is an obvious unfavorable clinical and work prognosis, no later than four months from the date of onset of VN, the patient is sent to undergo MSE in order to assess disability.

With a favorable clinical and work prognosis, no later than ten months from the date of onset of VL in the case of injuries and reconstructive surgeries and no later than twelve months in the treatment of tuberculosis, the patient is either discharged to work or sent to medical examination. The frequency of extension of LN by decision of the VC is no less than every 15 calendar days.

In case of illnesses, occupational illnesses, injuries, including those received as a result of an industrial accident, when treatment is carried out on an outpatient basis, the LN is issued on the day the incapacity for work is established for the entire period of the VN, including non-working holidays and weekends.

Citizens who seek medical help at the end of the working day, at their request, are issued with LN from the next calendar day.

During regular examinations of the patient, it is necessary to reflect in the documentation the dynamics of his condition, changes in the course of the disease, if necessary, make changes to therapy and justify further release from work.

The diagnosis should be established in accordance with the International Statistical Classification of Diseases, X revision, indicating the etiology, severity and nature of the course, stage, leading clinical syndrome, complications and dysfunction of the body.

The basis for issuing LN is most often an acute or exacerbation of a chronic disease (exacerbation, decompensation, paroxysms). If paroxysm, crisis, colic occurs, then the date of their occurrence is indicated (the same for acute myocardial infarction, cerebrovascular accident).

When deciding on the patient’s ability to work, in addition to medical criteria, socio-professional factors must be taken into account that influence the indications for issuing LN, the timing of VN and are taken into account when the patient is discharged to work (for example: LN for mild exacerbation of chronic cholecystitis is issued only to persons engaged in severe physical labor).

The criteria for restoration of working capacity and discharge to work are: reverse development of the morphological process in acute diseases, stabilization of the process in chronic diseases, restoration of the functions of organs and systems or their compensation, normalization of the results of additional research methods, etc.

Issuance of LN for the past days when the citizen has not been examined by a medical professional, prohibited.In exceptional cases, LN can be issued for the past period by decision of the VC when a citizen applies to the Moscow Region or a medical worker visits him at home.

If the patient works in shifts, if at the time of seeking medical help at the health center ( ambulance station, hospital emergency department - not specified in current regulatory documents), the patient was unable to work, he is given a certificate of any form. The certificate includes information about the exact time of seeking medical help, a detailed description of the clinical manifestations of the disease, the results of the examination, the amount of assistance provided and an assessment of the state of working ability. The decision to issue LN in these cases is made by the VC of the Moscow Region at the place of constant observation of the patient. If the HC decides to issue a medical license, it is issued on the basis of a certificate from the moment of contacting the health center and is extended if the medical license persists (Fig. No. 5).

Example: The patient works as a taxi driver (shift work), 31.12. At 20 o'clock he went to the emergency medical service, was diagnosed with ARVI, and was issued a certificate confirming his incapacity for work. It is recommended to go to the clinic on 02.01. When examined at the clinic on January 2, the disability remains.

If at the time of examination at the Moscow Region no signs of disability are identified, the LN is issued from the time of application to the health center and is closed from the day of the examination.

Violation of the regime

Violations of the prescribed regime are

One of the most common violations of the regime is late attendance at a doctor's appointment. Registration of the LN depends on whether the patient’s disability remains during subsequent examination. If an able-bodied patient fails to show up on time for an appointment, a note is made in the “Violation of the regime” column - code 24 and indicated appointment date; the remaining unfilled lines in the “Exemption from work” section are crossed out with a straight line; in the “Other” column, code 36 is entered and the date of appearance is indicated (Fig. No. 6).

Example: A patient is temporarily disabled from 12.01 to 19.01, a second appearance is scheduled for 19.01. She showed up for an appointment only on January 23, and upon examination, her ability to work was restored.

If a patient fails to appear on time and is declared incapacitated, code 24 is entered in the column “Violation of the regime” and the date of the scheduled appearance for the appointment is indicated; a separate line indicates the time of failure to appear at the reception with the signature of the chairman of the VC (extension of the LN at a later date); further extension of LN is carried out on a general basis (Fig. No. 7).

Example: The patient is temporarily disabled from 12.01 to 19.01, re-appearance on 19.01. She showed up for an appointment only on January 23; upon examination, her disability remained.

In cases where an illness or injury was the result of alcohol or drug intoxication, a note is made about the fact of intoxication in the medical documentation and in the LN. The fact of intoxication is established in accordance with the Instructions on the procedure for a medical examination to establish the fact of alcohol consumption and state of intoxication” dated 1.09. 88 No. 06 – 14 / 33 – 14 and by order of the Ministry of Health of the Russian Federation No. 308 of July 14, 2003 “On medical examination for intoxication.”

The examination must be carried out in a medical organization that has a license for this type of activity, by specially trained personnel (with a certificate for this type of work). The medical record reflects clinical signs of intoxication and the results of laboratory tests for ethanol in biological media and exhaled air.

Criteria, in the presence of which there are sufficient grounds to believe that there is a state of intoxication and a referral for a medical examination is necessary (Order of the Ministry of Health of the Russian Federation No. 308): the smell of alcohol on the breath, instability of posture, speech impairment, severe trembling of the fingers, a sharp change in the color of the skin of the face , behavior inappropriate to the situation.

If a patient with a disorder comes to an appointment in a state of intoxication, a note about the fact of intoxication is made in the “regime violation” column (regime violation code 28 indicating the date). In cases where, during the initial application, a disability associated with intoxication is identified, in addition to the cause of the disability (illness, injury, etc.), an additional three-digit code 021 is indicated.

For citizens in need of treatment in specialized medical organizations (SMOs), PL is issued directly to the SMO; in exceptional cases, PL is issued upon referral to a SMO of the appropriate profile to continue treatment.

A citizen who is temporarily disabled and sent for consultation (examination, treatment) to a municipality located outside the administrative region, by decision of the Internal Affairs Committee, is issued a LN for the number of days required to travel to the location of the relevant municipality.

In case of VN in connection with an illness (injury, poisoning) during the next vacation, LN is issued on a general basis, including during the period of follow-up treatment in a sanatorium-resort institution.

In case of VN of a woman caring for a child until he reaches the age of 3 years, working part-time or at home, LN is issued on a general basis.

Citizens sent by court decision for a forensic medical or forensic psychiatric examination who are recognized as incapable of work are issued a LD from the date of admission for examination.

In some cases (complex urological, gynecological, proctological and other studies, manipulations, procedures) during outpatient treatment using the intermittent method, LN can be issued, by decision of the Institution, intermittently, for the days of interventions.

If the disability arose during a stay abroad, then upon returning to the country, a document confirming the VN (after legalization of the transfer) can be replaced by a decision of the Military Commission of the Moscow Region with a LN.

Citizens sent by the Ministry of Defense and health authorities for treatment at clinics of the Scientific Research Institute of Balneology, Physiotherapy and Rehabilitation, sanatorium-resort institutions, including specialized (anti-tuberculosis) ones, are issued a medical license by a medical worker on the basis of the decision of the Internal Affairs Committee for the duration of treatment, travel to the place of treatment and back (Fig. No. 8).

Example: The patient has voucher No. 2378519 to the Tomsk Research Institute of Cardiology (OGRN 213456789) from 1.02 to 24.02. The journey takes 4 days.

If there are appropriate medical indications, LN is extended by the attending physician of the specified clinics.

The procedure for sending citizens to ITU

Citizens who have persistent limitations in their ability to live and work and who are in need of social protection are sent to MSE, according to the conclusion of the VC when:

• obvious unfavorable clinical and labor prognosis, regardless of the timing of VN, but no later than 4 months from the date of its onset;
• favorable clinical and work prognosis for VN lasting more than 10 months (in some cases: conditions after injuries, reconstructive operations), in the treatment of tuberculosis - over 12 months);
• the need to change the professional rehabilitation program for working disabled people in the event of a worsening clinical and work prognosis, regardless of the disability group and the timing of the disability.

When referred to MSE, form No. 088/u-06 “Referral for medical and social examination by an organization providing medical and preventive care” is filled out, approved by order of the Ministry of Health and Social Security of the Russian Federation dated January 31, 2007 No. 77 “On approval of the form for referral to medical social examination by an organization providing treatment and preventive care.”

If disability is established, the period of disability ends on the date immediately preceding the day of registration of documents with the ITU bureau (Fig. No. 9).

Example: A patient has been temporarily disabled since January 12 due to complicated AMI (88 days). The clinical and work prognosis is unfavorable. The certificate of incapacity for work was extended by the VC from 09.04 to 14.04, the VC recommended that the patient be registered for medical examination. Sent to ITU on April 14, documents were registered with the bureau on April 15; On April 17, he was recognized as a disabled person of group 2.

Temporarily disabled persons for whom disability has not been established may be issued a LP by decision of the VC until their ability to work is restored for a period of no more than 4 months after the date of registration of documents at the ITU institution, with a periodicity of LP extension by decision of the VC no less than 15 days later, or re-referral to ITU.

If a citizen refuses to be referred to an ITU or fails to appear on time for an ITU for an unexcused reason, the LO is not extended from the date of refusal to be referred to an ITU or the day of registration of documents at the ITU institution, information about this is indicated in the LO and in the medical record of the outpatient (inpatient) patient.

The procedure for issuing a certificate of incapacity for work for the period of sanatorium treatment and medical rehabilitation

Patients are referred for further treatment to specialized sanatorium-resort institutions only immediately after hospital treatment according to the List of diseases approved by regulatory documents.

Patients are not referred for follow-up treatment to sanatoriums from outpatient clinics. LN is issued by the Ministry of Defense, referring the citizen for further treatment and is extended by the attending physician by decision of the Internal Affairs Committee of a specialized sanatorium-resort institution for the entire period of further treatment, but not more than 24 calendar days.

Example: A patient is being treated in the cardiology department of a hospital from January 15 to February 6 for AMI, and from February 7 she is sent for follow-up treatment to a sanatorium.

In the LN issued for the period of inpatient treatment, code 37 is entered in the “Other” line “in case of referral for follow-up treatment immediately after inpatient treatment” (Fig. No. 10/1). The continuation of the LP is formalized by the Ministry of Defense, which refers the citizen for further treatment (Fig. No. 10/2). In the “From what date” column of the “Exemption from work” table, the date of treatment start is indicated. Further registration of LN is carried out by the attending physician of the sanatorium-resort institution (department): in the line “Stayed in hospital” the length of stay in the sanatorium is indicated, in the columns “From what date” and “To what date” of the table “Exemption from work” the period is indicated in one line stay in a sanatorium-resort institution (department).

After completion of follow-up treatment, when the VC of a specialized sanatorium-resort institution makes a decision on the citizen’s ability to work, the closure of the LP is carried out by the sanatorium-resort institution.

If VN continues for the period of completion of follow-up treatment, the patient is sent with VN for treatment to the medical district at the place of residence.

When sending persons injured in connection with a serious accident at work to sanatorium-resort treatment during the period of VT (before referral to MSE), LP is issued for the entire period of treatment and travel.

When a medical organization sends patients with tuberculosis on vouchers to specialized (anti-tuberculosis) sanatoriums for treatment in case of detected active form of tuberculosis in the case when sanatorium treatment replaces inpatient treatment, as well as for follow-up treatment after inpatient treatment, the LV is issued by decision of the IC of the anti-tuberculosis dispensary and is extended by the VC of a specialized (anti-tuberculosis) ) sanatorium for the entire period of treatment, follow-up treatment and travel.

The procedure for issuing a certificate of incapacity for caring for a sick family member

LN for caring for a sick family member is issued by a medical worker to one of the family members (guardian, trustee, other relative) who is actually providing care.

LN is issued to care for a sick family member:

• a child under the age of 7 years, a disabled child under the age of 15 years - during outpatient treatment or the joint stay of one of the family members in the hospital for the entire period of an acute illness or exacerbation of a chronic disease;
• a child aged 7 to 15 years - for outpatient treatment or a joint stay of one of the family members in a hospital for a period of up to 15 days for each case of illness, unless a longer period is required according to a medical report;
• children under 15 years of age infected with HIV, with an illness associated with a post-vaccination complication, malignant neoplasms, as well as severe blood diseases - for the entire period of joint stay with the child in the hospital;
• children under the age of 15 years living in a resettlement zone or a residence zone with the right to resettlement, evacuated and resettled from exclusion zones, resettlement, residence with the right to resettlement, including those who were in a state of fetal development on the day of evacuation, as well as children of the first and subsequent generations of citizens born after radiation exposure of one of the parents - for the entire duration of the illness;
• children under 15 years of age suffering from diseases due to radiation exposure on their parents - for the entire duration of the illness;
• over 15 years old - for outpatient treatment for up to 3 days, by decision of the Internal Affairs Committee - for up to 7 days for each disease. LN for adult care is issued only in outpatient settings in the case of an acute illness (during exacerbation of a chronic disease) and the impossibility of hospitalization (Fig. No. 11).

Example: A 67-year-old patient has a stroke; she refused hospitalization; her daughter is caring for her.

If necessary, personal income tax for caring for a sick child can be issued alternately to different family members. If two or more children become ill, one LN is issued to care for them. If the second (third) child falls ill during the period of illness of the first, the personal allowance issued to care for the first child is extended until all children recover, without counting the days that coincided with the days of release from work to care for the first child. At the same time, the LN indicates the dates of the onset and end of the disease, names, and ages of all children.

LN for care is not issued:

• for a sick family member over 15 years of age during inpatient treatment;
• for chronic patients during remission;
• if the caregiver is on regular leave or leave without pay; maternity leave; parental leave until the child reaches the age of 3 years.

If a child falls ill during a period when the mother (another family member actually caring for the child) does not need to be released from work, a childcare license is issued from the day the mother is supposed to start work.

The LN issued for caring for a sick family member indicates the reason for the LN “caring for a sick family member”; last name, first name, patronymic, age of the citizen (child) being cared for, as well as family ties.

When caring for two or more children at the same time, the LN indicates the last name, first name, patronymic, and age of each child being cared for.

The procedure for issuing a certificate of incapacity for work during quarantine

Quarantine refers to a system of measures aimed at preventing the spread of infectious diseases. During quarantine, persons who are actually able to work and have been in contact with sick people are temporarily suspended from work.

In case of temporary suspension of persons who have been in contact with an infectious patient, or in the case of bacterial carriage, the FN is issued by an infectious disease doctor, in case of his absence - by the attending physician only upon the recommendation of an epidemiologist. The duration of suspension from work is determined by the periods of isolation of persons with various infectious diseases. The periods of isolation are determined by the methodological recommendations “Time limits for isolation of patients with infectious diseases and persons in contact with them”, approved by the Ministry of Health on October 15, 1980.

Employees of public catering enterprises, water supply enterprises, and children's institutions, if they have helminthiasis, are issued LN for the entire period of deworming.

During quarantine, LN for caring for a child under 7 years old attending a preschool institution, or a family member recognized as legally incompetent in the prescribed manner, is issued by the attending physician who carries out supervision, to one of the family members (guardian) for the entire quarantine period based on a decision of the Government of the Russian Federation or executive body of a constituent entity of the Russian Federation, a local government body, as well as decisions of authorized officials, a federal executive body or its territorial bodies in charge of defense and other special purpose facilities, adopted in accordance with Article 31 of the Federal Law of March 30, 1999 N 52-FZ “On the sanitary and epidemiological welfare of the population.”

The procedure for issuing a certificate of incapacity for prosthetics

When a patient is referred for prosthetics to an inpatient specialized institution, the LN is issued for the duration of travel to the place of treatment. The issued LN is extended in the hospital for the entire period of prosthetics and the time of travel to the place of residence. When using prosthetics in outpatient settings, LN is not issued.

The procedure for issuing a certificate of incapacity for work during pregnancy and childbirth

LN is issued by an obstetrician-gynecologist, in his absence - by a general practitioner (family doctor), and in the absence of a doctor - by a paramedic.

FN is issued at 30 weeks of pregnancy at a time for 140 (70 + 70) calendar days (Fig. No. 12).

Example: On January 12, a pregnant woman came to the antenatal clinic to apply for maternity leave, the pregnancy was 30 weeks, the pregnancy progressed without complications, she was registered at 10 weeks of pregnancy.

In case of multiple pregnancy - at 28 weeks for 194 calendar days (84 + 110). The period of incapacity for work is included in one line of the table “exemption from work”, the reason for incapacity for work is 05, in the column “Date 1” the due date is indicated; a note is made about early registration.

If a woman, when contacting the Ministry of Defense within the prescribed period, refuses to receive medical treatment for pregnancy and childbirth, the refusal is recorded in the medical documentation. When a woman applies for PL again before giving birth, it is issued for 140 calendar days (194 days for a multiple pregnancy) from the date of the initial application, but not earlier than 30 (28) weeks.

When a diagnosis of multiple pregnancy is made during childbirth, the LN is issued for an additional 54 calendar days to the municipality where the birth occurred.

In case of complicated childbirth, LN is issued for an additional 16 calendar days of the municipality where the birth took place.

For births occurring between 22 and 30 completed weeks of pregnancy, LN is issued for 156 calendar days.

In case of termination of pregnancy up to 21 full weeks of pregnancy, LN is issued for the entire period of incapacity, but not less than 3 days.

Women living (working) in populated areas exposed to radioactive contamination as a result of the Chernobyl accident, the Mayak production association, and the discharge of radioactive waste into the Techa River are given prenatal leave for 90 calendar days.

When the prenatal leave period arrives while a woman is on annual basic or additional paid leave, or maternity leave for up to 3 years, LN is issued on a general basis (the leave is considered invalid).

A woman who has adopted a child under 3 months of age, including from a surrogate mother, is issued a LD from the date of adoption for a period of up to 70 calendar days (for simultaneous adoption of two or more children - for 110 days) from the date of birth of the child.

When carrying out an in vitro fertilization procedure, the LN is issued to a woman MO who has a license for medical activities, including work in obstetrics and gynecology and examination of VN, for the entire period of treatment until the result of the procedure is determined and travel to the place of residence and back. If the MO that performed the in vitro fertilization procedure does not have a license, the LN is issued to the woman by the MO at her place of residence based on an extract (certificate) from the medical record.

In case of abortion, the LN is issued for the entire period of incapacity, but not less than 3 days.

Medical commission of a medical organization

Structure and organization of work

The VC is created for collegial discussion and decision-making on issues of diagnosis, treatment, rehabilitation, determining the working capacity of citizens, the professional suitability of certain categories of workers and other medical and social issues, as well as for monitoring the quality and effectiveness of diagnostic and treatment measures, including assessing the validity and effectiveness of drug prescription.

The procedure for the creation and activities of a medical commission is regulated by Federal Law No. 323-FZ of November 21, 2011. “On the fundamentals of protecting the health of citizens in the Russian Federation” (Article 48 “Medical commission and council of doctors”) and order of the Ministry of Health and Social Development of the Russian Federation dated May 5, 2012 No. 502n “On approval of the procedure for the creation and activities of a medical commission of a medical organization.”

The medical commission is created on the basis of an order from the head of the Moscow Region. Depending on the assigned tasks, the specifics of the activities of the Moscow Region, by decision of the head of the Moscow Region, subcommittees can be formed within the VC:

• treatment and control commission (considering cases of violation of medical practice);
• subcommittee on the study of lethal outcomes (FLI);
• subcommittee on the destruction of used ampoules (etc.) of narcotic drugs;
• subcommittee on the destruction of narcotic and psychotropic substances, including representatives of internal affairs bodies and environmental protection bodies;
• subcommittee to verify the feasibility of the use and circulation of narcotic and psychotropic substances;
• subcommittee on organizing additional drug provision (DLO):
• on authorization of prescription of medicinal products;
• for monitoring the prescription and discharge of drugs;
• to control the accounting, storage and use of prescription forms.
• subcommittee on control of the sanitary-epidemiological regime and prevention of nosocomial infections (HAI).

The regulations on the VC (subcommittees of the VC), regulating the goals, objectives and functions of the VC (its subcommittees), the procedure for work, accounting and reporting on the results of activities, and the composition of the VC (its subcommittees) are approved by the head of the Moscow Region.

The VC (subcommittee of the VC) consists of a chairman, one or two deputy chairmen, a secretary and members of the commission.

The head of the Moscow Region or a deputy head (head of a structural unit) is appointed as the Chairman of the VC, whose job responsibilities include resolving issues within the competence of the commission.

The composition of the VC and its subcommittees includes heads of structural divisions and medical specialists from among the employees of the Moscow Region. Responsibilities for participation in the work of the VC must be included in the functional responsibilities of employees.

Attending physicians represent the patient on the VC, but are not members of the VC

The Chairman of the VC (subcommittee) is responsible for its activities, timeliness, validity and objectivity of the decisions made.

The secretary of the VC (subcommission of the VC) draws up plans and schedules for meetings; prepares materials for the meeting; notifies members of the VC about the date and time of the meeting; draws up the decision of the VC (its subcommission) and maintains a special journal in which the decisions taken by the VC are entered; organizes the storage of materials from the work of the VC and its subcommissions .

Meetings of the VC and subcommittees are held at least once a week on the basis of schedules approved by the head of the Moscow Region. If necessary, by decision of the head of the Moscow Region, unscheduled meetings of the VC (VK subcommittees) may be held.

The decision of the VC (subcommission) is considered adopted if it is supported by two-thirds of the members of the commission. The decision is drawn up in the form of a protocol.

An extract from the protocol of the VC’s decision is handed over to the patient or his legal representative based on a written application.

The Chairman of the VC submits a written report on the work of the VC and its subcommittees to the head of the Moscow Region on a quarterly basis, as well as at the end of the year.

The work of the VC and its subcommittees is controlled by the head of the Moscow Region.

Functions of the medical commission

• making decisions on issues of prevention, diagnosis, treatment, medical rehabilitation and sanatorium-resort treatment of citizens in the most complex and conflict situations requiring commission consideration;
• resolving EWH issues in cases established by the legislation of the Russian Federation;
• conducting an examination of the professional suitability of certain categories of workers;
• assessment of the quality, validity and effectiveness of diagnostic and treatment measures, including the prescription of drugs;
• assessment of compliance in the Ministry of Defense with the established procedure for maintaining medical records;
• development of measures to eliminate and prevent violations in the process of diagnosing and treating patients;
• studying each case of death of a patient in order to identify the cause of death, as well as developing measures to eliminate violations in the activities of the Ministry of Defense and medical workers in the event that such violations led to the death of the patient;
• making decisions on issues of prescribing and adjusting treatment (including narcotic and psychotropic medications) in order to take into account patient data when providing medications in accordance with the legislation of the Russian Federation;
• selection of patients for the provision of high-tech medical care;
• issuing a medical opinion on the presence (absence) of medical indications and medical contraindications for medical rehabilitation and sanatorium treatment of citizens;
• issuing a conclusion on the need of a veteran to be provided with prosthetics (except dentures), prosthetic and orthopedic products;
• Conducting mandatory preliminary and periodic medical examinations (examinations) of workers engaged in heavy work and work with harmful and (or) dangerous working conditions;
• issuance of a certificate confirming the absence of medical contraindications for working with the use of information constituting a state secret;
• issuing a medical conclusion that when organs and tissues are removed for transplantation (transplantation) from a living donor, significant harm will not be caused to his health;
• analysis of the incidence, including of mothers and newborns, of nosocomial infections, development and implementation of measures to prevent the incidence of nosocomial infections;
• organizing and conducting internal control of the quality and safety of medical activities (by decision of the head of the Ministry of Defense);
• interaction in work on issues within the competence of the VC with territorial compulsory health insurance funds, regional branches of the Federal Social Insurance Fund of the Russian Federation, territorial bodies of the Federal Service for Surveillance in Healthcare and Social Development and the Federal Service for Surveillance in the Sphere of Consumer Rights Protection and Human Welfare, federal ITU institutions, with insurance MOs, other bodies and organizations;
• consideration of requests (complaints) on issues related to the provision of medical care to citizens in the Moscow Region;
• other functions provided for by federal laws, regulatory legal acts of the President, the Government of the Russian Federation, federal executive authorities and state authorities of constituent entities of the Russian Federation.

Chapter 7. Program of state guarantees for the provision of free medical care to citizens of the Russian Federation

Chapter 8. Medical personnel with secondary vocational education

Chapter 9. Organization of work of nursing staff in outpatient clinics

Chapter 10. Organization of work of nursing staff in hospitals

Chapter 11. Organization of work of emergency medical personnel

Chapter 12. Features of organizing the work of paramedical personnel of healthcare institutions in rural areas

Chapter 14. The role of paramedical workers in the organization of medical prevention

Chapter 15. Ethics in the professional activities of nursing staff

Chapter 16. Ensuring sanitary and epidemiological welfare of the population and protection of consumer rights in the consumer market

Chapter 17. Organization of healthcare in foreign countries

Chapter 13. Examination of work capacity

Chapter 13. Examination of work capacity

13.1. GENERAL PROVISIONS

Work ability examination - this is a type of examination, which consists in determining the causes, duration, degree of temporary or permanent disability of a person due to illness, injury or other cause, as well as determining the patient’s need for types of medical care and social protection measures.

Naturally, the question arises: what should be understood by a person’s ability to work?

Work ability - this is a state of the human body in which the totality of physical and spiritual capabilities allows one to perform work of a certain volume and quality. A medical professional, based on a comprehensive medical examination, must determine the presence or absence of a disease in a particular person. Work ability has medical and social criteria.

Medical criteria for working ability include a timely clinical diagnosis, taking into account the severity of morphological changes, the severity and nature of the course of the disease, the presence of decompensation and its stage, complications, determination of the immediate and long-term prognosis of the development of the disease.

However, a sick person is not always incapacitated. For example, two people suffer from the same disease - panaritium. One of them is a teacher, the other is a cook. A teacher with panaritium can perform his professional duties - he is able to work, but a cook cannot, that is, he is incapacitated. In addition, the cause of disability is not always the disease of the patient himself. For example, the same cook himself may be healthy, but someone in his family has contracted viral hepatitis, as a result of which the cook cannot perform his professional duties, that is, prepare food, since he has contact with a patient with viral hepatitis. Therefore, the disease

and disability are not identical concepts. If there is an illness, a person may be able to work if the illness does not interfere with the performance of professional duties, and disabled if their performance is difficult or impossible.

Social criteria for working ability determine the labor prognosis for a specific disease and its working conditions, reflect everything related to the patient’s professional activity: the characteristics of the prevailing stress (physical or neuropsychic), the frequency and rhythm of work, the load on individual systems and organs, the presence of unfavorable working conditions and professional harmfulness.

Using medical and social criteria for working ability, a medical professional conducts an examination, during which the fact of the patient’s incapacity for work can be established. Under disability should be understood as a condition caused by illness, injury, its consequences or other reasons, when the performance of professional work is impossible in whole or in part for a limited time or permanently. Disability can be temporary or permanent.

13.2. EXAMINATION TEMPORARY

DISABILITY

If changes in the patient’s health status are temporary, reversible, and recovery or improvement is expected in the near future, as well as restoration of working capacity, then this type of disability is considered temporary. Temporary disability(VN)- this is a condition of the human body caused by disease, injury and other reasons in which dysfunctions are accompanied by the inability to perform professional work in normal production conditions for a certain period of time, that is, they are reversible.

A distinction is made between complete and partial temporary disability.

Total temporary disability - this is the impossibility of performing any work for a certain period of time, accompanied by the need to create a special regime and carry out treatment.

Partial temporary disability occurs in a person in relation to his usual professional activities during

maintaining the ability to perform other work with a different light duty or reduced volume.

Establishing the fact of temporary disability is carried out on the basis of an examination and has important legal and economic significance, since it guarantees the citizen release from work and receipt of benefits from state social insurance funds. Timely release of sick people from work is one of the effective preventive measures to prevent complications of diseases and their chronicity.

Thus, examination of temporary disability is one of the types of medical examination, the main purpose of which is to assess the patient’s health status, the quality and effectiveness of the treatment, the ability to carry out professional activities, as well as determine the degree and timing of temporary disability.

Examination of temporary disability is carried out in state, municipal and private healthcare organizations.

Morbidity with temporary disability reflects the morbidity of the working population, therefore, in addition to medical and social, it is also of great economic importance.

A document certifying the temporary disability of citizens and confirming their temporary release from work is certificate of incapacity for work, which is issued:

For diseases;

In case of injuries, poisoning and other conditions associated with temporary disability;

For the period of follow-up treatment in sanatorium-resort institutions;

If it is necessary to care for a sick family member;

For the period of quarantine;

For the duration of prosthetics in a hospital setting;

For the period of maternity leave;

When adopting a child.

There are two ways to issue certificates of incapacity for work: centralized and decentralized. Centralized way It is more often used in large clinics, where sick leave certificates are issued at the reception desk or in specialized offices for the centralized issuance of sick leave certificates.

The nurse working in this office must be able to correctly fill out the passport part of the certificate of incapacity for work and the items regarding release from work. At in a decentralized way the certificate of incapacity for work is drawn up and issued by the attending physician himself, and a nurse helps him in filling out the passport part.

A certificate of incapacity for work, in addition to the attending physician, can be issued by paramedics and dentists of medical organizations by decision of the health care management body of a constituent entity of the Russian Federation, agreed upon with the regional branch of the Social Insurance Fund of the Russian Federation.

Medical workers of the following healthcare institutions do not issue certificates of incapacity for work:

Emergency medical facilities;

Blood transfusion institutions;

Reception departments of hospital institutions;

Medical and physical education clinics;

Balneological hospitals and mud baths;

Special types of healthcare institutions (centers for medical prevention, disaster medicine, forensic medical examination bureaus);

Health care institutions for supervision in the field of consumer rights protection and human well-being.

Certificates of incapacity for work are issued upon presentation of a passport or a document replacing it. If a citizen works for several employers, several certificates of incapacity for work are issued for each place of work.

Control over compliance with the procedure for issuing certificates of incapacity for work by medical workers is carried out by the Federal Service for Surveillance in Healthcare and Social Development together with the Social Insurance Fund of the Russian Federation.

13.3. STAND EXAMINATION

DISABILITY

Permanent disability - this is a long-term or permanent loss of ability to work or its significant limitation caused by a chronic disease (trauma, anatomical defect) leading to a pronounced impairment of body functions. Depending on the degree of permanent disability, disability is established by conducting a medical and social examination.

Medical and social examination (MSE)- this is the determination of the needs of the examined person for social protection measures based on an assessment of the limitations in life activity caused by a persistent disorder of body function. In Russia, a three-stage system of federal state institutions of ITU has been created, which includes: the Federal Bureau of Medical and Social Expertise, the main bureaus of medical and social expertise, as well as the bureaus of medical and social expertise in municipalities, which are branches of the main bureaus.

Citizens who have persistent limitations in their ability to live and work and who are in need of social protection are sent to MSE, based on the conclusion of a medical commission if:

Obvious unfavorable clinical and labor prognosis, regardless of the duration of temporary disability, but no later than 4 months from the date of its onset;

Favorable clinical and work prognosis with temporary disability lasting over 10 months (in some cases: conditions after injuries and reconstructive operations, in the treatment of tuberculosis - over 12 months);

The need to change the professional rehabilitation program for working disabled people in the event of a worsening clinical and work prognosis, regardless of the disability group and the duration of temporary disability.

A citizen is sent for a medical and social examination by an organization that provides him with medical and preventive care (the body providing pensions, the social protection body), after carrying out the necessary diagnostic, treatment and rehabilitation measures, if there is data confirming a persistent impairment of body functions caused by diseases, consequences of injury or defect -

mi. At the same time, the “Referral for medical and social examination” (f. 088/u-06) indicates data on the citizen’s health status, reflecting the degree of dysfunction of organs and systems, the state of the body’s compensatory capabilities, as well as the results of rehabilitation measures taken.

If an organization providing medical and preventive care refuses to send a citizen to MSA, he is issued a certificate, on the basis of which he has the right to contact the bureau independently. The bureau's specialists conduct an examination of the citizen and, based on its results, draw up a program of additional examination (and rehabilitation measures), after which they consider the question of whether he has disabilities.

Medical and social examination is carried out in the bureau at the place of residence. At the main bureau, a medical and social examination is carried out in the event of a citizen appealing the bureau’s decision, as well as upon referral from the bureau in cases requiring special types of examination. In the Federal Bureau, a medical and social examination is carried out in the event of a citizen appealing a decision of the main bureau, as well as in the direction of the main bureau in cases requiring particularly complex special types of examination. A medical and social examination can be carried out at home if a citizen cannot come to the bureau for health reasons, which is confirmed by the conclusion of an organization providing medical and preventive care, or in a hospital where the citizen is being treated, or in absentia by decision of the relevant bureau. The examination is carried out at the request of a citizen, which is submitted to the bureau in writing with the attachment “Referrals for medical and social examination” issued by the organization providing medical and preventive care (the body providing pensions, the social protection body) and medical documents confirming the violation health. Medical and social examination is carried out by specialists of the bureau by examining the citizen, studying the documents submitted to him, analyzing the social, professional, labor, psychological and other data of the citizen. The decision to recognize a citizen as disabled or to refuse to recognize him as disabled is made by a simple majority vote of the specialists who conducted the medical and social examination, based on discussion

the results of his medical and social examination. The decision is announced to the citizen who has undergone a medical and social examination in the presence of all the specialists who conducted the medical and social examination, who, if necessary, give explanations on it. Based on the results of the medical and social examination of the citizen, a report is drawn up. In cases that require special types of examination of a citizen in order to establish the degree of disability (including the degree of limitation of the ability to work), rehabilitation potential, as well as obtaining other additional information, an additional examination program can be drawn up, which is approved by the head of the relevant bureau. This program is brought to the attention of the citizen undergoing a medical and social examination in a form accessible to him.

After receiving the data provided for by the additional examination program, specialists from the relevant bureau make a decision to recognize the citizen as disabled or to refuse to recognize him as disabled. If a citizen refuses an additional examination, such a decision is made by specialists based on the available data, about which a corresponding entry is made in the citizen’s medical and social examination report.

Forensic medical experts need to establish the degree of permanent loss of general ability to work when qualifying the severity of a bodily injury, when its severity is determined not by the danger to life, but by the outcome of the injury, since the amount of permanent loss of ability to work is a criterion of its severity.

In addition, the need to determine permanent loss of general and professional ability to work arises when the question of material compensation for harm to health caused by damage in connection with domestic or transport injuries is raised, as well as in civil claims against parents for the maintenance of children, against children of the sick or disabled parents, in divorce cases, etc.

Working capacity is generally understood as the totality of a person’s physical and spiritual capabilities, depending on his state of health and allowing him to engage in work.

There are general, professional and special.

General working capacity is a person’s ability to perform unskilled labor.

Professional work ability is a person’s ability to work in a certain profession.

Special ability to work means that a person can work in a certain specialty (for example, not just a builder, but a builder-installer, not just a doctor, but a surgeon or radiologist, etc.).

In accordance with current criminal, civil and labor legislation, compensation for harm caused to health is made by compensating for losses incurred by the victim in connection with the loss or reduction of wages. The amount of damages, in turn, depends on the degree of disability of the subject affected by the damage.

“Instructions on the conduct of forensic medical examinations in the USSR” (1978) requires that examinations to determine permanent disability be carried out only by a commission. The commissions working under the Bureau of Forensic Medicine consist of a forensic expert and experienced doctors (surgeons, therapists, neurologists, etc.). The task of these commissions is to resolve questions about the presence of permanent disability and its degree, establishing a causal relationship between the injury and the degree of disability, the need for sanatorium treatment, additional nutrition, outside care, prosthetics, etc.

Examinations to establish permanent loss of general and professional ability to work are carried out by court determination.

As a result of loss of ability to work, a disability develops, which can be either permanent (i.e. permanent) or temporary (i.e. such that after a certain period of time the victim’s health and ability to work are restored).

The determination of temporary disability is made by attending physicians in hospitals and clinics and by medical control commissions (MCC) of medical institutions. They issue a sick or injured person with a certificate of temporary incapacity for work or a certificate, upon expiration of which the person returns to his previous work. Persistent loss of ability to work and its extent (degree and nature of disability) are determined, in addition to forensic experts, also by medical labor commissions (). The task of the VTEK is to determine permanent disability resulting from diseases or injuries received in connection with production activities.

In addition to differences in the reasons for determining permanent disability by VTEK and during a forensic medical examination, there is a difference in the principles of assessing the amount of loss of ability: VTEK evaluates it in relation to three disability groups and as a percentage, while forensic experts, based on court requirements, determine the amount of permanent disability only as a percentage in relation to full working capacity, which is taken as 100%.

To determine the amount of permanent loss of general ability to work, use the table developed by the Main Directorate of State Insurance of the Ministry of Finance of the USSR dated May 12, 1974 No. 110 “On the procedure for organizing and conducting a medical insurance examination”).

The amount of permanent loss of professional ability to work is determined individually, taking into account the state of health, characteristics of the profession, etc., since approximately the same injury can have different outcomes for different people. In addition, compensatory and adaptive capabilities also vary from person to person, depending on age, education, professional skills, time since the injury, etc.

When determining the amount of permanent loss of professional ability to work, the recommendations of the Ministry of Social Security of the RSFSR for VTEK on the procedure for determining professional ability to work are taken into account.

Forensic medical expert commissions determine the amount of permanent disability after a thorough examination of the victim and study of his medical documents (in the original) and the circumstances of the case. Such an examination of the victim is carried out only after the outcome of the injury has been determined.

The “Rules of Forensic Medical Determination of the Degree of Severity of Bodily Injuries” stipulate that in disabled people, permanent loss of ability to work due to the injury received is determined as in practically healthy people, regardless of disability and its group. In children, permanent disability is established according to the same rules.

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MINISTRY OF HEALTH OF UKRAINE

DNEPROPETROVSK STATE MEDICAL ACADEMY

DEPARTMENT OF SOCIAL MEDICINE, ORGANIZATION AND MANAGEMENT OF HEALTHCARE

on the topic: Organization of medical examination. Examination of life and permanent disability

Completed:

5th year student, 2nd med. Fak. 202b groups

Koval Ekaterina Anatolevna

Dnepropetrovsk 2014

Plan

• 3.1 Procedure for conducting ITU
• Chapter 4. Rehabilitation
• Conclusion

Chapter 1. Examination of work capacity

A work ability examination is a medical examination of a person’s ability to work, carried out to determine the degree and duration of his disability.

Working ability is the totality of a person’s physical and spiritual capabilities (depending on his state of health), allowing him to engage in work.

The medical criterion for working ability is the presence of the disease, its complications, and clinical prognosis.

But a sick person does not always have to be disabled. For example, two people from different professions with the same disease: a stamper and a teacher with panaritium. There is a disease. However, the stamper cannot do his job with the felon, and the teacher can teach the lesson.

Therefore, the doctor, based on the severity of functional disorders, the nature and course of the pathological process, the patient’s work performed, and his working conditions, decides his question about the social criterion of working ability and issuing a certificate of incapacity to the patient. Consequently, the social criterion of working ability determines, in the presence of a disease, the labor prognosis for a specific position and working conditions.

Medical and social criteria should always be clearly defined and reflected in the outpatient record of a sick person.

The medical criterion is the leading one in establishing the fact of disability. However, it is not always the disease that is a sign of disability. There are times when a healthy person cannot work in his profession. For example, a cook’s wife was diagnosed with hepatitis. The cook himself is healthy, but he cannot cook food because he has a contact with hepatitis.

The main task of the work capacity examination is to determine the ability of a given person to perform his professional duties depending on medical and social criteria. In addition, the tasks of a medical examination of work ability include:

determining the treatment and regimen necessary to restore and improve human health;

determining the degree and duration of disability resulting from illness, accident or other reasons;

recommendation of the most rational and full use of the labor of persons with limited ability to work without compromising their health;

identification of long-term or permanent disability and referral of such patients to a medical and social expert commission.

If changes in health status are temporary, reversible, and recovery or significant improvement is expected in the near future, as well as restoration of working capacity, then this type of disability is considered temporary. Temporary disability by nature is divided into complete or partial.

Total disability is when a person, due to illness, cannot and should not perform any work and needs a special treatment regimen.

Partial disability is an inability to work in one's occupation while maintaining the ability to perform other work. If a person can work in easier conditions or perform a smaller amount of work, then he is considered to have partially lost his ability to work.

When examining disability, the doctor sometimes has to encounter manifestations of aggravation and simulation.

Aggravation (aggravatio; Latin, aggravo, aggravatum - to burden, worsen) is an exaggeration by a patient of the symptoms of an actual disease.

With active aggravation, the patient takes measures to worsen his health or prolong the disease. With passive aggravation, it is limited to exaggeration of individual symptoms, but does not accompany them with actions that interfere with treatment.

Pathological aggravation is characteristic of mental patients (hysteria, psychopathy, etc.), being one of the manifestations of these diseases.

Simulation (Latin simulatio - “pretense”) is a person’s imitation of the symptoms of a disease that he does not have.

The difficulties of the initial period of the work ability examination (release of the patient from work) are significantly inferior to the difficulties of its final stage - discharge of the recovered person to work.

The doctor has the right to issue a certificate of incapacity for work until the patient has fully recovered or until the moment when signs of permanent incapacity clearly appear. However, there are no such objective signs by which it would be possible to accurately determine when exactly the incapacity for work ended and the ability to work was fully restored. Here, fluctuations of 1-2 days are always possible, and the correct solution to the issue requires a highly qualified doctor. It is impossible, as a form of “reinsurance,” to provide the patient with extra days off from work, and at the same time, it is unacceptable to discharge the patient to work before he has recovered.

No less difficulties arise when establishing the moment when temporary disability becomes permanent.

medical examination ability to work

Chapter 2. Examination of temporary disability

Examination of temporary disability is a type of medical examination, the main purpose of which is to assess the health status of patients, the quality and effectiveness of the examination and treatment, the ability to carry out professional activities, as well as determining the degree and timing of temporary disability.

Temporary disability is the inability to perform work in general or in one’s profession.

Examination of temporary disability of workers is carried out in health care institutions by a doctor or a commission of doctors who provide leave for illness and injury, for pregnancy and childbirth, for caring for a sick family member and for quarantine, for prosthetics, sanatorium treatment, and determine the need and timing of temporary transfer employee due to illness to another job in accordance with the established procedure in accordance with the instructions on the procedure for issuing sick leave. When conducting an examination, the doctor must determine: whether there is a loss of ability to work, its cause; duration and degree of disability; labor functions available to the patient; necessary treatment and daily routine of the patient. If the fact of temporary incapacity for work is established, the doctor issues a certificate of incapacity to work to the patient. A certificate of incapacity for work and a certificate have legal and static meaning, as it certifies temporary ability to work and justifies absence from work. A certificate of incapacity for work is also a financial document.

The doctor can issue sick leave at a time for the first period of up to 10 days, then he can individually release him from work for up to 30 days. The issuance of a certificate of incapacity for work is carried out on the basis of an entry in the outpatient card recording the patient’s complaints, objective examination data and diagnosis of the disease. A certificate of incapacity for work is issued on the day of application, releasing from work either from the day of application or from the next day, but in no case the day, and in no case retroactively. If the prescribed medical and protective regime is violated, the doctor is obliged to make an appropriate entry on the certificate of incapacity for work indicating the date and type of the violated regime.

If treatment is delayed for more than 30 days, then the period of incapacity for work can be extended on the recommendation of a doctor to the clinical expert commission up to 4 months with a favorable labor prognosis, in some cases - up to 12 months.

A clinical expert commission (CEC) is appointed by the chief physician. It consists of the deputy chief physician of the clinic for clinical expert work, the head of the department, the attending physician, and is appointed by the chief physician. In addition to examining the ability to work, the CEC monitors the quality of treatment provided by the doctor; a conclusion is issued on the desirable transfer of an able-bodied patient to another job if he, for health reasons, needs easier or changed working conditions; refers the patient to a medical and social expert commission (MSEC); vacation for sanitary and resort treatment is presented. KEC of medical institutions are required to issue the following certificates (conclusion): on the need for health reasons to grant academic leave or transfer to another faculty of students and students; on the possibility of living in the natural and climatic conditions of the new place of residence for family members traveling to a new place of work; about medical indications for termination of pregnancy; o the existence of the right not to provide additional or separate living space for medical reasons; on registration of benefits for a disabled child from childhood to 16 years.

Temporary disability is often associated with the need to care for a sick family member. In this case, a certificate of incapacity for work is issued: if there is a threat to the life and health of the sick person in the absence of relatives; if it is impossible to admit the patient to a hospital if there are indications for this; in the absence of other non-working persons among family members who could care for the patient.

The duration of paid temporary disability depends on the age of the patient and the category of caregivers. The issuance of a certificate of incapacity for work for caregiving is permitted in the following cases: for caring for chronically ill people; if the patient or relative refuses hospitalization; for caring for healthy children when the mother is ill or establishing quarantine in a child care facility, if the mother is on regular leave or on leave without pay.

Temporary disability due to infectious diseases. A certificate of incapacity for work is issued not only to infectious patients themselves, but also to persons who have had contact with infectious patients if they pose a danger to others. The period for which a certificate of incapacity for work is issued is established in a specific case.

Special cases of issuing a certificate of incapacity for work:

Cosmetic surgery if performed for medical reasons. If such an operation is performed at the request of the patient, then a certificate of incapacity for work is not issued. But if the operation leads to complications, then a certificate of incapacity for work is issued for the entire period of treatment of the complication.

Prosthetics in station conditions. In the column “type of disability” an entry is made: “prosthetics” or “medical and social examination”.

Injury or illness resulting from alcohol intoxication. A note about this is made on the sick leave sheet (the patient does not receive payment for sick days).

Dismissal from a job and absence from a new one as a result of illness with temporary loss of incapacity for work, if no more than a month has passed since the dismissal and the duration of incapacity for work is less than 1 month.

Treatment for alcoholism and drug addiction. A certificate of incapacity for work is issued only if the patient is being treated in a specialized department or in a hospital.

Chapter 3. Examination of permanent disability

Permanent disability or disability is a permanent or long-term, total or partial loss of ability to work.

I Disabled person (lat. invalidus powerless, weak) - a person who has permanently or for a long time lost his ability to work, partially or completely as a result of illness or injury.

A comprehensive study of the causes of disability, the prevention of early disability, the restoration and use of the residual working capacity of the population are important in relation to both assessing the health of the population and preserving labor resources.

Recognition of a person as disabled is carried out during a medical and social examination (MSE) based on a comprehensive assessment of his health and the degree of limitation of his life activity in accordance with the classifications and criteria approved by the Ministry of Social Protection of the Population of the Russian Federation (RF) and the Ministry of Health of the Russian Federation.

Depending on the degree of impairment of body functions and limitations in life activity, a person recognized as disabled is assigned disability group I, II or III, and a person under the age of 16 is assigned the category “disabled child.”

The first disability group is established for patients who cannot care for themselves and need constant help, care or supervision. These include not only persons with complete disability, but also those who can be adapted to certain types of work activity in specially created individual conditions. For example, blind, blind-deaf, etc.

The second group of disability is established in case of severe impairment of body functions, which, however, does not cause complete helplessness. This group includes persons who experience permanent or long-term total disability, but who do not need constant care, as well as persons whose dysfunction at the time of examination is not so severe, but nevertheless all types of work for a long period are contraindicated for them due to the possibility of worsening the course of the disease under the influence of work activity.

The third disability group is established with a significant decrease in working capacity when:

due to health reasons, transfer to another job in another profession of lower qualification is necessary;

significant changes in working conditions in one’s profession are necessary, leading to a significant reduction in the volume of production activities;

employment opportunities are significantly limited due to severe functional impairments among people with low qualifications or who have not previously worked.

In addition to the listed cases, the third and second disability groups are established regardless of the work performed if patients have defects and deformations that lead to dysfunction, which are given in a special list attached to the Instructions for determining disability groups.

A medical and social examination of a citizen is carried out at the Bureau of Medical and Social Examination (BMSE) at his place of residence or at the place of attachment to a state or municipal medical and preventive healthcare institution. If, in accordance with the conclusion of a health care facility, a person cannot appear at the BMSE for health reasons, a medical and social examination can be carried out at home, in a hospital where the citizen is being treated, or in absentia, on the basis of submitted documents with his consent, or with consent of his legal representative.

According to the Regulations on recognizing a person as disabled (Resolution of the Government of the Russian Federation dated August 13, 1996 No. 965), the composition of specialists conducting a medical and social examination of a person and making an expert decision on recognizing a person as disabled is appointed by the head of the BMSE.

A citizen, or his legal representative, has the right to attract any specialist at his own expense to participate in a medical and social examination with the right of an advisory vote.

BMSE is obliged to familiarize the citizen in a form accessible to him with the procedure and conditions for conducting a medical and social examination.

3.1 Procedure for conducting ITU

A medical and social examination of a person is carried out upon his written application or a written application from his legal representative. The application is submitted to the head of the BMSE. The application is accompanied by a referral from a health care institution or social protection body, medical documents confirming the violation of his health.

BMSE specialists conducting a medical and social examination review the information presented (clinical, functional, social, professional, labor, psychological and other data), conduct a personal examination of the citizen, assess the degree of limitation of his life activity and collectively discuss the results obtained.

The grounds for recognizing a citizen as disabled are:

health disorder with persistent impairment of body functions. caused by diseases, consequences of injuries or defects;

limitation of life activity (complete or partial loss of a person’s ability or ability to perform self-care, move independently, navigate, communicate, control one’s behavior, study or engage in work);

the need to implement social protection measures for citizens. The presence of one of these signs is not a sufficient condition for recognizing a person as disabled.

The decision to recognize a person as disabled or to refuse to establish disability is made by a full panel of specialists making an expert decision, by a simple majority of votes.

The decision is announced to the citizen who has undergone a medical and social examination, or to his legal representative.

The specialists who make the expert decision provide explanations to the citizen or his legal representative.

In cases where the composition of BMSE specialists cannot make an expert decision, the certificate of examination of the person is sent within 3 days to the main bureau of medical and social examination (GBMSE), which makes a decision on the issue under consideration in the prescribed manner.

In cases requiring the use of complex types of expert rehabilitation diagnostics, special methods of examination, testing, as well as obtaining additional information, an additional examination program is drawn up, which is approved by the head of the BMSE and brought to the attention of the applicant in a form accessible to him.

The additional examination program may include conducting an additional examination in a treatment-and-prophylactic, rehabilitation or other institution, obtaining an opinion from the main bureau of medical and social examination, requesting the necessary information, conducting an examination of the conditions and nature of professional activity, the social and living situation of the person and other measures.

After receiving the data provided for by the additional examination program, BMSE specialists make a decision to recognize the person as disabled or to refuse to establish disability.

The date of establishment of disability is the day the institution receives a citizen’s application for recognition as a disabled person with the documents attached to it.

Group 1 disability is established for 2 years, groups II and III? for 1 year.

For a person under the age of 16 years, the category “disabled child” can be established for a period from 6 months to 2 years, from 2 to 5 years and until he reaches 16 years of age in accordance with medical indications approved by the Ministry of Health and Medical Industry of the Russian Federation.

The causes of disability are general illness, work injury, occupational disease, disability since childhood, disability since childhood due to injury (concussion, mutilation) associated with combat operations during the Great Patriotic War, military injury or illness received during military service, disability, associated with the accident at the Chernobyl nuclear power plant, the consequences of radiation exposure and direct participation in the activities of special risk units, as well as other reasons established by the legislation of the Russian Federation.

In the absence of documents about an occupational disease, work injury, military injury and other circumstances provided for by the legislation of the Russian Federation, the institution establishes that the cause of disability is a general disease, and at the same time assists the person in finding the necessary documents, after receiving which the cause of disability changes without additional full-time examination of a disabled person.

If a person is recognized as disabled by BMSE specialists conducting a medical and social examination, an individual rehabilitation program is developed within a month.

The program is approved by the head of the BMSE and within 3 days after its development is sent to the social protection authority.

Data from individual rehabilitation programs for disabled people are entered into the data bank of the Main Bureau of Medical and Social Expertise.

The data of the medical and social examination of the person and the decision of the specialists who conducted the medical and social examination are entered into the minutes of the meeting and the certificate of examination of the person, which are signed by the head of the BMSE, the specialists who made the decision, and certified by the seal of the BMSE.

The conclusion of the consultant involved in the medical and social examination, the list of documents and the basic information that served as the basis for making the expert decision are entered into the examination report or attached to it.

An extract from the examination report of a citizen recognized as disabled is sent to the body providing pensions within 3 days from the date the disability is established.

A person recognized as disabled in accordance with the established procedure is issued a certificate confirming the fact of disability, as well as an individual rehabilitation program. The forms of the certificate and individual rehabilitation program for a disabled person are approved by the Ministry of Social Protection of the Population of the Russian Federation.

A person who is not recognized as disabled, at his request, is issued a certificate of the results of the examination.

For a person who has a document on temporary disability and is recognized as a disabled person, the disability group and the date of its establishment are noted on a certificate of temporary disability or in a certificate certifying temporary disability in cases where a certificate of temporary disability is not issued.

3.2 Procedure for re-examination of disabled people

Re-examination of a disabled person is carried out in the manner established for recognizing a person as disabled.

Re-examination of disabled people of group I is carried out once every 2 years, disabled people of groups II and III? once a year, and for disabled children? within the time limits established in accordance with medical indications.

Disability is established until the first day of the month following the month for which the re-examination is scheduled.

Without specifying the period for re-examination, disability is established for men over 60 years of age and women over 55 years of age, disabled people with irreversible anatomical defects, and other disabled people in accordance with the criteria approved by the Ministry of Social Protection of the Population of the Russian Federation and the Ministry of Health and Medical Industry of the Russian Federation.

Re-examination of persons whose disability has been established without a period for re-examination, including men over 60 years of age and women over 55 years of age, is carried out in cases where forged documents on the basis of which the disability was established are detected in the prescribed manner.

Re-examination of a disabled person can be carried out in advance, but no more than two months before the expiration of the established period of disability.

Re-examination of a disabled person before the established deadlines is carried out at the direction of a health care institution in connection with a change in his health status.

3.3 Organization of activities of the medical and social examination bureau

The State Service for Medical and Social Expertise, in accordance with the Federal Law “On Social Protection of Disabled Persons in the Russian Federation,” is organized within the system of social protection bodies to conduct medical and social expertise of persons in need.

There are two types of institutions of this type: the Bureau of Medical and Social Expertise (BMSE), the Main Bureau of Medical and Social Expertise (GBMSE). Depending on the level, structure of morbidity and disability, general, specialized (for conducting medical and social examination of patients with various diseases, defects and consequences of injuries, for persons under 16 years old) or mixed profiles are formed.

In their activities, medical and social examinations are guided by federal laws, decrees and orders of the President of the Russian Federation, decrees and orders of the Government of the Russian Federation, laws of constituent entities of the Russian Federation, other regulatory legal acts, as well as the regulations on BMSE and GBMSE, which, when establishing disability, are guided by the Regulations on the recognition of a person disabled person approved by the Government of the Russian Federation (No. 965 of 08/13/96).

BMSE and GBMSE operate at the intersection of healthcare, social insurance and social security.

BMSE and GBMSE carry out their activities in cooperation with social protection authorities, health care institutions, employment services and other bodies and institutions operating in the field of medical and social rehabilitation of disabled people, as well as representatives of public organizations of disabled people.

The decision to establish disability is made collectively by a simple majority of votes of specialists who conducted a medical and social examination, and is mandatory for execution by the relevant government bodies, local governments, as well as organizations of all forms of ownership.

BMSE and GBMSE bear, in accordance with the procedure established by the legislation of the Russian Federation, responsibility for the implementation of the tasks assigned to them.

BMSE and GBMSE are created, reorganized and liquidated by decision of the executive authorities of the constituent entities of the Russian Federation in the manner established by the legislation of the Russian Federation.

Expenses for their maintenance are made from the budgets of the constituent entities of the Russian Federation.

The number of BMSE and GBMSE, as well as their profiles and staffing, are established by the executive authorities of the constituent entities of the Russian Federation.

The staffing standard of the ITU bureau includes specialists making expert decisions (3 doctors of various specialties), a rehabilitation specialist, a social work specialist and a psychologist.

In addition, the staffing table provides for the positions of a head nurse, a medical registrar and a driver.

If necessary, pediatricians, specialists in functional diagnostics, career guidance, ergonomics, occupational physiology, a teacher, a sign language interpreter and other specialists can be added to the bureau’s staffing standards.

The staffing standards of the ITU main bureau include several teams of specialists who make expert decisions, groups of specialists in functional diagnostics, career guidance and organization of work for people with disabilities, their social and environmental adaptation, as well as specialists from legal consulting and information and statistical support services.

The specialists making the expert decision include at least 4 doctors of various specialties, rehabilitation specialists of various profiles (depending on the need for expert rehabilitation diagnostics), social work specialists and psychologists.

If necessary, an inpatient work capacity examination department can be created at the main ITU bureau, the task of which is to clarify the diagnosis and study the functions of the patient’s body.

The number of teams of specialists included in the staffing standards of the main bureau is determined depending on the number of bureaus operating in the territory of a constituent entity of the Russian Federation, at the rate of one team of specialists for four bureaus.

To conduct a medical and social examination of citizens, the main ITU bureau can attract consultants on medical and social issues.

The main objectives of the BMSE and GBMSE are:

determination of the disability group, its causes (circumstances and conditions of occurrence), the timing and time of onset of disability, the needs of disabled people for various types of social protection;

development of individual rehabilitation programs for disabled people, assistance in the implementation of social protection measures for disabled people, including their rehabilitation, and evaluation of the effectiveness of these measures;

generating data from the state system for registering people with disabilities, studying the status, dynamics of disability and the facts leading to it;

participation in the development of comprehensive programs in the field of disability prevention, medical and social examination, rehabilitation and social protection of disabled people.

FunctionsbureauITU:

determines the structure and degree of disability of the persons being examined and their rehabilitation potential;

establishes the fact of the presence of disability, determines the group, causes (circumstances and conditions of occurrence), timing and time of onset of disability;

determines the degree of loss of professional ability (in percentage) of workers who have suffered injury, occupational disease or other health damage associated with the performance of their work duties, and the need for additional social protection measures;

determines the causal relationship of the death of the injured person with a work injury, occupational disease, time at the front and with other circumstances in which the law provides for the provision of benefits to the family of the deceased;

determines the need of disabled people for special vehicles;

forms and adjusts individual rehabilitation programs for disabled people (determines the types, forms, terms and volumes of measures for medical, social and professional rehabilitation), and also monitors their implementation;

provides comprehensive assistance to persons who have undergone a medical and social examination, including in the form of consultations on legal issues, and assists in providing the necessary social protection for people with disabilities, including rehabilitation;

forms a data bank on citizens who have passed a medical and social examination, carries out state statistical monitoring of the demographic composition of disabled people and submits the relevant information to the main bureau;

submits information to the relevant military commissariats about all cases of recognition of persons liable for military service and persons of conscription age as disabled.

FunctionsmainbureauITU:

conducts a medical and social examination of persons who appealed the decision of the bureau, and if these decisions are unfounded, changes them;

conducts medical and social examination of citizens in accordance with the directions of the bureau in cases requiring the use of special examination methods;

forms and adjusts individual rehabilitation programs for disabled people in cases requiring the use of special examination methods, and also monitors their implementation;

provides primary rehabilitation, psychological and professional assistance to citizens who have passed a medical and social examination;

takes part in the study of factors leading to disability and in the development of comprehensive disability prevention programs;

provides information to the relevant military commissariats on all cases of recognition of persons liable for military service and persons of conscription age as disabled;

provides advisory assistance to medical experts and other specialists of the bureau.

Chapter 4. Rehabilitation

Rehabilitation is a system of state socio-economic, medical, professional, pedagogical and psychological measures aimed at preventing pathological processes leading to temporary and permanent loss of ability to work and returning sick and disabled people to socially useful work.5

Rehabilitation measures are aimed at restoring the integrity of damaged tissues and organs (regeneration), restoring their activity and influencing processes associated with replacing or replenishing lost body functions. The ultimate goal of these activities is to restore the connections between the disabled person and society that have been disrupted due to disability.

Rehabilitation is closely related to restorative treatment and adaptation. Adaptation is the adaptation of the body to environmental conditions using the body's reserves. Rehabilitation is recovery. Treatment is aimed at eliminating disease processes, and rehabilitation affects residual functions that can be restored.

Types of rehabilitation:

Medical is a set of medical measures aimed at restoring or compensating for impaired or lost body functions. Medical measures include restorative and sanitary-spa treatment, prevention of complications and progression of the disease.

Social - environmental - involves the creation of an optimal living environment for a disabled person, which includes living conditions, access to socially significant objects of life and is carried out in two directions:

adaptation of environmental objects to the needs of people with disabilities (specially equipped apartments for people with disabilities, special residential buildings with a range of social services, equipped sidewalks, provision of prosthetic and orthopedic care for people with disabilities, etc.)

adaptation of a disabled person to the environment, development of skills that allow him to serve himself. For this purpose, a special device is used for reading, lifting objects from the floor, for wall mounting of personal appliances (electric, toothbrushes, etc.), for fixing dishes on the table.

Professional - labor - is a set of measures aimed at restoring the professional working capacity of disabled people in accessible working conditions and financial independence. Vocational rehabilitation includes examination of possible professional abilities, vocational guidance and selection, vocational training and retraining. The basis of vocational and labor rehabilitation of disabled people is training in special technical schools and vocational training institutions, training and production enterprises of disabled people's societies.

Psychological and pedagogical - restoration of prestige in one’s own eyes and in the eyes of others, correction of the internal picture of the disease, correction of attitude towards family, friends, society as a whole.

Rehabilitation of disabled people is currently one of the current and established areas of state policy in the social sphere.

The main principles of rehabilitation are: an integrated medical and social approach; start rehabilitation as early as possible.

Conclusion

In modern conditions, the worsening of social problems and declining health indicators of the population increases the objective need to solve interrelated problems of a medical and social nature at a qualitatively new level within the framework of medical and social work.

Currently, the most common medical and social problems are:

1. deterioration of health as a result of diseases, injuries, accidents, which entails the emergence of social problems, such as deterioration of the financial and living situation due to temporary or permanent disability; increased costs for medicines and rehabilitation.

2. deterioration of health due to age;

3. increase in single-parent families;

4. increase in the number of victims of emergency incidents, etc.

Literature

1. Artyunina G.P. Fundamentals of social medicine. Textbook for universities. M.: Academic Avenue, 2005 - 476 p.

2. Ten E.E. Fundamentals of medical knowledge. Textbook - M.: Mastery 2002 - 256

3. Encyclopedic Dictionary of Medical Terms. Ed. 1st. - M.: 1982 T 1. 700 p.

4. Encyclopedic Dictionary of Medical Terms. Ed. 1st. - M.: 1982 T 1. 23 p.

5. Artyunina G.P. Fundamentals of social medicine. Textbook for universities. M.: Academic Avenue, 2005 - 45 p.

6. Encyclopedic Dictionary of Medical Terms. Ed. 1st. - M.: 1982 T 1. 26 p.

7. Ten E.E. Fundamentals of medical knowledge. Textbook - M.: Mastery 2002-236 p.

8. Ten E.E. Fundamentals of medical knowledge. Textbook - M.: Mastery 2002-246 p.

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