Sample of filling out form n 088 y 06. List of documents for passing the ISE

Recommendations for the procedure for filling out registration form No. 088/u-06 “Referral for medical and social examination by an organization providing medical and preventive care”

The line “Date of issue” indicates the date of issue of the “Referral for a medical and social examination by an organization providing medical and preventive care” to the citizen referred for a medical and social examination or his legal representative.

APPROVED

• APPROVED Order of the Ministry of Health. Donetsk People's Republic.
• page 2 of form No. 088/у. 13. Change of profession or working conditions for Last year: 14. The patient’s condition when referred to MSEC (data objective examination specialist.

On approval of the Rules for conducting medical and social examination

• Preamble as amended by the order of the Minister of Health and social development RK from
• the following documents: 1) referral for medical and social examination (hereinafter referred to as form 088/u)
• Republic of Kazakhstan dated November 23, 2010 No. 907 “On approval of the form...

www.info.mintrud.kz

Application

• Appendix to the Order of the Ministry of Health and Social Development Russian Federation dated January 31, 2007 No. 77.
• Medical documentation. Form No. 088/у-06.
• Referral for medical and social examination by the organization...

www.invalidnost.com

Form No. 088/у-06

Appendix to the Order of the Ministry of Health and Social Development of the Russian Federation dated January 31, 2007 No. 77. Download Form No. 88/у-06 (.doc). Medical documentation. Form No. 088/у-06.

On approval of the Rules for conducting medical and social examination - IPS "Adilet"

• 1) referral for medical and social examination (hereinafter referred to as form 088/u), approved by order of the Acting Minister of Health of the Republic of Kazakhstan dated November 23, 2010 No. 907 “On approval of forms of primary medical documentation...

According to the Regulations on recognizing a person as disabled, approved by Decree of the Government of the Russian Federation dated August 13, 1996 N 965, medical institutions refer a citizen for examination for a medical and social examination after conducting the necessary diagnostic, therapeutic and rehabilitation measures in the presence of data confirming persistent impairment of body functions caused by diseases, consequences of injuries and defects.

This Instruction determines the procedure for filling out registration form N 088/u-97 “Referral for medical and social examination”, intended for entering information about the development of diseases, the course, frequency and duration of disability, ongoing treatment and preventive measures, measures to restore working capacity and others , necessary for medical social expertise.

This form is filled out for persons sent for a medical and social examination for the first time, for disabled people sent for re-examination, for citizens sent for an in-person consultation at ITU institutions. Responsibility for the correct filling out of the registration form rests with the chairman of the KEC of the medical institution or the chief physician.

The procedure for filling out the “Referral for medical and social examination”

In the line “Date of issue” - indicates the date of issue of the “Referral for medical and social examination” (hereinafter referred to as the “Referral”) to the person referred to the medical examination or his legal representative.

In line 1 - “Last name, first name, patronymic” of the person being sent is indicated in full.

In line 2 - “Date of birth” the day, month and year of birth are indicated, “Gender” - abbreviated as “m” or “f”.

Line 3 - "Patient's address" - indicates the place of residence (based on the registration in the passport).

In line 4 - “Disabled person of ___ group” - the disability group is indicated on the basis of the disabled person’s certificate from the ITU institution about established group disability or a dash if the patient is being referred for the first time.

Line 5 - "Place of work" - indicates the name of the organization in which the person being referred works at the time of filling out the "Referral". If a citizen does not work, a corresponding entry is made about this.

In line 6 - "Address of place of work" - the address of the organization in which the person sent on the day of opening the certificate of incapacity for work works.

Line 7 - “Profession” - indicates the profession that was obtained by special education(engineer, teacher, construction technician), or the one with the longest work experience and (or) the highest qualifications (for example: V-category repairman, etc.).

In line 8 - “Position” - you should indicate the one in which the patient was employed on the day the certificate of incapacity was opened for him.

In line 9 - “Under the supervision of a medical institution with...” - the date of initial filling is indicated outpatient card patient in a medical institution.

In line 10 - “History of the present disease (onset, development, course, date of exacerbations, treatment and preventive measures taken, measures to restore working capacity)” - during the initial registration of a referral for a medical and social examination, information about the onset of the disease (the nature of the injury, injuries), features of the course, dates of exacerbations (indicate the frequency and duration of exacerbations for the 12 months preceding the referral of the patient for a medical and social examination), information about the nature of the treatment provided (outpatient or inpatient, indicating the profile of the department), types of treatment: therapeutic, surgical, physiotherapeutic, etc. When making a referral for re-examination, line 10 indicates information about the course of the disease for the period that has passed since the date the disability group was established.

Line 11 - “Results of the rehabilitation measures taken” - indicates information about measures to restore the patient’s ability to work and their effectiveness or measures to implement an individual program medical rehabilitation disabled person when receiving a referral for re-examination.

In line 12 - “Frequency and duration of temporary disability for the last 12 months” in the column “Numbers from _____ to _____” the dates of opening and closing of certificates of incapacity for work are indicated, in the last line or under the line the total number of days of temporary disability is indicated. If the patient does not work, then this section indicates the frequency of calls for him medical care V medical institution and the name of the diseases for which the patient applied to the health care facility. In the column “Name of the disease” - on the line corresponding to the period for issuing the certificate of incapacity for work, indicate the name of the disease for which the patient was recognized as temporarily disabled during the corresponding period or sought medical help.

Line 13 - “Name of profession and working conditions for the last year” - indicates the profession (position) that the patient performed at the time he was issued a certificate of incapacity for work, as well as the prevailing production factor, degree of severity of physical or neuro-emotional stress, etc. Information is recorded from the patient’s words, in necessary cases requested from the place of work.

In line 14 - “The patient’s condition when referred for medical examination (data from an objective examination of a therapist, surgeon, neurologist and other doctors)” - when describing the objective status, each specialist sets out in detail and sequentially the patient’s complaints, first of all related to the underlying disease, then others , the data of an objective examination of the patient by specialists are reflected with exhaustive completeness, while the specialty of the doctor (therapist, surgeon, neurologist, etc.) is indicated.

If necessary, the insert for the “Referral” can be used to record the patient’s condition and the results of examination by specialists. free form, which must be sealed and signed by the chairman of the KEC and members of the commission.

On line 15 - " X-ray studies" - the results of x-ray studies confirming established diagnosis the underlying disease, and others that, to one degree or another, may influence the course of the underlying disease.

On line 16 - " Laboratory research" - the results of laboratory tests that are important to confirm the main diagnosis are indicated.

On line 17 - " Additional Methods research" - information about additional research carried out in the process of clarifying the diagnosis.

In line 18 - “Diagnosis upon referral to ITU”:

in paragraph 1. - "main disease ( clinical characteristics according to the accepted ICD)" - a detailed diagnosis is indicated, reflecting..... the ozoological form of the disease in accordance with the International Statistical Classification of Diseases, tenth revision, etiology, features of the course, stage, degree functional disorders. When several diseases are combined, the main one is the disease that determines the presence of signs of disability;

in paragraph 2 - " accompanying illnesses" - indicate those diseases that are not decisive when assessing disability;

v.3 - “complications” - complications caused by the underlying disease are indicated.

In line 18.1 - “Violations of the basic functions of the body (according to the adopted Classification, approved, section 1.2)” - the patient’s impairments are indicated in accordance with section 1.2 “Classification of violations of the basic functions of the human body”.

In line 18.2 - “Signs of disability (according to the adopted Classification, approved by the decree-order of the Ministry of Labor and Social Development of Russia and the Ministry of Health of Russia dated January 29, 1997 N 1/30, section 1.5)” - indicates the patient’s disability in accordance with section 1.5 “Classification of limitations vital activity according to degree of expression."

In line 19 - “Grounds for referral to medical examination: the presence of signs of disability, the end of the period of disability, early re-examination, the need to extend the sick leave” (underline) - the necessary is underlined. If it is necessary to extend the certificate of incapacity for work, it is extended within the period established by clause 2.3 of the instructions “On the procedure for issuing documents certifying temporary incapacity for work.”

The referral is signed by the chairman of the KEC and members of the commission and sealed with the seal of the medical institution.

The procedure for filling out the “Notification of a medical and preventive institution about the conclusion of the institution of the state service of medical and social examination”

Line 1 - “Last name, first name, patronymic of the patient” - is filled in by the medical institution when filling out form N 088/u-97.

All subsequent lines are filled in by the institution medical and social examination.

Line 2 - "Date" - indicates the start date of the medical and social examination.

Line 3 - “N of the inspection report” - indicates the number of the act corresponding to the inspection protocol.

In line 4 - "Institutional diagnosis civil service ITU" - indicates the disease that was decisive in establishing the disability group.

In line 5 - "The degree of impairment of body functions (according to the adopted Classification, approved by the resolution-order of the Ministry of Labor and Social Development of Russia and the Ministry of Health of Russia dated January 29, 1997 N 1/30, section 1.4)" - is indicated in accordance with clause 1.4 "Classification of impairments of body functions by degree of expression."

In line 6 - "The degree of disability (according to the Classification approved by the resolution-order of the Ministry of Labor and Social Development of Russia and the Ministry of Health of Russia dated January 29, 1997 N 1/30, section 15") - is indicated in accordance with clause 1.5 "Classification of disability by severity ".

Line 7 - “Conclusion of the ITU civil service institution” - indicates the state of the person being referred, the group, the cause of disability, the period for which the disability group was established, the date of the next re-examination; If the person examined is not recognized as disabled, a corresponding entry is made about this - “not recognized as disabled.”

In line 8 - “Recommendations for social and professional rehabilitation” - a short entry is made about the recommended types of rehabilitation and who will carry them out (social protection authorities, employment center, etc.).

Line 9 - “Recommendations for medical rehabilitation” - indicates the measures provided for by the individual rehabilitation program for a disabled person and agreed with the medical rehabilitation plan of the medical institution.

The notice is signed by the head of the ITU public service institution, the signature is deciphered and sealed with the seal of the institution.

“Date of dispatch” - indicates the date the “Notice” was sent to the medical institution.

The text of the document is verified according to:
"Directory of the Deputy Chief
doctor for medical work and CER",
M., 2000

Electronic referral to ITU

The program is designed to automatically fill out the referral form for medical examination (registration form No. 088/u-06) and related documentation (outpatient card diary, return coupon), save data on registered patients and generate a report on them.

Benefits of the program:

• speeding up the registration of a patient's referral to MSEC by 3-4 times, compared to the handwritten version
• use of templates for filling out such items as UAC, OAM, conditions and nature of work; quick entry of diagnosis code and dates, automatic calculation of body mass index
• quick filling of data for repeat patients by creating a copy of form No. 088 of last year
• automatic filling of the outpatient card diary and return coupon
• convenient and quick report generation
• self-sufficiency - no need to use in conjunction with other office applications (MS Word, Excel, etc.)
• preview of documents before printing, which allows you to visually control the correctness of its completion
• printing a list of documents required by the patient when undergoing medical examination
• continuous improvement, regular updates
• availability of a network version that allows several users to work with one database
• detailed instructions on working with the program

Referral for medical and social examination

One of the main documents when passing a medical and social examination is “Referral for a medical and social examination by an organization providing medical and preventive care” - form No. 088/u-06.

Correct filling of this form has great importance, because specialists from medical and social examination institutions are guided, first of all, by the data contained in form No. 088/u-06. Still missing normative act, regulating the procedure for filling out form No. 088/u-06 “Referral for medical and social examination by an organization providing medical and preventive care,” approved by order of the Ministry of Health and Social Development of Russia dated January 31, 2007 No. 77.

A referral for a medical and social examination is issued when the next re-examination is due, as well as in accordance with the order of the Ministry of Health and Social Development of Russia dated June 29, 2011. N 624n "On approval of the procedure for issuing certificates of incapacity for work" to citizens who have persistent limitations in their ability to live and work and who need social protection, according to the conclusion of the medical commission when:

Obvious unfavorable clinical and labor prognosis, regardless of the duration of temporary disability, but no later than 4 months from the date of its start;

Favorable clinical and work prognosis for temporary disability lasting more than 10 months (in some cases: conditions after injuries and reconstructive operations, in the treatment of tuberculosis - over 12 months);

The need to change the professional rehabilitation program for working disabled people in the event of a worsening clinical and work prognosis, regardless of the disability group and the duration of temporary disability.

List of documents for passing the ITU

To determine the disability group (category “disabled child”):

Download a sample application for ITU.

3. Referral for medical and social examination of a medical institution (Form 088\у-06); or Certificate from the medical commission in cases of refusal to refer a citizen to medical examination; or Court ruling.

4. Medical documents(outpatient card, hospital extracts, R-images, etc.).

5. Copy work book, certified by the HR department for working (original work book for non-working) citizens.

6. Education documents.

7. Information about the nature and conditions of work (for workers) - production characteristics.

8. Pedagogical characteristics a child attending a preschool institution.

9. Pedagogical characteristics for the student.

10. Certificate of disability upon re-examination.

11. Individual rehabilitation program for a disabled person (IPR) with notes on its implementation upon re-examination.

To determine the extent of loss professional ability to work:

1. Statement from a citizen (or his legal representative), employer (insured), insurer (FSS), court ruling.

3. Referral for medical and social examination of a medical institution (Form 088\у-06); or Court ruling.

5. Report on an industrial accident in form N-1, or Report on an occupational disease upon initial application to the ITU.

6. A copy of the work book, certified by the personnel department for working (original work book for non-working) citizens.

7. Conclusion of the Authority state examination working conditions about the nature and working conditions of the victim during the initial application to the ITU.

8. Conclusion of the medical commission of the health care facility on the need for medical rehabilitation.

9. Victim Rehabilitation Program (RPP) with notes on its implementation during re-examination.

10. Certificate on the results of determining the degree of loss of professional ability as a percentage during re-examination.

To develop (correct) an Individual Rehabilitation Program for a Disabled Person (IRP):

1. Application from a citizen (or his legal representative).

2. Passport or other identification document; citizens over 14 years of age have a passport (for persons under 14 years of age: birth certificate and passport of one of the parents or guardians).

3. Certificate of disability.

4. Referral for a medical and social examination of a medical institution (Form 088\u-06); or Referral of a citizen to medical examination, issued by a social protection authority.

5. Medical documents (outpatient card, hospital extracts, R-images, etc.).

6. Information about the nature and conditions of work (for workers) – production characteristics.

7. Pedagogical characteristics of a child attending a preschool institution.

8. Pedagogical characteristics for the student.

9. Individual rehabilitation program for a disabled person (IRP) with notes on its implementation upon re-examination.

To develop (correct) the Victim Rehabilitation Program (RPP):

1. Application from a citizen (or his legal representative).

2. Passport or other identification document.

4. Medical documents (outpatient card, hospital extracts, R-images, etc.).

5. Information about the nature and conditions of work (for workers) – production characteristics.

6. Conclusion of the medical commission of the health care facility on the need for medical rehabilitation.

7. Victim Rehabilitation Program (RPP) with notes on its implementation during re-examination.

The line “Date of issue” indicates the date of issue of the “Referral for a medical and social examination by an organization providing medical and preventive care” to the citizen referred for a medical and social examination or his legal representative.

In line 1, the last name, first name, and patronymic of the citizen sent for a medical and social examination are indicated in full.

Line 2 “Date of birth” indicates the day, month and year of birth.

In line 3, the citizen’s gender is indicated in abbreviation: “m” or “f”.

Line 4 “Last name, first name, patronymic of the legal representative of the citizen” is filled in completely if there is a legal representative.

In line 5 “Address of the citizen’s place of residence”, if there is no place of residence, the address of stay, actual residence in the territory of the Russian Federation is indicated.

In line 6 “Not a disabled person, disabled person of the first, second group, category “disabled child” group”, the disability group is indicated based on the certificate of the medical and social examination institution available to the disabled person about the established disability group, or it is emphasized “is not a disabled person” if the patient sent for the first time.

Line 7 “The degree of limitation of the ability to labor activity” is filled in when re-referring based on the citizen’s certificate from a medical and social examination institution about the established disability group and the degree of limitation of the ability to work, the degree is indicated (first, second, third, not established).

Line 8 “Degree of loss of professional ability to work as a percentage” is filled in during re-examination on the basis of a certificate available to the citizen from a medical and social examination institution on determining the degree of loss of professional ability to work.

Line 9 emphasizes whether the citizen is being referred initially or repeatedly to ITU.

In line 10 “Who works at the time of referral for medical and social examination”, you should indicate the position, profession, specialty, qualification and length of service in the specified position, profession, specialty, qualification; in a relationship unemployed citizens make a note: “doesn’t work.”

Line 11 “Name and address of the organization in which the citizen works” indicates the name of the organization with the address in which the person being sent works on the day the certificate of incapacity for work is opened. If a citizen does not work, a corresponding entry is made about this.

In line 12 “Conditions and nature of the work performed,” information is recorded from the patient’s words; if necessary, requested from the place of work in the form production characteristics(duration of the working day, shift; manual, machine-manual, mental, conveyor work: position during work (in percentage: sitting, standing, variable, walking); degree physical stress: permanently (mild, moderate, severe) and temporarily (mild, moderate, severe); degree neuropsychic stress: permanently (mild, moderate, severe) and temporarily (mild, moderate, severe); administrative and economic work (large, medium, small volume), indicate the number of subordinates; the presence of unfavorable working conditions (work in a hot shop, in the cold, increased dust and gas pollution, exposure to chemical substances, at height, with vibration).

Line 13 “Main profession (specialty)” indicates the profession obtained through special education (for example, engineer, teacher, construction technician), or the profession in which you have the longest work experience and (or) the highest qualifications (for example, repairman V category, etc.).

In line 14 “Qualification in the main profession (class, rank, category, rank)” you should indicate the qualifications that the patient had on the day the certificate of incapacity was opened.

Lines 15, 16. 17 are filled out for citizens who are studying at an educational institution at the time of referral for a medical and social examination (full-time or part-time). Line 15 indicates the name and address educational institution, line 16 underlines the indicated group, class, course, line 17 indicates the profession (specialty) that a citizen sent for a medical and social examination will receive upon graduation from an educational institution.

Line 18 “Observed in organizations providing medical and preventive care since _____” indicates the date of initial filling out of the patient’s outpatient card in the medical and preventive institution.

In line 19, when initially registering a referral for a medical and social examination, information about the onset of the disease (the nature of the injury, injury), characteristics of the course, exacerbations (indicate the frequency and duration of exacerbations for the 12 months preceding the referral of the patient for a medical and social examination), information about the nature of the treatment provided (outpatient or inpatient, indicating the profile of the department), types of treatment: therapeutic, surgical, physiotherapeutic, etc. When making a referral for re-examination, information about the course of the disease for the period elapsed from the date of establishment of the disability group is indicated, and the findings identified at this time are described in detail period of new cases of diseases leading to persistent impairment of body functions.

Line 20 “Life history” is filled in during the initial referral. Diseases suffered in the past, injuries, poisonings, operations, diseases for which heredity is aggravated are listed. In relation to the child, it is additionally indicated how the mother’s pregnancy and childbirth proceeded, the timing of the formation of psychomotor skills, self-care, cognitive and play activities, neatness and self-care skills, how development proceeded (by age, with a lag, with an advance).

In line 21 “Frequency and duration of temporary disability for the last 12 months” in the columns “Date (day, month, year) of the beginning of temporary disability” and “Date (day, month, year) of the end of temporary disability” indicate the dates of opening and closing certificates of incapacity for work , in the column “number of days (months and days) of temporary disability” the total number of days of temporary disability is indicated. If the patient does not work, then this section indicates the frequency of his requests for medical help in a medical institution and the diagnosis of diseases for which the patient applied to the health care facility. The column “Diagnosis” indicates the diagnosis of the disease for which the patient was recognized as temporarily disabled during the corresponding period or sought medical help.

Line 22 “Results of measures taken for medical rehabilitation in accordance with the individual rehabilitation program for a disabled person” indicates information about measures to restore the patient’s ability to work, specific types of rehabilitation therapy, reconstructive surgery, sanatorium-resort treatment, technical means rehabilitation, including prosthetics and orthotics, as well as the time frame within which they were provided; body functions that were able to be compensated or restored in whole or in part are listed, or a note is made that positive results are missing.

In line 23 “The condition of a citizen when referred for a medical and social examination (complaints, examination data by the attending physician and doctors of other specialties are indicated), when describing the objective status, each specialist sets out in detail and sequentially the patient’s complaints, first of all related to the underlying disease, then others, The data from an objective examination of the patient by specialists are reflected in exhaustive detail, and the specialty of the doctor (therapist, surgeon, neurologist, etc.) is indicated.

If necessary, to record the patient’s condition and the results of examination by specialists, a free-form referral insert can be used, which must be sealed and signed by the chairman of the medical commission and members of the commission.

Line 24 indicates the results of laboratory, radiological, endoscopic, ultrasound, psychological, functional and other types of studies.

Line 25 indicates the citizen’s body weight in kg, height in meters, body mass index. The latter is calculated by the formula:

BMI = Weight (kg)/Height (meters) squared

Pre-obesity 25–29.9

Obesity I degree 30–34.9

Obesity II degree 35–39.9

Obesity III degree 40 or more

A person's height is measured using a stadiometer. Normally, the height of men ranges from 160-180 cm, women 155-170 cm. Body weight is determined using medical scales.

Line 26 gives the estimate physical development– normal, deviation (underweight, overweight, short stature, high growth) – what is needed is emphasized. Physical development is a set of morphological functional signs organism, determining its reserve physical strength, endurance and performance.

In line 27 “Evaluation of psychophysiological endurance: norm, deviation” the necessary is emphasized. Psychophysiological endurance is a person’s ability to maintain any activity for a long time without reducing the effectiveness of its implementation, i.e. in a broad sense – performance. Psychophysiological endurance is determined by the degree of physical development, condition functional systems organism, personality traits, temperament, level of motivation to perform activities, and other factors. An assessment of psychophysiological stability is carried out by a psychologist based on an analysis of the dynamics of psychophysiological and physiological indicators in the process of performing psychological tests, sensory, sensorimotor and physical activity, as well as knowledge that imitates different kinds household, professional and other activities. In this case, not just the level of development or state of certain functions is assessed, but, first of all, their characteristics such as stability and the ability to maintain activity at a certain level for a long time.

In line 28 “Assessment of emotional stability: norm, deviation,” the necessary is emphasized. Emotional stability is a trait that expresses the preservation of organized behavior in ordinary and stressful situations and is characterized by maturity, excellent adaptation, lack of great tension, anxiety, a tendency to lead, and sociability; emotional instability - extreme nervousness, instability, poor adaptation, tendency to rapid mood swings, feelings of guilt and anxiety, preoccupation, depressive reactions, absentmindedness, instability in stressful situations, impulsiveness, uneven relationships with people, variability of interests, lack of self-confidence, pronounced sensitivity, impressionability, tendency to irritants. Emotional stability is assessed by a psychologist using various projective techniques, questionnaires and scales.

In line 29 “Diagnosis upon referral for medical and social examination” in paragraph “a” the code of the underlying disease according to ICD-10 is indicated; in paragraph “b” a detailed diagnosis is indicated, reflecting the nosological form of the disease in accordance with ICD-10, etiology, features of the course, stage, degree of functional impairment. When several diseases are combined, the main one is the disease that determines the presence of signs of disability; in paragraph “c” “concomitant diseases” indicate those diseases that are not decisive when assessing disabilities; in paragraph “c”, complications caused by the underlying disease are indicated.

On line 30 “ Clinical prognosis: favorable, relatively favorable, doubtful (uncertain), unfavorable” what is needed is emphasized. Clinical prognosis is a medical assessment of the outcome of the disease, taking into account the nature of the disease and its course, stage, severity of symptoms, degree of dysfunction of the affected organs and systems and the state of their compensation, as well as effectiveness adequate treatment. The prognosis can be: favorable - complete recovery or compensation of functions impaired as a result of illness, injury or injury, leading to limitation of life activity; relatively favorable - incomplete recovery with residual manifestations, reduction, stabilization or partial compensation of impaired functions leading to limitation of life activity, with chronic disease– slowing down the progression of the disease, lengthening periods of remission, etc., doubtful – unclear course of the disease, unfavorable – impossibility of stabilizing the health status, stopping the progression pathological process and reducing the degree of dysfunction of the body, leading to limitation of life. In order to predict the degree of restoration of impaired functions, it is possible to use various tests and scales.

In line 31 “Rehabilitation potential: high, satisfactory, low” the necessary is emphasized. Rehabilitation potential is a set of preserved physical, psychophysiological, mental abilities and inclinations that allow a person to compensate or eliminate, to one degree or another, limitations in life activity that have developed as a result of an illness or defect. High rehabilitation potential – complete restoration of health, all normal human activities, ability to work and social status. Satisfactory potential – incomplete recovery with persistence of moderately severe dysfunction, performing basic activities with difficulty to a limited extent or with the help of technical aids. Low rehabilitation potential – progressive course of the disease, pronounced violation functions; significant limitation in the performance of most types of activities, expressed by a decrease in working capacity and ability for social integration; need in social support and constant financial assistance. The rehabilitation potential is assessed by the attending physician, who refers the citizen for a medical and social examination.

In line 32 “Rehabilitation prognosis: favorable, relatively favorable, doubtful (uncertain), unfavorable” the necessary is emphasized. Rehabilitation prognosis is the estimated probability of realizing the rehabilitation potential and the expected level of integration of the disabled person into society. The rehabilitation prognosis is determined not only by the level and content of the rehabilitation potential, but also real opportunities application of modern rehabilitation technologies, means and methods for its implementation. The rehabilitation prognosis is assessed as: favorable – if possible full recovery impaired body functions and categories of disability, complete social, including professional integration of the disabled person; relatively favorable – opportunity partial recovery impaired body functions and categories of disability, with a decrease in the degree of their limitations or stabilization, with the expansion of the ability to integrate and the transition from full to partial social support; doubtful (uncertain) – unclear prognosis; unfavorable – the impossibility of restoring or compensating for impaired body functions and categories of disability. The rehabilitation prognosis is assessed by the attending physician, who refers the citizen for a medical and social examination.

Line 33 indicates the purpose of the referral for a medical and social examination (the necessary is underlined): to establish disability, the degree of limitation of the ability to work, the degree of loss of professional ability as a percentage, to develop (correct) an individual rehabilitation program for a disabled person (rehabilitation program for a victim of an accident incident at work and occupational disease), for another (specify).

Line 34 “Recommended measures for medical rehabilitation for the formation or correction of an individual rehabilitation program for a disabled person, a rehabilitation program for a victim of an industrial accident or occupational disease” indicates specific types of rehabilitation therapy (including drug provision in the treatment of a disease that has caused disability), reconstructive surgery, technical means of medical rehabilitation, including prosthetics and orthotics, a conclusion on spa treatment with a prescription of the profile, frequency, duration and season of recommended treatment, the need for special medical care persons injured as a result of industrial accidents and occupational diseases, about the need for medicines for the treatment of the consequences of industrial accidents and occupational diseases, other types of medical rehabilitation.

The referral is signed by the chairman of the medical commission, members of the commission with a transcript of the signatures and sealed with the seal of the medical institution.

Responsibility for the correct completion of Form No. 088/u-06 “Referral for medical and social examination by an organization providing medical and preventive care” rests with the chairman of the medical commission of the medical and preventive institution, or with the chief physician.

The form must be submitted to the bureau of medical and social examination no later than 1 month from the date of its issue.

(approved by order of the Ministry of Health of Russia dated May 14, 1997 No. 141)

Form No. 088/u-97 is filled out for persons sent to ITU for the first time (including for an in-person consultation) and for disabled people sent for re-examination.

The procedure for filling out the “Referral to ITU” is determined by the Instruction introduced by Order of the Ministry of Health of the Russian Federation dated December 15, 1999 No. 06-23/6-2.

In the line “Date of issue” – the date of issue of the referral to the person sent to the ITU or his legal representative is indicated.

In line 1, the “full name” of the person being sent is indicated in full.

In line 2 – “Date of birth” - day, month and year of birth; “gender” – “m” or “f”.

In line 3 – “Patient’s address” – place of residence according to the passport.

In line 4 – “Disabled person of ___group” – the disability group is indicated based on the available ITU certificate, or a dash if the patient is being referred for the first time.

Line 5 – “Place of work” – indicates the name of the organization in which the person being referred works at the time of filling out the referral. If a citizen does not work, a corresponding entry is made about this.

In line 6 – “Address of place of work” – the address of the organization in which the person sent on the day of opening the certificate of incapacity for work works.

In line 7 - “Profession” - indicates the profession that was obtained through special education (engineer, teacher, construction technician) or the one in which you have the longest work experience and (or) the highest qualifications.

Line 8 – “Position” – indicates the position in which the patient was occupied on the day the l/n was opened for him

Line 9 – “Under the supervision of a medical institution since...” indicates the date of initial filling out of the patient’s outpatient card in the health care facility.

In line 10 - “History of the present disease” - when initially registering a referral for medical examination, information about the onset of the disease (the nature of the injury, injury), features of the course, dates of exacerbations is provided in detail (indicate the frequency and duration of exacerbations for the 12 months preceding the patient’s referral for medical examination, information about the nature of the treatment provided (outpatient or inpatient, indicating the department's profile), types of treatment (therapeutic, surgical, physiotherapeutic, etc.) When making a referral for re-examination, line 10 indicates information about the course of the disease for the period elapsed from the date of diagnosis disability groups.

Line 11 – “Results of the rehabilitation measures taken” – indicates information about measures to restore the patient’s ability to work and their effectiveness, or measures to implement an individual program of medical rehabilitation for a disabled person when a referral for re-examination is issued.

In line 12 - “Frequency and duration of temporary disability for the last 12 months” in the column “Numbers from ____ to ____” the opening and closing dates of the l/n are indicated, in the last line or under the line the total number of days of temporary disability is indicated. If the patient does not work, then this section indicates the frequency of requests for medical care in health care facilities and the name of the diseases for which the patient applied. In the column “Name of the disease” - on the line corresponding to the date of issue of the l/n, the name of the disease for which the patient was recognized as temporarily disabled during the corresponding period is indicated.

Line 13 – “Name of profession and working conditions for the last year” – indicates the profession (position) that the patient was performing at the time the license was issued to him, as well as the predominant production factor, the severity of physical and neuro-emotional stress, etc. . Information is recorded from the patient’s words and, if necessary, requested from the place of work.

In line 14 - “The patient’s condition upon referral to medical examination” - when describing the objective status, each specialist sets out in detail and sequentially the patient’s complaints, primarily related to the underlying disease (determining permanent disability), then others; The data from an objective examination of the patient by specialists are reflected in full detail (opinions of a therapist, neurologist, surgeon, ophthalmologist, and for women, a gynecologist are required).

Lines 15 - “X-ray studies”, 16 - “Laboratory studies”, 17 - “Additional research methods” - include the results of studies confirming the established diagnosis of the underlying disease, and others that, to one degree or another, may influence the course of the underlying disease .

In line 18 “Diagnosis upon referral to ITU”:

In paragraph 1 – “main disease” – a detailed diagnosis is indicated in accordance with ICD-10, etiology, features of the course, stage, degree of functional impairment. When several diseases are combined, the main one is the disease that determines the disability.

In paragraph 2 - “concomitant diseases” - those diseases are indicated that are not decisive when assessing limitations in life activity;

In paragraph 3 – “complications” – complications of the underlying disease are indicated.

Line 18.1 – “Violations of the basic functions of the body” (according to the adopted Classification of January 29, 1997 No. 1/30) indicates the patient’s existing disorders in accordance with section 1.2 “Classification of violations of the basic functions of the human body.”

Line 18.2 – “Signs of disability” (according to the adopted Classification of January 29, 1997 No. 1/30) indicates the patient’s coolant in accordance with section 1.5 “Classification of disability”.

In line 19 - “Grounds for referral to ITU: presence of signs of disability; the end of the period of disability; early re-examination; the need to extend the l/n (underline)” – what is necessary is emphasized. If it is necessary to extend the l/n, it is extended within the period established by clause 2.3. instructions “On the procedure for issuing documents certifying temporary disability.”

Responsibility for the correct execution of the “Referral to the ITU” lies with the chairman of the KEC. The referral to ITU is signed by the members of the KEC, the date is indicated, and the seal of the health facility is affixed. The decision of the KEC to refer the patient to medical examination is recorded in the outpatient (inpatient) patient’s card and in the registration form. No. 035/u – 02 “Register of clinical expert work of health care facilities.”

More on the topic The procedure for filling out f. No. 088/u-97 “Referral for medical and social examination”:

1. The procedure for filling out f. No. 088/u-97 “Referral for medical and social examination”