Organization of the work of the local therapist. The structure of the work of the clinic. Organization of the work of the district therapeutic service. The local therapist. Job description It is not the responsibility of the local general practitioner

The therapist is one of the key figures of modern clinical medicine. This is a generalist with a rich medical outlook and deep encyclopedic knowledge, possessing a number of special knowledge and skills that help him competently carry out primary diagnostics, prescribe preventive measures, analyze the results of additional studies and prescribe the correct, effective treatment.

The need to consult a therapist

In the life of almost every person, sooner or later, health problems arise, entailing the need for qualified advice or even medical care. If there are ailments complicated by pain in the abdominal cavity or chest, fever, insomnia, aching joints, weakness or other uncomfortable conditions, and the nature of these phenomena is difficult to determine, you must go to see a therapist. In this situation, it is the consultation of the therapist - right choice, since his responsibilities include conducting primary diagnostic measures, prescribing extended diagnostics if necessary, analyzing the results obtained and deciding on further actions. Timely consultation with a therapist will identify the causes of ailments and prevent the transition of the disease into a protracted chronic or complicated phase.

At the appointment, the therapist performs an initial examination and collects an anamnesis, that is, finds out the details of the patient's lifestyle, the individual characteristics of his body, hereditary predispositions, clarifies the details of the onset and course of the disease. Based on the information received during the initial consultation, the therapist makes a preliminary assessment of the patient's state of health and prescribes an appropriate examination, if necessary, sends him for a consultation with specialized specialists. As an additional examination, the therapist may prescribe following procedures: clinical and biochemical analysis of blood; radiography of bones, joints and organs of the chest, ultrasound of the abdominal cavity, FGDS, ECG and some others diagnostic measures. Based on the results of the analyzes, the data obtained from examinations and the conclusions of specialized specialists, the therapist makes a diagnosis and prescribes a course of medication and physiotherapy, or refers the patient for treatment to a specialized specialist.

Subsequent consultations of the therapist are carried out as necessary in order to control the course of treatment and subsequent rehabilitation.

Local therapist

A special category of doctors are district therapists. These are the “number one” doctors, the specialists who are the first to encounter the manifestation of ill health in most people in our country. From this point of view, such a therapist is the most important, key link in the healthcare system.

The circle of their patients for a long time includes approximately the same people. To some extent, district therapists are family doctors, because they know the medical history of most patients permanently residing in their areas. As a rule, the district doctor is familiar with the living conditions of patients, their lifestyle, hereditary predispositions and other factors that can complicate the patient's condition, and therefore, faster than an ordinary general practitioner, can assume the causes of the disease and take measures to eliminate them.

The local therapist keeps a systematic record and observation of patients with chronic diseases (dispensary record), controls the timeliness of the passage preventive measures hostility, contributes to the direction of those who need it, to sanatorium-and-spa treatment.

The competence of the local therapist includes the initial diagnosis of the disease, the appointment and implementation of therapeutic and preventive measures necessary for the treatment of seasonal infectious diseases of mild and moderate severity, as well as some other diseases, the treatment of which is carried out at home and does not require hospitalization. After the patient has recovered, the local therapist evaluates the degree of his ability to work and issues sick leave- a document certifying the fact of the disease and provided at the place of work of the patient.

Responsibilities of the local therapist

The responsibilities of the local physician include:

• be well prepared to perform the basic functions of a local therapist: organizational, diagnostic, advisory, preventive, therapeutic and rehabilitation;
• competently combine thorough theoretical training with practical therapeutic skills, continuously engage in self-education, improving and increasing their professional competence;
• navigate in modern sources of scientific and technical information and use the knowledge gained in practice;
• as necessary, appoint additional special methods of research: lab tests, fluoroscopy, functional studies;
• if necessary, refer the patient for consultations to specialized specialists;
• determine the degree of disability of the patient or send him to the examination of temporary disability;
• organize rehabilitation activities for needy patients;
• reveal infectious diseases on early stages, notify the SES about the infection and take the necessary anti-epidemic measures;

Besides,

• the therapist must establish indications for hospitalization of the patient and take organizational measures for its implementation;
• according to the established procedure, the district doctor must organize and carry out preventive vaccination and deworming of residents in the area entrusted to him;
• must organize and implement a set of measures for the medical examination of adults living in his area, i.e. conduct preventive examinations, determine the need for therapeutic and preventive measures, draw up and maintain medical documentation, timely make reports on the work done;
• the general practitioner working at the site must be able to make a preliminary diagnosis and provide all possible first aid in case of emergency conditions patients specified in the job description;
• at the initial appointment, the therapist should be able to correctly prescribe a set of necessary therapeutic and preventive measures;
• the local therapist must have strong skills to carry out a number of manipulation procedures specified in the job description.

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Comments on the material (30):

1 2

Quoting Adeline:

Hello. For 2 months I suffered from chest pains. Once I got to the therapist, they prescribed NSAIDs. No diagnosis. The second time I almost got to a neurologist, but the doctor quit, and I had to go again for a coupon. I went to the paramedic this time. She doesn't give directions. As a result, I spent 5,000 to be examined by a neurologist in another city, they did an MRI and said that I had the initial stage of osteochondrosis and hernia. And that the therapist should have examined me. Tell me, is it legal that my therapist did not refer me for examinations (after all, due to ignorance of my illness, I could live to see complications when an operation would be required) and did not give a referral to the appropriate doctor?

Nadezhda doctor / 01 Sep 2018, 00:06

Quoting Lisa:

Hello. Was at the therapist because of frequent and prolonged dizziness, shaking hands, sweating, weakness, frequent urge to empty the bowels. She felt my thyroid gland and said that I had VSD. In a few days, I will give some tests by number (venous blood, urine and ECG), but they did not refer me to a neurologist or an endocrinologist. Now I am tormented by a lump in my throat and its tightness. I will go to the doctor only after passing the tests (I will go through all of them only on the 4th). So far, she has prescribed only glycine and pills for the heart. What should I do about the lump in my throat? Go back to the therapist?

Quoting Larissa:

Hello! I have oncology, I have completed 8 courses of chemistry, mastectomy, and a radiation course is ahead. Before irradiation, again tests, the conclusion of a gynecologist and a therapist. Under the therapist's office, it became bad, severe headaches and shaking of the whole body is a side effect of tamoxifen and after paclitaxel. And here at the therapist's door, it would seem that the therapist should take action, at least measure the pressure. No!!! She told me - "Let's calm down already, I don't need your tantrums here, your hemoglobin is normal, you are healthier than me..." and she remained alive, but what a sediment ... In the evening, only when she left, I read the conclusion of the "specialist" - "Healthy in therapy" and before that, my oncological diagnosis. I have been in shock for the third day, I don’t like to complain about walking, all the more you can’t be nervous, I’ll make it worse for myself. But is this doctor number 1? And given that I have hypertension of the 2nd degree, is this the conclusion of a general practitioner?

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1. General Provisions

1. This job description defines the job duties, rights and responsibilities of a local general practitioner.

2. A person with a higher medical education, past postgraduate training or specialization in the specialty "Therapy".

3. The local general practitioner must know the basics of the legislation of the Russian Federation on health care; legal documents regulating the activities of healthcare institutions; the basics of organizing medical and preventive care in hospitals and outpatient clinics, emergency and emergency medical care, disaster medicine services, sanitary and epidemiological services, drug supply population and healthcare facilities; theoretical foundations, principles and methods of clinical examination; organizational and economic foundations for the activities of health care institutions and medical workers in the context of budgetary insurance medicine; fundamentals of social hygiene, organization and economics of healthcare, medical ethics and deontology; legal aspects of medical activity; general principles and basic methods of clinical, instrumental and laboratory diagnostics functional state of organs and systems of the human body; etiology, pathogenesis, clinical symptoms, course features, principles of complex treatment of major diseases; rules for the provision of emergency medical care; bases of examination of temporary incapacity for work and medico-social examination; fundamentals of health education; internal labor regulations; rules and norms of labor protection, safety measures, industrial sanitation and fire protection.

According to his specialty, the local general practitioner must know modern methods of prevention, diagnosis, treatment and rehabilitation; content and sections of therapy as an independent clinical discipline; tasks, organization, structure, staffing and equipment of the therapeutic service; current legal and instructive and methodological documents in the specialty; rules for issuing medical documentation; the procedure for conducting an examination of temporary disability and medical and social examination; principles of planning activities and reporting of therapeutic services; methods and procedures for monitoring its activities.

4. The local general practitioner is appointed to the position and dismissed by the order of the chief physician of the health facility in accordance with the current legislation of the Russian Federation.

5. The district general practitioner directly reports to the head of the department, and in his absence to the head of the health facility or his deputy.

2. Job responsibilities

Provides qualified medical care in his specialty, using modern methods of prevention, diagnosis, treatment and rehabilitation, approved for use in medical practice. Determines the tactics of managing the patient in accordance with established rules and standards. Develops a plan for examining the patient, specifies the volume and rational methods of examining the patient in order to obtain complete and reliable diagnostic information in the shortest possible time. Based on clinical observations and examinations, anamnesis, clinical, laboratory and instrumental research establishes (or confirms) the diagnosis. In accordance with the established rules and standards, prescribes and controls the necessary treatment, organizes or independently conducts the necessary diagnostic, therapeutic, rehabilitation and preventive procedures and measures. Makes changes to the treatment plan depending on the patient's condition and determines the need for additional examination methods. Provides consultative assistance to doctors of other departments of health care facilities in their specialty. Supervises the work of secondary and junior medical personnel subordinate to him (if any), facilitates the fulfillment of his official duties. Controls the correctness of the diagnostic and medical procedures, operation of instruments, apparatus and equipment, rational use of reagents and medicines, compliance with safety and labor protection rules by middle and junior medical personnel. Participates in training sessions to improve the skills of medical personnel. Plans its work and analyzes the performance of its activities. Ensures timely and high-quality execution of medical and other documentation in accordance with established rules. Carries out sanitary-educational work. Complies with the rules and principles of medical ethics and deontology. Participates in the examination of temporary disability and prepares Required documents for medical and social expertise. Qualified and timely executes orders, orders and instructions of the management of the institution, as well as legal acts on his professional activities. Complies with the rules of internal regulations, fire safety and safety, sanitary and epidemiological regime. Promptly takes measures, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors. Systematically improves his skills.

The local general practitioner has the right to:

1. independently establish a diagnosis in the specialty on the basis of clinical observations and examinations, anamnesis, data from clinical, laboratory and instrumental studies; determine the tactics of patient management in accordance with established rules and standards; assign the necessary comprehensive examination patient methods of instrumental, functional and laboratory diagnostics; carry out diagnostic, therapeutic, rehabilitation and preventive procedures using approved diagnostic and treatment methods; involve in necessary cases doctors of other specialties for consultations, examination and treatment of patients;

2. to make proposals to the management of the institution on improving the diagnostic and treatment process, improving the work of administrative, economic and paraclinical services, issues of organization and conditions of their work;

3. control the work of subordinate employees (if any), give them orders within the framework of their official duties and demand their precise execution, make proposals to the management of the institution on their encouragement or imposition of penalties;

4. request, receive and use information materials and legal documents necessary for the performance of their duties;

5. to take part in scientific-practical conferences and meetings, which discuss issues related to his work;

6. pass certification in accordance with the established procedure with the right to obtain the appropriate qualification category;

7. to improve their qualifications at refresher courses at least once every 5 years.

The local general practitioner enjoys all labor rights in accordance with the Labor Code of the Russian Federation.

4. Responsibility

The primary care physician is responsible for:

1. timely and high-quality implementation of the duties assigned to him;

2. organization of their work, timely and qualified execution of orders, instructions and instructions of the management, regulatory legal acts on their activities;

3. compliance with internal regulations, fire safety and safety;

4. timely and high-quality execution of medical and other service documentation provided for by the current legal documents;

5. providing, in accordance with the established procedure, statistical and other information on their activities;

6. Ensuring compliance with executive discipline and performance of their duties by subordinate employees (if any);

7. prompt action, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors.

For violation of labor discipline, legislative and regulatory legal acts, a local general practitioner may be brought to disciplinary, material, administrative and criminal liability in accordance with the current legislation, depending on the severity of the misconduct.

Provides qualified medical care in his specialty, using modern methods of prevention, diagnosis, treatment and rehabilitation, permitted for use in medical practice. district doctor polyclinic

Determines the tactics of managing the patient in accordance with established rules and standards.

Develops a plan for examining the patient, specifies the volume and rational methods of examining the patient in order to obtain complete and reliable diagnostic information in the shortest possible time.

Based on clinical observations and examinations, anamnesis, data from clinical, laboratory and instrumental studies, establishes (or confirms) the diagnosis.

In accordance with the established rules and standards, prescribes and controls the necessary treatment, organizes or independently conducts the necessary diagnostic, therapeutic, rehabilitation and preventive procedures and measures.

Makes changes to the treatment plan depending on the patient's condition and determines the need for additional examination methods.

Provides consultative assistance to doctors of other departments of health care facilities in their specialty.

Supervises the work of secondary and junior medical personnel subordinate to him (if any), facilitates the performance of his duties.

Controls the correctness of diagnostic and therapeutic procedures, operation of instruments, apparatus and equipment, rational use of reagents and medicines, compliance with the rules of safety and labor protection by middle and junior medical personnel.

Participates in training sessions to improve the skills of medical personnel.

Plans its work and analyzes the performance of its activities.

Ensures timely and high-quality execution of medical and other documentation in accordance with established rules.

Carries out sanitary-educational work.

Complies with the rules and principles of medical ethics and deontology.

Participates in the examination of temporary disability and prepares the necessary documents for medical and social examination.

Qualified and timely executes orders, orders and instructions of the management of the institution, as well as legal acts on his professional activities.

Complies with the rules of internal regulations, fire safety and safety, sanitary and epidemiological regime.

Promptly takes measures, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors.

Systematically improves his skills.

Participation of the doctor in the work of the medical commission:

Determines the signs of temporary disability based on the assessment and health status, nature and working conditions, social factors;

Determines the period of incapacity for work;

Issues a certificate of incapacity for work;

Timely sends the patient for consultation and extension of the certificate of incapacity for work to the medical commission;

Identifies signs of persistent disability and timely directs to medical and social expertise;

Analyzes the causes of MTD and primary disability, takes part in the development and implementation of measures to reduce them.

The number of patients under dispensary observation by a doctor:

table 2

Table 3

Structure of dispensary patients

Figure 2. Dynamics of the number of patients under dispensary registration.

Conclusion: Based on the presented data, we see the dynamics of a decrease, and then an increase in the number of patients registered at the dispensary in the structure of dispensary patients, a large number are accounted for by cardiovascular diseases, then diseases of the urinary, respiratory, digestive systems and blood diseases, respectively.

Figure 3. Structure of diseases of dispensary patients.

Sanitary and educational work of the local general practitioner:

Every month, the district physician-therapist conducts two lectures on the road and two to four lectures in the clinic. Or publishes one sanbulletin in one month. There are also individual explanatory talks with the patient, familiarization of patients with new drugs with the help of advertising booklets, conversations with the promotion of healthy lifestyles, rational nutrition.

The district doctor is obliged to: prescribe laboratory, x-ray and other studies to the patient, conduct appropriate preparatory treatment, consult the patient with the head of the therapeutic department and doctors of other specialties. The results of the analyzes must be transferred to the hospital along with the Outpatient Medical Card or an extract from it.

The local general practitioner examines the conditions and lifestyle of the inhabitants of his district: when visiting them at home and at the clinic, finding out whether there are bad habits in patients - smoking, alcohol, drugs; nutritional balance; place of work, working conditions and recreation. It is also important to identify contacts of patients with infectious patients, various chemical and biological reagents. The assessment of living conditions can be partly carried out by visiting patients at home, noting the well-being of the area and the interior of the patient's home.

Documentation maintained by the local therapist

Table 4

The district physician-therapist analyzes the incidence of the population of his area as follows:

Business report - incidence rates for three years;

Accounting for attendance and morbidity of the population of the site - indicators for 1 month.

Increase in the amount of time per patient;

Improvement of the material and technical base, in particular, the provision of transport for providing assistance at home, the introduction of a common computerized database of the population served.

The main indicators of the activity of the local general practitioner

Average population in 1 therapeutic area

For 2012 = 2195 people

For 2011 = 2183 people

Conclusion: from 2011 to 2013 there is a positive population growth, in connection with which, the average population in one area increased from 2183 to 2200 people

Average number of medical visits per 1 inhabitant

For 2012 = 4.7 visits

For 2011 = 4.6 visits

Conclusion: from 2011 to 2013, there is a tendency towards an increase in medical visits per 1 inhabitant, while the average number of medical visits per 1 inhabitant is much higher than the norm (at a rate of 2.7)

Staffing (only for full-time positions of doctors)

For 2012 = 97%

For 2013 = 95.4%

Conclusion: from 2011 to 2013, there has been an increase in staffing (from 95.4% to 98.2%) due to the employment of young professionals. The staffing level is above the norm, a good indicator for a district polyclinic.

For 2012 = 4404 visits

For 2011 = 4567 visits

Conclusion: from 2011 to 2013, there has been a decrease in the number of visits, due to the unloading of young specialists into a medical position.

Locality at the reception of local general practitioners

For 2012 = 80%

For 2011 = 82%

Conclusion: from 2011 to 2013, there has been a decrease in the area at the reception of local general practitioners.

Local care at home for local general practitioners

For 2012 = 98%

For 2011 97.4%

Conclusion: From 2011 to 2013, the district coverage for home assistance remains within 98%.

Completeness of coverage of the population with medical examinations

For 2012 = 96%

For 2011 = 95%

Conclusion: From 2011 to 2013, there has been an increase in the completeness of coverage of the population with medical examinations, which indicates an improvement in the work of the district doctor

The share of preventive visits to the polyclinic

For 2012 = 10%

For 2011 = 11%

Conclusion: For 2011 to 2013, there has been an increase in the proportion of preventive visits to the clinic, it needs to be increased

Completeness of coverage of the population by dispensary observation

Conclusion: from 2011 to 2013, the completeness of coverage of the population by dispensary observation remains unchanged and in this case is optimal.

Lecture on the topic: "Rational human nutrition"

local doctor polyclinic food

Since ancient times, people have understood the great importance of nutrition for health. I. I. Mechnikov believed that people age prematurely and die due to malnutrition and that a person who eats rationally can live 120-150 years. Health and nutrition are closely linked. Substances that enter the body with food affect our mental state, emotions and physical health. Our physical activity or passivity, cheerfulness or depression largely depends on the quality of nutrition. And it was not in vain that the ancients said that "man is what he eats." Everything we are is ours appearance, the condition of the skin, hair, etc., is due to the combination of various substances that make up our body

Biological laws of nutrition

Medical science has revealed the biological laws of nutrition, developed and substantiated the concept of rational human nutrition, taking into account its social activities and allowed, taking into account age, sex and nature of work, to recommend a balanced diet. The adult able-bodied population is divided into five groups depending on the intensity of physical labor (energy consumption), age groups of the population that differ in nutritional needs are identified, and the nutritional and energy needs of pregnant women and nursing mothers are substantiated. Based on these ideas, recommendations on optimal diets for various groups population. A reasonable diet is justified. For sick people, diets are proposed that take into account the causes and characteristics of the development and course of diseases. In order to ensure the harmlessness (safety) of food products, regulations have been established for the permissible (safe) content of harmful substances in food products, methods have been developed for the detection and determination of these substances in food, a system of hygienic supervision of the quality and safety of food products has been created.

Basic principles of rational, balanced nutrition

Throughout life, the human body continuously undergoes a metabolism and energy exchange. The source of building materials and energy necessary for the body are nutrients that come from the external environment, mainly with food. If food does not enter the body, a person feels hungry. But hunger, unfortunately, will not tell you what nutrients and in what quantity a person needs. We often eat what is tasty, what can be prepared quickly, and do not really think about the usefulness and good quality of the products used.

Rational nutrition is nutrition that is sufficient in quantity and complete in quality, satisfies the energy, plastic and other needs of the body and provides the necessary level of metabolism. Rational nutrition is built taking into account gender, age, nature of work, climatic conditions, national and individual characteristics.

The principles of rational nutrition are:

• 1) compliance of the energy value of food entering the human body with its energy consumption;
• 2) the intake of a certain amount of nutrients into the body in optimal ratios;
• 3) correct diet;
• 4) variety of food products consumed;
• 5) moderation in food.

Adverse effects of overnutrition against the background of small physical activity allow us to consider that one of the basic principles of rational nutrition in intellectual work should be to reduce the energy value of food to the level of energy costs produced or increase physical activity to the level of caloric content of food consumed.

The biological value of food is determined by the content in it of essential nutrients necessary for the body - proteins, fats, carbohydrates, vitamins, mineral salts. For normal human life, it is required not only to supply it with an adequate (according to the needs of the body) amount of energy and nutrients, but also to observe certain relationships between numerous nutritional factors, each of which has a specific role in metabolism. Nutrition, characterized by the optimal ratio of nutrients, is called balanced.

A balanced diet provides for the optimal ratio for the human body in the daily diet of proteins, amino acids, fats, fatty acids, carbohydrates, vitamins.

According to the formula of a balanced diet, the ratio of proteins, fats and carbohydrates should be 1: 1.2: 4.6. At the same time, the amount of proteins in the composition of the diet is 11 - 13% of the daily energy value, fats - an average of 33% (for the southern regions - 27 - 28%, for the northern ones - 38 - 40%), carbohydrates - about 55 %.

Squirrels. These are high-molecular nitrogenous compounds consisting of amino acids, the main plastic material from which body tissues are built. The proteins from which the cells of the body are built have a complex structure and high chemical activity. Proteins are divided into simple and complex. The former are built only from amino acids. The composition of the latter, in addition to amino acids, also includes various nitrogen-free components (phosphoric acid residues, carbohydrates and other substances). Protein substances include enzymes - the most important accelerators of biochemical reactions in the body.

The main functions of protein in the body

PLASTIC. Proteins make up 15-20% of the fresh mass of various tissues and are the main building material of cells, organs and intercellular substance.

CATALYTIC. Proteins are the main component of all currently recognized enzymes. And ordinary enzymes are purely protein compounds. Enzymes also play a decisive role in the assimilation of nutrients by the human body and in the regulation of all intracellular metabolic activities.

HORMONAL. A significant part of the hormones by their nature are proteins. These include insulin, pituitary hormones, etc.

SPECIFICITY FUNCTION. The extraordinary abundance and uniqueness of personal proteins provide tissue individuality and species specificity.

TRANSPORT. Proteins are involved in the transport of oxygen, fats, carbohydrates, certain vitamins, hormones and other substances by the blood.

FATS. These are substances consisting of glycerol and fatty acids connected by ether bonds. By saturation with fatty acids, fats are divided into two groups: solid (lard, butter), which contain saturated fatty acids, and liquid fats(sunflower, olive oil, from nuts, seeds, etc.), containing mainly unsaturated fatty acids. Fats are the most powerful source of energy. Besides, body fat("depot" of fat) protect the body from heat loss and bruises, and fat capsules internal organs serve as a support and protection against mechanical damage. The deposited fat is the main source of energy in acute diseases, when the appetite is reduced and the absorption of food is limited.

CARBOHYDRATES. Carbohydrates are compounds of carbon, hydrogen and oxygen, with hydrogen and oxygen in a 2:1 ratio, as in water, hence their name. Carbohydrates are divided into simple - monosaccharides (glucose, galactose, fructose) and complex - polysaccharides. Individual monosaccharides, when combined with each other, form more or less complex carbohydrates. Of the two molecules, disaccharides are formed, with a larger number of them - polysaccharides. All monosaccharides and disaccharides have a sweet taste, but the degree of it is not the same. The sweetest is the monosaccharide fructose. Polysaccharides are widely distributed in nature. Most often, these are complex compounds of several hundred molecules. Polysaccharides include starch - a carbohydrate found in plant cells, glycogen - a carbohydrate in animal tissues, as well as fiber, which is part of the membranes of plant cells. None of the polysaccharides has a sweet taste. Carbohydrates serve as the body's main source of energy and help our muscles work. They are necessary for the normal metabolism of proteins and fats. In combination with proteins, they form certain hormones, enzymes, secretions of salivary and other mucus-forming glands, and other important compounds.

Sources of nutrients are animal food and plant origin, which are conditionally divided into several main groups.

The first group includes milk and dairy products (cottage cheese, cheeses, kefir, curdled milk, acidophilus, cream, etc.); the second is meat, poultry, fish, eggs and products made from them; the third - bakery, pasta and confectionery, cereals, sugar, potatoes; the fourth is fats; fifth - vegetables, fruits, berries, herbs; the sixth is spices, tea, coffee and cocoa.

Each group of products, being unique in its composition, is involved in the preferential supply of the body with certain substances. Therefore, one of the basic rules of rational nutrition is variety. Even during fasting, using a wide range of plant products, you can provide the body with almost everything you need.

In nature, there are no ideal foods that would contain a complex of all the nutrients needed by a person (the exception is mother's milk). With a varied diet, that is, a mixed diet consisting of products of animal and vegetable origin, the human body usually receives quite enough nutrients. A variety of foods in the diet has a positive effect on nutritional value, as different products complement each other with the missing components. In addition, a varied diet contributes to better absorption of food.

The concept of a diet includes the multiplicity and time of eating during the day, its distribution by energy value and volume. The diet depends on the daily routine, the nature of work and climatic conditions. For normal digestion great importance has regular meals. If a person always takes food at the same time, then he develops a reflex to secrete gastric juice at this time and conditions are created for better digestion of it.

It is necessary that the intervals between meals do not exceed 4-5 hours. The most favorable is four meals a day. At the same time, breakfast accounts for 25% of the energy value. daily ration, for lunch - 35%, for an afternoon snack (or second breakfast) - 15%, for dinner - 25%.

Eating disorders play a negative role in health. It manifests itself in a decrease in the number of meals per day from four to five to two, an incorrect distribution of the daily ration into separate meals, an increase in dinner to 35-65% instead of 25%, an increase in the intervals between meals from 4-5 to 7-8 hours. The commandments of folk wisdom about nutrition are forgotten: “Shorten dinner, lengthen life”; "Eat smart, live long." All nature lives in precise rhythms: the rotation of the planets, the seasons, day and night, life and death. Rhythm is inherent human body, its individual organs and systems. Therefore, the organization and strict observance of the daily routine, which provides for the transition from wakefulness to sleep and vice versa, the implementation of hygiene procedures, different kinds activities, rest, eating at the same time in accordance with age characteristics create best conditions for the life of the organism. Physiologically, the daily routine is justified by the development of conditioned reflexes, which over time are fixed for life in the form of stable skills and habits and have ...

Hygiene: a textbook for universities / Ed. acad. RAMS G.I. Rumyantsev. - 2nd ed., revised. and additional - M.: "GEOTAR-Media", 2008. - 607 p.: ill.

Medico-biological statistics / Glantz S.; trans. from English. Yu.A. Danilov, ed. N.E. Buzikashvili, D.V. Samoilova. - M.: Practice, 1999. - 459s

Public health and health care: a textbook for students. honey. universities / L. A. Alekseeva [and others], ed. V.A. Minyaeva, N.I. Vishnyakova. - 4th ed. - M.: MEDpress-inform, 2006. - 520s.

The organization of medical care for the population depends on the socio-economic, social and political changes taking place in the country. The main accessible and free type of medical care for the population in our country is primary health care (PHC), which since 2005 has been identified as a priority for improving health care.

Primary health care includes the treatment of the most common illnesses, injuries, poisonings and other emergencies; implementation of sanitary-hygienic and anti-epidemic measures, medical prevention the most important socially significant diseases; sanitary and hygienic education; measures to protect the family and other measures related to the provision of health care to citizens at the place of residence.

Order of the Ministry of Health of the Russian Federation No. 627 dated October 7, 2005 “On a unified nomenclature of state and municipal healthcare institutions” approved the following outpatient clinics:

• Ambulatory.
• Polyclinics, including city, consultative and diagnostic, physiotherapy, psychotherapy, central district, etc.

In the healthcare system, the polyclinic service occupies a leading position. About 80% of patients receive outpatient care. The activity of polyclinics is based on the territorial-district principle of serving the population, when the polyclinic provides assistance to the population living in a fixed territory.

Structure and organization of the polyclinic

Depending on the capacity, five categories of polyclinics are distinguished:

Approximate organizational structure of the city polyclinic:

Clinic management.

• Administrative and economic part.

Information and analytical department:

• Registry;
• Organizational methodological department (office) with a department (office) of statistics.

Department of Prevention(cabinet):

• Pre-medical reception room
• Observation room;
• Fluorography room;
• Cabinet of health education and hygienic education of the population;
• Health school office.

Treatment and prevention department:

• Therapeutic department;
• Department of general medical (family) practice;
• Surgical department (office);
• Dental department (office);
• Women's consultation (in its absence as part of the maternity hospital);
• Rehabilitation department;
• Treatment room.

Consultative and diagnostic division:

• Consultative department (offices of medical specialists);
• Branch (office) functional diagnostics;
• Department of Radiation Diagnostics;
• Laboratory.

Emergency Department.

Center for outpatient surgery.

Day hospital.

Station at home.

Medical and paramedical health centers.

Equipment of medical institutions with diagnostic equipment is carried out depending on the number of visits (up to 250, 250-500, more than 500) in accordance with the order of the Ministry of Health of the Russian Federation No. formations."

Clinic hours of operation: a six-day working week with the work of medical specialists and all departments on Saturday according to a rotating schedule.

The staffing table depends on the number of people served (categories of polyclinics). The positions of polyclinic doctors are established on the basis of:

The activity of any medical institution is largely determined by the level of its management, while a clear distribution of the functional responsibilities of all officials working in the clinic, from the nurse to the head physician, is of great importance. The practical activities of the personnel are regulated by orders, orders and instructions of the Ministry of Health, health authorities. The functional responsibilities of employees can be adjusted locally, taking into account the specifics of the work of a medical institution.

Depending on the capacity of the clinic chief physician has several substitutes. The first deputy - the second person in the polyclinic is the deputy chief physician for medical work (chief medical officer), who is appointed by the chief physician from the most qualified doctors with organizational skills. In the absence of the chief physician, the chief medical officer performs his duties. The chief medical officer is responsible for all medical activities of the polyclinic. He organizes and controls the correctness and timeliness of the examination and treatment of patients in the clinic and at home; monitors the introduction into the work of modern, most promising methods of prevention, diagnosis, treatment and rehabilitation of patients, new organizational forms and methods of work of the polyclinic.

Nachmed ensures continuity in the management of patients between the polyclinic and SSMP, polyclinic and hospitals, analyzes discrepancies in clinical and polyclinic diagnoses; organizes planned hospitalization of patients.

Under the leadership of the chief medical officer, all the preventive work of the clinic is carried out: periodic and targeted medical examinations, timely preventive vaccinations and medical examinations of the population, sanitary and educational work.

The Deputy Chief Physician for the Examination of Temporary Disability (EVN), who heads the Medical Commission (MC), is responsible for the quality examination of working capacity, interaction with insurance companies.

If there are 6 - 8 positions of general practitioners in the polyclinic, a therapeutic department is created, which is headed by the head of the department. He is responsible for monitoring the activities of the department's doctors in all areas of work, organizational and methodological work, drawing up plans, reports with an analysis of the main indicators, introducing new technologies into the treatment and diagnostic process.

The first acquaintance of visitors with the clinic begins at the reception. This is one of the main structural divisions of the clinic. The tasks of the registry include:

• organization of preliminary and urgent appointment of patients for an appointment with a doctor, both with the patient's direct contact and by phone;
• ensuring a clear regulation of the flow of patients in order to create a uniform workload of doctors through the issuance of coupons for appointments;
• carrying out timely selection and delivery of medical documentation to doctors' offices, proper maintenance and storage of the polyclinic file cabinet.

Organization of the work of the district therapeutic service

Medical care for the population in the polyclinic is organized according to the district principle in accordance with the order of the Ministry of Health of the Russian Federation No. 584 dated August 4, 2006 “On the procedure for organizing medical care for the population according to the district principle” and is carried out taking into account the criteria for territorial (including transport) accessibility of all types of medical (pre-medical, medical and emergency medical = emergency) care. IN medical institutions The following medical districts with the recommended population size can be organized:

• therapeutic - 1700 people of the adult population (18 years and older);
• general practitioner (GP) - 1500 people of the adult population;
• family doctor - 1200 adults and children;
• complex therapeutic area - 2000 or more people of the adult and child population.

A complex therapeutic area is formed from the population of the medical area of ​​an outpatient clinic (APU) with an insufficient number of attached population (small area) or the population served by an outpatient general practitioner and the population served by feldsher-obstetric stations.

The distribution of the population by sites is carried out by the heads of the APU, depending on the specific conditions for the provision of primary health care to the population in order to maximize its availability and respect for other rights of citizens.

In order to ensure the right of citizens to choose a doctor and a medical institution, the heads of the APA assign citizens living outside the service area of ​​the APA to district general practitioners (GPs) for medical supervision and treatment, while not exceeding the population per position of a district doctor by more than 15% normative.

Therapeutic and preventive care for the population of the site is provided by a permanent local general practitioner and a nurse. The district principle enables the attending physician to know his area better, to carry out dynamic monitoring taking into account working and living conditions, to identify frequently and long-term sick people, to carry out therapeutic and preventive measures in a timely manner, and to prevent the occurrence of infectious diseases. All this ultimately determines the effectiveness of the clinic.

Appointment and dismissal of the local general practitioner is carried out by the chief physician of the polyclinic. In his work, he reports directly to the head of the therapeutic department, in his absence - to the deputy chief physician for medical work.

Responsibilities of the primary care physician

The activities of the local general practitioner are regulated by the order of the Ministry of Health No. 765 of December 7, 2005 “On the organization of the activities of the district general practitioner”.

Local therapist:

• forms a medical (therapeutic) site from the population attached to it;
• provides sanitary and hygienic education, advises on the formation healthy lifestyle life;
• carries out preventive measures to prevent and reduce morbidity, identify early and latent forms of diseases, socially significant diseases and risk factors, organize and lead health schools;
• studies the needs of the population served in recreational activities and develops a program for their implementation;
• carries out medical examination of the population, including those entitled to receive a set of social benefits;
• organizes and conducts diagnostics and treatment various diseases and conditions, including the rehabilitation treatment of patients on an outpatient basis, a day hospital and a hospital at home;
• provides emergency medical care to patients with acute conditions (acute diseases, injuries, poisoning and other emergency conditions) in a polyclinic, day hospital and hospital at home;
• promptly refers patients for consultations to specialists, including for inpatient and rehabilitation treatment for medical reasons;
• organizes and conducts anti-epidemic measures and immunoprophylaxis;
• conducts an examination of temporary disability (EVN) and draws up documents for referral of patients for medical and social examination (MSE);
• issues a conclusion on the need to refer patients for medical reasons to sanatorium-and-spa treatment and draws up, if necessary, after the examination, a sanatorium-and-spa card;
• interacts with medical organizations, medical insurance companies, other organizations;
• organizes jointly with authorities social protection population medical and social assistance to certain categories of citizens in need of care: the lonely, the elderly, the disabled, the chronically ill;
• supervises the activities of paramedical personnel providing primary health care;
• maintains medical documentation, analyzes the health status of the attached population and the activities of the medical site.

The district doctor is the main organizer of medical care for the population of the district, but he cannot and should not do what is supposed to be done by doctors of narrow specialties. It is not the district doctor who is obliged to work for doctors of other specialties, but, on the contrary, all other specialists, including doctors of functional diagnostics, X-ray, and dental offices, must provide him with the information necessary for social and hygienic analysis and planning of general medical and recreational activities. The district physician-therapist should coordinate all the work carried out.

The main sections of the work of the local general practitioner

Medical work

The work of the local therapist is carried out according to the work schedule approved by the administration of the polyclinic. A rationally drawn up work schedule allows you to increase the availability of the district service to the population of the site. The working day consists of working at the reception for 3-4 hours, handling calls (3 hours) and other types of work (sanitary and educational work, reporting, etc.).

Reception of patients is an important part of the work of the district doctor. At the first examination of the patient, the doctor must make a preliminary diagnosis, prescribe an examination and treatment.

A large place in the activities of the local general practitioner is occupied by medical care for calls at home. On average, the time spent by a local doctor in providing home care should be 30-40 minutes per patient. At home, it is more difficult than in a clinic or hospital to conduct an examination of patients. Moreover, most calls are made to patients of older age groups. After examining the patient at home on call, the local doctor should subsequently appoint him to appear for an appointment or, if necessary, visit him actively. Repeated (active) visits, with properly organized work, make up to 70 - 75% of the total number of calls (the doctor must serve at least 6 calls per day).

The responsible section of the work of the local doctor is the preparation and referral of the patient to planned hospitalization. The patient should be examined as fully as possible. The data of the examination, the treatment performed and the purpose of hospitalization are entered in the form No. 057u-04. In the referral from the medical record, diagnoses of all existing diseases, as well as conditions requiring clarification, must be entered. The diagnosis is written in accordance with the accepted classification, indicating the form of the disease, severity, phase, functional disorders and complications. The main is indicated first, then the competing and concomitant diseases. In case of emergency hospitalization, a direction of an arbitrary form is filled out on the form of a medical institution.

Work with accounting and reporting documentation

In his work, the district doctor should use only the forms approved by the orders of the Ministry of Health: No. 1030 dated 04.10.80 "On approval of the forms of primary medical documentation of healthcare institutions", No. 255 dated 11.22.04 "On the procedure for providing primary health care citizens entitled to receive a set of social services, etc. The orders contain forms of primary documentation, the rules for filling them out and the terms of storage in a medical institution. In their work, therapists should use the following forms:

For better control of the entire situation on the site, targeted work planning, the district doctor fills out medical passport (therapeutic) site(form 030-P/u), approved by order of the Ministry of Health of the Russian Federation No. 765 dated 07.12.05 (Appendix No. 2).

The following sections should be highlighted in the passport:

1. Characteristics of the medical therapeutic area:

• Population;
• site plan indicating the number of storeys of houses, the number of apartments, the location of schools, preschool institutions;
• a list of enterprises and institutions indicating the number of employees (lists are updated annually, certified by the administration of enterprises).

1. Characteristics of the attached population:

• age and sex composition of the population;
• working-age population (men, women);
• population over 60 (men, women);
• working population (men, women);
• non-working population (men, women);
• pensioners (men, women);
• the number of persons with occupational hazard (men, women);
• the number of persons belonging to risk groups and abusing alcohol, smoking, drugs (men, women);
• list of persons suffering from socially significant diseases (tuberculosis, diabetes, neoplasms, diseases of the cardiovascular system and lesions of the musculoskeletal system).

1. Health status and results of treatment of the attached population:

• the age composition of the population, including able-bodied and disabled men and women;
• dispensary group (age and sex characteristics, movement “D” of the group, needed to carry out medical and recreational activities and received them (outpatient, inpatient treatment, HTMP, treatment in a day hospital, sanatorium treatment);
• the number of activities carried out: vaccinations, tests, studies, procedures, consultations;
• the number of persons who received emergency medical care when traveling (persons), including those sent to a hospital;
• access to disability (total, in the reporting year);
• number of deaths (total, including at home).

The district physician-therapist is obliged to correctly draw up medical documentation. An important document is medical card outpatient(form No. 025 / y), which is maintained in accordance with the Standard for the medical history of an inpatient and outpatient patient, approved by order of the Ministry of Health of the Trans-Baikal Territory No. 155 dated February 3, 2009. The results of the examination, data on the prescribed treatment and examination are entered into the medical record. The diagnosis should correspond to the complaints, the data of an objective study, anamnesis. The formulation of the diagnosis is carried out in accordance with the accepted classification, indicating the clinical variant, severity of the course, phase, functional disorders and complications. It is necessary to single out the main, competing and concomitant diseases in the diagnosis.

Data on the patient's awareness and his consent to the examination and treatment, confirmed by his signature, are entered into the medical documentation.

The encryption of diseases is carried out by the doctor in accordance with ICD 10. The nurse, on the basis of the doctor's record, fills out a statistical coupon for each identified disease. If the disease is detected for the first time, then the diagnosis is made with a “+” sign. If there is a chronic disease for which the patient was previously observed, the statistical coupon is filled out once a year with a “-” sign.

Statistical coupons(form 025-2 / y) serve to record all cases of diseases, according to their presence, an accounting form No. 071 / y is drawn up "Consolidated record of diseases", according to the results of which the morbidity and general morbidity rates are calculated at each site, department and polyclinic. The form is completed quarterly.

Total registered for the first time

detected diseases in the area

Incidence = ———————————————- × 1000

Total registered

diseases in the area

Total incidence = ————————————— × 1000

The number of people in the area

Voucher for a doctor's appointment(form 025-4 / y) serves to evenly distribute patients and draw up records of medical visits(form No. 039-y), which reflects the time of work at the reception and calls, the number of patients admitted, and other types of work. The form can be completed by a doctor or centrally. On a monthly basis, based on the data of form No. 039-y, load indicators are calculated at the reception, at home, preventive examinations, district coverage and activity (percentage of active calls).

Number of visits to the local doctor

residents of their area

Locality = —————————————————- × 100

Total GP visits

Number of visits Total number of visits to polyclinic doctors

per one = ————————————————————

inhabitants per year Average annual population,

living in the service area

polyclinics

The number of active visits of residents of their site

Activity = ———————————————————- × 100

Total number of home visits

Stationary-replacing technologies in the work of a local general practitioner

Hospital care is expensive, and studies have shown that 20 to 50% of patients treated in a hospital are referred for hospitalization unreasonably and could receive more effective and less expensive care in outpatient settings. For this, it is necessary to use hospital-replacing technologies: day hospitals(DS) hospitals and clinics, hospitals at home(SD).

The regulatory document for the organization of DS is the order of the Ministry of Health of the Russian Federation No. 438 dated 09.12.99 "On the organization of the activities of day hospitals in medical institutions."

The district general practitioner uses hospital-replacing technologies in his work, in particular, diabetes, which is created to treat patients with acute and chronic diseases that do not require round-the-clock medical supervision. SD is created for the treatment of patients with follicular tonsillitis (for at least three days), acute pneumonia of the lung flow, acute bronchitis, with exacerbation of chronic diseases (hypertension, peptic ulcer and etc.).

A patient with diabetes should be examined ( general analysis blood, urine, ECG, consultations of the necessary specialist doctors), the local general practitioner is obliged to examine the patient in the first days of the disease - daily, then - as needed. Treatment should be comprehensive: procedures are performed at home nurse(various types of injections, banks, mustard plasters), massage, exercise therapy, etc. Information about the organization of diabetes is entered in the medical record.

The work of the Board of Directors can be carried out centrally and decentralized. In the first case, a doctor is allocated in the polyclinic to serve SD throughout the territory, he is provided with transport. The load rate is visiting patients at 16-18 DM per day. With a decentralized form, each district therapist independently visits patients in DM in his area on a daily basis.

Working capacity examination

The local general practitioner is the attending physician who provides medical care to the patient during his observation and treatment in a medical facility. When examining a patient, he solves not only medical and diagnostic problems, but also determines the possibility of continuing his labor activity. He is responsible for the examination of temporary disability and registration of patients for medical and social examination.

Anti-epidemic section of the work of the district service

The local doctor is entrusted with the implementation of elementary anti-epidemic measures. The local therapist should be well versed not only in the diagnosis of infectious diseases, but also in epidemiology, since the ability to collect an epidemiological history allows the doctor to recognize the disease in the early stages and take the necessary measures in a timely manner.

If an infectious disease is suspected, the local general practitioner must notify the management of the clinic, the infectious disease specialist and the authorities of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare. The patient must be urgently hospitalized, within 24 hours an emergency notification of an infectious patient (form No. 058 / y) must be completed and transmitted. If the patient is not hospitalized, everything necessary is done to prevent the spread of infection (maximum isolation, contact monitoring, disinfection). When a patient is hospitalized, the district therapist monitors the contacts in the outbreak for the entire incubation period diseases with the necessary documentation.

Preventive work

The local general practitioner pays great attention to preventive work aimed at preventing the occurrence of diseases, increasing the duration and quality of life. For this purpose, preventive examinations of the population are carried out to detect diseases at an early stage (target: tuberculosis, oncological diseases, goiter, etc.) and mandatory preliminary and periodic examinations of workers (exclusion of exposure to harmful professional factors).

Preliminary medical examinations upon admission to work are carried out in order to determine the compliance of the state of health of the examined person with the work assigned to him.

The purpose of periodic inspections is to dynamically monitor the state of health of employees under the influence of occupational hazards. Prevention and timely detection of signs of general and occupational diseases that prevent the continuation of work in these conditions, as well as the prevention of accidents. Timely implementation of preventive and rehabilitation measures.

The regulatory documents for this section of work are the order of the Ministry of Health No. 90 dated March 14, 1996 “On the procedure for conducting preliminary and periodic medical examinations workers and medical regulations for admission to the profession”, Order No. 83 dated August 16, 2004 “On approval of the lists of harmful and (or) hazardous production factors and work, during the performance of which preliminary and periodic medical examinations (examinations) are carried out, and the procedure for conducting these inspections (examinations).

Lists approved by orders:

• harmful, hazardous substances and production factors, work, during which preliminary and periodic medical examinations of employees are mandatory;
• medical contraindications;
• medical specialists involved in examinations;
• necessary laboratory and functional studies;
• general medical contraindications;
• occupational diseases.

The frequency of periodic inspections is determined territorial bodies of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare together with the employer based on the specific sanitary-hygienic and epidemiological situation, but should not be less than 1 time in two years, and for persons under 21 years of age at least once a year. For workers employed in hazardous industries for 5 years or more, medical examinations are carried out by occupational pathology centers.

Medical examinations are carried out by medical institutions licensed for the specified type of activity.

The employer submits a list of names of persons subject to inspection, previously agreed with the territorial bodies of the Federal Supervision Service, indicating workshops, hazardous work and factors in medical institution 2 months before the start of the examination.

The chief physician of the health care facility approves the composition of the medical commission, the chairman of which should be an occupational pathologist or a doctor of another specialty who has training in occupational pathology; commission members must also have special training. The commission determines the types and volumes of necessary studies, taking into account the specifics of production factors and medical contraindications to work in this specialty.

For the examination, the employee submits a referral issued by the employer, a passport, an outpatient card, and the results of previous examinations.

The main person conducting examinations is the local doctor. The examination data are entered in the medical record (form No. 025-y). Each doctor participating in the examination gives his opinion on professional suitability and, if indicated, prescribes medical and recreational measures.

The employee is informed about the results of the medical examination. When establishing signs of an occupational disease in an employee during a medical examination or when applying, he is sent by the attending physician, head of the medical facility or occupational pathologist in the prescribed manner to the center of occupational pathology to clarify the diagnosis.

The final act based on the results of the periodic examination is drawn up by the responsible doctor together with representatives of the Federal Supervision Service and submitted to the employer within 30 days.

One of the sections of preventive work is vaccination, which is carried out by the district service in accordance with the National Calendar of Preventive Immunizations, approved by order of the Ministry of Health No. 673 of October 30, 07. A file is created for the entire population of the district, in which vaccination data is entered.

Health education and patient education work.

Sanitary and educational work of the district doctor is determined by the needs of the improvement of society. In it, the doctor, with the help of a public sanitary activist, should pay attention to the fight against weakness, overeating, smoking, excessive and unreasonable drug therapy, stress, etc.

The duties of the local therapist include teaching patients with socially significant diseases and their relatives in specialized schools.

Medical examination of the population

The preventive section of the work of the local general practitioner includes clinical examination, which is an active method of continuous medical monitoring of the state of health of the population with the aim of early detection of diseases; timely registration; dynamic observation and complex treatment sick; preventing the development and spread of diseases; job retention.

The main purpose of medical examination healthy is the preservation and strengthening of their health, ensuring proper physical and mental development, the creation of normal working and living conditions, the prevention of the development of diseases, the preservation of working capacity.

The purpose of medical examination of patients- prevention of exacerbations and worsening of the clinical course of diseases, reduction of morbidity with temporary disability and prevention of disability.

The dispensary includes:

• annual medical examination with a prescribed amount of laboratory and instrumental studies;
• additional examination of those in need using all diagnostic methods;
• identifying individuals with risk factors that contribute to the emergence and progression of diseases;
• detection of diseases at an early stage;
• development and implementation of a set of necessary medical and social measures and dynamic monitoring of the health status of the population.

The dispensary is carried out in three stages:

Stage 1 - registering: selection of contingents for dispensary observation;

Stage 2 - conducting the actual dispensary observation and treatment;

Stage 3 - evaluation of the effectiveness and quality of clinical examination (after three years of observation and treatment).

The formation of dispensary observation groups is carried out actively (with the help of medical examinations) and passive (by request, after inpatient treatment) by.

The priority groups for dispensary registration include disabled people and participants in the Second World War, other military operations, workers in leading industries, transport, agriculture, students and students of higher and secondary specialized educational institutions, workers in hazardous industries, women of reproductive age and others.

According to the results of the registration stage, dispensary observation groups(health):

Group 1 - healthy (formed mainly from students, workers in hazardous and hazardous industries, women of childbearing age, etc.).

Group 2 - practically healthy people who have moved in the past acute diseases or having a chronic disease in the stage of stable remission (there was no exacerbation of the disease for five or more years).

Group 3 - patients with diseases in the stage of compensation, subcompensation, decompensation.

Healthy and practically healthy patients should be observed in the prevention department, in the presence of diseases - by specialist doctors according to the profile of the disease.

Order No. 770 of the Ministry of Health approved instructions for the medical examination of healthy people and persons with risk factors in outpatient clinics (Appendix No. 9). The scheme of dynamic observation of patients was drawn up for doctors of all specialties, including, in accordance with the nosological form, the frequency of observation, the required volume of laboratory and instrumental studies, examination of specialists, basic medical and recreational activities, criteria for the effectiveness of clinical examination.

Preparation of documentation for medical examinations

For each dispensary patient, an outpatient medical record (form No. 025-y), a dispensary observation control card (form No. 030-y) is filled out.

Medical cards must be marked with letters or color, the letter “D” is put on each card and the group of dispensary observation (health) is indicated. When registering, an introductory epicrisis is written (data substantiating the diagnosis, information about the previous examination and treatment, its effectiveness, a plan of medical and recreational activities is drawn up, repeated appearances are scheduled in accordance with Appendix No. 9 of the Order of the Ministry of Health No. 770). After a year of observation, a milestone epicrisis is compiled, in which the attending physician reflects a detailed diagnosis, the dynamics of the condition, the implementation of the examination plan and therapeutic measures; on New Year a plan of medical and recreational activities is being drawn up. To facilitate the work of a doctor, unified typographic forms of epicrises are currently used.

For each dispensary patient, a dispensary observation control card is filled out, which is also marked as a medical card, and is used for operational control over the work with the dispensary group of patients. The card contains information about taking the patient to "D" registration, the timing of planned and actual appearances for dispensary examinations, which makes it possible to call the patient to the doctor in time. Data on the planned medical and recreational activities are entered into the form No. 030 / y, and a note is made about their implementation at the end of the observation year.

For one patient, there may be several control cards according to the number of etiologically unrelated diseases, they are marked “duplicate”. Control cards facilitate the control of visits to patients, are stored in a box with 13 compartments (12 months and a cell for control cards of those who did not appear).

Quality indicators

• the number of dispensaries in the area, distribution by health groups, the number of dispensaries per 1000 population;
• percentage of coverage of dispensary observation of patients by nosological forms of the number of registered patients per this section(in the clinic):

Total dispensary patients with PU

= ——————————————————— × 100

Registered patients with PU (form 071/y)

In 100%, patients who have had acute pneumonia, follicular tonsillitis, acute glomerulonephritis, acute infarction myocardium, patients with rheumatic fever, systemic diseases connective tissue, chronic atrophic gastritis, diabetes mellitus, COPD, bronchial asthma, etc.;

• timeliness of taking on dispensary registration (the number of patients registered within a month from the date of diagnosis or discharge to work, of the total number of newly diagnosed patients);
• completeness of the examination (the number of those examined from the number of those in need of examination);
• completeness of the implementation of medical and recreational activities in% (anti-relapse treatment, diet, spa treatment, employment, planned hospitalization)

number of patients who received anti-relapse treatment

= ————————————————————————× 100

number of patients requiring anti-relapse treatment

Performance indicators

(calculated in the group of patients observed for three or more years)

• dynamics of the state for the year of observation: improvement, no dynamics,
• deterioration;
• % of patients transferred to the second observation group for recovery or persistent improvement in their condition (there was no exacerbation for at least five years);
• temporary disability in cases and days (% change compared to the previous year);
• primary access to disability (per 100,000 employees);
• mortality from the underlying disease.

Additional medical examination

Since 2006, the country has been carrying out additional medical examinations (DD) of citizens working in state and municipal institutions in the field of education, healthcare, social protection, culture, physical culture and sports, and in research institutions. The order and scope of conducting DD is regulated by the order of the Ministry of Health of the Russian Federation No. 188 dated 03/22/2006. In 2006, DD was carried out for the above contingents aged 35-55 years, since 2007 all workers are subject to DD. DD is carried out by specialist doctors using established laboratory and functional studies in the following scope:

Examination by medical specialists:

• therapist (district general practitioner, GP),
• endocrinologist,
• surgeon
• neurologist
• ophthalmologist,
• urologist (for men),
• obstetrician-gynecologist.

Laboratory and functional studies:

• Clinical blood and urine tests,
• cholesterol, blood sugar,
• Fluorography 1 time per year,
• Mammography (for women 40-55 years old - once every 2 years) or ultrasound of the breast.

The local general practitioner, taking into account the conclusions of specialist doctors and the results of the examination, determines the state of health of citizens who have undergone DD, and in order to plan further activities categorized into the following groups:

Group I - practically healthy citizens who do not need D-observation, with whom a conversation is held about a healthy lifestyle.

Group II - citizens at risk of developing diseases in need of preventive measures. For them, an individual prevention program is drawn up, carried out in a medical facility at the place of residence.

Group III - citizens who need additional examination to clarify (establish) the diagnosis (for the first time established chronic disease) or outpatient treatment (acute respiratory disease, influenza and other diseases, after the treatment of which recovery occurs) "*".

Group IV - citizens in need of additional examination and treatment in a hospital, who are on the D-registration according to chronic disease «*».

Group V - citizens with newly diagnosed diseases or observed for a chronic disease and having indications for the provision of high-tech (expensive) medical care "*".

"*" - additional examination in outpatient and inpatient conditions is not included in the scope of the DD.

The institution that conducted the DD not at the place of residence of the citizen transmits the “DD Record Card” with the results of the examination to the health facility at the place of residence of the citizen.

Based on the information about the results of passing the DD, the district therapist (GP), who carries out dynamic monitoring of the state of health of the citizen, determines the necessary amount of additional examination, directs to further treatment and carries out D-surveillance for a chronic disease.

Medical examination of women of childbearing age with extragenital pathology, is carried out in accordance with the order of the Ministry of Health of the Russian Federation of February 10, 2003 No. 50 "On the improvement of obstetric and gynecological care in outpatient clinics" (Appendix 2, section 3 "Pregnancy and extragenital pathology"). The order contains a scheme of dynamic monitoring indicating the terms of hospitalization.

Dispensary observation of patients with occupational diseases regulated by order of the Ministry of Health of the Russian Federation No. 555 dated September 29, 1989 "On improving the system of medical examinations of workers and drivers of individual vehicles." The therapist carries out supervision in accordance with the approximate scheme given in Appendix No. 7 "Regulations on the procedure for conducting medical examinations of patients with occupational diseases."

Disabled people and participants of the Great Patriotic War observed in accordance with federal law dated January 12, 1995 No. 5-FZ "On Veterans".

Clinical examination of persons exposed to radiation due to the disaster at the Chernobyl nuclear power plant, is carried out on the basis of the order of the Ministry of Health of the Russian Federation No. 293 of October 3, 1997 "On improving the medical examination of persons exposed to radiation as a result of the disaster at the Chernobyl nuclear power plant." This order regulates the frequency and volume of clinical examination of this category of persons.

The work of the district physician-therapist as part of the ATPK

In connection with the current unfavorable demographic situation in the country, the district therapist should Special attention pay attention to the work to preserve the health of women of childbearing age, which is carried out as part of the district obstetric-therapeutic-pediatric complexes (ATPC). The district ATPC includes 4-5 therapeutic, 2-3 pediatric and 1 obstetric sites, united according to the territorial principle. In all medical institutions, doctors work according to an agreed schedule at the same time. The local therapist (general practitioner) should know what somatic pathology adversely affects the reproductive function of a woman, her health during pregnancy, intrauterine development of the fetus and the condition of the child in the postnatal period. He is obliged to transfer information about the state of women's health to the antenatal clinic, to organize the rehabilitation of women of childbearing age.

All women of childbearing age with extragenital pathology should be under dispensary observation, the tactics of their management are determined by the order of the Ministry of Health No. 50 dated 10.02. pathology").

On the basis of polyclinics for adults, there is a consultative-expert commission (ECC) for women of childbearing age, the purpose of which is to control the quality of medical examinations for women, the implementation of a plan of medical and recreational activities. All women coming under the supervision of doctors of the polyclinic (transferred under supervision after reaching the age of 18 from pediatric health facilities, changed their place of residence, etc.) should be submitted to the CEC after additional examination to clarify the health group and the plan of medical and recreational activities.

An examination of healthy pregnant women in an adult polyclinic is carried out upon registration and at a period of 30 weeks of pregnancy (when taking maternity leave), the results of the examination are transferred to the antenatal clinic. The district service also provides postpartum patronage with a complex of necessary medical and rehabilitation measures.

The local service, together with employees of family planning centers, should work on timely, high-quality contraception, especially for women with extragenital pathology. If medical contraindications to pregnancy are identified, the issue is resolved jointly with doctors women's consultations(for CEC pregnant) in accordance with the List of medical indications for artificial termination of pregnancy, approved by the order of the Ministry of Health No. 736 of 03.12.07 and social indications (Decree of the Government of the Russian Federation No. 485 of 11.08.03 "On the list of social indications for artificial termination pregnancy").

Registration of patients for sanatorium treatment

An important issue in the activities of the local doctor is the selection and referral of patients for sanatorium treatment. The normative document for this section of work is the order of the Ministry of Health of the Russian Federation No. 256 dated November 22, 2004 “On the procedure for medical selection and referral of patients for sanatorium treatment” with changes approved by order of the Ministry of Health No. 3 dated January 9, 2007. Medical selection and the direction of patients in need of sanatorium treatment is carried out by the attending physician and the head of the department (if there is a benefit, the attending physician and the chairman of the VC).

If there are indications (it is impossible to recommend treatment at the resort to healthy people) and there are no contraindications for sanatorium treatment, the doctor issues a certificate (070 / y-04) to the patient about the need for treatment, which is valid for 6 months, which is noted in the outpatient's medical record. For beneficiaries, a certificate for obtaining a voucher is issued by the VK, and for disabled people - if there is a recommendation in individual program rehabilitation issued by ITU bodies.

In complex and conflict cases, on the recommendation of the attending physician and the head of the department, a conclusion on the indications for sanatorium treatment is issued by the VK LPU.

Patients with concomitant diseases or health disorders of an age-related nature for whom sanatorium treatment is indicated, in cases where a trip to remote resorts can adversely affect general condition health should be sent to nearby sanatoriums.

Upon receipt of a voucher (kursovka), the patient is obliged not earlier than two months before the start of its validity to come to the attending physician for the necessary additional examination. Attending physicians and heads of departments should be guided by the following mandatory list diagnostic studies and consultations of specialists, the results of which must be reflected in the health resort card (form 072 / y-04):

• clinical analysis of blood and urine;
• fluorography;
• for diseases of the digestive system - x-ray examination (if more than 6 months have passed since the last examination), ultrasound, endoscopy;
• in necessary cases, to clarify the diagnosis, additional research: biochemical, instrumental and others;
• when sending women to the resort, the conclusion of an obstetrician-gynecologist is mandatory, for pregnant women - an additional exchange card;
• in the presence of a history of neuropsychiatric disorders - the conclusion of a psychiatrist;
• with underlying or concomitant diseases (urological, skin, blood, eyes, and others) - the conclusion of the relevant specialists.

Inspection data, research results are recorded in the outpatient card. The health resort card is certified by the head of the department. In the case of registration for treatment of a person entitled to a set of social services, the sanatorium card is certified by the attending physician, the head of the department or the chairman of the VC.

If a patient has contraindications to treatment in the first five days of his stay at the resort, the VK resort (sanatorium) decides whether the patient can continue to stay there, transfer to a hospital or transport him to his place of residence. If the patient claims against the health facility, all material costs are reimbursed by the attending physician.

Work on drug provision of patients

The responsible section of the work of the local therapist is the work for the intended purpose. drug therapy and prescribing medicines, including in the supplementary drug provision (DLO) system.

The prescription of medicines (PM) is made by the doctor directly involved in the management of the patient (the attending physician). In cases of a typical course of the disease, the prescription of drugs is carried out based on the severity and nature of the disease, in accordance with the standards of medical care and the list of vital and essential drugs approved by the Government Russian Federation, as well as a list of drugs dispensed to persons entitled to receive state social assistance.

The main regulatory documents regulating drug provision are the orders of the Ministry of Health and social development No. 785 of December 14, 2005 “On the procedure for dispensing medicines” and No. 110 of February 12, 2007 “On the procedure for prescribing and prescribing medicines, products medical purpose and specialized products medical nutrition". Order No. 110 approved the prescription forms and the rules for filling them out.

Special prescription form for narcotic drug and psychotropic substance made on paper Pink colour watermarked and has a serial number. Filled in by the doctor legibly, clearly, corrections are not allowed. LS is issued for Latin, the amount of the drug is indicated in words, recommendations for admission are indicated in Russian and should be specific. The number of the outpatient's medical card is indicated on the prescription (the number of "attachment" to the pharmacy institution, the full surname, first name, patronymic of the patient and the doctor. The prescription is signed by the doctor and certified by his personal seal, the head physician of the health facility (his deputy or head of the department) and certified by a round seal The prescription must have a stamp with the details of the healthcare facility Only one drug is prescribed on the form (a narcotic or psychotropic drug included in List II of the List drugs, psychotropic substances and their precursors subject to control in the Russian Federation. The prescription is valid for 5 days.

The rules for the storage and accounting of narcotic drugs and psychotropic substances, the estimated requirements for them, the provision for write-off and destruction are regulated by order No. 330 of 11/12/1997 (as amended by orders No. 2 of 01/09/2001 and No. 205 of 05/16/2005 G.).

On the prescription form (form No. 148-1 / y-88(a) Schedule III psychotropic substances are prescribed; other drugs subject to quantitative accounting, anabolic steroids. The prescription form has a series and a number. On the form, you can write out only one name of the drug, corrections are not allowed. The full surname, first name, patronymic of the patient, his age, address (or medical card number) and the full surname, first name, patronymic of the doctor are indicated on the prescription. The prescription is signed by the doctor and certified by his personal seal and the seal of the medical institution "For prescriptions". The prescription must be stamped with the details of the health facility. The validity period of the prescription (10 days, 1 month) is indicated by a strikethrough.

On prescription form No. 107/y all drugs are prescribed, with the exception of narcotic, psychotropic substances, drugs subject to quantitative accounting, anabolic steroids. No more than three drugs are prescribed on one form. Prescription requirements - as in previous cases. The prescription must be stamped with the details of the health facility. The prescription is signed by the doctor and certified by his personal seal. The validity of the prescription (10 days, 2 months, a year) is indicated by a strikethrough.

Recipe Form No. 148-1/y-04 is intended for prescribing drugs, medical devices included in the lists of drugs dispensed free of charge or at a discount. The prescription form is issued in triplicate, having a single series and number. When filling out the form, the full name, first name, patronymic of the patient, date of birth, SNILS, medical insurance policy number, address or medical card number, ICD disease code X. It is allowed to issue a prescription using a computer. The prescription is signed by the doctor, certified by his personal seal and the seal of the medical institution "For prescriptions". When a drug is issued by decision of the medical commission (VC), a special stamp is placed on the back of the form. By decision of the VC, the prescription of drugs is carried out in cases of simultaneous prescription of five or more drugs; prescribing narcotic drugs, psychotropic substances; drugs subject to subject-quantitative accounting; anabolic steroids.

The issuance of "preferential" drugs is carried out in accordance with the annually updated List of medicines dispensed by prescription of a doctor (paramedic) when providing additional free medical care to certain categories of citizens entitled to receive state social assistance. Currently valid normative document is the order of the Ministry of Health of the Russian Federation No. 665 dated September 18, 2006.

Population groups:

• Participants and invalids of the Second World War, military operations to protect the country.
• Parents and wives of military personnel who died in defense of the country or in the performance of other duties of military service.
• Citizens who worked during the blockade in Leningrad, awarded the medal "For the Defense of Leningrad", citizens awarded the sign "Inhabitant of the besieged Leningrad".
• Former minor prisoners of concentration camps, ghettos created by the Nazis during World War II.
• Citizens from among the former internationalist soldiers who took part in the hostilities in Afghanistan and on the territory of other countries.
• Disabled by disease, children with disabilities.
• Citizens exposed to radiation due to the Chernobyl accident, the Techa River, Mayak Ave. and others

Categories of diseases(regional benefit): cerebral palsy, AIDS, HIV-infected, oncological diseases, acute intermittent porphyria, cystic fibrosis, hematological diseases, hemoblastosis, cytopenia, hereditary hemopathy, radiation sickness, tuberculosis, bronchial asthma, rheumatism, rheumatoid arthritis, SLE, ankylosing spondylitis, myocardial infarction (first 6 months), condition after valve replacement, diabetes, multiple sclerosis, Parkinson's disease, myopathy, etc.

Analysis of the activities of the district doctor

Performance indicators:

• Seeking medical care at the reception and at home;
• Morbidity at the site: primary, general;
• Infectious morbidity;
• Morbidity with temporary disability, compliance with the terms of temporary disability;
• Coverage by fluorographic examination;
• Efficiency of clinical examination (according to established criteria);
• Rate of hospitalization of patients;
• Mortality in the area;
• Preventive work: vaccinations, targeted examinations, sanitary and educational work, etc.;
• The incidence of tuberculosis and oncopathology;

Each case is assessed by experts

• sudden death;
• deaths at home of people of working age;
• discrepancies in diagnosis during hospitalization;
• inconsistencies in the terms of temporary disability of the MES;
• temporary disability for more than 120 days;
• justified complaints of patients;
• issuance of preferential prescriptions through VK;
• primary access to disability;
• advanced forms of cancer, tuberculosis, diabetes.

Criteria for the effectiveness of the work of the local general practitioner

Evaluation of the effectiveness of the work of the local general practitioner is carried out according to the criteria approved by the order of the Ministry of Health of the Russian Federation No. 282 dated April 19, 2007 “On approval of the criteria for evaluating the effectiveness of the activities of the district general practitioner”.

When evaluating the effectiveness of work, the main accounting documents are:

• outpatient medical record (025/y-04),
• passport of the medical site (030/u-ter),
• record of medical visits to the APU, at home (039 / y-02),
• control card of dispensary observation (030/u-04),
• outpatient voucher (025-12/y),
• card of a citizen entitled to receive a set of social services for accounting for the release of medicines (030-L / u).

Performance Evaluation Criteria:

• stabilization or decrease in the level of hospitalization of the attached population;
• reducing the frequency of SSMP calls to the attached population;
• increase in the number of visits of the attached population for preventive purposes;
• completeness of coverage with medical and preventive care of persons under dispensary supervision;
• completeness of preventive vaccination coverage of the attached population against diphtheria (at least 90% in each age group), against hepatitis B (at least 90% under the age of 35 years), against rubella (at least 90% of women under 25 years of age), against influenza ( implementation of a plan).
• stabilization or decrease in the mortality rate of the population at home with cardiovascular diseases, tuberculosis, diabetes;
• a decrease in the number of people who died at home from diseases of the circulatory system under the age of 60 and were not observed for last year life;
• stabilization of the incidence of diseases of a social nature: tuberculosis, hypertension, diabetes, oncological diseases.
• complete coverage of measures for dynamic medical monitoring of the state of health of certain categories of citizens who have the right to receive a set of social services, including drug provision, sanatorium-resort and rehabilitation treatment;
• reasonableness of prescribing medicines and compliance with the rules for discharge to patients, including those entitled to receive a set of social services.

Specific indicators of the criteria for evaluating the effectiveness of the work of a local general practitioner are determined by the head of the healthcare institution, taking into account the size, density, age and sex composition of the population, the incidence rate, geographical and other features.

From the performance indicators of district doctors, the performance indicators of the polyclinic as a whole are added up:

Key performance indicators of the polyclinic

1. Indicators that allow assessing the state of organization of medical care for the population:

• the average number of visits to the polyclinic per inhabitant living in the service area of ​​the polyclinic;
• district coverage of public services in the polyclinic and at home;
• proportion of active visits to patients at home;
• share medical services provided in the system of mandatory health insurance(CMI) (%).

1. Indicators that allow assessing the organization and results of preventive medical examinations of the population:

• implementation of a plan preventive examinations population;
• morbidity according to preventive examinations per 100 (1000) examined persons.

1. Indicators of the quality and effectiveness of clinical examination:

• coverage of the population with medical examinations by groups of dispensary observation;
• indicator of the structure of morbidity of persons under dispensary supervision;
• completeness of coverage by dispensary observation;
• indicator of compliance with the terms of dispensary examinations;
• indicator of the completeness of medical and recreational activities;
• indicators of the effectiveness of clinical examination.

1. Indicators that allow assessing the quality of the clinic and the level of staff training: The quality of the work of the polyclinic as a whole can be characterized by the dynamics of the incidence rate of the population over several years, the proportion of coincidences between the diagnoses of the polyclinic and the hospital, etc.

APPROVE:

[Job title]

_______________________________

_______________________________

[Name of company]

_______________________________

_______________________/[FULL NAME.]/

"______" _______________ 20___

JOB DESCRIPTION

District physician

1. General Provisions

1.1. This job description defines and regulates the powers, functional and job duties, rights and responsibilities of the district general practitioner [Name of organization in the genitive case] (hereinafter referred to as the Medical Organization).

1.2. The district general practitioner is appointed to the position and dismissed from the position in accordance with the procedure established by the current labor legislation by order of the head medical organization.

1.3. The local general practitioner belongs to the category of specialists and is subordinate to [name of the position of subordinates in the dative case].

1.4. The district general practitioner reports directly to the [name of the position of the immediate supervisor in the dative case] of the Medical Organization.

1.5. A person who has a higher professional education in one of the specialties "Medicine", "Pediatrics" and postgraduate professional education (internship and (or) residency) in the specialty "Therapy" or professional retraining in the presence of a postgraduate vocational education in the specialty "General Medical Practice (Family Medicine)", a certificate of a specialist in the specialty "Therapy" without presenting requirements for work experience.

1.6. The general practitioner is responsible for:

• effective performance of the work entrusted to him;
• compliance with the requirements of performance, labor and technological discipline;
• the safety of the documents (information) that are in his custody (become known to him), containing (constituting) the trade secret of the Medical Organization.

1.7. The general practitioner must know:

• the Constitution of the Russian Federation;
• laws and other regulatory legal acts of the Russian Federation in the field of healthcare;
• Fundamentals of legislation on the protection of the health of citizens;
• general issues of organizing therapeutic care in the Russian Federation;
• the work of medical and preventive institutions, the organization of the work of the ambulance and emergency care adults and children;
• organization of the work of the polyclinic, continuity in its work with other institutions;
• organization of a day hospital and a hospital at home;
• the main issues of normal and pathological anatomy, normal and pathological physiology, the relationship functional systems organism and levels of their regulation;
• basics of water-electrolyte metabolism, acid-base balance, possible types of their disorders and principles of treatment;
• the system of hematopoiesis and hemostasis, the physiology and pathophysiology of the blood coagulation system, homeostasis indicators in normal and pathological conditions;
• fundamentals of immunology and reactivity of the body;
• clinical symptoms and pathogenesis of major therapeutic diseases in adults and children, their prevention, diagnosis and treatment, clinical symptoms of borderline conditions in a therapeutic clinic;
• basics of pharmacotherapy in the clinic of internal diseases, pharmacodynamics and pharmacokinetics of the main groups of drugs, complications caused by the use of drugs, methods for their correction;
• basics of non-drug therapy, physiotherapy, physiotherapy exercises and medical supervision, indications and contraindications for spa treatment;
• the basics of rational nutrition of healthy individuals, the principles of diet therapy for therapeutic patients;
• anti-epidemic measures in the event of a focus of infection;
• medical and social expertise in internal diseases;
• dispensary observation of healthy and sick people, problems of prevention;
• forms and methods of sanitary and educational work;
• demographic and social characteristics of the site;
• principles of organization of medical service of civil defense;
• questions of the relationship of the disease with the profession.

1.8. The local general practitioner in his activities is guided by:

• local acts and organizational and administrative documents of the Medical Organization;
• internal labor regulations;
• rules of labor protection and safety, ensuring industrial sanitation and fire protection;
• instructions, orders, decisions and instructions of the immediate supervisor;
• this job description.

1.9. During the period of temporary absence of the district general practitioner, his duties are assigned to [name of the position of the deputy].

2. Job responsibilities

The primary care physician is required to perform the following duties:

2.1. Identifies and monitors risk factors for the development of chronic noncommunicable diseases.

2.2. Provides primary prevention in high-risk groups.

2.3. Performs a list of works and services for diagnosing a disease, assessing the patient's condition and the clinical situation in accordance with the standard of medical care.

2.4. Performs a list of works and services for the treatment of a disease, condition, clinical situation in accordance with the standard of medical care.

2.5. Provides symptomatic assistance to oncological patients of the IV clinical group in cooperation with an oncologist.

2.6. Carries out an examination of temporary disability of patients, presentation to the medical commission, referral of patients with signs of permanent disability for examination for medical and social examination.

2.7. Issues conclusions on the need to refer the patient for medical reasons for sanatorium treatment, draws up a sanatorium card.

2.8. Carries out organizational, methodological and practical work on medical examination of the population.

2.9. Organizes the vaccination of the population in accordance with the national calendar of preventive vaccinations and according to epidemic indications.

2.10. Prepares and sends an emergency notification to the institutions of Rospotrebnadzor when an infectious or occupational disease is detected.

2.11. Organizes and conducts activities for sanitary and hygienic education (health schools, schools for patients with socially significant noncommunicable diseases and persons with high risk their occurrence).

2.12. Monitors and analyzes the main medical and statistical indicators of morbidity, disability and mortality in the serviced area in the prescribed manner.

2.13. Maintains accounting and reporting documentation of the established sample.

In the event of an official need, a district general practitioner may be involved in the performance of his official duties overtime, in the manner prescribed by the provisions of federal labor legislation.

3. Rights

The local general practitioner has the right to:

3.1. To give instructions to subordinate employees and services, tasks on a range of issues included in his functional duties.

3.2. To control the fulfillment of production tasks, the timely execution of individual orders and tasks by subordinate services.

3.3. Request and receive the necessary materials and documents related to the activities of the district general practitioner, subordinate services and units.

3.4. Interact with other enterprises, organizations and institutions on production and other issues related to the competence of the local general practitioner.

3.5. Sign and endorse documents within their competence.

3.6. Submit for consideration by the head of the Medical Organization submissions on the appointment, transfer and dismissal of employees of subordinate units; proposals for their promotion or for the imposition of penalties on them.

3.7. Enjoy other rights established by the Labor Code of the Russian Federation and other legislative acts of the Russian Federation.

4. Responsibility and performance evaluation

4.1. The local general practitioner shall bear administrative, disciplinary and material (and in some cases provided for by the legislation of the Russian Federation - and criminal) responsibility for:

4.1.1. Non-fulfillment or improper fulfillment of official instructions of the immediate supervisor.

4.1.2. Failure or improper performance of labor functions and the tasks assigned to him.

4.1.3. Unlawful use of the granted official powers, as well as their use for personal purposes.

4.1.4. Inaccurate information about the status of the work entrusted to him.

4.1.5. Failure to take measures to suppress the identified violations of safety regulations, fire and other rules that pose a threat to the activities of the enterprise and its employees.

4.1.6. Failure to enforce labor discipline.

4.2. Evaluation of the work of the local general practitioner is carried out:

4.2.1. The immediate supervisor - regularly, in the course of the daily implementation by the employee of his labor functions.

4.2.2. Attestation Commission of the enterprise - periodically, but at least once every two years based on the documented results of the work for the evaluation period.

4.3. The main criterion for evaluating the work of a local general practitioner is the quality, completeness and timeliness of his performance of the tasks provided for by this instruction.

5. Working conditions

5.1. The work schedule of the district general practitioner is determined in accordance with the internal labor regulations established in the Medical Organization.

6. Right to sign

6.1. To ensure his activities, the district general practitioner is given the right to sign organizational and administrative documents on issues referred to his competence by this job description.

Familiarized with the instruction ___________ / ____________ / "____" _______ 20__