ORDER OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

of October 30, 2020 No. 1184n

About introduction of amendments to the Order of the Ministry of Health of the Russian Federation of March 19, 2020 No. 198n "About temporary procedure for the organization of work of the medical organizations for the purpose of implementation of measures for prevention and decrease in risks of spread of new koronavirusny infection of COVID-19"

According to the Federal Law of November 21, 2011 No. 323-FZ "About bases of protection of public health in the Russian Federation" (The Russian Federation Code, 2011, No. 48, Art. 6724; 2020, No. 31, the Art. 5062) and subitem 5.2.208 of the Regulations on the Ministry of Health of the Russian Federation approved by the order of the Government of the Russian Federation of June 19, 2012 No. 608 (The Russian Federation Code, 2012, to No. 26, of the Art. 3526), I order:

Make changes to the order of the Ministry of Health of the Russian Federation of March 19, 2020 No. 198n "About temporary procedure for the organization of work of the medical organizations for the purpose of implementation of measures for prevention and decrease in risks of spread of new koronavirusny infection of COVID-19" (it is registered by the Ministry of Justice of the Russian Federation on March 19, 2020, registration No. 57786) with the changes made by orders of the Ministry of Health of the Russian Federation of March 27, 2020 No. 246n (registration No. 57860) is registered by the Ministry of Justice of the Russian Federation on March 27, 2020, of April 2, 2020 No. 264n (registration No. 57956) is registered by the Ministry of Justice of the Russian Federation on April 3, 2020, of April 29, 2020 No. 385n (registration No. 58255) is registered by the Ministry of Justice of the Russian Federation on April 30, 2020, of May 18, 2020 No. 459n (registration No. 58449) is registered by the Ministry of Justice of the Russian Federation on May 25, 2020, of May 29, 2020 No. 513n (registration No. 58560) is registered by the Ministry of Justice of the Russian Federation on June 3, 2020, of July 7, 2020 No. 685n (registration No. 58913) is registered by the Ministry of Justice of the Russian Federation on July 13, 2020, of August 27, 2020 No. 905n (registration No. 59645) is registered by the Ministry of Justice of the Russian Federation on September 4, 2020, of September 15, 2020 No. 982n (registration No. 59939) is registered by the Ministry of Justice of the Russian Federation on September 17, 2020, of October 1, 2020 No. 1062n (it is registered by the Ministry of Justice of the Russian Federation on October 7, 2020, registration No. 60279) and of October 23, 2020 No. 1140n (registration No. 60610) according to appendix is registered by the Ministry of Justice of the Russian Federation on October 28, 2020.

Appendix

to the Order of the Ministry of Health of the Russian Federation of October 30, 2020 No. 1184n

Changes which are made to the Order of the Ministry of Health of the Russian Federation of March 19, 2020 No. 198n "About temporary procedure for the organization of work of the medical organizations for the purpose of implementation of measures for prevention and decrease in risks of spread of new koronavirusny infection of COVID-19"

1. To add Item 5 of the order with subitems "v" and "g" of the following content:

"c) organize delivery of health care using telemedicine technologies to citizens with the confirmed diagnosis of new koronavirusny infection of COVID-19, the condition of which allows to be observed at home, and also with signs or the confirmed diagnosis of extra hospital pneumonia, acute respiratory viral infections, flu;

organize providing the medical organizations with necessary rooms, means of communication and the equipment for carrying out consultations (consultations of doctors) for implementation of remote interaction of health workers with patients. In case of implementation of consultations using telemedicine technologies by health workers in case of remote operating mode to organize providing the specified health workers with means of communication and the equipment for carrying out consultations;

d) organize the out-patient centers of diagnostics and treatment of new koronavirusny infection of COVID-19 (further - the Center);

organize interaction of the Centers with the medical organizations providing emergency medical service and the medical organizations providing medical care in out-patient and stationary conditions;

provide equipment of the Centers road transport for delivery of patients, health workers, and also for transportation of biological materials for researches, delivery of medicines.".

2. To add Item 6 of the order with paragraphs of the following content:

"temporary regulations of the organization and rendering advisory medical care using telemedicine technologies to citizens with the confirmed diagnosis of new koronavirusny infection of COVID-19, and also with signs or the confirmed diagnosis of extra hospital pneumonia, acute respiratory viral infection, flu, receiving medical care in out-patient conditions (at home), according to appendix No. 18;

regulations on the organization of work of the out-patient center of diagnostics and treatment of new koronavirusny infection of COVID-19 according to appendix No. 19.

3. In appendix No. 2:

a) state Item 1.3 in the following edition:

"1.3. Determine the all-profile mobile teams of emergency medical service directed to challenge to patients with symptoms of SARS and extra hospital pneumonia to patients with the established diagnosis of new koronavirusny infection of COVID-19 (further - specialized mobile teams of emergency medical service) and for selection of biological material for laboratory researches on the availability of new koronavirusny infection of COVID-19, and also mobile teams of emergency medical service performing medical evacuation of patients with new koronavirusny infection of COVID-19.";

b) add with Item 2.8 of the following content:

"2.8. Attraction to delivery of health care, specified in Item 1.3 of this Temporary procedure, persons with the higher medical education, and also persons who mastered the educational program of the higher medical education in volume of three rates and more (in "Nurse business" in volume of two rates and more), after training according to short-term additional professional programs (at least 36 hours) with employment to positions of specialists with secondary medical education (the medical sister / nurse, the medical sister / nurse on call acceptance of emergency medical service and transfer to their mobile teams of emergency medical service) and implementation of activities under control of the doctor (paramedic) of mobile team of emergency medical service without passing an examination according to the admission is allowed to implementation of medical activities on positions of average medical personnel, the Ministry of Health of the Russian Federation provided by the order of June 27, 2016 No. 419n "About approval of the Procedure for the admission of persons which did not complete development of educational programs of the higher medical or higher pharmaceutical education and also persons with the higher medical or higher pharmaceutical education to implementation of medical activities or pharmaceutical activities on positions of average medical or average pharmaceutical personnel" (registration No. 42977) is registered by the Ministry of Justice of the Russian Federation on July 27, 2016.".

4. In appendix No. 3 to add Item 1.13 with the paragraph of the following content:

"Involvement of persons with the higher medical or higher pharmaceutical education, and also persons who mastered the educational program of the higher medical education in volume of three rates and more (in "Nurse business" in volume of two rates and more), after training according to short-term additional professional programs (at least 36 hours) with employment to positions of specialists with secondary medical education and implementation of activities under control of the senior nurse without passing an examination according to the admission to implementation of medical activities on positions of the average medical personnel provided by the order of the Ministry of Health of the Russian Federation of June 27, 2016 No. 419n "About approval of the Procedure for the admission of persons which did not complete development of educational programs of the higher medical or higher pharmaceutical education is allowed and also persons with the higher medical or higher pharmaceutical education to implementation of medical activities or pharmaceutical activities on positions of average medical or average pharmaceutical personnel" (registration No. 42977) is registered by the Ministry of Justice of the Russian Federation on July 27, 2016.".

5. In appendix No. 16:

a) in the Section "Reception for Adult Population with the Confirmed Diagnosis of New Koronavirusny Infection of COVID-19 or with Suspicion of New Koronavirusny Infection of COVID-19" "Disinfector" to replace line item with line item "The medical disinfector";

b) add the Section "Consulting and Diagnostic Group" with line of the following content:

"

Junior medical personnel

is calculated proceeding from amount of the carried-out diagnostic services, but 1,0 on the organization suffices

".

6. In appendix No. 17:

a) in the Section "Reception for Children with the Confirmed Diagnosis of New Koronavirusny Infection of COVID-19 or with Suspicion of New Koronavirusny Infection of COVID-19" "Disinfector" to replace line item with line item "The medical disinfector";

b) add the Section "Consulting and Diagnostic Group" with line of the following content:

"

Junior medical personnel

is calculated proceeding from amount of the carried-out diagnostic services, but 1,0 on the organization suffices

".

7. Add the order with appendices No. 18 and 19 of the following content:

"Appendix No. 18

to the Order of the Ministry of Health of the Russian Federation of March 19, 2020 No. 198n

Temporary regulations of the organization and rendering advisory medical care using telemedicine technologies to citizens with the confirmed diagnosis of new koronavirusny infection of covid-19, and also with signs or the confirmed diagnosis of extra hospital pneumonia, acute respiratory viral infection, flu, receiving medical care in out-patient conditions (at home)

1. These Temporary regulations determine rules of use of telemedicine technologies under the organization and delivery of health care to citizens with the confirmed diagnosis of new koronavirusny infection of COVID-19, the condition of which allows to be observed at home, and also to citizens with signs or the confirmed diagnosis of extra hospital pneumonia, acute respiratory viral infections, flu (further - patients).

2. For the purpose of the organization of medical care using telemedicine technologies heads of executive bodies of subjects of the Russian Federation in the field of health protection and heads of the medical organizations and their structural divisions:

2.1. Provide operational rendering advisory medical care to patients using telemedicine technologies according to requirements of the legislation of the Russian Federation in the field of health protection <1> taking into account the requirements established by these Temporary regulations.

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<1> Part 1 of article 36.2 of the Federal Law of November 21, 2011 No. 323-FZ "About bases of protection of public health in the Russian Federation" (The Russian Federation Code 2011, No. 48, Art. 6724; 2018, No. 53, the Art. 8415) (further - the Federal Law No. 323-FZ).

2.2. Determine the medical organizations providing medical care using telemedicine technologies and also provide creation in need of single advice center of the subject of the Russian Federation providing remote interaction of health workers with patients with the confirmed diagnosis of new koronavirusny infection of COVID-19, condition of which it allows to be observed at home, and also patients with signs or the confirmed diagnosis of extra hospital pneumonia, acute respiratory viral infection, flu (further - single advice center) for the purpose of implementation of remote interaction of health workers with patients.

2.3. Provide readiness of the medical organizations for remote interaction of health workers with patients, including the necessary room, means of communication and the equipment for carrying out consultations (consultations of doctors), and also training of health and other workers regarding use of telemedicine technologies.

2.4. Perform collection, processing and the analysis of the obtained statistical data about rendering advisory medical care to patients using telemedicine technologies.

2.5. Provide forming of account registers on the medical services rendered using telemedicine technologies.

3. The medical organizations provide medical care using telemedicine technologies with use of the federal state information system "Single Portal of the State and Municipal Services (Functions)" (further - EPGU), and also single state information system in the field of health care (further - the Single system), the state information system in the field of health care of the subject of the Russian Federation, medical information systems of the medical organization, other information systems intended for collection, storage, processing and provision of information concerning activities of the medical organizations and services provided by them (further - other information systems).

4. Remote interaction of health workers with patients and (or) their legal representatives under the organization and delivery of health care using telemedicine technologies is performed for the purpose of:

4.1. Prevention, collection, analysis of claims of the patient and data of the anamnesis.

4.2. Efficiency evaluations of medical and diagnostic actions.

4.3. Decision makings about need of carrying out internal appointment (survey, consultation).

4.4. Remote observation of the state of health of the patient and efficiency evaluation of medical and diagnostic actions.

4.5. Corrections of earlier appointed treatment on condition of establishment by the attending physician of the diagnosis and purpose of treatment on internal acceptance (survey, consultation), including forming of the electronic recipe on medicine with its subsequent direction to the patient by means of EPGU.

4.6. Purposes of necessary inspections, issues of the reference (medical certificate) in electronic form with the subsequent direction to the patient of medical documents by means of EPGU.

4.7. Prolongation and closings of the leaves of disability created in the form of electronic documents, and also forming of leaves of disability in the form of electronic documents in case of threat of spread of the diseases included in the list of diseases, constituting danger to people around <2>, according to features of the organization of delivery of health care in case of threat of spread of the diseases constituting danger to people around>.

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<2> The order of the Government of the Russian Federation of December 1, 2004 No. 715 "About approval of the list of socially important diseases and the list of the diseases constituting danger to people around" (The Russian Federation Code 2004, No. 49, Art. 4916; 2020, No. 6, Art. 674).

<3> the Order of the Government of the Russian Federation of July 2, 2020 No. 973 "About features of the organization of delivery of health care in case of threat of spread of the diseases constituting danger to people around" (The Russian Federation Code 2020, No. 28, the Art. 4425).

5. Rendering advisory medical care using telemedicine technologies is performed by directly medical organizations and (or) single advice center.

6. Telemedicine technologies are applied when rendering advisory medical care to patients in emergency (including to determination of indications for challenge of crew of emergency medical service), urgent or planned form.

7. The health worker during telemedicine consultation of patients:

7.1. Makes identification of the patient in system.

7.2. Performs collection of the anamnesis.

7.3. Performs collection of claims.

7.4. Adjusts therapy (if necessary).

7.5. Makes the decision on routing of the patient (if necessary).

7.6. Fills in the electronic medical record of the patient.

8. The medical organizations and (or) single advice center provide to patients carrying out daily in the round-the-clock mode (24/7) of consultations using telemedicine technologies, information transfer about patients, including by means of EPGU, and also will organize remote daily dynamic observation of the specified patients using telemedicine technologies in the round-the-clock mode. Acceptance of incoming calls of the patients (with use of audio or video conference) who signed consent to receipt of medical care in out-patient conditions (at home) is also performed daily in the round-the-clock mode (24/7).

9. In case of decision making of the subject of the Russian Federation by executive body in the field of health protection about creation of single advice center the specified center has the right to request from the medical organizations of the information about the patient, necessary for implementation of consultations using telemedicine technologies, with observance of requirements of the legislation of the Russian Federation in the field of personal data and medical secret.

10. Storage of information obtained by results of delivery of health care using telemedicine technologies is performed according to procedure for the organization and delivery of health care using telemedicine technologies <4>.

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<4> The order of the Ministry of Health of the Russian Federation of November 30, 2017 No. 965n "About approval of procedure for the organization and delivery of health care using telemedicine technologies" (registration No. 49577) is registered by the Ministry of Justice of the Russian Federation on January 9, 2018.

Appendix No. 19

to the Order of the Ministry of Health of the Russian Federation of March 19, 2020 No. 198n

Regulations on the organization of activities of the out-patient center of diagnostics and treatment of new koronavirusny infection of COVID-19

1. The out-patient center of diagnostics and treatment of new koronavirusny infection of COVID-19 (further - the Center) is created on functional basis for the purpose of diagnostics and the choice of tactics of treatment of patients with the confirmed diagnosis of new koronavirusny infection of COVID-19 or with suspicion of new koronavirusny infection of COVID-19 (further - patients).

2. The structure and the number of staff of the Center are established by the head of the medical organization in coordination with executive body of the subject of the Russian Federation in the field of health protection.

3. The center is recommended to be created based on the medical organization giving primary health care and incorporating office of x-ray computer tomography.

If as a part of the medical organization there is no office of x-ray computer tomography, the medical organization signs the contract with other medical organizations having office of x-ray computer tomography or having opportunity to provide carrying out computer tomography with use of portable medical complex.

4. The center is recommended to be placed in the certain building.

In the absence of possibility of allocation of the certain building placement of the Center in one building with other structural divisions of the medical organization in the presence of possibility of separation of flows of patients and workers (the separate entrances isolated from other rooms), and also availability of the isolated forced-air and exhaust ventilating system or possibility of its isolation is allowed.

5. The round-the-clock working hours of the Center are recommended.

6. Patients arrive in the Center for the directions of the medical organization giving primary health care or are brought by mobile team of emergency medical service.

7. At the patients who do not have test result on COVID-19, the intake of biological material for laboratory research on availability of new koronavirusny infection of COVID-19 is carried out.

8. In structure of the Center work of the following zones and structural divisions will be organized:

8.1. Zone of acceptance and distribution of the patients who arrived in the direction and with crew of emergency medical service.

8.2. Zone for the patients expecting diagnostic actions in the Center (waiting area).

8.3. The diagnostic zone consisting from: office of computer tomography; procedural office for express diagnostics, blood extraction on the analysis by IFA method, captures of biological material (dab from nose and pharynx); ECG office; offices of specialists doctors.

8.4. The waiting area of crew of emergency medical service for patients with indications to hospitalization following the results of inspection in the Center.

9. On entrance to the Center of patients provide with individual protection equipment (medical mask, dressing gown one-time, hat, gloves, boot covers).

10. Depending on weight of condition of the patient and load of the Center patients go to the waiting area.

11. If the kliniko-radiological diagnosis of new koronavirusny infection of COVID-19 at the patient in the Center is established for the first time and the patient will continue treatment in out-patient conditions (at home), consent to delivery of health care in out-patient conditions (at home) and observance of isolation mode in case of treatment of new koronavirusny infection of COVID-19 is drawn up (the recommended sample is given in appendix to the Basic principles of delivery of health care in out-patient conditions (at home) to patients with the approved application No. 8 to this order installed by the diagnosis of new koronavirusny infection COVID-19,).

12. Information on results of inspection and the location address of the patient are transferred by the Center of the medical organization giving primary health care for the organization of delivery of health care in out-patient conditions (at home).

13. In the presence of indications to hospitalization to the patient the direction is drawn up, the mobile team of emergency medical service performing medical evacuation of patients with new koronavirusny infection of COVID-19, the patient is caused goes to the waiting area of crew of emergency medical service.

14. Patients with new koronavirusny infection (COVID-19) which will receive medical care in out-patient conditions (at home) to the residence are delivered by road transport of the Center.

15. In the Center separation into net and dirty zones is obligatory:

15.1. Net zone: separate entrance for personnel, clothes, rooms of meal, the room for putting on of individual protection equipment (glasses, one-time gloves, respirator of the corresponding class of protection, protivochumny suit of 1 type or one-time dressing gown, boot covers). In the absence of separate entrance for net zone the floor is divided into net and dirty zones with the organization of separate entrances. Joint storage of outerwear and footwear of personnel with sanitary clothes, use of replaceable footwear from fabric materials is not allowed.

15.2. Dirty zone: for arrival of patients, diagnostics, hospitalization in profile hospitals for treatment. In office of computer tomography separation into equipment room (dirty zone) and console is obligatory (net zone), the X-ray laboratory assistant remains in console, and in equipment room there is health worker providing carrying out computer tomography to the patient.

16. Routing of patients in the Center is carried out accompanied by personnel in individual protection equipment (further - SIZ).

17. Health workers and not medical personnel working in the Center are provided to SIZ.

18. On border between net and dirty zones the filter for putting on and removal of SIZ will be organized.

19. Upon termination of working shift the personnel of the Center undergo sanitary processing.

20. In the Center the necessary quantity of SIZ, and also means for carrying out preventive and focal disinfection of rooms shall be provided.".

 

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