Health care facility stamp
Approved by Order of the Ministry of Health
and social development of the Russian Federation
dated January 31, 2007 N 77
Medical documentation
Form N 088/у-06
DIRECTION
for medical and social examination by an organization providing
medical and preventive care
Date of issue “______” ___________________________ 20_____
1. Last name, first name, patronymic of the citizen sent for a medical and social examination (hereinafter referred to as the citizen): Ivanov Viktor Alexandrovich
2. Date of birth: 07/11/1948.
3. Gender: male
4. Last name, first name, patronymic of the citizen’s legal representative (filled in if there is a legal representative):__________________________________________________________________________
5. Address of the citizen’s place of residence (if there is no place of residence, the address of stay, actual residence on the territory of the Russian Federation is indicated): Russian Federation, 000000, N-skaya region, N-sky district, N-sky, st. Gulagskaya, 1, GBUSONO "N-sky PNI"
6. Is not disabled, disabled person first, second, third groups, category “disabled child” (underline as appropriate).
7. Degree of loss of professional ability in percentage: __________________________
(to be filled in when re-referring)
8. Directed primarily, again(Underline whatever applicable).
9. Who does he work at the time of referral for medical and social examination: does not work
(indicate the position, profession, specialty, qualification and length of service for the specified position, profession, specialty, qualification; for non-working citizens, make an entry: “not working”)
10. Name and address of the organization in which the citizen works: does not work
11. Conditions and nature of the work performed: does not work
12. Main profession (specialty): driver, tractor driver
13. Qualification in the main profession (class, rank, category, title): No
14. Name and address of the educational institution: No
15. Group, class, course (underline what is indicated): No
16. Profession (specialty) for which training is provided: No
17. Observed in organizations providing medical and preventive care, with 2005
of the year.
18. History of the disease (onset, development, course, frequency and duration of exacerbations, treatment and rehabilitation measures taken and their effectiveness):
In 2005, he suffered a traumatic brain injury and was treated as an inpatient with a diagnosis of brain contusion. For 20 years he abused alcohol, long-term binges with severe withdrawal symptoms, for which he was repeatedly treated in hospital. His mental state changed - he began to leave home for a long time, wandered, and got lost. He became tearful, sentimental, lost his hygiene skills, spent a lot of time in bed, and became indifferent to his relatives. At the same time, he expressed unrealistic plans for the future, which he immediately forgot about. Due to an increase in emotional-volitional defect and behavioral disorders, he was repeatedly hospitalized in the mental hospital in Nsk. The first medical and social examination was carried out on November 18, 2013. During the period between ITUs, the mental state showed negative dynamics. The last hospitalization in PND No. 1 in Nsk was from April 3, 2014. to 06/20/2014, discharged with a diagnosis: “Organic personality disorder due to mixed diseases (TBI, intoxication) with cognitive impairment. Astheno-neurotic syndrome." In PND No. 1 in N-ska he received treatment: phenibut, vinpocetine, pentoxifylline, lobster, and during treatment the emotional background somewhat leveled out. After discharge, for social reasons, he was transferred to the N-sky PNI. In the boarding school he is passive, spends time in bed, does not take care of himself, does not go to the dining room himself, and washes himself with a reminder. Takes medication under the supervision of staff: piracetam, cinnarizine, betahistine, thioryl, combilipen, cavinton, phenazepam, azaphen. The patient's relatives do not visit. Needs outside help and care.
________________________________________________________________________________________
(described in detail during the initial referral; during repeated referral, the dynamics for the period between examinations are reflected, new cases of diseases identified during this period that led to persistent impairment of body functions are described in detail)19. Life history (past illnesses, injuries, poisonings, surgeries, diseases that are hereditary are listed; in addition, in relation to the child, it is indicated how the mother’s pregnancy and childbirth proceeded, the timing of the formation of psychomotor skills, self-care, cognitive and play activities, skills of neatness and self-care, how early development proceeded (by age, with a lag, with an advance)):
Born in Nsk. The younger of two brothers. Heredity is not psychopathologically burdened. He grew up, developed according to his age, and attended preschool institutions. I went to school at the age of 7 and graduated from 10th grade. Served in the army. He graduated from driving courses, worked as a bulldozer driver, tractor driver, and driver. He was married twice and has an adult son. Lived with his elderly mother. Family ties have been lost. Pensioner. Socially maladjusted. On June 20, 2014, he was admitted to live at the N-sky PNI by transfer from the PND No. 1 in N-sk.
_______________________________________________________________________________________
(to be completed upon initial referral)
20. Frequency and duration of temporary disability (information for the last 12 months):
№
Date (day, month, year) of the beginning of temporary disability
Date (day, month, year) of the end of temporary disability
Number of days (months and days) of temporary disability
Diagnosis
21. Results of medical rehabilitation measures taken in accordance with the individual rehabilitation program for a disabled person (to be completed upon re-referral, specific types of rehabilitation therapy, reconstructive surgery, sanatorium-resort treatment, technical means of medical rehabilitation, including prosthetics and orthotics, are indicated, as well as the time frame within which they were provided; body functions that were able to be compensated or restore completely or partially, or a note is made that there are no positive results):
Medical rehabilitation measures without a positive effect. He received treatment with nootropic and vasoactive drugs, vitamins, tranquilizers, and antidepressants according to indications in various doses.
22. State of a citizen when referred for a medical and social examination (indicate complaints, examination data by the attending physician and doctors of other specialties):
Examined by a psychiatrist: His posture is hunched, he moves independently, hesitantly, he uses glasses. Dresses and eats independently. Outwardly somewhat sloppy. Consciousness is not darkened. Disoriented in place, in time, believes that it is now 1948. He is oriented correctly in his own personality. Available to contact. He misunderstands many questions and asks again. He interrupts the doctor, tries to tell him how difficult his life is, refers to his helplessness, complains that no one is treating him. Complains of general weakness and dizziness. Requires bed rest, then rudely refuses this opportunity. Emotionally unrestrained, easily affected. Irritated, he answers the question about his health with anger: “How can a sick person feel?!” Intelligence, memory with a significant decrease. Thinking is slow in pace, viscous, unproductive. Finds words with difficulty and quickly becomes exhausted in conversation. Volitional abilities are significantly weakened. In the department, he spends time in bed, refuses to go to the canteen because he is afraid of getting lost, and rudely refuses outside help: “bring food to the ward.” The background mood is reduced. Denies the presence of suicidal thoughts. He is not critical of his condition and the current situation. No active psychoproduction is detected. Sleep and appetite are not affected. Controls physiological functions.
________________________________________________________________________________________
________________________________________________________________________________________
23. Results of additional research methods (the results of laboratory, radiological, endoscopic, ultrasound, psychological, functional and other types of studies are indicated):
UAC dated 10.23.14.:Hb=131g/l, WBC=5.7x109/l, ESR=5mm/h
OAM from 06.11.14.:Ket=no, Glu=no, Lev=no
FY from 11/18/14.:Lungs and heart are normal
ECG dated October 31, 2014.: Sinus rhythm, normal ECG
Chest circumference 85 cm,waist circumference 80 cm,hip circumference 87 cm.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
24. Body weight: 59
kg., height: 1,68
m., body mass index: 20,9
.
25. Assessment of physical development: normal, deviation (underweight, overweight, short stature, high stature) (underline as appropriate).
26. Assessment of psychophysiological endurance: norm, deviation(Underline whatever applicable).
27. Assessment of emotional stability: norm, deviation(Underline whatever applicable).
28. Diagnosis upon referral for medical and social examination:
A) code of the underlying disease according to the ICD: F07.08
B) underlying disease: Severe organic personality disorder due to mixed diseases (TBI, intoxication) with cognitive impairment. Persistent social and labor disadaptation.
B) concomitant diseases:
Therapist: Chronic toxic (alcoholic) hepatitis in remission.
Neurologist: Dyscirculatory encephalopathy stage III.combined genesis.Astheno-neurotic syndrome.
Oculist: Retinal angiopathy of both eyes.
D) complications: ________________________________________________________________________________
________________________________________________________________________________________
29. Clinical prognosis: favorable, relatively favorable, doubtful
30. Rehabilitation potential: high, satisfactory, short(Underline whatever applicable).
31. Rehabilitation prognosis: favorable, relatively favorable, doubtful(undefined), unfavorable (underline as appropriate).
32. Purpose of referral for medical and social examination (Underline whatever applicable): to establish disability
, degree of loss of professional ability as a percentage, for the development (correction) of an individual rehabilitation program for a disabled person
(disabled child), rehabilitation programs for victims of an industrial accident and occupational disease, for another (specify): _______________________________________
________________________________________________________________________________________
33. Recommended measures for medical rehabilitation for the formation or correction of an individual rehabilitation program for a disabled person (disabled child), a rehabilitation program for a victim of an industrial accident or occupational disease:
1. Constant observation by a psychiatrist.
2. Drug treatment: nootropics, vasoactive drugs, tranquilizers, antidepressants according to indications.
3. Rational occupational therapy for the development and maintenance of everyday self-care skills.
(indicates specific types of rehabilitation therapy (including drug provision for the treatment of a disease that has caused disability), reconstructive surgery (including drug provision for the treatment of a disease that has caused disability), technical means of medical rehabilitation, including prosthetics and orthotics, a conclusion on sanatorium- resort treatment with a prescription of the profile, frequency, duration and season of recommended treatment, the need for special medical care for persons injured as a result of industrial accidents and occupational diseases, the need for medicines to treat the consequences of industrial accidents and occupational diseases, others types of medical rehabilitation)
Chairman of the medical commission:
Members of the commission:
“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.
On line 1 the surname, name, and patronymic of the citizen sent for a medical and social examination are indicated in full.
On line 2“Date of birth” indicates the day, month and year of birth.
On line 3 The gender of a citizen 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.
On line 5“Address of the citizen’s place of residence”, in the absence of a place of residence, indicates the address of residence, actual residence on the territory of the Russian Federation.
On line 6“Not disabled, disabled of the first, second group, category “disabled child” group” indicates the disability group 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 “not disabled” if the patient is referred for the first time.
Line 7“The degree of limitation of the ability to work” was excluded by the Decree of the Government of the Russian Federation of December 30, 2009. N 1121
Line 8“The degree of loss of professional ability in 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.
On line 9 it is emphasized whether the citizen is referred initially or repeatedly to the ITU.
On line 10“Who works at the time of referral for medical and social examination” should indicate the position, profession, specialty, qualification and length of service in the specified position, profession, specialty, qualification; for non-working citizens, make an entry: “not working.”
On 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 of opening the certificate of incapacity for work. If a citizen does not work, a corresponding entry is made about this.
On line 12“Conditions and nature of the work performed” information is recorded from the patient’s words, and, if necessary, requested from the place of work in the form of production characteristics (working hours, shifts; manual, machine-manual, mental work, conveyor: working position (percentage: sitting , standing, alternating, walking); degree of physical stress: constantly (mild, moderate, severe) and temporarily (mild, moderate, severe); degree of neuropsychic stress: constantly (mild, moderate, severe) and temporarily (mild, moderate , heavy); 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 contamination, exposure to chemicals, at height, with vibration) .
On line 13“Main profession (specialty)” indicates a profession acquired through special education (for example, an engineer, teacher, construction technician), or a profession in which there is the longest work experience and (or) the highest qualifications (for example, a repairman of the V category and etc.).
On line 14“Qualification in the main profession (class, rank, category, rank)” should indicate the qualifications that the patient had on the day of opening the certificate of incapacity for work.
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 of the educational institution, line 16 indicates 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 the educational institution.
On line 18“Observed in organizations providing medical and preventive care since _____ year” indicates the date of initial filling out of the patient’s outpatient card in a medical and preventive institution.
On line 19 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, injury), features 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 (outpatient or inpatient, indicating the department's profile), types of treatment: therapeutic, surgical, physiotherapeutic, etc. When making a referral for re-examination, information about the course of the disease for the period that has passed since the date of establishment of the disability group is indicated, new cases identified during this period are described in detail diseases that lead to persistent impairment of body functions.
Line 20“Life history” is filled out 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).
On 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, in the column “number of days (months and days) of temporary disability” indicates the total number of days of temporary disability. 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.
On line 22“The results of measures taken for medical rehabilitation in accordance with the individual rehabilitation program for a disabled person” indicate information about measures to restore the patient’s ability to work, specific types of rehabilitation therapy, reconstructive surgery, sanatorium treatment, technical means of 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 there are no positive results.
On 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 consistently the patient’s complaints, first of all related to the underlying disease, then others, with exhaustive completeness the data of an objective examination of the patient by specialists is reflected, and the doctor’s specialty is indicated (therapist, surgeon, neurologist, etc.).
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.
On line 24 the results of laboratory, radiological, endoscopic, ultrasound, psychological, functional and other types of studies are indicated.
On line 25 The citizen’s body weight in kg, height in meters, and body mass index are indicated. 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.
On line 26 an assessment of physical development is given - normal, deviation (underweight, overweight, short stature, high stature) - the necessary is emphasized. Physical development is a set of morphological functional characteristics of the body that determine its reserve of physical strength, endurance and performance.
On line 27“Assessment of psychophysiological endurance: norm, deviation” is underlined as necessary. 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, the state of the body's functional systems, 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 loads, as well as knowledge simulating various types of everyday, 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.
On line 28“Assessment of emotional stability: norm, deviation” is underlined. Emotional stability is a trait that expresses the preservation of organized behavior in normal and stressful situations and is characterized by maturity, excellent adaptation, the absence of great tension, anxiety, a tendency to leadership, and sociability; emotional instability - extreme nervousness, instability, poor adaptation, tendency to rapid mood swings, feelings of guilt and anxiety, anxiety, depressive reactions, absent-mindedness, 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.
On 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 limitations in life activity; in paragraph “c”, complications caused by the underlying disease are indicated.
On line 30“Clinical prognosis: favorable, relatively favorable, doubtful (uncertain), unfavorable” 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, the degree of dysfunction of the affected organs and systems and the state of their compensation, as well as the effectiveness of 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 activities; in case of a chronic disease - slowing down the progression of the disease, prolongation of periods of remission, etc., doubtful - unclear course of the disease, unfavorable - impossibility of stabilization state of health, stopping the progression of the 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.
On line 31“Rehabilitation potential: high, satisfactory, low” is highlighted as necessary. 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, severe dysfunction; significant limitation in the performance of most types of activities, expressed by a decrease in working capacity and ability for social integration; the need for 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.
On line 32“Rehabilitation prognosis: favorable, relatively favorable, doubtful (uncertain), unfavorable” 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 by the real possibilities of using modern rehabilitation technologies, means and methods for its implementation. The rehabilitation prognosis is assessed as: favorable - with the possibility of complete restoration of impaired body functions and categories of disability, full social, including professional integration of the disabled person; relatively favorable - the possibility of partial restoration of impaired body functions and categories of disability, with a decrease in the degree of their restrictions or stabilization, with an 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.
On line 33 the purpose of the referral for medical and social examination is indicated (the necessary is underlined): to establish disability, the degree of limitation of the ability to work, the degree of loss of professional ability in percentage, to develop (correct) an individual rehabilitation program for a disabled person (rehabilitation program for a victim of an industrial accident and occupational disease), for another (specify).
On 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 accident at work and an occupational disease” indicate specific types of rehabilitation therapy (including drug provision in the treatment of the disease that caused disability), reconstructive surgery, technical means of medical rehabilitation, including prosthetics and orthotics, a conclusion on sanatorium treatment with a prescription of the profile, frequency, duration and season of recommended treatment, on the need for special medical care of persons injured as a result of industrial accidents and occupational diseases, on the need for medicines to treat the consequences of accidents at work and occupational diseases, and 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.
Related information.
Important information update!
What does this paper look like?
If a person received a referral at a clinic or other medical organization, then the appearance and form of this paper are subject to the rules. They are formulated in order No. 77 of the Ministry of Health and Social Development of the Russian Federation:
- Already in the referral itself, the results of previous examinations and studies, the expected severity of the established disease and the disability that it may entail, as a percentage, must be included.
- The results of rehabilitation measures and the actual purpose pursued by issuing a referral are also indicated in such a paper.
Referrals issued by authorized pension and social security institutions are somewhat different in appearance due to the fact that they fall under another regulatory act - order of the Ministry of Health and Social Development of the Russian Federation No. 874.
The differences are as follows:
- The restrictions that the patient is forced to comply with are considered in this case not as a fact, and not from the point of view of working capacity, but from the point of view of whether the person needs social assistance and protection.
- The purpose of receiving the referral, as in the previous case, is required to be written.
Procedure for registration for medical and social examination
The registration procedure for ITU consists of several stages:
Clarifications
Who directs?
Directions are issued by:
- Medical institutions providing medical and preventive care (clinics, hospitals, including psychiatric ones).
- Organizations for social support of citizens.
- Pension funds.
Who issues the document?
The attending physician or therapist at the local clinic is the one who most often refers citizens to undergo medical examination, based on studies of their health status or a sick leave that has been going on for about 10-12 months. But, if there is an appropriate desire, the patient can begin this process independently.
Paper of any other type cannot be considered as a valid beginning of the procedure. The form, officially executed in accordance with all regulatory standards, is sent to the ITU center when an application is submitted by a citizen or his authorized representative.
Advice! For those situations where a citizen, due to his serious condition, is not physically able to come to the institution and undergo an examination, the legislation provides for the possibility of undergoing a medical and social examination in a hospital hospital or at home.
Procedure for temporary disability
There are situations when an employee took a sick leave - and keeps extending and extending it, and no positive changes are observed in the condition of such a patient. If a sheet with an unchanged diagnosis is repeated many times, an employee of the medical organization is authorized to write a referral to the patient for medical examination.
As you know, the standard validity period for sick leave is ten days. By decision of a council of doctors, it can be extended for up to thirty days, and sometimes up to 10 months, but certainly no more than a year.
If the patient’s ability to work has not been restored within a year, the attending physician is obliged to send him for examination. The MSA commission will decide whether a further extension of sick leave is possible, or whether final rehabilitation is impossible, as a result of which the citizen acquires the status of a disabled person.
If a person was not satisfied with the results of the commission, then he has the opportunity to submit an application to the appropriate higher authority. Statistics on such practices show that at the highest level the commission rarely refuses to recognize a citizen as disabled.
When something like this is made, the endlessly extendable sick leave is finally closed on the date preceding the day of the examination, and the commission’s verdict is also entered. All days on which the patient underwent medical examination while not working are not considered absenteeism, but are not paid.
What to do if the clinic refuses to undergo an examination?
For various reasons, medical care institutions may refuse to issue a referral for medical examination. However, this does not mean that you will not be able to get tested. In this case, protecting your rights is not so difficult.
The fact is that long ago, since 2005, Order No. 535 of the Ministry of Health of the Russian Federation deprived doctors of the opportunity to decide whether to give a referral or not. According to it, an employee of a medical institution must accept a citizen’s application for MSA, and then issue a referral. This document is no longer in force, but this requirement is still relevant.
And if a therapist refuses to accept an application, it is quite possible to make a similar request to, say, the head physician of the clinic. As a last resort, the local government has a body such as the health department.
Important! If a citizen applied for a referral to medical examination, but was refused, then you need to insist and ensure that the doctor of the appropriate authority writes about his refusal in the patient’s outpatient record (which contains summarized data from all studies and observations over many years).
The reason for this is that without a documented recording of the medical worker’s refusal, it is impossible to appeal his current decision and further attempts to achieve his goal at a higher level.
Conclusion
Health is a huge value for every person. Admitting that you have serious illnesses is a difficult step for any person and a test for those around him.
And that is why citizens of the Russian Federation have the right to apply for specialized medical examination as many times as they need. It is not only possible to defend your rights and needs for social protection, but moreover, it is necessary.
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1 MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT OF THE RUSSIAN FEDERATION ORDER of January 31, 2007 N 77 On approval of the form of referral for medical and social examination by an organization providing treatment and preventive care (as amended on October 28, 2009) Document as amended by: order of the Ministry of Health and Social Development of Russia dated October 28, 2009 N 853n (Rossiyskaya Gazeta, N 232,) (came into force on January 1, 2010). In accordance with Decree of the Government of the Russian Federation of February 20, 2006 N 95 “On the procedure and conditions for recognizing a person as disabled” (Collection of Legislation of the Russian Federation, 2006, N 9, Art. 1018) I order: Approve form N 088/u-06 “Referral for a medical and social examination by an organization providing medical and preventive care" according to the appendix. Minister M. Zurabov Registered with the Ministry of Justice of the Russian Federation on March 12, 2007, registration N 9089 Appendix. Form N 088/у-06. Referral for medical and social examination by an organization providing medical treatment
2 preventive care Appendix to the order of the Ministry of Health and Social Development of the Russian Federation dated January 31, 2007 N 77 (as amended, put into effect on January 1, 2010 by order of the Ministry of Health and Social Development of Russia dated October 28, 2009 N 853n, - see the previous edition) Medical documentation Form N 088/u-06 Ministry of Health and Social Development of the Russian Federation (name and address of the organization providing treatment and preventive care) DIRECTION FOR MEDICAL AND SOCIAL EXAMINATION BY THE ORGANIZATION PROVIDING TREATMENT AND PREVENTIVE CARE Date of issue " " 20*
3 1. Last name, first name, patronymic of the citizen sent for a medical and social examination (hereinafter - citizen): 2. Date of birth: 3. Gender: 4. Last name, first name, patronymic of the legal representative of the citizen (filled in if there is a representative) : legal 5. Address of the Citizen’s place of residence (if there is no place of residence, the address of stay, actual residence on the territory of the Russian Federation is indicated): 6. Not disabled, disabled of the first, second, third groups, category “disabled child” (underline as appropriate). 7. Excluded 8. Degree of loss of professional ability in percentage:
4 (to be filled in when sending again) 9. Sent initially, repeatedly (underline as necessary). 10. Who does he work at the time of referral for a medical and social examination (indicate the position, profession, specialty, qualification and length of service for the specified position, profession, specialty, qualification; for non-working citizens, make an entry: “not working”) 11. Name and address of the organization in which the citizen works: 12. Conditions and nature of the work performed: 13. Main profession (specialty): 14. Qualification for the main profession (class, rank, category, rank):
5 15. Name and address of the educational institution: 16. Group, class, course (underline what is indicated): 17. Profession (specialty) for which training is carried out: 18. Observed in organizations providing medical care since one year. 19. History of the disease (onset, development, course, frequency and duration of exacerbations, treatment and rehabilitation measures taken and their effectiveness):
6 (described in detail during the initial referral; during repeated referral, the dynamics for the period between examinations are reflected, new cases of diseases identified during this period that led to persistent impairment of body functions are described in detail) 20. Life history (past diseases, injuries, poisonings, operations, diseases for which heredity is aggravated; in addition, in relation to the child, it is indicated how pregnancy and childbirth proceeded in the mother, the timing of the formation of psychomotor skills, self-care, cognitive and play activities, neatness and self-care skills, how early development proceeded (by age, with a lag, with a lead): (to be filled in upon initial referral) 21. Frequency and duration of temporary disability (information for the last 12 months): N Date (day, month, year) of the beginning of temporary disability Date (day, month, year) of the end of temporary disability Number of days (months and days) of temporary disability Diagnosis
7 22. Results of measures taken for medical rehabilitation in accordance with the individual rehabilitation program for a disabled person (to be filled in upon re-referral, specific types of rehabilitation therapy, reconstructive surgery, sanatorium treatment, technical means of medical rehabilitation, including prosthetics and orthotics, as well as terms, to which they were provided; body functions that were able to be compensated or restored fully or partially are listed, or a note is made that there are no positive results): 23. The condition of the citizen when referred for a medical and social examination (complaints, examination data by the attending physician and doctors are indicated other specialties):
8 24. Results of additional research methods (the results of laboratory, radiological, endoscopic, ultrasound, psychological, functional and other types of studies are indicated): 25. Body weight (kg), height (m), body mass index. 26. Assessment of physical development: normal, deviation (underweight, overweight, short stature, tall stature) (underline as appropriate).
9 27. Assessment of psychophysiological endurance: norm, deviation (underline as appropriate). 28. Assessment of emotional stability: norm, deviation (underline as appropriate). 29. Diagnosis upon referral for medical and social examination: a) code of the underlying disease according to the ICD: b) underlying disease: c) concomitant diseases: d) complications: 30. Clinical prognosis: favorable, relatively favorable, doubtful (uncertain), unfavorable ( Underline whatever applicable).
10 31. Rehabilitation potential: high, satisfactory, low (underline as appropriate). 32. Rehabilitation prognosis: favorable, relatively favorable, doubtful (uncertain), unfavorable (underline as appropriate). 33. The purpose of referral for a medical and social examination (underline as necessary): to establish disability, the degree of loss of professional ability in percentage, to develop (correct) an individual rehabilitation program for a disabled person (disabled child), a rehabilitation program for a victim of an industrial accident or occupational disease , for another (specify): 34. Recommended measures for medical rehabilitation for the formation or correction of an individual rehabilitation program for a disabled person (disabled child), a rehabilitation program for a victim of an industrial accident or occupational disease:
11 (indicates specific types of rehabilitation therapy (including drug provision in the treatment of a disease that has caused disability), reconstructive surgery (including drug provision in the treatment of a disease that has caused disability), technical means of medical rehabilitation, including prosthetics and orthotics, a conclusion on sanatorium -resort treatment with a prescription of the profile, frequency, duration and season of recommended treatment, the need for special medical care for persons injured as a result of industrial accidents and occupational diseases, the need for medicines to treat the consequences of industrial accidents and occupational diseases, other types of medical rehabilitation) Chairman of the medical commission: (signature) (signature transcript) Members of the medical commission: (signature) (signature transcript) (signature) (signature transcript) (signature) (signature transcript) M.P. Cutting line
12 To be returned to the organization providing medical and preventive care that issued the referral for medical and social examination Return coupon (name of the federal state institution of medical and social examination and its address) 1. Last name, first name, patronymic of the citizen: 2. Date of examination: 3. Act N medical- social examination 4. Diagnosis of the federal state institution of medical and social examination: a) code of the underlying disease according to the ICD:
13 c) associated diseases: c**) complications: 5. Types of dysfunctions of the body and the degree of their severity (according to the classifications approved by order of the Ministry of Health and Social Development of Russia dated August 22, 2005 N 535 (registered with the Ministry of Justice of Russia on September 13, 2005 N 6998): 6. Limitations of the main categories of life activity and the degree of their severity (according to the classifications and criteria approved by order of the Ministry of Health and Social Development of Russia dated August 22, 2005 N 535):
14 7. Decision of the federal state institution of medical and social examination: disability of the first, second, third groups is established, in the category “disabled child” (underline as appropriate); cause of disability: degree of loss of professional ability in percentage: date of re-examination: recommendations for medical rehabilitation: recommendations for professional, social, psychological and pedagogical rehabilitation:
15 8. Reasons for refusal to establish disability: 9. Date of sending the return coupon: " " 20. Head of the federal state institution of medical and social examination (signature) (signature transcript) M.P. * No later than one month from the date of issue, this referral can be submitted by a citizen (his legal representative) to the branch of the main bureau of medical and social examination - the Bureau of Medical and Social Examination. **Numbering corresponds to the original. - Database manufacturer's note.
16 The document edition, taking into account changes and additions, was prepared by Codex JSC
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