A new procedure for the organization of sanatorium-and-spa treatment. Sanatorium and resort care Sanitary resort care

In accordance with articles 5.2.11. and 5.2.101. Regulations on the Ministry of Health and Social Development of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 2004 N 321 (Collected Legislation of the Russian Federation, 2004, N 28, Art. 2898), article 6.2. Federal Law of July 17, 1999 N 178-FZ "On State Social Assistance" (Collected Legislation of the Russian Federation, 1999, N 29, Art. 399; 2004, N 35, Art. 3607) and in order to improve the procedure for medical selection and referral of patients to sanatorium-and-spa treatment I order:

1. Approve:

1.1 The order of medical selection and referral of patients for sanatorium treatment (Appendix N 1).

1.2. Form N 070 / y-04 "Certificate for obtaining a ticket" (Appendix N 2).

1.3. Form N 072 / y-04 "Sanatorium card" (Appendix N 3).

1.4. Form N 076 / y-04 "Sanatorium card for children" (Appendix N 4).

1.5. Instructions for filling out the form N 070 / y-04 "Help for obtaining a ticket" (Appendix N 5).

1.6. Instructions for filling out the form N 072 / y-04 "Sanatorium card" (Appendix N 6).

1.7. Instructions for filling out the form N 076 / y-04 "Sanatorium card for children" (Appendix N 7).

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

3. To impose control over the execution of this order on the Deputy Minister of Health and Social Development of the Russian Federation V.I. Starodubova.

Minister M. Zurabov

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

Appendix No. 1

The order of medical selection and referral of patients for sanatorium-and-spa treatment

I. The order of medical selection and referral to sanatorium treatment of adults (except for patients with tuberculosis)

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

1.2. Medical selection and referral of patients in need of sanatorium treatment is carried out by the attending physician and the head of the department, and where there is no head of the department, the head physician (deputy head physician) of the medical institution (outpatient clinic (at the place of residence) or medical unit (at the place of work, study) of the patient when he is sent for preventive sanatorium treatment and a hospital institution when the patient is sent for aftercare).

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

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

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

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

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

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

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

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

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

1.7. Having received a voucher, the patient is obliged not earlier than 2 months before the start of its validity to come to the attending physician who issued him a certificate for obtaining a voucher, in order to conduct the necessary additional examination. If the SCO profile specified in the voucher corresponds to this recommendation before, the attending physician fills out and issues to the patient a sanatorium-resort card in the form N 072 / y-04 (hereinafter referred to as the sanatorium-resort card) (Appendix N 3) of the established sample, signed by him and the head department.

The darkened field of the sanatorium card is filled in and marked with the letter "L" in the organizational and methodological office only for citizens who are entitled to receive a set of social services.

The attending physician of the medical institution makes an appropriate entry in the medical record of the outpatient (in the case history when referring for follow-up care) about the issuance of a sanatorium-and-spa card.

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

The number of issued certificates for obtaining a ticket;

Number of health resort cards issued;

The number of return coupons for sanatorium cards.

1.9. Attending physicians and heads of departments should be guided by the following mandatory list of diagnostic studies and specialist consultations, the results of which must be reflected in the health resort card:

a) clinical blood analysis and urinalysis;

b) electrocardiographic examination;

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

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

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

f) when referring women to sanatorium-resort treatment for any disease, the conclusion of an obstetrician-gynecologist is mandatory, and for pregnant women - an additional exchange card;

g) a certificate-conclusion of a psycho-neurological dispensary if the patient has a history of neuropsychiatric disorders;

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

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

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

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

Accounting for children in need of sanatorium treatment;

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

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

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

is determined by the attending physician of the medical institution with the issuance of a certificate for obtaining a ticket for a child (to be provided at the place of demand) and a sanatorium card for children in the form N 076 / y-04 (hereinafter referred to as the sanatorium card for children) (Appendix N four).

In the organizational and methodological office, it is marked with the letter "L" and a darkened reference field is filled in for obtaining a voucher and a sanatorium card for children, only for children from among citizens entitled to receive a set of social services.

2.3. Referral of children to sanatorium treatment is carried out in the same manner as for adult patients.

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

2.5. Before sending a child to a spa treatment, the attending physician organizes his clinical and laboratory examination, depending on the nature of the disease, as well as the rehabilitation of chronic foci of infection, antihelminthic or antigiardia treatment.

2.6. When referring a child to a sanatorium-resort treatment, the following documents must be presented:

a voucher;

Sanatorium-resort card for children;

Compulsory health insurance policy;

Analysis for enterobiasis;

The conclusion of a dermatologist about the absence of contagious skin diseases;

A certificate from a pediatrician or epidemiologist about the absence of contact between the child and infectious patients at the place of residence, in kindergarten or school.

2.7. At the end of the sanatorium-and-spa treatment, a return coupon of the sanatorium-and-spa card is issued for the child to be presented to the medical institution that issued the sanatorium-and-spa card, as well as a sanatorium book with data on the treatment performed in the North Kazakhstan region, its effectiveness, and medical recommendations.

This documentation is handed out to parents or an accompanying person.

III. The order of admission and discharge of patients

3.1. Upon arrival in the North Kazakhstan region, the patient presents a voucher and a sanatorium-and-spa card, which is stored in the North Kazakhstan region for three years. In addition, the patient is recommended to have a compulsory health insurance policy with him.

3.2. After the initial examination, the attending physician of the NKR issues a sanatorium book to the patient, in which the prescribed medical procedures and other appointments are recorded. The patient presents it in the medical units of the North Kazakhstan region to mark the treatment or examination.

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

3.4. Upon completion of the course of sanatorium-resort treatment, the patient is issued a return coupon of the sanatorium-resort card and a sanatorium book with data on the treatment performed in the North Kazakhstan region, its effectiveness, recommendations for a healthy lifestyle, which the patient must submit to the medical institution that issued the sanatorium-resort card or to an outpatient clinic at the place of residence of the patient after completion of the aftercare course.

3.5. Reverse coupons of sanatorium-and-spa cards are filed into the medical record of an outpatient and stored in a medical institution for three years.

3.6. Documents certifying temporary incapacity for work of citizens due to an acute illness, injury or exacerbation of a chronic disease that occurred during their stay at a sanatorium-and-spa treatment are issued, as a rule, by medical institutions at the place of stay of the patient, in accordance with the current regulatory legal documents.

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

4.1. Staying in the SKO, which entails a deterioration in the patient's health, is considered contraindicated for him.

4.2. When determining contraindications to sanatorium-and-spa treatment, doctors of a medical institution and a medical institution should be guided by duly approved contraindications that exclude the referral of patients to sanatorium-and-spa treatment, taking into account in each individual case not only the form and stage of the disease, but also the degree of danger of staying at a resort or in a sanatorium for him, as well as for others.

4.3. The contraindication of the direction and stay of the patient in the NKR is established by the attending physician, and in conflict cases - by the VC of the medical institution, NKR.

The attending physician or VC of a medical and preventive institution, RCO determines:

Presence of contraindications for treatment;

The possibility of leaving the patient in the North Kazakhstan region for balneological, climatic, medical or other treatment;

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

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

4.4. The term for identifying contraindications for a patient's stay in the SKO, as a rule, should not exceed 5 days from the moment of his admission.

4.5. In the event that a patient has contraindications, the VK SKR draws up an act of contraindication to the patient of sanatorium-and-spa treatment in 3 copies: one of which is sent to the health management body of the subject of the Russian Federation, the second - to the address of the medical institution that issued the sanatorium-and-spa card, for analysis on VK, and the third copy of the act remains in the North Kazakhstan region.

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

Appendix No. 5

Instructions for filling out the form N 070 / y-04 "Help for obtaining a ticket"

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

The certificate for obtaining a permit is filled in by the attending physicians of medical institutions providing outpatient care.

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

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

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

In the paragraph "Region of residence" the code of the subject of the Russian Federation, in which the patient lives, is indicated in accordance with the list of subjects of the Russian Federation, located on the back of the certificate for obtaining a ticket.

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

In the paragraphs "Climate in the place of residence" and "Climatic factors in the place of residence" numerical codes are indicated in accordance with the list of climates in the place of residence, given on the back of the certificate for obtaining a ticket.

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

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

In the paragraph "Main disease or disease that causes disability" the diagnosis of the underlying disease is indicated, and for disabled people and children with disabilities - the diagnosis of the disease that causes disability.

Under "Concomitant diseases" diagnoses of concomitant diseases are indicated.

Items "Preferred place of treatment" and "Recommended seasons of treatment" are optional.

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

Appendix No. 6

Instructions for filling out the form N 072 / y-04 "Sanatorium card"

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

Sanatorium-resort card;

Return ticket.

The sanatorium card is filled in by the attending physicians of medical institutions providing outpatient care.

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

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

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

In paragraph "N of the medical history or outpatient card" indicates the registration number of these documents, established by the medical institution.

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

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

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

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

In the paragraph "Insurance number of an individual personal account (SNILS)" the insurance number of an individual personal account is indicated according to a document certifying the right to receive a set of social services. The "Accompaniment" item is filled in if the patient belongs to citizens who have a III degree disability in their ability to work.

Items "Place of work, study" and "Position held, profession" are filled in according to the patient.

The item "Complaints, duration of the disease, history, previous treatment, including spa treatment" is filled in on the basis of medical documentation and according to the patient.

The item "Data of clinical, laboratory, X-ray and other studies" is filled in on the basis of medical documents with the obligatory indication of the date of the study.

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

The return coupon is filled in by the attending physician of the sanatorium-resort organization to present it to patients at the medical institution that issued the sanatorium-resort card (after completion of the aftercare course - to the outpatient institution at the place of residence).

Surname, name, patronymic are filled in in accordance with the document proving the identity of a citizen, recognized in the territory of the Russian Federation.

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

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

The subparagraph "Main disease or disease causing disability" indicates the diagnosis of the underlying disease, and for disabled people, the diagnosis of the disease that causes disability.

In the subparagraph "Concomitant diseases" diagnoses of concomitant diseases are indicated.

The subparagraph "Main disease or disease causing disability" indicates the diagnosis of the underlying disease, and for disabled people, the diagnosis of the disease that causes disability.

In the subparagraph "Concomitant diseases" diagnoses of concomitant diseases are indicated.

Appendix No. 7

Instructions for filling out the form N 076 / y-04 "Sanatorium card for children"

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

The form of the sanatorium-resort card consists of:

Sanatorium-resort card;

Return ticket.

The sanatorium-resort card is filled in by the attending physicians of medical institutions providing outpatient care for children.

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

On the title page of the health resort card, the full name of the medical institution is affixed in accordance with the registration document.

The number of the sanatorium-resort card is an individual registration number of the sanatorium-resort card, established by the medical institution.

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

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

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

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

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

The items "Educational institution" and "Place of work of parents" are filled in according to the words of the person accompanying the child.

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

The item "Diagnosis" is filled in in accordance with ICD-10 according to the medical documentation on the forms, stages, nature of the course of diseases.

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

In the subparagraph "Concomitant diseases" diagnoses of concomitant diseases are indicated.

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

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

On the title page of the return coupon, the full name of the sanatorium and resort organization is affixed in accordance with the registration document.

The surname, name, patronymic of the child are filled in in accordance with the document proving the identity of the citizen, recognized in the territory of the Russian Federation.

The item "Diagnosis upon discharge from the sanatorium" is filled in in accordance with ICD-10 according to the medical documentation of the sanatorium-resort organization on the forms, stages, nature of the course of the disease.

The subparagraph "Main disease or disease causing disability" indicates the diagnosis of the underlying disease, and for disabled children, the diagnosis of the disease that causes disability.

In the subparagraph "Concomitant diseases" diagnoses of concomitant diseases are indicated.

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

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

The items "Results of treatment", "Presence of exacerbations that required cancellation of procedures" and "Recommendations for further treatment" are filled in based on the data specified in the item "Epicrisis".

If there is contact with infectious patients during their stay in a sanatorium-resort organization, a mark is made in the item "Contacts with patients with infectious diseases" indicating the date and diagnosis of the disease.

The item "Past intercurrent diseases and exacerbation of the underlying and concomitant diseases" is filled in on the basis of medical records.

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

^ The procedure for providing sanatorium-resort medical care

1. Sanatorium-resort treatment is provided to patients within the framework of sanatorium-resort medical care in state, municipal, departmental and other forms of ownership of sanatorium-resort institutions and clinics that are part of medical scientific organizations licensed to provide services for the type of activity "sanatorium-resort resort care”, which provides for the performance of works (services) for the provision of health resort medical care to citizens in accordance with the list of works (services) in the implementation of medical activities approved by the Ministry of Health and Social Development of the Russian Federation, mainly using natural healing factors (mineral waters , therapeutic mud, climate, etc.) in combination with physiotherapy, exercise therapy, therapeutic nutrition and other therapeutic agents.

The main objectives of sanatorium treatment are: activation of protective and adaptive reactions of the body for the purpose of primary prevention of diseases, restoration and compensation of impaired functions in chronic diseases, reduction in the number of exacerbations, prolongation of the remission period, slowing down the progression of diseases (secondary prevention) and prevention of disability.

2. The provision of sanatorium care to patients is carried out in accordance with the standards of medical care and regulatory legal acts of the federal executive body in the field of healthcare,

Relevant executive authorities of the constituent entity of the Russian Federation and local government.

3. The procedure for organizing sanatorium-resort care includes two main stages - the selection of patients for sanatorium-resort treatment and sanatorium-resort treatment in sanatorium-resort institutions.

4. The effectiveness of ongoing medical and recreational activities, the duration and stability of the results of sanatorium treatment to a large extent depends on compliance with the rules for selecting and referring patients to this type of treatment.

5. Medical selection of patients for sanatorium treatment is carried out by clinical expert commissions of medical institutions. When deciding on the indication of spa treatment, the medical commission must take into account the nature of both the underlying and concomitant diseases; their compliance with natural healing factors (landscape, climate, mineral waters, mud); contrast of climatic and geographical conditions; distance distance (from the permanent place of residence of the patient to the resort); the severity of the course of diseases, the possibility of their seasonal exacerbation (spring-autumn with peptic ulcer of the stomach and duodenum, vegetative-vascular disorders, diseases of the respiratory system, kidneys in the cold season, etc.).

Patients with more severe forms of diseases are sent to local nearby sanatoriums, for whom long-distance travel is contraindicated for health reasons. In territories (territories, regions) with resorts

Federal significance, it is allowed to refer patients with severe forms of diseases (for aftercare, medical rehabilitation) from among local residents who are indicated for treatment in local and suburban sanatoriums.

6. The list of medical indications and contraindications for adults, adolescents and children is developed by research institutes of balneology and physiotherapy.

Recommendations are given for the examination of patients on the ground with the obligatory study of their general condition, blood tests, urine tests, electrocardiography, X-ray examination of the chest organs (fluorography); in diseases of the digestive system - fluoroscopy of the stomach or endoscopic examination (esophagogastro-duodenofibroscopy), ultrasound of the abdominal organs; liver (blood levels of bilirubin, protein fractions, transaminase activity, glucose), intestines (fecal analysis, sigmoidoscopy); in diseases of the respiratory system - sputum analysis, spiro-, fluorography; in allergic diseases - skin allergic diagnostic tests, the study of indicators of the state of the immune system, etc.

All women sent to the resort must first be examined by a gynecologist. In the presence of gynecological diseases, the complex of special examinations includes the determination of the "hormonal profile" of patients, in case of infertility - indicators of patency of the fallopian tubes.

If patients have neuropsychiatric diseases, the conclusion of a psychoneurological dispensary is necessary.

In nephrourological diseases - a study of the functional state of the kidneys, x-ray, ultrasound and other examinations.

Carrying out a thorough examination of patients allows us to clarify the nature of the underlying and concomitant diseases: their form, severity and activity of the process. If disease activity is detected, a doctor should conduct a preliminary course of treatment. In order to avoid exacerbation of the disease, anti-relapse treatment is prescribed at the resort; in the presence of foci of local infection (in carious teeth, palatine tonsils, paranasal sinuses, gallbladder, etc.), their sanitation is carried out - recreational activities with the help of medication or non-drug means before going to the resort.

7. When selecting patients for resort treatment, it is important to take into account the meteo-lability (meteosensitivity) of patients, the features of their adaptation to new climatic conditions. The greatest meteorological sensitivity is observed in patients with diseases of the cardiovascular system, nonspecific diseases of the respiratory system, both in adolescents and in the elderly. Therefore, sending them to remotely located resorts should be treated with caution.

When selecting patients for sanatorium treatment, it is necessary to take into account the peculiarities of the adaptation of patients to contrasting climatic and geographical conditions (seaside or mountain resorts). Persons with increased meteotropy have a longer period of adaptation to the peculiarities of resorts with contrasting climatic and geographical conditions, especially during the transitional season (spring, autumn); it can be complicated by negative meteotropic reactions. Therefore, the direction of such patients to resorts with dramatically changing meteorological conditions (fluctuations in temperature, atmospheric pressure) during the transitional seasons of the year is not advisable. They should be directed to resorts close to their permanent place of residence.

The need to refer the patient to sanatorium treatment is determined by the attending physician and the head of the department, and where there is no head of the department, by the deputy head physician for medical work or the head physician of the medical institution.

8. The procedure for obtaining free vouchers for sanatorium treatment.

Citizens of Russia who are entitled to state assistance (state service) in the form of a set of social services (Federal Law No. 122-FZ of August 22, 2004) can receive a ticket paid for from the federal budget.

Vouchers are provided subject to medical indications to health resort organizations located on the territory of the Russian Federation and included in the List, which is approved by the Ministry of Health and Social Development of the Russian Federation.

The public service is provided, first of all, to low-income families, large families, single-parent families, participants in the liquidation of the Chernobyl accident; children left without parental care.

Documents provided by the recipient of the public service:

1. Application in any form;

2. Certificate for obtaining a ticket - form No. 070 / y-04 (Appendix 3);

3. Applicant's passport (for children under 14 - birth certificate);

4. Passport of one of the parents (in the case of the "Mother and Child" package);

5. Passport of the accompanying person (if accompanied by another person);

6. Certificate of disability (if any);

If there are grounds for priority receipt of a voucher, photocopies of the relevant documents are attached to the application (low-income family, large family, single-parent family, participation of parents in the liquidation of the Chernobyl accident, a child left without parental care).

Documents are provided in one copy personally.

To obtain a ticket, you need to contact the attending physician of the medical institution in the place

Residence. If there are medical indications and there are no contraindications for sanatorium treatment, the doctor will fill out a certificate for obtaining a voucher in the form No. A certificate for obtaining a voucher must contain the following information: the name of the resort, the profile of the sanatorium, the recommended season (valid for 6 months). With this certificate and an application for a voucher, you need to contact the regional branch of the Social Insurance Fund of the Russian Federation. In addition, in order to receive a voucher for sanatorium-and-spa treatment, it is necessary to provide: documents confirming the inclusion of a citizen in the appropriate preferential category (certificate, ITU certificate on the establishment of disability, etc.), passport. Within two weeks, the Foundation will inform about the possibility of providing a sanatorium-resort voucher corresponding to the declared treatment profile, indicating the date of arrival.

The sanatorium and resort voucher is issued in completed form with the seal of the executive body of the Fund and with the mark "Paid for at the expense of the federal budget and is not subject to sale."

After receiving a sanatorium and resort voucher, but not earlier than 2 months before the start of its validity, you need to get a sanatorium and resort card (recording form 072 / y-04, for children - 076 / y-04, approved by order of the Ministry of Health and Social Development of Russia dated 22.11 .2004 No. 256) at the clinic that issued the certificate for obtaining a ticket. After the end of the sanatorium treatment (no later than 30 days), you must return the return ticket to the clinic, and the sanatorium will return the voucher to the Social Insurance Fund of the Russian Federation.

9. Aftercare in a sanatorium.

At the expense of the federal budget, aftercare in a sanatorium is also paid. Since 2006, the list of diseases in which patients are treated in sanatoriums immediately after inpatient treatment has expanded significantly. It includes patients who have undergone acute myocardial infarction, acute cerebrovascular accident, operations on the heart and main vessels, operations for pancreatitis (pancreonecrosis), gastric ulcer, duodenal ulcer and removal of the gallbladder, as well as after treated unstable angina pectoris and diabetes mellitus, working pregnant women.

Patients after surgical or conservative treatment immediately after discharge from the hospital are sent to sanatoriums included in the "List of sanatorium-and-spa institutions to which vouchers for sanatorium-and-spa treatment of citizens entitled to receive state social assistance" (approved by order of the Ministry of Health and Social Development of Russia dated July 22 .2009 No. 540n “On approval of the list of sanatorium and resort institutions to which vouchers for sanatorium and resort treatment are provided to citizens entitled to receive state social assistance” (as amended by the order of the Ministry of Health and Social Development of Russia dated October 29, 2009 No. 854n).

The main selection criterion is the optimal price/quality ratio. That is, the health resort is obliged for state compensation to provide privileged patients with sufficiently comfortable living conditions and full treatment in accordance with the diagnosis (Federal Law of the Russian Federation of December 10, 2006 No. 234-FZ).

Upon receipt of a budget voucher, patients are issued special coupons (nominal referrals) for travel to the place of treatment to receive medical care (filled in by the executive authority of the constituent entity of the Russian Federation in the field of healthcare) to citizens who are entitled to a set of social services.

10. The Administrative Regulations for the provision of public services in the direction of citizens (children and citizens 18 years of age and older) for sanatorium treatment and rehabilitation also provide grounds for refusing to provide public services: medical contraindications for sanatorium treatment; corrections in the application or documents attached to the application that do not allow unambiguous interpretation of their content; Providing false information; the absence of a complete list of documents necessary to resolve the issue of sending a citizen to sanatorium treatment; lack of sanatorium vouchers to the health resorts indicated in the application; lack of sanatorium vouchers for the period specified in the application; lack of tickets.

11. The procedure for obtaining preferential vouchers.

In sanatoriums, sanatoriums, rest homes, student winter and summer camps, you can get preferential vouchers through the trade union committees of enterprises and state universities. To obtain such a voucher, you must take a doctor's certificate for obtaining a voucher and submit it to the trade union committee with an application of the established form. After receiving the voucher, it is necessary to issue a sanatorium-resort card; within ten days after the end of the check-in at the sanatorium, provide a return ticket to the voucher to the trade union committee.

In departments and large associations, employees and their children are allocated preferential vouchers to departmental sanatoriums, dispensaries and children's health camps.

Preferential vouchers can also be obtained through various funds, for example, the Family World Rehabilitation and Support Fund, one of whose tasks is to organize recreation for children from large families.

12. Purchase of paid vouchers.

You can buy (or order) a voucher by contacting the sanatorium directly through the voucher sales departments or through travel companies that are members of the Russian Union of the Tourist Industry and work with sanatoriums under direct contracts.

13. General contraindications that exclude the direction of patients (adults and adolescents) to resorts and local sanatoriums:

● All diseases in the acute stage, chronic diseases in the acute stage and complicated by an acute purulent process.

●Acute infectious diseases before the end of the isolation period.

●All sexually transmitted diseases in acute and contagious form.

●All blood diseases in the acute stage and in the acute stage.

●Cachexia of any origin.

●Malignant neoplasms.

Note. Patients after radical treatment for malignant neoplasms (surgical, radiant energy, chemotherapeutic) with a generally satisfactory condition, no metastasis, normal peripheral blood counts can only be sent to local sanatoriums for general strengthening treatment.

● All diseases and conditions requiring inpatient treatment, including surgical intervention, all diseases in which patients are not able to move independently and self-care, require constant special care (except for persons to be treated in specialized sanatoriums for spinal patients).

● Echinococcus of any localization.

● Frequent or heavy bleeding.

● Pregnancy at all times for balneological and mud resorts, and for climatic resorts, starting from 26 weeks.

● All forms of pulmonary tuberculosis in the active stage - for any resorts and sanatoriums of a non-tuberculosis profile.

14. The procedure for sending children to sanatoriums is regulated by the Order of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004 “On the procedure for selecting and referring patients to sanatorium treatment (as amended by the Order of the Ministry of Health and Social Development of the Russian Federation of January 9, 2007 No. 3). The procedure for sending children with their parents to sanatoriums, vouchers to which are provided free of charge, is regulated by the order of the Ministry of Health and Social Development of Russia dated March 27, 2009 No. 138n “On the procedure for organizing work on the distribution of vouchers and referring patients from institutions providing specialized, including high-tech, medical care to treatment in sanatorium-and-spa institutions under the jurisdiction of the Ministry of Health and Social Development of Russia”.

Referral of children aged 3 to 18 years for sanatorium treatment is carried out according to the results of a medical selection, which is carried out by medical institutions (HCIs) at the place of residence of the child. If there are medical indications and there are no contraindications for sanatorium treatment in a child, the attending physician of the health facility issues a certificate for obtaining a voucher for sanatorium treatment and a completed sanatorium card. On the basis of these documents, the executive authority of the constituent entity of the Russian Federation in the field of healthcare makes a decision to send the child to the Roszdrav sanatorium and issues an appropriate voucher. If there are contraindications for sanatorium treatment, a decision is made to return the documents to the medical facility with a reasoned justification for the refusal.

Before going to the resort of the child, the attending physician organizes his clinical and laboratory examination, depending on the nature of the disease, as well as the rehabilitation of chronic foci of infection, antihelminthic or antigiardia treatment.

The child must have the following documents:

Sanatorium and resort card for children (Form No. 076 / y-04).
Compulsory health insurance policy.
The results of the analysis for enterobiasis.
The conclusion of a dermatologist about the absence of contagious skin diseases.
A certificate from a pediatrician or epidemiologist about the absence of contact between the child and infectious patients at the place of residence, in kindergarten or school.

The organization of children's recreation and treatment is regulated by the annual Decree of the Government of the Russian Federation "On the provision of recreation, rehabilitation and employment of children."

Almost all working parents have the right to receive a voucher to a children's sanatorium or a country camp for children aged 4 to 15 inclusive, paid with the participation of the Social Insurance Fund. By Decree No. 144 dated March 5, 2007, the Government of Russia instructed the Social Insurance Fund of the Russian Federation to pay for the children of insured citizens in full or in part the cost of vouchers to sanatorium-resort and health-improving organizations located on the territory of the Russian Federation, opened in the prescribed manner:

Children's sanatoriums – for children aged 4 to 15 years and sanatorium health camps all year round - for children of school age up to 15 years (inclusive) with a stay of 21–24 days at a rate of up to 500 rubles. per child per day. The maximum amount of payment for the cost of a voucher per child per day in these organizations located in regions and localities in which regional coefficients are applied to wages in the prescribed manner is determined taking into account these regional coefficients;

Out-of-town stationary children's health camps (with a stay of at least 7 days during the spring, autumn, winter school holidays and no more than 24 days during the summer school holidays) - for children of school age up to 15 years old in the amount of up to 50% of the average cost vouchers (up to 100% of the average cost of vouchers for children of employees of budgetary organizations).

15. General contraindications, excluding the referral of children to sanatorium-and-spa treatment:

●All diseases in the acute period.

●Somatic diseases requiring treatment in a hospital setting.

●Perceived infectious diseases before the end of the period of isolation.

● Bacillus carrying diphtheria and intestinal infectious diseases.

●Malignant neoplasms, pernicious anemia, leukemia (except for specialized sanatoriums).

● Amyloidosis of internal organs.

● Tuberculosis of lungs and other organs.

●Convulsive seizures and their equivalents, mental retardation (except for specialized sanatoriums for children with cerebral palsy), pathological personality development with severe behavioral disorders and social adaptation.

● Presence in children of concomitant diseases that are contraindicated for this resort or sanatorium.

● Patients requiring constant individual care.

●Psychic illnesses.

Sanatorium-resort treatment, as a stage of medical rehabilitation, can be provided to patients and disabled people with the consequences of injuries, operations, chronic diseases within the framework of specialized medical care in state and municipal specialized sanatorium-resort healthcare institutions that have the appropriate license to provide medical care to disabled people. The main task of sanatorium-and-spa treatment in this case is the complete or partial restoration of impaired functions or compensation for the lost functions of the affected organ or body system.

2. The provision of sanatorium and resort care to the sick and disabled is carried out in accordance with the standards of medical care and regulatory legal acts of the federal executive body in the field of health care, the relevant executive authorities of the constituent entity of the Russian Federation and the local government.

3. The following shall be sent to the sanatorium-resort stage of medical rehabilitation, if there are relevant medical indications and there are no contraindications:

Citizens entitled to receive state social assistance in the form of a set of social services, in accordance with the established procedure;

Insured persons who have received damage to health due to accidents at work and occupational diseases, in accordance with the established procedure;

Citizens (adults and children) who need sanatorium and resort treatment in sanatorium and resort institutions under the jurisdiction of the Ministry of Health and Social Development of Russia, in accordance with the established procedure;

4. Sick and disabled people are sent to sanatorium-and-spa institutions on the condition of a complete examination, the ability to move independently and self-service, there is no need for bed rest and individual care from the middle and junior medical personnel.

5. The selection of patients and disabled people and referral to the sanatorium-resort stage of medical rehabilitation is carried out in the manner approved by the order of the Ministry of Health and Social Development of Russia dated November 22, 2004 No. 256 "On the procedure for medical selection and referral of patients to sanatorium-resort treatment", taking into account the established indications and contraindications.

6. Upon admission of patients and disabled people to sanatorium-resort institutions, based on the results of the previous stages of treatment, a comprehensive individual program of medical rehabilitation is drawn up using natural and preformed physical factors, which reflects the initial state of impaired (lost) functions, existing limitations of life, as well as specific volumes and methods of carrying out rehabilitation measures.

The duration of medical rehabilitation is determined by the standards of medical care.

7. In cases of exacerbation of the disease or the emergence of a new pathological process requiring the provision of specialized medical care, the patient is transferred to the appropriate healthcare institution in the prescribed manner.

8. Upon completion of the course of sanatorium-resort medical rehabilitation, the effectiveness of the rehabilitation measures carried out is evaluated, after which the need, timing and stage of a repeated course of medical rehabilitation in a sanatorium are determined. The issued recommendations are implemented by specialists of the medical institution at the place of residence (work) of the patient.

Medical care for the rehabilitation of persons at risk is provided to patients with risk factors that contribute to the emergence and development of diseases, within the framework of sanatorium-resort care in state and municipal institutions of sanatorium-resort institutions that have the appropriate license.

The main task of improving the health of people at risk is the primary prevention of diseases using diagnostic and health-improving technologies of resort medicine.

2. The provision of sanatorium and resort care to patients for recovery is carried out in accordance with the standards for the provision of medical care and regulatory legal acts of the federal executive body in the field of healthcare, the relevant executive authorities of the constituent entity of the Russian Federation and the local government.

3. In order to provide affordable and high-quality medical care for the rehabilitation of people at risk groups, the health authorities of the constituent entities of the Russian Federation develop an appropriate procedure for providing medical care, taking into account the stage of medical care, regional needs, structure, capacity, level of equipment and provision with qualified personnel of the relevant medical institutions .

4. The following are sent to the sanatorium-resort stage of recovery:

Insured employees employed in work with harmful and (or) hazardous production factors, in accordance with the established procedure;

Children of insured citizens when sent to children's sanatoriums and sanatorium health camps all year round in accordance with the established procedure;

5. Persons (adults and children) who have risk factors that contribute to the emergence and development of diseases are sent to the sanatorium-resort stage of recovery if there are established medical indications and there are no contraindications.

6. Medical selection and referral to the sanatorium stage of rehabilitation of workers employed in work with harmful and (or) dangerous production factors is carried out by the medical commission of a medical organization that carries out preliminary and periodic medical examinations, based on the results of periodic medical examinations. Recommendations for health resort rehabilitation are indicated in the final act of the medical commission in accordance with the established rules.

7. Medical selection and referral to the sanatorium-resort stage of rehabilitation of children of insured citizens is carried out in the manner approved by the order of the Ministry of Health and Social Development of Russia dated November 22, 2004 No. 256 “On the procedure for medical selection and referral of patients to sanatorium-resort treatment”.

8. When a patient is admitted for rehabilitation, depending on the risk factors identified in him, the attending physician of the sanatorium and resort institution draws up a comprehensive individual rehabilitation program, which reflects the volumes and methods of conducting recreational activities.

The duration of recovery is determined by the standards of medical care.

9. Upon completion of the rehabilitation course, the patient is sent to an outpatient clinic at the place of residence (work, stay) for further dispensary observation.

Appendix No. 15.1

To the Procedure for the provision of sanatorium-resort medical care, approved by order of the Ministry of Health and Social Development of the Russian Federation

dated ______________.2010 No. ______

1. The sanatorium is a medical institution intended for the treatment of patients with predominantly natural healing factors (climate, mineral waters, therapeutic mud, etc.) in combination with physiotherapy, physiotherapy, therapeutic nutrition and other means, subject to the obligatory observance of the established sanatorium regimen providing full treatment and rest of patients.

2. The sanatorium is organized as an independent medical and preventive sanatorium and health resort organization and operates on the basis of a license granted in accordance with the legislation of the Russian Federation to carry out medical activities.

3. The founder of a sanatorium, based on the form of ownership, may be a federal executive body, an executive body of a constituent entity of the Russian Federation, a local self-government body, a public organization (association), legal entities or individuals.

4. The activities of the sanatorium are carried out in accordance with the legislative acts of the Russian Federation, the regulatory legal acts of the executive authorities of the constituent entities of the Russian Federation or local governments, the regulatory legal acts of the Ministry of Health and Social Development of the Russian Federation, the regulatory legal or legal acts of the founders, these Regulations and constituent documents .

5. The main activity of the sanatorium is the implementation of medical activities, which provides for the performance of works (services) for the provision of health resort medical care to citizens in accordance with the list of works (services) in the implementation of medical activities approved by the Ministry of Health and Social Development of the Russian Federation, mainly using natural therapeutic factors (mineral waters, therapeutic mud, climate, etc.) in combination with physiotherapy, exercise therapy, therapeutic nutrition and other therapeutic agents.

6. Sanatoriums are organized in specially constructed or adapted buildings that meet the sanitary and hygienic requirements of the state sanitary inspection bodies and the standards approved by the State Committee for Construction.

7. A sanatorium is organized at health resorts or health-improving areas. Outside the resorts, a local suburban sanatorium can be organized. The local sanatorium is intended for the treatment of patients who, for health reasons, are contraindicated in changing climatic conditions of stay and traveling to remote resorts, as well as for providing outpatient care to patients without changing their permanent place of residence and stopping work.

8. The sanatorium is not intended for the treatment of patients who are not capable of independent movement and self-care, in need of constant special care (except for persons to be treated in specialized sanatoriums for spinal patients).

9. A sanatorium may be intended to provide sanatorium medical care to adults (sanatorium), children (children's sanatorium), adults and children (sanatorium for children with parents).

10. A sanatorium can be single-profile (for the treatment of patients with similar diseases) and multi-profile (with two or more specialized departments).

The medical profile (specialization) of the sanatorium (its departments and beds) is established depending on the availability of certain natural therapeutic factors and a license for medical activity, as well as the needs of the population in the types of sanatorium-and-spa care based on the classes (groups) of diseases that are treated in this resort.

11. According to the period of operation, the sanatorium can be year-round or seasonal.

12. The management of the sanatorium is carried out by the head (director, chief physician) of the sanatorium, appointed to the position and dismissed by the founder, in the prescribed manner. The medical activities of the sanatorium are managed by the chief physician (deputy chief physician for medical affairs) - a specialist with a higher professional medical education, postgraduate or additional professional medical education and work experience in the specialty for at least 5 years. The head doctor of the sanatorium is appointed to the position and dismissed by the founder. The deputy chief physician for medical affairs is appointed to the position and dismissed by the head of the sanatorium.

13. The structure of the sanatorium is approved by the head of the sanatorium, depending on the needs of the population in the types of sanatorium care in accordance with the recommended approximate structure:

Reception department;

Functional diagnostic department:

Clinical diagnostic laboratory;

Department (rooms) of functional diagnostics;

Cabinet of ultrasound diagnostics;

Medical departments (including specialized departments, beds);

Hydrotherapy (hydrotherapy, balneotherapy);

thermotherapy;

Physiotherapy;

barotherapy;

Kinesiotherapy;

Manual therapy;

Reflexology;

Phytotherapy;

Psychotherapy;

Offices of medical specialists;

Administrative and economic divisions and services:

Administration;

catering unit;

Accounting;

Human Resources Department;

Purchase department;

Pharmacy;

Technical services.

The sanatorium may organize other departments and offices, depending on the medical profile of the sanatorium.

The equipment of diagnostic and treatment rooms, utility and utility rooms is determined depending on the profile and capacity of the sanatorium,

14. To provide sanatorium-and-spa medical care, a staff of medical, middle and junior medical personnel is formed in the sanatorium in accordance with the recommended staff.

15. To ensure the activities of the sanatorium, administrative, financial, economic, technical personnel, personnel for conducting educational, cultural events, for ensuring the protection of public order, for the prevention and elimination of possible emergencies are also formed.

The states of the sanatorium are approved by the head of the sanatorium, depending on the need and the amount of work performed, taking into account the current standards of working hours and loads.

16. The sanatorium exists on the funds of the federal, regional or local budget or on funds received from the sale of vouchers.

17. The sanatorium provides sanatorium-resort and rehabilitation treatment (treatment) of patients immediately after inpatient and outpatient treatment, medical rehabilitation of patients and disabled people with the consequences of injuries, operations, chronic diseases, including those affected by accidents at work and occupational diseases, improvement of practically healthy individuals and persons at risk (hereinafter referred to as sanatorium-and-spa treatment), as well as measures to promote a healthy lifestyle among patients of the sanatorium, the introduction of new health-improving, rehabilitation and preventive technologies, internal quality control of sanatorium-and-spa treatment, its compliance with recommended standards health resort care, maintaining accounting and reporting medical documentation in the prescribed manner, analysis of the work of the sanatorium, organization of professional development of medical and paramedical personnel.

18. The selection and referral to sanatorium-resort treatment of citizens, the determination of medical indications and contraindications for sanatorium-resort treatment, the volume and conditions for the provision of sanatorium-resort care, as well as the duration of stay in a sanatorium, depending on the disease, are carried out in the prescribed manner.

19. Sanatorium-resort treatment may be provided to citizens with accommodation and meals in a sanatorium (sanatorium-resort care) or without accommodation, without accommodation and meals in a sanatorium (outpatient care).

20. For the implementation of the tasks provided for by this provision, the sanatorium is entrusted with:

A) ensuring the correct diagnosis and qualified treatment of patients in accordance with modern requirements of medical science and approved medical technologies developed and recommended by specialized research institutions of the Ministry of Health and Social Development and approved by Roszdravnadzor for use;

B) organization of proper cultural and consumer services for patients;

C) carrying out preventive measures and sanitary and educational work, both among patients and among attendants;

D) study of the immediate results of sanatorium treatment of patients;

E) provision of measures to improve the professional qualifications of medical, paramedical and service personnel.

21. Works (services) of the sanatorium for the provision of sanatorium-resort or outpatient-resort care are issued, respectively, with a sanatorium-resort voucher or a course.

22. Internal regulations, job duties of employees are established by the head of the sanatorium.

23. Fire and sanitary and epidemiological measures are provided by the administration of the sanatorium in accordance with the regulatory legal acts in force in these areas of activity.

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

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

When organizing sanatorium-and-spa treatment, therapeutic nutrition is part of complex therapy.

Federal Law No. 323-FZ of November 21, 2011 “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” (as amended on July 3, 2016), Article 39 “Healthy Nutrition”:

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

Clinical nutrition should be organized in accordance with the norms of therapeutic nutrition and the requirements of Russian legislation for the organization of dietary therapeutic and dietary preventive nutrition.

New requirements

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

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

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

(8) Order of the Ministry of Health of the Russian Federation of 05.08.2003 No. 330 “On measures to improve therapeutic nutrition in medical institutions of the Russian Federation” (registered by the Ministry of Justice of the Russian Federation on September 12, 2003, registration No. 5073), as amended, introduced by orders of the Ministry of Health and Social Development of the Russian Federation dated October 7, 2005 No. 624 (registered by the Ministry of Justice of the Russian Federation on November 1, 2005, registration No. 7134), dated January 10, 2006 No. 2 (registered by the Ministry of Justice of the Russian Federation January 24, 2006, registration No. 7411), dated April 26, 2006 No. 316 (registered by the Ministry of Justice of the Russian Federation on May 26, 2006, registration No. 7878) and by order of the Ministry of Health of the Russian Federation dated June 21, 2013 No. 395n (registered by the Ministry of Justice of the Russian Federation on July 5, 2013, registration No. 28 995).

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

Six standard diets

Cancellation of old norms

features of the application of legal documents

Purpose of diets

Specialty Products - Order Requirement

Vitamins in the diet

Individual therapeutic nutrition program

Drawing up an individual program

Summary

Rice. one. Standard diets used in sanatorium and resort organizations

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

Table 1. Diet Prescribing (Part 1)

Table 1.2. Diet Prescribing (Part 2)

Layout card No. 5.4

Name of the dish: cottage cheese casserole with sugar with the addition of a dry protein composite mixture (SBCS) 9 g
Indicated for diets: ATS, ShchD, IAP, VKD, NKD
Weight of the finished dish (g): 110

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

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

4916 0

The selection of persons in need of sanatorium treatment is carried out by the attending physician and the head of the department of the medical institution (hospital, polyclinic, antenatal clinic, dispensary, medical unit) in which the patient is treated. In their work, they are guided by the “Procedure for Medical Selection and Referral of Patients to Sanatorium and Resort Treatment”, approved by Order of the Ministry of Health and Social Development of the Russian Federation dated November 22, 2004 No. 256.

When deciding whether to send patients to a sanatorium, the attending physician must take into account the requirements of the Guidelines (“Medical indications and contraindications for sanatorium treatment of adults and adolescents”) approved by the Ministry of Health of the Russian Federation on December 22, 1999 No. 99/227. They also define general contraindications that exclude the direction of sick adults and adolescents to resorts and local sanatoriums.

These include the following states:
1. All diseases in the acute stage, chronic diseases in the acute stage and complicated by an acute purulent process.
2. Acute infectious diseases before the end of the isolation period.
3. All sexually transmitted diseases in acute and contagious form.
4. All blood diseases in the acute stage and the stage of exacerbation.
5. Cachexia of any origin.
6. Malignant neoplasms (after radical treatment with a generally satisfactory condition, no metastasis, normal peripheral blood counts, patients can only be referred to local sanatoriums for general strengthening treatment).
7. All diseases and conditions requiring inpatient treatment, including surgical intervention, all diseases in which patients are not capable of independent movement and self-care, require constant special care (except for persons to be treated in specialized sanatoriums for spinal patients) .
8. Echinococcus of any localization.
9. Frequent or profuse bleeding.
10. Pregnancy at all times - for balneological and mud resorts, and for climatic resorts - starting from the 26th week.
In addition, during all periods of pregnancy, it is impossible to send residents of the plains to mountain resorts located at an altitude of more than 1000 m above sea level.
11. All forms of tuberculosis in the active stage - for any resorts and sanatoriums of a non-tuberculosis profile.

When deciding on the appropriateness of treatment at resorts, it is necessary to take into account the patient's concomitant diseases, which should not be a contraindication for referral to this sanatorium, the contrast of climatic and geographical conditions, the features of the hydro-mineral resources of the resort and the severity of the move for the patient. In the presence of a serious illness or short periods of rehabilitation, the direction of patients is shown mainly to local sanatoriums.

If there are indications and no contraindications for sanatorium treatment, the patient is issued a certificate for obtaining a voucher (form 070 / y-04), approved by Order of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004 No. 256 (Appendix 2), in which it should be indicated using the code region of residence and, if necessary, the nearest region; climate and climatic factors in the place of residence; diagnosis, which is the basis for referral to a sanatorium, diagnosis - the cause of disability (if any), concomitant diseases; recommended treatment, preferred treatment site and recommended seasons. For persons entitled to receive a package of social services, the darkened field (clauses 8-13) of the certificate is filled in and marked with the letter “L”. The certificate is valid for 6 months from the date of issue. The certificate is a medical basis for obtaining a voucher, is preliminary informational in nature and is issued to the patient for presentation at the place where the voucher was provided, where it is stored for three years.

Having received a voucher, the patient is obliged not earlier than 2 months before the start of its validity to come to the attending physician who issued the certificate for obtaining a voucher to conduct the necessary examination, which includes a clinical blood and urine test, ECG, chest x-ray (FLG) , consultation of an obstetrician-gynecologist (for women). In necessary cases, special studies and consultations of specialists are carried out to clarify the diagnosis of the underlying and concomitant diseases.

Based on the medical examination data, the attending physician fills in and issues to the patient a sanatorium-and-spa card (form 072 / y-04), approved by order of the Ministry of Health of the Russian Federation of November 22, 2004 No. 256 (Appendix 3), signed by him and the head of the department. It reflects complaints, anamnesis, examination data of specialists, results of analyzes and instrumental studies, a diagnosis - for the treatment of which they are sent to a sanatorium, the cause of disability (if any), concomitant diseases. For persons entitled to receive a package of social services, the darkened field (clauses 8-13) of the sanatorium card (clauses 6-11) is filled in and marked with the letter "L".

When a patient enters a sanatorium, he presents a completed voucher, passport, compulsory medical insurance policy and a sanatorium card. Based on the initial and subsequent in-depth examination, the doctor fills in the medical history and issues a spa book, in which he notes the order and sequence of the procedures, the necessary motor regimen and diet.

Upon completion of the course of sanatorium-resort treatment, the patient is issued a return coupon of the sanatorium-resort card and a sanatorium book with data on the treatment carried out in the sanatorium-resort organization, its effectiveness, recommendations on the mode of work, nutrition and rest for presentation to the medical institution that issued the sanatorium - a resort card or an outpatient clinic at the place of residence of the patient after completion of the aftercare course. Reverse coupons of sanatorium-and-spa cards are filed into the medical card of an outpatient.

The terms of sanatorium treatment in accordance with the letter of the Ministry of Health of Russia dated 08.10.1997 No. 2510 / 7551-97-23 are 24 calendar days in sanatoriums of all-Russian significance, and 21 calendar days in local sanatoriums.

For the treatment of some categories of patients, longer periods of treatment have been established in highly specialized sanatorium-resort institutions (in accordance with the resolution of the Executive Committee of the Council of the Federation of Independent Trade Unions of Russia dated 16.06.1992 No. 6-7, agreed with the Ministry of Health and Medical Industry of the Russian Federation): in sanatoriums (departments) for the treatment of patients with diseases and consequences of spinal cord injuries - 45 days; with inflammatory diseases of the kidneys - 36 days; with occupational respiratory diseases - 45 days; with occupational lung diseases (pneumoconiosis, silicosis) - 30 days.

Martsyash A.A., Lastochkina L.A., Nesterov Yu.I.