Chapter 10 Fundamentals of Expertise of Work Ability

The concept of working capacity

Work capacity- a set of physical and spiritual capabilities of a person (depending on the state of his health), allowing him to engage in labor activities. The medical criterion for work capacity is the presence of a disease, its complications and prognosis.

Medical and social criteria should always be clearly defined and reflected in the patient's outpatient card.

Medical criterion is leading in establishing the fact of incapacity for work. However, it is not always the disease that is a sign of disability.

Examination of working capacity

The main task of the examination of the ability to work is to determine the ability of a given person to fulfill his professional duties, with the obligatory consideration of medical and social criteria. Besides, the tasks of a medical examination of working capacity include:

determining the treatment and regimen that are necessary to restore and improve human health;

determination of the degree and duration of incapacity for work due to illness, accident or other reasons;

identification of long-term or permanent disability and referral of such patients to the medical and social expert commission.

By type, temporary work ability can be:

disease

1. pregnancy and childbirth

   adoption from a maternity hospital

   Spa treatment

   for the period of medical rehabilitation

   quarantine

   for prosthetics

   caring for a sick family member

   when switching to light work

Temporary disability by nature is divided into: full and partial.

Complete incapacity for work- this is the impossibility of performing any work by a person due to illness and the need for a special treatment regimen.

Partial incapacity for work- this is incapacity for work in one's profession while maintaining the ability to perform other work. If a person can work in lighter conditions or perform a smaller amount of work, then he is considered partially disabled.

When examining a disability, a doctor sometimes has to meet with manifestations of aggravation and simulation.

Aggravation- patient exaggeration of the symptoms of a really existing disease. With active aggravation, the patient takes measures to deteriorate his health or prolong the disease.

At passive aggravation it is limited to exaggerating individual symptoms, but does not accompany them with actions that interfere with the treatment.

Pathological aggravation typical for mental patients (hysteria, psychopathy, etc.), being one of the manifestations of these diseases.

Simulation- a person's imitation of the symptoms of a disease that he does not have.

The concept of a certificate of incapacity for work

Documents certifying temporary disability and confirming temporary release from work (study) are certificate of incapacity for work(sick leave) and, in some cases, reference, fixed or freeform.

Functions of the certificate of incapacity for work:

legal - certifies the right to be released from work for a certain period

statistical - is an accounting document for reporting and analyzing the incidence of temporary disability

financial is a document that gives the right to receive social insurance benefits in accordance with current legislation

Functions of the certificate of incapacity for work:

legal

statistical

Forms of certificates of incapacity for work are documents of strict accountability. They should be stored in fireproof cabinets in rooms that should be sealed outside of working hours. All health authorities and medical institutions are required to keep accurate quantitative records of the availability, receipt and consumption of forms of sick leave. If a patient loses a certificate of incapacity for work, a duplicate is issued by the institution that issued the certificate of incapacity for work, upon presentation of a certificate from the place of work that this time has not been paid for with benefits. Disability certificates are issued to patients and patients upon presentation of their identity document.

Features of issuing a certificate of incapacity for work

There are two ways to issue certificates of incapacity for work:

centralized

decentralized.

Centralized The way of issuing a certificate of incapacity for work is more common in large polyclinics, where a nurse is located in the registry or in a separate office to issue a certificate of incapacity for work, who, on the basis of a doctor's certificate (coupon), writes out a certificate of incapacity for work and registers its issuance in the "Book of registration of certificates of incapacity for work."

With a decentralized system the issuance of a certificate of incapacity for work, the document is written out by the doctor himself, who receives the forms of the certificate of incapacity for work on receipt from the persons appointed by the chief doctor and responsible for keeping them.

Doctors are required to report on the expenditure of sick leave by handing over the stubs of previously received forms. Doctors bear personal responsibility for the safety of the received forms of sick leave.

The issuance and extension of a document certifying temporary disability is carried out by a doctor after a personal examination and is confirmed by a record justifying temporary release from work in medical records.

All columns of the certificate of incapacity for work are filled out in clear handwriting, without errors and corrections, in ink or paste in accordance with the instructions.

The diagnosis of the disease, in order to observe medical confidentiality, is made with the consent of the patient, and in case of his disagreement, only the reason for the disability is indicated (illness, caring for a child, etc.).

Exception in the sheets of incapacity for work is put down a code in the following cases of incapacity for work:

injuries and poisoning in accidents at work

injuries and poisoning on the way to and from work in the performance of public duties, the duty of a citizen of the Russian Federation

trauma and poisoning in everyday life

1. exemption from work in connection with quarantine and bacterial carriers

free, which is assigned in two cases - with additional leave for tuberculosis patients or with maternity leave (prenatal and postnatal)

sick leave is prescribed for treatment in a hospital

bed - if it is impossible to visit the clinic

bed with a visit to the clinic - with this regime, the patient should mainly be in bed, but on certain days and hours he can visit the clinic

sanatorium - during treatment in sanatoriums, dispensaries, boarding houses

outpatient

nursing

Disability certificates are issued:

Russian citizens, foreign citizens, including citizens of the CIS member states, stateless persons, refugees and internally displaced persons working in enterprises, organizations and institutions of Russia, regardless of their form of ownership;

in accordance with the Agreement "On the procedure for providing medical care to citizens of the member states of the Commonwealth of Independent States";

foreign citizens of other states are issued an extract from the medical history indicating the timing of temporary disability;

citizens who have a disability or maternity leave within a month after being dismissed from work for valid reasons;

citizens recognized as unemployed and registered with the territorial bodies of labor and employment of the population;

former servicemen dismissed from military service from the Armed Forces of Russia upon the onset of disability within a month after dismissal;

when providing medical care under contracts with citizens or organizations (on a paid basis), a certificate of incapacity for work is issued on a general basis in accordance with the established procedure.

Disability certificates are not issued:

not working;

upon the onset of incapacity for work during the leave without pay;

for prosthetics in outpatient settings;

caring for a sick family member during the next vacation;

for the period of periodic medical examinations in the occupational pathology departments of hospitals and clinics of the Research Institute of Occupational Hygiene and Occupational Diseases.

Features of the examination of temporary incapacity for work

The examination of temporary disability is organized in polyclinics if there are at least 15 doctors in their staff. The expertise includes the chairman - chief physician or (in large medical institutions) his deputy for medical and labor expertise, the head of the relevant department and the attending physician. If necessary, the heads of specialized offices can be involved in consulting patients. The specific composition of the commission is appointed by the head of the medical institution.

Doctors on the commission decide the following issues:

resolves complex and conflicting issues of medical and labor expertise;

authorizes the extension of the certificate of incapacity for work for more than 30 days and carries out systematic control over the validity and correctness of their issuance;

issues an opinion on the need for transfer to another job, release from work on the night shift, etc.;

issues extra pay certificates of incapacity for work in case of temporary transfer to another job for patients with tuberculosis and occupational diseases;

issues certificates of incapacity for work for spa treatment, as well as for special treatment in another city;

directs patients to medical social expertise.

Functions of the attending physician during the examination of temporary disability:

establishes the fact of temporary incapacity for work of the sick person, taking into account the nature of his work and working conditions;

identifies possible cases of simulation and aggravation;

issues a certificate of incapacity for work individually and at a time for up to 10 calendar days and extends it individually for up to 30 calendar days;

registers in the relevant documents anamnestic and objective data that served as the basis for issuing a certificate of incapacity for work;

monitors the exact implementation of the patient's medical prescriptions and the prescribed regimen;

identifies signs of disability;

promptly directs the patient for consultation to the head of the department and to the clinical expert commission to resolve the issue of further treatment and extension of the certificate of incapacity for work or referral of the patient to a medical and social examination.

Duties of the head of the department during temporary examination of incapacity for work:

The head of the department during the examination of temporary disability is responsible:

for the setting and quality of the examination in the department;

provides consultations to treating doctors on diagnostics, treatment and employment of patients;

authorizes the extension of sick leave beyond 30 days;

carries out selective control over the initially issued certificates of incapacity for work;

controls the timeliness and completeness of examination, diagnosis and treatment of patients;

controls the correctness of the issuance, execution, extension and closing of certificates of incapacity for work;

carries out organizational and methodological guidance and control over the work of attending physicians in the study and prevention of morbidity with temporary disability and disability;

together with the attending physician, issues a certificate of incapacity for work for the entire period of stay in the inpatient department upon discharge from it.

The position of the deputy chief physician for the examination of temporary disability is established when the number of posts of outpatient doctors due to the polyclinic is at least 25.

Duties of the deputy chief physician for examination of incapacity for work:

organizes and supervises the activities of attending physicians and heads of departments on issues of medical labor expertise;

examines complaints from the public on expert examination and takes the necessary measures;

is the chairman of the commission;

quarterly organizes medical conferences on morbidity and errors in the examination of temporary work ability;

If a medical institution does not have the position of a deputy chief physician for the examination of temporary disability, then his functional duties are performed by the chief physician of this medical institution.

Issuance of a certificate of incapacity for work in case of illness,

trauma or abortion

A certificate of incapacity for work is issued to a patient who is at work for a period from the onset of the disease to the restoration of working capacity or the onset of permanent incapacity for work (disability). In case of abortion surgery, a certificate of incapacity for work is issued from the first day for the entire period of incapacity for work, but not less than 3 days, including with a mini-abortion.

In case of diseases and injuries, the attending physician issues a certificate of incapacity for work at a time for up to 10 calendar days and extends it individually for up to 30 calendar days, taking into account the approximate terms of temporary incapacity for work for various diseases and injuries approved by the Ministry of Health of Russia.

Features of drawing up a certificate of incapacity for work

Citizens who are outside their permanent place of residence (business trip, vacation, etc.), a certificate of incapacity for work is issued (extended) by the attending physician who established the fact of incapacity for work, with the permission of the administration of the medical institution, taking into account the days required to travel to the place of residence. Such a certificate of incapacity for work is stamped with the official (round) seal of the medical institution.

When a temporarily disabled person who has a certificate of incapacity for work leaves the place of permanent residence, its extension in another place is allowed only if there is a conclusion of the attending and chief physician or the clinical expert commission on the possibility of leaving.

Documents confirming the temporary disability of Russian citizens during their stay abroad, upon their return, must be replaced with a certificate of incapacity for work by the attending physician with the approval of the administration of the medical institution.

In the event that a disease or injury that caused temporary disability was the result of alcoholic, narcotic, non-narcotic intoxication, the certificate of incapacity for work is issued with a corresponding note about the fact of intoxication in the medical history (outpatient card) and in the certificate of incapacity for work.

In case of temporary incapacity for work of women on parental leave, or persons caring for a child who work part-time or at home, a certificate of incapacity for work is issued on a general basis.

Citizens sent by a court decision for a forensic medical or forensic psychiatric examination, recognized as incapable of work, are issued a certificate of incapacity for work from the date of admission for examination.

For outpatient treatment of patients for the period of invasive methods of examination and treatment (endoscopic studies with biopsy, chemotherapy using the intermittent method, hemodialysis, etc.), a certificate of incapacity for work, by the decision of the clinical expert commission, may be issued intermittently, on the days of arrival at a medical institution ... In these cases, the days are indicated on the certificate of incapacity for work procedures, and release from work is made only for these days.

In the event of temporary disability during the period of unpaid leave, maternity leave, partially paid parental leave, a certificate of incapacity for work is issued from the date of the end of the said leave in case of continuing disability.

In case of temporary incapacity for work that has arisen during the period of the next annual leave, including during sanatorium treatment, a certificate of incapacity for work is issued in the manner prescribed by the Instruction.

Citizens who independently apply for advice, undergo research in outpatient and inpatient institutions in the direction of military commissariats, investigative bodies, prosecutors and the court, are issued certificates of arbitrary form.

In case of illness of students and pupils of secondary and higher educational institutions, a certificate of the established form is issued to release them from studies.

Terms of issuance of a certificate of incapacity for work for pregnancy and childbirth

For pregnancy and childbirth, a certificate of incapacity for work is issued by an obstetrician-gynecologist, and in its absence - by a doctor conducting a general appointment for the following periods:

in the absence of complications from 30 weeks of pregnancy lasting 140 calendar days (70 days before delivery and 70 days after delivery)

with multiple pregnancies - from 28 weeks of gestation to 180 days

in case of complicated childbirth, a certificate of incapacity for work is issued for an additional 16 calendar days. In these cases, the total duration of prenatal and postnatal leave is 156 calendar days (70 + 16 + 70)

Features of issuing a certificate of incapacity for work for pregnancy and childbirth:

In case of childbirth before 30 weeks of pregnancy and the birth of a live child, a certificate of incapacity for work for pregnancy and childbirth is issued by a medical and preventive institution where the birth took place for 156 calendar days, and in case of a stillbirth or death within the first 7 days after birth - for 86 calendar days (70 + 16).

When pregnancy occurs while a woman is on partially paid leave or additional leave without retention wages for child care, a certificate of incapacity for work is issued on a general basis.

If a pregnant woman is registered with a medical institution when the pregnancy is up to 12 weeks, she is issued a certificate that is attached to the certificate of incapacity for work for pregnancy and childbirth and is paid at the rate of 50% of the minimum wage along with a certificate of incapacity for work (one-time childbirth allowance) ...

In the event that a woman, for some reason, did not use her right to timely registration of maternity leave or in the event of premature birth, a certificate of incapacity for work for the entire period of maternity leave is issued by an antenatal clinic or a maternity hospital. At the same time, the maternity clinic and the maternity hospital do not issue a certificate of incapacity for work.

For a woman who has adopted newborn baby, the certificate of incapacity for work is issued by the hospital at the place of his birth for 70 calendar days from the date of birth.

In the case of embryo replanting, a certificate of incapacity for work is issued by the operating physician for the period from the moment of hospitalization to the establishment of the fact of pregnancy.

Features of issuing a certificate of incapacity for work in case of complicated childbirth:

Currently under the term "Complicated labor" means the following conditions:

multiple births

childbirth that was accompanied or immediately preceded by severe nephropathy (kidney disease), preeclampsia, eclampsia

childbirth accompanied by the following obstetric operations ( caesarean section and other gluttony during childbirth, classical or combined rotation of the fetus on the pedicle, the imposition of obstetric forceps, extraction of the fetus using a vacuum extractor, fruit-destroying operations, manual separation of the placenta, manual or instrumental examination of the uterine cavity)

childbirth accompanied by significant blood loss, causing secondary anemia

childbirth accompanied by a rupture of the cervix of the III degree, rupture of the perineum of the III degree, divergence of the bottom articulation

childbirth complicated by postpartum diseases: endometritis, thrombophlebitis, inflammation of the pelvic peritoneum and cellulose, sepsis, purulent mastitis

childbirth in women suffering from diseases of the heart and blood vessels

childbirth in women with other chronic diseases (eg, chronic lung disease, amyloidosis, hepatitis)

premature birth and childbirth with an immature fetus, regardless of the gestational age, if the postpartum woman was discharged with a living child (fetal immaturity is determined by a commission-related act with a record in the history of the development of the newborn)

childbirth in women after in vitro fertilization and embryo transfer into the uterine cavity (ECOiPE)

The provision of postnatal leave for an additional 16 days (with the birth of two or more children - for 40 days) is formalized by the doctor of the antenatal clinic, polyclinic, rural medical outpatient clinic on the recommendation of the medical institution in which the birth took place. In this case, in the "exchange card of the maternity hospital, the maternity ward of the hospital" in the section "information of the maternity hospital, the maternity ward of the hospital about the postpartum woman", clause 15 "special remarks" is written: "86 (110) days postnatal leave" or "additional postnatal leave for 16 (40) days ".

In cases where a woman temporarily left her place of permanent residence during the period of prenatal leave, a certificate of incapacity for work for an additional period of postnatal leave must be issued by the medical institution in which the birth took place, regardless of the woman's place of permanent residence.

If a complicated delivery took place outside a medical institution, then when granting postnatal leave for 86 (110) days, the attending physician may, if necessary, consult with the medical worker who took the delivery.

Examination of working capacity- this is a type of examination, which consists in determining the reasons, duration, degree of temporary or permanent disability of a person due to illness, injury or other reason, as well as determining a person's need for certain types of medical care and social protection measures.

Disability- the impossibility, due to medical or social contraindications, to continue the usual professional activity. Establishment of incapacity for work has legal significance, as it releases from work, provides free treatment under the SGBP and benefits from social insurance funds. Disability may be temporary and persistent. WITH permanent disability or disability - permanent (or long-term), complete or partial loss of ability to work.

When conducting an examination of the ability to work, medical and social criteria are distinguished. Medical criteria include timely installed, correct and complete clinical diagnosis taking into account the severity of morphological changes, the degree of functional disorders, the severity and nature of the course of the disease, the presence of decompensation and its stage, complications. Great importance has a clinical diagnosis based on the analysis of treatment results, reversibility of morphological and functional changes, the nature of the course of the disease and the possibility of eliminating complications. Social criteria

determine the labor prognosis for a specific disease and specific working conditions of the patient, reflect everything that is associated with his professional activity (stress, occupational hazards, etc.).

14.2. Examination of temporary disability

Temporary disability(VUT) - temporary disability - a state of the human body caused by a disease or injury, in which it is impossible to perform professional work in normal production conditions for a relatively short period of time, i.e. the inability to perform labor functions is temporary, reversible.

VUT is established for the entire period of the disease with a favorable prognosis; with an unfavorable prognosis, it continues until a permanent disability is revealed.

VUT is established for persons who have lost the ability to work due to illness or injury, but it can also be established with preventive purpose in case of quarantine or spa treatment. Indications of a social order are possible, when the release from work of an able-bodied person is associated with caring for a sick family member, carriage of the pathogen, deworming, etc. Temporary disability is subdivided into full and partial.

Full VUT- This is the loss of the working ability to work for a certain period and the need for a special regime and treatment. Partial VUT- such a condition of a sick person (injured) when he is temporarily unable to perform his usual professional work, but without harm to his health can perform other work, with a different regime and volume.

The examination of VUT includes an assessment of the patient's health status, the quality and effectiveness of the examination and treatment, the ability to carry out professional activities, as well as the determination of the degree and terms of VUT.

In health care facilities, the following levels of VUT expertise are distinguished: attending physician; medical commission (VK) of a medical facility; the medical commission of the health management body of the municipal formation,

included in the subject of the Federation; expert commission of the healthcare management body of the constituent entity of the Federation; chief specialist in the examination of high-tech standards of the Ministry of Health and Social Development of the Russian Federation.

The examination of VUT is carried out by attending physicians in medical institutions, regardless of their level, profile, departmental affiliation and form of ownership, subject to a license for this type of medical activity.

Therapist, carrying out the examination of VUT:

Determines the signs of VUT based on an assessment of health status, the nature and conditions of work, social factors;

Issues a certificate of incapacity for work (certificate) in accordance with the "Instruction on the procedure for issuing documents certifying the temporary incapacity for work of citizens" (including when visiting at home);

During subsequent examinations, it reflects the dynamics of the disease, the effectiveness of the treatment, justifies the extension of the release from work;

Timely directs the patient for consultation to the VC in order to determine further treatment and resolve other expert issues (this is how, for example, a private practitioner acts if it is necessary to extend the certificate of incapacity for work for more than 30 days).

Head of the department of a hospital, polyclinic(in the presence of a position in the staffing table) carries out constant control over the performance of the functions of the attending physicians for the organization and conduct of the treatment and diagnostic process and examination of the VUT, for the issuance of documents certifying the VUT of citizens, the timely and correct referral of patients to the VC and medical and social expertise; conducts an expert assessment of the CMP at different periods of treatment with a mandatory examination of the patient and a record in the primary documents, and also carries out an expert assessment of medical documentation at the end of the VUT period or when the patient is transferred to another stage of treatment, etc.

Deputy head of the institution(chief physician, chief, head) for clinical and expert work, heads the VC and provides conditions for its work; carries out selective monitoring of completed cases of patient treatment

ent and examination of VUT, takes part in the solution of clinical and expert issues; analyzes clinical expert errors, reports at medical conferences the results of the analysis of the examination and measures taken to reduce the incidence of TD.

Head of a healthcare institution is responsible for the examination of VUT in health care facilities, issues orders on its organization and implementation; organizes accounting and reporting on VUT; approves the composition of the VC, the rules of its work; determines the need for forms of certificates of incapacity for work, annually within the established time frame (by 15.01) sends an application to the territorial health authority for the required number of forms and reports on their use.

Difficult cases on CUT issues are brought to the meeting

Is the activity of VK established by order of the Ministry of Health and Social Development of the Russian Federation? 513-n dated September 24, 2008 "On Approval of the Regulations on the Medical Commission of a Medical Organization", which in more detail (in comparison with the similar order of the Ministry of Health and Social Development of Russia No. 170 dated March 14, 2007) describes the functions of the commission (for details on VK see section 12.3).

Chief freelance specialist on the clinical and expert work of the Ministry of Health and Social Development of Russia, the health management body of the constituent entity of the Federation and the municipal formation that is part of the constituent entity of the Federation, analyzes the state and quality of the examination of high-tech education in subordinate institutions.

Incapacity for work certifies VUT and confirms temporary release from work (study); in some cases, it is replaced by certificates of the established form, issued to citizens with diseases and injuries for a period medical rehabilitation, if it is necessary to care for a sick family member, a healthy child under 3 years old, for the quarantine period, during maternity leave, with prosthetics in a prosthetic and orthopedic hospital.

A certificate of incapacity for work, or sick leave, is the main document certifying the VUT. It gives the right not to go to work, on vacation and to receive cash benefits from social insurance funds.

The issuance and renewal of a document certifying a VUT is carried out by a doctor after a personal examination and is confirmed by an entry in the medical documentation justifying the temporary release from work. The document certifying the VUT is issued and closed, as a rule, in one medical facility, if indicated, it can be extended in another medical facility

Disability certificate for care for a patient, a medical facility doctor is issued in cases where the lack of care threatens the life and health of the sick person; it is impossible to put him in the hospital; there is no other unemployed person among the family members who can take care of the sick person. A certificate of incapacity for work for patient care is issued by the attending physician to one of the family members (guardian) who is directly caring for the patient. All relatives living in the same family with the sick person are considered family members.

Issuance of sick leave in case of an industrial accident. An industrial accident should be considered the impact on a working hazardous production factor in the performance of work duties or tasks of work supervisors. Loss of ability to work is equated to accidents at work:

1) when performing donor functions;

2) when performing state or public duties, as well as when performing special tasks of public organizations, even if these tasks were not related to the main work;

3) when fulfilling the duty of a citizen of the Russian Federation to save human life, to protect state property, as well as to protect state law and order;

4) on the way to and from work (not on the company's transport);

5) on a business trip.

Work-related injuries are investigated, recorded and documented in an act of the established form. Investigation of an occupational injury case must be carried out within 24 hours from the moment of the accident.

Accidents on the way to work (from work) are investigated within 3 days from the moment of their establishment. In the event of an accident (at work and at home), a certificate of incapacity for work is issued from the date of contacting a doctor for help. Allowance for temporary non-

disability due to an industrial accident is paid at the rate of 100% of wages.

In the event of an injury at home, the certificate of incapacity for work is paid from the 6th day of incapacity for work on a general basis.

Terms of issuance of a certificate of incapacity for work in case of diseases and injuries and the amount of compensation. The attending physician issues a certificate of incapacity for work individually and at a time for up to 10 calendar days and extends it individually for up to 30 calendar days, taking into account the approximate terms of temporary incapacity for work for various diseases and injuries approved by the Ministry of Health and Social Development of Russia.

In accordance with the amendments to the Federal Law? 255-FZ "On the provision of benefits for temporary disability, pregnancy and childbirth of citizens subject to compulsory social insurance" the first two days of lost earnings are compensated by the employer, hereinafter - the FSS. With an insurance experience of up to 5 years, the allowance will be paid in the amount of 60% of the average earnings, from 5 to 8 years - 80%, and over 8 years - 100%.

EXPERTISE OF EMPLOYMENT 1. Principles of examination of working ability. 2. Examination of temporary disability. 3. Spa treatment and medical rehabilitation. 4. The order of registration and storage of certificates of incapacity for work. 5. Examination of persistent disability. 6. Analysis of morbidity with temporary disability.

Principles of the examination of the ability to work 1. The right to resolve all issues related to the incapacity for work of citizens belongs to the state. 2. Preventive direction of expertise with maximum quick recovery work capacity and prevention of disability. 3. The collegiality of solving all issues with the simultaneous participation of several specialists and administration in its implementation. The bodies for the examination of the ability to work are: 1) medical and preventive establishments, regardless of their level, profile, departmental affiliation and forms of ownership, provided there is a license for this type of medical activity; 2) bodies of social protection of the population of various territorial levels; 3) trade union bodies.

The tasks of the examination of the ability to work: - a scientifically substantiated assessment of the state of the patient's ability to work with various diseases or anatomical defects; the establishment of the fact of the patient's incapacity for work and his release from work due to the presence of social and medical indications; determination of the nature of disability in a particular patient - temporary, persistent, complete or partial; establishing the reasons for the temporary or permanent disability of the patient to determine the amount of benefits, pensions and other types social security; rational employment of a patient who does not have signs of disability, but who, for health reasons, need to ease working conditions in their profession; determination of work recommendations for the patient, which can help him to use the residual working capacity; study of the levels, structure and causes of morbidity with temporary disability and disability at the site; definition different types social assistance in case of a patient's temporary incapacity for work or his disability; carrying out professional (labor) and social rehabilitation of patients.

The object of the study of the examination of the working capacity is the working capacity of a sick person. The criteria for the examination of the ability to work include the correct, timely clinical diagnosis, reflecting the severity of morphological changes, the degree of functional disorders, the severity and nature of the course of the disease, the presence of decompensation and its stage, complications. The immediate and long-term prognosis of the disease, the reversibility of morphological and functional changes, the nature of the course of the disease are of great importance. The social criteria for the examination of the ability to work reflect everything that is associated with the patient's professional activity. These include the characteristics of the prevailing physical or neuropsychic stress, the organization, the frequency and rhythm of work, the load on individual organs and systems, the presence of unfavorable working conditions and occupational hazards. In the examination of the ability to work, the clinical and work prognosis are related to each other and are interdependent. With a favorable clinical prognosis, as a rule, the labor prognosis is also favorable. In case of a doubtful or unfavorable clinical prognosis, it is necessary to take into account possible positive changes in the state of health under the influence of labor.

Examination of temporary incapacity for work Temporary incapacity for work in case of diseases internal organs it is subdivided into full and partial: - complete temporary disability - this is the loss of the working ability to work for a certain period and the need for a special regime and treatment; - partial temporary incapacity for work - a condition of a sick employee when he is temporarily unable to perform his usual professional work, but without harm to his health can perform other, with a different mode and volume of work. The examination of temporary disability is carried out in accordance with the Instruction "On the procedure for issuing documents certifying the temporary disability of citizens" dated 01.12.1994 No. 713, approved by order M 3 of the Russian Federation dated 19.10.1994 No. 206 "On approval of instructions on the procedure for issuing documents, certifying temporary disability of citizens ", current legislation and the Regulation" On the examination of temporary disability in medical and preventive institutions "dated 13.01.1995 No. 5. The entire organizational structure of the examination of temporary disability is regulated by the above Regulation and the current staffing table of institutions and health authorities.

There are five levels of examination of temporary disability: the first level - the attending physician; the second level - the clinical expert commission of the medical and preventive institution; the third level is the clinical expert commission of the healthcare management body of the territory included in the constituent entity of the Federation; the fourth level - the clinical expert commission of the healthcare management body of the constituent entity of the Federation; the fifth level - the chief specialist in the examination of temporary disability M 3 and social development of the Russian Federation. The physician therapist of the polyclinic is the initial link in the examination of temporary disability. During its implementation, he performs the following functional duties: 1) determines the signs of temporary disability based on an assessment of the state of health, the nature and conditions of work, social factors; 2) in the primary medical documents records the patient's complaints, anamnestic and objective data, prescribes the necessary examinations and consultations, formulates the diagnosis of the disease and the degree of functional disorders of organs and systems, the presence of complications and their severity, causing disability; 3) recommends medical and health-improving measures, the type of medical protective regime, prescribes additional examinations, consultations;

4) determines the terms of disability, taking into account the individual characteristics of the course of the main and concomitant diseases, the presence of complications and approximate terms of disability for various diseases and injuries; 5) issues a certificate of incapacity for work (certificate) in accordance with the instructions on the procedure for issuing documents certifying temporary incapacity for work of citizens (including when visiting at home), appoints the date of the next visit to the doctor (which makes a corresponding entry in the primary medical documentation). During subsequent examinations, it reflects the dynamics of the disease, the effectiveness of the treatment, justifies the extension of the patient's release from work; 6) promptly sends the patient for consultation to the clinical expert commission to extend the certificate of incapacity for work beyond the time limits established by the instructions on the procedure for issuing documents certifying temporary disability of citizens, resolving issues about further treatment and other expert issues; 7) in case of violation of the prescribed medical protective regime (including intoxication), makes an appropriate entry in the certificate of incapacity for work and, in the prescribed manner, in the medical history (outpatient card) indicating the date and type of violation;

8) identifies signs of persistent limitation of life activity and persistent disability, timely organizes the referral of the patient to the clinical expert commission and medical and social examination; 9) carries out clinical examination of long-term and frequently ill patients (citizens who have 4 or more cases and 40 days of temporary disability per year for one disease or 6 cases and 60 days, taking into account all diseases); 10) when restoring the ability to work and being discharged from work, reflects in the primary medical documents the objective status and reasoned justification for closing the certificate of incapacity for work; 11) analyzes the causes of morbidity with temporary disability and primary disability, takes part in the development and implementation of measures to reduce them; 12) constantly improves knowledge on the examination of temporary disability. He conducts his work on the examination under the supervision of the head of the department of therapy of the polyclinic. In the absence of the position of the head of the department in the staffing table, his functions are performed by the deputy head of the institution for clinical expert work.

At the suggestion of the attending physician and the head of the department, the clinical expert commission (CEC) of the medical and preventive institution makes decisions and gives opinions in the following cases: when extending the certificate of incapacity for work; in difficult and conflict situations, examination of temporary disability; when referred for treatment outside the administrative territory; when referring a patient to a medical and social examination; if it is necessary to transfer able-bodied persons for health reasons to another job or rational employment of persons with disabilities; in cases of claims and claims of medical insurance organizations and executive bodies of the Social Insurance Fund on the quality of medical care and the quality of examination of temporary disability; upon exemption from exams in schools, secondary and higher educational institutions, granting academic leave for health reasons.

The conclusions of the commission are recorded in the outpatient card, the book of records of the conclusions of the clinical expert commission, signed by the chairman and members of the commission. The head of the institution is responsible for the examination of temporary disability in a medical and prophylactic institution. Documents certifying temporary disability and confirming temporary release from work (study) are a certificate of incapacity for work and, in some cases, certificates of the established form issued to citizens in case of diseases and injuries, for the period of medical rehabilitation, if it is necessary to care for a sick family member, healthy child disabled for the period of quarantine, with maternity leave, with prosthetics in a prosthetic orthopedic hospital. The following persons have the right to receive sick leave: -workers and employees; members of collective farms, LLC, AOZT, OJSC; workers and employees working in military organizations or organs of the Ministry of Internal Affairs and who are not military personnel (secretaries, typists, waitresses, barmaids, nurses, doctors, etc.); foreign citizens (including citizens of the CIS member states) working at enterprises of the Russian Federation abroad, in organizations and institutions of the Russian Federation; refugees and internally displaced persons working at the enterprises of the Russian Federation; unemployed, registered with the territorial bodies of labor and employment; persons whose incapacity for work occurred within a month after being dismissed from work for a good reason; former military personnel dismissed from military service from the Armed Forces of the Russian Federation upon the onset of temporary disability within a month after dismissal.

Disability certificates are issued upon presentation of an identity document of the patient (passport or military ID for a soldier). The issuance and extension of a document certifying temporary disability is carried out by a doctor after a personal examination and is confirmed by an entry in the medical documentation justifying the temporary release from work. A document certifying temporary disability is issued and closed, as a rule, in one medical and prophylactic institution. Not eligible for sick leave: servicemen of all categories; graduate students and clinical residents; students of all categories; citizens performing work for private employers; persons working under a work contract, orders, etc.; unemployed and dismissed from work; patients who are under arrest or under compulsory treatment as determined by the court; persons who do not have an insurance policy.

In case of diseases (injuries), the local physician therapist issues a certificate of incapacity for work alone and at a time for up to 10 calendar days and can extend it alone for up to 30 calendar days, with a mandatory examination of the patient at least once every 10 days and taking into account the indicative terms of temporary disability for various diseases. Physicians engaged in private medical practice outside of a medical and prophylactic institution have the right to issue documents certifying temporary disability for a period not exceeding 30 days. V special conditions(in certain areas of rural areas) by decision of local health authorities, the issuance of certificates of incapacity for work may be allowed to the attending physician until the full recovery of the ability to work or referral to a medical and social examination. A certificate of incapacity for work is issued on the day of establishment of incapacity for work, including holidays and days off. It is not allowed to issue it for the past days when the patient was not examined by a doctor. In exceptional cases, a certificate of incapacity for work can be issued for the past period by decision of the KEC.

Citizens who applied for medical help at the end of the working day, a certificate of incapacity for work, with their consent, is issued from the next calendar day. Citizens sent by a health center to a medical and preventive institution and recognized as disabled are issued a certificate of incapacity for work from the moment they contact the health center. When patients refer to after hours for outpatient clinics (evening, night hours, weekends and holidays) for medical care for acute (exacerbation of chronic) diseases, poisoning or injuries at the ambulance station or in the admission departments of hospitals in cases that do not require inpatient observation and treatment, documents certifying temporary disability are not issued. A free-form certificate is issued indicating the date and time of treatment, diagnosis, examinations carried out, working capacity, medical care provided and recommendations for further patient management. In case of a shift nature of the patient's work, if he was disabled at the time of seeking medical help, on the basis of the above certificate, the doctor of the polyclinic at the place of constant observation issues a certificate of incapacity for work for the past period for the days when, according to the shift schedule, he was supposed to go to work, but no more three days. In the event of continuing incapacity for work, the certificate of incapacity for work is extended in accordance with the established procedure.

Citizens who are outside their permanent place of residence are issued (extended) by the attending physician who has established the fact of incapacity for work, with the permission of the administration of the medical and prophylactic institution, taking into account the days required to travel to the place of residence. Documents confirming the temporary disability of citizens during the period of their stay abroad, upon their return, must be replaced with a certificate of incapacity for work by the attending physician with the approval of his administration of the medical and prophylactic institution. Citizens who need treatment in special medical and prophylactic institutions are given a certificate of incapacity for work by the attending physicians with subsequent referral to institutions of the appropriate profile to continue treatment. Disabled citizens sent for consultation (examination, treatment) to a medical and prophylactic institution outside the administrative district, a certificate of incapacity for work is issued for the number of days required for travel, and is extended in accordance with the established procedure. If it is necessary to transfer a citizen to light work in the event of an occupational disease or tuberculosis, a certificate of incapacity for work is issued to him by the decision of the clinical expert commission for a period of not more than 2 months a year with the mark “extra paid certificate of incapacity for work”.

In cases where a disease or injury that caused disability was the result of alcoholic, narcotic, non-narcotic intoxication, a certificate of incapacity for work is issued with a corresponding note about the fact of intoxication in the medical history (outpatient card) and in the certificate of incapacity for work. Objective Clinical signs intoxication and the results of laboratory tests are recorded in the "Protocol of medical examination to establish the fact of alcohol consumption and intoxication." The primary medical documents indicate the conclusion about the presence of a state of intoxication and the number of the protocol: the journal of registration of cases of examination is filled in. In the certificate of incapacity for work, in the column "type of incapacity for work", a corresponding entry is made with the date and two signatures (the attending physician, the head of the department or a member of the KEC). In case of temporary incapacity for work of a woman on parental leave, or a person caring for a child, working part-time or at home, a certificate of incapacity for work is issued on a general basis.

For outpatient treatment of patients for the period of invasive methods of examination and treatment (endoscopic studies with biopsy, chemotherapy using the intermittent method, hemodialysis, etc.), a certificate of incapacity for work, by the decision of the clinical expert commission, may be issued intermittently, on the days of arrival at a medical institution. In these cases, the days of the procedures are indicated on the certificate of incapacity for work and the release from work is made only for these days. In the event of temporary disability during the period of unpaid leave, maternity leave, partially paid parental leave, sick leave in case of continuing disability is issued from the date of the end of the said leave. In case of temporary incapacity for work that has arisen during the period of annual leave, including during sanatorium and spa treatment, a certificate of incapacity for work is issued in the usual manner. Citizens who independently apply for advice, undergoing examination in outpatient polyclinic and inpatient institutions in the direction of military commissariats, investigative bodies, prosecutors and the court, are issued a certificate of arbitrary form. In case of illness of students (pupils) of secondary and higher educational institutions, a certificate of the established form is issued to release them from studies.

Sanatorium treatment and medical rehabilitation A certificate of incapacity for work is issued before departure to the sanatorium upon presentation of a voucher (voucher) and a certificate from the administration about the duration of regular and additional vacations. For sanatorium resort (outpatient resort) treatment, including boarding houses with treatment in the Mother and Child sanatoriums, in tuberculosis sanatoriums, it is issued for the number of days missing for the next and additional vacations and for the duration of the trip. With the total regular vacation for 2 - 3 years, its entire duration is deducted. In the case of using regular and additional vacations before leaving for a sanatorium and the administration provides unpaid leave for a number of days equal to the regular and additional vacations, a certificate of incapacity for work is issued for the period of treatment and travel, minus the days of the main and additional vacations. When a patient is sent to a rehabilitation center directly from hospital institutions, the sick leave is extended by the attending physician of the center for the entire period of aftercare or rehabilitation.

During the sanatorium and resort rehabilitation of liquidators of the accident at the Chernobyl nuclear power plant, as well as persons with diseases associated with radiation exposure, and working disabled people, whose permanent disability is associated with an illness due to radiation exposure, evacuated from the exclusion zone, liquidators of the consequences of an accident at the production association " Mayak "and other sick leave is issued for the entire period of treatment. When registering persons for treatment in rehabilitation centers, the following features must be taken into account. Vouchers to these centers are issued according to the order M 3 of the Russian Federation and social development. Warriors internationalists, participants in the Great Patriotic War, disabled military personnel who have such vouchers, receive sick leave for the entire period of validity of the voucher and the days of travel. When a disabled child under 16 years of age is sent to a health resort spa treatment in the health resort "Mother and Child", if there is a medical certificate on the need for individual care, a certificate of incapacity for work is issued to one of the parents (guardian) for the entire period of the child's sanatorium treatment, taking into account travel time

Citizens sent to rehabilitation clinics scientifically research institutes balneology and physiotherapy, a certificate of incapacity for work is issued by the attending physician of a medical and prophylactic institution on the basis of the conclusion of the KEC for the duration of treatment and travel and, if indicated, is extended by the attending physician of the institute clinic. A certificate of incapacity for work for patient care is issued by the attending physician to one of the family members (guardian) who directly cares for an adult family member and a sick teenager over 15 years of age receiving treatment in an outpatient clinic for up to 3 days, according to the decision of the KEC - up to 10 days; In case of temporary suspension from work of persons who have been in contact with infectious patients, or as a result of bacterial carriage, disability certificates are issued upon the recommendation of an epidemiologist at a medical and prophylactic institution, an infectious disease doctor or attending physician (quarantine). The duration of suspension from work in these cases is determined by the approved terms of isolation of persons who have undergone infectious diseases and in contact with them. Employees of public catering, water supply, children's institutions, if they have helminthiasis, a disability certificate is issued for the entire period of deworming.

The procedure for recording and storing certificates of incapacity for work The registration of sheets of certificates of incapacity for work issued by physicians is carried out in the registration logs (f. 036 / y). The damaged forms are stored in a separate folder with an inventory, which contains the surname, name, patronymic of the doctor, date of delivery, numbers and series. Destruction of damaged forms is carried out according to the act of the commission created by order of the head of the healthcare facility at the end of the calendar year, the backs of damaged and used forms are stored for 3 years, after which they are liquidated. Control over the observance of the procedure for recording, storing and issuing certificates of incapacity for work in state, municipal, private medical and prophylactic institutions, as well as a private practitioner, is carried out within the limits of its competence by a health management body of the corresponding level, a professional medical association, and an executive body of the Social Insurance Fund of the Russian Federation. Commissions (committees, bureaus) for accreditation and licensing of medical and pharmaceutical activities and subdivisions of territorial compulsory medical insurance funds can participate in the exercise of control. For violation of the procedure for issuing certificates of incapacity for work, the perpetrators bear disciplinary or criminal liability in accordance with the legislation of the Russian Federation.

Examination of persistent disability Permanent disability is a long-term or permanent disability or significant disability caused by a chronic disease that has led to a significant dysfunction of the body. Disability is established depending on the degree of disability. Establishing the fact of permanent disability is a complex and responsible act carried out by the medical and social expert commission (MSEC). A certain order of referral of the patient to MSEC has been established. The attending physician conducts a thorough clinical, laboratory, instrumental examination of the patient, if necessary, consults with various specialists, determines the conditions, nature and severity of work, the presence of occupational hazards, clarifies how the patient copes with work, his work installation vi presents the patient to the head of the department. The head of the department compares the data on functional disorders due to the disease with the working conditions of the patient, determines the ability to work, which is recorded in the outpatient card as his conclusion. If there are indications for referral to MSEC, the patient is sent to the clinical expert commission, which makes an appropriate decision. A citizen, on his own initiative, cannot apply to MSEC for a medical and social examination, he can only be sent for this purpose by an institution of health care and social development. Usually, patients in whom the disease has become stable are sent for medical and social examination. At the same time, temporary disability should not exceed 4 months.

To pass the MSEC, 3 documents are submitted: a passport, an open certificate of incapacity for work and a parcel sheet. The main document for referral to MSEC is "Referral to MSEC" (f. 088 / y), which indicates the number of issued certificates of incapacity for work, their beginning and end, as well as the reason for temporary incapacity for work. Mandatory are the conclusions of a therapist, neuropathologist, surgeon, ophthalmologist, and for women - a gynecologist. The diagnosis for referral to MSEC should be formulated in accordance with ICD 10 and contain a definition of the nosological form, the nature and degree of functional disorders, the stage of the disease, the course, indicating the frequency, duration and severity of exacerbations. In addition to the main diagnosis, all concomitant diseases should be reflected. The certificate of incapacity for work is filled in by the KEK, signed by its chairman and certified by the round stamp of the healthcare facility, the date of sending to the MSEK is indicated. Health care and social development institutions are responsible for the accuracy and completeness of the information specified in the direction for medical and social expertise, in the manner prescribed by the legislation of the Russian Federation.

A citizen is sent to MSEC after carrying out the necessary diagnostic, therapeutic and rehabilitation measures in the presence of data confirming a persistent violation of the functions of the body and systems. 1) With an obvious unfavorable clinical and labor prognosis, regardless of the timing of temporary disability, but not more than 4 months. In cases where the temporary disability of a disabled person is due to the progression of the underlying disease or concomitant disease with an obvious unfavorable clinical and labor prognosis, the patient should be referred for a medical and social examination as early as possible to change (cancel) labor recommendations and change the disability group. 2) With a favorable labor prognosis in case of prolonged disability up to 10 months (in some cases: injuries, conditions after reconstructive surgery, tuberculosis - up to 12 months), to decide whether to continue treatment or establish a disability group. 3) To change the labor recommendation for a disabled worker in the event of a worsening clinical and labor prognosis. In case of refusal of the health care and social development institution in the direction of the medical and social examination, the person has the right to apply to the Bureau of Medical Social Expertise on his own if medical documents, confirming the dysfunction of the body caused by diseases, the consequences of injuries and defects, and the associated limitation of life.

If the patient refuses to be sent to the MSEC or his untimely appearance for examination for an unjustified reason, the certificate of incapacity for work is not extended from the day of refusal or the day of registration of the MSEC documents. In this case, in the certificate of incapacity for work, in the column "Mark of violation of the regime", it is indicated "Refusal to be sent to MSEC" or "Failure to appear at MSEC" and the date of refusal or non-appearance is indicated. MSEC has the right to return a patient to a medical and prophylactic institution as insufficiently examined. In such cases, for the period of his MSEC examination, the sick leave is extended. A person is recognized as a disabled person during a medical and social examination based on a comprehensive assessment of his health and the degree of disability in accordance with the classifications and criteria approved by the Ministry of Health and Social Development of the Russian Federation. In the event that a person cannot appear for an examination for health reasons, a medical and social examination can be carried out at home, in a hospital where a citizen is being treated, or in absentia on the basis of submitted documents with his consent or with the consent of his legal representative. The institution is obliged to familiarize the citizen in a form accessible to him with the procedure and conditions for conducting a medical and social examination. In the case when a citizen was recognized as a disabled person of the 3rd group, but fell ill again, not having time to start work with a favorable clinical and labor prognosis, a certificate of incapacity for work is issued on a general basis.

In cases where a citizen was recognized as incapable of work without labor recommendations, but continued to work, in case of illness and injury, a certificate of incapacity for work is issued, but at the end of the period of temporary incapacity for work, the column “start work” indicates “cannot start work as the second (first) disabled person group ”and this fact is additionally reported to the administration of the enterprise where the specified person works. Medical and social examination of a citizen in most cases is carried out in an institution at his place of residence or at the place of attachment to a state or municipal medical and preventive institution of health care and social development. MSEC work on a territorial basis. Primary MSEC are organized on the basis of medical and prophylactic institutions. These include: district, city and inter-district. The next step is the highest MSEC - republican, regional, regional, and in Moscow and St. Petersburg - the central city MSEC. Primary MSEC are subdivided into general and specialized commissions. The general profile MSEC includes: three doctors (therapist, surgeon, neuropathologist); representatives of the department of social development; a trade union representative; medical registrar.

One of the expert doctors, most often a therapist, is appointed by the chairman. On the basis of an expert decision, patients are exempted for health reasons from professional work or training. This conclusion is drawn up in the form of "MSEC Help". The certificate indicates the group and the reason for the disability, labor recommendations and the term for the next re-examination. Within 3 days, MSEC sends a notification of the established form about the decision to the relevant enterprises, organizations, institutions. Without MSEC labor recommendations, heads of enterprises and institutions are not entitled to provide work for people with disabilities. Re-examination of a disabled person is carried out in the manner established for recognizing a person as disabled. Re-examination of disabled people of group I is carried out once every 2 years, disabled people of groups II and III - once a year, and disabled children - within the time limits established in accordance with medical indications. Disability is established before the first day of the month following the month for which the re-examination is scheduled. Without specifying the period for re-examination, disability is established for men over 60 years old and women over 55 years old, disabled people with irreversible anatomical defects, other disabled people in accordance with the criteria approved by the Ministry of Health and Social Development of the Russian Federation. Re-examination of a disabled person can be carried out in advance, but not more than two months before the expiration of the established period of disability. Re-examination of a disabled person before the established deadlines is carried out on the direction of a health care institution in connection with a change in his state of health.

Analysis of the incidence with temporary disability The physician therapist of the polyclinic conducts an analysis of the incidence with temporary disability for half a year and for a year. Sick leave certificates for these periods are summed up in the accounting form 16 VN. Temporary disability by incidents (in%), days of incapacity for work (in%) and the average duration of one case in days are calculated using the formulas. By cases: Number of incapacities for this class of diseases Total number of incidents of incapacity for work By days: Number of incidents of incapacity for work for this class of diseases The total number of incidents of incapacity for work. Average duration of one incident in days: Total number of days of incapacity for work Total number of incidents of incapacity for work

When analyzing the incidence of temporary disability, medical and social factors are taken into account. The analysis of the medical aspect of temporary disability is based on accurate diagnosis of diseases. Social factors make up working and living conditions, education, profession, specialty. When analyzing the 16 VN form, the district doctor identifies those diseases that make up the largest percentage. The ranking place for cases in the form of 16 VN is usually occupied by diseases of the respiratory system, which make up from 10 to 30% of the total. By the day, a significant place is occupied by diseases of the heart vascular system... The average duration of one case with this pathology is 30-40 days. This is due to the fact that this group of diseases includes disability certificates with acute myocardial infarction, hypertension with crises and strokes, when patients are hospitalized for 2 to 6 months or more. After the analysis, an action plan is drawn up to reduce the incidence of temporary disability. It should be dominated by activities related to rank groups of diseases, the implementation of which is in the competence of doctors.

The action plan also includes indicators of low quality of examination: 1) issuance of sick leave only on the basis of patient complaints; 2) issuance of sick leave for a chronic disease without exacerbation; 3) extension of sick leave for more than 4 months without a decision of the medical and social expert commission; 4) a long stay on sick leave that does not correspond to the course of the disease; 5) long-term treatment of chronic patients on an outpatient basis; 6) issuance of a sick leave for examining a patient and performing procedures if it is possible to perform them outside of working hours; 7) waiting 4 months for referral to a medical and social examination in the presence of signs of an unfavorable labor prognosis; 8) issuance of sick leave if there is a possibility of temporary transfer to another job; 9) insufficient examination of the patient when referring to a medical and social examination; 10) issuance of sick leave to working disabled people without taking into account the patient's condition; 11) issuance of sick leave retroactively; 12) issuance of a sick leave for sanatorium and spa treatment without a clinical expert commission; 13) incorrect registration of sick leave. The plan is drawn up and analyzed annually for at least three years, when it becomes possible to ascertain the effectiveness of primary and secondary prevention.

Federal Agency for Education

State educational institution

PETROZAVOD STATE UNIVERSITY

EXPERTISE

EMPLOYMENT

Toolkit

Petrozavodsk

Reviewed and approved for publication at a meeting of the editorial committee for the field of science and technology "Medicine"

Reprinted by the decision of the University Editorial and Publishing Council

Compiled by: Ph.D., associate professor of the course public health and health

1. The concept of working capacity and incapacity for work ……………… .5

and childbirth …………………………………………………………… .33

12. Filling out the certificate of incapacity for work ……………………….… 35

13. The order of registration, accounting and storage of documents,

certifying temporary disability ……. ………… .45

14. Estimated terms of temporary disability

for the most common diseases and injuries

(in accordance with ICD-10) ………………………………………… 47

15. Situational tasks for the examination of temporary

incapacity for work ………………………………………………… 71

16. The procedure for sending citizens to medical and social

expertise …………………………………………………………… 78

17. Expertise of persistent disability …………………… 79

18. References ………………………………………………… ..97

1. The concept of working capacity and incapacity for work

Under work capacity it is customary to understand such the state of the body, in which the combination of physical and spiritual capabilities allows you to perform work of a certain volume and quality. The doctor, on the basis of the data of a comprehensive medical examination, must establish the presence or absence of a disease in a particular person.

Medical criteria for work ability include a timely delivered complete clinical analysis, taking into account the severity of morphological changes, the severity and nature of the course of the disease, the presence of decompensation and its stage, complications, determination of the immediate and long-term prognosis. Thus, medical criterion for work ability - this is the presence of a disease in a patient, its complications, clinical prognosis.

The medical criterion is the leading one in establishing the fact of incapacity for work.

But a sick person may not always be disabled. For example, two people of different professions with the same disease: a cook and a teacher with a panaritium. There is a disease. However, the cook cannot do his job with panaritium, and the teacher can lead the lesson. In addition, it is not always the disease that is a sign of disability. There are times when a healthy person cannot work in his profession. For example, the wife of the same cook was diagnosed with hepatitis. The cook himself is healthy, but he cannot cook food, as he has contact with hepatitis.

Thus, illness and disability are not always identical concepts. In the presence of a disease, a person can be able to work, if the disease does not interfere with the performance of professional work, and disabled, if the performance of work is difficult or impossible. Therefore, the doctor, based on the severity of functional disorders, the nature and course of the disease, the patient's work, the conditions of his work, decides his question about the social criterion of work ability and the issuance of a certificate of incapacity for work to the patient.

Hence, social criterion for work ability determines the labor prognosis for a specific disease, a specific position of the patient and his working conditions. Social criteria reflect everything related to the patient's professional activity: the characteristics of the prevailing stress (physical or neuropsychic), the organization, frequency and rhythm of work, the load on individual organs and systems, the presence of unfavorable working conditions and occupational hazards. Medical and social criteria should always be clearly defined and reflected in the patient's outpatient card.

Thus, under incapacity for work should be understood a condition caused by illness, injury, its consequences or other causes, when performing professional activity- in whole or in part, for a limited time or permanently - not possible.

Depending on the degree of dysfunctions of the body, there is a distinction between the examination of temporary and permanent disability.

If changes in the patient's health are temporary, reversible, if recovery or significant improvement is expected in the near future, as well as restoration of working capacity, then this type of disability is considered temporary. Thus, temporary disability - This is a state of the human body caused by illness, injury and other reasons in which functional disorders are accompanied by the impossibility of performing professional work in normal production conditions for a certain period of time, that is, they are reversible. Establishing the fact of temporary incapacity for work is medical action, since it is aimed at eliminating adverse factors and means the beginning of treatment.

Distinguish between full and partial temporary disability. Complete incapacity for work- This is the loss of the working ability to any kind of work for a certain period, accompanied by the need to create a special regimen and treatment. Partial incapacity for work - temporary incapacity for work in relation to their usual professional work, while maintaining the ability to perform other work with a different, lightened, mode or reduced volume.

Disability

2. Examination of temporary disability in medical institutions

Examination of temporary disability - This is a type of medical activity, the main purpose of which is to assess the patient's health status, the quality and effectiveness of the examination and treatment, the possibility of carrying out professional activities, as well as determining the degree and timing of temporary disability.

The main task of the examination of the ability to work is to determine the ability of a given person to fulfill his professional duties, with the obligatory consideration of medical and social criteria. In addition, the tasks of the medical examination of the ability to work include:

· Determination of the treatment and regimen that are necessary to restore and improve human health;

· Determination of the degree and duration of incapacity for work due to illness, accident or other reasons;

· Identification of long-term or permanent disability and referral of such patients to the medical and social expert commission.

The medical examination of the ability to work is the most important area of ​​medical and practical activity, closely related to clinical disciplines, the social insurance system and social security. The assessment of the health status of the population and the analysis of the economic losses incurred by the society as a result of diseases largely depend on the organization and quality of the examination of disability in medical and preventive institutions. Timely release of sick people from work is one of the most effective preventive measures to prevent complications of diseases and their chronicity.

The examination of temporary disability is carried out in connection with illness, injury, abortion, pregnancy, childbirth, adoption from a maternity hospital, caring for a sick family member, prosthetics, spa treatment, quarantine, a period of medical rehabilitation and in other cases established by law.

The right to conduct an examination of temporary disability and the issuance of documents confirming the temporary loss of ability to work is vested in the attending physicians of medical and prophylactic institutions of state, municipal and other forms of ownership on the basis of a license obtained by the institution to conduct an examination of temporary disability. Physicians engaged in private medical practice outside the institution must have a license for the main type of medical activity and conduct an examination of temporary disability, as well as a certificate (certificate) of completion of a refresher course on examination of temporary disability.

In some cases (in hard-to-reach remote areas, in the Far North, etc.), by decision of the health management body, an examination of temporary disability may be allowed for a paramedical worker.

Medical workers are not entitled to issue documents certifying temporary disability:

· Blood transfusion stations;

· Balneo-mud baths and city resort water-mud baths;

· Rest houses and tourist centers;

· Institutions of Rospotrebnadzor;

· Paraclinical services (radiologists, physiotherapists, doctors-laboratory assistants, etc.).

Control over the observance of the instruction on the examination of temporary disability in state, municipal and private medical and preventive institutions, as well as private practicing doctors, is carried out by the health authorities of the corresponding level, the professional medical association. Commissions for accreditation and licensing of medical and pharmaceutical activities and subdivisions of territorial compulsory medical insurance funds can participate in the exercise of control.

Conducting levels examination of temporary disability:

first - Therapist;

second - medical commission (VK) of a medical facility;

third - the medical commission (VC) of the health management body;

fourth- the medical commission of the healthcare management body of the constituent entity of the Russian Federation;

fifth- Chief freelance expert in the examination of the Ministry of Health and Social Development of the Russian Federation.

3. Organization and procedure for the examination of temporary disability

The organization and procedure for the examination of temporary disability are based on the functions of each of the listed levels.

Functions of the attending physician when examining temporary disability:

· Determines the type of temporary disability;

· Identifies signs of temporary disability based on an assessment of health status, the nature and conditions of work and other social factors;

· Reflects in the primary medical documents anamnestic and objective data justifying the diagnosis of the disease or other cause of disability;

· Determines the terms of disability, taking into account the individual characteristics of the course of the disease and the approximate terms of disability for various diseases;

· Issues a document certifying incapacity for work;

· Appoints the mode and date of the next visit to the doctor, about which he makes an appropriate entry in the primary medical documentation;

· Promptly directs the patient for a VC consultation to extend the certificate of incapacity for work and resolve other expert issues;

· Makes an appropriate entry in the certificate of incapacity for work on the violation by the patient of the prescribed medical and protective regime, indicating the date and type of violation;

· Conducts selection and medical examination of long-term and often ill patients (having 4 or more cases and 40 days of temporary disability for one disease per year or 6 cases and 60 days of temporary disability, taking into account all diseases), conducts medical and diagnostic work, gives expert labor recommendations and studies their effectiveness;

If the patient has signs of persistent disability, prepares documents in the VC for referral to the medical-social expert commission;

· Analyzes the causes and dynamics of morbidity with temporary disability and primary disability, develops measures to reduce them.

Head of the department of an outpatient polyclinic and inpatient institution:

· Carries out constant control over the organization and examination of temporary disability by the attending physicians of the departments, including the quality and effectiveness of treatment and the correctness of the documents certifying temporary disability;

· Directs, together with the attending physician, the patient to KEK and MSEK;

· Analyzes the reasons and terms of temporary disability, primary disability, the quality of the expert work of the attending physicians.

Medical commission of a medical and prophylactic institution (VK) created in state and municipal health care facilities. VC is organized for collegial discussion and decision-making on all the most significant clinical and expert issues of diagnosis, treatment, management tactics, rehabilitation, determination of work ability and professional suitability, resolution of conflict situations. VK is headed by the deputy head for clinical and expert work, or the deputy for medical work, and in their absence - by the head; consists of leading experts from this and other medical institutions.

VK functions:

1) Makes decisions on the recommendation of the attending physicians and heads of departments:

· On the extension of the certificate of incapacity for work;

· On conflict and disputable cases of expertise;

· On referral of patients to MSEC;

· On the transfer of patients for health reasons to another job and their rational employment;

· When referred for treatment outside the territory served by the institution;

· In cases of provision of additional living space for health reasons and priority receipt of housing;

· Upon release for health reasons of schoolchildren from exams and granting academic leave to students;

· On claims and claims of citizens and insurance organizations on the quality of medical care and examination of the ability to work;

· At the request of organizations, institutions (including medical), social insurance funds, courts, prosecutors, military commissariats, etc. on the examination of working capacity.

Head of a healthcare institution:

· Is responsible for the examination of temporary disability in the institution, issues orders for its organization and conduct;

· Organizes accounting and reporting on temporary disability;

· Approves the composition of the VC and the regulation on the rules of its work;

· Appoints persons responsible for accounting, receipt, storage and use of forms of documents certifying temporary disability, creates conditions for their registration and issuance;

· Determines the need for forms of certificates of incapacity for work;

Takes measures of disciplinary and material action against employees who have committed clinical and expert errors, violations of the rules for storing, recording, processing and issuing documents certifying temporary disability, the procedure for conducting an examination of temporary disability (and, if necessary, in the prescribed manner, sending - there are materials to the investigating authorities to bring the perpetrators to criminal responsibility).

The deputy head of the institution for clinical and expert work has:

A. Responsibilities:

· Organizes work to control the quality of medical activities of a medical and preventive institution, its subdivisions, doctors;

· Heads the VC of the institution and provides conditions for its work;

· Carries out selective (in person) and on completed cases (according to documentation) quality control of diagnostics, treatment, rehabilitation, examination of temporary disability (including control over the maintenance of medical records, statistical records and reporting on temporary disability);

· Takes part in solving complex clinical and expert issues;

· Analyzes clinical expert errors;

· Reports at medical conferences the results of the analysis of measures to reduce morbidity with temporary disability;

· Interacts with MSEC, takes into account and analyzes the discrepancy of expert decisions, errors, violations of the procedure for referring patients to MSEC;

· Considers claims and claims of insurance medical organizations, territorial bodies of the Social Insurance Fund, complaints of patients on the quality of medical care and examination of temporary disability, quarterly organizes medical conferences on examination of temporary disability;

· Organizes training of attending physicians on the examination of temporary disability;

· Participates in the development of models of the final results of the activities of health care facilities, departments, specialists; monitors their implementation.

B. Rights:

· Supervise the work of specialists with higher and secondary medical education within the limits of their competence;

· To be involved as an expert doctor in the work of licensing and accreditation commissions, medical insurance organizations, health authorities and others on a contractual basis;

· Take part in meetings, scientific and practical conferences on the issues of medical and preventive care;

· Be a member of various public and professional organizations, whose activities do not contradict the activities and tasks of the expert doctor;

· To make, in accordance with the established procedure, proposals on the quality of medical care and its expertise, reduction of morbidity and labor losses due to illness.

B. Responsibility:

· For the organization of clinical and expert work in a medical institution, the objectivity of expert opinions, advanced training of doctors on the examination of temporary disability.

A qualified specialist with a higher medical education, experience in medical and organizational work, who has passed specialization in clinical expert work or in the examination of temporary disability is appointed as a deputy for clinical expert work .. He heads the clinical expert commission at the medical facility, is appointed and dismissed the head of the health care facility in accordance with the current legislation and the terms of the contract.

Chief Freelance Clinical Expert The Ministry of Health of Russia, the health management body of the constituent entity of the Federation and the territory that is part of the constituent entity of the Federation:

· Analyzes the state and quality of medical care, examination of temporary disability in the administrative territory, prepares proposals and analytical notes on this issue for consideration by the clinical expert commission and the board of the healthcare management body;

· Studies the causes of morbidity, including those with temporary disability and primary disability, takes part in the development of a program to reduce them;

· Controls the organization and efficiency of work carried out by health care institutions for the comprehensive rehabilitation of sick and disabled people;

· Organizes work to control the quality of medical care and improve the examination of temporary disability;

· Oversees the implementation of regulatory and regulatory documents on the examination of temporary disability;

· Interacts with the relevant social protection bodies, territorial executive bodies of the Social Insurance Fund, medical insurance funds, medical insurance organizations, trade union organizations;

· Organizes activities to systematically improve the qualifications of doctors on the examination of temporary disability;

· Considers independently or prepares for consideration by medical commissions the most complex expert issues encountered in the practice of medical institutions;

· Considers, if necessary, together with other main specialists complaints from the population on the examination of temporary disability and the quality of medical care;

Determines the need for medical institutions of the administrative territory in forms of certificates of incapacity for work and on time
submits to the Federal Social Insurance Fund applications for forms of certificates of incapacity for work, agreed with the territorial executive body of the Social Insurance Fund.

Chief specialists for other specialized profiles, the state and quality of the examination of temporary disability are analyzed for each specialized service.

4. The procedure for issuing a certificate of incapacity for work (certificate)

The procedure for issuing a certificate of incapacity for work is regulated by the order of the Ministry of Health and Social Development of the Russian Federation of 01.01.2001, No. 000n (registered by the Ministry of Justice of Russia on July 7, 2011, No. 000).

The form of the certificate of incapacity for work is approved by order of the Ministry of Health and Social Development of the Russian Federation of April 24, 2011 No. 000n. (registered by the Ministry of Justice of Russia on June 10, 2011 No. 000).

In the event of disability among students, the general educational institutions, institutions of primary vocational, secondary vocational and higher vocational education, a certificate of the established form 095 / y is issued.

Employees "href =" / text / category / sluzhashie / "rel =" bookmark "> employees, municipal employees;

- citizens recognized as unemployed and registered with government agencies employment services, in case of illness, injury, poisoning and other conditions associated with temporary disability, during prosthetics in a hospital, pregnancy and childbirth, when a child is adopted

- to insured persons from among foreign citizens and stateless persons temporarily staying in the territory of the Russian Federation, who have lost their ability to work due to an industrial accident or occupational disease.

A certificate of incapacity for work is not issued to citizens:

- seeking medical help in medical organization if they do not show signs of temporary disability;

- undergoing medical examination, medical examination or treatment in the direction of military commissariats;

- those in custody or administrative arrest;

- undergoing periodic medical examinations (examinations), including in the centers of occupational pathology;

- with chronic diseases without exacerbation (deterioration), undergoing examination, taking various procedures and manipulations in an outpatient setting;

- students of educational institutions of primary vocational, secondary vocational and higher vocational education and institutions of postgraduate vocational education.

In these cases, at the request of a citizen, an extract from the medical card of an outpatient (inpatient) patient is issued.

The issuance of certificates of incapacity for work is carried out by persons who, in accordance with the legislation of the Russian Federation on licensing, have a license for medical activities, including work (services) for the examination of temporary incapacity for work.

The issuance of certificates of incapacity for work is carried out upon presentation of an identity document. If a citizen at the time of the onset of temporary disability, maternity leave is occupied by several employers and in the two previous calendar years before the issuance of the certificate of incapacity for work was employed by the same employers, several certificates of incapacity for work are issued for each place of work.

The issuance and extension of a certificate of incapacity for work is carried out by a medical worker after examining a citizen and recording data on his state of health in the medical record of an outpatient (inpatient) patient, justifying the need for temporary release from work.

Forms of certificates of incapacity for work are registered in the primary medical documentation with an indication of their number, dates of issue and renewal, discharge of a citizen to work, information on the direction of a citizen to another medical organization.

A certificate of incapacity for work is issued and closed, as a rule, in one medical organization. When a citizen is sent for treatment to another medical organization, a new certificate of incapacity for work (continued) is issued by the medical organization to which the citizen is sent, except for cases when the certificate of incapacity for work is issued by the decision of the VC for the period of treatment and travel to the place of treatment and back.

Documents confirming the temporary disability of citizens during their stay abroad (after a legalized transfer), by decision of the medical commission of a medical organization (hereinafter referred to as the medical commission), can be replaced with certificates of incapacity for work of the standard established in the Russian Federation.

The procedure for providing blanks of certificates of incapacity for work, their accounting and storage is carried out in accordance with the Order of the Social Insurance Fund of the Russian Federation and the Ministry of Health of the Russian Federation dated 01.01.01, N 18/29 "On approval of the Instruction on the procedure for providing blanks for certificates of incapacity for work, their accounting and storage "(Registered by the Ministry of Justice of Russia on February 19, 2004 N 5573) as amended by the Order of the Ministry of Health and Social Development of Russia and the Social Insurance Fund of the Russian Federation dated 01.01.01, N 42/130 (registered by the Ministry of Justice of Russia on August 3, 2004 N 5956).

Control over the observance of the established procedure for issuing certificates of incapacity for work is carried out by the Federal Service for Supervision in Healthcare and Social Development in conjunction with the Social Insurance Fund of the Russian Federation.

5. The procedure for issuing a certificate of incapacity for work (certificate) for diseases and injuries

In the case of outpatient treatment of diseases (injuries), poisoning and other conditions associated with the temporary loss of capacity for work by citizens, the medical worker single-handedly issues a certificate of incapacity for work at a time for up to 10 calendar days (until the next examination of a citizen by a medical worker) and individually extends it for up to 30 calendar days. days. For periods of temporary incapacity for work exceeding 30 calendar days, a certificate of incapacity for work is issued by the decision of the medical commission.

A paramedic or dentist shall single-handedly issue a certificate of incapacity for work at a time for up to 5 calendar days and extend it for up to 10 calendar days, and in exceptional cases, after consultation with the medical commission of a medical organization (by subordination) - up to 30 calendar days (with mandatory entry on the consultation held in the primary medical documentation).

With a period of temporary incapacity for work exceeding 30 calendar days, the decision of the issue of further treatment and issuance of a certificate of incapacity for work is carried out by a medical commission.

In special conditions (in remote areas of rural areas, the Far North, etc.), according to the decision of local health authorities, the issuance of certificates of incapacity for work may be allowed to the attending physician until full recovery of working capacity or referral to a medical and social examination.

Doctors who have a license for medical activities, including work (services) for the examination of temporary disability, with a period of temporary disability exceeding 30 calendar days, send a citizen to a medical commission at a medical organization at the place of his attachment or registration at the place of residence (at the place of stay, temporary residence) to extend the certificate of incapacity for work.

By the decision of the medical commission, with a favorable clinical and labor prognosis, a certificate of incapacity for work may be issued in the prescribed manner until the day of restoration of the ability to work, but for a period not exceeding 10 months, and in some cases (injuries, conditions after reconstructive operations, tuberculosis) - for a period not exceeding 12 months, with the frequency of extension by the decision of the medical commission at least 30 calendar days.

In case of diseases, occupational diseases (injuries, including those obtained as a result of an industrial accident), when treatment is carried out in an outpatient setting, a certificate of incapacity for work is issued on the day of establishing temporary incapacity for work for the entire period of temporary incapacity for work, including non-working holidays and weekends.

It is not allowed to issue a certificate of incapacity for work for the past days when the citizen was not examined by a medical worker. The issuance of a certificate of incapacity for work for the past time can be carried out in exceptional cases by decision of the medical commission when a citizen applies to a medical organization or visits him by a medical worker at home.

Citizens who seek medical help after the end of working hours (shift), at their request, the date of release from work in the certificate of incapacity for work can be indicated from the next calendar day.

A citizen sent to a medical organization from a health center and recognized as incapable of work is issued a certificate of incapacity for work from the moment of contacting a health center if there are medical documents confirming his incapacity for work.