Contract with a medical institution for medical care. The contract for the provision of paid medical services includes a specific court to resolve disputes

The concept of medical services implies a procedure or procedures in which the client (patient) comprehensive assistance is provided, including the diagnosis of diseases, their prevention and treatment.

They also include rehabilitation Events.

According to the current legislation, any citizen has the right to use medical services that provide both free, so on paid basis.

The latter type can be paid from the patient's personal budget or at the expense of his employer.

Rendering rules

Medical services are provided in accordance with the current government decree dated 04.10.2012 number 1006. According to this document, paid medical services are rendering medical care on a reimbursable basis.

The list of these services that a medical organization can provide should not contradict the licenses. In other words, a clinic dealing with the treatment of the musculoskeletal system, at the request of the client, will not fill the problem tooth.

The concept of an agreement

The regulation of the concept of a contract for the provision of paid services implements the same legislative norms as regulate other contracts, the meaning of which is to provide services on a reimbursable basis.

Based on the articles of the Civil Code of the Russian Federation, it turns out that after the conclusion of the contract in question, the customer undertakes to perform a certain list of actions and activities, directions for meeting requirements by the performer.

Contract for the provision medical services recognized public.

The parties to the agreement are:

• customer. He is represented natural or legal person. He concludes an agreement with the contractor for the provision of medical services in favor of the consumer;
• executor. Specific medical organization;
• consumer, or patient. This is the person to whom the activity of the medical organization is directed to fulfill the terms of the contract.

This agreement imposes certain obligations on all its participants. The subject of the agreement is medical service procedure.

If an organization is in a good position to provide the required care to a patient, by law it not entitled to refuse from its provision.

In the event that this happens, the latter may apply to the court, presenting demands and forcing the medical institution to duly fulfill its obligations, as well as pay the due penalty for damage caused by the refusal to conclude the contract.

In addition, any organization not allowed to prioritize. That is, she cannot conclude an agreement with one person, refusing to do so to another. These rules are governed by paragraph 3 of Article 426 of the Civil Code of the Russian Federation.

Civil Code of the Russian Federation. Article 426. Public contract

1. A public contract is a contract concluded by a person engaged in entrepreneurial or other income-generating activities, and establishing his obligations to sell goods, perform work or provide services that such a person, by the nature of his activity, must carry out in relation to everyone who applies to him ( retail, transportation by public transport, communication services, energy supply, medical, hotel services, etc.).

   A person carrying out entrepreneurial or other income-generating activities shall not have the right to give preference to one person over another person in relation to the conclusion of a public contract, except in cases provided for by law or other legal acts.

2. In a public contract, the price of goods, works or services must be the same for consumers of the corresponding category. Other conditions of a public contract cannot be established based on the advantages of individual consumers or giving them preference, except in cases where the law or other legal acts allow the provision of benefits to certain categories of consumers.
3. The refusal of a person engaged in entrepreneurial or other income-generating activities to conclude a public contract, if it is possible to provide the consumer with the relevant goods, services, to perform the relevant work for him, is not allowed.

   In case of unjustified evasion of a person engaged in entrepreneurial or other income-generating activities from concluding a public contract, the provisions provided for by paragraph 4 of Article 445 of this Code shall apply.

4. In cases provided by law, the Government Russian Federation, as well as federal executive bodies authorized by the Government of the Russian Federation, may issue rules binding on the parties when concluding and executing public contracts (standard contracts, provisions, etc.).
5. The terms of a public contract that do not meet the requirements established by paragraphs 2 and 4 of this article are void.

When is it necessary?

Before signing the contract in question, its executor obliged to writing warn patient that non-fulfillment or improper fulfillment of the recommendations and requirements of one or more doctors who are employees of a particular medical organization, as well as avoiding the requirements for the prescribed course of treatment, may cause medical service will not be provided on time and/or the patient's health will deteriorate.

The contract for the provision of paid medical services is concluded before the start of measures aimed at treating the patient.

At the request of a client of a medical organization, its employees must provide comprehensive information about what services this institution provides, the procedure for performing this action.

It is also their responsibility to talk about the standards related to the provision of paid medical services. Besides, the patient has a right to know about:

• doctor involved in his treatment. The information in this case may relate to his name, age, work experience, skills and other similar information;
• treatment. The patient has the right to demand to be told about ways and methods used in the treatment in this institution; what risks may arise in this case and what consequences in this case are; what to expect after carrying out the necessary measures aimed at providing medical care;
• other information directly related to the subject matter of the contract.

Contracts for the provision of medical services.

What does it contain?

As already noted, a contract for the provision of paid medical services can be concluded only in writing. In addition, it must contain the following information about the contractor of the contract:

In the presence of customer The contract is made in triplicate. If it is only between patient and performer— then two.

Required and optional items

Contract for the provision of paid medical services in without fail should contain the list of services, which at the same time corresponds to the issued license for the conduct of such activities to the institution and meets the needs of the client.

It also contains:

• information related to assigned task for the performance of medical services;
• payment schedule, according to which the patient is obliged to pay for the medical services provided to him.

Other required items are listed in the previous section.

As optional items references are made to annexes to the treaty, which may include:

Contracts for the provision of paid dental services.

Contracts for the provision of medical services "Pre-trip inspection".

Validity

The term of the contract is determined by how much time the medical institution needs to carry out the necessary measures to provide the required medical care. The contract cannot be considered fulfilled if expiry date if the course of treatment is not carried out to the end.

"Underwater rocks"

The medical institution is not entitled to provide Additional services for a fee if patient vs. this.

If during the provision of medical services in accordance with the contract a situation has arisen in which the patient urgently needs assistance due to the threat to his life arising from unexpectedly exacerbated diseases, then assistance is provided free of charge.

In such cases, the requirements medical institution pay their expenses contrary to existing law in the field of protection and protection of the health of citizens of the country.

A patient who has used the paid services of a medical organization has the right to apply petition to tax authority for deduction from personal income tax (PIT).

Service cost

How is the cost determined?

According to the second paragraph of Article 426 of the Civil Code of the Russian Federation, when determining the cost of medical services, the relevant institution not allowed to install different prices for citizens belonging to the same category.

This also follows from the definition of the concept of "public contract". But the legislation provides for a change in value in the event that the consumer of these services is a person endowed with certain benefits, the list of which is approved by the government and the president of the Russian Federation.

The cost of services of organizations that are subordinate government agencies, is determined by the latter. Medical institution of any other form of organization has the right to set prices for the services they provide.

Summary

Summarizing the above, we can say that this agreement provides certain protection to all its participants: the medical institution will receive appropriate payment for the work performed, and the patient will receive proper care according to his requirements.

Without the conclusion of such an agreement, a medical organization may suffer serious losses. after the necessary steps have been taken. The patient, in turn, is threatened with harm to his health.

in a person acting on the basis of , hereinafter referred to as " Executor", on the one hand, and a citizen, passport (series, number, issued) residing at the address, hereinafter referred to as " Customer”, on the other hand, hereinafter referred to as “ Parties”, have concluded this agreement, hereinafter referred to as the “Agreement”, as follows:

1. THE SUBJECT OF THE AGREEMENT

1.1. The Contractor undertakes to provide the Customer with the medical services specified in Appendix No. 1, which is an integral part of this agreement.

2. COST AND PAYMENT PROCEDURE

2.1. Approximate cost of services under the contract in accordance with preliminary plan treatment according to the price list of the Contractor is rubles.

2.2. The amount indicated in paragraph 2.1 is preliminary. The final cost is determined after the end of the treatment in accordance with the Contractor's price list and the actual volume of services rendered to the Customer.

2.3. In the event that the Customer pays a lump sum pre-established amount of 100% immediately after signing the contract, he is provided with a discount in the amount of % of the approximate amount of the contract specified in clause 2.1.

2.4. Payment can be made by the Customer in stages:

• 1st visit - % of the contract value;
• 2nd visit - % of the contract value;
• 3rd visit - % of the contract value;

In the case of a phased payment for services under the contract, the discount is not provided.

2.5. The cost of services may be changed by the Contractor due to inflation, expansion of the scope of services. If necessary, for the provision of high-quality medical services, the performance of work not provided for by the contract, they are performed with the consent of the Customer with payment in accordance with the price list of the Contractor.

2.6. Payment is made in cash.

3. TERMS OF PERFORMANCE OF OBLIGATIONS

3.1. The Contractor will provide the services provided for in clause 1.1 of this agreement within the time frame established by the treatment plan (Appendix No. 2), which is an integral part of this agreement.

3.2. The Agreement is considered to be duly executed upon completion of receipt by the Customer of the last paid service.

4. RIGHTS AND OBLIGATIONS OF THE CONTRACTOR

4.1. The contractor is obliged:

• provide the Customer with a qualified, high-quality medical service in accordance with internal quality standards, within the time period established by the treatment plan (Appendix No. 2);
• provide the Customer with free, accessible, reliable information about the service provided;
• obtain informed voluntary consent of the Customer for medical intervention.

4.2. The performer has the right:

• in the event of emergency conditions, independently determine the scope of studies, manipulations, surgical interventions necessary to establish a diagnosis, examination and provision of medical care, including those not provided for by the contract;
• suspend the provision of the service if, in the process of fulfilling obligations, it becomes clear that a negative result is inevitable or that further performance of the service is inappropriate - in this case, the parties are obliged to consider within a day the issue of the advisability of further provision of medical services under the contract;
• unilaterally refuse to fulfill obligations under this agreement in the event that the Customer's actions make it impossible to perform the medical service in general or of proper quality, namely:
  1. violation of the treatment plan;
  2. diet violation;

5. RIGHTS AND OBLIGATIONS OF THE CUSTOMER

5.1. The customer is obliged:

• follow the treatment plan (Appendix No. 2);
• pay for the services of the Contractor in the amount and within the time specified in the contract;
• inform the Contractor before the start of the provision of medical services about past and concomitant diseases and complications, allergic reactions known to him and contraindications;
• strictly and accurately follow the doctor's prescriptions;
• inform about the change in the scheduled date of the doctor's visit no later than 24 hours before it;
• pay the cost of the Contractor's services in full, if the impossibility of fulfilling the contract arose due to the fault of the Customer, namely:
  1. violation of the treatment plan;
  2. violation of the regime of ongoing procedures;
  3. diet violation;
  4. alcohol abuse, drugs etc.

5.2. The customer has the right:

• to provide information about the medical service;
• familiarization with the documents confirming the doctor's qualifications and the availability of the necessary permits and licenses for the provision of medical services by the Contractor;
• to receive information about their health status, as well as to choose the persons to whom, in the interests of the Customer, information about his health can be transferred.

6. INFORMATION ABOUT THE SERVICE PROVIDED

6.1. The medical service provided is:

6.2. The medical service is not provided if the Customer has acute inflammatory diseases.

6.3. Before providing a medical service, the doctor establishes the absence of contraindications, examines the Patient: .

6.4. Service duration minutes;

6.5. Service provided by a doctor qualification category certified specialist.

6.6. Taking into account the very technology of medical services, the Customer must know and be aware of the likelihood, but not the necessity of harmful (side) effects of medical intervention and complications that can harm the health of the Customer.

6.6.1. Main possible side effects: .

6.6.2. The main possible side complications:, the possibility of an onset in an average of % of cases.

6.7. Due to the fact that the above in paragraphs. 6.6.1. and 6.6.2. side effects and complications arise due to the biological characteristics of the body, and the technology used to provide medical care cannot completely exclude the possibility of their occurrence. The Contractor is not responsible for the onset of complications if the medical service was provided in compliance with all necessary rules and requirements.

6.8. In the event that complications require urgent medical care, the Contractor provides such assistance at no additional charge.

6.9. The customer confirms that he is familiar with additional information concerning the medical service and the conditions for its provision, posted on the information stand medical center Contractor.

7. RESPONSIBILITIES OF THE PARTIES

7.1. In case of impossibility to fulfill obligations due to the fault of the Customer, the cost of the Contractor's services is payable in full.

7.2. In the event that the impossibility of fulfilling obligations arose due to circumstances beyond the control of the parties, the Customer shall reimburse the Contractor for the expenses actually incurred by him.

7.3. The Contractor shall be released from liability for non-fulfillment or improper fulfillment of its obligations under this agreement, if this happened due to force majeure circumstances, violation by the Customer of its obligations or in other cases provided for by the legislation of the Russian Federation.

7.4. The Customer is obliged to fully compensate the Contractor for the losses incurred if the Contractor was unable to provide services or was forced to stop providing them due to the fault of the Customer.

8. OTHER TERMS

8.1. All disputes and disagreements between the parties are resolved through negotiations, in case of failure to reach an agreement - in judicial order, in accordance with the legislation of the Russian Federation.

8.2. Prior to the appeal of the parties to the court, a mandatory claim procedure for considering the dispute is established. The term for consideration of claims is days.

8.3. In order to apply to the court regarding the quality of the medical services provided, the parties agreed to conduct independent expertise quality of medical care.

8.4. This agreement comes into force from the moment of its signing by the parties and is valid until the parties fulfill their obligations.

The contract for the provision of paid medical services refers to paid contracts of a civil law nature, as expressly stated in paragraph 2 of Art. 779 of the Civil Code of the Russian Federation. Thus, it carries in its structure the main features inherent in any other contract for the provision of services. We understand the features of drawing up a contract for the provision of paid medical services in the article.

The contract for the provision of paid medical services as a paid contract of a civil law nature

Art. nine federal law"On the Enactment of Part Two of the Civil Code of the Russian Federation" establishes a rule common to all types of civil law contracts.

Use in your work a sample contract for the provision of paid medical services. The download is available to registered users.

According to it, in cases where one of the parties to the obligation is a citizen using, acquiring, ordering or intending to purchase or order goods (works, services) for personal household needs, such a citizen enjoys the rights of a party to the obligation in accordance with the Civil Code of the Russian Federation , as well as the rights granted to him by the Law "On Protection of Consumer Rights" and other legal acts issued in accordance with it.

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Contract for the provision of paid medical services - parties to the contract

The main requirements for the Contract for paid medical services (a sample can be downloaded above) are contained in the Rules for the provision of services approved by the Government of the Russian Federation medical organizations paid medical services dated 04.10.2012 No. 1006.

An agreement for the provision of paid medical services between a medical institution and a patient is concluded in writing (clause 16 of the Rules). The parties to the PMU Agreement include:

• medical organization licensed for the relevant type of activity (executor)
• consumer (patient) - an individual who directly receives (intends to receive) a medical service.

Also, a customer can act as a party to the contract - an individual or legal entity ordering / paying for a service for a consumer (for example, in the case of a minor or incapable person receiving a paid medical service).

Requirements for the execution and content of the contract for the provision of paid medical services by a medical organization

The rules state that each party must receive a copy of the agreement. The presence of signatures of all counterparties in the document is mandatory (clauses 17, 18 of the Rules). That is, according to paragraph 4 of Art. 434 of the Civil Code of the Russian Federation, an agreement for the provision of paid medical services is drawn up as a document signed by all its participants.

However, the jurisprudence contains a different conclusion. So, for example, the requirement to have the number of copies of the agreement according to the number of participants does not indicate the obligation to draw up this agreement as one document signed by the parties. In particular, the written form of the contract is considered to be complied with in case of acceptance of a public offer by signing by the patient (legal representative for a minor and / or incapacitated citizen) an application (decree of the 9th AAC dated 01/23/2017 in case No. A40-139802 / 2016).

Given that the contract for the provision paid medical services is paid, one party (executor) undertakes to provide services to the other party (customer), defined by the treaty and the other party undertakes to pay for these services. The terms, place of service provision and payment procedure are also stipulated in the relevant clauses of the contract. It also specifies the duration of the contract.

Prior to the entry into force of the Rules (until 01.01.2013), which fixed the written form of the contract for paid medical services, there was arbitrage practice with the opposite position: in relation to the performer - individual entrepreneur– an oral form of a transaction for the provision of medical services was allowed (decision of the Arbitration Court of the Republic of Komi dated February 25, 2013 in case No. A29-10947 / 2012).

The contract for the provision of paid medical services by a medical organization must also include the following items (clause 17 of the Rules):

Regarding the performer:

1. name of the medical institution (organization providing medical services to the population), its location, data of the document on registration in the Unified State Register of Legal Entities and information about the registering authority - for the organization;
2. Full name, address of the place of residence and address of the place of business, data of the document on registration in the USRIP - for an individual entrepreneur;
3. information about the license to carry out activities, indicating the list of services and data of the licensing authority.

Regarding the customer:

1. individual and consumer: full name, address, phone
2. legal entity: full name, details and legal address.

Mandatory clauses of the contract for paid medical services

Also, the PMU Agreement must contain the following items:

1. The list of specific services provided in accordance with the contract, the conditions and terms of their provision. As a rule, the contract is drawn up in a standard form, and the terms for the provision of services, their complete list is drawn up separate document(for example, an application for the provision of services, additional agreement or other document) which is an integral part of the contract. In this case, a reference to such a document is required in the text of the contract.

As a rule, the clauses of the contract in this case look like this: “The list of services to be provided by the Contractor is determined by the Patient (Legal representative) independently in accordance with the “Price List of Medical Services” and is indicated in [here should be the name of the document that specifies the list of services and their price - “Document”], which are drawn up at each request of the Patient for the provision of medical services. [Document] is an integral part of the Agreement. The terms for the provision of medical services are provided for by the “Price List of Medical Services” valid at the time of the conclusion of the Agreement and ordering services and are reflected in the [Document]”.

1. The cost of services, the procedure and terms of payment. As a rule, the procedure for paying for the services rendered is specified in the contract, and the actual amount payable is entered in a separate document (see the previous paragraph).
2. Terms of liability, modification and termination of the transaction, given by the representatives of the contractor signing the agreement.

Given that, according to paragraph 4 of Art. 421 of the Civil Code of the Russian Federation, the terms of the agreement are determined by agreement of the parties, other requirements that do not contradict the current legislation may be introduced into the PMU Agreement. However, as practice shows, citizens do not use this right, agreeing to the terms of a standard contract adopted by a particular medical organization.

Violations for which the performer is responsible

It is worth paying special attention to the fact that the absence in the contract of paid medical services of any of mandatory conditions provided by the Rules and Civil Code, is an administrative violation under Art. 14.4 of the Code of Administrative Offenses of the Russian Federation. This is the sale of goods, the performance of work or the provision of services to the population inadequate quality or in violation of the requirements established by the legislation of the Russian Federation (decree of the 11th AAC dated July 21, 2015 in case No. A65-6484 / 2015).

These actions entail the imposition of an administrative fine on the legal entity in the amount of 20,000 to 30,000 rubles.

It is unlawful to include in the agreement conditions that infringe on the rights of the consumer (part 2 of article 14.8 of the Code of Administrative Offenses of the Russian Federation, resolution of the 13th AAS dated December 12, 2016 in case No. A26-5443 / 2016), or a violation of the consumer's rights to receive the necessary and reliable information about sold goods (work, service).

In addition, in the Russian Federation there is a program of State guarantees and other Programs and Standards, according to which a citizen is guaranteed to receive a certain amount of medical care (services) free of charge (at the expense of compulsory medical insurance). Thus, the receipt of a service on a reimbursable basis, if it can be received by the patient free of charge, must be voluntary and conscious.

You may be interested

The inclusion in the contract of paid medical services of a clause that the customer/consumer is informed that a specific medical service can be received by him under the State Guarantees Program free of charge is highly desirable for inclusion in the PMU Contract. As a rule, this item refers to the section "Responsibilities of the performer." It is written in the document as follows: “The Contractor is obliged to provide the Patient with free, accessible and reliable information about paid medical services, containing information about 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; on the Procedure for the Provision of Medical Assistance and the Standards of Medical Assistance Used in the Provision of Paid Medical Services.

Inform the customer that a specific medical service can be obtained under the CHI program if the clinic is included in this program.

It should be noted that the consumer has the right to choose the service provider. This norm is enshrined both in the Law on the Fundamentals of Protecting the Health of Citizens in the Russian Federation and in the Law on the Protection of Consumer Rights. Thus, for inclusion in the contract of paid medical services, the obligation of the Contractor to provide reliable information is indispensable "about a specific medical worker providing medical services under the Contract, his qualifications, mode of work."

The Contractor is obliged to inform the Consumer "about the methods of providing a medical service associated with the risks of possible types of medical intervention and the expected results of the medical service, other information and information in accordance with the current Russian legislation in the direction."

The information listed in the above paragraphs regarding the risks and methods of providing services, guarantee programs for understanding requires special knowledge. Therefore, in practice, after a conversation with the attending physician (in this case, the Contractor's representative responsible for the provision of the service), the patient signs the appropriate document, which indicates that he (the patient) had the opportunity to ask any questions of interest to him and received exhaustive answers to them. answers in a form that he can understand.

As a rule, such a document is called "Informed voluntary consent to medical intervention", and its main attributes are specified in Art. 20 of the Law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation". Such consent is preliminary, that is, it is signed by the patient before the counterparties begin to fulfill their obligations under the contract for paid medical services.

On confidentiality in the contract for the provision of paid medical services to individuals and legal entities

Information about any request for medical care, the nature of the disease and treatment, other information related to the health of the patient and became known to the Contractor in the course of concluding and executing a contract for the provision of paid medical services to individuals and legal entities constitutes a medical secret. In accordance with Art. 13 of the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”, disclosure of medical confidentiality is allowed only with the written consent of the patient or in other cases, an exhaustive list of which is available in paragraph 4 of this article.

In view of the foregoing, the inclusion in the PMU Agreement of a clause on the observance of medical secrecy is not necessary, since such observance is stipulated by law, but it is desirable. For example, in the "Confidentiality" section, it is additionally worth paying attention to the following paragraph: "the information contained in the Patient's medical documents may be provided by the Contractor without the consent of the Patient only on the grounds provided for by the current legislation of the Russian Federation."

Law on the protection of consumer rights in relation to the contract for the provision of paid medical services

Taking into account that according to the Federal Law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation", a patient who applied for medical care nevertheless receives a medical service (clauses 3-4 of article 2 of the said law), that is, is a consumer, it should be said that the norms of the Law on the Protection of Consumer Rights apply to legal relations under the Contract for Paid Medical Services.

So, when making an agreement, the clinic must provide the patient with information about himself in accordance with the Rules. This is, among other things, information about the license and the general list of services provided with prices and terms of their provision. As a rule, these documents are very voluminous and their application to the contract is difficult. Rospotrebnadzor, in its letter dated 03/08/2016, explained that copies of the license and all price list the contractor should not be attached to the contract. As a rule, these documents are freely available in institutions and anyone can familiarize themselves with them.

In addition, the contract for the provision of paid medical services is public (Article 426 of the Civil Code of the Russian Federation). Therefore, the price of services for all consumers should be the same. An unmotivated refusal of the contractor to execute a transaction with a citizen is also prohibited. Failure to conclude an agreement with a patient if the performer has the opportunity to provide a service is considered an administrative offense under Art. 14.4 of the Code of Administrative Offenses of the Russian Federation.

As a rule, a medical organization draws up a standard contract for the provision of a medical service that contains the items listed above, and the actual services paid by the customer, as well as their total cost, are listed in an annex to the contract. In the same applications, as a rule, the terms for the performance of services are also reflected.

What is "medical services of inadequate quality"

Particular attention should be paid to such a concept, provided for by the Consumer Protection Law, as “medical services of inadequate quality”. In accordance with Art. 4 of the Law "On Protection of Consumer Rights" the consumer has the right to provide medical services of adequate quality. Clause 1 of this article states that the quality of goods, works or services must comply with the contract. If the terms of quality are not regulated in the contract, it (quality) must comply with the usual requirements for services of this kind (clause 2, article 4 of the Law).

Unfortunately, the Rules do not contain criteria that determine the quality of a medical service, and this vague wording does not make it possible to unequivocally say whether medical services meet the usual requirements, since such requirements do not actually exist.

To some extent, the issue of the quality of medical services is resolved in clause 5 of the Rules, which explains that medical services must comply with the diagnostic and treatment methods used in the territory of the Russian Federation. As a rule, experts are involved in the role of arbitrators in disputable situations, who rely on the relevant Clinical recommendations (a collection of algorithms for diagnosis and treatment) for a certain group of diseases. However, the issue of the quality of medical services is currently not fully regulated by law and judicial practice on this issue is ambiguous.

Safety of medical services

Article 7 of the Law "On Protection of Consumer Rights" provides for the right of consumers to the safety of medical services. In accordance with this provision, the consumer of medical services must be informed about the presence of contraindications for the use of medicines, medical devices or certain methods of diagnosis and treatment. Such information must be preliminary, that is, the relevant information must be communicated to the consumer before the provision of the relevant medical services, since the decision on whether to give consent to the relevant medical intervention or not depends on this.

As a rule, these points for ensuring the safety of medical services are stipulated in separate documents not related to the PMU Agreement. These are, for example, Informed voluntary consent to medical intervention and refusal of medical intervention (Article 20 of the Federal Law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation").

In the PMU Agreement, in the section “Patient Responsibilities”, it is desirable to include the following paragraph “The patient is obliged to inform the authorized medical worker of the Contractor about diseases, contraindications to taking any medications or procedures, allergic reactions known to him, and report any changes in his state of health. The patient is also obliged to comply with all requirements, recommendations of the Contractor's medical staff, including for the agreed period after the provision of medical services.. In the latter case, such recommendations are drawn up in the form of a discharge summary or other document, which specifies the recommendations themselves and the terms for their observance.

In addition, it should be taken into account that the medical service has a very changeable substance under it - human health, the change of which is complexly influenced by many factors. Therefore, it is necessary to take into account this influence in order to achieve the optimal result and, if possible, neutralize their negative influence.

From the point of view of medicine, the patient himself plays a huge role in this process. And to ensure the safety of the provision of medical services, it is good for the Contractor to insure with a clause in the contract as follows: “The patient confirms that he was notified by the Contractor that non-compliance with the instructions (recommendations) of the Contractor ( medical worker), including the prescribed treatment regimen, may reduce the quality of the medical service provided, make it impossible to complete it on time, or adversely affect the Patient's health status, as well as the quality of medical services.

Given the above, the PMU Agreement often includes a clause that relieves the contractor of liability in the event of incomplete or inaccurate indication by the customer/consumer of information about himself.

Example: “The signing of this Agreement by the Patient indicates that the Patient has received from the Contractor complete, known to the latter, information about his state of health, the presence of a disease, diagnosis, method of treatment, risks associated with it, options medical intervention, their consequences, the results of treatment, diagnosis. By signing this agreement, the Patient undertakes to inform the Contractor of all reliable information known to the Patient about the state of his health, to fully and truthfully answer the questions of the Contractor's representatives regarding the Patient's health. Judicial practice on this issue, unfortunately, is currently insufficiently formed.

Errors in the contract for the provision of medical services

Let's analyze the most common mistakes that are found in the contract for the provision of paid medical services.

The contract does not specify the period for the provision of medical services

Often there is a substitution of terms - the time of rendering medical services both the term of the contract and the clinic believe that the latter can be limited. Meanwhile, according to the requirements of the law, it is necessary to designate exactly the period for the provision of medical services (subparagraph “e” of paragraph 17 of the Rules for the provision of paid medical services by medical organizations, approved by Government Decree No. 1006 of 04.10.2012).

Note that there is no information in the legislation on how to designate these terms in the document. You can go two ways:

1. The period for the provision of medical services is prescribed directly in the contract. This option is suitable if a new contract is created with a client for each service. Although situations of this kind are not common, especially if the client came to a multidisciplinary center for two or three services;
2. Conclude a framework agreement, and required list services, their cost and time, specify in the accompanying documents - applications.

The document sometimes contains the item "The list, time and cost of medical services provided are approved by the parties in the treatment plan." If there is such a clause, a treatment plan must be included in the contract for the provision of medical services. Make it in several copies - for the clinic, the patient and the customer, if it is concluded by a third party.

List of medical services not specified

Some multidisciplinary centers indicate in the contract for the provision of paid medical services that assistance will be provided to him in accordance with the types of activities from the license. However, in many cases, the patient will not receive all the services listed in the clinic's license. Legislatively, the contract must include a list of services individually for each patient (subclause “c”, clause 17 of Regulation No. 1006). This can be done not only in the contract for the provision of paid medical services, but also in the annex to the document.

In the absence of a list of services in the contract, the client of the clinic may report that the contract has no legal force. In fact, he has the right to demand the money back. At the same time, the client does not need to refute the entire document, it is enough to state that a number of services are not agreed with him, which means that he is not obliged to pay for them.

The contract for the provision of paid medical services includes a specific court to resolve disputes

The clinic makes a provision in the contract for the provision of paid medical services, according to which any disputes under this contract will be considered in court according to location of the clinic. Often such an item is included if the patient is not local, and the medical institution does not plan additional expenses for the court. Accordingly, when signing the paper, the representative of the clinic can submit everything so that the client himself agreed to change the jurisdiction.

However, jurisprudence proves the right to choose a court for the client, even if he signed the agreement under the reverse approval (part 7 of article 29 of the Code of Civil Procedure, article 17 of the Law of 07.02.1992 No. 2300-1 "On Protection of Consumer Rights") .

If the contract contains a clause on jurisdiction, the clinic faces administrative liability.

Important information is missing from the health care contract

The document should include not only data on the time, the list of services and their cost. Mandatory requirements- entering into the contract for the provision of medical care information about the medical organization, the client and the customer, if any. In addition, if the clinic operates in CHI system, you need to indicate in the contract that you informed the patient about the option of receiving free medical care.

So, what should be included in the contract for the provision of medical care:

• name and company name (if any);
• address of the location of the clinic;
• information of the document confirming the fact of entering information about the legal entity in the Unified State Register of Legal Entities, and the body that registered the medical company;
• the number of the license for medical activities, the date of its registration, indicating the list of works (services) constituting the medical activities under the license;
• name, location address and telephone number of the licensing authority that issued the license.

Inclusion in the contract of the patient's consent to data processing

Sometimes the clinic includes a clause on consent to the processing of personal data in the contract for paid medical services. The reason is the reduction in the volume of documents that need to be given to the client for signature. However, a significant point is not taken into account here - consent to the processing of personal data is legally enshrined as a patient's right. It is impossible to impute this as a duty, respectively, and also include it in the contract (Article 9 of the Federal Law of July 27, 2006 No. 152-FZ “On Personal Data”).

Consent to the processing of personal data is a separate document. However, if the patient does not sign it, the clinic retains the right to process the data required to fulfill the terms of the contract for paid medical services (clause 5, part 1, article 6 of the Federal Law of July 27, 2006 No. 152-FZ "On Personal Data" ). However, this information may not be used for marketing purposes. Break this law - expect claims not only from the patient himself, but also from the inspectors of Roskomnadzor and Roszdravnadzor.

Restriction of the patient's right to withdraw from the contract

Medical organizations include in the contract with the patient a clause stating that they can fully or partially withhold the advance payment if the client refuses services. Also, the document can be supplemented with the condition that the cancellation of the contract is permissible only before the start of the provision of the service. Meanwhile, the patient has the right to cancel the contract at any time (part 1 of article 782 of the Civil Code, article 32 of the Consumer Rights Protection Law). He will have to compensate only the amount that is associated with the actual expenses of the medical institution.

Each patient has their own compensation amount. It is formed from those costs that arose before the client refused medical care. In the absence of actual expenses, the clinic will have to return the prepayment.

Lack of information about the likely consequences

Once a patient has signed an informed voluntary consent, the clinic believes they have all the information they can about the service. For example, if the patient does not follow the doctor's prescriptions, the result of treatment may be of less quality. However, the IDS is signed after the signing of the contract for the provision of medical services and does not replace the contract. A notice of the consequences of non-compliance with the doctor's instructions must be in paper form and signed by the client.

The agreement can be made a separate document and given to the patient for signature before the conclusion of the contract. It can also be included in the contract for the provision of paid medical services. The main thing is to keep the entire text of clause 15 of Regulation No. 1006, retaining the volume and original wording: “The contractor notifies the consumer (customer) in writing that non-compliance with the instructions (recommendations) of the contractor (medical worker providing paid medical services), including including the prescribed treatment regimen, may reduce the quality of the provided paid medical service, make it impossible to complete it on time, or adversely affect the health of the consumer.

The notice must be included in the contract before the block with the signature of the parties. If you add text after the signatures, representatives of Rospotrebnadzor will consider that the client was informed only after the conclusion of the contract.

The requirements for the contract for the provision of paid medical services are contained in the Rules for the provision of paid medical services by medical organizations dated 04.10.2012 No. 1006 adopted by the Government of the Russian Federation (hereinafter referred to as the Rules). The parties to the transaction are (clause 2 of the Rules):

• A medical organization providing services (executor) is a legal entity or individual entrepreneur. Activities for the provision of medical services require that the person performing it has a special permit - a license.
• A citizen who directly receives services or intends to receive them (consumer/patient).
• A customer who purchases services for a consumer. It can be either an individual or a legal entity.

An example of the participation of a customer as a counterparty under a contract for paid medical services is the following scheme:

• state state-financed organization of health care, within the framework of procurement for state needs, concludes an agreement (state contract) with a medical organization (executor) in favor of patients of this GBUZ, which is indicated in the contract;
• this qualifies as a service in favor of a third party (decree of the 16th AAC of October 28, 2015 in case No. A63-4450 / 2015).
• the patient does not participate in the conclusion of such an agreement.

In turn, a sample contract for the provision of paid medical services, concluded directly with the consumer, will be discussed in the article in more detail and is available for download.

Contract form for the provision of paid medical services

The contract for the provision of paid medical services is concluded in writing (clause 16 of the Rules). It is established that each of the parties has a copy of the agreement in their hands. The presence of signatures of all counterparties in the document is mandatory (clauses 17, 18 of the Rules). Thus, it should be said that a transaction for the provision of medical services is formalized as a single document signed by all its participants (clause 4, article 434 of the Civil Code of the Russian Federation).

However, the jurisprudence contains another conclusion. In particular, the requirement to have the number of copies of the agreement according to the number of participants does not indicate the obligation to draw up this agreement as 1 document signed by the parties. The written form is considered to be complied with when accepting a public offer by signing an application by the patient (decree of the 9th AAC dated 01/23/2017 in case No. A40-139802 / 2016).

It is worth mentioning that before the entry into force of the Rules (until 01/01/2013), which fixed the written form of the contract for paid medical services, there was judicial practice with the opposite position: in relation to the contractor - an individual entrepreneur, an oral form of a transaction for the provision of medical services was allowed (decision of the Arbitration Court of the Republic Komi dated February 25, 2013 in case No. A29-10947 / 2012).

The content of the contract for paid medical services

The contract for the provision of paid medical services in 2018-2019 must include the following conditions (clause 17 of the Rules):

1. Regarding the performer:

• name and companies. name, location, data of the document on registration in the Unified State Register of Legal Entities and information about the registering authority - for the organization;
• Full name, address of the place of residence and address of the place of medical activity, data of the document on registration in the USRIP - for an individual entrepreneur;
• information about the license to carry out medical activities, indicating the list of services and data of the licensing authority.

1. In relation to the consumer and the customer - a citizen: full name, address of residence, telephone.

1. In relation to the customer-legal entity: name and address.
2. The list of specific services provided in accordance with the contract, the conditions and terms of their provision.
3. The cost of services, the procedure and terms of payment.
4. Terms of liability, modification and termination of the transaction, given by the representatives of the contractor signing the agreement.

The parties may agree on other terms of the contract.

IMPORTANT! The absence of any of the mandatory conditions in the contract is a violation under Art. 14.4 of the Code of Administrative Offenses of the Russian Federation - non-compliance with the requirements of the law in the provision of services to consumers (decree of the 11th AAC dated July 21, 2015 in case No. A65-6484 / 2015). It would also be unlawful to include in the agreement conditions that infringe on the rights of citizens (part 2 of article 14.8 of the Code of Administrative Offenses of the Russian Federation, Decree of the 13th AAS dated 12/12/2016 in case No. А26-5443/2016).

Features of the contract for the provision of paid medical services with a patient: sample 2018 - 2019

Earlier it was noted that the parties to the contract for the provision of paid medical services are the contractor, the customer and the consumer. Let's take a closer look at the agreement between the medical organization and the patient directly:

• Legal relations under the contract "executor - citizen" are subject to the rules on the protection of consumer rights. For example, when drawing up an agreement, a medical organization must provide the patient with information about himself in accordance with the Rules. This is, among other things, information about the license and a general list of services with prices and terms of provision. In practice, employees of medical organizations often had the question of the need to attach these very voluminous documents in the form of copies to contracts with patients. On March 8, 2016, Rospotrebnadzor spoke on this topic. In his letter, he explained that copies of the license and the entire price list of the contractor should not be attached to the contract.
• In addition, the “performer-patient” agreement is public (Article 426 of the Civil Code of the Russian Federation). Because of this, the price of services for all consumers should be the same, and an unmotivated refusal of the contractor to complete a transaction with a citizen is also prohibited.
• Failure to conclude an agreement with a patient if the contractor has the opportunity to provide medical services is considered by Rospotrebnadzor as an offense under Art. 14.4 of the Code of Administrative Offenses of the Russian Federation (decision of the Arbitration Court of the Amur Region dated August 22, 2016 in case No. A04-5937 / 2016).

Taking into account the features disclosed in the article, the form of the contract was prepared: Sample contract for the provision of paid medical services with a patient in 2018-2019.

Thus, the article considered the main aspects of the form of the contract for the provision of paid medical services, taking into account the different composition of the participants. The agreement between the contractor and the patient directly differs from the agreement between 2 medical organizations (the contractor and the customer). The first case has a number of features due to the presence of a weak element on the side of the recipient of services - the consumer.

Practicing lawyers of medical organizations are advised to be especially careful when preparing standard contracts with patients and thoroughly check them for compliance with specific industry standards. This is due to increased attention to such transactions by the authorities of Rospotrebnadzor.

Attention! Submitted text is a sample contract for medical care. To make a document according to your conditions use the FreshDoc template: Contract for the provision of medical services.

A contract for medical care is a public contract for the provision of services for a fee, according to which the Contractor undertakes to provide the Customer (patient) with medical services for a certain fee.

Paid medical care for the population is carried out by institutions if they have a certificate and license for the chosen type of activity. State and municipal institutions provide paid medical services with special permission from the relevant health authority.

Individuals and legal entities can act as customers under a medical service agreement, the Contractor is an organization that provides paid medical services. If the customer himself is not a consumer of services, then the contract may contain a third party - a consumer - a patient who personally wants to receive or is already receiving medical care.

Such an agreement is drawn up in a simple written form in 2 copies: one copy remains with the patient, the other - with the Contractor. If a third party appears in the contractual relationship, then it will be necessary to sign 3 copies of the document, one for each of the parties.

Information about medical care provided to the patient before the conclusion of the contract

When concluding a contract, the patient must provide the following information about paid medical services in an accessible form:

• the procedure for providing and standards of assistance used for paid services:
• information about a specific employee providing the relevant paid medical service (his vocational education and qualifications, valid certificates);
• information about the methods of providing medical care, the risks associated with them, possible types of medical intervention, their consequences and expected results.

Also, prior to the conclusion of the contract, the contractor must inform the patient in writing that non-compliance with the instructions of the medical worker, including the prescribed treatment regimen, may reduce the quality of medical care, lead to the impossibility of completing it on time or adversely affect the patient's health.

Structure and content of the contract

1. Date and place of conclusion of the agreement.
2. Names of the parties. This paragraph contains information about the Contractor (name of the organization - a legal entity, location address, data of documents on entering information into the Unified State Register of Legal Entities; full name of the individual entrepreneur, his place of residence and address of the place of business, document on entering data into the Unified State Register of Legal Entities), number and date issuance of a license to provide medical care. Information about the patient and / or the Customer is also prescribed (last name, first name, patronymic of an individual, his phone number and registration address).
3. Thing. The subject is paid medical services. The list of services provided is indicated in the Annex to the contract.
4. The duration of the agreement.
5. The term for the provision of services.
6. Rights and obligations of the parties. The Contractor undertakes to provide the medical services specified in the contract, and the Customer undertakes to timely pay for these services.
7. The order of delivery and acceptance of services.
8. Service cost.
9. The order of calculations. The content of the clause depends on the conditions under which the contract is concluded.
10. Confidentiality. The parties mutually undertake not to disclose information obtained in the course of the execution of this agreement.
11. Responsibility of the parties. In case of failure to comply with the terms of the agreement, the parties are liable under the current legislation.
12. Grounds and procedure for termination.
13. Dispute resolution. Claims and disputes arising between the consumer and the Contractor are resolved by agreement of the parties or in court in accordance with applicable law.
14. Force Majeure.
15. Other conditions.
16. List of applications. Annexes to the contract are the "List of services" and "Assignment for the provision of services".
17. Addresses and details of the parties.
18. Signatures of the parties.

You can download the form of a standard contract for medical care on our website along with related documents:

• Service acceptance certificate;
• Executor's report;
• Service list;
• Supplementary agreement;
• Protocol of disagreements;
• Dispute resolution protocol.

For more information about Contracts for the provision of services, see the pages.