Medical examination. How to pass a medical examination for an adult Who must undergo medical examinations

To live fully and happily, we need good health. Only in this way will you be able to realize yourself in the profession and create a full-fledged family.

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

What is a medical examination (medical examination)?

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

• preventive;


• preliminary;


• periodic;


• pre-shift.

All employees are required to undergo a medical examination prior to employment. To do this, you need to get a referral from the personnel department, come with a passport or a medical book to the right medical institution. Next, you need to pass a medical examination, get a conclusion from a doctor and bring it to the personnel department of the enterprise.

The number of medical examinations per year is determined by the legislation depending on the type of production, but this should take place at least once a year.

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

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

PREVENTIVE INSPECTION
AND DISPENSERIZATION OF CERTAIN GROUPS OF THE ADULTS POPULATION

The procedure for conducting a preventive medical examination and medical examination for certain groups of the adult population is determined by Order of the Ministry of Health of Russia dated March 13, 2019 N 124n "On approval of the procedure for conducting a preventive medical examination and medical examination for certain groups of the adult population."

This procedure regulates issues related to the conduct of preventive medical examinations and medical examinations in medical organizations of the following groups of the adult population (aged 18 years and older):

1) working citizens;

2) non-working citizens;

This procedure does not apply in cases where legislative and other regulatory legal acts of the Russian Federation establish a different procedure for conducting a preventive medical examination or medical examination of certain categories of citizens.

Preventive medical examination and clinical examination are carried out within the framework of the program of state guarantees of free provision of medical care to citizens and the territorial program of state guarantees of free provision of medical care to citizens.

The executive authorities of the constituent entities of the Russian Federation in the field of health care ensure that citizens undergo preventive medical examinations, medical examinations, including in the evenings and Saturdays, and also provide citizens with the opportunity to remotely book appointments (examinations, consultations) with medical workers, research and other medical interventions carried out as part of preventive medical examinations and medical examinations.

A citizen undergoes a preventive medical examination and medical examination in a medical organization in which he receives primary health care.

A necessary precondition for conducting a preventive medical examination and medical examination is the giving of an informed voluntary consent of a citizen (his legal representative) to medical intervention in compliance with the requirements established by Article 20 of Federal Law N 323-FZ.

A citizen has the right to refuse to conduct a preventive medical examination and (or) medical examination in general or from certain types of medical interventions included in the scope of a preventive medical examination and (or) medical examination.

DISPENSERIZATION OF CERTAIN GROUPS OF THE ADULTS POPULATION

What is dispensary?

Clinical examination is a set of measures that includes a preventive medical examination and additional methods of examinations conducted to assess the state of health (including the definition of a health group and a group for dispensary observation) and carried out in relation to certain groups of the population in accordance with the legislation of the Russian Federation.

Medical examination is carried out is free under the OMS policy.

The list of studies and examinations performed by doctors or a paramedic / midwife during medical examinations varies depending on the age and gender of the citizen.

The dispensary is carried out in two stages.

In order to pass the first stage of the survey as quickly and efficiently as possible, you must follow simple rules:

Come to the clinic in the morning;

Before testing, you must not eat anything, give up smoking, alcohol and playing sports.

Why do you need to undergo a medical examination?

Medical examination of the adult population is carried out through an in-depth examination of the health status of citizens in order to:

1) prevention and early detection (screening) of chronic non-communicable diseases (conditions) that are the main cause of disability and premature death of the population of the Russian Federation, risk factors for their development, including high blood pressure, hypercholesterolemia, high fasting blood glucose, tobacco smoking, the risk of harmful alcohol consumption, poor nutrition, low physical activity, overweight or obesity, as well as the risk of using narcotic drugs and psychotropic substances without a doctor's prescription;

2) determination of the health group, necessary preventive, therapeutic, rehabilitation and recreational activities for citizens with identified chronic non-communicable diseases and (or) risk factors for their development, as well as for healthy citizens;

3) conducting preventive counseling of citizens with identified chronic non-communicable diseases and risk factors for their development;

4) determination of a group for dispensary observation of citizens with identified chronic non-communicable diseases and other diseases (conditions), including citizens with high and very high cardiovascular risk.

Regular medical examinations are necessary, regardless of how you feel. Even if a person considers himself healthy, during the medical examination, chronic non-communicable diseases are often found in him, the treatment of which is most effective at an early stage.

Clinical examination will allow to maintain and strengthen health, and, if necessary, conduct additional examination and treatment in a timely manner. Doctors' consultations and test results will help you not only learn about your health, but also get the necessary recommendations on the basics of a healthy lifestyle or on identified risk factors.

Who can get screened?

Since 2013, the following groups of the adult population have been undergoing medical examinations:

working citizens;

non-working citizens;

Students in educational institutions full-time.

How often is screening done?

The examination is carried out:

1) once every three years at the age of 18 to 39 inclusive;

2) annually at the age of 40 and older, as well as in relation to certain categories of citizens, including:

a) disabled veterans of the Great Patriotic War and invalids of combat operations, as well as participants of the Great Patriotic War who became disabled due to a general illness, labor injury or other reasons (except for persons whose disability was due to their unlawful actions);

b) persons awarded the badge "Inhabitant of besieged Leningrad" and recognized as disabled due to a general illness, labor injury and other reasons (except for persons whose disability occurred as a result of their illegal actions);

c) former juvenile prisoners of concentration camps, ghettos, other places of detention created by the Nazis and their allies during the Second World War, recognized as disabled due to a general illness, labor injury and other reasons (with the exception of persons whose disability occurred as a result of their illegal actions);

d) working citizens who have not reached the age giving the right to receive an old-age pension, including ahead of schedule, within five years before the onset of such age, and working citizens who are recipients of an old-age pension or a service pension.

Where can you get a medical examination?

Citizens undergo a medical examination in a medical organization at the place of residence (attachment), in which they receive primary health care (in a polyclinic, in a center (department) of general medical practice (family medicine), in a medical outpatient clinic, medical unit, etc.). Each person who would like to undergo a medical examination should contact their local therapist.

How to get a medical examination for a working person?

According to Article 185.1 of the Labor Code of the Russian Federation, since 2019, employees, when undergoing a medical examination in the manner prescribed by the legislation in the field of health protection, have the right to be released from work for one working day once every three years, while retaining their place of work (position) and average earnings .

Employees who have not reached the age that gives the right to receive an old-age pension, including early, within five years before the onset of such an age, and employees who are recipients of an old-age pension or a superannuation pension, when undergoing medical examination in the manner prescribed by law in in the field of health protection, have the right to be released from work for two working days once a year, while retaining their place of work (position) and average earnings.

The employee is released from work to undergo medical examination on the basis of his written application, while the day (days) of release from work is (are) agreed upon with the employer.

What documents are required for medical examination?

Each citizen going for a medical examination must have a passport and a compulsory medical insurance policy.

If you underwent medical examinations in the current or previous year, take the documents confirming this and show them to medical workers before starting the medical examination.

What diagnostic studies are carried out as part of the clinical examination at the first stage?

The first stage of medical examination (screening) is carried out in order to identify in citizens signs of chronic non-communicable diseases, risk factors for their development, the risk of harmful alcohol consumption, the use of narcotic drugs and psychotropic substances without a doctor's prescription, determining the health group, as well as determining medical indications for additional examinations. and examinations by specialist doctors to clarify the diagnosis of the disease (condition) at the second stage of clinical examination and includes:

1. for citizens aged 18 to 39 inclusive once every 3 years:

10) examination by a paramedic (midwife) or obstetrician-gynecologist of women aged 18 to 39 years once a year;

1) screening for the detection of malignant neoplasms of the cervix (in women): at the age of 18 to 64 years inclusive - taking a smear from the cervix, a cytological examination of a smear from the cervix 1 time in 3 years;

2) examination to identify visual and other localizations of oncological diseases, including examination of the skin, mucous lips and oral cavity, palpation of the thyroid gland, lymph nodes;

c) conducting a brief individual preventive counseling in the department (office) of medical prevention (health center) by a general practitioner;

d) admission (examination) by a general practitioner based on the results of the first stage of medical examination, including an examination to identify visual and other localizations of oncological diseases, including examination of the skin, mucous lips and oral cavity, palpation of the thyroid gland, lymph nodes, in order to establish a diagnosis , determining the health group, dispensary observation group, determining medical indications for examinations (consultations) and examinations as part of the second stage of clinical examination;

2. for citizens aged 40 to 64 inclusive once a year

a) carrying out a preventive medical examination in the amount of:

1) questioning of citizens aged 18 years and older once a year in order to:

Collecting anamnesis, identifying aggravated heredity, complaints, symptoms characteristic of the following non-communicable diseases and conditions: angina pectoris, transient ischemic attack or acute cerebrovascular accident, chronic obstructive pulmonary disease, diseases of the gastrointestinal tract;

Determination of risk factors and other pathological conditions and diseases that increase the likelihood of developing chronic non-communicable diseases: smoking, the risk of harmful alcohol consumption, the risk of using narcotic drugs and psychotropic substances without a doctor's prescription, diet, physical activity;

2) calculation based on anthropometry (measurement of height, body weight, waist circumference) of the body mass index, for citizens aged 18 years and older, once a year;

3) measurement of blood pressure in the peripheral arteries for citizens aged 18 years and older once a year;

4) study of the level of total cholesterol in the blood (using the express method is allowed) for citizens aged 18 years and older once a year;

5) determination of the level of glucose in the blood on an empty stomach (using the express method is allowed) for citizens aged 18 years and older once a year;

7) fluorography of the lungs or radiography of the lungs for citizens aged 18 years and over 1 time in 2 years;

8) electrocardiography at rest during the first passage of a preventive medical examination, then at the age of 35 years and older once a year;

9) measurement of intraocular pressure during the first passage of a preventive medical examination, then at the age of 40 years and older once a year;

b) carrying out screening activities aimed at early detection of oncological diseases:

1) screening for the detection of malignant neoplasms of the cervix (in women): at the age of 18 years and older - examination by a paramedic (midwife) or obstetrician-gynecologist once a year; at the age of 18 to 64 years inclusive - taking a smear from the cervix, a cytological examination of a smear from the cervix 1 time in 3 years;

3) screening for the detection of malignant neoplasms of the prostate gland (in men): at the age of 45, 50, 55, 60 and 64 years - determination of prostate-specific antigen in the blood;

4) screening for the detection of malignant neoplasms of the large intestine and rectum: at the age of 40 to 64 years inclusive - examination of feces for occult blood by immunochemical qualitative or quantitative method 1 time in 2 years;

5) examination to identify visual and other localizations of oncological diseases, including examination of the skin, mucous lips and oral cavity, palpation of the thyroid gland, lymph nodes;

6) screening for the detection of malignant neoplasms of the esophagus, stomach and duodenum: at the age of 45 - esophagogastroduodenoscopy (if necessary, it can be carried out with the use of anesthesia, including in medical organizations providing specialized medical care, in a day hospital).

d) conducting a brief individual preventive counseling in the department (office) of medical prevention (health center);

e) reception (examination) by a general practitioner based on the results of the first stage of clinical examination, including an examination to identify visual and other localizations of oncological diseases, including examination of the skin, mucous lips and oral cavity, palpation of the thyroid gland, lymph nodes, in order to establish a diagnosis , determining the health group, dispensary observation group, determining medical indications for examinations (consultations) and examinations as part of the second stage of clinical examination;

3. for citizens aged 65 and over once a year(with the exception of appointments (examinations), medical examinations and other medical interventions included in the scope of the first stage of clinical examination, with a different frequency):

a) carrying out a preventive medical examination in the amount of:

1) questioning of citizens aged 18 years and older once a year in order to:

Collecting anamnesis, identifying aggravated heredity, complaints, symptoms characteristic of the following non-communicable diseases and conditions: angina pectoris, transient ischemic attack or acute cerebrovascular accident, chronic obstructive pulmonary disease, diseases of the gastrointestinal tract;

Determination of risk factors and other pathological conditions and diseases that increase the likelihood of developing chronic non-communicable diseases: smoking, the risk of harmful alcohol consumption, the risk of using narcotic drugs and psychotropic substances without a doctor's prescription, diet, physical activity;

2) calculation based on anthropometry (measurement of height, body weight, waist circumference) of the body mass index, for citizens aged 18 years and older, once a year;

3) measurement of blood pressure in the peripheral arteries for citizens aged 18 years and older once a year;

4) study of the level of total cholesterol in the blood (using the express method is allowed) for citizens aged 18 years and older once a year;

5) determination of the level of glucose in the blood on an empty stomach (using the express method is allowed) for citizens aged 18 years and older once a year;

6) determination of absolute cardiovascular risk in citizens aged 40 to 64 inclusive once a year;

7) fluorography of the lungs or radiography of the lungs for citizens aged 18 years and over 1 time in 2 years;

8) electrocardiography at rest during the first passage of a preventive medical examination, then at the age of 35 years and older once a year;

9) measurement of intraocular pressure during the first passage of a preventive medical examination, then at the age of 40 years and older once a year;

b) carrying out screening activities aimed at early detection of oncological diseases:

1) screening for the detection of malignant neoplasms of the cervix (in women): at the age of 18 years and older - examination by a paramedic (midwife) or obstetrician-gynecologist once a year;

2) screening for the detection of malignant neoplasms of the mammary glands (in women): at the age of 40 to 75 years inclusive - mammography of both mammary glands in two projections with double reading of radiographs 1 time in 2 years;

3) screening for the detection of malignant neoplasms of the large intestine and rectum: at the age of 65 to 75 years inclusive - examination of feces for occult blood by immunochemical qualitative or quantitative method once a year;

4) examination to identify visual and other localizations of oncological diseases, including examination of the skin, mucous lips and oral cavity, palpation of the thyroid gland, lymph nodes;

c) complete blood count (hemoglobin, leukocytes, ESR);

d) conducting brief individual preventive counseling in the department (office) of medical prevention (health center);

e) reception (examination) by a general practitioner based on the results of the first stage of clinical examination, including an examination to identify visual and other localizations of oncological diseases, including examination of the skin, mucous lips and oral cavity, palpation of the thyroid gland, lymph nodes, in order to establish a diagnosis , determining the health group, dispensary observation group, determining medical indications for examinations (consultations) and examinations as part of the second stage of clinical examination.

Based on the results of the first stage, the therapist determines the health group and decides whether a more detailed examination is necessary (referral to the second stage of medical examination).

What diagnostic studies are carried out as part of the clinical examination at the second stage?

The second stage of clinical examination is carried out for the purpose of additional examination and clarification of the diagnosis of the disease (condition) and includes:

1) examination (consultation) by a neurologist (in the presence of newly identified indications or suspicions of a previously suffered acute cerebrovascular accident for citizens who are not under dispensary observation on this occasion, as well as in cases of detection of motor function disorders, cognitive impairments based on the results of the questionnaire and suspicions of depression in citizens aged 65 years and older who are not under dispensary observation on this occasion);

2) duplex scanning of the brachycephalic arteries (for men aged 45 to 72 years inclusive and women aged 54 to 72 years inclusive in the presence of a combination of three risk factors for the development of chronic non-communicable diseases: high blood pressure, hypercholesterolemia, overweight or obesity , as well as in the direction of a neurologist with a first identified indication or suspicion of a previously suffered acute cerebrovascular accident for citizens aged 65 to 90 years who are not under dispensary observation on this occasion);

3) examination (consultation) by a surgeon or urologist (for men aged 45, 50, 55, 60 and 64 years with an increase in the level of prostate-specific antigen in the blood of more than 4 ng / ml);

4) examination (consultation) by a surgeon or coloproctologist, including sigmoidoscopy (for citizens aged 40 to 75 years inclusive with identified pathological changes based on the results of screening for the detection of malignant neoplasms of the large intestine and rectum, with aggravated heredity by family adenomatosis and (or) malignant neoplasms of the large intestine and rectum, if other medical indications are identified based on the results of the questionnaire, as well as by appointment of a general practitioner, urologist, obstetrician-gynecologist in cases of detection of symptoms of malignant neoplasms of the large intestine and rectum );

5) colonoscopy (for citizens in case of suspicion of malignant neoplasms of the large intestine as prescribed by a surgeon or coloproctologist);

6) esophagogastroduodenoscopy (for citizens in case of suspicion of malignant neoplasms of the esophagus, stomach and duodenum as prescribed by a general practitioner);

7) radiography of the lungs, computed tomography of the lungs (for citizens in case of suspicion of malignant neoplasms of the lung as prescribed by a general practitioner);

8) spirometry (for citizens with suspected chronic bronchopulmonary disease, smoking citizens, identified by the results of the questionnaire, - as prescribed by a general practitioner);

9) examination (consultation) by an obstetrician-gynecologist (for women aged 18 years and older with identified pathological changes as a result of screening for the detection of malignant neoplasms of the cervix, aged 40 to 75 years with identified pathological changes as a result of screening activities, aimed at early detection of malignant neoplasms of the mammary glands);

10) examination (consultation) by an otorhinolaryngologist (for citizens aged 65 years and older in the presence of medical indications based on the results of a questionnaire or appointment (examination) of a general practitioner);

11) examination (consultation) by an ophthalmologist (for citizens aged 40 years and older with increased intraocular pressure, and for citizens aged 65 years and older who have a decrease in visual acuity that is not amenable to spectacle correction, identified by the results of the questionnaire);

12) conducting individual or group (school for patients) in-depth preventive counseling in the department (office) of medical prevention (health center) for citizens:

a) with diagnosed coronary heart disease, cerebrovascular diseases, chronic ischemia of the lower extremities of atherosclerotic origin or diseases characterized by high blood pressure;

b) with the risk of harmful consumption of alcohol and (or) consumption of narcotic drugs and psychotropic substances identified by the results of the questionnaire without a doctor's prescription;

c) for all citizens aged 65 years and older in order to correct identified risk factors and (or) prevent senile asthenia;

d) when a high relative, high and very high absolute cardiovascular risk is detected, and (or) obesity, and (or) hypercholesterolemia with a total cholesterol level of 8 mmol / l or more, as well as smoking more than 20 cigarettes in day, the risk of harmful alcohol consumption and (or) the risk of non-medical use of narcotic drugs and psychotropic substances;

13) reception (examination) by a general practitioner based on the results of the second stage of medical examination, including the establishment (clarification) of the diagnosis, the definition (clarification) of the health group, the determination of the group for dispensary observation (taking into account the conclusions of medical specialists), the direction of citizens in the presence of medical indications for additional an examination not included in the scope of medical examination, including a referral for examination (consultation) by an oncologist in case of suspected oncological diseases in accordance with the Procedure for providing medical care to the population in the field of oncology, approved by order of the Ministry of Health of Russia of November 15, 2012 N 915n, as well as to receive specialized, including high-tech, medical care, for sanatorium treatment.

If a citizen in the process of clinical examination reveals medical indications for examinations (consultations) by specialist doctors, research and activities, including examination (consultation) by an oncologist in case of suspicion of oncological diseases of visual and other localizations that are not included in the scope of medical examination in accordance with by this procedure, they are appointed and performed in accordance with the provisions of the procedures for the provision of medical care according to the profile of the identified or suspected disease (condition), taking into account the standards of medical care, as well as on the basis of clinical recommendations.

The result of medical examination

According to the questionnaire, the results of laboratory tests and screening studies, the therapist determines the patient's health group.

To determine, based on the results of a preventive medical examination or clinical examination, a citizen’s health group and a dispensary observation group, the following criteria are used:

I health group- citizens who do not have chronic non-communicable diseases, do not have risk factors for the development of such diseases or have these risk factors at low or medium absolute cardiovascular risk and who do not need dispensary observation for other diseases (conditions);

II health group- citizens who have not established chronic non-communicable diseases, but have risk factors for the development of such diseases at high or very high absolute cardiovascular risk, as well as citizens who have obesity and (or) hypercholesterolemia with a total cholesterol level of 8 mmol / l and (or) persons who smoke more than 20 cigarettes per day, and (or) persons with an identified risk of harmful alcohol consumption and (or) the risk of using narcotic drugs and psychotropic substances without a doctor's prescription, and who do not need dispensary observation for about other diseases (conditions).

Citizens with group II health with a high or very high absolute cardiovascular risk are subject to dispensary observation by a doctor (paramedic) of the department (office) of medical prevention or a health center, as well as a paramedic of a medical assistant's health center or a medical and obstetric station, with the exception of patients with a level of total cholesterol 8 mmol / l and more, which are subject to dispensary observation by a general practitioner. Citizens with health group II, if there are medical indications, are prescribed medicines for medical use for the purpose of pharmacological correction of identified risk factors;

IIIa health group- citizens with chronic non-communicable diseases requiring the establishment of dispensary observation or the provision of specialized, including high-tech, medical care, as well as citizens suspected of having these diseases (conditions) who need additional examination;

IIIb health group- citizens who do not have chronic non-communicable diseases, but require the establishment of dispensary observation or the provision of specialized, including high-tech, medical care for other diseases, as well as citizens suspected of having these diseases who need additional examination.

Citizens with IIIa and IIIb health groups are subject to dispensary observation by a general practitioner, medical specialists with preventive, therapeutic and rehabilitation measures.

Regular medical examinations will allow you to significantly reduce the likelihood of developing the most dangerous diseases, which are the main cause of disability and premature death of the population, or to identify them at an early stage of development, when their treatment is most effective. But medicine is powerless without an initiative about one's own health.

PREVENTIVE MEDICAL EXAMINATION

A medical examination is a complex of medical interventions aimed at identifying pathological conditions, diseases and risk factors.

Preventive medical examination is carried out for the purpose of early (timely) detection of conditions, diseases and risk factors for their development, non-medical use of narcotic drugs and psychotropic substances, as well as in order to determine health groups and develop recommendations for patients.

In 2019, preventive examination received the same status as medical examination. It can be called "abbreviated medical examination" or its lightweight version.

How often is a preventive medical examination carried out?

Preventive medical examination is carried out annually:

1) as an independent event;

2) within the framework of medical examination;

3) within the framework of dispensary observation (during the first dispensary appointment (examination, consultation) in the current year).

Who can get a preventive medical examination?

Preventive medical examination of the adult population is carried out from the age of 18.

Preventive medical examinations are subject to:

1) working citizens;

2) non-working citizens;

3) students in educational institutions full-time.

Where can I get a preventive medical examination?

A citizen undergoes a preventive medical examination in a medical organization in which he receives primary health care.

Your district doctor (paramedic) or district nurse or receptionist will tell you in detail where, when and how you can undergo a preventive medical examination, agree with you the approximate date (period) of its passage.

How long does a preventive medical examination take?

A preventive medical examination usually requires two visits. The first visit takes approximately 2-3 hours. The second visit in 1-2 days (depending on the length of time required for the results of your research to reach the doctor) to the local doctor takes about 1 hour.

If, according to the results of a preventive medical examination, you are suspected of having a chronic non-communicable disease or a high or very high total cardiovascular risk, the district doctor informs you about this and sends you for additional examination or in-depth preventive counseling.

Preventive medical examination includes:

1) questioning of citizens aged 18 years and older once a year in order to:

Collecting anamnesis, identifying aggravated heredity, complaints, symptoms characteristic of the following non-communicable diseases and conditions: angina pectoris, transient ischemic attack or acute cerebrovascular accident, chronic obstructive pulmonary disease, diseases of the gastrointestinal tract;

Determination of risk factors and other pathological conditions and diseases that increase the likelihood of developing chronic non-communicable diseases: smoking, the risk of harmful alcohol consumption, the risk of using narcotic drugs and psychotropic substances without a doctor's prescription, diet, physical activity;

Identification in citizens aged 65 years and older of the risk of falls, complaints characteristic of osteoporosis, depression, heart failure, uncorrected hearing and vision impairments;

2) calculation based on anthropometry (measurement of height, body weight, waist circumference) of the body mass index, for citizens aged 18 years and older, once a year;

3) measurement of blood pressure in the peripheral arteries for citizens aged 18 years and older once a year;

4) study of the level of total cholesterol in the blood (using the express method is allowed) for citizens aged 18 years and older once a year;

5) determination of the level of glucose in the blood on an empty stomach (using the express method is allowed) for citizens aged 18 years and older once a year;

6) determination of the relative cardiovascular risk in citizens aged 18 to 39 years inclusive, once a year;

7) determination of absolute cardiovascular risk in citizens aged 40 to 64 inclusive once a year;

8) fluorography of the lungs or radiography of the lungs for citizens aged 18 years and older, once every 2 years;

9) electrocardiography at rest during the first preventive medical examination, then at the age of 35 years and older once a year;

10) measurement of intraocular pressure at the first passage of a preventive medical examination, then at the age of 40 years and older once a year;

11) examination by a paramedic (midwife) or obstetrician-gynecologist of women aged 18 to 39 years once a year;

12) reception (examination) based on the results of a preventive medical examination, including an examination to identify visual and other localizations of oncological diseases, including examination of the skin, mucous membranes of the lips and oral cavity, palpation of the thyroid gland, lymph nodes, by a paramedic of a paramedical health center or feldsher-obstetric point, a general practitioner or a doctor for medical prevention of the department (office) of medical prevention or a health center.

If a citizen in the course of a preventive medical examination reveals medical indications for examinations (consultations) by specialist doctors, research and activities, including an examination (consultation) by an oncologist in case of suspicion of oncological diseases of visual and other localizations that are not included in the scope of preventive medical examination in accordance with this procedure, they are appointed and performed in accordance with the provisions of the procedures for the provision of medical care for the profile of the identified or suspected disease (condition), taking into account the standards of medical care, as well as on the basis of clinical recommendations.

If a citizen is identified by the results of a preventive medical examination of a high relative, high and very high absolute cardiovascular risk, and (or) obesity, and (or) hypercholesterolemia with a total cholesterol level of 8 mmol / l or more, as well as establishing, based on the results of a questionnaire, smoking more than 20 cigarettes a day, the risk of harmful alcohol consumption and (or) the risk of using narcotic drugs and psychotropic substances without a doctor's prescription, a citizen is referred for in-depth preventive counseling outside the framework of a preventive medical examination.

Regular medical examinations and preventive medical examinations will allow you to significantly reduce the likelihood of developing the most dangerous diseases that are the main cause of disability and mortality in our country, or to identify them at an early stage of development, when their treatment is most effective. But medicine is powerless without an initiative about one's own health.

List of medical organizations involved in preventive medical examinations and medical examinations in the territory of the Chuvash Republic in 2019

A number of people regularly have to undergo medical periodic examinations. Often they are associated with queues and wasting time. Remember, at the SkoroMed clinic at the Belorusskaya metro station (Moscow), preventive examinations of workers in various fields are carried out without a queue. At the same time, they are affordable, and the regulations correspond to it.

It is important to remember that according to the current legislation of the Russian Federation, periodic medical examinations are mandatory for most employees, including some office firms. And managers should conduct regular medical examinations at their enterprise, not only in order to avoid liability and fines, but also to increase the efficiency of employees, which is necessary for the successful prosperity of the business.

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The professional examination of employees is a special medical examination that allows to determine the suitability and ability of a person to engage in certain professional activities. Passing it allows you to identify diseases that can affect the work of an employee, and helps to significantly increase the labor potential of the enterprise.

Who needs to be screened

Professional examinations are mandatory for workers in hazardous and hazardous industries. Employees must also undergo such medical examinations:

• engaged in construction;
• managers of automobile, railway and water transport (passenger, freight);
• providing communal services;
• health workers working in medical and preventive and medical institutions, pharmacies;
• workers at food industry enterprises, in catering and trade establishments;
• serving in private security;
• working in educational institutions (studios, kindergartens, schools, sports clubs);
• workers in water treatment plants;
• engaged in the maintenance of electric power facilities.

In addition, professional athletes, employees under the age of 18, employees in the office who spend more than half of their working time at the computer, as well as representatives of some other specialties, must undergo a mandatory medical examination.

Types of medical examinations

• Preliminary inspection. It is carried out during employment at an enterprise in order to determine the suitability of the applicant for work in a particular area for health reasons. Such a mandatory prophylactic examination is carried out once and is often also called primary. Allows you to select future employees for medical reasons.
• Periodic inspection. Such examinations are carried out once a year, six months or at other intervals. The purpose of the annual professional examination is to monitor the health of employees, identify diseases, determine the impact of harmful factors and form risk groups for possible occupational diseases.
• Extraordinary inspection. Such a medical examination does not have a frequency and is not mandatory. It can be carried out at the initiative of the employee (in the presence of complaints) or the employer (in the event of a deterioration in the health of the employee). It is also carried out on the recommendation of a medical organization.

What does a screening include

The composition of the mandatory professional examination may include a different amount of research. It is determined on the basis of the type of activity, as well as the harmful factors that the worker has to deal with in production. As a rule, standard medical examinations of employees include fluorography, cardiogram, general clinical tests of urine and blood, as well as examination by such specialist doctors:

• ophthalmologist,
• neuropathologist,
• surgeon,
• therapist,
• otolaryngologist,
• gynecologist (for women).

At the request of the employer, the list of studies within the framework of the professional examination of employees can be expanded by additional tests and examinations by other medical specialists.

Order of the Ministry of Health and Social Development of Russia No. 302n, as amended on December 5, 2014, contains the procedure for conducting mandatory preliminary and periodic professional examinations (examinations), as well as a list of harmful and / or dangerous production factors and work in which they must be carried out. It also contains information about medical contraindications for admission to work.

What you need to pass a medical examination

To pass the primary or periodic annual medical examination, you must have the following documents:

• passport or other identity document;
• referral to undergo a medical examination from the enterprise;
• outpatient card;
• an extract with the results of previous examinations;
• conclusion of a psychiatric commission (not always necessary).

The cost of a medical examination

Prices for medical examinations of employees are calculated based on the provisions of Order N302n of the Ministry of Health and Social Development of the Russian Federation, issued on 04/12/2011, and take into account various factors. The total cost of the service for your business will depend on the number of employees surveyed. Also, when calculating it, the composition of laboratory tests and the number of specialist doctors involved in the framework of periodic medical examinations will be taken into account.

Responsibility for the lack of professional examination of employees

All enterprises are regularly checked by the Rospotrebnadzor inspectorate for violations of labor laws. If employees are found who have not passed the mandatory periodic medical examination, the organization can be fined up to 50 thousand rubles and even suspend its activities for up to 90 days. Also, the head of the company may be held liable, for which a fine of 1-5 thousand rubles is provided, and in some cases, removal from office for a period of 1 to 3 years.

Benefits of conducting medical examinations at the Skoromed clinic

• Complex solution. In our center, your employees can undergo any type of examination: mandatory primary and periodic, as well as extraordinary. The service will include a full list of necessary laboratory tests and examination by key specialists.
• Quality service. Medical examinations are carried out by qualified doctors who have additionally been certified in the field of determining occupational pathologies. Our service is not just a formality, but a real diagnosis of diseases of the company's employees.
• Convenient service. Our center takes care of the full organization of the medical examination process. Professional examinations of employees are carried out in the most comfortable conditions. It is also possible for us to leave the medical board to the customer's facility.
• The accuracy of the results. Our company guarantees prompt examination by doctors, quick laboratory tests and the reliability of the results. Upon completion of the procedure, we issue a correctly executed final act with recommendations from specialists.
• Individual approach. When cooperating with enterprises, we always take into account their specifics. Periodic medical examinations include only necessary studies. Thanks to this, the accuracy of the results is achieved and the cost of the service is reduced.

Yulia Egorova talks about the new rules for medical examinations

The law obliges

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

The Labor Code defines the groups of people for whom examinations are mandatory.

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

Workers engaged in heavy work and work with harmful working conditions<…>undergo obligatory preliminary (upon employment) and periodic medical examinations to determine the suitability of these workers for the performance of the assigned work and the prevention of occupational diseases.

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

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

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

Preventive examination is obligatory only for certain groups of workers in order to protect public health. The arrangement for such responsible work can only be voluntary, and consent to preliminary and periodic professional examinations is assumed to be automatic upon signing an employment contract, which most often includes an item on passing inspections as an essential condition.

What has changed in the examination?

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

Compared with the old procedure for conducting professional examinations several fundamental differences emerged.

1. Now only an occupational pathologist should head the medical commission, and the medical specialists of the commission need to improve their qualifications in the field of occupational pathology.

2. The principles of forming the lists of employees sent for medical examination have changed. If earlier employees were included in the list depending on the position, now an employee can be included in this list only on the basis of workplace certification, which must be carried out in accordance with another order of the Ministry of Health and Social Development of Russia (No. jobs according to working conditions). That is, even if a person works at a uranium mine, but the job attestation card is not indicated in the employment contract, then he does not need to undergo a medical examination, and he has no medical contraindications to work.

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

On the whole, these innovations can be considered positive, especially if professional examinations of employees are not reduced to a formality, as, unfortunately, sometimes happens. The emphasis on occupational pathology increases the preventive value of medical examinations, and the exclusion of persons with alcohol or drug addiction from hazardous work will certainly reduce the level of injuries at the workplace.

Health passport

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

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

Organization of professional examination of employees

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

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

Our physical examination or medical examination of doctors

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

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

The result of a medical examination

If the subject does not have any health disorders, the occupational pathologist makes a conclusion about the suitability for the work performed. But what if any diseases are found during the physical examination? A complete list of contraindications is quite extensive and is contained in paragraph 48 of Appendix No. 3 to Order No. 302n.

It must be said that many of the points as applied to medical workers are controversial. For example, how stable angina pectoris, post-infarction cardiosclerosis, drug-compensated epilepsy, widespread ichthyosis, or even cancer in the initial stage can interfere with the performance of the duties of a therapist is not clear to me personally.

Of course, for emergency work in the ambulance, operating room, emergency department and similar areas, good health is necessary, but for scheduled appointments and advisory work, such requirements seem to me excessive. With detailed observance of all the contraindications indicated in this list, medicine risks losing a large number of age-related specialists whose knowledge and experience are of great value, despite their imperfect state of health.

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

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

Individual difficulties in passing a medical examination may arise for employees who, for any reason, have a disability. Together with the referral for a medical examination, it is better for them to provide the conclusion of the next medical and sanitary examination, so that the commission can decide on admission to work.

There is something to strive for

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

In this article, we will consider what a medical examination is, who needs it, for what purposes, at whose expense it is carried out, how often it needs to be passed, which is mandatory.

What is a pre-survey?

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

Who needs a background check?

The majority of the officially working population know firsthand what a medical examination is. when hiring, in most cases, the employer asks the employee for a medical book with access to work. Not always and not everyone likes it, but this is a necessity that cannot be avoided, and for health it will not be superfluous to check whether everything is in order with the body.

In the Russian Federation, there is a project "Health", which is aimed at maintaining the health of the working population. The most important measure for maintaining health is the regular examination of people at the time of employment and further regular examinations.

Goals of the medical examination

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

. Definition of prof. suitability of employees before performing the assigned work tasks;

Ensuring labor safety;

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

Detection of any diseases unrelated to work, but in which a deterioration in a person’s condition is possible;

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

Regular monitoring of the health of workers in hazardous production;

Timely preventive maintenance and rehabilitation of employees to preserve their health;

Avoidance of accidents in the workplace.

Employees are required to undergo a medical examination at work:

. in hazardous production;

in hazardous production;

Guards;

Railway workers;

Drivers;

Social workers;

Workers of children's and preschool institutions.

Conducting medical examinations is stipulated by law, and persons who have not passed the examination are not allowed to work. The employer is responsible for passing the medical examination. Usually, the employer enters into an agreement with one of the professional examination clinics, and all employees are examined in one place. Reviews fall into two categories:

. preliminary;

Periodic.

Preliminary examination - this is when applying for a job, to determine suitability. Periodic inspection is to detect and prevent diseases obtained at work, and not only.

Who pays for the screening?

All activities related to the passage of medical examinations are undertaken by the employer, this is prescribed by the law of the Russian Federation. If the employee was not allowed to work by the medical examination doctor, the employer must not allow him to the workplace.

Frequency of checkups

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

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

. general blood analysis;

General urine analysis;

Fluorography.

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

Professionals that are required:

. therapist;

Surgeon;

Gynecologist;

Neurologist.

The surgeon will determine the size of the liver and spleen and other abdominal organs, and also checks for varicose veins. In men, this also includes the prostate. A neurologist checks for abnormalities associated with the nervous system. A gynecologist is a must for women. The therapist measures the pressure and identifies signs of hypertension, and also puts a conclusion and admission to work after passing through all the specialists and passing all the tests.