Order of the Ministry of Health of the Russian Federation of December 21, 2012 N 1346n
"On the procedure for passing medical examinations by minors, including upon admission to educational institutions and during the period of study in them"
accounting form N 030-PO / y-12 "Card of preventive medical examination of a minor" in accordance with Appendix N 2;
reporting form N 030-PO / o-12 "Information on preventive examinations of minors" in accordance with Appendix N 3.
|
IN AND. Skvortsova |
Registration N 27961
Rules have been established for minors to undergo medical examinations: preventive, preliminary upon admission to educational institutions and periodic during the period of study in them. The rules update, streamline and bring together the requirements for medical examinations of children of various age groups - from 0 to 17 years.
All medical examinations are carried out free of charge within the framework of the territorial CHI program in polyclinics at the place of residence (structural divisions of educational institutions). The obligatory preliminary voluntary consent of a minor or his legal representative for a medical examination is fixed.
Medical examinations are supposed to take place for children under 1 year old - monthly, from 1 to 2 years old - once every 3 months, from 2 to 3 years old - once every six months, then once a year. The list of examinations by specialist doctors and studies depends on the age of the child. So, babies at the age of 1 month are examined by a pediatrician, a neurologist, a pediatric surgeon and an ophthalmologist. They should have an ultrasound scan of the abdomen, heart, and hip joints, neurosonography (examination of the child's brain through an open large fontanel), and audiological screening (if not previously done).
All one-year-old children, among other things, should also be examined by a child psychiatrist. Adolescents at the age of 14 will also be consulted by a dentist and a neurologist.
For each child at the age of 1 year, 2, 3 years and in subsequent age periods, a preventive medical examination card is filled out (form N 030-PO / y-12). One copy is given to the minor (his legal representative).
Before entering kindergarten, school, college, technical school undergo a preliminary medical examination. In this case, a written application for its conduct must be submitted to the clinic. A list of inspections and studies carried out has been determined. So, for admission to a kindergarten, one must undergo examinations by 8 doctors (including a psychiatrist and a gynecologist (urologist)) and pass blood tests (including glucose levels), urine, and feces. Before school, you will additionally need to undergo an examination by an orthopedic traumatologist, do an ultrasound scan of the abdominal cavity, reproductive organs, heart, thyroid gland, as well as electrocardiography.
Based on the results of such a medical examination, a medical card (certificate) is issued, which, among other things, indicates a group for physical education.
Order of the Ministry of Health of the Russian Federation of December 21, 2012 N 1346n "On the Procedure for Underage Medical Examinations, including when entering educational institutions and during the period of study in them"
Registration N 27961
This Order shall enter into force 10 days after the date of its official publication.
By order of the Ministry of Health of Russia dated August 10, 2017 N 514n, this order was declared invalid from January 1, 2018.
“On the procedure for passing medical examinations by minors, including upon admission to educational institutions
and during the period of study in them "
28. Preliminary examinations are carried out in medical organizations, regardless of their organizational and legal form, providing primary health care to minors and having a license to carry out medical activities, providing for the performance of work (provision of services) for “medical examinations (preliminary, periodic)”, “ pediatrics" or "general practice (family medicine)", "neurology", "ophthalmology", "traumatology and orthopedics", "pediatric surgery", "psychiatry", "otorhinolaryngology" or "otorhinolaryngology (excluding cochlear implantation)", "pediatric dentistry" or "stomatology", "pediatric urology-andrology" or "urology", "pediatric endocrinology" or "endocrinology", "laboratory diagnostics", "clinical laboratory diagnostics", "functional diagnostics", "ultrasound diagnostics" and "radiology".
30. Preliminary examinations are carried out upon admission to an educational institution on the basis of a written application of a minor (his legal representative) addressed to the head of a medical organization.
31. An application for a preliminary examination of a minor shall contain the following information:
1) type of medical examination (preliminary);
2) last name, first name, patronymic of a minor entering an educational institution;
3) date of birth of a minor entering an educational institution;
4) the address of the place of residence of a minor entering an educational institution;
5) the full name of the medical organization providing primary health care to a minor, the address of its location;
6) full name and type educational institution where the minor will study, the address of his location;
7) details (series, number, insurance medical organization) of the compulsory medical insurance policy;
8) contact information.
The application is signed by a minor (his legal representative) indicating the surname, initials and date of completion.
If the application is filled out by the legal representative of the minor, it shall indicate the details of the documents confirming the authority of the legal representative, copies of these documents are attached to the application.
32. An authorized official of a medical organization, within 5 working days from the date of registration of the application, provides the applicant with a referral for a preliminary examination indicating a list of examinations by specialist doctors and studies, the date and place of their conduct, as well as information about the pediatrician, district pediatrician , a general practitioner (family doctor) of a medical organization responsible for conducting a preliminary examination (hereinafter referred to as a doctor responsible for conducting a preliminary examination).
33. On the day of the preliminary examination, the minor arrives at a medical organization and presents a referral for a preliminary examination and a compulsory medical insurance policy. A minor who has not reached the age established by paragraph 2 of Article 54 federal law, arrives at a medical organization accompanied by a parent or other legal representative.
34. Preliminary examinations are carried out by medical organizations in accordance with section 2 of the List of studies.
35. When conducting preliminary examinations, the results of examinations by medical specialists and studies included in the medical documentation of the minor (history of the development of the child) are taken into account, the prescription of which does not exceed 3 months from the date of the examination and (or) examination, and for children under the age of 2 years, the results of examinations and examinations are taken into account, the prescription of which does not exceed 1 month from the date of examination and (or) examination.
36. If a minor is suspected of having a disease (condition), the diagnosis of which cannot be established during examinations by specialist doctors and studies included in section 2 of the List of studies, the doctor responsible for conducting a preliminary examination, medical specialists participating in carrying out a preliminary examination, send the minor for additional consultation and (or) research, indicating the date and place of their conduct.
37. Preliminary examination is completed in case of examinations by specialist doctors and laboratory, instrumental and other studies provided for in section 2 of the List of studies, in the absence of suspicions that the minor has an undiagnosed disease (condition) and (or) the need to obtain information about the state of health a minor from other medical organizations (in accordance with clause 8 of part 4 of article 13 of the Federal Law) (I stage).
In case of suspicion that a minor has a disease (condition), the diagnosis of which cannot be established during examinations by specialist doctors and studies included in section 2 of the List of studies, and (or) the need to obtain information about the state of health of a minor from other medical organizations, a preliminary examination is completed in the event of additional consultations, studies scheduled in accordance with paragraph 36 of this Procedure, and (or) obtaining information about the state of health of a minor from other medical organizations (stage II).
38. The total duration of the I stage of the preliminary examination should be no more than 10 working days, and when additional consultations, studies and (or) the need to obtain information about the state of health of a minor from other medical organizations, the total duration of the preliminary examination - no more than 30 working days (I and II stages).
39. The data on the passage of the preliminary examination, specified in paragraph 21 of this Procedure, are entered in the medical documentation of the minor (history of the development of the child).
40. Based on the results of the preliminary examination physician in charge of pre-examination , defines:
1) health group minor;
2) medical group for classes physical education And draws up a medical report on the belonging of a minor to a medical group for physical education (in relation to minors entering educational institutions that provide for physical education);
3) draws up a child's medical card for educational institutions of preschool, primary general, basic general, secondary (complete) general education, institutions of primary and secondary vocational education, orphanages and boarding schools (hereinafter referred to as the child's medical record for educational institutions) and (or) a medical certificate for minors entering primary, secondary and higher vocational education institutions (hereinafter referred to as the medical certificate), which indicates information about the state of health minor and assessment of the minor's compliance with educational requirements.
41. A child's medical card for educational institutions and (or) a medical certificate is drawn up in one copy, which is sent (issued) to a minor (his legal representative).
Appendix No. 4
to the order of passage
juvenile medical
inspections approved by order
Ministry of Health
Russian Federation
Medical opinion
on belonging of a minor to a medical group
for physical education
Issued by __________________________________________________________________________
(full name of the medical organization)
___________________________________________________________________________
(surname, name, patronymic of a minor in the dative case,
Date of Birth)
About the fact that he (she) is admitted (a) (not admitted (a)) to classes
Creating the necessary conditions for the protection and promotion of the health of students is one of the activities of educational organizations. In turn, health protection includes the passage by students in accordance with the legislation of the Russian Federation of periodic medical examinations. However, minors may be subject to other types of examinations. Let's consider the order of each of them.
Types of medical examinations of minors
The legislation on health care establishes the obligation to conduct preliminary medical examinations of minors entering the educational organizations as well as periodic medical examinations of students. This requirement is contained in paragraph 2, 3, part 2 of Art. 46 of the Federal Law of November 21, 2011 No. 323-FZ “On the Basics of Protecting the Health of Citizens in the Russian Federation” (as amended on December 28, 2013; hereinafter - Federal Law No. 323-FZ).
Medical checkup is a complex of medical interventions aimed at identifying pathological conditions, diseases and risk factors for their development (Part 1, Article 46 of Federal Law No. 323-FZ). A necessary prerequisite for medical intervention is the giving of informed voluntary consent of a minor or his legal representative to medical intervention in compliance with the requirements established by Art. 20 of Federal Law No. 323-FZ. The procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types of medical interventions, the form of informed voluntary consent to medical intervention and the form of refusal of medical intervention were approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1177n.
For your information
In accordance with Art. 26, 28 of the Civil Code of the Russian Federation, Art. 64 of the Family Code of the Russian Federation, the legal representatives of minors are parents, adoptive parents, guardians (trustees).
The procedure for the passage of medical examinations by minors, including upon admission to educational institutions and during the period of study in them(hereinafter - the Procedure), approved by Order of the Ministry of Health of Russia dated December 21, 2012 No. 1346n. The document is valid from 05/06/2013. Clause 1 of the Procedure provides for the following types of medical examinations of minors :
- preventive;
- preliminary for admission to educational institutions;
- periodic during the period of study in educational institutions.
Preventive medical examinations of minors are carried out at established age periods for the purpose of early (timely) detection of pathological conditions, diseases and risk factors for their development, as well as in order to form health status groups and develop recommendations for minors (clause 3 of the Order).
preliminary medical examinations of minors are carried out upon admission to educational institutions in order to determine the student's compliance with the requirements for education (clause 4 of the Order).
Periodic medical examinations of minors are carried out in order to dynamically monitor the health of students, timely detection of the initial forms of diseases, early signs of exposure to harmful and (or) dangerous factors educational process on the state of their health and the identification of medical contraindications to continue their studies (clause 5 of the Order). Periodic inspection is carried out at regular intervals established by law.
It is important! All types of examinations of minors can be carried out only by medical organizations, regardless of their organizational and legal form, that provide primary health care to minors and have a license to carry out medical activities.
The procedure for conducting preventive examinations
By general rule The license of medical organizations in which preventive examinations can be carried out must provide for the performance of works (rendering of services):
- for preventive medical examinations;
- pediatrics or general medical practice (family medicine);
- neurology;
- ophthalmology;
- traumatology and orthopedics;
- pediatric surgery;
- psychiatry;
- pediatric dentistry or dentistry;
- pediatric urology-andrology or urology;
- pediatric endocrinology or endocrinology;
- otorhinolaryngology or otorhinolaryngology (with the exception of cochlear implantation);
- obstetrics and gynecology or obstetrics and gynecology (with the exception of the use of assisted reproductive technologies);
- laboratory diagnostics;
- clinical laboratory diagnostics;
- functional diagnostics;
- ultrasound diagnostics;
- radiology.
A prerequisite for conducting preventive examinations of minors is that a medical organization has a license to carry out medical activities, which provides for the performance of work (provision of services) for preventive medical examinations, pediatrics or general medical practice (family medicine). However, for certain types of medical activities listed above, a medical organization may not have a license. In this case, it attracts specialists from other medical organizations that are licensed to perform the required work (services). For this, relevant agreements are concluded between medical organizations.
In addition, clause 11 of the Procedure provides interchangeability medical specialists conducting preventive examinations. For example, if a medical organization does not have a pediatric urologist-andrologist, then a urologist or a pediatric surgeon who has been trained in additional professional education programs in terms of the features of urological diseases in children is involved in the preventive examination. At the same time, a medical organization must have a license to carry out medical activities, providing for the performance of work (rendering of services) in urology or pediatric surgery, respectively.
In the absence of a pediatric dentist in a medical organization, a dentist who has been trained in additional professional education programs in terms of the characteristics of dental diseases in children is involved in the preventive examination. At the same time, a medical organization must have a license to carry out medical activities, providing for the performance of work (provision of services) in dentistry.
If the medical organization does not have the services of a pediatric endocrinologist, then an endocrinologist who has been trained in additional professional education programs in terms of the characteristics of endocrinological diseases in children is involved in the preventive examination, provided that the medical organization has a license to carry out medical activities, providing for the implementation works (provision of services) in endocrinology.
In the absence of a child psychiatrist (adolescent psychiatrist) in a medical organization, a psychiatrist who has been trained in additional professional education programs in terms of the characteristics of mental disorders and behavioral disorders in children is involved in the preventive examination. In this case, the medical organization must have a license to carry out medical activities, providing for the performance of work (provision of services) in psychiatry.
It is important! The list of studies carried out during preventive examinations depends on the age of the minor.
Information about the preventive examination is entered in medical records of a minor(history of child development). It must contain the following information:
1) history data:
- about previous diseases (conditions), the presence of functional disorders, chronic diseases, disability;
- on the results of the dispensary observation (if any) indicating the diagnosis of the disease (condition), including the code according to the International Statistical Classification of Diseases and Related Health Problems (ICD);
2) data obtained during the preventive examination:
– objective data and results of examinations by medical specialists;
– results of laboratory, instrumental and other studies;
- the results of additional consultations and studies not included in the list of studies during preventive examinations and appointed during the preventive examination;
- diagnosis of a disease (condition) detected (established) during a preventive examination, indicating the ICD code, whether it was detected for the first time or not;
3) assessment of physical development;
4) juvenile health group;
- for the formation healthy lifestyle life, daily routine, nutrition, physical development, immunoprophylaxis, physical education;
- on the need to establish or continue dispensary observation, including the diagnosis of the disease (condition) and the ICD code, for treatment, medical rehabilitation and sanatorium treatment, indicating the type of medical organization (sanatorium and resort organization) and the specialty (position) of the doctor.
Such requirements for the execution of medical documentation are contained in clause 21 of the Procedure. In addition, according to the results of a preventive examination in a medical organization, an accounting form No. 030-PO / y-12 “Card of preventive medical examination of a minor” is filled out, given in Appendix 2 to the Order of the Ministry of Health of Russia dated December 21, 2012 No. 1346n.
The procedure for conducting preliminary inspections
A prerequisite for conducting preliminary examinations of minors is that a medical organization has a license to carry out medical activities that provide for the performance of work (rendering services) for medical examinations (preliminary, periodic), pediatrics or general medical practice (family medicine). Other types of work (services) are similar to those provided by the license required for routine inspections. However, for certain types of medical activities from among them, a medical organization may not have a license. In this case, it attracts specialists from other medical organizations that have a license to carry out medical activities in terms of performing the required work (services). Cooperation between medical organizations is carried out on the basis of relevant agreements.
It is important! According to clause 29 of the Procedure, during preliminary examinations, the interchangeability of medical specialists is also possible.
To pass a preliminary examination upon admission to an educational institution, a minor (his legal representative) must write statement in the name of the head of the medical organization. According to paragraph 31 of the Procedure, the following information must be indicated in the application for a preliminary examination of a minor:
- type of medical examination (preliminary);
- surname, name, patronymic of a minor entering an educational institution; date of birth and residential address;
- the full name of the medical organization providing primary health care to a minor, the address of its location;
- the full name and type of educational institution where the minor will study, the address of his location;
- details (series, number, insurance medical organization) of the compulsory medical insurance policy;
- contact information (for example, home and mobile phone numbers, e-mail).
The application must be signed and indicate the surname, initials and date of completion by the minor himself or his legal representative. If the application is made by the legal representative of the minor, then it shall indicate the details of the documents confirming the authority of the representative, and copies of the said documents shall be attached to the application. It is subject to registration in a medical organization and is the basis for registration directions for a preliminary inspection. The following information is indicated in the direction:
- list of examinations and examinations by medical specialists;
- date and place of inspections;
- information about the pediatrician, district pediatrician, general practitioner (family doctor) of the medical organization responsible for the preliminary examination.
According to clause 32 of the Procedure, the direction drawn up in the prescribed manner is handed over to the applicant by an authorized official within 5 working days from the date of registration of the application.
To undergo a preliminary examination, a minor must independently arrive at a medical organization on time, present a referral and a policy of compulsory medical insurance. A minor under the age of 15 arrives at a medical organization accompanied by a parent or other legal representative.
Preliminary examinations of minors are carried out in two stages. At the first stage, medical specialists conduct examinations, perform laboratory, instrumental and other studies provided for in Section 2 of the List of studies during preliminary medical examinations. Those entering the kindergarten are examined by 8 specialists, including a psychiatrist and a gynecologist (urologist), they take urine, feces and blood tests, including glucose levels. Before entering school, you will additionally need to undergo an examination by an orthopedic traumatologist, do an ultrasound scan of the abdominal cavity, reproductive organs, heart, thyroid gland, as well as electrocardiography. In the absence of suspicions that the minor has an undiagnosed disease (condition) and (or) the need to obtain information about the state of health of the minor from other medical organizations in accordance with paragraph 8 of part 4 of Art. 13 of Federal Law No. 323-FZ preliminary inspection is considered completed. The duration of the first stage of the preliminary inspection should be no more than 10 working days (clause 38 of the Procedure).
At the second stage, additional consultations, studies are carried out, which are appointed in accordance with clause 36 of the Procedure, and (or) information about the state of health of a minor is requested from other medical organizations. This stage is carried out only in case of suspicion of the presence of a disease (condition) in a minor, the diagnosis of which cannot be established during examinations by specialist doctors and studies included in section. 2 of the List of studies during preliminary medical examinations, and (or) the need to obtain information about the state of health of a minor from other medical organizations.
The total duration of the two stages of the preliminary inspection should be no more than 30 working days (clause 38 of the Procedure).
Preliminary inspection information are entered in the medical documentation of the minor (the history of the development of the child). The nature of the information is similar to that indicated when registering the results of a preventive examination. Based on the data on the preliminary examination, the doctor responsible for its conduct determines the health status group of the minor and the medical group for physical education, and also draws up a medical report on the minor's belonging to the medical group for physical education (in relation to minors entering educational institutions that provide physical education classes). In addition, when processing the results of a preliminary examination, it is required to issue a child’s medical record for educational institutions of preschool, primary general, basic general, secondary (complete) general education, primary and secondary vocational education institutions, orphanages and boarding schools and (or) a medical certificate for minors entering institutions of primary, secondary and higher professional education. The medical record (certificate) contains information about the state of health and an assessment of the minor's compliance with the requirements for education. These documents are drawn up in one copy, which is issued to the minor or his legal representative.
The procedure for conducting periodic inspections
According to clause 42 of the Procedure, periodic inspections are organized educational organizations. Such examinations are carried out annually and only in relation to minors enrolled in full-time. The license of a medical organization in which periodic examinations are carried out must provide for the performance of work (provision of services) for medical examinations (preliminary, periodic), pediatrics or general medical practice (family medicine). At the same time, the educational institution has the right to organize conducting periodic inspections in structural unit carrying out medical activity (for example, in a medical center, medical unit, etc.). In this case, the educational organization must have a license to carry out medical activities, providing for the performance of work (provision of services) in pediatrics.
Periodic inspections are carried out on the basis of lists, drawn up in an educational institution, in which minors are listed by name, subject to periodic examination in the coming calendar year. The list contains the following information:
- surname, name, patronymic, age (date, month, year of birth) of the student;
- full name and address of the medical organization in which the minor receives primary health care.
The list is approved by the head (authorized official) of the educational institution, after which it is sent to a medical organization with which an agreement has been concluded on conducting periodic examinations. This must be done no later than 2 months before the start of the calendar year. When changing the number of minors subject to periodic examinations, the head (authorized official) of the educational institution is obliged to submit an updated list to the medical organization before the 20th day of the current month.
Based on the list in a medical organization, a schedule for periodic inspections. Responsibilities for its compilation are assigned to the head (authorized official) of the medical organization. This document contains the following information:
- pediatrician, district pediatrician, general practitioner (family doctor) of a medical organization responsible for conducting periodic examinations;
- laboratory tests, date and time of their conduct;
- the number of minors in each age group.
The plan must be agreed with the head (authorized official) of the educational institution, and also approved by the head (authorized official) of the medical organization no later than one month before the start of the calendar year. After the plan is brought to the attention of medical professionals involved in the periodic examination.
Note!
If periodic examinations are carried out in a structural unit of an educational institution that carries out medical activities, the list and plan are compiled by the pediatrician of this institution and agreed with its head (authorized official).
For the passage of a periodic examination, each student is issued direction. It must indicate the date, time and place of the inspection. The authorized official shall hand over the referrals to minors or their legal representatives no later than 5 working days before the start of the periodic inspection. Obligation to ensure the presence of minors for periodic medical examinations is assigned to the head (authorized official) of the educational institution.
To undergo a periodic examination, a minor must independently arrive at a medical organization or at a structural unit of an educational institution that carries out medical activities within the prescribed period and present a referral and a policy of compulsory medical insurance. Periodic examinations of minors are carried out in accordance with Sec. 3 of the List of studies during periodic medical examinations, given in Appendix 1 to the Procedure.
Data on the passage of a periodic examination is entered into the medical documentation of the minor - the history of the development of the child and the child's medical record for educational institutions. These documents contain information about the state of health of the minor and a conclusion on the presence (absence) of medical contraindications for continuing education. If a periodic examination is carried out in a structural unit of an educational institution, then data on its passage are entered only in the child's medical record for educational institutions.
