Social criterion of working capacity. Social criterion of ability to work Disability certificates are not issued
Employability - a set of physical and spiritual capabilities of a person, allowing him to engage in labor activity.
There are general (ability to unskilled labor) and professional (ability to work in one's own, or adequate to her, profession) capacity for work.
Each of them can be full or partial.
Disability - the inability to perform the usual profession, due to medical or social contraindications. Establishing the fact of incapacity for work has legal significance, since, according to Art. 39 and 41 of the Constitution of the Russian Federation and Art. 20 Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens, guarantees the employee the right to be released from work, free treatment under the compulsory medical insurance program and the payment of benefits from social insurance funds.
Distinguish between temporary and permanent disability.
Temporary incapacity for work (T) is a temporary inability of an employee to perform work duties due to medical reasons (illness, injury, Spa treatment, prenatal and postnatal leave, prosthetics in a hospital), when health changes are reversible and recovery or significant improvement is expected in the near future with the restoration of working capacity, as well as social factors provided for by law (care for a sick family member, for a healthy child up to 3 years and a disabled child, quarantine, adoption from a maternity hospital).
VN can be full and partial.
Full VL is determined when a person, due to a disease, cannot and should not perform any work and needs a special treatment regimen. Documents confirming temporary release from work (study) are: for employees - a certificate of incapacity for work (l / n), which serves as the basis for the appointment and payment of benefits for VN; for students - certificate f.095 / y. In some cases, VN is confirmed by certificates of any form.
Partial VL - VN in their profession, while maintaining the ability to perform other work, with a different regimen and volume, without violating the treatment process, harming health and production. Rational employment of an employee in this case is carried out on the basis of a certificate issued by the clinical expert commission of the medical institution.
Persistent disability - permanent or long-term disability, when a violation of body functions caused by a disease or injury has taken on an irreversible (partially reversible) character, has led to a significant decrease in the volume of work (lower qualifications, termination of work in normal production conditions, loss of profession), persistent social insufficiency a person requiring measures of social assistance and protection determined by institutions medical and social expertise(establishment of a disability group, determination of the percentage of loss of professional ability to work in case of accidents at work and occupational diseases, etc.).
The main criterion that differentiates LN from persistent is a favorable clinical and labor prognosis, the potential reversibility of the disease process with the possibility of restoring impaired body functions, the patient's ability to work and social activity.
Examination of working capacity is a kind of medical examination, the main task of which is to assess the health of the patient with a decision on the possibility of continuing his labor activity.
The main principles of the organization of the examination of working capacity are its state character, preventive orientation and collegiality in resolving all issues.
The state nature of the examination of working capacity lies in the fact that for its implementation, the legislation defines single bodies - health care facilities that carry out the examination of the VN (if there is a license for this type of medical activity), and the bodies of social protection of the population (bureau of medical and social examination) that carry out the examination of permanent loss employment and disability.
The preventive focus of the examination of working capacity lies in the most effective implementation of medical, labor and social rehabilitation of the disabled, the main goal of which is fastest recovery employment and prevention of disability.
Tasks of the examination of working capacity:
Determination of a person's ability to fulfill their professional duties, depending on medical and social criteria;
Determination of the degree and duration of disability due to illness, accident or other reasons, timely referral of patients with signs of permanent disability (disability) to the ITU;
Determination of the treatment and regimen necessary to restore and improve human health;
Determination and implementation of a plan for medical, labor and social rehabilitation of the disabled (treatment and regimen necessary to restore health; rational employment of temporarily disabled people in need of easier working conditions in their profession; determination of labor recommendations for disabled people in order to use their residual working capacity);
The study of the levels, structure and causes of morbidity with temporary disability and disability, in order to reduce these indicators among the population.
Examination of VN is a type of medical examination, the main tasks of which are: assessing the patient’s health with the decision of the possibility of continuing his labor activity, determining the terms of VN, timely detection of signs of permanent disability (disability) and referral of the patient to the ITU.
Medico-social expertise (MSE) - a type of medical expertise, the main tasks of which are: assessing the patient's health, determining signs of permanent disability, establishing (if indicated) the relevant disability groups and the degree of limitation of the ability to work, their causes and timing; determination of the degree of loss of professional ability to work in case of accidents at work and occupational diseases as a percentage; development individual program rehabilitation of a disabled person, as well as determining the need for a disabled person in measures of social assistance or protection.
Ministry of Health of the Russian FederationStavropol State Medical Academy
Department of "Public health and healthcare"
Teaching aid by specialty
"Public health and healthcare"
Stavropol 2006
BBC 51.1(2)
51.1(2)k8
51.1(2)3
Disability examination. Educational and methodological manual on the specialty "Public health and healthcare". - Stavropol., Publisher: StGMA, S 44
Compiled by:
Candidate of Medical Sciences, Assistant of the Department of "Public Health and Health Care" SSMA, Igor Nikolaevich Bobrovsky;
Candidate of Medical Sciences, Associate Professor, Head of the Department "Public Health and Health Care" of the StSMA, Lyudmila Leonidovna Maksimenko.
Reviewer:
Candidate of Medical Sciences, Associate Professor, Vice-Rector for academic work STGMA, ^ Yuri Alexandrovich Filimonov .
This manual covers issues related to the organization and procedure for conducting medical expertise temporary and permanent disability in medical institutions. In the teaching aid, separate concepts of the criteria for the examination of working capacity are given; temporary disability; temporary disability examinations; functions of the attending physician for the examination of temporary disability; head functions polyclinic and head hospital department; functions of the deputy chief physician for clinical and expert work; functions of the head of the medical facility; functions of the chief freelance specialist in the examination of temporary disability; composition and functions of the CEC. Questions about the procedure for issuing a disability certificate for diseases and injuries are highlighted; for sanatorium treatment and medical rehabilitation; caring for a sick family member, caring for a healthy child and a disabled child; during quarantine; with prosthetics; on pregnancy, childbirth and abortion. Particular attention is paid to the issues of permanent disability and social protection of the disabled.
The educational and methodical manual is intended for senior students of medical universities, students of the faculty of postgraduate education, primary health care physicians.
UDC 614.2.061.64.003.13(07.07)
BBC 51.1(2)
51.1(2)k8
51.1(2)3
© I.N. Bobrovsky
© Stavropol State
medical academy, 2005
INTRODUCTION
Medical examination of incapacity for work is the most important area of medical and practical activity, closely adjoining to clinical disciplines, the system of social insurance and social security. The assessment of the health status of the population and the analysis of the economic losses incurred by society as a result of the disease largely depend on the organization and quality of the examination of disability in medical institutions. Timely release of sick people from work is one of the most effective preventive measures to prevent complications of diseases, their chronicity. Therefore, one of the most responsible and complex sections of the practical activity of the attending physician of any specialty is the study and the possibility of conducting a medical and labor examination, and, first of all, an examination of temporary disability. Thus, more than half of all visits by the population to outpatient clinics and more than two-thirds of all cases of hospitalization in hospitals are associated with the need to resolve issues of temporary disability and conduct its medical examination.
When organizing and conducting an examination of temporary disability by doctors, especially those starting their professional activity Due to their lack of sufficient practical work experience and their poor knowledge of the current legislation, mistakes are often made that lead to conflict situations with patients and the administration of medical institutions.
Most often there are errors in the issuance and execution of documents certifying temporary disability, untimely referral of the patient to the clinical expert commission and the ITU, leading to a decrease in the effectiveness of diagnosis, treatment and rehabilitation.
Therefore, the main purpose of this educational and methodological manual is to train practitioners and young professionals in the skills of organizing and conducting an examination of disability (both temporary and permanent) in their professional activities.
^ SUBJECT AND OBJECTIVES OF MEDICAL LABOR EXAMINATION
Expertise- this is the study by a specialist or a group of specialists of an issue that requires special knowledge in any field of science, technology, art, etc. for its solution, with the issuance of a certain judgment / conclusion. One of the types of examination that a doctor has to deal with in his daily work is an examination of incapacity for work.
^ Disability examination - this is a determination on the basis of medical and social criteria of the ability of a given person to perform their professional duties. To clarify the above definition, it is necessary to distinguish between two concepts: ability to work and disability, to determine their medical and social criteria.
Under ability to work it is customary to understand 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 (V.A. Medic, V.K. Yuryev, Moscow, 2003). The doctor's task is to establish the presence or absence of a disease in a particular person on the basis of a comprehensive medical examination.
Examination of ability to work is currently determined by three criteria: medical, social and legal.
^ Medical criterion of working capacity - this is the presence of a disease in a patient (correct and timely formulation of a 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), its complications, the use of timely rational therapy, clinical prognosis of the disease (determination of the immediate and long-term prognosis, taking into account its course).
^ Social criterion of working capacity - this is a correct assessment of labor, professional, domestic and other social and hygienic factors to create the most favorable conditions for recovery and restoration of the patient's ability to work. In other words, the social criterion of ability to work determines the labor prognosis for a specific disease, a specific position of the patient and the conditions of his work. Social criteria reflect everything related to the patient's professional activity: a characteristic of the prevailing stress (physical or neuropsychic), organization, frequency and rhythm of work, load on individual organs and systems, the presence of adverse working conditions and occupational hazards.
However, a sick person is not always disabled. Let us give an example (V.A. Medic, V.K. Yuryev, Moscow, 2003): two people suffer from the same disease - panaritium. One of them is a teacher, the other is a cook. A teacher with this disease can perform his duties, i.e. is employable. A cook with a similar disease - no, i.e. is disabled. In addition, the cause of disability is not always the disease of the patient himself. For example, the same cook himself can be an absolutely healthy person, but one of his family members has become ill with hepatitis, as a result of which the cook cannot cook, i.e. perform his professional duties, as he has an epidemic contact for hepatitis.
In this way, sickness and disability are not always synonymous. In the presence of an illness, a person can be able to work if the disease does not interfere with the performance of professional work, and disabled if the performance of work is difficult or impossible. Therefore, only a doctor, based on the severity of functional disorders, the nature and course of the pathological process, the work performed by the patient, the conditions of his work, decides on the social criterion for working capacity and on issuing a certificate of incapacity for work.
Medical and social criteria must always be clearly defined and reflected in medical records in accordance with the legal criterion of working capacity.
^ Legal eligibility criterion - this is the knowledge and significance of the current legislation in the field of social insurance of citizens.
Based on the foregoing, under disability should be understood as a condition caused by illness, injury, its consequences or other causes, when the performance of professional activity - in whole or in part, for a limited time or permanently - is impossible. By duration, temporary and permanent disability are distinguished (Table 1).
Medical examination of disability, as one of the functions of healthcare, is aimed at: 1) preventing the development of a disease process; 2) creating favorable conditions for the patient in the process of treatment and recovery; 3) a more complete recovery of the patient's ability to work is possible.
If changes in the patient's state of health are temporary, reversible, if recovery or significant improvement is expected in the near future, as well as restoration of working capacity, then this type of disability is considered temporary. In this way, temporary disability- this is a state of the human body due to illness, injury and other reasons, in which dysfunction is 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 temporary disability is a medical action, since it is aimed at eliminating adverse factors and means the start of treatment.
There are two types of temporary disability: full and partial.
^ Complete temporary disability - this is the loss by a working individual of the ability to any work for a certain period, accompanied by the need to create a special regime and conduct treatment. In other words, this is a condition when a person, due to an illness, cannot and should not perform any work and needs a special regimen.
^ Partial temporary disability occurs when a sick person cannot perform his professional work in full, but without harm to health he can perform another job or his former one, but under facilitated conditions (light regimen and / or a reduced amount of work performed).
Table 1.
Examination of temporary disability is carried out in medical and preventive institutions of state, municipal and other forms of ownership.
Under persistent disability or disability it is customary to call such a condition in which functional and organic disorders caused by a disease, injury or anatomical defect are of a stable or permanent nature and prevent the continuation of work in the main profession (in whole or in part) for a long time or permanently. In other words, permanent disability (disability) is a permanent or long-term, complete or partial loss of ability to work.
In establishing the fact of persistent disability, doctors of medical institutions (medical facilities) and medical experts of medical and social expert commissions (MSEC) take part. Moreover, the functional responsibilities and workloads of the above doctors are different: doctors of medical institutions identify signs of disability, and medical experts of the MSEC establish the fact of persistent disability.
In this way, medical and labor examination- a field of medical and scientific knowledge that studies a person’s ability to work if he has a disease, injury, injury, anatomical defect, as well as some other reasons regulated by state social insurance legislation and pursuing social and preventive goals (care for a sick family member, sanatorium- resort treatment, quarantine, stationary prosthetics, etc.)
Main tasks of medical and labor examination are:
scientifically substantiated assessment of the working capacity of workers in various diseases, injuries, mutilations, anatomical defects;
establishment of the fact of temporary incapacity for work and release from work due to the presence of social and medical indications provided for by law;
determination of the nature of disability (temporary, permanent, full or partial);
establishing the cause of temporary or permanent disability or determining the amount of benefits, pensions and other types of social security;
rational employment of workers who do not have signs of disability, but who, for health reasons, need to facilitate labor in their professional activities;
determination of labor recommendations for disabled people, allowing them to use their residual working capacity;
study of the causes of morbidity and disability for the development of medical and social preventive programs;
definition various kinds social assistance to those working with temporary disability and the disabled;
carrying out social and labor rehabilitation.
^ EXAMINATION OF TEMPORARY DISABILITY
Morbidity with temporary disability reflects the incidence of the working population and, as a result, has not only medical and social, but also socio-economic significance. Not only healthcare workers are interested in reducing the incidence of temporary disability
^ Examination of temporary disability - a type of medical examination, the main purpose of which is to assess the patient's health status, the quality and effectiveness of the treatment provided and the ability to carry out professional activities, as well as the determination of temporary disability and its terms in accordance with the instructions, is carried out by the attending physicians, regardless of the profile, department and forms property.
Physicians engaged in private practice must be licensed for this type of activity and a certificate of completion of the advanced training cycle for the examination of temporary disability.
In remote rural areas, on floating ships, the right to issue certificates of incapacity for work can be granted to a paramedical worker with the permission of local health authorities.
Organization and procedure for conducting an examination of temporary disability in medical institutions.
Levels of examination of temporary disability.
^ ATTENDING PHYSICIAN
CLINICAL EXPERT COMMISSION
^
CLINICAL EXPERT COMMISSION + MAIN EXPERTS OF THE SUBJECT OF THE FEDERATION
^
Ministry of Health of the Russian Federation LEADED BY THE CHIEF SPECIALISTS FOR TEMPORARY DISABILITY
The organization and procedure for conducting an examination of temporary disability are based on the functions of each of the listed levels.
Functions of the attending physician for the examination of temporary disability.
Determination of the presence of temporary disability;
the right to issue a certificate of incapacity for work for up to 10 days at a time and up to 30 days individually;
presentation of the patient for a consultation with the appropriate specialist to decide on further treatment;
referral of the patient to CEC;
study and analysis of morbidity with TUT (temporary disability).
Functions of the head of the clinic
and head of the hospital department.
Control over the conduct of the diagnostic and treatment process;
control over the examination of temporary disability and timely referral of the patient to MSEK;
expert quality assessment medical care by personal examination of the patient with a corresponding entry in the outpatient card or medical history;
participation in the work of the CEC;
analysis of the causes and timing of temporary disability and the reasons for the initial exit to disability.
Functions of the Deputy Chief Physician for Clinical and Expert Work.
Management and analysis of work on quality control of examination of temporary disability;
analysis of the causes and timing of temporary disability;
selective control over the examination of temporary disability on the basis of a personal examination of the patient;
analysis of clinical and expert errors;
interaction with MSEC in solving expert issues;
consideration of claims and claims of insurance companies and complaints of patients;
organization of training of doctors on the ground on the examination of disability.
Functions of the head of a medical institution.
Issuance of an order on the composition and regulations of the KEC;
imposition of a disciplinary sanction on doctors for clinical and expert errors;
sending relevant materials to the competent authorities to bring doctors to criminal liability for offenses in the field of disability examination.
Functions of the Chief Freelance Specialist
on examination of temporary disability.
Assessment of the quality of the examination of temporary disability in the given territory;
development of a program to reduce the initial exit to disability;
control over the rehabilitation of sick and disabled people;
interaction with social protection authorities and trade union organizations;
organization of advanced training of doctors for the examination of temporary disability.
Composition and functions of the Clinical Expert Commission (CEC) of health facilities.
Composition : KEK chairman- Deputy chief physician for clinical and expert work and KEK members: head of the polyclinic or head of the department, attending physician, secretary.
KEK functions:
expert assessment of the quality and effectiveness of the treatment and diagnostic process;
extension of disability certificates for more than 30 days;
examination of temporary disability in complex and conflict situations;
referral of patients to MSEC;
recommendations for transfer to another job for medical reasons;
referral for specialized treatment to the clinics of research institutes;
conclusion on the provision of academic leave for health reasons to students of secondary and higher educational institutions;
conclusion on the provision of benefits for health reasons to individual contingents of patients.
Extract from the instruction on the procedure for issuing documents,
certifying temporary disability of citizens.
Basic provisions.
Documents certifying temporary disability:
sick leave certificate;
Help form.
The following have the right to receive a disability certificate:
citizens of the Russian Federation;
Foreign citizens;
stateless persons;
refugees and forced migrants;
working at enterprises and institutions of the Russian Federation, regardless of their form of ownership;
the unemployed who are registered with the labor and employment authorities.
Doctors are entitled to issue a certificate of incapacity for work:
state healthcare facilities;
municipal healthcare facilities;
engaged in private practice with a license and a certificate of advanced training in the examination of temporary disability;
tuberculosis sanatoriums;
clinics of the Research Institute of Prosthetics;
medical and social expertise;
rehabilitation centers for prosthetics of the musculoskeletal system;
hospitals of prosthetic and orthopedic organizations.
Doctors are not entitled to issue a certificate of incapacity for work:
ambulance stations;
blood transfusion stations;
institutions of forensic medical examination;
urban resort balneological and mud treatment facilities;
rest houses;
tourist bases;
institutions of the State Sanitary and Epidemiological Supervision.
medical institution
The certificate of incapacity for work is a document of strict financial reporting. At the moment, there is the following approach to the payment of temporary disability leaves:
50% payment - continuous experience up to 3 years. Non-union members - 25%.
100% payment - continuous experience of 8 years or more, pregnancy, work injury and occupational diseases and invalids of the great patriotic war;
Therefore, when examining disability in medical institutions, medical workers sometimes have to deal with manifestations of aggravation and simulation.
Aggravation Exaggeration by the patient of the symptoms of a really existing disease. With active aggravation, the patient takes measures to worsen his health or prolong the disease. With passive aggravation, it is limited to an exaggeration of individual symptoms, but does not accompany them with actions that interfere with treatment. Pathological aggravation is characteristic of patients with mental illness and is one of the manifestations of this disease.
Simulation - imitation by a person of the symptoms of a disease that he does not have.
In order to record clinical and expert activities, further evaluate and analyze it, and create monitoring of the results of examinations in medical institutions, a “Journal of accounting for clinical and expert work of a medical institution” (f.035 / y - 02) is maintained.
^ PROCEDURE FOR REGISTRATION AND ISSUANCE OF DOCUMENTS CONFIRMING TEMPORARY INABILITY TO WORK
Documents certifying temporary incapacity for work and confirming temporary release from work (study) are a certificate of temporary incapacity for work and, in some cases, certificates of the established form, issued to citizens in case of diseases and injuries for the period of medical rehabilitation, if necessary, care for a sick family member, a healthy child and a disabled child, during maternity leave, during prosthetics in a prosthetic and orthopedic hospital.
A certificate of incapacity for work is 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. There are two ways of issuing disability certificates - centralized and decentralized.
^ centralized path the issuance of a certificate of incapacity for work is more often introduced in large clinics, where, in order to issue a form for a certificate of incapacity for work, in the registry or in a separate office is nurse, which, on the basis of a certificate (coupon) of a doctor, writes out a certificate of incapacity for work and registers the issuance in the "Book of registration of certificates of incapacity for work".
At decentralized system issuance of certificates of incapacity for work, the document is issued by the doctor himself.
The certificate of incapacity for work is a multifunctional document that serves as the basis for:
release from work in case of temporary disability (legal function);
accrual of benefits for temporary disability (financial function).
The front side of the sick leave form is filled in by the attending physician (in some cases, by a paramedical worker), the reverse side - by the administration of the enterprise (institution, organization) where the patient works. Entries in the disability certificate (sick leave, certificate) are made in blue, purple, black ink in Russian. The corrected or crossed out text is confirmed by the entry “to believe corrected”, the signature of the attending physician and the seal of the medical institution. No more than two corrections are allowed on the form. Depending on whether a certificate of incapacity for work is issued for the first time or is a continuation, the corresponding entry (“primary” or “continuation of the sheet”) is underlined in the spine and on the form of the certificate of incapacity for work. When issuing a “continuation”, it indicates the number of the previous disability certificate.
In the spine of the disability certificate is entered:
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;
the signature of the patient who received the certificate of incapacity for work;
name of the medical institution, its address (for a private practitioner - last name, first name, patronymic, license number);
surname, name, patronymic (in full), gender, age of the patient;
full name of the place of work.
The column "regime" indicates the type of prescribed medical and protective regimen: "stationary", "outpatient", "home", "sanatorium". In the column "mark on the violation of the regime" the date of the violation and its type are put:
non-compliance with the prescribed regimen;
untimely appearance to your doctor;
alcohol intoxication;
going to work without being discharged by a doctor;
unauthorized departure from a medical institution;
leaving for treatment in another administrative region without the permission of a doctor;
refusal to refer or untimely appearance for a medical and social examination.
In the "release from work" section, it is written in Arabic numerals from what date, month, year and in words to what date 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 “start work” column, 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 the place of work. In case of continuing disability, the “continuation” is emphasized on the disability certificate, the date and number of the new sheet are recorded, in which (in the spine and at the top of the form) “continuation of the certificate of disability No. ” is emphasized and the number of the primary sheet is indicated.
If a certificate of incapacity for work is lost, 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. A “duplicate” is written in the upper corner of the form, 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.
The seal of a medical institution (for non-resident citizens - a stamp) or a private practitioner is placed in the upper and lower right corners of the form when discharged from work or continuing a 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 sick leave forms, the date of their issue, the date of extension or discharge from work are recorded in the outpatient card (medical history). Forms of certificates of incapacity for work and certificates of the established form (f. 095-u) are documents of strict accountability. Responsibility for the receipt, storage and distribution of forms, as well as for accounting and reporting on them, lies with the heads and chief accountants of health authorities and institutions. Forms of documents certifying temporary incapacity for work must be stored in fireproof cabinets in special rooms, sealed during non-working hours.
The provision of sick leave forms should be carried out at the expense of the Social Insurance Fund of the Russian Federation. Health authorities and health care facilities should keep accurate quantitative records of the receipt, availability and consumption of forms. For these purposes, a book is kept of the forms of disability certificates with numbered pages and an entry on the last page: the name of the institution, the number of pages and the seal of the institution. Entries in the book are kept in chronological order when transactions are made by the person responsible for receiving and storing forms of documents certifying temporary disability.
The use of sick leave forms within the institution is recorded in the registration book for the distribution of forms. All documents on receipt of forms and documents on their consumption are numbered in chronological order and stored in folders separately from each other. Documents must be marked with an entry in the book. Medical workers of the medical and preventive institution receive forms of certificates of incapacity for work against receipt from the persons responsible for their storage and distribution, report on the expenditure of documents, handing over the roots of previously received forms. For the safety of received forms medical workers bear personal responsibility.
Accounting for certificates in connection with the illness of students, students of technical schools, vocational schools, schools (f. 095-y) is kept separately. Accounting for sick leave forms issued by doctors (paramedics) is carried out in registration logs (f. 036-y).
Spoiled forms of documents certifying temporary disability are stored in a separate folder with an inventory that indicates the doctor's surname, name, patronymic, date of submission, numbers and series of damaged forms. The destruction of these documents is carried out according to the act by the commission, created by order of the head of the institution, at the end of the calendar year. The roots of damaged and used forms are stored for 3 years, after which they are eliminated.
Treatment-and-prophylactic institutions are obliged to submit reports-applications (the report is compiled by the chief accountant) on the actual expenditure of the forms to the higher health authorities once a quarter, on the 5th day of each month following the reporting quarter. Health authorities annually submit to the Social Insurance Fund of the Russian Federation a quarterly application for sick leave forms for the next year before February 1 of the current year. The application is signed by the head of the health management authority or his deputy for medical issues and is coordinated with the territorial executive body of the Social Insurance Fund of Russia.
Working capacity examination- this is a type of examination, which consists in determining the causes, duration, degree of temporary or permanent disability of a person due to a disease, injury or other reason, as well as determining the person's need for certain types of medical care and social protection measures.
Disability- impossibility due to medical or social contraindications to continue their usual professional activities. The establishment of incapacity for work has a legal significance, since it exempts from work, provides free treatment under the SGBP and the payment of benefits from social insurance funds. Disability may be temporary and permanent. FROM persistent incapacity for work or disability - a permanent (or long-term), complete or partial loss of ability to work.
When conducting an examination of working capacity, medical and social criteria are distinguished. Medical Criteria include a timely established, correct and complete clinical diagnosis, taking into account the severity of morphological changes, the degree of functional disorders, the severity and nature of the course of the disease, the presence of decompensation and its stage, complications. Great importance has a clinical diagnosis based on an analysis of the results of treatment, the reversibility of morphological and functional changes, the nature of the course of the disease and the possibility of eliminating complications. Social Criteria
determine the labor prognosis for a specific disease and specific working conditions of the patient, reflect everything related to his professional activity (stress, occupational hazards, etc.).
14.2. Examination of temporary disability
Temporary disability(TWT) - temporary disability - a state of the human body caused by a disease or injury, in which it is impossible to perform professional work in normal production conditions for a relatively short period of time, i.e. the inability to perform labor functions is temporary, reversible.
VUT is established for the entire period of the disease with a favorable prognosis; with an unfavorable prognosis, it continues until a permanent disability is detected.
VUT is established for persons who have lost their ability to work due to illness or injury, but can also be established with preventive purpose in case of quarantine or spa treatment. There may be indications of a social order, when the release of an able-bodied person from work is associated with caring for a sick family member, carrying a pathogen, deworming, etc. Temporary disability is divided into full and partial.
Full VUT- this is the loss of the working ability to work for a certain period and the need for a special regimen and treatment. Partial VUT- such a condition of a sick (injured) person when he is temporarily unable to perform his usual professional work, but without damage to health he can perform other work, with a different regimen and volume.
The examination of the VUT includes an assessment of the patient's health status, the quality and effectiveness of the examination and treatment, the ability to carry out professional activities, as well as determining the degree and timing of the VUT.
In health care facilities, the following levels of expertise of VUT are distinguished: the attending physician; medical commission (MC) of health facilities; medical commission of the health management body of the municipality,
included in the subject of the Federation; expert commission of the health management body of the subject of the Federation; chief specialist in the examination of the VUT of the Ministry of Health and Social Development of Russia.
Examination of the VUT is carried out by attending physicians at health facilities, regardless of their level, profile, departmental affiliation and form of ownership, if they have a license for this type of medical activity.
Attending doctor, carrying out the examination of VUT:
Determines the signs of VUT based on an assessment of the state of health, the nature and conditions of work, social factors;
Issues a disability certificate (certificate) in accordance with the "Instruction on the procedure for issuing documents certifying temporary disability of citizens" (including when visiting at home);
At subsequent examinations, it reflects the dynamics of the disease, the effectiveness of the treatment, justifies the extension of the release from work;
Timely sends the patient for a consultation to the VC in order to determine further treatment and resolve other expert issues (this is how, for example, a private practitioner acts if it is necessary to extend the sick leave for more than 30 days).
Head of the department of a hospital, polyclinic(if there is a position in the staff list) constantly monitors the performance by the attending physicians of the functions of organizing and conducting the treatment and diagnostic process and examination of the VUT, the issuance of documents certifying the VUT of citizens, the timely and correct referral of patients to the VC and to the medical and social examination; conducts an expert assessment of the CMP at different periods of treatment with a mandatory examination of the patient and an entry in the primary documents, and also performs an expert assessment of medical documentation at the end of the VUT period or when the patient is transferred to another stage of treatment, etc.
Deputy Head of Institution(chief physician, chief, head) for clinical and expert work, heads the VC and provides conditions for its work; carries out selective current monitoring of completed cases of treatment of patients
ents and expertise of VUT, takes part in solving clinical and expert issues; analyzes clinical and expert errors, reports at medical conferences the results of the analysis of expertise and measures taken to reduce the incidence of TD.
Head of a healthcare institution is responsible for the examination of the VUT in health care facilities, issues orders on its organization and conduct; organizes accounting and reporting on VUT; approves the composition of the VC, the rules of its work; determines the need for forms of certificates of incapacity for work, annually within the established time limits (until 15.01) sends an application to the territorial health authority for the required number of forms and reports on their use.
Difficult cases on VUT issues are brought to the meeting
Is the activity of the VC established by the order of the Ministry of Health and Social Development of the Russian Federation? 513-n dated September 24, 2008 "On approval of the Regulations on the medical commission of a medical organization", which describes in more detail (compared to the similar order of the Ministry of Health and Social Development of Russia? 170 dated March 14, 2007) 12.3).
Chief Freelance Specialist on clinical and expert work of the Ministry of Health and Social Development of Russia, the health management body of the constituent entity of the Federation and the municipality that is part of the constituent entity of the Federation, analyzes the state and quality of the examination of the VUT in subordinate institutions.
Certificate of incapacity for work certifies the VUT and confirms temporary release from work (study); in some cases, it is replaced by certificates 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 under 3 years old, for a quarantine period, during maternity leave, during prosthetics in prosthetic conditions - Orthopedic hospital.
The certificate of incapacity for work, or sick leave, is the main document certifying the VUT. It gives the right not to go to work, on vacation and to receive cash benefits from social security funds.
The issuance and renewal of a document certifying the VUT is carried out by a doctor after a personal examination and is confirmed by an entry in the medical documentation justifying the temporary release from work. A document certifying the VUT is issued and closed, as a rule, in one medical facility, if indicated, it can be extended in another facility
Care leave certificate for the sick, the doctor of the healthcare facility is issued in cases where the lack of care threatens the life and health of the sick person; it is impossible to put him in the hospital; there is no other non-working person among the family members who can care for the sick person. A certificate of incapacity for work for caring for a patient is issued by the attending physician to one of the family members (guardian) who directly provides care. Family members are all relatives living in the same family as the sick person.
Issuance of sick leave certificates in case of an accident at work. An accident at work should be considered the impact on a worker of a hazardous production factor in the performance of work duties or tasks of work supervisors. Loss of ability to work is equated to accidents at work:
1) when performing donor functions;
2) when performing state or public duties, as well as when performing special tasks of public organizations, even if these tasks were not related to the main work;
3) when fulfilling the duty of a citizen of the Russian Federation to save human life, for the protection of state property, as well as for the protection of state law and order;
4) on the way to and from work (not on company transport);
5) on a business trip.
Injuries at work are investigated, recorded and documented in an act of the established form. The investigation of a case of industrial injury must be carried out within 24 hours from the moment of the incident.
Accidents on the way to work (from work) are investigated within 3 days from the moment of their establishment. In the event of an accident (at work and at home), a certificate of incapacity for work is issued from the date of contacting a doctor for help. Allowance for temporary non-
disability due to an accident at work is paid in the amount of 100% of wages.
In the event of an injury at home, sick leave is paid from the 6th day of disability on a general basis.
Deadlines for issuing a certificate of incapacity for work in case of diseases and injuries and the amount of compensation. The attending physician issues a certificate of incapacity for work individually and at a time for a period of up to 10 calendar days and extends it solely for a period of up to 30 calendar days, taking into account the approximate periods of temporary disability approved by the Ministry of Health and Social Development of Russia for various diseases and injuries.
In accordance with the amendments to the Federal Law? 255-FZ "On the provision of benefits for temporary disability, pregnancy and childbirth of citizens subject to compulsory social insurance" the first two days of lost earnings are compensated by the employer, then - the FSS. With an insurance period of up to 5 years, benefits will be paid in the amount of 60% of average earnings, from 5 to 8 years - 80%, and over 8 years - 100%.
When conducting an examination of working capacity, the attending physician is guided by medical and social criteria.
Medical criterion (clinical)- this is a timely and clearly formulated diagnosis of the disease in accordance with the existing classification.
The diagnosis should reflect the stage of the disease, the severity, the nature of the course, as well as the degree of functional disorders of the body, which led to the temporary disability of the patient.
Social or labor criterion, takes into account the professional activity of the patient, the working conditions in which he works, the degree of physical or neuropsychic stress experienced, the presence of adverse production factors.
A well-founded expert opinion is possible only if medical and social criteria are taken into account, the combination of which determines the practice of disability examination.
When making a decision about the state of working capacity of patients, either a medical or a social criterion may be of particular importance. Yes, at acute diseases or exacerbation of chronic processes occurring with severe functional disorders, when the patient needs a regimen and any work is contraindicated for him, the social criterion is practically irrelevant. The doctor, having made a diagnosis, prescribes the appropriate treatment and releases the patient from work, giving him a certificate of incapacity for work. In this case, the patient's ability to work is determined only by medical criteria.
The social criterion becomes important in establishing temporary disability in persons whose work is associated with overstrain of certain organs and body systems (singer, announcer, musician, diver, etc.). So, for example, with the same disease, but a different profession, a person in one case can be recognized as able-bodied, but not in another: a singer, an announcer with residual effects laryngitis will be recognized as disabled, and an accountant, computer operator with a similar diagnosis can perform professional activities.
The terms of temporary incapacity for work are different for the same disease in people of intellectual labor and those working with significant physical stress, in unfavorable working conditions.
Determining the duration of temporary disability without taking into account one of the criteria often leads to expert errors.
The issuance and extension of a certificate of incapacity for work is carried out by a doctor after examining the patient and recording data on his state of health in an outpatient card, justifying the need for temporary release from work. The certificate of incapacity for work is registered in the outpatient card indicating its number, dates of issue and extension, and the patient's discharge to work. Disability certificate issued to the patient medical organization on the day of its closure.
In the event of illness of a citizen of the Russian Federation during a stay abroad, documents confirming temporary disability, by decision of the medical commission of a medical institution, can be replaced with a certificate of incapacity for work established in the Russian Federation.
Ability to work- a set of physical and spiritual capabilities of a person (depending on the state of his health), allowing him to engage in labor activity. Encyclopedic Dictionary of Medical Terms (ESMT). M., 1984. T.Z.S. 202.
The medical criterion for working capacity is the presence of a disease, its complications, and clinical prognosis.
But not always a sick person must necessarily be disabled. For example, two people of different professions with the same disease: a stamper and a teacher with panaritium. There is a disease. However, a stamper cannot do his job with panaritium, and a teacher can teach a lesson.
Therefore, the doctor, based on the degree of severity of functional disorders, the nature and course of the pathological process, the patient's work, his working conditions, decides his question about the social criterion for working capacity and about issuing a sick leave to the patient. Consequently, the social criterion of ability to work determines, in the presence of a disease, a labor prognosis for a specific position and working conditions.
Medical and social criteria should always be clearly defined and reflected in the outpatient card of a sick person.
The medical criterion is the leading one in establishing the fact of incapacity for work. However, it is not always the disease that is a sign of disability. There are times when a healthy person cannot work in his profession. For example, a cook's wife has hepatitis. The cook himself is healthy, but he cannot cook food, as he has a hepatitis contact.
The main task of the examination of working capacity is to determine the ability of a given person to perform their professional duties, depending on medical and social criteria. In addition, the tasks of a medical examination of working capacity include:
* determination of the treatment and regimen necessary to restore and improve human health;
* determination of the degree and duration of disability due to illness, accident or other reasons;
* Identification of long-term or permanent disability and referral of such patients to the medico-social expert commission.
If changes in the state of health are temporary, reversible, and recovery or significant improvement is expected in the near future, as well as restoration of working capacity, then this type of disability is considered temporary. Temporary disability by nature is divided into full or partial.
Complete disability is when a person, due to a disease, cannot and should not perform any work and needs a special treatment regimen.
Partial disability is disability in one's profession while maintaining the ability to perform other work. If a person can work in lighter conditions or perform a smaller amount of work, then he is considered partially disabled.
When examining disability, the doctor sometimes has to deal with manifestations of aggravation and simulation.
Aggravation (aggravatio; Latin, aggravo, aggravatum - aggravate, worsen) - an exaggeration by the patient of the symptoms of a really existing disease. Encyclopedic dictionary of medical terms. Ed. 1st. M., 1982. T. 1. S. 23.
With active aggravation, the patient takes measures to worsen his health or prolong the disease. With passive aggravation, it is limited to an exaggeration of individual symptoms, but does not accompany them with actions that interfere with treatment.
Pathological aggravation is characteristic of mental patients (hysteria, psychopathy, etc.), being one of the manifestations of these diseases.
Simulation (Latin simulatio - "pretense") - a person's imitation of the symptoms of a disease that he does not have.
The difficulties of the initial period of the examination of working capacity (the release of the patient from work) are significantly inferior to the difficulties of its final moment - the discharge of the recovered person to work.
The doctor has the right to issue a certificate of incapacity for work until the patient has fully recovered or until the moment when signs of permanent disability clearly appear. However, there are no such objective signs by which it would be possible to establish exactly when the incapacity for work ended and the working capacity was fully restored. Here, fluctuations of 1-2 days are always possible and the correct solution of the issue requires a highly qualified doctor. It is impossible in the order of "reinsurance" to provide the patient with extra days of release from work and at the same time it is unacceptable to discharge the patient to work before he has recovered.
No less difficulties arise when establishing the moment of transition of temporary disability to permanent ...