The procedure and conditions for the provision of medical care
PROGRAM OF STATE GUARANTEES OF FREE RENDERING TO CITIZENS IN THE TERRITORY OF LIPETSK REGION
MEDICAL CARE FOR 2018 AND FOR THE PLANNED PERIOD 2019 and 2020
VIII. The procedure and conditions for the provision of medical care, including the waiting time for medical care provided in a planned manner
Medical assistance under the territorial compulsory health insurance program is provided upon presentation of a compulsory health insurance policy, with the exception of cases of emergency medical care.
The consent (refusal) of the citizen (his legal representatives) to (from) the provision (s) of medical care is formalized in the medical documentation. The provision of medical care without his (their) consent is possible to persons suffering from diseases that pose a danger to others, severe mental disorders, to persons who have committed socially dangerous acts, on the grounds and in the manner established by the legislation of the Russian Federation.
The scope of diagnostic and therapeutic measures for the patient is determined by the attending physician in accordance with the established procedures for the provision of medical care and / or standards of medical care, clinical recommendations (treatment protocols) for the provision of medical care, and in cases of their absence - generally accepted norms of clinical practice.
If it is impossible to provide a citizen with medical care in accordance with the standards and procedures for the provision of medical care by a medical organization, the citizen is sent to provide the necessary medical care to another medical organization included in the list of medical organizations participating in the implementation of the Program.
Conditions for the provision of medical care in outpatient institutions and units:
a) the waiting time for an appointment by district general practitioners, general practitioners (family doctors), district pediatricians should not exceed 24 hours from the moment the patient contacts a medical organization (not implemented in the conditions of the State Medical Institution "LOCB") ;
b) the waiting time for consultations of specialist doctors should not exceed 14 calendar days from the date of the patient's appeal to a medical organization;
c) waiting times for diagnostic instrumental (X-ray examinations, including mammography, functional diagnostics, ultrasound examinations) and laboratory examinations in the provision of primary health care should not exceed 14 calendar days from the date of appointment;
d) waiting times for computed tomography (including single-photon emission computed tomography), magnetic resonance imaging and angiography in the provision of primary health care in a planned form should not exceed 30 calendar days from the date of appointment;
e) the attending physicians of medical organizations, if indicated, refer the patient to hospitalization in a planned manner;
f) drug provision of outpatient care is carried out at the expense of citizens' personal funds, with the exception of drug provision for certain categories of citizens in accordance with federal and regional legislation;
g) waiting times for the provision of primary health care in an emergency form - no more than 2 hours from the moment the patient contacts a medical organization.
Conditions for the provision of emergency medical care in outpatient facilities and departments:
a) the patient is admitted out of turn and without an appointment;
b) emergency reception of all applicants is carried out regardless of the patient's attachment to the clinic;
c) the absence of an insurance policy and an identity document is not a reason for refusing an emergency admission;
d) emergency and urgent assistance on holidays and weekends is carried out by ambulance and trauma centers.
Conditions for the provision of medical care in a hospital setting:
a) when providing planned inpatient care, it is necessary to have a referral for hospitalization from the attending physician;
b) the waiting time for the provision of specialized (except for high-tech) medical care does not exceed 30 calendar days from the date the attending physician issues a referral for hospitalization
c) in a medical organization that provides specialized medical care, a "waiting list for the provision of specialized medical care in a planned form" is maintained for each profile of medical care; informing citizens about the waiting time for hospitalization is carried out in an accessible form, including using the information and telecommunications network "Internet", taking into account the requirements of the legislation of the Russian Federation on personal data;
d) waiting times for planned care in day hospitals and home hospitals should not exceed 14 calendar days.
Conditions for the provision of emergency medical care (not implemented in the conditions of the State Healthcare Institution "LOKB") :
a) ambulance, including specialized ambulance, medical care is provided to patients with diseases, accidents, injuries, poisoning and other conditions requiring urgent medical intervention;
b) ambulance, including specialized ambulance, medical care is provided in an emergency or urgent form outside a medical organization, as well as on an outpatient and inpatient basis;
c) emergency medical care is provided urgently in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient's life;
the time of arrival of the ambulance teams to the patient in the provision of emergency medical care in an emergency form should not exceed 20 minutes from the moment it was called;
emergency medical care is provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life;
d) when providing emergency medical care, if necessary, medical evacuation is carried out, which is the transportation of citizens in order to save lives and preserve health;
e) medical evacuation is carried out by mobile ambulance teams with medical assistance during transportation, including with the use of medical equipment;
f) the absence of a compulsory medical insurance policy and identity documents is not a reason for refusing to call and provide emergency medical assistance.
Conditions for the provision of medical care at home, including when organizing a hospital at home (not implemented in the conditions of the State Healthcare Institution "LOCB") :
a) medical care at home is provided for acute diseases and exacerbations of chronic;
b) with the patronage of children under one year old;
c) if necessary, observation until recovery of children under the age of 3 years and children with infectious diseases.
Conditions for the provision of palliative medical care (not implemented in the conditions of the State Healthcare Institution "LOCB") :
a) inpatient palliative care is provided in palliative care units (nursing care units);
b) palliative medical care on an outpatient basis is provided in the offices of palliative medical care, as well as by the teams of the outpatient patronage service of palliative care.
The conditions for the provision of high-tech medical care are established by order of the Ministry of Health of the Russian Federation dated December 29, 2014 No. 930n "On approval of the Procedure for organizing the provision of high-tech medical care using a specialized information system."
When providing high-tech medical care, the waiting time for patients for planned hospitalization is determined by the profile of high-tech medical care and the volume of treatment provided for by the types of high-tech medical care.
Conditions for exercising the right to choose a doctor, including a general practitioner (family doctor) and an attending physician
In accordance with Article 21 of the Federal Law of November 21, 2011 No. 323-FZ "On the Basics of Health Protection of Citizens in the Russian Federation", when providing a citizen with medical assistance under the Program, a citizen has the right to choose a medical organization in the manner prescribed by order of the Ministry of Health and Social development of the Russian Federation dated April 26, 2012 No. 406n "On approval of the Procedure for choosing a medical organization by a citizen when providing him with medical care within the framework of the program of state guarantees of free provision of medical care to citizens", and the choice of a doctor subject to the consent of the doctor.
Upon receipt of primary health care, a citizen has the right to choose a general practitioner, district general practitioner, pediatrician, district pediatrician, general practitioner (family doctor) or paramedic no more than once a year (except in cases of replacement medical organization) by submitting an application personally or through a representative addressed to the head of the medical organization.
In the event of a patient's request to replace the attending physician (except for the provision of specialized medical care), the patient applies to the head of the medical organization (its subdivision) with a written statement indicating the reasons for replacing the attending physician.
The head of a medical organization (its subdivision), within three working days from the date of receipt of the application, informs the patient in writing or orally (in person or by mail, telephone, electronic communication) about the doctors of the relevant specialty and the timing of the provision of medical care by these doctors.
Based on the information provided by the head of the medical organization (its subdivision), the patient chooses a doctor.
The assignment of the functions of the attending physician to the physician of the corresponding specialty is carried out subject to his consent.
When choosing a doctor and a medical organization, a citizen has the right to receive information in an accessible form, including information posted on the Internet information and telecommunication network (hereinafter referred to as the Internet), about a medical organization, about its medical activities and doctors, about their level of education and qualifications.
The procedure for exercising the right to extraordinary provision of medical care to certain categories of citizens
The basis for the extraordinary provision of medical care is a document confirming the privileged category of citizens.
On an extraordinary basis, medical care is provided in the following conditions:
- stationary (except for high-tech medical care).
The order of emergency medical care:
- planned medical care on an outpatient basis is provided to citizens on an extraordinary basis at the place of attachment. Scheduled consultations, diagnostic and laboratory tests are carried out within 5 working days from the date of contact registered with the attending physician;
- scheduled consultations, diagnostic and laboratory tests in consultative polyclinics, specialized polyclinics and dispensaries - within 10 working days from the date of contact;
- when providing planned medical care in inpatient conditions, the waiting period for planned hospitalization should not be more than 14 working days;
- medical organizations at the place of attachment organize, in accordance with the procedure established in the medical organization, the registration of privileged categories of citizens and dynamic monitoring of their state of health;
- in the case of a request from several citizens eligible for emergency medical care, planned assistance is provided on a first-come, first-served basis.
Information about certain categories of citizens who have the right to an extraordinary provision of medical care is posted on stands in medical organizations