of April 16, 2019 No. KR DSM-39
About modification of the order of the Minister of health and social development of the Republic of Kazakhstan of September 29, 2015 No. 761 "About approval of Rules of rendering the stationary help"
According to the subitem 94) of Item 1 of article 7 of the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system", I ORDER:
1. Bring in the order of the Minister of health and social development of the Republic of Kazakhstan of September 29, 2015 No. 761 "About approval of Rules of rendering the stationary help" (it is registered in the Register of state registration of regulatory legal acts of the Republic of Kazakhstan for No. 12204) the following change:
The rules of rendering the stationary help approved by the specified order to be reworded as follows according to appendix to this order.
2. To provide to department of the organization of medical care of the Ministry of Health of the Republic of Kazakhstan in the procedure established by the legislation of the Republic of Kazakhstan:
1) state registration of this order in the Ministry of Justice of the Republic of Kazakhstan;
2) within ten calendar days from the date of state registration of this order the direction it the copy in electronic form in the Kazakh and Russian languages in the Republican state company on the right of economic maintaining "The republican center of legal information" for official publication and inclusion in Reference control bank of regulatory legal acts of the Republic of Kazakhstan;
3) placement of this order on Internet resource of the Ministry of Health of the Republic of Kazakhstan;
4) within ten working days after state registration of this order in the Ministry of Justice of the Republic of Kazakhstan submission to Department of legal service of the Ministry of Health of the Republic of Kazakhstan of data on execution of the actions provided by subitems 1), 2), 3) of this Item.
3. To impose control of execution of this order on the vice-Minister of Health of the Republic of Kazakhstan Aktayeva L. M.
4. This order becomes effective after ten calendar days after day of its first official publication.
Minister of Health of the Republic of Kazakhstan
E.Birtanov
Appendix
to the Order of the Minister of Health of the Republic of Kazakhstan of April 16, 2019 No. KR DSM-39
Approved by the Order of the Minister of health and social development of the Republic of Kazakhstan of September 29, 2015 No. 761
1. These rules of rendering the stationary help (further - Rules) are developed according to Item 3 of article 47 of the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system" (further - the Code) and establish procedure for rendering the stationary help to the population within the guaranteed amount of free medical care (further - GOBMP) and systems of compulsory social medical insurance.
2. In these rules the following concepts are used:
1) the stationary help - form of provision of pre-medical, qualified, specialized medical care, including using high-technology medical services, with the round-the-clock medical observation;
2) qualified medical care - the medical care provided by health workers with the higher medical education in case of the diseases which are not requiring specialized methods of diagnostics, treatment and medical rehabilitation including with use of means of telemedicine;
3) specialized medical care - the medical care provided by profile specialists in case of the diseases requiring ad hoc methods of diagnostics, treatment and medical rehabilitation including with use of means of telemedicine;
4) high-technology medical services (further - VTMU) - the services rendered by profile specialists in case of the diseases requiring use of innovative, resource-intensive and (or) unique methods of diagnostics and treatment;
5) the organization of health care - the legal entity performing activities in the field of health care;
6) the subject of informatization in the field of health care (further - the subject of informatization) - the state bodies, physical persons and legal entities performing activities or entering legal relationship in the field of informatization in the field of health care;
7) the Commission on high-technology medical services (further - the Commission of VTMU) - the commission created under local authorities of public administration by health care of areas, cities of republican value and the capital for the solution of question of hospitalization in the organization of health care providing VTMU;
8) treatment-and-prophylactic council (further - LPS) - permanent coordinating and the advisory advisory body created under local authorities of public administration by health care of areas, cities of republican value and the capital for the purpose of consideration of questions of the organization of hospitalization of patients in hospitals, management of structure of hospitalization, dynamics of planned and emergency hospitalization on levels of delivery of health care, justification of the directions on planned hospitalization, availability of medical care, protection of the rights of the patient;
9) consultation - research of person for the purpose of establishment of the diagnosis, determination of tactics of treatment and the forecast of disease with participation at least three doctors;
10) the portal of Bureau of hospitalization (further - the Portal) - single system of electronic registration, accounting, processing and storage of the directions of patients for hospitalization in hospital within the guaranteed amount of free medical care (further - GOBMP);
11) the planned date of planned hospitalization - the date of hospitalization determined in the Portal after registration of the direction for planned hospitalization;
12) code of planned hospitalization - automatically the generated patient's Code in case of registration of the direction in the Portal by the following principle: the first two signs - area code (from where it is directed), following four - code of the medical organization (where it is directed); following three - bed profile code (where it is directed), the last figures - sequence number of the patient;
13) final date of planned hospitalization - date of the actual hospitalization of the patient in the organization of health care;
14) the coupon of planned hospitalization - the document confirming the registration fact in the Portal of the direction on planned hospitalization;
15) the waiting list - the electronic registration form in the Portal of the direction of patients on planned hospitalization with determination of the planned and final date of hospitalization, specifying of the reasons and reasons for removals of the directions in case of refusal in hospitalization;
16) urgentnost - work in waiting mode of the patients requiring emergency medical service;
17) medical sorting on триаж to system - distribution of victims and patients to groups, proceeding from needs in priority and homogeneous actions (medical, preventive, evacuation).
18) hospital with the round-the-clock observation - in case of condition with high risk and possibility of development of complications and requiring medical observation at least 2-3 times a day and at night, including after surgeries, and also holding diagnostic and medical actions at least 2 times a day;
19) day hospital - rendering the hospital-replacing help to the population based on the organizations of health care. Persons with availability sharp or exacerbations of chronic disease in need of holding medical and diagnostic actions no more than 2 times within several hours in APP, including after surgeries and about one days in the round-the-clock hospital are subject to observation in day hospital.
3. The indication for hospitalization is need of rendering pre-medical, qualified, specialized medical care, including using high-technology medical services, with the round-the-clock medical observation of patients in the organizations of health care.
4. Hospitalization of the patient in the organization of health care within GOBMP is performed:
1) in planned procedure - in the direction of specialists of primary health care (further - PHC) or other organization of health care according to the list of diseases by codes of the International Statistical Classification of the diseases and problems connected with health of the 10th review (further - MKB - 10) and the list of transactions and manipulations by codes of the International Statistical Classification of the diseases and problems connected with health of the 9th review (further - MKB-9) for preferential treatment in the conditions of the round-the-clock hospital according to appendices 1, 2 to these rules, in the organization of health care of district value and the village according to appendices 3, 4 to these rules;
2) according to the emergency indications (including days off and holidays) - regardless of direction availability;
5. Acceptance and registration of patients in reception of the organization of health care on receipt of planned hospitalization is performed in working hours according to the approved working schedule of the organization, within 60 minutes from the moment of the address. The emergency medical care is provided round the clock. In need of reception the consultation is organized.
In case of complete inspection and lack of contraindications hospitalization in profile department is performed.
6. If the disease is not included into the list of diseases by the MKB 10 codes for treatment in the round-the-clock hospital of hospitalization are subject person who when evaluating condition by criteria determines need of the round-the-clock medical observation with data entry in information system by algorithm according to appendix 9 to these rules.
7. In case of hospitalization of the patient in the organization of health care the medical record with leaf of appointments (further - the medical record) in the form 003/at approved by the order of the acting minister of health care of the Republic of Kazakhstan of November 23, 2010 No. 907 "About approval of forms of primary medical documentation of the organizations of health care" is drawn up (it is registered in the Register of state registration of regulatory legal acts at No. 6697) (further - the Order No. 907).
8. In case of detection of signs of alcoholic, drug or toxic intoxication of the patient during the request for medical care in the organization of health care, the health worker makes about it entry in the medical record with the subsequent fence of biological environments on determination of content of psychoactive agent with entering of results in the medical record.
9. In case of receipt in hospital of the patient inform on regulations of the organization of health care with mark in the medical record and the Contract between the patient and the organization of health care according to the order of the Minister of health and social development of the Republic of Kazakhstan of May 29, 2015 No. 418 "About approval of the standard agreement on provision of medical care within the guaranteed amount of free medical care concluded between the patient and the medical organization" is signed (it is registered in the Register of state registration of regulatory legal acts at No. 11520).
10. Medical care is provided after receipt of written voluntary consent of the patient or his legal representative on holding medical and diagnostic actions.
Delivery of health care without consent is allowed concerning persons which are in shock, the coma which is not allowing to express the will; suffering diseases constituting danger to people around; suffering from heavy mental disturbances (diseases); suffering from mental disturbances (diseases) and made socially dangerous act.
Delivery of health care without the consent of citizens continues before disappearance of the above-stated conditions.
11. Concerning the minors and persons recognized by court incapacitated their legal representatives give consent to delivery of health care. In the absence of legal representatives the decision on delivery of health care is made by consultation, and in case of impossibility to collect consultation - directly health worker with the subsequent notification of officials of the organization of health care.
12. In case of receipt of medical care the patient obtains exhaustive information on condition of the health, including data on possible risk and the benefits offered and alternative methods of treatment, data on possible effects of refusal of treatment, information on the diagnosis, the forecast and the plan of medical actions in form, available to the patient, and also explanation of the reasons of the statement home or transfer in other organization of health care.
13. The health worker with the higher medical education (further - the doctor) inspects the patient in day of receipt in hospital, prescribes it necessary treatment and informs on the appointed medical and diagnostic actions.
14. Holding medical and diagnostic actions, provision of medicines, the organization of clinical nutrition and the corresponding leaving of the patient are performed from the moment of receipt in the organization of health care.
15. Depending on condition of the patient complete or partial sanitary processing is carried out. Obligatory sanitary processing there undergo persons of no fixed abode.
16. Chambers or boxes for separate accommodation of the patients with diseases constituting danger to people around are provided in hospitals.
17. The patients who are in hospital are subject to daily survey by the attending physician, except days off and holidays. In case of survey and appointment of additional diagnostic and medical manipulations as the doctor on duty the corresponding entries in the medical record are carried out.
In case of deterioration in condition of the patient the doctor on duty notifies the manager of department / the attending physician or the responsible doctor on duty, approves modification of process of diagnostics and treatment, and makes entry in the medical record (paper/electronic).
In case of heavy and extremely heavy course of disease frequency rate of records depends on dynamics of weight of condition. Records of the doctor shall reflect specific changes in condition of the patient and need of correction of appointments, reasons for the appointed inspection and treatments, assessment and interpretation of the received results and efficiency of the carried-out treatment. Frequency rate of survey in case of medical emergencies at least each three hours, with indication of time of rendering emergency aid on hours and minutes.
18. The clinical diagnosis is established together with the manager of department no later than three calendar days from the date of hospitalization of the patient in the organization of health care.
In day of establishment of the clinical diagnosis in the medical record the corresponding entry is made.
19. The manager of department performs inspection of heavy patients in day of hospitalization, in subsequent - daily. The patients who are in medium-weight condition are inspected at least once a week.
Results of survey of the patient are registered in the medical record with indication of recommendations about further tactics of maintaining the patient with obligatory identification of the health worker making records.
20. Rendering the surgical help is performed depending on amount and nature of operational injury on four categories:
In case of the first category operations, small on amount, which do not cause violations of functions of bodies and systems of the patient according to the list according to appendix 5 to this order are performed.
The transactions which are followed by opening of internal cavities and removal of small anatomic educations which cause passing violations of functions of different bodies and systems of the patient which are independently normalized without special treatment according to the list according to appendix 6 to this order are referred to the second category.
The transactions which are followed by removal or resection of body (resection of stomach, transaction on the bilious ways, etc.) which cause the expressed violations of functions of the different bodies and systems requiring intensive correction according to the list according to appendix 7 to this order are referred to the third category.
The transactions which are followed by removal of one or several bodies, resection of several bodies, reconstruction of anatomic educations which cause the expressed functional frustration according to the list according to appendix 8 to this order are referred to the fourth category.
21. In case of treatment in hospital of children under three years, and also seriously ill patients of the children of advanced age needing according to the conclusion of the attending physician additional leaving, mother (father) or the other person who is directly performing child care is given opportunity to be with it in the medical organization with issue of leaf about temporary disability; it is free of charge provided with berth.
The nursing mother of the child up to one year of life is provided with free food for the entire period of stay on child care in the organization of health care.
22. Conditions for life-long education in the conditions of children's multi-profile hospitals are created to children of school age during hospitalization.
23. Conditions for games, rest and carrying out educational work are created to patients of multi-profile children's hospitals.
24. At any level of delivery of health care in case of difficulty in identification of the diagnosis, inefficiency of the carried-out treatment, and also in case of other indications, the managing department/deputy manager by medical part will organize consultation (survey of the patient by the specialist of higher qualification or other profile) or consultation (survey of the patient, with participation at least three specialists of one profile of higher qualification, or other profile, with carrying out additional inspection of the patient for the purpose of establishment of the diagnosis, determination of tactics of treatment and the forecast of disease), including the indications specialist of republican level.
In evening, night time, days off and holidays - consultation or consultation will be organized by the responsible doctor on duty of the organization of health care.
25. In case of lack of necessary intrumentalny and laboratory escort of the heavy patient needing permanent monitoring of the vital functions on medical indications, according to the solution of consultation and the notification of heads of the organizations of health care, this patient after stabilization of condition is transferred to other medical organization for disease profile for further inspection and treatment.
26. Criteria of the statement from hospital are:
1) the commonly accepted result of treatment (recovery, improvement, without changes, death, it is transferred to other medical organization);
2) the written application of the patient or his legal representative in the absence of direct danger to life of the patient or to people around.
3) cases of abuse of regulations of internal rules and procedures, established by the organization of health care, and also creation of obstacles for medical and diagnostic process, infringement of the rights of other patients to receipt of appropriate medical care (in the absence of direct threat of his life) about what entry in the medical record is made.
27. In case of the statement from hospital the form 027/at approved by the order No. 907, is issued to the patient where the final clinical diagnosis, the carried-out amount of diagnostic testings, medical actions, recommendations about further observation and treatment are specified.
Data on the statement are entered in information systems to the day, with indication of the actual time of the statement.
28. The organizations of health care provide timely and reliable filling of accounting forms according to the MKB-9, MKB-10 code.
29. Planned hospitalization with registration of the direction in the Portal is performed by determination of the planned date of planned hospitalization taking into account the patient's right to the free choice of the organization of health care:
1) the specialist of hospital in the direction of the specialist of PHC or other organization of health care irrespective of patterns of ownership;
2) automatic detection in the direction of the specialist of PHC or other organization of health care;
3) the specialist of the accident ward of the organization of health care in case of the independent appeal of patients and the decision of the head on hospitalization of the patient to this organization of health care.
Planned hospitalization on paid basis is performed with obligatory logging of accounting of acceptance of patients and refusals in hospitalization, in the form 001/at approved by the order No. 907 and realized in the Portal in electronic format.
The organizations of health care which signed the contract for delivery of health care within GOBMP have access to the Portal. In case of the conclusion of the agreement of non-commercial joint-stock company "Fund of Social Medical Insurance" (further - FSMS) with the new supplier of medical services, irrespective of patterns of ownership, on delivery of health care within GOBMP, assignment of login and the password for work in the Portal is performed within 2 working days from the moment of application by the supplier.
30. Participants of process of the organization of hospitalization are:
1) organizations of health care;
2) FSMS and its branches;
3) subject of informatization;
4) local authorities of public administration of health care of areas, cities of republican value and capital (Astana, Almaty, Shymkent).
31. In the presence of indications to planned hospitalization the specialist of PHC or other organization of health care conducts to the patient kliniko-diagnostic (laboratory, tool and functional) researches (further - researches), consultations of profile specialists, according to the directed diagnosis, being guided by clinical protocols of diagnostics and treatment.
In case of automatic detection of date of hospitalization the minimum amount of pre-hospital inspection of the patient is carried out in 14 days prior to the appointed date of hospitalization. To hospital observation the directed medical organization performs.
Additional and repeated implementation in hospital of the researches conducted before hospitalization in the PHC organization or other organization of health care is carried out on medical indications, with reasons in the medical record for dynamic assessment of condition of the patient, according to clinical protocols of diagnostics and treatment.
32. In case of the choice by the patient of the organization of health care the responsible specialist of PHC or other organization of health care approved by the internal order (further - the responsible specialist), provides it information on possibility of the alternative choice of the organization of health care on the meeting profile with the smallest term hospitalization expectations.
The responsible specialist informs the patient on date of hospitalization in the chosen hospital and need of obligatory appearance in the established date of planned hospitalization by the oral or electronic notification in personal account of the Portal of the electronic government (push or sms).
In case of impossibility to be in hospital, in the established date of planned hospitalization on reasonable excuses, the patient informs the PHC organization or the organization of health care which directed to hospitalization. The hospital transfers hospitalization for the term of no more than 3-x days.
33. In the presence of indications for planned hospitalization in the scientific organizations created in the cities of republican value (further - the scientific organizations) and the capital on rendering ВТМУи SMP, the patient is hospitalized according to the decision of the Commission of VTMU according to the order of the Minister of Health of the Republic of Kazakhstan of February 7, 2017 No. 12 "About approval of rules of provision of high-technology medical services".
34. In case of determination of date of planned hospitalization by the specialist of hospital in the direction of the specialist of PHC or other organization of health care:
1) the responsible specialist registers the direction on planned hospitalization in the waiting list located on the Portal in form, according to appendix 10 to Rules and issues to the patient the coupon of planned hospitalization in form, according to appendix 11 to Rules;
2) daily the specialist of hospital checks the list of the patients directed to hospitalization in this organization of health care, create data on free beds on profiles and till 9 hours 30 minutes brings them in the leaf of accounting of free beds placed in the Portal in form, according to appendix 12 to Rules. The planned date of planned hospitalization is determined by the responsible specialist within 2 working days from the date of registration of the direction for planned hospitalization in the Portal;
3) daily responsible specialist performs monitoring of the waiting list and issues to the patient the direction on hospitalization in the organization of health care for form according to appendix 13 to Rules after putting down by the organization of health care of the planned date of planned hospitalization;
4) the patient is hospitalized according to the established date of planned hospitalization;
35. The planned date of planned hospitalization is determined by the responsible specialist according to the order of the Minister of health and social development of the Republic of Kazakhstan of April 28, 2015 No. 284 "About approval of the state standard rate of network of the organizations of health care" (It is registered in the Register of state registration of regulatory legal acts on May 29, 2015 at No. 11231) in:
1) the organizations of health care and (or) their structural divisions giving stationary help at the district level;
2) the organizations of health care and (or) their structural divisions giving stationary help at the city level:
perinatal (delivery room), oncological, infectious, skin and venereologic, traumatologic, insultny, rheumatologic, ophthalmologic, cardiological and cardiac centers;
the organizations of recovery treatment and medical rehabilitation - sanatorium, specialized sanatorium, dispensary, the rehabilitation center or department (beds) of rehabilitation organized under multi-profile hospital;
the organizations giving palliative care and sisterly leaving - the hospice, hospital of sisterly leaving or department, beds organized under multi-profile hospital, antitubercular dispensary;
the scientific organizations created in the city of republican value;
3) the organizations of health care and (or) their structural divisions rendering stationary pomoshchn regional level:
the multi-profile regional children's hospital created in the regional center;
the regional center of mental health created in the regional center;
perinatal (delivery room), oncological, infectious, skin and venereologic are created as structural divisions of multi-profile hospitals;
the organizations of recovery treatment and medical rehabilitation - sanatorium, specialized sanatorium, dispensary, the rehabilitation center, or department (beds) of rehabilitation organized under multi-profile hospital;
the organizations giving palliative care and sisterly leaving - the hospice, hospital of sisterly leaving or department, beds organized under multi-profile hospital, antitubercular dispensary;
36. In the presence of medical indications for transfer of the patient in other organization of health care, the attending physician in coordination with the deputy chief physician for medical work performs registration of the direction in the Portal;
37. In case of automatic detection of date of hospitalization in the direction of the responsible specialist:
1) the responsible specialist registers the direction on planned hospitalization, provides information on the planned date of the hospitalization established automatically in the Portal and issues the direction (on the paper/electronic medium);
2) if the patient refuses the planned date of the hospitalization established automatically in the Portal, the attending physician of PHC or other organization of health care offers it later date of hospitalization or the choice of other organization of health care in which the possibility of earlier hospitalization is provided;
3) in the presence of medical indications to transfer of the patient in other organization of health care, the attending physician in coordination with the deputy chief physician for medical work performs registration of the direction in the Portal;
4) the patient is hospitalized in the organization of health care, specified in the direction in time, automatically by certain Portal;
5) in case of absence of the patient in time, the medical organization uses this bed for hospitalization of the emergency patients;
6) automatic detection of the planned date of hospitalization is performed in the Portal in case of registration of the direction for hospitalization in the organization of health care according to the criteria developed from calculation:
the general planned amount of financing;
annual average value of specific weight of the predicted financing amount for planned and emergency hospitalization taking into account cases by nozologiya based on data of last year;
annual average value of specific weight of the predicted financing amount for cases of planned hospitalization by the nozologiya on profiles which are not participating in hospitalization process based on data of last year;
the predicted cost of all cases (planned and emergency) which statement is planned during the accounting period, in compliance of the plan of general financing for month under report;
terms of average duration of stay of the patient on bed by nozologiya;
the information about the number of patients who are possible for hospitalizing in planned procedure in 1 working day;
data on days off, holidays (with transfer), the operational, urgentny days, days intended on sanitary processing (according to the medical organizations);
data on graphics of labor leaves which activities influence process of planned hospitalization;
data on share on independent planned hospitalization of patients.
7) for forming of criteria the forthcoming year hospitals need to represent to informatization subject in two months prior to the beginning of the following financial year the following data:
the number of the patients planned for planned hospitalization in one working day by profiles;
days of planned hospitalization by profiles;
schedule of operating rooms;
the schedule of the days intended on sanitary processing;
the schedule of labor leaves, advanced trainings of specialists which activities influence process of planned hospitalization;
the planned share on independent planned hospitalization of patients.
8) in case of change of data for forming of criteria it is necessary to provide the informatizations this in subject, no later than ten working days prior to the planned changes in time;
9) in case of optimization of bed fund of the organization of health care no later than one calendar month prior to the planned changes is notified in time by managements of health care and the subject of informatization for carrying out timely updating of changes of structure of bed fund in the corresponding information systems of the Ministry of Health of the Republic of Kazakhstan (further - the Ministry);
10) the planned date of planned hospitalization is determined automatically in the Portal in case of the direction by the responsible specialist in:
The scientific organizations taking into account the patient's right to the free choice of the organization of health care, provide services SMP and VTMU;
multi-profile hospitals of city or regional levels, except for following profiles of beds:
hematologic, oncohematological, infectious, psychiatric, psychoneurological, antitubercular, narcological, skin and venereologic, oncological, palliative care and sisterly leaving, nurseries, perinatal (delivery room).
11) for the organizations of health care participating in automatic detection of date of planned hospitalization removal at sight of expectation is provided in the following cases:
at the level of the PHC organization or other organization of health care:
written refusal of the patient of hospitalization after registration of the direction on the Portal;
registration of case of death of the patient at pre-hospital stage;
availability of medical contraindications at the time of hospitalization in the medical organization;
emergency hospitalization.
at the level of the accident ward of the organization of health care:
lack of medical indications to hospitalization;
availability of medical contraindications at the time of hospitalization;
absence of the patient on hospitalization;
written refusal of the patient of hospitalization after registration of the direction on the Portal;
non-core hospitalization;
emergency hospitalization.
38. In case of determination of date of planned hospitalization by the specialist of the accident ward of the organization of health care, in case of the independent address of patients, the decision on hospitalization is approved with the responsible person of the organization of health care.
39. The management of the organization of health care, for the purpose of protection of the rights of the patient, independently makes the decision on planned hospitalization of the patient in the presence of medical indications for the social and unprotected national groups: children up to 18 years, pregnant women, participants of the Great Patriotic War, disabled people, mothers the having many children, health workers, pensioners sick with socially important diseases within 15% of amount of planned hospitalization for the scientific organizations, 10% for the organizations of health care of district, city, regional levels irrespective of pattern of ownership;
40. The doctor of reception of the organization of health care in case of the independent address of patients with medical indications performs planned hospitalization in day of the appeal to the following organizations of health care / structural divisions:
infectious, psychiatric, psychoneurological, antitubercular, narcological, skin and venereologic, oncological, hospital for disabled people of the Great Patriotic War and persons equated to them, hospices and hospitals of sisterly leaving, the perinatal center (delivery room) taking into account regionalization of the perinatal help;
multi-profile hospitals irrespective of the level and patterns of ownership on the next stage of operational, oncohematological, oncological, hematologic, therapeutic treatment and holding actions for recovery treatment and medical rehabilitation according to medical part of the individual program of rehabilitation of the disabled person.
41. Under the organization of planned hospitalization there are emergency situations when stages of process of hospitalization go beyond admissible limits:
1) cancelled planned hospitalization:
lack of medical indications to planned hospitalization;
availability of medical contraindications at the time of hospitalization.
2) the cases which are negatively influencing the level of planned hospitalization:
written refusal of the patient of hospitalization after registration of the direction on the Portal;
absence of the patient on hospitalization;
registration of death of the patient at pre-hospital stage;
emergency hospitalization;
hospitalization, independent of the procedure.
42. In case of origin and the termination of force majeur circumstances the organization of health care within one working day sends the written notice to management of health care, to FSMS and to informatization subject.
In case of suspension of operations of the organization of health care, the subject of informatization within one working day notifies the PHC organizations and other organizations of health care. The responsible specialist informs the patient about emergence of force majeur circumstances and offers the choice of other organization of health care or hospitalization in the organization of health care chosen earlier after renewal of its activities.
In case of not functioning in the Portal of electronic registration of the direction for hospitalization more than 3 hours, the organization of health care provides continuity of process of the direction on planned hospitalization in the following sequence:
1) the PHC organization or other organization of health care draws up the direction on planned hospitalization for the date approved with the organization of health care on paper;
2) the organization of health care provides hospitalization of the patient according to date of hospitalization on paper;
3) the PHC organization or other organization of health care directly after resumption of work of information system provides registration of the directions of patients in the Portal hospitalized or planned for hospitalization during shutdown of system based on these papers.
4) subject of informatization:
draws up the protocol on the fact of shutdown of electronic registration of the direction for hospitalization for the term of more than 3 hours;
requests information from the PHC organization or other medical organization for the facts of the directions on planned hospitalization on papers;
coordinates process of registration of the directions in the Portal according to data of papers.
43. In case of removal of the directions from "Waiting list" in the Portal for the reason "The death of the patient at pre-hospital stage" the information is provided to the subject of informatization (within three working days from the date of removal registration): the statement from the out-patient card, the copy of the medical death certificate in the form No. 106-12/u approved by the order No. 907, except as specified which are subject to forensic medical examination.
44. Participants of process of the organization of hospitalization perform monitoring of emergency situations with taking measures to their non-admission.
45. The organizations of health care weekly send on electronic media, information on refusal to hospitalization of the patient in form according to appendix 14 to Rules, to the PHC organization or other organization of health care. The refusal form in hospitalization is handed out to the patient on demand.
46. Managements of health care:
1) perform permanent monitoring of the following indicators of the organizations of health care with acceptance of managerial measures:
level of consumption of the stationary help in the region;
work of bed fund and its rationalization;
reshaping of beds according to their demand;
structure of the treated cases in the round-the-clock and day hospitals;
unreasonable hospitalization;
emergency situations.
2) hold LPS meetings with involvement of heads of the organizations of health care, irrespective of pattern of ownership, with the subsequent submission of data on the taken measures to the subject of informatization till the tenth following reporting.
47. In case of emergency the patient is brought to reception of the organization of health care by crew of the station (department) of emergency medical service, crew of department SMP in case of PHC, mobile crew of sanitary aircraft, from other organizations of health care or addresses independently. In some cases, patients are brought to the organization of health care by citizens or law enforcement officers.
48. When transporting the patient the dispatcher of the station of emergency medical service or department SMP in case of PHC informs reception of the organization of health care on delivery of the patient.
49. In case of approach of lethal outcome in reception, the fact of death of the patient is registered on this medical organization.
50. In case of hospitalization of the patient the doctor/nurse of reception carry out distribution across Triazh to system on groups:
The first group (red zone) - patients whose condition poses direct threat of life and requires holding immediate medical and diagnostic actions.
The second group (yellow zone) - patients whose condition poses potential hazard for health, but does not require the emergency intervention.
The third group (green zone) - patients whose condition at the time of address/delivery does not pose direct threat of life and to health.
51. On completion of assessment of condition of the patient by the nurse color marking is carried out (red, yellow, green).
52. Responsibility for the patient for stay in reception is born by the manager of reception of the organization of health care, at night, festive and the days off - the responsible doctor of reception.
53. In case of determination of the patient in the first group (red zone) the emergency medical care is provided in conditions of PITAS or the operating room. In case of stabilization of condition the patient is translated in ОАРиТ (ORIT) or profile department of the organization of health care.
54. The patient of the second group (yellow zone) accompanied by the health worker is hospitalized in diagnostic chamber. In need of dynamic observation, the patient is in diagnostic chamber till 24 o'clock. For this period the complete amount of urgent medical and diagnostic actions is carried out.
55. The patient of the third group (green zone) goes to viewing office of reception. In viewing office the necessary amount of medical and diagnostic actions before establishment of the diagnosis with further determination of tactics of treatment is carried out.
In the absence of indications for hospitalization in the organization of health care, the doctor of reception issues to the patient the medical certificate (form No. 071/at) approved by the order No. 907 with written reasons for refusal.
The nurse of reception the asset goes to the PHC organization for the place of attachment of the patient in the presence of the last.
56. The patient brought by mobile crew of sanitary aircraft is hospitalized in profile department according to the prior notice of management of the organization of health care.
57. In case of the emergency hospitalization registration of patients in the portal is performed by specialists of reception of the organization of health care.
58. Registration in the Portal of data on the addressed patients in reception of the organization of health care, is performed in electronic format for accounting of patients on hospitalization and refusals in hospitalization.
59. In case of rendering to not hospitalized patients of medical services and use of medicines, data are entered in form according to appendix 15 to Rules.
to Rules of rendering the stationary help
See Appendix 1 (0.35Mb In original language)
to Rules of rendering the stationary help
See Appendix 2 (0.21Mb In original language)
to Rules of rendering the stationary help
See Appendix 3 (0.32Mb In original language)
to Rules of rendering the stationary help
The list of transactions and manipulations by the MKB codes - 9 subjects to treatment in the round-the-clock hospital in the village
|
№ |
MKB-9 code |
Name of transaction |
|
1 |
Transactions and manipulations on skull, brain and brain covers | |
|
2 |
01:12 |
Open biopsy of cover of brain |
|
3 |
01:19 |
Other diagnostic procedures on skull |
|
4 |
01:20 |
Cranial trepanation |
|
5 |
01:24 |
Other forms of cranial trepanation |
|
6 |
01:25 |
Other kranioektomiya |
|
7 |
01:26 |
Implantation of catheter in cranial cavity or fabric |
|
8 |
02:01 |
Opening of cranial seams |
|
9 |
02:02 |
Raising of fragments of fracture of skull |
|
10 |
02:03 |
Forming of cranial bone transplant |
|
11 |
02:05 |
Installation of cranial plate |
|
12 |
02:07 |
Removal of cranial plate |
|
13 |
02:11 |
Imposing of simple seam on firm cover of brain |
|
14 |
02:14 |
Removal of horoidalny texture |
|
15 |
|
Transactions on drainage, shunting |
|
16 |
01:01 |
Tank puncture |
|
17 |
01:02 |
Ventrikulopunktion through previously implanted catheter. Puncture of tube of the ventrikulyarny shunt |
|
18 |
01:09 |
Other cranial punctures: aspiration from subarachnoidal space, subdural space |
|
19 |
02:20 |
Ventrikulostomiya |
|
20 |
02:32 |
The Ventrikulyarny shunt in the blood circulatory system, ventrikuloperitonostomiya |
|
21 |
02:33 |
The Ventrikulyarny shunt in thorax cavity |
|
22 |
02:39 |
Other manipulations on drainage of ventricle |
|
23 |
Transactions on brain with rehabilitation of the first stage | |
|
24 |
01:10 |
Monitoring of intracranial pressure, including implantation of catheter or the probe for monitoring |
|
25 |
01:14 |
Open biopsy of brain |
|
26 |
01:16 |
Implantation of catheter or the probe for monitoring of intracranial pressure |
|
27 |
01:31 |
Section of brain covers |
|
28 |
01:39 |
Other forms of section of brain |
|
29 |
01:51 |
Excision of affected area or fabric of brain covers |
|
30 |
01:52 |
Gemisferektomiya |
|
31 |
01:59 |
Other types of excision or destruction of the damaged site or tissue of brain |
|
32 |
Transactions on craniocereberal and peripheral nerves, gangliya with rehabilitation of the first stage | |
|
33 |
04:04 |
Other types of section of cranial and peripheral nerves |
|
34 |
04:30 |
Sewing together of cranial and peripheral nerves |
|
35 |
04:49 |
Other types of decompression of peripheral nerve or gangliya or lysis of solderings |
|
36 |
04.74 |
Other types of anastomoz of cranial or peripheral nerve |
|
37 |
04.76 |
Recovery of old traumatic injury of cranial and peripheral nerves |
|
38 |
04.99 |
Other manipulations on cranial and peripheral nerves |
|
39 |
05:29 |
Other simpatektomiya and ganglionarny simpatektomiya |
|
40 |
Transactions on spinal cord and structures of the vertebral channel with rehabilitation of the first stage | |
|
41 |
03:01 |
Removal of foreign matter from the vertebral channel |
|
42 |
03:02 |
Repeated opening of the place of lamineektomiya |
|
43 |
03:09 |
Other types of inspection and decompression of structures of the vertebral channel |
|
44 |
03:51 |
Operational elimination of meningocele |
|
45 |
03:53 |
Recovery of spinal fracture |
|
46 |
03:59 |
Other recovery and plastic surgeries on structures of spinal cord |
|
47 |
03.72 |
Spinal subarachnoidal мочеточниковый shunt |
|
48 |
Diagnostic procedures on nervous system | |
|
49 |
01:18 |
Other diagnostic procedures on brain and its covers |
|
50 |
03:39 |
Other diagnostic manipulations on spinal cord and structures of the vertebral channel |
|
51 |
Transactions on pancreas | |
|
52 |
51.33 |
Anastomoz of gall bladder in pancreas |
|
53 |
52.00 |
Transactions on pancreas |
|
54 |
52.02 |
Pankreatotomiya |
|
55 |
52.09 |
Other pankreatotomiya |
|
56 |
52.12 |
Open biopsy of pancreas |
|
57 |
52.20 |
Local excision or destruction of fabric or affected area of pancreas and its channel |
|
58 |
52.403 |
Pankreatikotsistoyeyunostomiya |
|
59 |
52.95 |
Other recovery manipulations on pancreas |
|
60 |
52.96 |
Anastomoz of pancreas |
|
61 |
52.99 |
Other manipulations on pancreas |
|
62 |
Spondylodesis of vertebrae | |
|
63 |
81.00 |
Spondylodesis of vertebrae |
|
64 |
81.03 |
Other zadnesheyny spondylodesis |
|
65 |
81.05 |
Spondylodesis of chest and lumbar vertebrae, back access |
|
66 |
81.083 |
Spondylodesis of lumbar and sacral vertebrae, back access, prosthetics of disk |
|
67 |
81.09 |
Spondylodesis of backbone, any department and any method |
|
68 |
Other transactions and manipulations on nervous system | |
|
69 |
02.99 |
Other manipulations on skull, brain and brain covers |
|
70 |
03.99 |
Other manipulations on spinal cord and structures of the vertebral channel |
|
71 |
05.89 |
Other manipulations on sympathetic nerves or gangliya |
|
72 |
05.90 |
Other manipulations on nervous system |
|
73 |
Transactions on thyroid, parathyroid glands | |
|
74 |
06:20 |
Unilateral lobectomy of thyroid gland |
|
75 |
06:21 |
Subtotal resection of thyroid gland |
|
76 |
06:30 |
Other types of partial tireoidektomiya |
|
77 |
06:31 |
Excision of the damaged site of thyroid gland |
|
78 |
06:32 |
Enucleation of cyst or node of thyroid gland |
|
79 |
06:39 |
Other partial tireoidektomiya |
|
80 |
06:40 |
Complete tireoidektomiya |
|
81 |
06.92 |
Bandaging of vessels of thyroid gland |
|
82 |
06.98 |
Other transactions on thyroid gland |
|
83 |
Transactions on adrenal glands | |
|
84 |
07:22 |
Unilateral adrenalektomiya |
|
85 |
07:30 |
Bilateral adrenalektomiya |
|
86 |
07:41 |
Adrenal gland section |
|
87 |
07:42 |
Crossing of nerves of adrenal glands |
|
88 |
07:43 |
Bandaging of vessels of adrenal glands |
|
89 |
Transactions on structures of nose and almonds | |
|
90 |
21:04 |
Stop of nasal bleeding by bandaging of etmoidalny arteries |
|
91 |
21:05 |
Stop of nasal bleeding by bandaging of maxillary artery transantral access |
|
92 |
21:06 |
Stop of nasal bleeding by bandaging of outside carotid |
|
93 |
21:07 |
Stop of nasal bleeding by excision of mucous membrane of nose and implantation of skin of nasal partition and sidewall of nose |
|
94 |
21:40 |
Nose resection |
|
95 |
21:50 |
Submucosal resection of partition of nose |
|
96 |
21.72 |
Open reposition of fracture of nose |
|
97 |
21.901 |
Opening of furuncle of nose |
|
98 |
Transactions on outside ear | |
|
99 |
18.60 |
Reconstruction of the outside acoustical channel |
|
100 |
18.71 |
Recovery of auricle |
|
101 |
18.72 |
Sewing of the amputated ear |
|
102 |
Transactions on middle ear and mastoidal shoot | |
|
103 |
20:21 |
Section of mastoidal shoot |
|
104 |
20:41 |
Simple mastoidektomiya |
|
105 |
20:42 |
Radical mastoidektomiya |
|
106 |
20:49 |
Other types of mastoidektomiya |
|
107 |
Transactions on inner ear | |
|
108 |
19:20 |
Audit of stapedektomiya |
|
109 |
19:52 |
Timpanoplastika type II |
|
110 |
Transactions on bosoms and sine | |
|
111 |
22.79 |
Other types of recovery of bosom of nose |
|
112 |
22.90 |
Other manipulations on nose bosoms |
|
113 |
ENT SPECIALIST of manipulation | |
|
114 |
20:39 |
Other diagnostic manipulations on middle and inner ear |
|
115 |
20.99 |
Other manipulations on middle and inner ear |
|
116 |
21.90 |
Other manipulations on nose |
|
117 |
Transactions on throat, trachea and bronchial tubes | |
|
118 |
31.64 |
Recovery transactions in case of throat fracture |
|
119 |
31.71 |
Sewing up of gap of trachea |
|
120 |
32.28 |
Endoscopic excision or destruction of the damaged site or tissue of bronchial tube |
|
121 |
32.291 |
Torakostomiya of the damaged site or tissue of bronchial tube |
|
122 |
Recovery and plastic surgeries and manipulations on throat and trachea | |
|
123 |
29.31 |
Krikofaringialny miotomiya |
|
124 |
31.61 |
Sewing up of gap of throat |
|
125 |
32.20 |
Local excision or destruction of the damaged site or tissue of bronchial tube |
|
126 |
32.29 |
Other types of local excision or destruction of the damaged site or tissue of bronchial tube |
|
127 |
33.42 |
Closing of fistula of bronchial tube |
|
128 |
Transactions on lungs, diaphragm | |
|
129 |
34.84 |
Other types of recovery transactions on diaphragm |
|
130 |
32.30 |
Lung segment resection |
|
131 |
32.301 |
Ekhinokokkektomiya of lung |
|
132 |
32.36 |
Torakoskostomiya of lung segment |
|
133 |
32.40 |
Lobectomy of lung |
|
134 |
32.90 |
Other types of excision of lung |
|
135 |
33.10 |
Lung section |
|
136 |
33.43 |
Sewing up of gap of lung |
|
137 |
34.51 |
Lung decortication |
|
138 |
53.80 |
The elimination of hernia of diaphragm thoracic access which is not specified differently |
|
139 |
53.81 |
Elimination of hernia of diaphragm thoracic access, diaphragm plication |
|
140 |
Transactions on thorax, pleura | |
|
141 |
32.60 |
Radical excision of structures of thorax |
|
142 |
34.03 |
Retorakotomiya |
|
143 |
34.05 |
Creation of the plevroperitonealny shunt |
|
144 |
34.60 |
Pleura scarification |
|
145 |
34.93 |
Recovery of pleura |
|
146 |
Manipulations on respiratory organs | |
|
147 |
33.22 |
Sanatsionny fibrobronkhoskopiya |
|
148 |
33.29 |
Other diagnostic procedures on bronchial tubes and lungs |
|
149 |
33.93 |
Lung puncture |
|
150 |
34.02 |
Diagnostic torakotomiya |
|
151 |
34.04 |
Drainage of pleural cavity |
|
152 |
34.06 |
Torakoskopichesky drainage of pleural cavity |
|
153 |
34.20 |
Torakoskopichesky pleural biopsy |
|
154 |
34.21 |
Transpleural torakoskopiya |
|
155 |
34.91 |
Diagnostic pleural puncture |
|
156 |
Other transactions and manipulations on respiratory organs | |
|
157 |
31.20 |
Trakheostomiya |
|
158 |
31.00 |
Other manipulations on throat and trachea |
|
159 |
31.29 |
Other types of permanent trakheostomiya |
|
160 |
31.30 |
Other types of section of throat or trachea |
|
161 |
31.99 |
Other manipulations on trachea |
|
162 |
33.00 |
Other transactions on lungs and bronchial tubes |
|
163 |
33.49 |
Other recovery and plastic manipulations on lung |
|
164 |
33.98 |
Other manipulations on bronchial tube |
|
165 |
33.99 |
Other manipulations on lung |
|
166 |
34.28 |
Other diagnostic manipulations on chest wall, pleura and diaphragm |
|
167 |
34.59 |
Other types of excision of pleura |
|
168 |
34.79 |
Other recovery transactions on chest wall |
|
169 |
34.89 |
Other manipulations on diaphragm |
|
170 |
34.99 |
Other manipulations on thorax |
|
171 |
38.65 |
Other types of excision of other vessels of thorax |
|
172 |
Transactions on bodies of sredosteniye, aorta | |
|
173 |
31.21 |
Mediastinal trakheostomiya |
|
174 |
34.30 |
Excision or destruction of the damaged site or fabric of sredosteniye |
|
175 |
37.40 |
Recovery iatrogenic damage and wounds of heart and pericardium |
|
176 |
37.99 |
Other manipulations on heart and pericardium |
|
177 |
Medical and diagnostic transactions on heart | |
|
178 |
37.12 |
Perikardiotomiya |
|
179 |
37.29 |
Other diagnostic procedures on heart and pericardium |
|
180 |
88.50 |
Angiocardiography |
|
181 |
88.52 |
Angiocardiography of the right departments of heart |
|
182 |
88.53 |
Angiocardiography of the left departments of heart |
|
183 |
88.54 |
Angiocardiography of the right and left departments of heart |
|
184 |
Transactions on vessels of chest and abdominal cavity | |
|
185 |
38.06 |
Section of arteries of abdominal cavity |
|
186 |
38.07 |
Section of veins of abdominal cavity |
|
187 |
38.47 |
Resection of veins of abdominal cavity with replacement |
|
188 |
38.57 |
Bandaging and extirpation of varicose veins of abdominal cavity |
|
189 |
44.91 |
Bandaging of varikoznorasshirenny veins of stomach |
|
190 |
Transactions on vessels of the upper and lower extremity | |
|
191 |
38.00 |
Section of vessel, not specified localization |
|
192 |
38.03 |
Section of vessels of the upper extremity |
|
193 |
38.08 |
Section of arteries of the lower extremity |
|
194 |
38.18 |
Endarterektomiya of arteries of the lower extremity |
|
195 |
38.38 |
Resection of arteries of the lower extremity with anastomozy |
|
196 |
38.49 |
Resection of veins of the lower extremity with replacement |
|
197 |
38.63 |
Other types of excision of vessels of the upper extremity |
|
198 |
39.30 |
Sewing together of not specified blood vessel |
|
199 |
39.31 |
Sewing together of artery |
|
200 |
39.32 |
Sewing together of vein |
|
201 |
39.491 |
Femoral and subnodal shunting |
|
202 |
Manipulations on vessels | |
|
203 |
38.29 |
Other diagnostic manipulations on blood vessels |
|
204 |
39.49 |
Other audit of manipulation on vessel |
|
205 |
39.59 |
Other methods of recovery of vessel |
|
206 |
39.91 |
Release of vessel |
|
207 |
39.93 |
Introduction of catheter from vessel in vessel |
|
208 |
39.94 |
Replacement of the catheter which is carried out from vessel to vessel |
|
209 |
39.98 |
The bleeding stop which is not specified differently |
|
210 |
39.99 |
Other manipulations on vessels |
|
211 |
88.55 |
Coronary arteriography with use of one catheter |
|
212 |
88.56 |
Coronary arteriography with use of two catheters |
|
213 |
88.57 |
Other coronary arteriography which is not specified above |
|
214 |
Transactions and manipulations on marrow | |
|
215 |
41.30 |
Diagnostic procedures on marrow and spleen |
|
216 |
41.98 |
Other manipulations on marrow |
|
217 |
Transactions on structures of mouth | |
|
218 |
22:30 |
Outside maxillary antrotomiya |
|
219 |
22:31 |
Radical maxillary antrotomiya |
|
220 |
22:39 |
Other outside maxillary antrotomiya |
|
221 |
24:40 |
Excision of the struck tooth site of jaw |
|
222 |
25.50 |
Recovery and plastic surgeries in language |
|
223 |
26.21 |
Marsupialization of cyst of salivary gland |
|
224 |
26.29 |
Excision of the damaged site of salivary gland |
|
225 |
26.41 |
Sewing up of gap of salivary gland |
|
226 |
26.90 |
Other manipulations on salivary gland or channel |
|
227 |
27.00 |
Drainage of area of person and mouth floor |
|
228 |
27.10 |
Sky section |
|
229 |
27.43 |
Other types of excision of the damaged site or tissue of lip |
|
230 |
27.61 |
Sewing up of gap of the sky |
|
231 |
27.92 |
Section in mouth without refining of structure |
|
232 |
29.20 |
Excision of cyst of branchyogenic crevice or vestigiya |
|
233 |
Recovery and plastic surgeries on structures of oral cavity | |
|
234 |
25.20 |
Partial resection of language |
|
235 |
26.30 |
Sialadenektomiya who is not specified differently |
|
236 |
26.31 |
Partial sialadenektomiya |
|
237 |
26.32 |
Complete sialadenektomiya |
|
238 |
27.42 |
Broad excision of the damaged site of the bay |
|
239 |
27.49 |
Other excision of mouth |
|
240 |
29.52 |
Closing of fistula of branchyogenic crevice |
|
241 |
Transactions on drink | |
|
242 |
29.32 |
Faringialny divertikulektomiya |
|
243 |
29.51 |
Sewing up of gap of throat |
|
244 |
29.99 |
Other manipulations on drink |
|
245 |
Transactions on gullet | |
|
246 |
42.01 |
Gullet diaphragm section |
|
247 |
42.21 |
Operational ezofagoskopiya with section |
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The document ceased to be valid since April 10, 2022 according to Item 2 of the Order of the Minister of Health of the Republic of Kazakhstan of March 24, 2022 No. KR-DSM-27