Rules for organizing the provision of primary medical care to adults - Rossiyskaya Gazeta. Changes to the regulation on the organization of the provision of primary health care Federal Law 543

MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT
RUSSIAN FEDERATION

ORDER

On approval of the Procedure for organizing the provision of primary health care

Repealed from January 4, 2013 on the basis of
order of the Ministry of Health and Social Development of Russia dated May 15, 2012 N 543n
____________________________________________________________________

In accordance with clause 5.2.11 of the 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 (Collection of Legislation Russian Federation, 2004, N 8, article 2898; 2005, N 2, art. 162) and in order to improve the organization of the provision of primary health care to the population

I order:

Approve the attached Procedure for organizing the provision of primary health care.

Minister
M.Yu.Zurabov

Registered
at the Ministry of Justice
Russian Federation
August 30, 2005
registration N 6954

Appendix. PROCEDURE for organizing the provision of primary health care

Appendix

1. This Procedure regulates issues related to the organization of the provision of primary health care to the population on the territory of the Russian Federation.

2. Primary health care is the main type, accessible and free for every citizen. medical care and includes: treatment of the most common diseases, as well as injuries, poisonings and other urgent conditions; medical prevention of major diseases; sanitary and hygienic education; carrying out other activities related to the provision of health care to citizens at the place of residence*.
________________
* Part 1

3. Primary health care, including medical care for women during pregnancy, during and after childbirth, is provided by institutions of the municipal health care system mainly at the place of residence:

3.1. outpatient clinics: an outpatient clinic, a general medical (family) practice center, a district (including central), city polyclinic, a children's city polyclinic, a women's consultation.

4. In the provision of primary health care, institutions of the state and private systems health care on the basis of contracts with insurance medical organizations*.
________________
* Part 2 of Article 38 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens dated July 22, 1993 N 5487-1 (Bulletin of the Congress of People's Deputies of the Russian Federation and the Supreme Council of the Russian Federation, 1993, N 33, Article 1318; Collection of Legislation of the Russian Federation, 2004, N 35, art. 3607).

5. Institutions providing primary health care shall carry out their activities in accordance with established order.

6. The obligation of institutions to provide primary health care is performed by medical workers of these institutions: district therapists, district pediatricians, general practitioners (family), obstetrician-gynecologists, other medical specialists, as well as specialists with secondary medical and higher nursing education, in accordance with the established procedure.

7. Citizens have the right to free medical care in the state and municipal health care systems in accordance with the legislation of the Russian Federation, the legislation of the constituent entities of the Russian Federation and the regulatory legal acts of local governments.

Guaranteed amount of free medical care provided to citizens in accordance with the Program of State Guarantees for the Provision of Free Medical Care to Citizens of the Russian Federation*.
________________
* Part 3, Article 20 of the Basic Legislation of the Russian Federation on the protection of the health of citizens dated July 22, 1993 N 5487-1 (Bulletin of the Congress of People's Deputies of the Russian Federation and the Supreme Council of the Russian Federation, 1993, N 33, Article 1318; Collection of Legislation of the Russian Federation, 2004, N 35, art. 3607).

8. Outpatient care includes:

- provision of first (pre-medical, medical) and emergency medical care to patients with acute diseases, injuries, poisoning and other urgent conditions;

- carrying out preventive measures to prevent and reduce morbidity, abortion, identify early and latent forms of diseases, socially significant diseases and risk factors;

- diagnosis and treatment of various diseases and conditions;

- rehabilitation treatment;

- clinical and expert activities to assess the quality and effectiveness of therapeutic and diagnostic measures, including the examination of temporary disability;

- dispensary observation of patients, including certain categories of citizens entitled to receive a set social services;

- medical examination of pregnant women, puerperas;

- clinical examination of healthy and sick children;

- dynamic medical monitoring of the growth and development of the child;

- catering for children early age;

- organization of additional free medical care for certain categories of citizens, including the provision of necessary medicines;

- establishment of medical indications and referral to institutions state system health care to receive specialized types of medical care;

- establishment of medical indications for sanatorium treatment, including certain categories of citizens entitled to receive a set of social services;

- medical care for students, pupils educational institutions general and correctional types;

- carrying out sanitary-hygienic and anti-epidemic measures, vaccination in the prescribed manner;

- implementation of sanitary and hygienic education, including on the formation healthy lifestyle life;

- medical consultation and medical career guidance;

- medical support for the preparation of young men for military service.

9. Inpatient care provided to the population of municipalities in hospitals and inpatient polyclinic institutions includes:

- provision of emergency medical care to patients with acute diseases, injuries, poisoning and other urgent conditions;

- diagnosis, treatment of acute, chronic diseases, poisoning, injuries, conditions during the pathology of pregnancy, childbirth, postpartum period, abortion and other conditions requiring round-the-clock medical supervision or isolation according to epidemic indications;

- restorative treatment and rehabilitation.

10. Hospitalization in a hospital (inpatient polyclinic) institution is carried out for medical reasons:

- in the direction of a doctor of a medical institution, regardless of the form of ownership and departmental affiliation;

- emergency medical care;

- in case of self-treatment of the patient according to emergency indications.

Electronic text of the document
prepared by CJSC "Kodeks" and verified according to.

Recall that order No. 139n is another change in order No. 543n. Prior to this, order No. 543n was changed in 2015 by the following departmental regulatory legal acts:

• Order of the Ministry of Health of June 23, 2015 No. 361n,
• Order of the Ministry of Health of September 30, 2015 No. 683n.

Changes in the work of polyclinics

Clause 4 of the Appendix to Order No. 139n clarifies Appendix 1 of the Regulations on the organization of primary health care for the adult population

Head of the polyclinic

The text of the third paragraph has changed here, which specifies that a medical worker with higher education in the direction of training "Health care and medical sciences", according to qualification requirements, approved in order No. 707n with changes in order No. 328n. The head of the clinic must have training (retraining courses) in the specialty ""

In addition, it must comply with the requirements of the order of the Ministry of Health and Social Development of the Russian Federation dated July 23, 2010 No. 541n "Unified qualification guide positions ... "according to the characteristic" Chief physician of a medical organization.

Head of the structural unit of the polyclinic

A medical worker is appointed to this position, who must comply with the requirements of order No. 707n (as amended in order No. 328n).

Polyclinic paramedic

A paramedic is appointed a medical worker who meets the Qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education, approved by order of the Ministry of Health of the Russian Federation of February 10, 2016 N 83n and have the specialty "General Medicine".

Clinic nurse

A health worker is appointed to this position, who must have a secondary professional education in the specialty "" or "Nursing in Pediatrics".

Day hospital equipment standard

In this standard, the nurse's workplace and the stethophonendoscope are excluded from the list.

The "AntiAIDS" package has been replaced by the package for emergency prevention of parenteral infections for primary health care, emergency, specialized and palliative care.

Changes for medical outpatient clinics

It also prescribes specific regulatory legal acts, the requirements of which must be met by health workers of outpatient clinics appointed to the position of head of an outpatient clinic, an outpatient doctor. Namely, a link to the order of the Ministry of Health 328n was added here.

Position of a paramedic of an outpatient clinic

A health worker who meets the requirements of Order No. 83n and has training in the specialty "General Medicine" is appointed to this position.

Office midwife position

To occupy this position, you must have training in the specialty "" in accordance with order No. 83n.

Position of outpatient nurse

Here, too, the nurse must be trained in Nursing or Pediatric Nursing.

The standard for equipping FAPs (medical outpatient clinics) has been changed

Changes have been made to Appendix No. 14 of Order No. 543 here

In other words, here are added:

• portable pulse oximeter;
• spirometer (portable with disposable mouthpieces);
• containers for disinfection of instruments and consumables, as well as for the collection of household and medical waste;
• disposable kit for conicotomy;
• styling with pediculocidal agents;
• tool table;
• changing table;
• gynecological chair;
• automatic defibrillator

The execution of this Order is compulsory for medical organizations, since according to p.p. "b" of paragraph 4 of the Government Decree of April 16, 2012 No. 291 "Regulations on the licensing of medical activities", compliance with the equipment standard is a licensing requirement.

For the position of a nurse, an employee with training in the specialty "nursing (including" in pediatrics ")".

Paramedic health center

A specialist trained in the specialty "" can be appointed as a paramedic of a health center, and "(including in pediatrics)" for the position of a nurse.

also in Medical equipment standard item 57 added: Portable pulse oximeter – 1 pc.

Changes for centers and departments of general medical practice

Order of the Ministry of Health and social development RF dated May 15, 2012 N 543n
"On approval of the Regulations on the organization of the provision of primary health care to the adult population"

With changes and additions from:

In accordance with Article 32 of the Federal Law of November 21, 2011 N 323-FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2011, N 48, Art. 6724) I order:

1. To approve the attached Regulations on the organization of the provision of primary health care to the adult population.

2. Recognize as invalid:

order of the Ministry of Health and Social Development of the Russian Federation of July 29, 2005 N 487 "On approval of the Procedure for organizing the provision of primary health care" (registered by the Ministry of Justice of the Russian Federation on August 30, 2005, registration N 6954);

order of the Ministry of Health and Social Development of the Russian Federation of August 4, 2006 N 584 "On the procedure for organizing medical care for the population on the basis of the district principle" (registered by the Ministry of Justice of the Russian Federation on September 4, 2006, registration N 8200).

Registration N 24726

The Regulations on the organization of the provision of primary medical care have been approved. It's about on assistance to the adult population in Russia.

This type of assistance is the basis of the system of medical care. It includes activities for the prevention, diagnosis, treatment of diseases and conditions, rehabilitation, monitoring the course of pregnancy, the formation of a healthy lifestyle and hygiene education.

Assistance is provided free of charge within the framework of the Program of State Guarantees for the Free Provision of Medical Assistance to Russian Citizens at the expense of Compulsory Medical Insurance Funds and funds from the relevant budgets, as well as in other cases established by law.

Assistance is provided in planned and emergency forms, on an outpatient basis and in a day hospital. It includes pre-medical, medical and specialized health care.

To improve the efficiency of care in case of sudden acute diseases, conditions, exacerbation of chronic diseases that are not dangerous for the patient's life and do not require emergency intervention, an emergency department (office) can be organized in medical organizations.

Orders on approval of the procedure for organizing the provision of primary medical care and on the procedure for organizing medical care for the population on the basis of the district principle were declared invalid.

Order of the Ministry of Health and Social Development of the Russian Federation of May 15, 2012 N 543n "On approval of the Regulations on the organization of the provision of primary health care to the adult population"

Registration N 24726

This Order shall enter into force 10 days after the date of its official publication.

Registered with the Ministry of Justice of the Russian Federation on June 27, 2012.
Registration N 24726

In accordance with Article 32 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724) I order:

1. Approve the attached Regulations on the organization of the provision of primary health care.

2. Recognize as invalid:

Order of the Ministry of Health and Social Development of the Russian Federation of July 29, 2005 N 487 "On approval of the procedure for organizing the provision of primary health care" (registered by the Ministry of Justice of the Russian Federation on August 30, 2005 N 6954);

Order of the Ministry of Health and Social Development of the Russian Federation of August 4, 2006 N 584 "On the procedure for organizing medical care for the population on the basis of the district principle" (registered by the Ministry of Justice of the Russian Federation on September 4, 2006 N 8200).

I. about Minister T. Golikov

Note. Ed .: the order was published in the Bulletin of Normative Acts of Federal Executive Bodies, N 52, 12/24/2012.


Application to the Order

Regulations on the organization of the provision of primary health care to the adult population

1. This Regulation establishes the rules for organizing the provision of primary health care to the adult population on the territory of the Russian Federation.

2. The organization of the provision of primary health care is carried out in medical and other organizations of the state, municipal and private healthcare systems, including individual entrepreneurs licensed for medical activity received in the manner prescribed by the legislation of the Russian Federation (hereinafter - medical organizations).

The organization of the provision of primary health care is carried out by medical organizations and their structural divisions in accordance with annexes No. 1 - 27 to this Regulation.

3. Employees of organizations included in the list of organizations of certain industries approved by the Government of the Russian Federation with special hazardous conditions labor, and the population of closed administrative-territorial formations, territories with physical, chemical and biological factors hazardous to human health, included in the list of territories approved by the Government of the Russian Federation, primary health care is carried out taking into account the specifics of the organization of medical care established by the Government of the Russian Federation .

4. Primary health care in medical organizations may be provided to the population:

A) as free - within the framework of the Program of State Guarantees of Free Provision of Medical Care to Citizens of the Russian Federation at the expense of compulsory medical insurance and funds from the relevant budgets, as well as in other cases established by the legislation of the Russian Federation;

B) as paid medical care - at the expense of citizens and organizations.

5. Primary health care is the basis of the medical care system and includes measures for the prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, monitoring of pregnancy, the formation of a healthy lifestyle, including reducing the level of risk factors for diseases, and health education.

6. Primary health care is provided in planned and emergency forms.

7. Primary health care is provided:

1) outpatient, including:
in a medical organization providing primary health care, or its division, at the place of residence (stay) of the patient - in case of acute diseases, exacerbations of chronic diseases in case of a call from a medical worker or when he visits a patient in order to monitor his condition, the course of the disease and timely appointment (correction) of the necessary examination and (or) treatment (active visit), with the patronage of certain groups of the population in case of detection or threat of an epidemic of an infectious disease, patients with an infectious disease, persons in contact with them and persons suspected of an infectious disease, including by door-to-door (door-to-door) rounds, inspections of workers and students;
at the place of departure of the mobile medical team, including for the provision of medical care to residents of settlements with the predominant residence of persons older than working age, or located at a considerable distance from the medical organization and (or) having poor transport accessibility, taking into account climatic and geographical conditions.

2) in a day hospital, including a hospital at home.

8. In order to improve the efficiency of primary health care in case of sudden acute illnesses, conditions, exacerbation of chronic diseases that are not dangerous to the life of the patient and do not require emergency medical care, an emergency medical care department (office) can be organized in the structure of medical organizations, providing its activities in accordance with Appendix No. 5 to these Regulations.

Taking into account the formation of contingents of citizens temporarily (seasonally) residing in the territory of a settlement (including summer cottages and garden associations), the department (office) of emergency medical care can be organized in close proximity to the place of temporary (seasonal) residence.

9. Primary health care is provided in accordance with established procedures for the provision certain types(by profile) of medical care and standards of medical care.

10. Primary health care includes the following types:

Primary pre-hospital health care, which is provided by paramedics, obstetricians, other medical workers with secondary medical education of paramedic health centers, feldsher-obstetric centers, medical ambulance stations, health centers, polyclinics, polyclinic divisions of medical organizations, departments (offices) of medical prevention, health centers;
primary medical care, which is provided by general practitioners, district general practitioners, general practitioners (family doctors) of medical outpatient clinics, health centers, polyclinics, outpatient departments of medical organizations, offices of general practitioners (family doctors), health centers and departments (rooms) of medical prevention;
primary specialized health care, which is provided by specialist doctors of various profiles of polyclinics, polyclinic divisions of medical organizations, including those providing specialized, including high-tech, medical care.

11. In small and (or) located at a considerable distance from a medical organization or its subdivision of settlements, including temporary (seasonal), medical organizations providing primary health care on a territorial-district basis, in the service area of ​​which such settlements, carry out the organization of first aid to the population before arrival medical workers in case of sudden, life-threatening acute diseases, conditions, exacerbations of chronic diseases, injuries, poisoning with the involvement of one of the households.

The organization of first aid includes the formation of a first aid kit, its replenishment as necessary, training in first aid skills, provision of first aid providers, as well as persons at high risk of developing sudden cardiac death, acute coronary syndrome and other life-threatening conditions, and members of their families, teaching aids and first aid instructions for the most common life-threatening conditions that are the main cause of death (including sudden cardiac death, acute coronary syndrome, acute cerebrovascular accident), containing information about the characteristic manifestations of these conditions and the necessary measures to eliminate them before arrival medical workers.

12. Primary pre-medical and primary medical health care are organized according to the territorial-district principle.

13. The territorial-district principle of organizing the provision of primary health care is to form groups of the serviced contingent on the basis of residence (stay) in a certain territory or on the basis of work (training) in certain organizations and (or) their divisions.

14. The distribution of the population by areas is carried out by the heads of medical organizations providing primary health care, depending on the specific conditions for the provision of primary health care to the population in order to maximize its accessibility and observance of other rights of citizens.

15. In order to ensure the right of citizens to choose a doctor and a medical organization, it is allowed to attach citizens living or working outside the service area of ​​a medical organization to local general practitioners, general practitioners (family doctors), for medical observation and treatment, taking into account the recommended number of attached citizens, established by paragraph 18 of this Regulation.

16. In medical organizations, sites can be organized:

medical assistant;
therapeutic (including workshop)
general practitioner (family doctor);
complex (a site is formed from the population of a site of a medical organization with an insufficient number of attached population (small population site) or the population served by a general practitioner of a medical outpatient clinic and the population served by feldsher-obstetric stations (paramedic health centers);
obstetric;
attributed.

17. Services to the population at the sites are carried out:

Paramedic of the paramedical health center, feldsher-obstetric station;
a district general practitioner, a district general practitioner of a shop medical section, a district nurse in a therapeutic (including shop) area;
general practitioner (family doctor), assistant general practitioner, nurse of the general practitioner at the site of the general practitioner (family doctor);

At the medical assistant's station - 1300 people of the adult population aged 18 years and older;
at the therapeutic site - 1,700 adults aged 18 years and older (for a therapeutic site located in a rural area - 1,300 adults);
at the site of a general practitioner - 1200 people of the adult population aged 18 years and older;
at the family doctor's site - 1,500 adults and children;
on the complex site - 2000 and more people of the adult and children's population.

19. In areas of the Far North and similar areas, high-mountainous, desert, waterless and other areas (areas) with severe climatic conditions, with long-term seasonal isolation, as well as in areas with low population density, sites can be formed with a smaller number of attached population, while maintaining positions local general practitioners, local pediatricians, general practitioners (family doctors), nurses district, general practitioner nurses, paramedics (obstetricians) in full.

20. Depending on the specific conditions for the provision of primary health care to the population, in order to ensure its accessibility, permanent medical teams can be formed, consisting of a district general practitioner, paramedics, obstetricians and nurses, with distribution between them functional duties according to competence, based on the established staffing standards designed to calculate the number of positions provided for the medical organization to perform the functions assigned to it.

21. Primary specialized health care is organized in accordance with the needs of the population in its provision, taking into account morbidity and mortality, the sex and age composition of the population, its density, as well as other indicators characterizing the health of the population.

Primary specialized health care is provided in the direction of medical workers providing primary pre-medical and primary medical health care, as well as when the patient independently applies to a medical organization.

22. For the provision of medical care to patients with acute chronic diseases and their exacerbations, who need inpatient treatment, but are not referred to provide inpatient medical care to a medical organization, a home hospital may be organized, provided that the state of health of the patient and his home conditions allow organizing medical care and home care.

The selection of patients for treatment in a hospital at home is carried out on the recommendation of local physicians, general practitioners (family doctors) and medical specialists.

When organizing a hospital at home, the patient is monitored daily by a specialist doctor and a nurse, laboratory diagnostic examinations, drug therapy, various procedures, as well as consultations of specialist doctors on the profile of the disease.

On Saturdays, Sundays and holidays Patients can be monitored by doctors and nurses on duty, as well as by the emergency medical service. If the course of the disease worsens, the patient should be immediately transferred to a round-the-clock hospital.

Appendix No. 1 to the Regulation

Rules for organizing the activities of the polyclinic

1. These Rules determine the procedure for organizing the activities of the polyclinic.

2. The polyclinic is an independent medical organization, or a structural subdivision of a medical organization (its structural subdivision) that provides primary health care, and is organized to provide primary pre-hospital health care, primary medical health care, primary specialized health care and palliative care for the population.

3. The polyclinic is managed by the chief physician, to whose position specialists are appointed who meet the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009 14292), as well as by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247).

4. For the position of the head of the structural unit of the polyclinic, as well as for the position of the doctor of the polyclinic, specialists are appointed who meet the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice Russia July 9, 2009, No. 14292).

5. Specialists who meet the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292) ), specializing in paramedic.

6. A specialist corresponding to the qualifications positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), in the specialty "Paramedic", "Midwife" or "Nurse".

7. The structure of the polyclinic and the staffing are established by the chief doctor of the polyclinic or the head of the medical organization (its structural unit), in the structure of which it is included, based on the volume of ongoing medical and diagnostic work, taking into account the recommended staffing standards established by Appendix No. 2 to the Regulations on the Organization provision of primary health care to the adult population approved by this order, the level and structure of morbidity and mortality, the sex and age composition of the population, its density, as well as other indicators characterizing the health of the population.

8. To organize the work of the polyclinic in its structure, it is recommended to provide the following units:

Registry;
department (office) of first aid;
department of general medical (family) practice;
department (office) of primary specialized health care;
departments of primary specialized health care (traumatological and orthopedic, surgical, therapeutic, otorhinolaryngological, ophthalmological, neurological and others);

Department (office) of emergency medical care;
department (office) of functional diagnostics;
dental department (office);
treatment room;
examination room;
fluorography room;
trust office;
cabinet crisis conditions and medical and psychological relief;
medical aid office for smoking cessation;
department (office) of radiation diagnostics;
clinical laboratory;
biochemical laboratory;
microbiological laboratory;

health center;
premises (classrooms, audiences) for group prevention (health schools);
day hospital;
information and analytical department or medical statistics office;
organizational and methodological cabinet (department);
administrative divisions.

9. Equipping departments and offices is carried out in accordance with the established procedures for the provision of certain types (by profile) of medical care.

10. In the absence of the effect of the treatment carried out on an outpatient basis and (or) in the absence of the possibility of conducting additional examinations for medical reasons, a local general practitioner, a general practitioner, a general practitioner, a family doctor in agreement with a doctor - a specialist in profile of the patient's disease sends him to a medical organization for additional examinations and (or) treatment, including inpatient conditions.

11. The main tasks of the clinic are:

Provision of primary (pre-hospital, medical, specialized) health care, including emergency care to patients residing in the service area and (or) attached to the service, in case of acute illnesses, injuries, poisoning and other urgent conditions;
carrying out preventive measures to prevent and reduce morbidity, identify early and latent forms of diseases, socially significant diseases and risk factors;
medical examination of the population;
diagnosis and treatment of various diseases and conditions;
restorative treatment and rehabilitation;
clinical and expert activities to assess the quality and effectiveness of therapeutic and diagnostic measures, including the examination of temporary disability and referral of citizens for medical and social examination;
dispensary monitoring of the health of persons suffering from chronic diseases, including certain categories of citizens entitled to receive a set of social services, functional disorders, other conditions in order to timely identify (prevent) complications, exacerbations of diseases, other pathological conditions, their prevention and implementation of medical rehabilitation;
organization of additional free medical care, including necessary medicines, for certain categories of citizens;
establishment of medical indications and referral to medical organizations to receive specialized types of medical care;

carrying out all kinds medical examinations(preventive, preliminary, periodic);
establishment of medical indications for sanatorium treatment, including in relation to certain categories of citizens entitled to receive a set of social services;
carrying out anti-epidemic measures, including vaccination, in accordance with the national calendar of preventive vaccinations and according to epidemic indications, identifying patients with infectious diseases, dynamic monitoring of persons in contact with patients with infectious diseases at the place of residence, study, work and convalescents, as well as the transmission in accordance with the established procedure, information on detected cases of infectious diseases;
implementation of medical consultations;
implementation of medical support for the preparation of young men for military service;
examination of temporary incapacity for work, issuance and extension of certificates of incapacity for work;
organizing and holding events to promote a healthy lifestyle, including the issues of rational nutrition, increasing physical activity, preventing the use of psychoactive substances, including alcohol, tobacco, drugs;
identification of smokers and persons who consume excessive alcohol, as well as persons at high risk of developing diseases associated with smoking, alcohol and poisoning with alcohol surrogates;
providing medical assistance to quit smoking and alcohol abuse, including referral for consultation and treatment to specialized specialized medical organizations;
organization of informing the population about the need and possibility of identifying risk factors and assessing the degree of risk of developing chronic non-communicable diseases, their drug and non-drug correction and prevention, as well as counseling on maintaining a healthy lifestyle in departments (offices) of medical prevention and health centers;
conducting recreational activities, drug and non-drug correction of risk factors, providing memos, dispensary observation of persons at high risk of developing a chronic non-communicable disease and its complications, referral, if necessary, of persons with a high risk of developing a chronic non-communicable disease for a consultation with a specialist doctor;
advanced training of doctors and workers with secondary medical education;

interaction with medical organizations, Rospotrebnadzor, Roszdravnadzor, other organizations on the provision of primary health care and palliative care.

12. The work of the polyclinic should be organized according to a shift schedule that ensures the provision of medical care throughout the day, and also provide for the provision of emergency medical care on weekends and holidays.

Appendix No. 3 to the Regulation

Rules for organizing the activities of an office (department) of pre-medical care in a polyclinic (medical outpatient clinic, center for general medical practice (family medicine))

1. These Rules stop the procedure for organizing the activities of an office (department) of pre-medical care of a polyclinic (medical outpatient clinic, center of general medical practice (family medicine)) (hereinafter referred to as the Cabinet).

2. The office is organized as a structural subdivision of a polyclinic, a medical outpatient clinic or a center for general medical practice (family medicine) (hereinafter referred to as a medical organization).

3. Medical assistance in the Cabinet is provided by medical workers with secondary medical education from among the most experienced employees, as well as nurses with higher medical education.

4. The organization of work in the Cabinet can be carried out both on a permanent basis by the medical workers of the Cabinet, and on a functional basis by medical workers of other departments of the medical organization in accordance with the schedule approved by the head of the medical organization.

5. The management of the Cabinet is carried out by the head of one of the departments of the medical organization authorized by the head of the medical organization.

7. The main tasks of the cabinet (department) of first aid are:

Admission of patients to resolve the issue of the urgency of referral to a doctor;
referral for laboratory and other studies of patients who do not need a medical appointment on the day of treatment;
anthropometry, measurement of arterial and eye pressure, body temperature, visual acuity and hearing, other diagnostic manipulations, the performance of which is within the competence of workers with secondary medical education, filling out the passport part of the mailing list for medical and social examination, sanitary-resort card, laboratory data and other functional diagnostic studies before being sent for medical and social examination, for sanatorium treatment, issuing certificates, extracts from individual cards outpatient and other medical documentation, the execution and maintenance of which is within the competence of employees with secondary medical education;
registration of leaflets and certificates of temporary disability, confirmation of the certificates issued to the patient with appropriate seals, directions, prescriptions and extracts from medical records, strict accounting and registration in special journals of leaflets, certificates of temporary disability and prescription forms;
participation in the organization and conduct of preventive medical examinations.

8. The office is provided with the necessary medical equipment, tools and forms of medical documentation.

Appendix No. 4 to the Regulation

Rules for organizing the activities of the registry of a polyclinic (medical outpatient clinic, center of general medical practice (family medicine))

1. These Rules establish the procedure for organizing the activities of the registry of a polyclinic (medical outpatient clinic, center of general medical practice (family medicine)) (hereinafter referred to as a medical organization).

2. The registry is a structural unit that ensures the formation and distribution of patient flows, timely recording and registration of patients for an appointment with a doctor, including using information technology.

3. Direct management of the work of the registry of a medical organization is carried out by the head of the registry, appointed to the position and dismissed by the head of the medical organization.

4. The main tasks of the registry of a medical organization are:

Organization of unhindered and immediate pre-registration of patients for an appointment with a doctor, including in an automated mode, in the medical prevention room, first aid room (both when they directly contact the clinic and by phone);
organization and implementation of registration of doctors' calls to the house at the place of residence (stay) of the patient;
ensuring the regulation of the intensity of the flow of the population in order to create a uniform workload of doctors and its distribution by type of assistance provided;
systematic storage of patients' medical records, ensuring timely selection and delivery of medical records to doctors' offices.

5. To carry out its tasks, the registry organizes and implements:

Informing the public about the time of reception of doctors of all specialties, the working hours of laboratories, offices, a health center, a day hospital and other divisions of a medical organization, including Saturday and Sunday, indicating the hours of admission, location and numbers of rooms;
informing about the rules for calling a doctor at home, about the procedure for making an appointment with doctors, about the time and place of reception of the population by the head of the medical organization and his deputies; addresses of the nearest pharmacies, the nearest health center, in the area of ​​​​responsibility of which this medical organization is located;
informing about the rules for preparing for research (fluoroscopy, radiography, blood tests, gastric juice, etc.);
making an appointment with doctors of a medical organization and registering doctors' calls at the place of residence (stay) of the patient, timely transfer of information to doctors about registered calls;
referral in the prescribed manner to those who applied to the clinic for preventive examinations and examinations *;
selection of medical records of outpatients who made an appointment or called a doctor at home;
delivery of medical documentation of patients to doctors' offices;
registration of sheets (certificates) of temporary incapacity for work; confirmation with appropriate seals of certificates issued to the patient, directions, prescriptions and extracts from medical records, strict accounting and registration in special journals of sheets, certificates of temporary incapacity for work and prescription forms;
sorting and entering into medical documentation the results of laboratory, instrumental and other examinations.

6. As part of the registry of a medical organization, it is recommended to provide a reference desk, a self-recording room (desk), workplaces for receiving and registering doctor's calls to the house, a room for storing and selecting medical documentation, a room for processing medical documents, a medical archive.

* for all citizens who applied to a medical organization for the first time, a list of control of risk factors for chronic non-communicable diseases is created, which are sent (with their consent) to identify risk factors and the degree of risk to the medical prevention office or to the health center, the same units are sent to persons already having this sheet control and those who wish to receive medical assistance for the correction of risk factors and / or additional advice on maintaining a healthy lifestyle

Appendix No. 5 to the Regulation

Rules for organizing the activities of the department (office) of emergency medical care of a polyclinic (medical outpatient clinic, center of general medical practice (family medicine))

1. These Rules establish the procedure for organizing the activities of the department (office) of emergency medical care of a polyclinic (medical outpatient clinic, center of general medical practice (family medicine)).

2. The department (office) of emergency medical care is a structural subdivision of a polyclinic (medical outpatient clinic, a center for general medical practice (family medicine)) and is organized to provide medical care in case of sudden acute diseases, conditions, exacerbation of chronic diseases that are not life-threatening and do not require emergency medical care (hereinafter referred to as emergency conditions).

3. The provision of emergency medical care to persons who applied with signs of emergency conditions may be carried out on an outpatient basis or at home when a medical worker is called.

4. Emergency medical care may be provided as primary pre-medical health care by paramedics, as well as as primary medical health care by medical specialists.

5. The staffing of the medical and other personnel of the department (office) of emergency medical care is established by the head of the medical organization, in the structure of which he is a member.

Medical care in the department (cabinet) of emergency medical care can be provided by medical workers of the department (cabinet) of emergency medical care or medical workers of other departments of a medical organization in accordance with the duty schedule approved by its head.

6. Emergency medical assistance to persons who apply to a medical organization with signs of emergency conditions is provided in the direction of the registrar without delay.

7. Emergency medical care at home is carried out within no more than 2 hours after the receipt of the request of the patient or another person for the provision of emergency medical care at home.

8. If there is no effect from the medical care provided, the patient's condition worsens and life-threatening conditions occur, medical workers take measures to eliminate them using stationary or portable emergency medical equipment and arrange for an ambulance team to be called or the patient to be transported to a medical organization, providing specialized medical care, accompanied by a medical worker.

9. After the provision of emergency medical care to the patient and the elimination or reduction of manifestations of the emergency condition, the patient is sent to the doctor or the district doctor is transferred information about the patient to visit the patient in order to monitor his condition, the course of the disease and timely appointment (correction) of the necessary examination and (or ) treatment (active visit) during the day.

Appendix No. 6 to the Regulation

Rules for organizing the activities of the office of a general practitioner (family doctor)

1. These Rules establish the procedure for organizing the activities of the office of a general practitioner (family doctor).

2. The office of a general practitioner (family doctor) (hereinafter - the Office) is a structural subdivision of a medical organization (its structural subdivision) that provides primary health care and palliative care.

3. The office is organized to provide primary medical care and palliative care to the population.

4. The provision of medical care in the Cabinet is carried out on the basis of the interaction of general practitioners (family doctors) and medical specialists in the profile of the patient's disease (cardiologists, rheumatologists, endocrinologists, gastroenterologists, etc.) who carry out their activities in a medical organization, the structure of which includes the Cabinet, as well as other medical organizations.

5. The structure of the Cabinet and the number of staff are established by the head of the medical organization in which the Cabinet was created, based on the volume of ongoing medical and diagnostic work, the number, sex and age composition of the population served, indicators of the level and structure of morbidity and mortality of the population, and other indicators characterizing the health of the population.

6. The main tasks of the Cabinet are:

Provision of primary medical care in accordance with the established procedures for the provision of certain types (by profile) of medical care and standards of medical care, including in a day hospital;


implementation of dispensary observation of patients with chronic diseases with the necessary examination, treatment and rehabilitation;


providing medical assistance to smokers and excessive drinkers of alcohol to stop smoking and alcohol abuse, including sending them for consultation and correction of risk factors for the development of diseases to departments (offices) of medical prevention, health centers and, if necessary, to specialized specialized medical organizations;
organizing and conducting activities for sanitary and hygienic education, including activities to improve the health of the population;
organizing and conducting health schools, schools for patients with socially significant non-communicable diseases and diseases that are the main causes of death and disability in the population, as well as for people at high risk of their occurrence;
elimination of life-threatening conditions with the subsequent organization of medical evacuation to medical organizations or their units providing specialized medical care, accompanied by a medical worker or an ambulance team;
provision of emergency medical care to patients with sudden acute diseases, conditions, exacerbation of chronic diseases that are not life-threatening and do not require emergency medical care, followed by referral to a medical specialist of a medical organization that provides primary medical care at the patient's place of residence, and a subsequent visit to the patient in order to monitor his condition, the course of the disease and timely appointment (correction) of the necessary examination and (or) treatment (active visit) if there are medical indications;
training the population in first aid, as well as individual and / or group training of persons at high risk of developing life-threatening conditions and their families in the rules of first aid for these conditions;
referral of patients to medical organizations for the provision of primary specialized health care and specialized, including high-tech, medical care in cases stipulated by the procedures for providing certain types (by profiles) of medical care;

formation of risk groups;

organization and provision of palliative care to patients, including patients with oncological diseases, who need narcotic and potent drugs medicines in accordance with the recommendations of medical specialists;
implementation of an examination of temporary disability, referral to a medical and social examination;

conducting preliminary or periodic medical examinations of employees and drivers of vehicles;

interaction with medical organizations, territorial bodies of Rospotrebnadzor and Roszdravnadzor, other organizations on the provision of primary pre-medical health care.

10. To ensure its activities, the Cabinet uses the capabilities of the structural units of the medical organization, in which it is formed.

Appendix No. 7 to the Regulation

Rules for organizing the activities of the department (office) of medical prevention

1. These rules establish the procedure for organizing the activities of the department (cabinet) of prevention (hereinafter - the Department).

2. The department is organized in a medical organization (its structural subdivision) providing primary health care.

3. The department of prevention includes the following structural units:

anamnestic office;
functional (instrumental) research room;
office promoting a healthy lifestyle;
an office for centralized accounting of annual medical examinations;
smoking cessation clinic.

4. When organizing the activities of the Department, it is recommended to provide for the possibility of conducting the necessary diagnostic tests directly in the Department.

5. The department is headed by a head who reports directly to the chief physician of a medical organization (the head of its structural unit) that provides primary health care.

6. The main functions of the Department are:

Participation in the organization and conduct of medical examinations;
participation in the organization and conduct of preventive medical examinations;
early detection of diseases and persons with risk factors for the development of diseases;
control and accounting of the annual medical examination of the population;
preparation and transfer to doctors of medical documentation for patients and persons with an increased risk of diseases for additional medical examination, dispensary observation and medical and recreational activities;
sanitary and hygienic education and promotion of a healthy lifestyle (combating smoking, alcoholism, overnutrition, physical inactivity, and others).

Appendix No. 8 to the Regulation

Rules for organizing the activities of a mobile medical team

1. These Rules establish the procedure for organizing the activities of a mobile medical team.

2. A mobile medical team is organized in the structure of a medical organization (its structural unit) providing primary health care to provide primary health care to the population, including residents of settlements with a predominant residence of persons older than working age or located at a considerable distance from a medical organization and (or) having poor transport accessibility, taking into account climatic and geographical conditions.

3. The composition of the mobile medical team is formed by the head of the medical organization (its structural unit) from among doctors and medical workers with a secondary medical education, based on the purpose of its formation and the tasks assigned, taking into account the existing medical organizations providing primary health care, medical demographic characteristics of the service area of ​​a medical organization, its human and technical potential, as well as gender and age, social structure population and its needs for certain types (according to the profile) of medical care (including issues of individual and group prevention of non-communicable diseases, teaching the population the rules of first aid, counseling on maintaining a healthy lifestyle).

As agreed, medical workers of other medical organizations may be included in the mobile medical team.

4. The work of the mobile medical team is carried out in accordance with the plan approved by the head of the medical organization in which it is organized.

5. The leadership of the mobile medical team is entrusted to the head of the medical organization in which it is organized, to one of the doctors of the mobile medical team from among those with experience in medical and organizational work.

6. Mobile medical team is provided vehicles, including special ones, equipped with medical equipment, consumables, medicines necessary to provide medical care to the population in accordance with paragraph 2 of these Rules, teaching aids and sanitary and educational literature.

7. Provision and control of the activities of mobile medical teams is carried out by the head of the medical organization in which they are created.

Appendix No. 9 to the Regulation

Rules for organizing the activities of a day hospital

1. These Rules establish the procedure for organizing the activities of a day hospital of a medical organization (subdivision of a medical organization) that provides primary health care.

2. A day hospital is a structural subdivision of a medical organization (its structural subdivision) that provides primary health care and is organized to carry out therapeutic and diagnostic measures for diseases and conditions that do not require round-the-clock medical supervision.

3. The structure and staffing of a day hospital are established by the head of the medical organization in which it was created, based on the volume of treatment and diagnostic work carried out and the number of people served, and taking into account the recommended staffing standards in accordance with Appendix No. 10 to the Regulations on the organization of the provision of primary healthcare -sanitary care for the adult population, approved by this order.

4. To the position of the head of the day hospital, specialists are appointed who meet the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292).

5. Medical care in a day hospital can be provided by medical workers of a day hospital, or medical workers of other departments of a medical organization in accordance with the duty schedule approved by its head.

6. To organize the work of a day hospital, it is recommended to provide in its structure:

Chambers;
procedural (manipulative);
post of a nurse;
office of the head of the day hospital;
a room for the sick to eat;
doctors' offices;
staff room;
room for temporary storage of equipment;
bathroom for staff;
bathroom for patients;
sanitary room.

7. The equipment of the day hospital is carried out in accordance with the standard for equipping the day hospital in accordance with Appendix No. 11 to the Regulations on the organization of the provision of primary health care to the adult population, approved by this order.

8. The number of beds and the mode of operation of the day hospital is determined by the head of the medical organization, taking into account the capacity of the medical organization (its structural unit) and the volume of medical events carried out (in 1 or 2 shifts).

9. The day hospital performs the following functions:

Providing medical care to patients who do not require round-the-clock medical supervision in accordance with approved standards of medical care;
treatment of patients discharged from the hospital under the supervision of a doctor of a medical organization after surgical interventions, if it is necessary to carry out therapeutic measures that require observation by medical personnel for several hours in a medical organization;
putting into practice modern methods diagnostics, treatment and rehabilitation of patients;
maintaining accounting and reporting documentation, providing reports on activities in the prescribed manner, the maintenance of which is provided for by law;
participation in carrying out activities to improve the skills of doctors and medical workers with secondary medical education.

10. If there is no effect from the ongoing treatment in a day hospital or if there are indications for round-the-clock medical supervision and treatment, as well as in the absence of the possibility of additional examinations for medical reasons, the patient is sent for additional examinations and (or) treatment, including in hospitals. conditions.

Appendix No. 12 to the Regulation

Rules for organizing the activities of a medical outpatient clinic

1. These Rules determine the procedure for organizing the activities of a medical outpatient clinic.

2. A medical outpatient clinic is organized to provide primary medical health care (hereinafter referred to as primary medical care), as well as primary pre-hospital health care (hereinafter referred to as pre-hospital medical care) as part of the provision of emergency medical care to the population.

A medical outpatient clinic is an independent medical organization or a structural subdivision of a medical organization (its structural subdivision).

3. The provision of primary medical care in a medical outpatient clinic is carried out by district general practitioners, general practitioners (family doctors) and specialist doctors on a territorial-district basis.

4. A specialist who meets the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009, is appointed to the position of head of the outpatient clinic. No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292), as well as by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247).

5. Specialists who meet the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by the order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292).

6. For the post of paramedic of a medical outpatient clinic, specialists are appointed who meet the qualification characteristics of positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position of "Paramedic" .

7. A specialist is appointed to the position of a midwife in a medical outpatient clinic, corresponding to the qualification characteristics of positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position of "Midwife".

8. A specialist is appointed to the position of a nurse in an outpatient clinic, corresponding to the qualification characteristics of positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position of "Nurse ".

9. The outpatient clinic is provided by class A ambulances.

10. The structure of the outpatient clinic and the staffing are established by the head of the medical organization, the structure of which includes the medical outpatient clinic, based on the volume of ongoing medical and diagnostic work, the number of people served and taking into account the recommended staffing standards in accordance with Appendix No. 13 to the Regulation on the organization of primary medical care. sanitary care for the adult population, approved by this order.

11. To organize the work of a medical outpatient clinic, it is recommended to provide the following premises in its structure:

Registry;
procedural;
doctors' offices;
cabinet of medical prevention;
staff room;
bathroom for staff;
bathroom for patients;
clinical laboratory;
biochemical laboratory;
sanitary room.

12. In order to improve the provision of medical care in a medical outpatient clinic, an office (department) of first aid, an office (department) of emergency medical care, a day hospital, including a hospital at home, can be organized.

13. The provision of medical care in a medical outpatient clinic is carried out on the basis of the interaction of local general practitioners, general practitioners (family doctors) and specialists in the patient’s disease profile (cardiologists, rheumatologists, doctors - endocrinologists, gastroenterologists and others) operating in a medical outpatient clinic or in a medical organization, the structure of which includes a medical outpatient clinic, as well as other medical organizations.

14. Equipment of the outpatient clinic is carried out in accordance with the equipment standard, installed application No. 14 to the Regulations on the organization of the provision of primary health care to the adult population, established by this order.

15. The main tasks of the outpatient clinic are:

Diagnosis and treatment of acute diseases, chronic diseases and their exacerbations, injuries, poisonings and other conditions;
implementation of dispensary observation of patients with chronic diseases;
implementation of measures for medical rehabilitation;
elimination of life-threatening conditions with the subsequent organization of medical evacuation to medical organizations providing specialized medical care, accompanied by a medical worker of a medical outpatient clinic or an ambulance team;
provision of emergency medical care to patients with sudden acute diseases, conditions, exacerbation of chronic diseases that are not life-threatening and do not require emergency medical care, followed by referral to a specialist doctor of a medical organization in whose area of ​​responsibility this medical outpatient clinic is located;
visiting a patient in cases stipulated by the procedures for providing medical care in order to monitor his condition, the course of the disease and timely prescribe (correct) the necessary examination and (or) treatment (active visit);
referral of patients to medical organizations for the provision of primary specialized medical and sanitary, specialized, including high-tech, medical care in cases stipulated by the procedures for providing certain types of medical care (by profile);

active detection of malignant neoplasms and precancerous diseases and referral of patients with suspected malignant neoplasms to primary oncology rooms;
implementation of measures to promote a healthy lifestyle;
implementation of measures for medical prevention, including the organization and conduct of measures for sanitary and hygienic education and promotion of the health of the population, health schools for patients with socially significant non-communicable diseases and persons at high risk of their occurrence, the formation of risk groups for developing diseases, including training the population in the rules for providing first aid assistance, referral to a consultation on maintaining a healthy lifestyle;
implementation of sanitary-hygienic and anti-epidemic measures;
identification of smokers and persons who consume alcohol excessively, with a high risk of developing diseases associated with smoking, alcohol and poisoning with alcohol surrogates;
providing medical assistance to persons who smoke and excessively consume alcohol, to stop smoking and alcohol abuse, including referral for consultation and treatment to medical prevention departments, health centers and specialized medical organizations;
interaction with a medical organization, the structure of which includes a medical outpatient clinic, the territorial bodies of Rospotrebnadzor and Roszdravnadzor on the provision of primary health care.

16. The work of a medical outpatient clinic should be organized according to a shift schedule that ensures the provision of medical care throughout the day, and also provide for the provision of emergency medical care on weekends and holidays.

Appendix No. 15 to the Regulation

Rules for organizing the activities of a feldsher-obstetric station

1. These Rules determine the procedure for organizing the activities of a feldsher-midwife station.

2. FAP is organized to provide primary pre-hospital health care (hereinafter - pre-hospital care) and palliative care to the population in rural areas.

In the presence of water and other barriers, remoteness from the nearest medical organization, low population density in the region (3 times lower than the average Russian indicator), the number of the population served can be adjusted relative to the recommended number of the population served by the FAP.

4. A specialist is appointed to the position of head of the feldsher-obstetric station - a paramedic, corresponding to the qualification characteristics of the positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position "Paramedic".

5. A specialist is appointed to the position of obstetrician of the feldsher-obstetric station, corresponding to the qualification characteristics of the positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position of "midwife ".

6. A specialist is appointed to the position of a nurse at the feldsher-obstetric station, corresponding to the qualification characteristics of the positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position " Nurse".

7. The structure of the feldsher-obstetric station and the staffing level are established by the head of the medical organization, the structure of which includes the feldsher-obstetric station, based on the volume of ongoing diagnostic and treatment work, taking into account the level and structure of morbidity and mortality, the age and sex composition of the population, its density, and other indicators and taking into account the recommended staffing standards in accordance with Appendix No. 16 to the Regulation on the organization of the provision of primary health care to the adult population, approved by this order.

8. To organize the work of the feldsher-obstetric station in its structure, it is recommended to provide the following premises:

procedural;
paramedic and midwife room;
emergency delivery room;
room for temporary stay of patients;
bathroom for staff;
bathroom for patients;
sanitary room.

9. To provide emergency pre-hospital medical care in case of sudden, life-threatening acute diseases, conditions, exacerbations of chronic diseases, injuries, poisoning (hereinafter referred to as life-threatening conditions and (or) diseases), instructions are placed in the FAP in places accessible to medical personnel, including a sequence of actions for diagnosing life-threatening conditions and (or) diseases and providing medical care for them using packs containing the necessary medicines and medical products, the stocks of which are replenished as needed.

10. The equipment of the FAP is carried out in accordance with the equipment standard established by Appendix No. 17 to the Regulations on the organization of primary health care for the adult population, established by this order. FAP is provided by an ambulance, class A.

11. The main tasks of the FAP are:

Annex No. 18 to the Regulation

Rules for organizing the activities of a paramedical health center of a medical organization

1. These Rules determine the procedure for organizing the activities of a paramedical health center of a medical organization.

2. The paramedical health center of a medical organization (hereinafter referred to as the paramedical health center) is a structural subdivision of a medical organization and is organized to provide primary pre-hospital health care (hereinafter referred to as pre-medical care) and palliative care to the population in rural areas with small numbers of the population and (or) located at a considerable distance from medical organizations, including feldsher-obstetric stations, or in the presence of water, mountain and other barriers, as well as in the case of predominant (more than 40%) people over working age living in them.

3. A specialist is appointed to the position of a medical assistant of a medical assistant's health center, corresponding to the qualification characteristics of the positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position of "Paramedic".

A specialist is appointed to the position of a nurse in the feldsher's health center, corresponding to the qualification characteristics of the positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position "Nurse".

4. The staffing of the medical and other personnel of the medical assistant's health center is established by the head of the medical organization, in the structure of which he is a member, in accordance with the recommended staffing standards of the medical assistant's health center of the medical organization, established by Appendix No. 19 to the Regulation on the organization of primary health care for the adult population, approved by this order.

5. For the organization of a paramedical health center in its structure, it is recommended to provide for:

procedural;
paramedic's office;
bathroom.

6. The equipment of the feldsher's health center is carried out in accordance with the standard established by Appendix No. 20 to the Regulations on the organization of the provision of primary health care to the adult population, approved by this order.

7. To provide emergency pre-hospital medical care for sudden, life-threatening acute diseases, conditions, exacerbations of chronic diseases, injuries, poisoning (hereinafter referred to as life-threatening conditions), instructions are posted in the feldsher's health center in places accessible to medical workers, including a sequence of actions for diagnosing life-threatening conditions and (or) diseases and the provision of medical care for them, including the use of packs containing the necessary medicines and medical devices, the stocks of which are replenished as needed.

8. The main tasks of the feldsher health center are:

Diagnosis and treatment of uncomplicated acute, exacerbations of chronic diseases and other conditions, injuries, poisoning;
implementation of prevention of communicable and non-communicable diseases;
identification of smokers and persons who consume alcohol excessively, with a high risk of developing diseases associated with smoking, alcohol and poisoning with alcohol surrogates;
providing assistance to smokers and persons who consume excessive alcohol in the prevention and cessation of smoking and alcohol abuse, including referral for consultation and treatment to departments (offices) of medical prevention, health centers and specialized medical organizations;
implementation of measures to promote a healthy lifestyle;
referral of patients to medical organizations for the provision of primary (medical, specialized) health care or specialized medical care in cases stipulated by the procedures for the provision of medical care according to profiles, organization of an appointment with specialist doctors;
elimination of life-threatening conditions with the subsequent organization of medical evacuation to medical organizations providing specialized medical care, accompanied by a medical worker of a paramedical health center or an ambulance team;
detection of precancerous diseases and malignant neoplasms of visual localizations and referral of patients with suspected malignancy and with precancerous diseases to the primary oncology office of a medical organization;
organization and provision of palliative care to patients, including patients with cancer, who need narcotic and potent drugs in accordance with the recommendations of medical specialists;
implementation of sanitary-hygienic and anti-epidemic measures;

implementation of measures to protect the family, motherhood, fatherhood and childhood;
examination of temporary disability;
interaction with a medical organization, the structure of which includes a feldsher health center, territorial bodies of Rospotrebnadzor and Roszdravnadzor on the provision of primary pre-medical health care.

Appendix No. 21 to the Regulation

Rules for organizing the activities of the Center (Department) of General Medical Practice (Family Medicine)

1. These Rules establish the procedure for organizing the activities of the Center (Department) of General Medical Practice (Family Medicine).

2. The Center (Department) of General Medical Practice (Family Medicine) (hereinafter referred to as the Center) is organized as an independent medical organization or as a structural unit of a medical organization (its structural unit) providing primary health care, and is organized to provide primary medical care. sanitary care (hereinafter referred to as medical care), primary pre-medical health care (hereinafter referred to as pre-hospital medical care) as part of the provision of emergency medical care, as well as palliative care.

3. The provision of medical care in the Center is carried out on the basis of the interaction of general practitioners (family doctors) and medical specialists in the profile of the patient's disease (cardiologists, rheumatologists, endocrinologists, gastroenterologists, etc.) who carry out their activities in a medical organization, the structure of which includes the Center, as well as other medical organizations.

4. The structure of the Center and the number of staff are established by the head of the Center or the head of the medical organization in which it was created, based on the volume of ongoing medical and diagnostic work, the number, sex and age composition of the population served, indicators of the level and structure of morbidity and mortality of the population, other indicators characterizing public health, and taking into account the recommended staffing standards in accordance with Appendix No. 22 to the Regulation on the organization of primary health care for the adult population, approved by this order.

5. The Center is headed by the chief physician (head), to whose position a specialist is appointed who meets the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia 9 July 2009, No. 14292), in the specialty "General Medicine", "Pediatrics" "General Medical Practice (Family Medicine)" and the qualification characteristics of positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n ( registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247).

6. A specialist who meets the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292) is appointed to the position of the doctor of the Center ), in the specialty "General Medical Practice (Family Medicine)" and the qualification characteristics of positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position " General practitioner (family doctor).

7. A specialist is appointed to the position of a nurse of the Center, corresponding to the qualification characteristics of positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position of "Nurse" .

8. For the position of the medical assistant of the Center, specialists are appointed who meet the qualification characteristics of the positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position of "Paramedic".

9. To organize the work of the Center, it is recommended to provide for the following in its structure:

Registry;
consultative and medical department, which may include:
general practitioner (family doctor) offices),
gynecological (examination) room,
dental office,
manipulation,
children's vaccination room,
procedural,
dressing room,
physiotherapy room;
day hospital department;
department (office) of medical prevention;
clinical diagnostic laboratory;
baby food station.

10. In order to improve the provision of medical care in the Center (Department), an office (department) of first aid, an office (department) of emergency medical care, a day hospital, including a home hospital, a medical aid office for smoking cessation, can be organized.

11. The Center performs the following functions:

Provision of medical care in accordance with the established procedures for the provision of certain types (by profile) of medical care and standards of medical care, including:
informing the population about the need and possibility of identifying risk factors and assessing the degree of risk of developing chronic non-communicable diseases, their drug and non-drug correction and prevention, as well as counseling on maintaining a healthy lifestyle in the Center's subdivisions, departments (offices) of medical prevention and health centers;
identification of smokers and excessive alcohol users with a high risk of developing diseases associated with smoking, alcohol and poisoning with alcohol surrogates;
providing medical assistance to smokers and persons who consume alcohol excessively to stop smoking and alcohol abuse, including referral for consultation and treatment to health centers and specialized specialized medical organizations;
conducting preventive examinations, individual and group preventive counseling and examination;
training in health schools, in schools for patients and people at high risk of developing non-communicable diseases, including training risk groups on first aid rules for sudden cardiac arrest, acute coronary syndrome, acute cerebrovascular accident and other life-threatening conditions that are the main causes of death in the population outside medical organizations;
carrying out recreational activities, drug and non-drug correction of risk factors for diseases, dispensary observation of persons at high risk of developing a chronic non-communicable disease and its complications, referral, if medically indicated, of persons with a very high risk of a chronic non-communicable disease for a consultation with a specialist in the profile of a threatened disease or its complications;
implementation of measures to promote a healthy lifestyle, prevent chronic non-communicable diseases among the population of the territory (zone) of service;
prevention of infectious diseases;
implementation of measures for medical rehabilitation;
implementation of dispensary observation of the state of health of patients with the necessary examination, treatment and rehabilitation;
organizing and conducting health education activities, including health promotion activities;
elimination of life-threatening conditions with subsequent organization of medical evacuation to medical organizations or their units providing specialized medical care accompanied by a medical worker or an ambulance team;
provision of emergency medical care to patients with sudden acute diseases, conditions, exacerbation of chronic diseases that are not life-threatening and do not require emergency medical care, followed by referral to a medical specialist of a medical organization providing medical care at the patient's place of residence, followed by a visit to the patient in cases stipulated by the procedures for providing medical care in order to monitor his condition, the course of the disease and the timely appointment (correction) of the necessary examination and (or) treatment (active visit);
organization of a hospital at home;
training the population in first aid;
referral of patients to medical organizations for the provision of primary specialized medical and sanitary, specialized, including high-tech, medical care in cases stipulated by the procedures for providing certain types (by profile) of medical care;
detection of malignant neoplasms and precancerous diseases and referral of identified cancer patients and patients with suspected malignant neoplasms to primary oncology rooms;
formation of risk groups;
implementation of dispensary observation of precancerous diseases;
organization and provision of palliative care to patients, including patients with cancer, who need narcotic and potent drugs in accordance with the recommendations of medical specialists;
carrying out an examination of temporary disability, referral to a medical and social examination.
implementation of sanitary-hygienic and anti-epidemic measures;
conducting preliminary or periodic medical examinations of employees;
implementation of measures to protect the family, motherhood, fatherhood and childhood,
sanitary and hygienic education of the population;
interaction with medical organizations, territorial bodies of Rospotrebnadzor and Roszdravnadzor, other institutions and organizations on the provision of pre-hospital medical care;
organization independently or jointly with the social protection authorities of medical and social medical care for the disabled and chronically ill.

12. To ensure its activities, the Center uses the capabilities of the structural units of the medical organization in which it was created.

Annex No. 24 to the Regulation

Rules for organizing the activities of the health center

1. These Rules determine the procedure for organizing the activities of a health center, which is created to provide the adult population with primary medical health care, as well as primary pre-hospital health care aimed at implementing measures to promote a healthy lifestyle, including reducing alcohol and tobacco consumption.

2. The health center is a structural subdivision of a medical organization (its structural subdivision).

3. The health center is managed by the head, who is appointed to the position and dismissed from it by the head of the medical organization.

To the position of the head of the health center, specialists are appointed who meet the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292) with appropriate training in healthy lifestyles and medical prevention.

4. Specialists who meet the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by the order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia on July 9, 2009, No. 14292), in the specialties "organization of health care and public health", "therapy", "pediatrics", "hygienic education", "general medical practice (family medicine)", "allergology and immunology", "restorative medicine", "dietology" , "physiotherapy and sports medicine", "cardiology", "pulmonology", "gastroenterology", "psychiatry-narcology", "preventive dentistry", "medical psychology" and having appropriate training in healthy lifestyles and medical prevention.

5. A specialist is appointed to the position of a nurse at the health center, corresponding to the qualification characteristics of positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. hygiene education, nurse with appropriate training in healthy lifestyles and medical prevention.

6. A specialist is appointed to the position of a hygienist of a dental health center, corresponding to the qualification characteristics of positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), specializing in preventive dentistry ".

7. A specialist is appointed to the position of a nurse to work in the ophthalmological office of the health center, corresponding to the qualification characteristics of the positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), in the specialty "medical optician-optometrist" or in the specialty "nurse", who has completed additional professional training in the specialty "medical optics" and has appropriate training in healthy lifestyles and medical prevention.

8. The structure of the health center and the staffing are established by the head of the medical organization, the structure of which includes the health center, based on the volume of work performed, the number of people served and taking into account the recommended staffing standards in accordance with Appendix No. 25 to the Regulation on the organization of primary health care for adults population approved by this order.

9. To organize the work of a health center in its structure, it is recommended to provide for:

Offices of medical specialists;
dental hygienist's office;
ophthalmological office;
testing room on a hardware-software complex;
cabinets for instrumental and laboratory examinations;
office (hall) of physiotherapy exercises;
classrooms (audiences) of health schools.

10. In order to improve the provision of medical care, a preventive cabinet (department) may be organized in the Health Center.

11. The equipment of the Health Center is carried out in accordance with the equipment standard established by Appendix No. 26 to the Regulation on the organization of primary health care for the adult population, established by this order

12. The main tasks of the Health Center are:

Comprehensive medical examination, including the measurement of anthropometric data, screening assessment of the level of psychophysiological and somatic health, functional and adaptive reserves of the body, express assessment of cardiac activity, the vascular system, basic hemodynamic parameters, express analysis of laboratory markers of socially significant diseases and atherosclerosis, assessment of complex indicators of respiratory function system, organ of vision, detection of pathological changes in teeth, periodontal diseases and oral mucosa, based on the results of which an assessment of the functional and adaptive reserves of the body, a prognosis of the state of health and an assessment of the risk of developing diseases and their complications, including the risk of developing cardiovascular diseases, development of an individual program for maintaining a healthy lifestyle, health-improving and preventive measures;
medical assistance in refusing to consume alcohol, tobacco, in reducing overweight, organizing a balanced diet, correcting hyperlipidemia and dyslipidemia, optimizing physical activity;
dynamic monitoring of patients at high risk of developing non-communicable diseases, training them effective methods prevention of diseases, taking into account age characteristics;
group training in health schools, lectures, talks and individual counseling on maintaining a healthy lifestyle, hygiene habits, maintaining and strengthening health, including recommendations on rational nutrition, physical activity, physical education and sports, sleep patterns, living conditions, work ( education) and recreation, mental hygiene and stress management, prevention and correction of behavioral risk factors for non-communicable diseases, responsible attitude to one’s health and the health of one’s loved ones, principles of responsible attitude to the health of one’s children;
informing about harmful and dangerous factors for human health external environment, risk factors for the development of diseases, as well as teaching the population to maintain a healthy lifestyle, reducing the level of correctable risk factors, motivating them to give up bad habits;
development of action plans for the formation of a healthy lifestyle among the population, including with the participation of medical and other organizations, their coordination and implementation;
providing methodological and practical assistance to doctors and specialists with secondary medical education of medical organizations and their departments in the implementation of measures to promote a healthy lifestyle, conduct health schools;
training medical workers of medical organizations in methods of conducting activities to promote a healthy lifestyle, conducting health schools;
analysis of the dynamics of morbidity and mortality of the population from chronic non-communicable diseases in the service area, participation in studies of the level and dynamics of the prevalence of the main risk factors for chronic non-communicable diseases;
maintenance of medical records in the prescribed manner and reporting;
interaction with medical organizations, Rospotrebnadzor, Roszdravnadzor, other organizations on the formation of a healthy lifestyle, the organization and implementation of medical prevention of chronic non-communicable diseases, including the issues of teaching the population the rules for providing first aid for diseases (conditions) that are the main cause of death outside medical organizations.

In accordance with Article 32 of the Federal Law of November 21, 2011 N 323-FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2011, N 48, Art. 6724) I order:

order of the Ministry of Health and Social Development of the Russian Federation of July 29, 2005 N 487 "On approval of the procedure for organizing the provision of primary health care" (registered by the Ministry of Justice of the Russian Federation on August 30, 2005 N 6954);

order of the Ministry of Health and Social Development of the Russian Federation of August 4, 2006 N 584 "On the procedure for organizing medical care for the population on the basis of the district principle" (registered by the Ministry of Justice of the Russian Federation on September 4, 2006 N 8200).

2. The organization of the provision of primary health care is carried out in medical and other organizations of the state, municipal and private healthcare systems, including individual entrepreneurs who have a license for medical activities obtained in the manner prescribed by the legislation of the Russian Federation (hereinafter referred to as medical organizations) .

The organization of the provision of primary health care is carried out by medical organizations and their structural divisions in accordance with Annexes No. 1-27 to this Regulation.

3. Employees of organizations included in the list of organizations of certain industries with especially dangerous working conditions approved by the Government of the Russian Federation, and the population of closed administrative-territorial formations, territories with physical, chemical and biological factors hazardous to human health, included in the list approved by the Government of the Russian Federation territories, primary health care is carried out taking into account the specifics of the organization of medical care established by the Government of the Russian Federation.

a) as free of charge - within the framework of the Program of State Guarantees of Free Provision of Medical Care to Citizens of the Russian Federation at the expense of compulsory medical insurance and funds from the relevant budgets, as well as in other cases established by the legislation of the Russian Federation;

5. Primary health care is the basis of the medical care system and includes measures for the prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, monitoring of pregnancy, the formation of a healthy lifestyle, including reducing the level of risk factors for diseases, and health education.

in a medical organization providing primary health care, or its division, at the place of residence (stay) of the patient - in case of acute diseases, exacerbations of chronic diseases in case of a call from a medical worker or when he visits a patient in order to monitor his condition, the course of the disease and timely appointment (correction) of the necessary examination and (or) treatment (active visit), with the patronage of certain groups of the population in case of detection or threat of an epidemic of an infectious disease, patients with an infectious disease, persons in contact with them and persons suspected of an infectious disease, including by door-to-door (door-to-door) rounds, inspections of workers and students;

at the place of departure of the mobile medical team, including for the provision of medical care to residents of settlements with the predominant residence of persons older than working age, or located at a considerable distance from the medical organization and (or) having poor transport accessibility, taking into account climatic and geographical conditions.

8. In order to improve the efficiency of primary health care in case of sudden acute illnesses, conditions, exacerbation of chronic diseases that are not dangerous to the life of the patient and do not require emergency medical care, an emergency medical care department (office) can be organized in the structure of medical organizations, providing its activities in accordance with Appendix No. 5 to this Regulation.

Taking into account the formation of contingents of citizens temporarily (seasonally) residing in the territory of a settlement (including summer cottages and garden partnerships), an emergency medical department (office) can be organized in close proximity to the place of temporary (seasonal) residence.

primary pre-hospital health care, which is provided by paramedics, obstetricians, other medical workers with secondary medical education of paramedical health centers, feldsher-obstetric centers, medical ambulance stations, health centers, polyclinics, polyclinic divisions of medical organizations, departments (offices) of medical prevention, health centers;

primary medical care, which is provided by general practitioners, district general practitioners, general practitioners (family doctors) of medical outpatient clinics, health centers, polyclinics, outpatient departments of medical organizations, offices of general practitioners (family doctors), health centers and departments (rooms) of medical prevention;

primary specialized health care, which is provided by specialist doctors of various profiles of polyclinics, polyclinic divisions of medical organizations, including those providing specialized, including high-tech, medical care.

11. In small and (or) located at a considerable distance from a medical organization or its subdivision of settlements, including temporary (seasonal), medical organizations providing primary health care on a territorial-district basis, on the service territory of which such settlements, carry out the organization of first aid to the population before the arrival of medical workers in case of sudden, life-threatening acute diseases, conditions, exacerbations of chronic diseases, injuries, poisoning with the involvement of one of the households.

The organization of first aid includes the formation of a first aid kit, its replenishment as necessary, training in first aid skills, provision of first aid providers, as well as persons at high risk of developing sudden cardiac death, acute coronary syndrome and other life-threatening conditions, and their family members, manuals and first aid instructions for the most common life-threatening conditions that are the main cause of death (including sudden cardiac death, acute coronary syndrome, acute cerebrovascular accident), containing information about the characteristic manifestations of these conditions and necessary measures to eliminate them before the arrival of medical workers.