A new procedure for the organization of sanatorium-and-spa treatment. Sanatorium and resort care Military sanatorium "Gagra" of the Ministry of Defense of the Russian Federation

Appendix N 1. The procedure for medical selection and referral of patients to sanatorium-resort treatment Appendix N 2. Form N 070 / y-04 "Reference for obtaining a permit" invalid) Annex N 4. Form N 076 / y-04 "Sanatorium and resort card for children" (no longer valid) Annex N 6. Instructions for filling out the form N 072 / y-04 "Sanatorium-resort card" (no longer valid) Appendix N 7. Instructions for filling out the form N 076 / y-04 "Sanatorium-resort card for children" (no longer valid)

Order of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004 N 256
"On the order of medical selection and referral of patients for sanatorium treatment"

With changes and additions from:

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

* Registered with the Ministry of Justice of Russia on 07/10/2001 registration N 2800

Registration N 6189

Medical selection and referral of patients in need of sanatorium treatment is carried out by the attending physician and the head of the department, or in his absence, the head physician (his deputy) of the medical institution (outpatient clinic (at the place of residence) or medical unit ( place of work, study).

The doctor determines the medical indications for sanatorium-and-spa treatment and the absence of contraindications for its implementation based on the analysis of the patient's objective condition and the results of previous treatment, data from laboratory, functional, radiological and other studies. In difficult and conflict situations, the conclusion on the indications for sanatorium treatment is issued by the medical commission of the medical institution.

The features of medical selection and referral to sanatorium treatment of children, as well as the procedure for admission and discharge of patients are established.

Forms of documents N 070 / y-04 "Reference for obtaining a ticket", N 072 / y-04 "Sanatorium-resort card", N 076 / y-04 "Sanatorium-resort card for children" and the procedure for filling them out are given.

Order of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004 N 256 "On the procedure for medical selection and referral of patients for sanatorium treatment"

Registration N 6189

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

4916 0

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

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

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

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

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

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

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

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

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

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

For the treatment of certain categories of patients, longer periods of treatment have been established in highly specialized sanatorium-and-spa institutions (in accordance with the resolution of the Executive Committee of the Council of the Federation of Independent Trade Unions of Russia dated June 16, 1992 No. 6-7, agreed with the Ministry of Health and Medical Industry of the Russian Federation): in sanatoriums (departments) for the treatment of patients with diseases and consequences of spinal cord injuries - 45 days; with inflammatory diseases of the kidneys - 36 days; with occupational respiratory diseases - 45 days; with occupational lung diseases (pneumoconiosis, silicosis) - 30 days.

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

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

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

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

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

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

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

New requirements

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

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

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

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

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

Six standard diets

Cancellation of old norms

features of the application of legal documents

Purpose of diets

Specialty Products - Order Requirement

Vitamins in the diet

Individual therapeutic nutrition program

Drawing up an individual program

Summary

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

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

Table 1. Diet Prescribing (Part 1)

Table 1.2. Diet Prescribing (Part 2)

Layout card No. 5.4

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

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

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

It occupies the main place in the system of treatment and preventive measures, primarily in the rehabilitation of patients.

The resort stationary medical and preventive institution is sanatorium. Most sanatoriums are organized in resort areas in order to maximize the use of the natural features of the area.

Resorts and sanatoriums

Resort- the area, the natural features of which allow you to effectively deal with the treatment and prevention of diseases. According to the nature of these features, resorts are divided into three groups: (waters of mineral springs), mud (therapeutic mud) and climatic (seaside, mountain, plain, forest and steppe). For resorts, three zones of sanitary protection have been established, within which it is prohibited. An important role is given to local resorts, which are most often intended for patients who, after treatment, for health reasons, are contraindicated in climate change.

The sanatorium is intended for the treatment of patients mainly with natural remedies in combination with physiotherapy, physiotherapy exercises, and therapeutic nutrition in conditions of active recreation and a specially organized regimen. Drug treatment and bed rest are not typical for a sanatorium, although they can be prescribed. Patients with a variety of diseases are treated in sanatoriums. In this regard, there are sanatoriums with diseases of the circulatory organs, digestive organs, gynecological diseases, etc. Depending on the age of the patients, sanatoriums are divided into children's, adolescent and adult.

The basis of sanatorium treatment is the sanatorium regime, which provides the most favorable conditions for treatment and rest. Patients are provided with treatment in mud baths, solariums, swimming pools, etc. In most resorts, along with sanatorium treatment, outpatient treatment of patients who come on course vouchers is also carried out.

Sanatoriums-preventoriums are also widely used - medical and preventive institutions organized at industrial enterprises, maintained at the expense of state insurance funds. The workers of this enterprise, on the recommendation of the attending physician, are given the opportunity to undergo treatment in a dispensary within 24 days after work, where they are delivered by special transport. In addition, sanatorium institutions include resort clinics, hydropathic clinics, mud baths, etc.

The order of referral to sanatorium-resort treatment

The effectiveness of spa treatment depends on the correct direction of patients to the resort and the sanatorium.

For the possibility of spa treatment, you must contact the doctor of the clinic at the place of residence. The doctor gives a referral to the sanatorium selection committee (SOK), which determines the need for sanatorium treatment, the profile of the sanatorium and the season for treatment. After receiving the conclusion of the SOK, it is necessary to write an application for a voucher addressed to the chairman of the commission (authorized) for social insurance at the place of work. Pensioners apply to the social security authorities (district departments of social protection of the population) at their place of residence. The Social Insurance Commission must consider the application and make a decision within 10 days. In case of disagreement with the decision of the commission, it is possible to appeal against its decision through the department (branch of the department) of the social protection institution. In addition to resolving the issue of allocating a voucher, the social insurance commission has the right to resolve the issue of paying 50% of the cost of travel to the sanatorium and back, depending on the patient's earnings and marital status. Permits are issued only for the period of vacation of the employee. Participants of the Great Patriotic War and persons equated to them are entitled to receive a ticket free of charge.

Upon arrival at the sanatorium, the patient submits a sanatorium-resort card, which is filled out at the clinic at the place of residence: a clinical blood and urine test no more than a month old, an ECG no more than a month old, an x-ray examination (FLG or chest X-ray) no more than six months ago, for women, the conclusion of a gynecologist, regardless of the diagnosis of the disease, the conclusions of other specialists, depending on the profile of the disease. Registration and issuance of medical documents and vouchers is carried out 15-20 days before the start of the voucher period. The voucher must be duly issued and certified by the seal of the institution that issued it. In addition to a voucher and a sanatorium card, when entering a sanatorium, you must have a passport, children under 16 years of age have a birth certificate or a copy of it. Military personnel present an identity card, and military pensioners present a pension certificate, where in the section for special marks it should be indicated that the pensioner enjoys the right to sanatorium treatment in sanatoriums of the Ministry of Defense of the Russian Federation.

In the sanatorium book issued to the patient in his hands, the doctor of the sanatorium notes the change in the patient's state of health, the treatment and research carried out, and at the end of the voucher period - the results of treatment and recommendations on the mode of work and therapeutic measures. Upon returning from the sanatorium, the patient presents the sanatorium book to the attending physician, who transfers all the necessary information to the outpatient card for the development of further therapeutic and preventive measures.

The effectiveness of sanatorium-and-spa treatment is evidenced by the long-term absence of exacerbations of the underlying disease, stable recovery, improvement in the general state of health and well-being of the patient.