of January 4, 2020 No. 2
About questions of the organization of activities of service of emergency medical service
Based on paragraph two of subitem 8.8-7, of subitem 8.37 of Item 8 and subitem 9.1 of Item 9 of the Regulations on the Ministry of Health of the Republic of Belarus approved by the resolution of Council of Ministers of the Republic of Belarus of October 28, 2011 No. 1446, the Ministry of Health of the Republic of Belarus DECIDES:
1. Establish forms of medical documents:
form No. 109/u-19 "The magazine of record of challenges of service of emergency medical service" according to appendix 1;
form No. 110/u-19 "The card of challenge of crew of emergency medical service" according to appendix 2;
form No. 114/u-19 "Accompanying leaf of the card of challenge of crew of emergency medical service" according to appendix 3;
form No. 115/u-19 "The diary of work of service of emergency medical service" according to appendix 4;
form No. 118/u-19 "The magazine of information transfer about the patient in the organization of health care providing medical care in out-patient conditions" according to appendix 5.
2. Approve the Instruction about procedure for the organization of activities of service of emergency medical service it (is applied).
3. Recognize invalid:
the resolution of the Ministry of Health of the Republic of Belarus of October 12, 2009 No. 110 "About approval of the Instruction about procedure for the organization of activities of service of fast (urgent) medical care";
the resolution of the Ministry of Health of the Republic of Belarus of August 15, 2012 No. 125 "About introduction of amendments to the resolution of the Ministry of Health of the Republic of Belarus of October 12, 2009 No. 110".
4. This resolution becomes effective after its official publication.
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Minister |
V. S. Karanik |
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It is approved Ministry of Internal Affairs of the Republic of Belarus |
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Investigative Committee of the Republic of Belarus |
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State committee of judicial examinations of the Republic of Belarus |
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Ministry of Emergency Situations of the Republic of Belarus |
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Ministry of Communications and Informatization of the Republic of Belarus |
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Brest regional executive committee |
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Vitebsk regional executive committee |
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Gomel regional executive committee |
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Grodno regional executive committee |
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Minsk regional executive committee |
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Mogilev regional executive committee |
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Minsk city executive committee |
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to the Resolution of the Ministry of Health of the Republic of Belarus of January 4, 2020 No. 2
Form No. 109/u-19
___________________________________
(name of the organization
health cares)
Magazine of record of challenges of service of emergency medical service
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It is begun ____ with ______________ 20 ___. |
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It is ended ____ by ______________ 20 ___. |
Storage duration _______ years |
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№ |
Date and time of the address (hours, minutes) |
Surname, own name, middle name (if that is available) (further – full name) the patient (identification number of the patient) |
Birth date of the patient, age (complete years, for children till 1 year – months, days) |
The address of challenge of crew of emergency medical service (further – SMP) |
Residence (place of stay) |
SMP crew challenge occasion |
Full name or position of person who addressed to service SMP, contact phone number |
SMP crew challenge priority |
Number of the card of challenge of crew of SMP |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
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Continuation
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Readdress of challenge in other organization of health care (the name of the organization of health care) |
Number of crew of SMP |
The preliminary diagnosis established by the doctor of SMP (paramedic) |
Date and time (hours, minutes) |
The result of departure (is left on site, transferred, transported) |
The organization of health care where the patient is transported |
Full name and the signature of person which entered data | ||
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departures/transfers of challenge to other organization of health care |
arrivals in the challenge address |
completion | ||||||
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11 |
12 |
13 |
14 |
15 |
16 |
17 |
18 |
19 |
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Note. It is conducted on paper or in the form of the electronic document processed according to the legislation on electronic documents and the digital signature.
to the Resolution of the Ministry of Health of the Republic of Belarus of January 4, 2020 No. 2
Form No. 110/u-19
___________________________________
(name of the organization
health cares)
Card of challenge of crew of emergency medical service No. _____
____ _____________ 20 __.
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The document ceased to be valid since December 19, 2025 according to Item 3 of the Resolution of the Ministry of Health of the Republic of Belarus of November 4, 2025 No. 179