№ of payment order

Name of criteria

Extent of violations

1. Criteria on information source "Results of the previous checks and special procedure for conducting checks (severity is established in case of non-compliance with following requirements)

Criterion for the objects of obstetric aid and (or) the stationary organizations incorporating delivery rooms and departments of pathology of newborns

1.

Availability of the license and appendices to it on the performed types of activity

rough

2.

Availability of the certificate of the specialist in the corresponding clinical specialty

rough

3.

Availability of the conclusion about compliance of the subject of health care to provision of high-technology medical services

rough

4.

Availability of written voluntary consent of the patient or his legal representative in case of invasive interventions and on holding medical and diagnostic actions

considerable

5.

Time of stay of crew of SSMP or department SMP under the PHC organization in reception of hospital does not exceed 10 minutes (time for transfer of the patient to the doctor of reception) from the moment of its arrival in hospital, except as specified need of rendering emergency medical service for emergency situations.
After transfer by crews of SMP or department SMP under the PHC organization of the patient the nurse carries out distribution of the arriving patients (medical sorting according to triazh-system) to groups to reception of hospital, proceeding from first priority of rendering the emergency medical care.
Medical sorting according to triazh-system is carried out continuously and preemstvenno. On completion of assessment, patients are marked with color of one of categories of sorting, in the form of special color label or color tape.
According to medical sorting, allocate 3 groups of patients:
the first group (red zone) – patients whose condition poses direct threat of life or deteriorations having high risk and requiring the emergency medical care;
the second group (yellow zone) – patients whose condition poses potential hazard for health or can progress with development of the situation, the requiring emergency medical care;
the third group (green zone) – patients whose condition does not pose direct threat for life and health and does not require hospitalization

rough

6.

In the absence of indications for hospitalization in the organization of health care, the doctor of reception issues to the patient the medical certificate with written reasons for refusal.
The nurse of reception the asset goes to the PHC organization for the place of attachment of the patient

considerable

7.

Availability of indications for hospitalization:
need of rendering pre-medical, qualified, specialized medical care, including using high-technology medical services, with the round-the-clock medical observation of patients:
1) in planned procedure – in the direction of specialists of PHC or other organization of health care:
2) according to the emergency indications (including days off and holidays) - regardless of direction availability

considerable

8.

Survey of the patient by the manager of department 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

considerable

9.

Daily survey of the patients who are in hospital, 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

considerable

10.

Additional and repeated carrying out the researches conducted before hospitalization in the PHC organization or other organization of health care 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.

considerable

11.

Observance of the following requirements in case of issue of leaf and certificate of temporary disability for pregnancy and childbirth:
- the sheet or the certificate of temporary disability on pregnancy and childbirth is issued by the health worker (the doctor the obstetrician-gynecologist), and in case of its absence - the doctor, together with the manager of department after the conclusion of VKK since thirty weeks of pregnancy for the term of lasting hundred twenty six calendar days (seventy calendar days before childbirth and fifty six calendar days after the delivery) in case of normal childbirth.
To the women living in the territories which were affected by nuclear testing, the sheet or the certificate of disability on pregnancy and childbirth is issued since twenty seven weeks lasting hundred seventy calendar days (ninety one calendar days before childbirth and seventy nine calendar days after the delivery) in case of normal childbirth;
2) to the women who temporarily left from the permanent residence within the Republic of Kazakhstan, the sheet or the certificate of temporary disability on pregnancy and childbirth is issued prolonged) in the medical organization where there was childbirth or in antenatal clinic (office) in the place of observation according to the statement (prenatal record) of the obstetrical organization
3) in case of the complicated childbirth, the birth of two and more children, the sheet or the certificate of temporary disability is prolonged in addition for fourteen calendar days by the health worker (the doctor the obstetrician-gynecologist), and in case of its absence - the doctor, together with the manager of department after the conclusion of VKK in the place of observation according to the statement of the obstetrical organization of health care. In these cases the general duration of prenatal and postnatal leaves constitutes hundred forty calendar days (seventy calendar days before childbirth and seventy calendar days after the delivery).
To the women living in the territories which were affected by nuclear testing in case of the complicated childbirth, the birth of two and more children, the sheet or the certificate of temporary disability is prolonged in addition for fourteen calendar days, the general duration of prenatal and postnatal leaves constitutes hundred eighty four days (ninety one calendar days before childbirth and ninety three calendar days after the delivery);
4) in case of childbirth in case of term from twenty two to twenty nine weeks of pregnancy and the child's birth with body weight five hundred grams and more, lived more than seven days, are issued to the woman the sheet or the certificate of disability upon childbirth for seventy calendar days after the delivery.
In case of childbirth in case of term from twenty two to twenty nine weeks of pregnancy and the birth of dead fruit or the child with body weight five hundred grams and more, died up to seven days of life, are issued to the woman the sheet or the certificate of temporary disability upon childbirth for fifty six calendar days after the delivery;
5) to the women living in the territories which were affected by nuclear testing, in case of childbirth in case of term from twenty two to twenty nine weeks of pregnancy and the child's birth with body weight five hundred grams and more, lived more than seven days, the sheet or the certificate of temporary disability is issued for ninety three calendar days after the delivery.
To the women living in the territories which were affected by nuclear testing, in case of childbirth in case of term from twenty two to twenty nine weeks of pregnancy and the birth of dead fruit or the child with body weight five hundred grams and more, died up to seven days of life, the sheet or the certificate of temporary disability is issued for seventy nine calendar days after the delivery;
6) in case of the address of the woman during pregnancy behind leaf of temporary disability the maternity leave is estimated totally and is provided completely irrespective of number of the days which are actually used by it before childbirth.
In case of the address of the woman to the period after the delivery behind leaf of temporary disability only leave after the delivery is granted by duration provided by this Item;
7) in case of approach of pregnancy during finding of the woman in paid annual labor leave or leave non-paid on child care before achievement of three years by it, the leaf about temporary disability is issued on all vacation days on pregnancy and childbirth, except as specified, provided by subitem part two 6) of this Item;
8) in case of the death of mother in case of childbirth or in the postnatal period, the sheet or the certificate of temporary disability is issued to person performing care of the newborn;
9) in case of transaction on abortion, the sheet or the certificate of temporary disability is issued by the doctor together with the manager of department for the period of stay in hospital and out-patient and polyclinic level where transaction was made, and in case of complication - for the entire period of temporary disability.
In case of spontaneous abortion (abortion) the sheet or the certificate of temporary disability for the entire period of temporary disability is issued;
10) when carrying out transaction of change of embryo the sheet or the certificate of temporary disability is issued by the medical organization performing operation from the date of replanting of embryo to the pregnancy establishment fact.
To persons who adopted (adopted) newborn child(children), and also the natural mother in case of surrogacy it is direct from maternity hospital the sheet or the certificate of temporary disability is issued, from the date of adoption (adoption) and before the expiration of fifty six calendar days since the birth of the child

considerable

12.

Availability of carrying out clinical audit by Support service of the patient and internal examination and its assessment by the following criteria:
1) quality of collection of the anamnesis which is estimated by the following criteria:
lack of collection of the anamnesis;
completeness of collection of the anamnesis;
availability of data on the postponed, chronic and heritable diseases, the carried-out hemotransfusions, portability of medicines, the allergologichesky status;
development of complications owing to the made tactical mistakes when holding medical and diagnostic actions because of low-quality collection of the anamnesis;
2) completeness and justification of conducting diagnostic testings which are estimated by the following criteria:
lack of diagnostic actions;
the wrong conclusion or lack of the conclusion by results of the conducted diagnostic researches which led to the wrong diagnosis and mistakes in treatment tactics;
conducting the diagnostic testings provided by clinical protocols;
conducting diagnostic testings with high, unjustified risk for the state of health of the patient, justification of conducting the diagnostic testings which did not enter in clinical the protocol;
conducting diagnostic testings, not informative for statement of the correct diagnosis and the terms of treatment which led to unreasonable increase and rise in price of cost of treatment;
3) correctness, timeliness and justification of the exposed clinical diagnosis taking into account results of the conducted researches (in case of planned hospitalization the researches conducted and at pre-hospital stage are considered), which are estimated by the following criteria:
the diagnosis is absent, incomplete or wrong, does not correspond to the international classification of diseases;
the leading pathological syndrome determining weight of course of disease is not allocated, associated diseases and complications are not distinguished;
the diagnosis is correct, but incomplete, the leading pathological syndrome in case of the allocated complications is not allocated, the associated diseases influencing outcome are not distinguished;
the diagnosis of the main disease correct, but the associated diseases influencing result of treatment are not diagnosed.
The objective reasons of the wrong and (or) untimely diagnostics (the atypical course of the main disease, the asymptomatic course of associated disease, seldom found complications and associated diseases) are reflected in results of examination. The impact assessment of the wrong and (or) untimely diagnosis on the subsequent stages of rendering medical services (help) is carried out;
4) timeliness and quality of consultations of profile specialists which are estimated by the following criteria:
the lack of consultation which resulted in wrong interpretation of the symptoms and syndromes which negatively affected disease outcome;
consultation is timely, rejection in attention of opinion of the consultant in case of diagnosis partially affected disease outcome;
consultation is timely, the opinion of the consultant is considered in case of diagnosis, failure to carry out of the recommendation of the consultant for treatment partially affected disease outcome;
the opinion of the consultant wrong also affected disease outcome.
In cases of carrying out consultations with delay, assessment of objectivity of the reasons of untimely consultation and influence of untimely diagnosis on the subsequent stages of rendering medical services (help) is carried out;
5) amount, quality and justification of holding medical actions which are estimated by the following criteria:
lack of treatment in the presence of indications;
purpose of treatment in the absence of indications;
purpose of ineffective medical actions without features of course of disease, associated diseases and complications;
accomplishment of medical actions not in full, without functional condition of bodies and systems, prescription of medicines without the proved clinical efficiency;
non-compliance with requirements of Standards, unreasonable variation from requirements of clinical protocols, the polypragmasy availability which led to development of new pathological syndrome and deterioration in condition of the patient;
6) absence or development of complications after medical interventions, are estimated all arisen complications including caused by surgeries (overdue surgery, inadequate amount and method, technical defects) and diagnostic procedures;
7) the achieved result which is estimated by the following criteria:
achievement of the expected clinical effect in case of respect for technology of rendering medical services (help);
lack of clinical effect of medical and preventive actions owing to low-quality collection of the anamnesis and conducting diagnostic testings;
lack of the expected clinical effect owing to holding ineffective medical, preventive actions without features of course of disease, associated diseases, complications, prescription of medicines without the proved clinical efficiency;
the polypragmasy availability which caused development of undesirable effects;
8) quality of maintaining medical documentation which is estimated on availability, completeness and quality of entries in primary medical documentation intended for data recording about the state of health of the patients reflecting nature, amount and quality of the provided medical care according to forms of reporting and accounting documentation in the field of health care according to the subitem 31) of article 7 of the Code

considerable

13.

Availability of the informed voluntary consent (refusal) to transfusion of components of blood in form of accounting and reporting documentation in the field of health care

considerable

14.

Observance of the following actions when carrying out pathoanatomical opening:
1) carrying out pathoanatomical opening of corpses after ascertaining by doctors of biological death, after provision of the medical record of the inpatient or the medical record of the outpatient with the written order of the chief physician or his deputy for medical (medical) part of the organization of health care about the direction on pathoanatomical opening;
2) registration of results of pathoanatomical opening in the form of the pathoanatomical diagnosis (the pathoanatomical diagnosis includes: the main disease, complication of the main disease, associated disease, the combined main disease);
3) transfer of the medical record of the inpatient or the medical record of the outpatient with the pathoanatomical diagnosis introduced in it in medical archive of the organization of health care no later than ten working days after pathoanatomical opening;
4) carrying out kliniko-pathoanatomical analysis in cases of death of patients in the organizations of health care;
5) pathoanatomical opening in case of suspicions of sharp infectious, oncological diseases, pathology of children's age, lethal outcome in connection with medical manipulations for the purpose of establishment of cause of death and refining of the diagnosis of disease from the death;
6) the organization by the chief physician and manager of pathoanatomical department of virologic (immunofluorescent) and bacteriological research of materials of opening of corpses in cases of suspicion of infectious diseases;
7) transfer to pathoanatomical bureau, centralized pathoanatomical bureau and pathoanatomical department of medical records of inpatients on all dead for prior days no later than 10 o'clock in the morning of the day following after factual determination of death;
8) registration:
- the health certificate on death (preliminary, final) the doctor in "pathological anatomy (adult, children's)" in day of carrying out pathoanatomical opening;
- the health certificate on perinatal death (preliminary, final) the doctor in "pathological anatomy (adult, children's)" in day of carrying out pathoanatomical opening;
9) registration of results of opening in the form of the protocol of pathoanatomical research;
10) availability of the written notice in judicial investigating bodies for the solution of question of transfer of corpse on forensic medical examination in case of detection of signs of violent death and the termination of carrying out pathoanatomical research of corpse;
11) availability of the notice in writing of the doctor in "pathological anatomy (adult, children's)" in case of primary detection during opening of signs of acute infectious disease, food or production poisoning, unusual reaction to inoculation, and also the emergency notice in bodies of the public sanitary and epidemiologic service, at once after their identification;
12) carrying out pathoanatomical research of placenta:
in case of still birth;
in case of all diseases of the newborns revealed at the time of the birth;
in cases, suspicious on hemolytic disease of newborns;
in case of early otkhozhdeniye of waters and in case of dirty waters;
in case of the diseases of mother proceeding with high temperature in the last trimester of pregnancy;
in case of explicit anomaly of development or attachment of placenta;
13) obligatory registration of fruit weighing less than 500 grams with anthropometrical data (weight, growth, head circle, thorax circle);
14) establishment of pathoanatomical opening depending on complexity on the following categories:
first category;
second category;
third category;
fourth category;
15) establishment by the doctor in "pathological anatomy (adult, children's)" categories of pathoanatomical opening and the reason of discrepancy of diagnoses in case of discrepancy of final clinical and pathoanatomical diagnoses
16) availability of the detailed analysis with determination of profile and categories of yatrogeniya in all cases of iatrogenic pathology, revealed as a result of pathoanatomical opening

rough