Order 543 of the Ministry of Health of the Russian Federation. Rules for organizing the provision of primary medical care to adults - Rossiyskaya Gazeta. With changes and additions from

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

Pursuant to article 32 Federal law of November 21, 2011 N 323-FZ "On the basics of health protection of citizens in Russian Federation"(Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724) I order:

1. To approve the attached Regulation on the organization of the provision of primary health care.

2. To declare invalid:

Order of the Ministry of Health and social development Of the Russian Federation of July 29, 2005 N 487 "On approval of the procedure for organizing the provision of primary health care" (registered by the Ministry of Justice of the Russian Federation on August 30, 2005 N 6954);

Order of the Ministry of Health and Social Development of the Russian Federation of August 4, 2006 N 584 "On the procedure for organizing health care population on a district principle "(registered by the Ministry of Justice of the Russian Federation on September 4, 2006 N 8200).

I. about Minister T. Golikov

Approx. ed .: the order was published in the "Bulletin of Normative Acts of Federal Executive Bodies", No. 52, 24.12.2012.


Appendix to the Order

Regulations on the organization of the provision of primary health care to the adult population

1. This Regulation establishes the rules for organizing the provision of primary health care to the adult population on the territory of the Russian Federation.

2. The organization of the provision of primary health care is carried out in medical and other organizations of the state, municipal and private health systems, including, individual entrepreneurs licensed to medical activity received in the manner prescribed by the legislation of the Russian Federation (hereinafter referred to as medical organizations).

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

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

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

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

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

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

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

7. Primary health care is provided:

1) on an outpatient basis, including:
in a medical organization that provides primary health care, or its subdivision, at the place of residence (stay) of the patient - in case of acute diseases, exacerbations of chronic diseases in case of calling a medical worker or when he visits a patient in order to monitor his condition, the course of the disease and timely appointment (correction) of the necessary examination and (or) treatment (active visit), with the patronage of certain groups of the population in the detection or threat of an epidemic of an infectious disease, patients with an infectious disease, contact persons and persons suspected of an infectious disease, including by door-to-door (door-to-door) rounds, examinations of employees and students;
at the place of departure of the mobile medical team, including for the provision of medical care to residents of settlements with the predominant residence of persons over working age, or located at a considerable distance from the medical organization and (or) having poor transport accessibility, taking into account climatic and geographical conditions.

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

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

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

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

10. Primary health care includes the following types:

Primary pre-medical health care, which is provided by paramedics, obstetricians, other medical workers with secondary medical education feldsher health posts, feldsher-obstetric points, medical outpatient clinics, health posts, polyclinics, polyclinic units of medical organizations, departments (offices) of medical prevention, health centers;
primary medical health care, which is provided by general practitioners, district therapists, doctors general practice(family doctors) of medical outpatient clinics, health centers, polyclinics, polyclinic units of medical organizations, offices of general practitioners (family doctors), health centers and departments (offices) of medical prevention;
primary specialized medical and sanitary care, which is provided by doctors-specialists of various profiles of polyclinics, polyclinic units of medical organizations, including those providing specialized, including high-tech, medical care.

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

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

12. Primary pre-medical and primary medical health care are organized according to the territorial-district principle.

13. The territorial-precinct principle of organizing the provision of primary health care consists in the formation of groups of the served contingent based on residence (stay) in a certain territory or on the basis of work (training) in certain organizations and (or) their subdivisions.

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

15. In order to ensure the right of citizens to choose a doctor and a medical organization, it is allowed to attach citizens who live or work outside the service area of ​​a medical organization, to district therapists, general practitioners (family doctors), for medical supervision and treatment, taking into account the recommended number of attached citizens, established by clause 18 of these Regulations.

16. In medical organizations, sites can be organized:

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

17. Service of the population at the sites is carried out:

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

At the paramedic site - 1,300 adults aged 18 and over;
at the therapeutic site - 1,700 adults aged 18 years and older (for a therapeutic site located in rural areas - 1,300 adults);
at the site of a general practitioner - 1200 adults aged 18 years and older;
at the family doctor's site - 1,500 adults and children;
in the complex area - 2000 and more people of the adult and child population.

19. In the regions of the Far North and equivalent areas, high-mountainous, desert, waterless and other areas (areas) with severe climatic conditions, with prolonged seasonal isolation, as well as in areas with a low population density, areas can be formed with a smaller number of attached population, with the preservation of the full-time positions of district general practitioners, district pediatricians, general practitioners (family doctors), district nurses, general practitioners' nurses, paramedics (obstetricians) in full.

20. Depending on the specific conditions for the provision of primary health care to the population, in order to ensure its availability, permanent medical teams can be formed, consisting of a district general practitioner, paramedics, obstetricians and nurses, with distribution between them. functional responsibilities by competence, based on the established staffing standards designed to calculate the number of positions provided for the performance of a medical organization of the functions assigned to it.

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

Primary specialized health care is provided in the direction of medical workers who provide primary pre-medical and primary medical health care, as well as when a patient independently applies to a medical organization.

22. In order to provide medical care to patients with acute chronic diseases and their exacerbations, who need inpatient treatment, but are not sent to provide inpatient medical care to a medical organization, an inpatient hospital may be organized at home, provided that the patient's state of health and his home conditions make it possible to organize medical care and home care.

The selection of patients for inpatient treatment at home is carried out on the recommendation of district physicians, general practitioners (family doctors) and specialist doctors.

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

Saturday, Sunday and holidays observation of patients can be carried out by doctors and nurses on duty, as well as by the emergency medical service. If the course of the disease worsens, the patient should be immediately transferred to a round-the-clock hospital.

Appendix No. 1 to the Regulation

Policlinic organization rules

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

2. A polyclinic is an independent medical organization, or a structural subdivision of a medical organization (its structural subdivision) that provides primary health care, and is organized to provide primary pre-medical health care, primary medical health care, primary specialized health care , as well as palliative care for the population.

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

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

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

6. A specialist is appointed to the position of a nurse of a polyclinic, corresponding to the qualification characteristics of positions of workers in the field of health care, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010, No. 18247), in the specialty "Paramedic", "Midwife" or "Nurse".

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

8. To organize the work of the polyclinic in its structure, it is recommended to provide the following units:

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

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

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

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

10. In the absence of the effect of the treatment carried out on an outpatient basis and (or) in the absence of the possibility of carrying out additional examinations for medical reasons, a local general practitioner, a local general practitioner, a general practitioner, a family doctor in agreement with a doctor - a specialist in the patient's disease profile directs him to a medical organization for additional examinations and (or) treatment, including in inpatient conditions.

11. The main tasks of the polyclinic are:

Provision of primary (first-aid, medical, specialized) health care, including in an emergency form, to patients living in the service area and (or) assigned to the service, in case of acute diseases, injuries, poisoning and other emergency conditions;
carrying out preventive measures to prevent and reduce morbidity, identify early and latent forms of diseases, socially significant diseases and risk factors;
medical examination of the population;
diagnostics and treatment of various diseases and conditions;
rehabilitation treatment and rehabilitation;
clinical and expert activities to assess the quality and effectiveness of medical and diagnostic measures, including an examination of temporary disability and referral of citizens to medical and social expertise;
dispensary observation of the state of health of persons suffering from chronic diseases, including certain categories of citizens who have the right to receive a set social services, functional disorders, other conditions for the purpose of timely detection (prevention) of complications, exacerbations of diseases, other pathological conditions, their prevention and implementation of medical rehabilitation;
organization of additional free medical care, including the necessary medicines, for certain categories of citizens;
establishment of medical indications and referral to medical organizations for receiving specialized types of medical care;

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

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

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

Appendix No. 3 to the Regulation

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

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

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

3. Medical assistance in the Cabinet is provided by medical workers with secondary medical education from among the most experienced staff, as well as nurses with higher medical education.

4. Organization of work in the Cabinet can be carried out both on a permanent basis by the medical staff of the Cabinet, and on a functional basis by medical workers of other departments of the medical organization in accordance with the schedule approved by the head of the medical organization.

5. The Cabinet is managed by the head of one of the departments of the medical organization authorized by the head of the medical organization.

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

Reception of patients to resolve the issue of the urgency of referral to a doctor;
referral to laboratory and other studies of patients who do not need a doctor's appointment on the day of treatment;
anthropometry, measurement of blood and eye pressure, body temperature, visual acuity and hearing, other diagnostic manipulations, the implementation of which is within the competence of workers with secondary medical education, filling out the passport part of the messenger sheet for medical and social examination, health resort card, laboratory data and other functional and diagnostic studies before being sent for medical and social expertise, for sanatorium-resort treatment, preparation of certificates, extracts from individual cards of an outpatient patient and other medical documentation, the preparation and maintenance of which is within the competence of workers with secondary medical education;
execution of leaflets and certificates of temporary disability, confirmation with the appropriate seals of certificates issued to the patient, referrals, prescriptions and extracts from medical records, strict accounting and registration in special magazines leaflets, certificates of temporary disability and prescription forms;
participation in the organization and conduct of preventive medical examinations.

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

Appendix No. 4 to the Regulation

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

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

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

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

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

Organization of unhindered and immediate preliminary registration of patients for an appointment with a doctor, including in an automated mode, in a medical prevention room, a first-aid room (both when they directly contact the polyclinic and by phone);
organization and implementation of registration of doctors' home calls at the place of residence (stay) of the patient;
ensuring regulation of the intensity of the flow of the population in order to create a uniform load of doctors and its distribution according to the types of care provided;
systematic storage of patients 'medical records, ensuring timely selection and delivery of medical records to doctors' offices.

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

Informing the population about the time of reception of doctors of all specialties, the working hours of laboratories, offices, a health center, a day hospital and other departments of a medical organization, including Saturday and Sunday, indicating the hours of reception, the location and numbers of the rooms of the premises;
informing about the rules for calling a doctor at home, about the procedure for making an appointment with doctors, about the time and place of reception of the population by the head of the medical organization and his deputies; the addresses of the nearest pharmacies, the nearest health center in the area of ​​responsibility of which this medical organization is located;
informing about the rules for preparing for research (fluoroscopy, radiography, blood tests, gastric juice, etc.);
making an appointment with doctors of a medical organization and registering calls to doctors at the place of residence (stay) of a patient, timely transmission of information about registered calls to doctors;
referral in the prescribed manner to the clinic for preventive examinations and examinations *;
selection of medical records of outpatients who made an appointment or called a doctor at home;
delivery of patients 'medical records to doctors' offices;
registration of leaflets (certificates) of temporary disability confirmation by appropriate seals of certificates issued to the patient, referrals, prescriptions and extracts from medical documentation, strict accounting and registration in special journals of leaflets, certificates of temporary disability and prescription forms;
sorting and entering the results of laboratory, instrumental and other examinations into the medical documentation.

6. As part of the registry of a medical organization, it is recommended to provide a reference table, a self-recording room (table), workplaces for receiving and registering doctor's home calls, a room for storing and selecting medical records, a room for processing medical documents, and a medical archive.

* for all citizens who first applied to a medical organization, a list of control of risk factors for chronic non-infectious diseases is set up, which are sent (with their consent) to identify risk factors and the degree of risk to a medical prevention office or to a health center, persons are sent to the same units, already having this control sheet and wishing to receive medical assistance to correct risk factors and / or additional advice on maintaining a healthy lifestyle

Appendix No. 5 to the Regulation

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

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

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

3. Provision of emergency medical care to persons who have applied with signs of emergency conditions can be carried out on an outpatient basis or at home when a medical worker is called.

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

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

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

6. Emergency medical care for persons who applied to a medical organization with signs of emergency conditions is provided by the registrar's direction without delay.

7. Emergency medical care at home is carried out within no more than 2 hours after the receipt of a request from a sick person or another person to provide emergency medical care at home.

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

9. After the provision of emergency medical care to the patient and the elimination or reduction of the manifestations of the emergency, the patient is sent to the doctor or the district doctor, information about the patient is transmitted to visit the patient in order to monitor his condition, the course of the disease and the timely appointment (correction) of the necessary examination and (or ) treatment (active visit) during the day.

Appendix No. 6 to the Regulation

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

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

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

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

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

5. The structure of the Cabinet and the number of staff are established by the head of the medical organization, in which the Cabinet was created, based on the volume of medical and diagnostic work, the number, age and sex composition of the population served, indicators of the level and structure of morbidity and mortality, and other indicators characterizing the health of the population.

6. The main tasks of the Cabinet are:

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


the implementation of dispensary observation of patients with chronic diseases with the necessary examination, treatment and recovery;


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

formation of risk groups;

organization and provision of palliative care to patients, including patients oncological diseases in need of narcotic and potent medicines in accordance with the recommendations of specialist doctors;
examination of temporary disability, referral to medical and social examination;

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

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

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

Appendix No. 7 to the Regulation

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

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

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

3. The Department of Prevention includes the following structural divisions:

Anamnestic office;
functional (instrumental) research room;
a room for promoting a healthy lifestyle;
an office for centralized accounting of annual medical examination;
smoking cessation medical aid cabinet.

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

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

6. The main functions of the Branch are:

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

Appendix No. 8 to the Regulation

Rules for organizing the activities of the mobile medical team

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

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

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

Medical workers of other medical organizations may be included in the mobile medical team by agreement.

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

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

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

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

Appendix No. 9 to the Regulation

Rules for organizing the activities of the day hospital

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

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

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

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

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

6. To organize the work of a day hospital in its structure, it is recommended to provide:

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

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

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

9. The day hospital carries out the following functions:

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

10. In the absence of an effect from the treatment carried out in a day hospital or in the event of indications for round-the-clock medical observation and treatment, as well as in the absence of the possibility of additional examinations for medical reasons, the patient is sent for additional examinations and (or) treatment, including in inpatient conditions.

Appendix No. 12 to the Regulation

Rules for organizing the activities of a medical outpatient clinic

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

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

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

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

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

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

6. For the position of a paramedic of a medical outpatient clinic, specialists are appointed, corresponding to the qualification characteristics of positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), for the position of "Paramedic" ...

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

8. A specialist is appointed to the position of a nurse of a medical outpatient clinic, corresponding to the qualification characteristics of the positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010, No. 18247), for the position "Nurse ".

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

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

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

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

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

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

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

15. The main tasks of the outpatient clinic are:

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

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

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

Appendix No. 15 to the Regulation

Rules for organizing the activities of a feldsher-obstetric center

1. These Rules determine the procedure for organizing the activities of the feldsher-obstetric station.

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

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

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

5. A specialist is appointed to the position of an obstetrician of a feldsher-obstetric station, corresponding to the qualification characteristics of the positions of workers in the health sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010, No. 18247), for the position of "midwife ".

6. A specialist is appointed to the position of a nurse of a feldsher-obstetric center, corresponding to the qualification characteristics of the positions of workers in the healthcare sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010, No. 18247), for the position " Nurse".

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

8. To organize the work of the feldsher-obstetric center, it is recommended to provide the following premises in its structure:

Procedural;
a paramedic and midwife's room;
emergency room for childbirth;
room for temporary stay of patients;
bathroom for staff;
bathroom for patients;
sanitary room.

9. For the provision of emergency first aid medical care in case of sudden, life-threatening acute diseases, conditions, exacerbations of chronic diseases, injuries, poisoning (hereinafter - life-threatening conditions and (or) diseases), instructions are placed in the FAP in places accessible to medical personnel, including a sequence of actions for the diagnosis of life-threatening conditions and (or) diseases and the provision of medical care for them with the use of packs containing the necessary drugs and medical products, the stocks of which are replenished as needed.

10. The equipment of the FAP is carried out in accordance with the equipment standard established by Appendix No. 17 to the Regulation on the organization of the provision of primary health care to the adult population, established by this order. FAP is provided with an ambulance vehicle, class A.

11. The main tasks of the FAP are:

Appendix No. 18 to the Regulation

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

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

2. A paramedic health center of a medical organization (hereinafter referred to as a paramedic health center) is a structural subdivision of a medical organization and is organized to provide primary pre-medical health care (hereinafter referred to as pre-medical care) and palliative care to the population in rural settlements with a small population and (or ) located at a considerable distance from medical organizations, including feldsher-obstetric points, or in the presence of water, mountain and other obstacles, as well as in the case of the predominant (more than 40%) residence in them of persons over working age.

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

A specialist is appointed to the position of a nurse of a medical assistant's health center, corresponding to the qualification characteristics of positions of workers in the health sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010, No. 18247), for the position "Nurse".

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

5. For the organization of a medical assistant's health center in its structure, it is recommended to provide:

Procedural;
paramedic's office;
bathroom.

6. The equipment of the medical assistant's health center is carried out in accordance with the standard established by Appendix No. 20 to the Regulation on the organization of the provision of primary health care to the adult population, approved by this order.

7. For the provision of emergency first aid medical care in case of sudden, life-threatening acute diseases, conditions, exacerbations of chronic diseases, injuries, poisoning (hereinafter - life-threatening conditions), instructions are placed in the medical assistant's health center in places accessible to medical workers, including a sequence of actions for diagnosis life-threatening conditions and (or) diseases and the provision of medical care for them, including the use of packs containing the necessary drugs and medical devices, the reserves of which are replenished as needed.

8. The main tasks of the medical assistant's health center are:

Diagnostics and treatment of uncomplicated acute, exacerbations of chronic diseases and other conditions, injuries, poisoning;
prevention of infectious and non-infectious diseases;
identification of smokers and those who consume alcohol excessively, with a high risk of developing diseases associated with smoking, alcohol and poisoning with alcohol substitutes;
providing assistance to smokers and people who consume alcohol in excess in the prevention and cessation of smoking and alcohol abuse, including referring them for consultation and treatment to medical prevention departments (offices), health centers and specialized medical organizations;
implementation of measures to promote a healthy lifestyle;
referral of patients to medical organizations for the provision of primary (medical, specialized) medical and sanitary or specialized medical care in cases stipulated by the procedures for providing medical care by profile, organizing an appointment with specialist doctors;
elimination of life-threatening conditions with the subsequent organization of medical evacuation to medical organizations providing specialized medical care accompanied by a medical worker of a paramedic health center or an ambulance team;
detection of precancerous diseases and malignant neoplasms of visual localizations and referral of patients with suspected malignancy and with precancerous diseases to the primary oncological office of a medical organization;
organization and provision of palliative care to patients, including patients with oncological diseases, in need of narcotic and potent medicines in accordance with the recommendations of specialist doctors;
implementation of sanitary and hygienic and anti-epidemic measures;

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

Appendix No. 21 to the Regulation

Rules for organizing the activities of the Center (Department) of general medical practice (family medicine)

1. These Rules establish the procedure for organizing the activities of the Center (Department) of general medical practice (family medicine).

2. The Center (Department) of general medical practice (family medicine) (hereinafter referred to as the Center) is organized as an independent medical organization or as a structural subdivision of a medical organization (its structural subdivision) that provides primary health care, and is organized to provide primary medical sanitary care (hereinafter referred to as medical care), primary pre-medical health care (hereinafter referred to as pre-medical care) in the framework of emergency medical care, as well as palliative care.

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

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

5. The center is headed by the chief physician (manager), to whose position a specialist is appointed that meets the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of health care, approved by order of the Ministry of Health and Social Development of Russia dated July 7, 2009 No. 415n (registered by the Ministry of Justice of Russia 9 July 2009, No. 14292), in the specialty "General medicine", "Pediatrics" "General medical practice (family medicine)" and the qualification characteristics of the positions of workers in the health sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n ( registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247).

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

7. A specialist is appointed to the position of a nurse of the Center, corresponding to the qualification characteristics of positions of workers in the field of health care, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010, No. 18247), for the position "Nurse" ...

8. Specialists are appointed to the position of a medical assistant of the Center, corresponding to the qualification characteristics of positions of workers in the field of healthcare, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010, No. 18247), for the position of "Medical Assistant".

9. To organize the work of the Center in its structure it is recommended to provide:

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

10.In order to improve the provision of medical care in the Center (Department), an office (department) of first aid, an office (department) of emergency medical care, a day hospital, including a hospital at home, a medical aid room for smoking cessation can be organized.

11. The Center performs the following functions:

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

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

Appendix No. 24 to the Regulation

Rules for organizing the activities of the health center

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

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

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

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

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

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

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

7. For the position of a nurse to work in the ophthalmological office of a health center, a specialist is appointed who corresponds to the qualification characteristics of the positions of workers in the health sector, approved by order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (registered by the Ministry of Justice of Russia on August 25, 2010 No. 18247), in the specialty "medical optometrist" or in the specialty "nurse", passed an additional vocational training specializing in medical optics and having appropriate training in healthy lifestyles and medical prevention.

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

9. To organize the work of a health center in its structure, it is recommended to provide:

Specialist doctors' offices;
dental hygienist office;
ophthalmological office;
testing room on the hardware and software complex;
instrumental and laboratory examination rooms;
room (hall) of physiotherapy exercises;
classrooms (auditoriums) of health schools.

10. In order to improve the provision of medical care, a prevention cabinet (department) may be organized in the Health Center.

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

12. The main tasks of the Health Center are:

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

In accordance with Article 32 of the Federal Law of November 21, 2011 N 323-FZ "On the Basics of Health Protection of Citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724) I order:

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

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

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

The organization of the provision of primary health care is carried out by medical organizations and their structural units in accordance with Appendices N 1-27 to this Regulation.

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

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

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

in a medical organization that provides primary health care, or its subdivision, at the place of residence (stay) of the patient - in case of acute diseases, exacerbations of chronic diseases in case of calling a medical worker or when he visits a patient in order to monitor his condition, the course of the disease and timely appointment (correction) of the necessary examination and (or) treatment (active visit), with the patronage of certain groups of the population in the detection or threat of an epidemic of an infectious disease, patients with an infectious disease, contact persons and persons suspected of an infectious disease, including by door-to-door (door-to-door) rounds, examinations of employees and students;

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

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

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

primary pre-medical health care, which is provided by feldshers, obstetricians, other medical workers with secondary medical education of feldsher health posts, feldsher-obstetric points, medical outpatient clinics, health centers, polyclinics, polyclinic units of medical organizations, departments (offices) of medical prevention

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

primary specialized medical and sanitary care, which is provided by doctors-specialists of various profiles of polyclinics, polyclinic units of medical organizations, including those providing specialized, including high-tech, medical care.

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

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

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

With changes and additions from:

In accordance with Article 32 of the Federal Law of November 21, 2011 N 323-FZ "On the Basics of Health Protection of Citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724) I order:

1. To approve the attached Regulation on the organization of the provision of primary health care to the adult population.

2. To declare invalid:

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

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

Registration N 24726

The Regulation on the organization of the provision of primary medical care was approved. It is about helping the adult population on the territory of Russia.

This type of care is the basis of the medical care system. It includes measures for the prevention, diagnosis, treatment of diseases and conditions, rehabilitation, monitoring the course of pregnancy, the formation of a healthy lifestyle and health education.

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

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

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

Orders on the approval of the procedure for organizing the provision of primary medical care and on the procedure for organizing medical care for the population on the basis of the district principle were declared invalid.

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

Registration N 24726

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