Order 543n dated May 15, 12 of the Ministry of Health. Changes to the regulations on the organization of primary health care

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

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

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

2. To recognize as invalid:

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

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

I. about Minister T. Golikov

Note ed.: the order was published in the "Bulletin of normative acts of federal executive authorities", N 52, 12/24/2012.


Appendix to the Order

Regulations on the organization of primary health care for the adult population

1. These Regulations establish the rules for organizing the provision of primary health care to the adult population on the territory of the Russian Federation.

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

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

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

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

A) as free - within the framework of the Program of State Guarantees for the free provision of medical care to citizens of the Russian Federation at the expense of compulsory health insurance and funds from the relevant budgets, as well as in other cases established by the legislation of the Russian Federation;

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

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

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

7. Primary health care is provided:

1) outpatient, including:
in a medical organization providing primary health care, or its division, at the patient’s place of residence (stay) - in case of acute diseases, exacerbations of chronic diseases in the event of a call from a medical worker or when he visits the patient in order to monitor his condition, the course of the disease and timely appointment (correction) of the necessary examination and (or) treatment (active visit), when patronizing certain groups of the population when an epidemic of an infectious disease is identified or threatened, patients with an infectious disease, persons in contact with them and persons suspected of an infectious disease, including through door-to-door (door-to-door) visits, inspections of workers and students;
at the place of departure of the mobile medical team, including to provide medical care to residents of settlements with predominantly people over working age, or located at a considerable distance from the medical organization and (or) with poor transport accessibility, taking into account climatic and geographical conditions.

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

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

Taking into account the formation of contingents of citizens temporarily (seasonally) living in the territory of a populated area (including in summer cottages and gardening communities), an emergency medical care department (office) can be organized in close proximity to the place of temporary (seasonal) residence.

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

10. Primary health care includes the following types:

Primary pre-hospital health care, which is provided by paramedics, midwives, and other medical workers with secondary medical education in paramedic health centers, paramedic-obstetric stations, medical outpatient clinics, health centers, clinics, outpatient departments of medical organizations, departments (offices) of medical prevention, health centers;
primary medical health care, which is provided by general practitioners, local physicians, general practitioners (family doctors) of outpatient clinics, health centers, clinics, outpatient departments of medical organizations, offices of general practitioners (family doctors), health centers and departments (offices) of medical prevention;
primary specialized health care, which is provided by medical specialists of various profiles in polyclinics, outpatient departments of medical organizations, including those providing specialized, including high-tech, medical care.

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

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

12. Primary pre-medical and primary medical health care are organized on a territorial-precinct basis.

13. The territorial-area principle of organizing the provision of primary health care is the formation of groups of the service population based on residence (stay) in a certain territory or on the basis of work (training) in certain organizations and (or) their divisions.

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

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

16. In medical organizations, areas can be organized:

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

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

Paramedic of a paramedic health center, paramedic and obstetric station;
a local therapist, a local therapist at a workshop medical site, a local nurse at a therapeutic (including workshop) site;
general practitioner (family doctor), assistant general practitioner, nurse of a general practitioner at the site of a general practitioner (family doctor);

At the paramedic station there are 1,300 adults aged 18 years and older;
at a therapeutic site - 1,700 adults aged 18 years and older (for a therapeutic site located in a rural area - 1,300 adults);
at the general practitioner's site - 1,200 adults aged 18 years and older;
at the family doctor's site - 1,500 adults and children;
on a complex site - 2000 or more adults and children.

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

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

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

Primary specialized health care is provided by referral from medical workers providing primary pre-medical and primary medical care, as well as when the patient independently contacts a medical organization.

22. To provide medical care to patients with acute chronic diseases and their exacerbations who require inpatient treatment, but are not referred to a medical organization for inpatient medical care, a hospital at home can be organized, provided that the patient’s health condition and his home conditions allow the organization medical assistance and home care.

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

When organizing a hospital at home, the patient is monitored daily by a medical specialist and a nurse, laboratory diagnostic examinations, drug therapy, various procedures are carried out, as well as consultations with medical specialists on the profile of the disease.

On Saturdays, Sundays and holidays, monitoring of patients can be carried out by doctors and nurses on duty, as well as emergency medical services. If the course of the disease worsens, the patient should be immediately transferred to a 24-hour hospital.

Appendix No. 1 to the Regulations

Rules for organizing the activities of the clinic

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

2. The clinic is an independent medical organization, or a structural unit of a medical organization (its structural unit) providing primary health care, and is organized to provide primary pre-medical health care, primary medical care, primary specialized health care , as well as palliative medical care to the population.

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

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

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

6. A specialist who meets the qualification characteristics of positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), with a specialty of “Paramedic”, is appointed to the position of a nurse in a polyclinic. "Midwife" or "Nurse".

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

8. To organize the work of the clinic, it is recommended to include the following divisions in its structure:

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

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

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

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

10. If there is no effect from the treatment on an outpatient basis and (or) in the absence of the possibility of conducting additional examinations for medical reasons, a local therapist, a local therapist of a workshop area, a general practitioner, a family doctor in agreement with a specialist doctor according to the patient’s disease profile, he is referred to a medical organization for additional examinations and (or) treatment, including in an inpatient setting.

11. The main objectives of the clinic are:

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

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

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

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

Appendix No. 3 to the Regulations

Rules for organizing the activities of the first-aid room (department) of a polyclinic (medical outpatient clinic, general medical practice center (family medicine))

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

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

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

4. Organization of work in the Office can be carried out both on an ongoing basis by medical workers of the Office, and on a functional basis by medical workers of other divisions of the medical organization in accordance with the schedule approved by the head of the medical organization.

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

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

Reception of patients to decide on the urgency of referral to a doctor;
referral for laboratory and other studies of patients who do not need a medical appointment on the day of treatment;
conducting anthropometry, measuring blood and eye pressure, body temperature, visual and hearing acuity, other diagnostic procedures, the implementation of which is within the competence of workers with secondary medical education, filling out the passport part of the delivery sheet for medical and social examination, sanitary and resort card, laboratory data and other functional diagnostic studies before referral for medical and social examination, for sanatorium-resort treatment, preparation of certificates, extracts from individual outpatient records and other medical documentation, the preparation and maintenance of which is within the competence of workers with secondary medical education;
registration of sheets and certificates of temporary disability, confirmation with appropriate seals of certificates, directions, prescriptions and extracts from medical records issued to patients, strict accounting and registration in special journals of sheets, certificates of temporary disability and prescription forms;
participation in the organization and conduct of preventive medical examinations.

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

Appendix No. 4 to the Regulations

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

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

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

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

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

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

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

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

6. It is recommended that the registry office of a medical organization include a information desk, a self-recording room (table), workstations for receiving and registering doctor’s house calls, a room for storing and selecting medical documentation, a room for processing medical documents, and a medical archive.

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

Appendix No. 5 to the Regulations

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

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

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

3. Providing emergency medical care to persons who apply with signs of emergency conditions can be carried out on an outpatient basis or at home when a medical professional is called.

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

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

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

6. Emergency medical care for persons who contact a medical organization with signs of emergency conditions is provided immediately by the registrar.

7. Emergency medical care at home is provided within no more than 2 hours after receiving an application from a patient or other person for emergency medical care at home.

8. If there is no effect from the medical care provided, the patient’s condition worsens and life-threatening conditions arise, medical workers take measures to eliminate them using a stationary or portable emergency medical care unit and organize a call for an ambulance team or transportation of the patient to a medical organization, providing specialized medical care, accompanied by a medical professional.

9. After providing emergency medical care to the patient and eliminating or reducing the manifestations of the emergency condition, the patient is sent to a doctor or information about the patient is transmitted to the local doctor to visit the patient in order to monitor his condition, the course of the disease and timely order (correction) of the necessary examination and (or ) treatment (active visit) during the day.

Appendix No. 6 to the Regulations

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

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

2. The office of a general practitioner (family doctor) (hereinafter referred to as the Office) is a structural unit of a medical organization (its structural unit) providing primary health care and palliative care.

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

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

5. The structure of the Cabinet and the staffing level are established by the head of the medical organization in which the Cabinet is created, based on the volume of diagnostic and treatment work carried out, the number, age and gender composition of the population served, indicators of the level and structure of morbidity and mortality of the population, and other indicators characterizing the health of the population.

6. The main tasks of the Cabinet are:

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


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


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

formation of risk groups;

organization and provision of palliative care to patients, including patients with cancer, who need narcotic and potent medications in accordance with the recommendations of medical specialists;
carrying out examination of temporary disability, referral for medical and social examination;

conducting preliminary or periodic medical examinations of workers and vehicle drivers;

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

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

Appendix No. 7 to the Regulations

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

1. These rules establish the procedure for organizing the activities of the prevention department (office) (hereinafter referred to as the Department).

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

3. The prevention department includes the following structural divisions:

Anamnesis room;
functional (instrumental) research room;
healthy lifestyle promotion room;
office for centralized recording of annual medical examinations;
medical aid room for smoking cessation.

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

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

6. The main functions of the Department are:

Participation in the organization and conduct of medical examinations;
participation in the organization and conduct of preventive medical examinations;
early detection of diseases and persons with risk factors for developing diseases;
control and recording of annual medical examination of the population;
preparation and transmission of medical documentation to doctors for patients and persons with an increased risk of disease for additional medical examination, clinical observation and treatment and recreational activities;
sanitary and hygienic education and promotion of a healthy lifestyle (fight against smoking, alcoholism, excess nutrition, physical inactivity, etc.).

Appendix No. 8 to the Regulations

Rules for organizing the activities of a mobile medical team

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

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

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

The mobile medical team may, by agreement, include medical workers from other medical organizations.

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

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

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

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

Appendix No. 9 to the Regulations

Rules for organizing the activities of a day hospital

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

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

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

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

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

6. To organize the work of a day hospital, it is recommended that its structure include:

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

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

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

9. The day hospital performs the following functions:

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

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

Appendix No. 12 to the Regulations

Rules for organizing the activities of a medical outpatient clinic

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

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

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

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

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

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

6. Specialists who meet the qualification characteristics of positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position “Paramedic” are appointed to the position of paramedic in a medical outpatient clinic. .

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

8. A specialist who meets the qualification characteristics of positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), is appointed to the position of nurse ".

9. The medical outpatient clinic is provided with class A ambulances.

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

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

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

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

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

14. The equipment of the medical outpatient clinic is carried out in accordance with the equipment standard established by Appendix No. 14 to the Regulations on the organization of primary health care for the adult population, established by this order.

15. The main tasks of a medical outpatient clinic are:

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

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

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

Appendix No. 15 to the Regulations

Rules for organizing the activities of a paramedic-midwife station

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

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

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

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

5. A specialist who meets the qualification characteristics of positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), is appointed to the position of midwife ".

" Nurse".

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

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

Procedural;
nurse and midwife room;
emergency room for childbirth;
room for temporary stay of patients;
staff bathroom;
bathroom for patients;
sanitary room.

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

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

11. The main tasks of the FAP are:

Appendix No. 18 to the Regulations

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

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

2. A paramedic health center of a medical organization (hereinafter referred to as a paramedic health post) is a structural unit of a medical organization and is organized to provide primary pre-hospital health care (hereinafter referred to as pre-hospital medical care) and palliative medical care to the population in rural settlements with a small population and (or ) located at a considerable distance from medical organizations, including medical and obstetric centers, or in the presence of water, mountain and other barriers, as well as in the case of predominantly (more than 40%) people living in them over working age.

3. A specialist is appointed to the position of paramedic at a paramedic health center who meets the qualification characteristics of positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position “Paramedic”.

A specialist is appointed to the position of nurse at a paramedic health center who meets the qualification characteristics of positions for workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position “Nurse”.

4. The staffing level of medical and other personnel of a paramedic health center is established by the head of the medical organization of which he is a part, in accordance with the recommended staffing standards for a paramedic health center of a medical organization, established by Appendix No. 19 to the Regulations on the organization of primary health care for the adult population, approved by this order.

5. To organize a paramedic health center, it is recommended that its structure include:

Procedural;
paramedic's office;
bathroom

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

7. To provide emergency pre-hospital medical care for sudden, life-threatening acute diseases, conditions, exacerbations of chronic diseases, injuries, poisonings (hereinafter referred to as life-threatening conditions), instructions are posted at the paramedic health center in places accessible to medical workers, including the sequence of diagnostic actions life-threatening conditions and (or) diseases and the provision of medical care for them, including the use of packages containing necessary medicines and medical products, the stocks of which are replenished as needed.

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

Diagnosis and treatment of uncomplicated acute, exacerbations of chronic diseases and other conditions, injuries, poisonings;
implementation of prevention of infectious and non-infectious diseases;
identification of smokers and people who consume alcohol in excess, with a high risk of developing diseases associated with smoking, alcohol and poisoning with alcohol substitutes;
providing assistance to smokers and people who consume alcohol excessively in the prevention and cessation of smoking and alcohol abuse, including referring them for consultation and treatment to medical prevention departments (offices), health centers and specialized medical organizations;
implementation of activities to promote a healthy lifestyle;
referral of patients to medical organizations for the provision of primary (medical, specialized) health care or specialized medical care in cases provided for by the procedures for the provision of medical care by profile, arranging appointments with medical specialists;
elimination of life-threatening conditions with subsequent organization of medical evacuation to medical organizations providing specialized medical care, accompanied by a medical worker from a paramedic health center or an emergency medical team;
identification of precancerous diseases and malignant neoplasms of visual localization and referral of patients with suspected malignancy and precancerous diseases to the primary oncology office of a medical organization;
organization and provision of palliative care to patients, including patients with cancer, who need narcotic and potent medications in accordance with the recommendations of medical specialists;
implementation of sanitary-hygienic and anti-epidemic measures;

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

Appendix No. 21 to the Regulations

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

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

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

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

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

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

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

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

8. Specialists who meet the qualification characteristics of positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position “Paramedic” are appointed to the position of paramedic of the Center.

9. To organize the work of the Center, it is recommended that its structure include:

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

10. In order to improve the provision of medical care, the Center (Department) can organize a pre-medical care room (department), an emergency medical care room (department), a day hospital, including a home hospital, a medical care room for smoking cessation.

11. The Center performs the following functions:

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

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

Appendix No. 24 to the Regulations

Rules for organizing the activities of the health center

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

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

3. The management of the health center is carried out by the manager, who is appointed to the position and dismissed by the head of the medical organization.

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

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

5. A specialist is appointed to the position of a nurse at a health center who meets the qualification characteristics of positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), in the specialty "instructor in hygienic education", "nurse" with appropriate training in healthy lifestyle issues and medical prevention.

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

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

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

9. To organize the work of a health center, it is recommended that its structure include:

Doctors' offices;
dental hygienist's office;
ophthalmology office;
testing room on a hardware and software complex;
instrumental and laboratory examination rooms;
physical therapy room (hall);
classrooms (auditoriums) of health schools.

10. In order to improve the provision of medical care, a prevention room (department) can be organized at the Health Center.

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

12. The main objectives of the Health Center are:

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

MINISTRY OF HEALTH AND SOCIAL DEVELOPMENT
RUSSIAN FEDERATION

ORDER

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

Lost force on January 4, 2013 on the basis
Order of the Ministry of Health and Social Development of Russia dated May 15, 2012 N 543n
____________________________________________________________________

In accordance with paragraph 5.2.11 of the Regulations on the Ministry of Health and Social Development of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 2004 N 321 (Collection of Legislation of the Russian Federation, 2004, N 8, Art. 2898; 2005, N 2, Art. .162) and in order to improve the organization of primary health care to the population

I order:

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

Minister
M.Yu.Zurabov

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

Application. PROCEDURE for organizing the provision of primary health care

Application

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

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

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

3.1. outpatient clinics: outpatient clinic, general medical (family) practice center, district (including central), city clinic, children's city clinic, antenatal clinic.

4. Institutions of public and private health care systems may also participate in the provision of primary health care on the basis of agreements with insurance medical organizations*.
________________
* Part 2 of Article 38 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens dated July 22, 1993 N 5487-1 (Gazette of the Congress of People's Deputies of the Russian Federation and the Supreme Council of the Russian Federation, 1993, N 33, Art. 1318; Collection of Legislation of the Russian Federation, 2004, N 35, Art. 3607).

5. Institutions providing primary health care carry out their activities in accordance with the established procedure.

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

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

A guaranteed volume of free medical care is provided to citizens in accordance with the Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation*.
________________
* Part 3 of Article 20 of the Fundamentals of Legislation of the Russian Federation on the protection of the health of citizens dated July 22, 1993 N 5487-1 (Gazette of the Congress of People's Deputies of the Russian Federation and the Supreme Council of the Russian Federation, 1993, N 33, Art. 1318; Collection of Legislation of the Russian Federation, 2004, N 35, Art. 3607).

8. Outpatient care includes:

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

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

- diagnosis and treatment of various diseases and conditions;

- restorative treatment;

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

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

- clinical examination of pregnant women and postpartum women;

- clinical examination of healthy and sick children;

- dynamic medical observation of the child’s growth and development;

- organization of nutrition for young children;

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

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

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

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

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

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

- medical consultation and medical career guidance;

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

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

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

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

- restorative treatment and rehabilitation.

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

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

- emergency medical care;

- when a patient self-refers for emergency reasons.

Electronic document text
prepared by Kodeks JSC and verified against.

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

With changes and additions from:

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

1. Approve the attached Regulations on the organization of primary health care for the adult population.

2. To recognize as invalid:

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

Order of the Ministry of Health and Social Development of the Russian Federation dated August 4, 2006 N 584 “On the procedure for organizing medical care for the population on a local basis” (registered by the Ministry of Justice of the Russian Federation on September 4, 2006, registration N 8200).

Registration N 24726

The Regulations on the organization of primary health care were approved. We are talking about helping the adult population in Russia.

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

Free assistance is provided within the framework of the Program of State Guarantees for the free provision of medical care to Russian citizens at the expense of compulsory medical insurance funds and funds from the relevant budgets, as well as in other cases established by law.

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

To increase the efficiency of providing care for sudden acute diseases, conditions, exacerbation of chronic diseases that are not life-threatening to the patient and do not require emergency intervention, an emergency department (office) can be organized in medical organizations.

Orders approving the procedure for organizing the provision of primary medical care and the procedure for organizing medical care for the population on a local basis were declared invalid.

Order of the Ministry of Health and Social Development of the Russian Federation dated May 15, 2012 N 543n “On approval of the Regulations on the organization of primary health care for the adult population”

Registration N 24726

This order comes into force 10 days after the day of its official publication

Let us remind you that order No. 139n is another amendment to order No. 543n. Prior to this, Order No. 543n was amended in 2015 by the following departmental regulations:

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

Changes in the work of clinics

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

Head of the clinic

Here the text of the third paragraph has changed, which clarifies that a medical worker with higher education in the field of training “Health and Medical Sciences” is appointed to the position of head of the clinic, in accordance with the qualification requirements approved in Order No. 707n as amended in Order No. 328n. The head of the clinic must have training (retraining courses) in the specialty ""

In addition, he must comply with the requirements of the order of the Ministry of Health and Social Development of the Russian Federation dated July 23, 2010 No. 541n “Unified qualification directory of positions ...” for the characteristic “Chief physician of a medical organization.”

Head of the structural unit of the clinic

A medical worker is appointed to this position, who must meet the requirements of Order No. 707n (as amended by Order No. 328n).

Clinic paramedic

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

Clinic nurse

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

Day hospital equipment standard

This standard excludes the nurse's workplace and stethoscope from the list.

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

Changes for medical outpatient clinics

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

Position of outpatient medical assistant

A medical worker who meets the requirements of Order No. 83n and is trained in the specialty “General Medicine” is appointed to this position.

Outpatient midwife position

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

Outpatient nurse position

Here, too, the nurse must have training in the specialty “Nursing” or “Nursing in Pediatrics”.

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

Here are changes made to Appendix No. 14 of Order No. 543

In other words, added here:

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

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

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

Paramedic health center

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

also in Standard for equipping a paramedic health center added 57 item: Portable pulse oximeter – 1 pc.

Changes for general practice centers and departments

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

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

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

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

The organization of primary health care is carried out by medical organizations and their structural divisions in accordance with Appendices No. 1-27 to these Regulations.

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

a) as free - within the framework of the Program of State Guarantees for the free provision of medical care to citizens of the Russian Federation at the expense of compulsory health insurance and funds from the relevant budgets, as well as in other cases established by the legislation of the Russian Federation;

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

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

at the place of departure of the mobile medical team, including to provide medical care to residents of settlements with predominantly people over working age, or located at a considerable distance from the medical organization and (or) with poor transport accessibility, taking into account climatic and geographical conditions.

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

Taking into account the formation of contingents of citizens temporarily (seasonally) living in the territory of a populated area (including in summer cottages and gardening communities), an emergency medical care department (office) can be organized in close proximity to the place of temporary (seasonal) residence.

primary pre-hospital health care, which is provided by paramedics, midwives, and other medical workers with secondary medical education in paramedic health centers, paramedic-obstetric stations, medical outpatient clinics, health centers, clinics, outpatient departments of medical organizations, departments (offices) of medical prevention, health centers;

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

primary specialized health care, which is provided by medical specialists of various profiles in polyclinics, outpatient departments of medical organizations, including those providing specialized, including high-tech, medical care.

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

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