Intensive indicator of morbidity with temporary disability. Morbidity with temporary disability
MODULE 3.8. EXAMINATION OF TEMPORARY DISABILITY
MODULE 3.8. EXAMINATION OF TEMPORARY DISABILITY
The purpose of studying the module: study the organization of the examination of temporary disability and the procedure for issuing documents certifying temporary disability.
After studying the topic, the student should know:
Basic concepts of examination of temporary disability;
Organization of examination of temporary disability in medical institutions;
Types of temporary disability;
Rules for issuing, the procedure for issuing documents certifying temporary disability;
Statistical indicators of morbidity with temporary disability;
Methodology for calculating morbidity rates with temporary disability.
The student must be able to:
Calculate, analyze and interpret statistical indicators of morbidity with temporary disability;
Prepare documents certifying temporary disability;
Use the acquired knowledge in the practice of a doctor.
3.8.1. Information block
Temporary disability - the state of the human body due to illness, injury and other reasons, in which dysfunctions are accompanied by the inability to perform professional duties in normal production conditions for a certain period of time, i.e. are reversible.
Examination of temporary disability - one of the types of medical examination, the main purpose of which is to assess the patient's state of health, the quality and effectiveness of the treatment, the ability to carry out professional activity, as well as determining the degree and timing of temporary disability.
Documents certifying temporary incapacity for work and confirming temporary release from work (study) are the “Disability Certificate”, in some cases - certificates of the established form, for example “Certificate of temporary disability of a student, student of a technical school, vocational school, illness, quarantine and other reasons for the absence of a child attending school, a preschool institution” (f. 095 / y).
The main statistical document registering diseases with temporary disability is “Information on the causes of temporary disability” (f. 16-VN). This document allows you to analyze the level and structure of individual diseases in cases and days of disability. In order to unify the formation of the state statistical report of a medical institution, the “Talon for a completed case of temporary disability” (f. 025-9 / y-96) is used.
The organization of an examination of temporary disability, the procedure for issuing certificates of disability, the analysis of morbidity with temporary disability are set out in section 8 of chapter 3 and sections 2, 3 of chapter 20 of the textbook. The procedure for filling out a disability certificate is given in Appendix 10.
3.8.2. Tasks for independent work
1. Study the materials of the relevant chapters of the textbook, module, recommended literature.
2. Answer security questions.
3. Parse the task-standard.
4. Answer the questions of the test task of the module.
5. Solve problems.
3.8.3. Control questions
1. Give a definition of the concept of "examination of temporary disability."
2. What is the examination of temporary disability?
3. List the types of temporary disability.
4. Name the documents certifying temporary disability.
5. Name the procedure for issuing a sick leave for diseases, injuries, poisoning, as well as for some other consequences of external causes.
6. What is the procedure for issuing a sick leave for caring for a sick family member?
7. How is a certificate of incapacity for work issued in cases of pregnancy and childbirth?
8. How is a certificate of incapacity for work issued for the period of sanatorium treatment, prosthetics and during quarantine?
9. Name the indicators of morbidity with temporary disability. Give the calculation formula.
3.8.4. Reference task
Initial data
1. At one of the industrial enterprises with the number of employees 1215 people, 840 cases of illness and 9200 days of temporary disability were registered during the year.
2. Lyubov Ivanovna Smirnova, 52 years old, accountant of Vympel LLC, residing at the address: Voronezh, st. Lebedeva, 45, apt. 126, turned to the city polyclinic No. 2, located at the address: Voronezh, st. Lebedeva, d. 5. After examination by a general practitioner Pavlova M.A. was diagnosed with hypertensive crisis. Treatment has been given. The disability certificate was issued from March 25 for 18 days.
Exercise
1. Based on the presented initial data, calculate and analyze the incidence rates with temporary disability.
2. Issue a certificate of incapacity for work in accordance with the rules for filling out a certificate of incapacity for work and the attached sample (Appendix 10).
Solution
To analyze the incidence with temporary disability at one of the industrial enterprises, we calculate the following indicators.
1. Statistical indicators of morbidity with temporary disability
1.1. Number of cases of temporary disability per 100 employees =
1.2. The number of days of temporary disability per 100 employees =
1.3. Average duration(severity) of temporary disability =
2. For registration of temporary incapacity for work, the attending physician has the right to issue a certificate of incapacity for work during the initial treatment for a maximum of up to 10 days and to extend it individually for up to 30 days. In this example, the doctor issues a sick leave for 7 days - from March 25 to March 31, then extends it for another 7 days - from April 1 to April 7, and then from April 8 to April 11. From April 12, the employee must start work.
We enter the results of the calculation of statistical indicators in a table and compare them with the recommended values or the prevailing average statistical corresponding indicators given in Section 8 of Chapter 3 of the textbook and the recommended literature, after which we draw the appropriate conclusions.
Table. Comparative characteristics of statistical indicators of morbidity with temporary disability
Conclusion
At this industrial enterprise, the indicator of the number of cases of temporary disability (69.1) is higher, and the number of days of temporary disability (757.2) per 100 employees is lower than the corresponding indicators prevailing on average in the Russian Federation. The indicator of the average duration of one case of temporary disability (11) is lower than the similar indicator for the Russian Federation.
3.8.5. Test tasks
Choose only one correct answer.
1. Under what conditions can persons engaged in private medical practice be granted the right to issue certificates of incapacity for work?
1) if you have a specialist certificate;
2) if there is an agreement with municipal or state medical institutions;
3) in case of injuries, poisoning and other acute diseases;
4) if there is a license to engage in medical activities and conduct an examination of temporary disability;
5) in cases of emergency medical care.
2. What to do if the patient remains temporarily disabled upon discharge from the hospital?
1) close the leaflet and send it to the clinic;
2) issue a certificate for 3 days;
3) extend the certificate of incapacity for work for up to 10 days;
4) extend the certificate of incapacity for work for a period not exceeding 4 days;
5) issue a certificate for a period not exceeding 10 days.
3. How is disability due to injury?
1) a certificate of incapacity for work is issued on the day of establishment of temporary incapacity for work;
2) a certificate of incapacity for work is issued from the day of contacting a doctor for the entire period of incapacity for work;
3) a certificate of incapacity for work is issued from the 6th day of incapacity for work, a certificate is issued for the first 5 days;
4) a certificate of incapacity for work is issued from the 11th day of incapacity for work;
5) for any injuries, a certificate is issued for the entire period of disability.
4. How long is a disability certificate issued to care for a sick child at home?
1) for 3 days, then a certificate is issued for up to 10 days;
2) for 7 days, then a certificate for 3 days is issued;
3) for up to 10 days, more than a certificate is issued;
4) for up to 14 days, more than a certificate is issued;
5) for the entire period of illness of a child under the age of 7 years.
5. In what cases is a certificate of incapacity for work issued to care for a healthy child?
1) upon departure of the mother (father) for sanatorium treatment;
2) when quarantine is imposed on this child;
3) when imposing quarantine on a nursery, garden;
4) in case of hospitalization of a person caring for a child under 3 years of age;
5) in case of inpatient treatment of a person caring for a child under 5 years of age.
6. How long is a sick leave certificate issued for uncomplicated pregnancy and childbirth?
1) for 56 calendar days;
2) for 70 calendar days;
3) for 126 calendar days;
4) for 140 calendar days;
5) for 170 calendar days.
7. What data is needed to calculate the average duration of a case of temporary disability?
1) the number of days of temporary disability; number of sick persons;
2) the number of days of temporary disability; population;
3) the number of days of temporary disability; the number of cases of temporary disability;
4) the number of days of temporary disability; average annual number of employees;
8. Name the type of temporary incapacity for work, in which a certificate of incapacity for work is issued for the entire period of aftercare, but not more than 24 calendar days:
1) trauma;
2) quarantine;
3) prosthetics;
4) patient care;
5) spa treatment.
9. After what period after the opening of the sick leave, long-term ill patients are sent to the ITU with an obvious unfavorable clinical and labor prognosis?
1) after 2 months;
2) after 3 months;
3) after 4 months;
4) after 6 months;
5) after 12 months.
10. Which health worker can be granted the right to issue a certificate of incapacity for work?
1) to the doctor of the ambulance station;
2) to the doctor of the admission department of the hospital;
3) a doctor at a rest home, sanatorium;
4) a nurse in a health center;
5) to the paramedic of the feldsher-obstetric station located in a remote area.
11. For how long can the attending physician issue a certificate of incapacity for work at once and independently?
1) for 4 and 15 days;
2) for 3 and 6 days;
3) for 10 and 25 days;
4) for 6 and 30 days;
5) for 10 and 30 days.
12. What data is needed to calculate the indicator "the number of cases of temporary disability per 100 employees"?
1) the number of cases of temporary disability; average annual population;
2) the number of cases of temporary disability; average duration of one case;
3) the number of cases of temporary disability; average annual number of employees;
4) the number of cases of temporary disability; number of sick persons;
5) the number of days of temporary disability; the number of cases of temporary disability.
13. Name the functions of the attending physician for the examination of working capacity:
1) establishment of the fact of temporary incapacity for work, issuance of a certificate of incapacity for work, referral to the ITU;
3) establishment of the fact of temporary incapacity for work, issuance of a certificate of incapacity for work, examination of permanent disability;
4) establishing the fact of permanent disability, issuing a referral to the medical commission, examination of temporary disability;
5) establishment of the fact of temporary incapacity for work, issuance of a certificate of incapacity for work up to a maximum of 30 days, referral to the VC to extend the certificate of incapacity for work.
14. What are the functions of the medical commission for the examination of working capacity:
1) consultations of doctors, referral to the ITU, issuance of an opinion on transfer to another job, quality control of treatment, examination of temporary disability for more than 30 days;
2) consultations of doctors, referral to the ITU, examination of permanent disability, professional unsuitability;
3) consultations of doctors, issuance of a certificate of incapacity for work to all patients, examination of permanent and temporary incapacity for work;
4) issuance of a certificate of incapacity for work, certificates of professional unsuitability, examination of temporary disability, issuance of an opinion on the transfer of pregnant women to another job;
5) issuance of a certificate of incapacity for work, extension of a certificate of incapacity for work.
15. What data is needed to calculate the indicator "number of days of temporary disability per 100 employees"?
1) the number of days of temporary disability; average annual population;
2) the number of days of temporary disability; average duration of one case;
3) the number of days of temporary disability; average annual number of employees;
4) the number of days of temporary disability; number of sick persons;
5) the number of days of temporary disability; number of working days in a year.
3.8.6. Tasks for independent solution
Task 1
Initial data
1. At one of the industrial enterprises with 945 employees, 782 cases of illness and 8125 days of temporary disability were registered during the year.
2. Petr Ivanovich Kirillov, 45 years old, turner of JSC Cable, residing at the address: Samara, st. Sibirskaya, 91, apt. 120, from 03.04 to 28.04 he underwent inpatient treatment at the city hospital No. 1, located at the address: Samara, st. Altai, d. 85, with a diagnosis of peptic ulcer, duodenal ulcer. The certificate of incapacity for work was issued by the head of the therapeutic department Solovyov M.A. and the attending physician Drozdova N.P.
Task 2
Initial data
1. At one of the industrial enterprises with the number of employees 1345 people, 915 cases of illness and 10,170 days of temporary disability were registered during the year.
2. Makarova Vera Ivanovna, 46 years old, seamstress of ST-fashion LLC, residing at the address: Ulyanovsk, Frunze Ave., 26, apt. 49. From 15.02 during
Diseases with temporary disability include cases of diseases of workers, employees, collective farmers, which resulted in absence from work. Thus, in this case we are talking about the incidence of working contingents. This is the reason for the large social significance this problem.
The unit of observation in the study of morbidity with temporary disability is each case of temporary disability due to a disease that occurred in a worker in a given year.
The accounting document is a certificate of incapacity for work, which is not only a legal document certifying temporary release from work, but also financial, since benefits are paid on the basis of it.
At each enterprise and in institutions, quarterly reports on temporary disability according to f. No. 16-VN. This report is sent to the city, regional (territorial, republican) committee of the trade union of the corresponding branch of the national economy.
On the basis of quarterly reports, semi-annual and annual reports on temporary disability are compiled.
The main indicators used in the analysis of morbidity with temporary disability:
1. The number of cases of temporary disability per 100 employees (total and for individual forms and groups of diseases):
number of cases of temporary disability x 100_
2. The number of days of temporary disability per 100 employees (total and for individual forms and groups of diseases):
number of days of temporary disability x 100____
number of year-round contingents of employees
3. The average duration of one case of temporary disability due to illness:
number of days of temporary disability
for all or specific diseases ____________
number of cases of temporary disability
for all or specific diseases
4. Indicators of the structure of morbidity:
a) the proportion of cases of temporary disability due to some disease among all cases of disability:
number of cases of temporary disability
on this disease x 100________________
number of all cases of temporary disability
b) the share of days of temporary disability due to any illness among all days of disability:
number of days of temporary disability
for this disease х 100______
number of days of temporary disability
The analysis of these indicators makes it possible to judge the dynamics of morbidity at a given enterprise (by quarters of the year, for a number of years), to conduct a comparative assessment with other enterprises in the industry, to identify those diseases that occupy a leading place in the structure of morbidity, and on this basis to plan the necessary medical and recreational and sanitary measures. However, the possibilities of using f. No. 16-VN for an in-depth study of morbidity with temporary disability are very limited, tk. using this form, it is impossible to assess the impact on the incidence of such important factors as gender, age, profession, experience. Therefore, in medical institutions serving industrial enterprises, morbidity with temporary disability is studied according to personal records.
For each employee of the enterprise, a special accounting document (“Personal employee card”) is filled out, which indicates his last name, first name, patronymic, gender, age, profession, work experience - general and in this profession. This card contains information about disability on sick leave during the year, indicating the diagnosis and the duration of the release from work.
Police registration of morbidity with temporary disability makes it possible to calculate and analyze again additional indicators depending on gender, age, length of service, profession:
1. Percentage of sick people:
number of ill persons x 100______________________________
number of year-round contingents of employees
2. Percentage of people who were not ill:
number of non-sick persons x 100_____________________
number of year-round contingents of employees
3. The frequency of sick people who had 1,2,3,4 cases or more of temporary disability due to illness, per 100 employees:
number of persons who had a certain number of cases of TD
due to illness (1,2,3,4 times or more) x 100______
number of year-round contingents of employees
4. Distribution of persons who temporarily lost their ability to work due to illness according to the frequency of cases of the disease:
number of persons who had a certain number of cases of TD in a year
due to illness (1,2,3,4 times or more) x 100_________________
total ill persons
5. Recurrence of exacerbations of certain chronic diseases:
the number of cases of exacerbations of a chronic disease,
accompanied by VUT _______________________
the number of people suffering from this chronic disease
The use of personal morbidity records also makes it possible to single out a group of long-term and frequently ill patients who had 4 or more cases and 40 days of disability for homogeneous etiologically related diseases or 6 or more cases and 60 or more days of disability for heterogeneous diseases during the year.
special morbidity with temporary disability, or morbidity of working contingents (MTD) is subject to accounting and analysis.
Gather information about the MTD into one of the following documents:
Outpatient card f. 025-6(7)/y-89
A single coupon for the ambulance of the patient f.025-8 / y-95
Coupon for a completed case of temporary disability f.025-9 / y-96
Outpatient coupon f.025-10 / y-97, if computer calculation
The book of registration of certificates of incapacity for work f. No. 36 / y
In order to summarize the data on the MTD of the health facility, form 16-VN “Information on the causes of temporary disability” is filled out. This report is intended for operational purposes of accounting and analysis of temporary disability of employees. For the analysis of SVUT, the following are calculated:
Incidence rate = Number of cases of TD on primary sick leave / Average number of employees X 100
Severity of the disease = Number of days of TD according to pre-clinical lists and their continuations / Average number of employees X 100
Average duration of one case of incapacity for work \u003d Number of days of TD / Number of cases of TD
It is necessary to study MTD monthly, only then it is possible to identify the causes of diseases. When analyzing MTD, one should compare the incidence rates of individual workshops with each other, with the average indicators for the entire plant, with the indicators of other enterprises in the same industry, the seasonality of incidence, etc.
ZVUT has not only a social-gig value, but also a social-economy value, i.e. reflect the morbidity of workers.
Reports with MTD take into account not only diseases with MTD, but also disability due to pregnancy, childbirth, nursing, nursing.
This type of morbidity includes those cases of illness, workers, employees, collective farmers, which resulted in absence from work. Thus, in this case we are talking about the incidence of working contingents.
The unit of observation in the study of morbidity with temporary disability is each such case that occurred in a worker in a given year. The accounting document is a certificate of incapacity for work (sick leave), which is not only a legal document certifying temporary release from work, but also a financial one. At each enterprise and in institutions, trade union committees and doctors of medical and sanitary units (or trusted doctors) draw up a quarterly report in the form No. 16-VN. This report is sent to the city, regional (territorial, republican) committee of the trade union of the branch of the national economy to which the given enterprise or institution belongs. On the basis of quarterly reports, semi-annual and annual reports are compiled on temporary disability. The reporting form No. 16-VN provides data on the number of employees at this point, on the number of cases of disability (according to primary disability certificates) and the number of calendar days of disability (according to primary disability certificates and continuations) that occurred among workers for reporting period (quarter, year).
An analysis of these indicators makes it possible to judge the dynamics of morbidity at a given enterprise (by quarters of the year and for a number of years), to conduct a comparative assessment with other enterprises in the industry, to identify the diseases that occupy the main place in the morbidity of workers, and on this basis to plan the necessary medical treatment. - recreational and sanitary-hygienic measures.
At the same time, the possibilities of using the form Hi 16-VN for in-depth study of the incidence of temporary disability are limited. It does not allow to establish who and how often gets sick at a given enterprise, since it reflects only information about registered cases of diseases, and not about sick people.
Using this form, it is impossible to assess the impact on the incidence of such important factors as gender, age, profession and length of service. In recent years, a method of studying morbidity with temporary disability according to personal records has become widespread in the activities of medical institutions serving industrial enterprises.
For each employee of the enterprise, a special accounting document (“Personal employee card”) is filled out, which indicates his last name, first name, patronymic, gender. age, profession and work experience (general and in this profession). During the year, employees of the medical unit copy out from the sick-lists and enter into these cards information about all cases of disability for each worker, indicating the diagnosis and the duration of his release from work.
ICD-10
The system of grouping diseases and pathological conditions, reflecting the current stage in the development of medical science. It is a regulatory document that defines the rules for systematizing observations in the study vision. causes of death and activities of health care institutions. The first ICD (list of causes of death), proposed by J. Bertillon in 1893, was adopted by the International Statistical Institute. Since 1900, regular revisions of the classification have been made approximately once every 10 years. In the USSR in 1981-1982. introduced by the ICD of the ninth revision. The last tenth revision of the ICD was in 1993.
International classification illness th (ICD) is a system of grouping diseases and pathological conditions, reflecting the current stage in the development of medical science. The ICD is the main regulatory document in the study of the health status of the population in the member countries of the World Health Organization.
Thus, it should be noted that the ICD is in constant development and improvement.
Further integration of medical information systems various countries of the world is associated with the development of the International Nomenclature of Diseases (MNB), the development of which has been carried out by the Council of International Medical Scientific Organizations since 1970. international name taking into account specificity, unambiguity, etiology.
Unlike the nomenclature, the main task of the ICD is to group pathological conditions of the same type for the purpose of subsequent analytical processing. In the ICD, all diseases are divided into classes, classes into blocks, blocks into headings (encrypted with three characters), headings into subheadings (encrypted with four characters or more). ICD 10 consists of three volumes.
First volume(In the Russian edition - in two books) contains a complete list of three-digit headings and four-digit subheadings, a list of headings for which countries submit information on diseases and causes of death to WHO, as well as special lists for the statistical development of mortality and morbidity data.
Second volume includes a description of the ICD-10, its purpose, scope, instructions, rules for using the ICD-10 and p(la coding of causes of death and diseases, as well as the basic requirements for the statistical presentation of information. For specialists, the section on the history of the ICD may also be of interest .
Third volume consists of an alphabetical list of diseases and the nature of injuries (injuries), a list of external causes of injuries, tables of medicines and chemicals (about 5.5 thousand items).
What are the main innovations in the ICD of the tenth revision compared to the ninth revision. In ICD-10, purely classes have been increased (from I 7 to 21). Disease class nervous system and organs chu is divided into classes VI "Diseases of the nervous system", VII "Diseases! :a and its adnexa” and VIII “Diseases of the ear and mastoid process”. Auxiliary E-code replaced by independent class XX " External causes morbidity and mortality”, and V-code for class XXI “Factors influencing the health status of people who visit health care institutions”.
Total number blocks in the ICD-10 has been increased to 258. The ICD-10 continues to develop the clinical focus of the systematization of diseases. In separate rubrics are collected diseases that represent the greatest problems for public health (myocardial infarction, disorders cerebral circulation and etc.). A systematization of the most common diseases according to their varieties has been introduced.
New classification provides for the possibility of assessing some diseases by severity by introducing a code of multiple damage to organs and systems. The tradition of double coding has been preserved, which makes it possible to evaluate the most damaged organs in infectious and some other diseases during special studies. The new classification retained special rubrics for ill-defined diseases and ill-defined diagnoses. This can help the healthcare manager evaluate the quality of the diagnostic process in the institution.
The ICD differs from the nomenclature of diseases in certain grouping principles.
The classification is structured in such a way that a limited number of rubrics covers most of the known diseases.
Diseases of particular importance to public health are placed in separate headings and are located at the beginning of classes or blocks. Rubrics for mixed or unspecified conditions are minimized. Subcategories whose codes (fourth character) end with a number "eight", mean usually "other" conditions and multiple lesions, and the number ".9" means, as a rule, the same. as the main heading, but the state is not specified. 1b of this provision have exceptions. For example, code 9 in headings E10 - E14 Diabetes means "no complications". .8 - "unspecified complications", a.7 - - "multiple complications". Thus, ICD-10 puts forward strict requirements for the formulation of a diagnosis, without which it is impossible to choose an exact code that most fully reflects the nature of the encoded disease or cause of death.
ICD principles
A disease of particular public health importance and high prevalence is presented in a separate rubric.
The ICD is intended for practical use, so it allows for a number of compromises between classifications.
Diseases are grouped as follows:
epidemic diseases;
Constitutional, or general, diseases;
Local diseases grouped by anatomical localization;
Developmental diseases;
The ICD-10 is not intended and is not suitable for indexing individual clinical cases.
There are some difficulties in using the ICD to study financial matters such as billing or resource allocation.
CURRENT STATUS. TRENDS AND FEATURES OF OB-TI:
Str-ra of the general z-ty: 1.6-nn org respiration-21.5 / o 2.6-in s-we blood circulation 11.4% 3 b-in eyes-9.2%
The level of total food in 2003 is 1712.5 (1655.3-2OO2) per 1000 of us (RF-1411.3). The total number of adults is 1582.8, children - 2000.2
Primary salary in 2003 was 896.1 (870.6-2002) per 100 of us. Primary care for children - 1468.9
Str-ra primary z-ty: 1. b-no org breathing-35.7%. 2. injury and poisoning - 15.5%. 3.b-no urogenital s-we-7.7%
Scheme for studying the building of us: legislative for the protection of the building. Conditions of collective life: work, life. rest, food, migration processes, level of education and culture. Organization of medical care. Sots-ek f-ry: for 6-th. disabled physical development, whether it is natural for two of us, the composition of the building for us. Natural and climatic: natural resources, bnoclimatic level, physiogeographic level. Biological: gender. age, constitution, heritage.
At the regional level, the potential of the building of residents depends on: the provision of uch-mi Z.O., medical staff. equipment to lay down. uch, sufficiency of financing and mat-th providing, availability of the help; the ecology of the region and its influence on its inhabitants; Income level of residents. Inequality in the distribution of availability of services Z.O. and their availability.
V general view The level of health in the conditions of family life is determined by the following group of basic f-s: nutrition-balance, calorie content, sufficiency, regularity, housing-heating, sewerage, centralized water supply, insufficient space; lifestyle (in connection with the social and professional status and standard of living) -bad habits; financial availability of medical care, medicines, professional opportunities.
WHO has identified 10 main goals of the Health for All in the 21st century:1. strengthening equity in relation to zd-I. 2. Improving opportunities for survival and improving the quality of life. 3. reversal of global trends in relation to 5 major pandemics (inf b-her, nennf b-her, injuries and violence, alcoholism and drug addiction, tobacco smoking). 4. complete or partial eradication of certain diseases (poliomyelitis, etc.). 5. Improving access to water, sanitation, food and housing. 6. promoting a healthy and counteracting an unhealthy lifestyle. 7. Improving access to comprehensive quality health care. 8. support for scientific research in the field of Z.O. 9. introduction of global and national systems of medical information and epidemiological surveillance. 10 development, implementation and monitoring of policies to achieve<д-я для всех» в странах.
DISABILITY: DEFINITION. HIS INF II:
Yavl 1 is one of the most important criteria for building. Until 1995, in our country, the concept of a disabled person was identified with a persistent disabled person. Inv 2gr-no laborsp-en 1gr-yet "and needed care. They were deprived of employment rights. 3 gr-was a worker, but they were reluctant to hire them. In 95, the law "Social protection of inv-s of the Russian Federation", for the first time in practice was inc-but-"disabled child".
Morbidity with temporary disability (TS)
For the qualitative and quantitative assessment of the health status of the population, including the working population, indicators of morbidity, mortality, disability, seeking medical care, fertility, and others are used. The health status of workers is most fully characterized by morbidity rates with temporary disability (Figure 1.1).
Figure 1.1 - Types and nature of disability
Temporary disability is a human condition caused by illness, injury, poisoning and other reasons, in which violations of body functions are accompanied by the inability to perform work duties and professional activities under normal working conditions for a certain period of time, that is, they are reversible.
The document certifying the fact of VL for employees is a certificate of incapacity for work, which gives grounds for dismissal from work due to VL (legal function), calculation of benefits (financial function), prescribes a certain type of treatment regimen (medical function) and is a primary document for analysis incidence (statistical function).
The analysis of morbidity with LN can be performed using two main methodological approaches: according to the form of statistical reporting and based on police records, each of which has its own advantages and disadvantages. Thus, analysis according to the form of statistical reporting allows you to quickly obtain information on the number of cases and days of VL in the context of industries, enterprises, workshops for predetermined classes and groups of diseases, identify the structure, dynamics of morbidity with VUT over a long period and calculate the forecast, determine the damage from labor losses. or the effectiveness of the measures implemented. But when using this method, the possibilities of a deeper analysis of individual classes and groups of diseases are limited; it does not take into account the influence of gender, age, work experience, and other factors on VL.
For the first time in the republic, unified unified methodological approaches to an in-depth interpretive analysis of morbidity with TD were substantiated, new statistical methods were developed for determining the reliability of differences in the indicator of the number of days of LT for the main classes of diseases and in total, two schemes for analyzing LT were proposed, including for the purposes of social and hygienic monitoring ( SGM), operational control, special scientific research.
Systematization of methodological approaches with bringing quantitative and qualitative characteristics into a single system for further analysis and generalization, as well as modeling of cause-and-effect relationships between levels of labor losses and environmental factors will make it possible to give an objective assessment of indicators of the health status of workers, to justify preventive and health measures.
The scheme for analyzing the VL of workers consists of the following steps:
Setting goals, objectives and justification of the need for research;
The choice of the object of study (workshop, enterprise, professional group) taking into account the studied and eliminated factors;
Collection of necessary information, including:
list of employees;
information from sick leave certificates;
data on the state of working conditions, materials for the study of social and other factors;
· primary processing, summary and preparation of materials for the creation of a database - statistical processing, logical analysis of data, preparation of conclusions, conclusions.
The purpose of an in-depth analysis of morbidity with VUT is to substantiate and develop measures to reduce VL and eliminate the causes that caused increased levels of morbidity based on determining the patterns of formation of labor loss levels among workers, studying the role of working conditions and other risk factors and their impact on VL indicators, determining priority directions for improving working conditions and improving the health of workers.
The main stages for the implementation of the goal:
Studying the composition of employees by professional, length of service and other characteristics;
Identification of the frequency and structure of VL, the study of the dynamics of labor losses;
Comparative assessment of morbidity rates of the studied contingents;
Establishing a connection between VL and possible risk factors;
Substantiation and development of health and preventive measures.
The justification for the need for an in-depth analysis of VL are:
High incidence with VUT;
A sharp increase in VL in general or for individual nosological forms compared to previous periods, industry or other indicators;
Growth of occupational pathology;
Increasing the appeal of workers for medical care;
Substantiation of new or confirmation of existing MPCs, MPCs and other regulations;
Development of current and long-term plans for optimizing working conditions based on identifying the role of an unfavorable working environment and other risk factors in the formation of VL;
Determining the economic damage from labor losses or the socio-economic effect of previously implemented preventive measures;
Isolation of frequently and long-term sick people, their recovery, organization of clinical examination;
Timely detection of early effects to prevent chronic diseases, reduce the severity of pathology;
Identification of factors that promote health, reduce morbidity;
Evaluation of the activities of medical institutions;
Formation of a database (DB), an automated information processing system (ASOI) on the state of health of workers for monitoring purposes.
The optimal period for studying VN is a three-year period. In the absence of the influence of registered outbreaks of infectious diseases, pronounced irregularity in the work of production (reconstruction, repair work), significant changes in the nature and characteristics of medical care and other uncontrollable factors characteristic or specific for individual years of observation, as well as in the presence of a sufficient number of contingents in groups, analysis morbidity with VUT can be carried out for one year.
Increasing the follow-up period to 5 years or more improves the statistical significance of the study and makes it possible to perform a more in-depth analysis of VL. But this, on the other hand, increases the complexity of the study, creates additional difficulties in identifying the real state of working conditions for the initial period of the study in a retrospective analysis of the incidence of TD.
Since statistically significant differences in the levels of morbidity in the compared groups of workers are the main evidence of the influence of unfavorable working conditions on their morbidity, the correct choice and formation of these groups is of decisive importance. They should differ in terms of working conditions, the impact of which on VL is supposed to be studied, but be equal (or similar) in terms of other factors affecting employees (medical care, travel to work, food, etc.) Forming groups on a professional basis, it is necessary to focus not only on the name of the profession, but also take into account specific production conditions, as well as the homogeneity of groups in terms of the rhythm of work, work schedule and the number of night shifts, pay and other issues of labor organization. A more complete consideration of these and other factors in the formation of homogeneous groups makes it possible to reveal significant differences in smaller groups, which may not manifest themselves if the groups are not homogeneous.
The growth of VL indicators with an increase in work experience under certain conditions indicates the undoubted influence of working conditions on the health of workers. The influence of working conditions on morbidity can also be judged by the growth of its levels with an increase in work experience based on data obtained on the same contingent in dynamics over several years. (Fig. 1.2.2., Fig. 1.2.3)
Figure 1.2 - Distribution of days of disability with TD among working men of the Republic of Belarus by age
Figure 1.3 - Distribution of days of disability with TD among working women of the Republic of Belarus by age
The most concrete evidence of the negative impact of unfavorable working conditions on VL indicators can be obtained if general morbidity rates are confirmed and reflected in differences in VL levels for certain groups of diseases or nosological forms characteristic of the impact of this factor, and they grow with an increase in professional experience or an increase in intensity. the impact of the production factor.
The quality of medical care and examination of disability has an impact on morbidity rates.
Thus, a more complete identification and rehabilitation of patients with chronic diseases can lead to a decrease in morbidity with VUT, a decrease in exacerbations of chronic pathology, and a reduction in the duration of LN. On the other hand, shortcomings in the work of the examination negatively affect the incidence rates, therefore it is preferable to choose the compared groups within the service of one medical unit, one health department, and take into account other features of the medical service of the studied groups.
number of cases of TD x 100 / average number of employees
3. Number of days of temporary disability per 100 workers
number of days of VUT x 100 / average number of employees
4. Average duration of one case of temporary disability
number of days of incapacity for work/average number of cases of incapacity for work
5. The percentage of patients transferred to disability.
Clinical examination v dentistry
Patients with active dental caries, diseases of the periodontium and oral mucosa, chronic osteomyelitis of the jaws, malignant neoplasms of the face and oral cavity are under dispensary observation. congenital splitting of the lip and palate, anomalies in the development and deformation of the jaws, etc.
The selection of patients is carried out during preventive examinations and planned sanitation, when applying to dentists for medical care.
The main tasks of medical and labor expertise, the levels of its implementation. The composition and functions of the clientnico-expert commission (medical commission).
Medical and labor examination (VTE) is a field of medical and scientific knowledge that studies a person’s ability to work if he has a disease, injury, injury, anatomical defect, pregnancy, and some other reasons regulated by state social insurance legislation and pursuing social and preventive goals (care for a sick family member, sanatorium treatment, quarantine, stationary prosthetics, etc.).
The main tasks of VTE:
1. Scientifically based assessment of the working capacity of workers with various diseases, injuries, injuries, anatomical defects
2. Establishing a fact temporary disability and release from work due to the presence of social and medical indications provided for by law
3. Determination of the nature of disability(temporary, permanent, full or partial)
4. Establishing the cause temporary or permanent disability to determine the amount of benefits, pensions and other types of social security
5. Rational employment workers who do not have signs of disability, but who, for health reasons, need to alleviate the load in their profession
7. Studying the causes of morbidity and disability to develop medical, social and preventive measures
8. Definition of various no social assistance working with temporary disability and disabled people
9. Conducting social and labor rehabilitation
Let's clarify some concepts.
Working capacity is usually understood as such a state of the body in which the totality of physical and spiritual capabilities allows you to perform work of a certain volume and quality.
Disability should be understood as a condition caused by illness, injury, its consequences or other reasons, when the performance of professional work in whole or in part, for a limited time or permanently, is impossible.
Disability can be temporary or permanent.
Temporary Disability (T)- the state of the human body due to illness, injury and other reasons, in which dysfunctions are accompanied by the impossibility of performing professional work in normal production conditions for a certain period of time, i.e. are reversible. Establishing the fact of VL is a medical action, because. it is aimed at eliminating adverse factors and means the beginning of treatment. Distinguish between full and partial temporary disability. Complete disability- the complete impossibility of performing any work for a certain period, accompanied by the need to create a special regime and conduct treatment.
Partial disability- temporary incapacity for work in relation to their usual professional work, while maintaining the ability to perform other work with another lightweight mode or reduced volume.
When determining the ability to work, it is necessary to take into account both medical and social criteria.
Medical Criteria include a timely complete clinical diagnosis, taking into account the severity of morphological changes, the severity and nature of the course of the disease, the presence of decompensation and its stage, complications, determining the clinical immediate and long-term prognosis.
Social Criteria reflect everything that is connected with the professional activity of the patient: a characteristic of the prevailing stress (physical or neuropsychic), organization, frequency and rhythm of work, the load on individual organs and systems, the presence of unfavorable working conditions and occupational hazards.
Establishing the fact of incapacity for work is of great legal importance, because it guarantees the citizen the appropriate rights: in case of temporary disability, to be released from work and receive benefits at the expense of compulsory state social insurance, and in case of disability, to retire at the expense of the pension fund of Russia.
Expertisetemporary disability - a type of medical activity, the main chain of which is the assessment of the patient's state of health, the quality and effectiveness of the examination and treatment, the possibility of carrying out professional activities, as well as determining the degree and timing of temporary disability.
Levels of examination of temporary disability:
5. Chief specialist in the examination of temporary disability of the Ministry of Health of Russia
4. QEC of the health management body of the subject of the Federation
3. QEC of the health management body of the territory included in the subject of the Federation;
2. Clinical expert commission (CEC) of health facilities
1. Attending physician
KEK makes a decision on the provision of the attending physician and head. department and makes a decision - when extending the sick leave for more than 30 days.
in complex and conflict situations during the examination of VN,
when sent for treatment outside the administrative territory,
when sent to MSEK
bet on the need to transfer able-bodied persons to other jobs or rational employment of persons with limited ability to work.
at the request of organizations and institutions. on the issue of examination of VN and counter N.
in case of claims and claims of insurance organizations. and bodies of the social fund. fear.
when exempting from examinations at school, etc. uch. head
when providing an academician
in case of need according to comp. healthy in add. living area.
includes leading specialists of LPU.
The role of the attending physician in the examination of disability.
Functions of the attending physician:
1. Determines the signs of VL based on an assessment of the state of health, the nature and working conditions, social factors
2. In the primary medical documents, he fixes the data necessary for making a diagnosis, formulates a diagnosis of the disease, taking into account the degree of functional disorders, complications and their severity
3. Appoints additional studies and consultations, medical and recreational activities
4. Determines the timing of the VN (taking into account the individual characteristics of the course of the underlying and concomitant diseases and the approximate terms of disability for various diseases and injuries)
5. Issues a sick leave certificate (certificate) and sets the date for the next visit to the doctor, fixing it in the primary medical documentation
6. At subsequent examinations, it reflects the dynamics of the disease, the effectiveness of treatment, justifies the extension of the patient's release from work
7. Refers the patient in a timely manner for consultation at CEC
8. In case of violation of the prescribed medical and protective regimen (including in case of alcohol intoxication), makes an appropriate entry in the disability certificate and in the medical history (outpatient card) indicating the date and type of violation
9. Reveals signs of permanent disability and permanent disability, timely organizes the referral of the patient to the CEC and the medical and social expert commission (MSEC);
10. Carries out medical examinations for long-term and frequently ill patients (citizens who have 4 or more cases per year by 40 days of VL for one disease, or 6 cases and 60 days, taking into account all diseases);
11. When restoring working capacity and being discharged from work, it reflects in the primary medical documents the objective status and reasoned justification for closing the sick leave;
12. Analyzes the causes of morbidity with LN and primary disability
Documents certifying temporary disability. Registration of a certificate of incapacity for work by the attending physicians of health facilities. private practitioners, paramedics. The list of institutions that do not have the right to issue disability certificates.
Documents: BC, Certificate of a student, student, graduate student, Certificate of any form signed by the head physician and stamped.
The right to conduct an examination of temporary incapacity for work and issue documents confirming temporary disability is granted to attending physicians of medical institutions of the state, municipal and private healthcare systems on the basis of a license obtained by the institution to conduct an examination of temporary incapacity for work.
Physicians in private medical practice outside the institution should have license for the main type of medical activity and examination of VN, as well as certificate (certificate) of completion of the advanced training course for the examination of temporary disability.
In some cases (in hard-to-reach remote areas, in the regions of the Far North, etc.), by decision of the health authority, an examination of temporary disability may be allowed paramedical worker.
Medical workers do not have the right to issue documents certifying temporary disability:
ambulance stations (departments);
blood transfusion stations;
institutions of forensic medical examination;
balneological and urban spa water and mud baths;
rest houses and tourist bases;
sanitary institutions.
The attending physician issues a certificate of incapacity for work individually and at a time for up to 10 calendar days and extends it singly for a period of up to 30 calendar days.
Private practitioners also have the right to single-handedly issue documents certifying temporary disability for a period not exceeding 30 days.
An average medical worker who has the right to issue a certificate of incapacity for work, alone and at the same time issue it for a period up to 5 days and extends up to 10 days in exceptional cases, after consultation with the doctor of the nearest health facility, for up to 30 days.
With a VUT period of more than 30 days, the decision on the issue of further treatment and extension of the disability certificate is carried out KEK.
By decision of the CEC, with a favorable clinical and labor prognosis, the sick leave can be extended until full recovery of working capacity, but for a period not exceeding 10 months, and in some cases (injuries, conditions after reconstructive operations, tuberculosis) no more than 12 months, with a frequency of extension of the CEC no less than 30 days later.
A private practitioner, if it is necessary to extend the sick leave for more than 30 days, sends the patient for consultation and to decide on further treatment at the CEC of a healthcare institution that provides him (the patient) with medical care in accordance with the compulsory medical insurance program.
Temporary disability is the inability for an employee to perform their professional duties. Such disability occurs due to illness, injury or other reasons and is of a transitory nature. Examination of temporary disability is carried out by doctors of medical institutions. The duties of the attending physician include establishing the fact of temporary disability in the patient with the issuance of a certificate of incapacity for work. In case of diseases and injuries, a sick leave certificate can be issued in institutions of both outpatient and inpatient types.
A certificate of incapacity for work is issued in connection with an illness, injury, when caring for a sick family member, for quarantine, for sanatorium treatment, for pregnancy and childbirth, when transferring to another job due to an occupational disease, for prosthetics, etc. The doctor alone has the right issue a certificate of incapacity for work for a period not exceeding 30 days. The right to extend the sick leave is granted to the head of the department, the medical commission and the head physician. In case of long-term disability, a certificate of incapacity for work can be issued for up to 10 months, in some cases up to 12 months, and then the patient must be referred to a medical and social expert commission.
In case of an industrial injury, a certificate of incapacity for work is issued from the first day of the injury in the presence of an accident report.
A quarantine disability certificate is issued by an epidemiologist or the attending physician. The terms of disability in this case depend on the infectious disease (determined by the instructions).
A certificate of incapacity for work in case of illness during a vacation is issued if the illness began during the next or additional vacation; in this case, the vacation is subject to extension by the number of days specified in the sick leave. In case of illness during the period of vacation without maintenance (at one's own expense), the sick leave is not paid.
In the event of disability outside the place of permanent residence and work, a sick leave is issued to the sick person for the entire period of disability, but with the obligatory approval of the head physician of the medical institution.
A disability certificate for pregnancy and childbirth is issued to a woman at 32 weeks of pregnancy for 70 days - before childbirth, in the postpartum period - for 70 days, and in cases of severe complications, operations, the birth of a premature baby - for 86 days, at the birth of 2 children or more - for 110 days.
The composition of the medical commission includes the attending physician, the head of the department and the deputy chief physician for examination, who is the chairman. The commission is organized in a polyclinic if there are at least 15 doctors in its staff. Its functions are: consultations of doctors on diagnostics and treatment; control over the quality of treatment, examination of working capacity and resolving the issue of temporary disability in complex and conflict cases; referral of patients for examination; granting vacations for sanatorium-and-spa treatment; issuance of conclusions on the transfer to facilitated working conditions.
In a hospital, sick leaves are issued to patients for the entire period of treatment, signed by the attending physician and the head of the department.
Registration of disability certificates by doctors of health facilities. Terms of lump-sum and single-handedly registration of disability certificates by the attending physician, the timing of referral to the CEC (VK). Types of violation of the regime and the issuance of a certificate of incapacity for work in case of violations of the regime.
Documents certifying temporary disability and confirming temporary release from work (study) are sick leave certificate and, in some cases, references of the established form, issued to citizens in case of diseases and injuries, for the period of medical rehabilitation, if it is necessary to care for a sick family member, a healthy child and a disabled child, during maternity leave, during prosthetics in a prosthetic and orthopedic hospital.
Certificate of temporary disability issued by the attending physician upon presentation of an identity document of the patient after a personal examination and is confirmed by an entry in the medical records.
The certificate of incapacity for work is a multifunctional document that serves as the basis for
1. Exemptions from work in case of VL (legal function)
2. Accrual of benefits for VN (financial, function).
3. Prescribes a certain type of medical and protective regimen (medical function)
4. Is the primary document for the analysis of morbidity with VUT (statistic function)
In order for the disability certificate to perform these functions, it is necessary to strictly follow the rules for its execution.
Front side sick leave form is filled in by the attending physician, reverse side - the administration of the enterprise (institution, organization) where the patient works.
Entries in the disability certificate (certificate) are made blue, purple, black ink, in Russian. Corrected or strikethrough text is confirmed by recording "corrected to believe", signature of the attending physician and the seal of the health facility. On the form no more than two corrections are allowed.
Depending on whether a certificate of incapacity for work is issued for the first time or is a continuation, the corresponding entry is underlined in the spine and on the form of the certificate of incapacity for work. ("primary" or "continuation sheet"). When issuing a "continuation", it indicates the number of the previous sick leave.
V sick leave stub recorded: surname, name, patronymic of the patient (in full); age; home address; place of work; surname of the attending physician; date of issue of the certificate of incapacity for work; signature of the patient who received the disability certificate.
On sick leave form the following is recorded: the name of the medical institution, its address (for a private practitioner - last name, first name, patronymic, license number); surname, name, patronymic (in full), gender. patient's age; full name of the place of work.
WITH for the purpose of maintaining medical secrecy, columns "diagnosis" and "final diagnosis" are not filled.
In the graph "cause of disability" the corresponding type of disability (disease, accident at work or at home, quarantine, patient care, child care, sanatorium treatment, prenatal or postnatal leave) is underlined and written below ^ additional information given on the form in brackets.
In the graph "mode" the type of prescribed medical and protective regimen is noted (see below), in the column "mark of violation of the regime" the date of the violation and its type are put.
In case of continued disability of the patient, the extension of the leaflet is carried out from the day of the appearance at the doctor's appointment; if the patient is recognized as able-bodied in the column "get to work" it is noted "was (date) able-bodied".
In chapter "exemption from work" it is written in Arabic numerals from what date, month, year and in words to what day and month inclusive the patient is released from work. The position of the doctor, his last name are clearly indicated and a signature is put. In case of a collegial extension, the names of the members of the clinical expert commission (at least three) are indicated and their signatures are put.
In the graph "get to work" the date of restoration of working capacity is noted the next day after the examination and recognition of the patient as able-bodied. Other cases of completion of the disability certificate are indicated: date of death, date of registration of the MSEC document when establishing a disability group.
The disability certificate cannot be closed at the request of the patient or at the request of the administration from his place of work.
In case of continuing disability, the disability certificate emphasizes "continuation", the date and number of the new sheet are recorded, in which (in the spine and at the top of the form) the "continuation of the sheet of incapacity for work No." is underlined and the number of the primary sheet is indicated.
In case of loss of sick leave a duplicate is issued by the attending physician if there is a certificate from the place of work stating that the allowance for this sheet has not been paid. In the upper corner of the form, a "duplicate" is written, in the "exemption from work" section, the entire period of disability is recorded in one line, certified by the attending physician and the deputy head of the health facility for clinical and expert work. At the same time, a corresponding entry is made in the medical documentation and the number of the issued disability certificate is affixed.
Printing facility(for non-resident citizens stamped) or a private practitioner is placed in the upper and lower right corners of the form when discharged from work or continuing the sick leave. When continuing treatment in another health facility, the corresponding entry in the sick leave is certified by the signature of the attending physician, the deputy head for clinical and expert work (in complex and conflict cases - by three members of the CEC), the seal of the institution that issued the sick leave.
The numbers of forms of disability certificates, the date of their issue, the date of extension or discharge from work are recorded in the outpatient card (medical history).
Terms of referral to CEC: Attending physician - on the 30th day, Private practitioner - on the 30th day to the clinic at the place of residence, Nursing assistant - to the attending physician.
Registration of temporary disability during the period of the next vacation, leave without paycontent. Registration of temporary disability of non-resident patients with Ambulatorny and inpatient treatment.
In the event of temporary disability due to illness (injury) during the stay on your next vacation the allowance is issued for all days of release from work, certified by a sick leave.
Upon the occurrence of temporary incapacity for work during the period leave without pay or holidays for child care no allowance is given. If the incapacity for work continues after the end of unpaid leave or partially paid parental leave, the benefit is paid from the day when the employee was supposed to start work.
Registration of temporary disability for the care of a sick child in outpatient and inpatient treatment. Registration of temporary disability to care for a sick adult family member.
A certificate of incapacity for work for caring for a sick child is issued by the attending physician to one of the family members (guardian) directly involved in the care.
Deadlines for issuing a certificate of incapacity for work:
caring for a child under 7 years old in outpatient treatment - for the entire period of an acute disease or until the onset of remission in case of an exacerbation of a chronic disease;
caring for a child over 7 years of age with outpatient treatment - for up to 15 days, unless a longer period is required by a medical report;
care for a child under 7 years of age with inpatient treatment - for the entire period of treatment, over 7 years - after the conclusion of the CEC for the period necessary for care.
care for children under 15 years of age infected with HIV, suffering from severe blood diseases, malignant neoplasms, burns - for the entire period of treatment in a hospital.
The disability certificate records the name and age of the person being cared for.
If two or more children fall ill at the same time, one certificate of incapacity for work is issued to care for them.
In case of a multi-temporal illness of several children, for the care of them, the second certificate of incapacity for work is issued only after the closure of the first one, excluding the days that coincided with the days of release from work on the first certificate of incapacity for work.
Certificate of incapacity for work is not issued care:
for chronic patients in remission
during the period of the next vacation and leave without pay
during maternity leave
during part-paid parental leave
Registration of disability for pregnancy, childbirth and in case of termination of pregnancy(including for medical and social reasons and for induced abortion).
For pregnancy and childbirth, a certificate of incapacity for work is issued by an obstetrician-gynecologist, and in his absence, by a general doctor.
A sick leave certificate is issued from 30 weeks of pregnancy at a time for 140 calendar days (70 before childbirth and 70 after childbirth).
The disability certificate indicates: in the column "diagnosis" gestational age at the time of application in the column "Final Diagnosis" estimated date of birth in the column "kind of disability""maternity leave"
in the column "mode""-"outpatient + inpatient" in the column "Release from work" the total duration of the vacation in one line.
The certificate of incapacity for work is signed by the attending physician and the head of the antenatal clinic (for those who did not attend the antenatal clinic and those from other cities, the head of the department of the maternity hospital).
At multiple pregnancy and childbirth, a certificate of incapacity for work is issued from 28 weeks of pregnancy, while the total duration of prenatal and postnatal leave is 180 days.
At complicated childbirth sick leave issued for an additional 16 calendar days. In these cases, the total duration of prenatal and postnatal leave is 156 calendar days.
In case of multiple pregnancy and complicated childbirth, a new form is issued for additional days of the postpartum period.
At childbirth before 30 weeks of gestation and the birth of a living child, a certificate of incapacity for work is issued for 156 calendar days, and in the case of the birth of a dead child or his death within 7 days after birth - for 86 calendar days.
artificial interruption pregnancy is carried out at the request of a woman with a gestational age of up to 12 weeks, according to social indications - with a gestational age of up to 22 weeks, and if there are medical indications - at any time with the consent of the woman.
At abortion surgery a certificate of incapacity for work is issued on the general basis provided for by the procedure for issuing a certificate of incapacity for work in case of diseases and injuries for the entire period of incapacity for work, but not less than 3 days (including with mini-abortions).
In case of termination of pregnancy for medical reasons, the entry "disability for medical reasons" is made in the column "type of disability" in the disability certificate.
Registration of a sick leave during quarantine. Form of incapacity for workprosthetics in outpatient and inpatient settings.
A certificate of incapacity for work is issued by an infectious disease doctor or the attending physician on the proposal of an epidemiologist, if necessary, temporary suspension from work of persons who have been in contact with infectious patients or due to bacterial carriage.
The duration of the quarantine is determined by the approved periods of isolation.
The disability certificate indicates the mode - "home".
For caring for a healthy child under 7 years of age or an incompetent family member, on the basis of a certificate from an epidemiologist, a certificate of incapacity for work is issued to one of the working family members for the entire quarantine period.
Employees of public catering establishments, water supply, children's institutions, if they have helminthiasis, are issued a certificate of incapacity for work for the entire period of deworming.
Medico-social expertise (ITU) its value and tasks. Organization of medical and social expertise. The procedure for sending citizens to the ITU and the rules for issuing a sick leave certificate.
Medical and social expertise - determination in accordance with the established procedure of the needs of the examined person in measures of social protection, including rehabilitation, on the basis of an assessment of the limitations of life activity caused by a persistent disorder of body functions.
Medico-social examination (MSE) is carried out on the basis of a comprehensive assessment of the state of the body based on an analysis of clinical, functional, social, vocational, psychological data of the person being examined using classification criteria in the manner determined by the Government of the Russian Federation.
ITU is carried out by the ITU State Service, which is part of the system (structure) of the bodies of social protection of the population of the Russian Federation. The decision of the ITU public service body is binding on the relevant state authorities, local governments, as well as organizations, regardless of organizational and legal forms and forms of ownership.
Tasks of medical and social expertise:
1) Establishing the fact of the presence of disability, determining the group, cause (circumstances and conditions of occurrence), the timing and time of the onset of disability;
2) Determining the needs of disabled people for social protection measures, including medical, vocational and social rehabilitation measures and developing individual rehabilitation programs (IPR), monitoring their implementation;
3) Assistance in the implementation of measures for the social protection of persons with disabilities, including their rehabilitation, and evaluation of the effectiveness of these measures;
4) Determining the degree of loss of professional ability to work (in percent) of employees who have been injured, an occupational disease or other damage to health associated with the performance of their work duties, the need for additional measures for their social protection and rehabilitation;
5) Determining the needs of disabled people in special vehicles;
6) Determination of the causal relationship of the death of the injured person with an industrial injury, occupational disease, stay at the front and with other circumstances in which the legislation of the Russian Federation provides for the provision of benefits to the family of the deceased;
7) Formation of data from the state system for registering persons with disabilities, studying the state, dynamics of disability and factors leading to it;
8) Participation in the development of comprehensive programs in the field of disability prevention, medical and social expertise, rehabilitation and social protection of people with disabilities.
Citizens are sent at ITU by a health care institution or a social welfare authority. The basis for referral to the ITU is:
the presence of signs of disability or loss of professional ability to work.
end of disability
early re-examination of a disabled person due to aggravation of the condition,
availability of indications for providing a disabled person with special transport,
the need for face-to-face consultation.
The health care institution sends the patient to the ITU after the necessary diagnostic, therapeutic and rehabilitation measures have been taken. Based on the results of the activities carried out, the health care institution issues to the patient "Referral for medical and social examination" form No. 088 / y-97 (for persons over 18 years of age) or form 080 / y-97 (for persons under 18 years of age). It contains information about the development of the disease, the course, frequency and duration of temporary disability, clinical examination data, diagnosis, the nature and degree of violation of the basic functions of the body, the category and degree of disability, and therapeutic and prophylactic and rehabilitation measures taken. The direction is signed by the chairman of the KEK and members of the commission, sealed by the seal of the medical institution.
ITU procedure defined by the “Regulations on Recognizing a Person as a Disabled Person”, approved by a decree of the Government of the Russian Federation (1996). The examination is carried out in the ITU bureau at the place of residence of the patient or at the place of attachment to the healthcare institution. It can be carried out both in person at the ITU office, at home or in a hospital where the patient is being treated, and (with the consent of the patient) in absentia based on an analysis of the submitted medical documents.
ITU is carried out upon a written application of the patient (or his legal representative) addressed to the head of the ITU bureau. The application is accompanied by: a referral to the ITU, issued by a healthcare institution or a social protection authority, medical documents confirming the patient’s health impairment, as well as documents necessary to make a decision on the cause of disability, the degree of loss of professional ability to work, and other issues of expertise.
The composition of the bureau specialists who make the expert decision is appointed by the head. The patient has the right to involve in the examination with the right of an advisory vote any specialist at his own expense. The specialists conducting the ITU consider the information provided (clinical-functional, social, vocational, psychological and other data), conduct a personal examination of the patient, assess the degree of limitation of his life activity and collectively discuss the results.
If the patient is recognized as a disabled person, an ITU certificate is issued confirming the fact of disability, the head of the ITU bureau announces an expert decision to the patient.
A patient referred to ITU with disability certificate, The ITU Bureau indicates in the disability certificate the start date of the examination (the date the patient’s application was received by the ITU Bureau with the attached documents), the date of its completion, as well as the expert decision: “Recognized as a disabled person of group I (II or III)”, or “Not recognized as a disabled person” . The date of establishment of disability is the day when the ITU Bureau receives the application of the patient with the documents attached to it. In the event that the patient is recognized as disabled, the medical institution closes the disability certificate that day. If the patient is recognized as able-bodied, all are counted. days of examination, from the next day he is discharged for work. If aftercare is necessary, the certificate of incapacity for work is extended in the usual manner,
Based on the results of the examination, they are also issued "Notice of LPU on the conclusion of the establishment of the public service of the ITU"(for persons over 18) or "Tear-Off Ticket"(for persons under 18 years of age), which indicate the diagnosis, degree of dysfunction and disability, group, cause of disability (and for persons under 18 years of age - the decision to recognize the child as disabled), the period for which the disability was established, the date of the next re-examination; recommendations are made on the medical, professional and social rehabilitation of a disabled person.
Disability. Grounds for recognizing a citizen as disabled. disability groups. Creterii to determine the disability group. Violations of health and limitations of the life workerness. Recertification deadlines. Individual rehabilitation programs for the disabled.
Organization of medical care to the population.
Life restriction- deviation from the norm of human activity due to a health disorder, which is characterized by a violation of the ability to carry out self-service, movement, orientation, control over one's behavior, training and work.
health disorder- physical, mental and social ill-being associated with the loss, anomaly, disorder of the psychological, anatomical and physiological structure and function of the body.
Disability- social insufficiency due to a health disorder with a persistent disorder of body functions, leading to a limitation of life and the need for social protection.
Disabled person- a person who has a health disorder with a persistent disorder of body functions due to a disease, the consequences of injuries or defects, leading to a limitation of life and causing the need for his social protection.
Grounds for recognizing a citizen as disabled are: a health disorder with a persistent disorder of body functions due to diseases, consequences of injuries or defects; limitation of life activity (complete or partial loss by a person of the ability or ability to carry out self-service, move independently, navigate, communicate, control their behavior, study or engage in work activities); the need to implement measures of social protection of a citizen due to the presence of social insufficiency.
Allocate three groups of disability, of which the third is the lightest and the first is the heaviest.
I group- social insufficiency requiring social protection or assistance due to health problems with a persistent, pronounced a disorder of body functions caused by a disease, a consequence of injuries, defects leading to a sharp violation one or more categories of life*.
II group- social insufficiency requiring social protection or assistance due to a health disorder persistent pronounced a disorder of body functions caused by a disease, a consequence of injuries, defects leading to pronounced violation and one or more life categories.
III group- social insufficiency requiring social protection or assistance due to a health disorder with persistent disability significant or moderate a disorder of body functions caused by a disease, a consequence of injuries, defects leading to mild or moderate impairment one or more life categories.
For a person under the age of 18, when determining disability, a category is established "disabled child".
Deadlines for determining disability:
disability group 1 - 2 years
II and III groups - 1 year
"disabled child" - 1 year, 2 years or until the age of 18
TO main categories vital activity relate ability To self-service, Tability To independent movement, ability To learning, downtime ability activities, ability To orientation, ability To communication, demolition control his behaviorTo true- ability
After that, it is necessary to undergo a re-examination to extend the disability. Criteria for establishing permanent disability
(without further examination):
1. The impossibility of eliminating or reducing the social insufficiency of a disabled person due to a long-term limitation of life (with a follow-up period of at least 5 years) caused by health disorders with persistent irreversible morphological changes and dysfunction of organs and body systems.
2. Age over 60 for men and over 55 for women
3. Inefficiency of rehabilitation measures, dictating the need for long-term (permanent) social protection
4. Other criteria provided by law
When establishing disability, the ITU institution also decides on the cause of disability, which determines the features of social protection measures (pension amount, benefits, and a number of others). The following causes of disability are established:
"General illness": in the absence of grounds or supporting documents for an industrial injury, occupational disease, military injury, illness associated with military service or radiation exposure, as well as disability in childhood.
"Labor injury": persons whose health damage occurred in the performance of work duties
"Occupational disease": persons whose disease that led to disability is recognized as an occupational disease, about which there is a conclusion of specialized institutions (occupational pathology center, clinic or department of occupational diseases).
"Disability since childhood": persons who had a disability before the age of 18 (or there is reliable information that there were disabilities at a specified age).
"Military injury": if an injury (wound, injury, contusion) was received by a serviceman in the performance of military service duties (official duties).
“The disease was received during military service” if the disease occurred during the period of military service or injury (wound, trauma, contusion) was received by a soldier as a result of an accident not related to the performance of military service duties.
Rehabilitation of the disabled - a system of medical, psychological, pedagogical, socio-economic measures aimed at eliminating or, if possible, more fully compensating for limitations in life activity caused by a health disorder with a persistent disorder of body functions.
The goal of rehabilitation is restoration of health, ability to work, personal and social status of persons with disabilities, their achievement of material and social independence, integration (or reintegration) into the normal conditions of society.
In accordance with the WHO classification, there are three main types (directions) of rehabilitation:
1) Medical rehabilitation - a set of therapeutic measures aimed at restoring impaired or lost functions and health of patients and disabled people. Its purpose is the elimination or mitigation of the consequences of an illness, injury or injury until the full or partial restoration or compensation of disorders in the mental, physiological and anatomical state of the patient. Medical rehabilitation of the disabled is carried out within the framework of the compulsory medical insurance program.
2) Vocational rehabilitation - a system of state and public measures aimed at the return or inclusion of a disabled person in socially useful work in accordance with his state of health, ability to work, personal inclinations and desires. Includes: medical and social expertise; professional orientation; preparation of a disabled person for professional work (including vocational training); preparation of production for the use of the labor of disabled people (with the creation of appropriate conditions for their labor activity); measures to ensure employment (employment) of the disabled; dynamic observation and control of the rationality of employment - measures but social and labor adaptation (fixing) of disabled people at work.
In normal production conditions (at ordinary enterprises and ordinary workplaces, together with healthy workers), the employment of disabled people of group III is mainly carried out: in a new profession with the performance of work in full; in the former profession with a decrease in the volume of work or with a decrease in qualifications. In specially created conditions, the employment of disabled people of groups 1 and 2 is mainly carried out: at special workplaces; in special workshops, special stages, at specialized enterprises intended for the work of disabled people; at home.
3) Social rehabilitation - a system of social, socio-psychological, pedagogical, legal and economic measures aimed at creating conditions for disabled people to overcome life restrictions and social insufficiency by restoring social skills and connections, achieving free and independent life together and on an equal footing with healthy citizens.
The main document in the current system of rehabilitation of the disabled, on the basis of which a disabled person can receive the rehabilitation services he needs, is an individual rehabilitation program (IPR), which is developed for him in the ITU institution.
The IPR is developed by a rehabilitation specialist with the involvement of expert doctors, a social work specialist, a psychologist and other specialists of the ITU Bureau. The IPR is advisory in nature for a disabled person.
The role and place of outpatient clinics in the healthcare system of the Russian Federation. struk tour and performance of the clinic. The main directions of reforming outpatient care. Functions of a general practitioner (family doctor).
The activity of the polyclinic is based on territorial principle, those. provision of medical care to the population living in the assigned territory.
The territorial-district principle gives many advantages in organizing medical care for the population, the main of which is the full awareness of the polyclinic and individual doctors about the population, i.e. about the demographic situation, morbidity, living conditions, work, etc.
The modern polyclinic is a large multidisciplinary, specialized medical institution designed to provide medical care and implement a set of preventive measures to improve the health of the population and prevent diseases.
Functions of the clinic:
1. Providing first aid for acute and sudden illnesses, injuries
2. Treatment of patients when contacting the clinic and at home
3. Organization of medical examination
4. Examination of temporary disability, release of patients from work and referral for medical and social examination of persons with signs of permanent disability
6. Timely hospitalization of those in need of inpatient treatment.
The main structural divisions of the polyclinic:
1. Polyclinic management
2. Registration
3. Department of prevention
4. Treatment and prevention units (therapeutic, surgical, traumatological and other specialized departments and offices)
5. Auxiliary diagnostic and treatment departments (X-ray department, laboratory, department of functional diagnostics, physiotherapy, etc.).
6. Cabinet of accounting and medical statistics
7. Administrative and economic part
Currently, the structure of the polyclinic may include a day hospital, an emergency department, an outpatient surgery center and other services.
Functions precinct doctor:
1. Provision of timely therapeutic assistance to the population of the site in the clinic and at home
2. Provision of emergency medical care to patients who applied
3. Timely hospitalization of therapeutic patients
4. Consultation of patients, if necessary, with specialists
5. Use in their work of modern methods of prevention, diagnosis and treatment of patients
6. Conducting an examination of temporary disability
7. Dispensary observation
8. Organization and conduct of preventive examinations
9. Early detection, diagnosis and treatment of infectious diseases
10. Conducting an examination of working capacity
11. 11 preventive work on site
12. Medical care for patients at home
Main indicators work polyclinics
There are many indicators of the work of the polyclinic, the most basic ones.
(1) Indicators of provision of the population with outpatient care