PQU of individual medicines

I. Medicines - pharmaceutical substances and medicines containing narcotic drugs, psychotropic substances and their precursors (their salts, isomers, stereoisomers), included in lists II, III, IV of the list of narcotic drugs, psychotropic substances and their precursors subject to control in Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 1998 N 681 “1” (hereinafter referred to as narcotic drugs, psychotropic substances and their precursors), in combination with pharmacologically inactive substances, as well as medicines containing narcotic drugs, psychotropic substances and their precursors in combination with pharmacologically active substances (provided they are included in the list as a separate item):
II. Medicines - pharmaceutical substances and drugs containing potent and toxic substances(their salts, isomers, ethers and esters, mixtures and solutions, regardless of concentration), included in the lists of potent and toxic substances for the purposes of Article 234 and other articles of the Criminal Code of the Russian Federation, approved by Decree of the Government of the Russian Federation of December 29, 2007 N 964 “1” (hereinafter referred to as potent and toxic substances), in combination with pharmacologically inactive substances, as well as medicinal preparations containing potent and toxic substances in combination with pharmacologically active substances (provided they are included in the list as a separate item):

Order of the Ministry of Health of the Russian Federation dated April 22, 2014 N 183n “On approval of the list of medicines for medical use that are subject to subject-quantitative accounting” (with amendments and additions)

Order of the Ministry of Health of the Russian Federation dated April 22, 2014 N 183n
“On approval of the list medicines For medical use subject to subject-quantitative accounting"

With changes and additions from:

2. To recognize as invalid:

Registration N 33210

A new list of medicines (medicines) for medical use, subject to subject-quantitative accounting, has been approved.

It includes 3 groups of drugs.

The first included drugs containing narcotic drugs, psychotropic substances and their precursors (their salts, isomers, stereoisomers) from lists II, III, IV. In particular, we are talking about prazepam, thebaine, fentanyl, ephedrine (at a concentration of 10% or more), estazolam, phenobarbital, etc.

The second group of drugs contains drugs containing potent and toxic substances (their salts, isomers, ethers and esters, mixtures and solutions, regardless of concentration), included in the corresponding lists. This includes snake and bee venoms (except for creams, ointments, gels), tramadol, chloroform, ergotal, ethanol.

The third part of the list consists of combination drugs containing, in addition to small quantities of narcotic drugs, psychotropic substances and their precursors, other pharmacological active substances.

The previous list was declared invalid.

Order of the Ministry of Health of the Russian Federation dated April 22, 2014 N 183n “On approval of the list of medicines for medical use, subject to subject-quantitative accounting”

Registration N 33210

This order comes into force 10 days after the day of its official publication

IN this document The following documents have been amended:

Order of the Ministry of Health of the Russian Federation (Ministry of Health of Russia) dated April 22, 2014 N 183n, Moscow “On approval of the list of medicines for medical use, subject to subject-quantitative accounting”

Registration N 33210

In accordance with paragraph 5.2.171(1) of the Regulations on the Ministry of Health of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 19, 2012 N 608 (Collected Legislation of the Russian Federation, 2012, N 26, Art. 3526; 2013, N 16, Art. 1970; N 20, Art. 2477; N 22, Art. 2812; N 33, Art. 4386; N 45, Art. 5822; 2014, N 12, Art. 1296), I order:

1. Approve the list of medicines for medical use, subject to subject-quantitative recording, in accordance with the appendix.

2. To recognize as invalid:

Appendix No. 1 to the Procedure for the dispensing of medicines, approved by order of the Ministry of Health and social development Russian Federation dated December 14, 2005 N 785 (registered by the Ministry of Justice of the Russian Federation on January 16, 2006, registration N 7353);

Order of the Ministry of Health and Social Development of the Russian Federation dated October 13, 2006 N 703 “On amendments to the order of the Ministry of Health and Social Development of the Russian Federation dated December 14, 2005 N 785” (registered by the Ministry of Justice of the Russian Federation on November 7, 2006, registration N 8445);

paragraph 4 of the Amendments to the Procedure for Dispensing Medicines, approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 14, 2005 N 785, approved by order of the Ministry of Health and Social Development of the Russian Federation dated February 12, 2007 N 109 (registered by the Ministry of Justice Russian Federation March 30, 2007, registration N 9198);

paragraph 4 of the Amendments to the Procedure for Dispensing Medicines, approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 14, 2005 N 785, approved by order of the Ministry of Health and Social Development of the Russian Federation dated August 6, 2007 N 521 (registered by the Ministry of Justice Russian Federation August 29, 2007, registration N 10063).

Minister V. Skvortsova

List of medicines for medical use,

subject to subject-quantitative accounting 1

(hereinafter referred to as narcotic drugs, psychotropic substances and their precursors), in combination with pharmacologically inactive substances, as well as medicines containing narcotic drugs, psychotropic substances and their precursors in combination with pharmacologically active substances (subject to their inclusion in the list as a separate item) :

Subject-quantitative accounting within the framework of order 183n

Articles on the topic

Order 183n subject-to-quantitative accounting is the main document for organizing the accounting of PKU drugs in a medical institution.

We will tell you about the new provisions of the order - which drugs have been added to it and which are excluded. Current list of PKU drugs for downloading.

The main thing in the article:

Latest changes to Order 183n

Order 183n for specific quantitative accounting of medicines is an important document that is used in a medical institution to organize special accounting of certain groups of medicines.

The list of subject-to-quantitative medications is exhaustive, therefore, the management of a medical institution does not have the right to demand from employees a complete PQU of all groups of drugs.

The list of medicines subject to subject-quantitative registration is relevant in 2018
view/download>>

Order of the Ministry of Health 183n on subject-quantitative recording in the new edition
view/download>>

Order PKU 183n was changed in 2018.

The Ministry of Health added “Buprenorphine + Naloxone” and “Oxycodone + Naloxone” to List I of the list of drugs subject to PCU (Order of the Ministry of Health dated April 22, 2014 No. 183n). Medicines can be prescribed on form No. 148–1/у-88. Codeine powder, sodium hydroxybutyrate in the form of a solution and syrup, as well as Promedol (INN - Trimeperidine) in the form of an injection solution were excluded from the list. Codeine remained in the Omnopon preparation in a solution for subcutaneous administration.

The Ministry allowed two drugs from the PCU list to be prescribed on one prescription: “Buprenorphine + Naloxone” in the form of sublingual tablets 0.2 mg + 0.2 mg (no more than 60 tablets) and “Oxycodone + Naloxone” in the form of extended-release tablets (no more than 100 tablets for a dosage of 5 mg + 2.5 mg, 60 for 10 mg + 5 mg, 40 tablets for a dosage of 20 mg + 10 mg and no more than 20 tablets for a dosage of 40 mg + 20 mg).

Release and accounting of medicines

Only those drugs, the list of which is approved by Order 183n, are subject to subject-quantitative accounting. There is no need to demand continuous PKU medications from subordinates, dressing material etc. This provision is outdated.

How and what now needs to be controlled by the main nurse when organizing subject-quantitative accounting, read the special review “Drug circulation in medical organizations” in the journal “Chief Nurse”.

List of medicinal products subject to PCU

Order of the Ministry of Health 183n on substantive quantitative accounting contains several groups of medicines that are intended for medical use.

When compiling a list of PCU drugs, their trade name does not matter.

Thus, we can distinguish two main groups of drugs, which, in addition to narcotic drugs and psychotropic substances, are subject to subject-quantitative accounting.

Combination medications containing potent and narcotic substances, but in relatively small quantities in combination with other active substances.
Potent and poisonous drugs, which are combined in the drug with other pharmacologically inactive substances (monoprugs).

Scheme: PKU within the framework of order 183n

PQU of individual medicines

Order 183 subject-to-quantitative accounting provides for special accounting of certain pharmaceutical substances and medicines.

These include:

eye drops and ethyl alcohol (in bottles);
medications that are given to patients multiple times throughout the day.

Let us consider the features of subject-quantitative accounting of these drugs.

PKU ethyl alcohol in a medical organization>>

Ethyl alcohol and eye drops

Only approximate alcohol costs for carrying out certain activities have been approved by law. medical procedures. In this regard, in a medical institution it is impossible to take into account the exact consumption of alcohol for each patient during the day.

In this regard, subject-to-quantitative accounting of alcohol according to order 183n is carried out in bottles. Thus, alcohol is written off after consuming a whole bottle without indicating the data of specific patients.

Order 183n provides for the same accounting scheme for eye drops. Since the healthcare provider does not know how many drops or milliliters are in the bottle before use, it is more convenient to dispense eye drops in bottles.

In a medical institution, the procedure for recording eye drops and alcohol in bottles is approved by the chief physician.

An example of keeping a subject-quantitative accounting journal

Download a ready-made example of keeping a log of PKU ethyl alcohol based on Appendix No. 3 to the order of the Ministry of Health of the Russian Federation dated June 17, 2013 No. 378n. The form was checked by experts of the Chief Nurse System.

How to organize PCU of tropicamide and cyclopentolate eye drops

Let's consider an example of organizing the accounting of eye drops in a medical institution in accordance with the rules established by Order 183 of the PKU.

As is known, accurate accounting of the consumption of eye drops in a medical institution is difficult for the following reasons:

one bottle can be used to instill drops into several patients at once;
During the procedure, losses of the drug often occur, for example, if drops spilled past or the solution leaked from the bottle;
due to the manufacturer’s permissible deviations, the exact quantity (millimeters, drops) of the drug in the bottle is not known in advance;
When using a dropmer, 1 ml of the drug contains 20 drops of liquid. However, in practice, healthcare workers often use conventional pipettes, so the recording of droplet flow is inaccurate;
Order 183n for detailed quantitative accounting provides for monthly reconciliation of drug balances with their book balance. If you take into account eye drops according to medical prescriptions, and not according to their actual consumption, then the balances according to the documents will not coincide with the real ones;
For Tropicamide eye drops, the shelf life of an open bottle is limited. If it is not used up during this time, the medicine must be destroyed. In this case, the whole bottle is written off, and not the remaining drops.

In this regard, these pharmaceutical substances must be taken into account vials.

The following accounting algorithm is suitable:

The chief physician of a medical institution approves the procedure for accounting for eye drops by bottle.
In the subject-quantitative accounting journal, a separate section (page) is created for each type of eye drops. One bottle is taken as one unit of measurement of drugs. When new drops arrive in the department, the nurse writes the corresponding value in the “arrival” column. The consumption of drops is recorded in the same way - in bottles.
When a new batch of drugs arrives in a particular department, the nurse at the post also records the number of bottles received. When they are used up, enter the number of bottles used in the journal.

Order of the Ministry of Health of April 22, 2014 N 183n On approval of the list of medicines for medical use, subject to subject-quantitative recording

1. Approve the list of medicines for medical use, subject to subject-quantitative recording, in accordance with the appendix.

2. To recognize as invalid:

Appendix No. 1 to the Procedure for Dispensing Medicines, approved by Order of the Ministry of Health and Social Development of the Russian Federation of December 14, 2005 No. 785 (registered by the Ministry of Justice of the Russian Federation on January 16, 2006, registration No. 7353);

paragraph 4 of the Amendments to the Procedure for Dispensing Medicines, approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 14, 2005 N 785, approved by order of the Ministry of Health and Social Development of the Russian Federation dated August 6, 2007 N 521 (registered by the Ministry of Justice Russian Federation August 29, 2007, registration N 10063).

Application

to the order of the Ministry of Health

Russian Federation

dated April 22, 2014 N 183n

MEDICINES FOR MEDICAL USE,

SUBJECT TO SUBJECT-QUANTITATIVE ACCOUNTING “1”

“1” The medicinal products for medical use listed in this list are subject to subject-quantitative registration, regardless of their trade name.

I. Medicines - pharmaceutical substances and medicines containing narcotic drugs, psychotropic substances and their precursors (their salts, isomers, stereoisomers), included in lists II, III, IV of the list of narcotic drugs, psychotropic substances and their precursors subject to control in of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 1998 N 681 “1” (hereinafter referred to as narcotic drugs, psychotropic substances and their precursors), in combination with pharmacologically inactive substances, as well as medicines containing narcotic drugs, psychotropic substances and their precursors in combination with pharmacologically active substances (provided they are included in the list as a separate item):

“1” Collection of Legislation of the Russian Federation, 1998, No. 27, Art. 3198; 2004, N 8, art. 663; N 47, art. 4666; 2006, N 29, art. 3253; 2007, N 28, art. 3439; 2009, N 26, art. 3183; N 52, art. 6572; 2010, N 3, art. 314; N 17, art. 2100; N 24, Art. 3035; N 28, art. 3703; N 31, art. 4271; N 45, art. 5864; N 50, art. 6696, 6720; 2011, N 10, art. 1390; N 12, art. 1635; N 29, art. 4466, 4473; N 42, art. 5921; N 51, art. 7534; 2012, N 10, art. 1232; N 11, art. 1295; N 19, art. 2400; N 22, art. 2864; N 37, art. 5002; N 41, art. 5625; N 48, art. 6686; N 49, Art. 6861; 2013, N 6, art. 558; N 9, art. 953; N 25, art. 3159; N 29, art. 3962; N 37, art. 4706; N 46, art. 5943; N 51, art. 6869.

Diethyl ether (at a concentration of 45 percent or more)

Potassium permanganate (at a concentration of 45 percent or more)

Pseudoephedrine (at a concentration of 10 percent or more)

Phenylpropanolamine (at a concentration of 10 percent or more)

Ergometrine (at a concentration of 10 percent or more)

Ergotamine (at a concentration of 10 percent or more)

Ephedrine (at a concentration of 10 percent or more)

“1” Collection of Legislation of the Russian Federation, 2008, No. 2, Art. 89; 2010, N 28, art. 3703; 2012, N 10, art. 1232; N 41, art. 5625; 2013, N 6, art. 558; N 9, art. 953; N 45, art. 5831.

Snake venom (except for dosage forms for external use - creams, ointments, gels)

Bee venom (except for dosage forms for external use - creams, ointments, gels)

Ethyl alcohol (Ethanol)

Total belladonna alkaloids (excluding solid dosed dosage form- suppositories)

1-testosterone (except for dosage forms for external use - creams, ointments, gels)

Tramadol 37.5 mg + paracetamol

III. Combined medicinal products containing, in addition to small quantities of narcotic drugs, psychotropic substances and their precursors, other pharmacological active substances “1”:

“1” Clause 5 of the Vacation Procedure individuals medicinal products for medical use containing, in addition to small quantities of narcotic drugs, psychotropic substances and their precursors, other pharmacological active substances, approved by order of the Ministry of Health and Social Development of the Russian Federation dated May 17, 2012 N 562n (registered by the Ministry of Justice of the Russian Federation on June 1, 2012 ., registration N 24438), as amended by order of the Ministry of Health of the Russian Federation dated June 10, 2013 N 369n (registered by the Ministry of Justice of the Russian Federation on July 15, 2013, registration N 29064).

1) codeine or its salts (in terms of pure substance) in an amount up to 20 mg inclusive (per 1 dose of solid dosage form) or in an amount up to 200 mg inclusive (per 100 ml or 100 g of liquid dosage form for internal use);

2) pseudoephedrine hydrochloride in an amount exceeding 30 mg and up to 60 mg inclusive (per 1 dose of solid dosage form);

4) dextromethorphan hydrobromide in an amount up to 200 mg inclusive (per 100 ml or 100 g of liquid dosage form for internal use);

5) ephedrine hydrochloride in an amount exceeding 100 mg and up to 300 mg inclusive (per 100 ml or 100 g of liquid dosage form for internal use);

6) ephedrine hydrochloride in an amount up to 50 mg inclusive (per 1 dose of solid dosage form);

7) phenylpropanolamine in an amount up to 75 mg inclusive (per 1 dose of solid dosage form) or up to 300 mg inclusive (per 100 ml or 100 g of liquid dosage form for internal use);

8) phenobarbital in an amount up to 15 mg inclusive in combination with codeine (or its salts) regardless of the amount (per 1 dose of solid dosage form);

9) phenobarbital in an amount up to 20 mg inclusive in combination with ephedrine hydrochloride, regardless of the amount (per 1 dose of solid dosage form);

10) chlordiazepoxide in an amount exceeding 10 mg and up to 20 mg inclusive (per 1 dose of solid dosage form).

IV. Other medicines subject to subject-quantitative accounting:

Pregabalin (medicines)

Tropicamide (medicines)

Cyclopentolate (medicines).

(section IV introduced by Order of the Ministry of Health of Russia dated September 10, 2015 N 634n)

The order of the Russian Ministry of Health approved a list of medicines for medical use that are subject to subject-quantitative accounting

The new list has been published and will come into effect on August 16 this year. The previous list has been in effect since 2005 and will be canceled by the same Order (Order of the Ministry of Health of Russia dated April 22, 2014 No. 183n “On approval of the list of medicines for medical use, subject to subject-quantitative registration”).

The new list includes a group of potent and toxic drugs. In this case, all medicinal products for medical use listed in the list are subject to subject-quantitative accounting, regardless of their trade name.

The order excludes medicinal forms for external use - creams, ointments, gels containing snake venom, bee venom, 1-testosterone and its isomer.

Thus, the List includes three groups of medicines. The first group included pharmaceutical substances and medicinal preparations containing narcotic drugs, psychotropic substances and their precursors (their salts, isomers, stereoisomers), included in lists II, III, IV of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation. Federation, in combination with pharmacologically inactive substances.

The second group includes pharmaceutical substances and medicinal preparations containing potent and toxic substances (their salts, isomers, ethers and esters, mixtures and solutions, regardless of concentration), included in the lists of potent and toxic substances for the purposes of Article 234 and other articles of the Criminal Code Russian Federation, in combination with pharmacologically inactive substances, as well as one combined medicinal product containing the potent substance “Tramadol” in an amount of 37.5 mg in combination with the pharmacologically active substance “Paracetamol”.

The third group consists of combination drugs containing, in addition to small quantities of narcotic drugs, psychotropic substances and their precursors, other pharmacological active substances, and dispensed according to prescriptions written out on prescription forms, registration form No. 148-1/u-88.

At the same time, the procedure for dispensing drugs of the 1st and 3rd groups does not change, only their registration is introduced, since the drugs were already dispensed on special forms of forms No. 148-1/u-88. And drugs of the 2nd group, which until now were dispensed according to a prescription written out on prescription forms No. 107-1/u, must be dispensed with prescription form No. 148-1/u-88, as required by the Order of the Ministry of Health of Russia dated December 20 .2012 No. 1175n “On approval of the procedure for prescribing and prescribing medicines, as well as forms of prescription forms for medicines, the procedure for completing these forms, their recording and storage.”

In particular, this applies to a number of hormonal drugs, drugs used for obesity and gynecology (for example, drugs containing sibutramine, danazol, gestrinone). The Russian Ministry of Health draws attention to this fact Special attention regional executive authorities in the field of healthcare and medical workers and asks to take this into account in their work. The corresponding information letters (No. 1152, No. 1119) were posted by the Russian Ministry of Health on the procurement portal for seven costly nosologies.

"It is important to note,— comments the Director of the Department drug provision and regulation of circulation medical products Elena Maksimkina, - that the List will be expanded in connection with proposals to include other medicines, the circulation of which must be controlled. They will be included in accordance with the regulations prescribed in the Order of the Ministry of Health of Russia dated January 20, 2014 No. 30n “On approval of the procedure for including medicines for medical use in the list of medicines for medical use subject to subject-quantitative accounting” by decision of the interdepartmental commission, which includes representatives of the Russian Ministry of Health, the Russian Ministry of Industry and Trade, Roszdravnadzor and the Federal Drug Control Service.”

In addition, in accordance with the new Order, the following are recognized as no longer in force: Appendix No. 1 to the Procedure for the Dispensing of Medicines, approved by Order of the Ministry of Health and Social Development of Russia dated December 14, 2005 No. 785, and other orders of the Ministry of Health and Social Development of Russia (dated October 13, 2006 No. 703, dated February 12, 2007 No. 109, dated August 6, 2007 No. 521), introducing changes to the above Appendix.

Violation of the requirements for maintaining subject-quantitative records is a gross violation of licensing requirements when carrying out pharmaceutical activities and entails administrative liability in accordance with Article 14.1 (clause 4) of the Code of the Russian Federation on Administrative Offenses.

Registration N 29362

In accordance with paragraph 7 of part 2 of article 9 Federal Law dated July 20, 2012 N 125-FZ “On the donation of blood and its components” (Collected Legislation of the Russian Federation, 2012, N 30, Art. 4176) I order:

Approve the attached Rules clinical use donated blood and (or) its components.

Minister V. Skvortsova

Rules for the clinical use of donor blood and (or) its components

I. General provisions

1. These Rules establish the requirements for conducting, documentation and control of the clinical use of donor blood and (or) its components in order to ensure the effectiveness, quality and safety of transfusion (transfusion) and the formation of reserves of donor blood and (or) its components.

2. These Rules are subject to application by all organizations engaged in the clinical use of donor blood and (or) its components in accordance with Federal Law of July 20, 2012 N 125-FZ “On the donation of blood and its components” (hereinafter referred to as organizations).

II. Organization of activities for transfusion (transfusion) of donor blood and (or) its components

3. Organizations create a transfusiology commission, which includes heads of clinical departments, heads of the transfusiology department or transfusiology room, and if they are not on the organization’s staff, doctors responsible for organizing the transfusion (transfusion) of donor blood and (or) its components in the organization and other specialists.

The transfusion commission is created on the basis of a decision (order) of the head of the organization in which it was created.

The activities of the transfusiology commission are carried out on the basis of the regulations on the transfusiology commission, approved by the head of the organization.

4. The functions of the transfusion commission are:

a) control over the organization of transfusion (transfusion) of donor blood and (or) its components in the organization;

b) analysis of the results of clinical use of donor blood and (or) its components;

c) development of optimal programs for transfusion (transfusion) of donor blood and (or) its components;

d) organization, planning and control of leveling up vocational training doctors and other medical workers on issues of transfusion (transfusion) of donor blood and (or) its components;

e) analysis of cases of reactions and complications that arose in connection with transfusion (transfusion) of donor blood and (or) its components, and development of measures for their prevention.

5. In order to ensure the safety of transfusion (transfusion) of donor blood and (or) its components:

a) transfusion (transfusion) of donor blood and (or) its components to several recipients from one container is prohibited;

b) transfusion (transfusion) of donor blood and (or) its components that has not been examined for markers of human immunodeficiency viruses, hepatitis B and C, the causative agent of syphilis, ABO blood group and Rh status is prohibited;

c) when transfusion (transfusion) of donor blood and (or) its components that have not been subjected to leukoreduction, disposable devices with a built-in microfilter are used, ensuring the removal of microaggregates with a diameter of more than 30 microns;

d) in case of multiple transfusions in persons with a burdened transfusion history, transfusion (transfusion) of erythrocyte-containing components, fresh frozen plasma and platelets is carried out using leukocyte filters.

6. After each transfusion (transfusion) of donor blood and (or) its components, its effectiveness is assessed. The criteria for the effectiveness of transfusion (transfusion) of donor blood and (or) its components are clinical data and laboratory results.

III. Rules for transfusion (transfusion) of donor blood and (or) its components

7. Upon admission of a recipient in need of a transfusion (transfusion) of donor blood and (or) its components, an initial study of the group and Rh affiliation of the recipient’s blood is carried out by a doctor from the clinical department of the organization who has been trained in transfusiology.

8. Confirmatory determination of blood group according to the ABO system and Rh, as well as phenotyping for antigens C, c, E, e, Cw, K, k and determination of anti-erythrocyte antibodies in the recipient is carried out in a clinical diagnostic laboratory.

The results of confirmatory determination of the ABO blood group and Rh, as well as phenotyping for antigens C, c, E, e, Cw, K, k and determination of anti-erythrocyte antibodies in the recipient are included in the medical documentation reflecting the recipient’s health status.

It is prohibited to transfer data on blood group and Rh status to medical documentation reflecting the health status of the recipient, the organization in which it is planned to carry out a transfusion (transfusion) of donor blood and (or) its components to the recipient, from medical documentation reflecting the health status of the recipient, other organizations where the recipient previously received medical care, including transfusion (transfusion) of donor blood and (or) its components, or was carried out medical examination.

9. Recipients with a history of post-transfusion complications, pregnancy, birth of children with hemolytic disease of the newborn, as well as recipients with alloimmune antibodies, undergo individual selection blood components in a clinical diagnostic laboratory.

10. On the day of transfusion (transfusion) of donor blood and (or) its components (no earlier than 24 hours before the transfusion (transfusion) of donor blood and (or) its components), blood is taken from the recipient’s vein: 2-3 ml per a test tube with an anticoagulant and 3-5 ml into a test tube without an anticoagulant for mandatory control studies and compatibility tests. The tubes must be labeled indicating the surname and initials of the recipient, the number of medical documentation reflecting the health status of the recipient, the name of the department where the transfusion (transfusion) of donor blood and (or) its components is carried out, group and Rh affiliation, the date of taking the blood sample.

11. Before starting a transfusion (transfusion) of donor blood and (or) its components, the doctor conducting the transfusion (transfusion) of donor blood and (or) its components must ensure their suitability for transfusion, taking into account the results of laboratory control, check the tightness of the container and the correctness certification, conduct a macroscopic examination of the container with blood and (or) its components.

12. When transfusing erythrocyte-containing components of donor blood, the doctor conducting the transfusion (transfusion) of erythrocyte-containing components conducts a control check of the blood group of the donor and recipient according to the ABO system, as well as tests for individual compatibility.

If the results of the primary and confirmatory determination of the blood group according to the ABO system, Rhesus, the phenotype of the donor and recipient coincide, as well as information about the absence of anti-erythrocyte antibodies in the recipient, the doctor conducting the transfusion (transfusion) of erythrocyte-containing components, before the transfusion, during a control check, determines the recipient's group and blood donor according to the ABO system and performs only one test for individual compatibility - on the plane at room temperature.

13. After conducting a control check of the blood group of the recipient and the donor according to the ABO system, as well as tests for individual compatibility, the doctor conducting the transfusion (transfusion) of donor blood and (or) its components performs a biological test.

14. A biological test is carried out regardless of the type and volume of donor blood and (or) its components and the rate of their administration, as well as in the case of individually selected erythrocyte-containing components in a clinical diagnostic laboratory or phenotyped ones. If it is necessary to transfuse several doses of donor blood components, a biological test is performed before the start of transfusion of each new dose of a donor blood component.

15. A biological test is carried out through a single transfusion of 10 ml of donor blood and (or) its components at a rate of 2-3 ml (40-60 drops) per minute for 3-3.5 minutes. After this, the transfusion stops and the recipient’s condition is monitored for 3 minutes, his pulse, number of respiratory movements, blood pressure are monitored, general state, skin color, body temperature is measured. This procedure repeated twice. When appearing during this period clinical symptoms: chills, lower back pain, feelings of heat and tightness in the chest, headache, nausea or vomiting, the doctor performing the transfusion (transfusion) of donor blood and (or) its components immediately stops the transfusion (transfusion) of donor blood and (or) its components components.

16. A biological test is performed, including during emergency transfusion (transfusion) of donor blood and (or) its components. During transfusion (transfusion) of donor blood and (or) its components, continued transfusion of saline solutions is urgently allowed.

17. When transfusion (transfusion) of donor blood and (or) its components under anesthesia, signs of a reaction or complication are increased bleeding in the surgical wound for no apparent reason, decreased blood pressure, increased heart rate, change in urine color during catheterization Bladder. If any of the above cases occurs, transfusion (transfusion) of donor blood and (or) its components is stopped.

A surgeon and an anesthesiologist-resuscitator, together with a transfusiologist, determine the cause of the reaction or complication. If a connection between a reaction or complication and a transfusion (transfusion) of donor blood and (or) its components is established, the transfusion (transfusion) of donor blood and (or) its components is stopped.

The issue of further transfusion (transfusion) of donor blood and (or) its components is decided by a council of doctors specified in this paragraph, taking into account clinical and laboratory data.

18. A doctor performing a transfusion (transfusion) of donor blood and (or) its components is obliged to register the transfusion in the register of blood transfusion and its components, as well as make an entry in the medical documentation of the recipient, reflecting the state of his health, with the obligatory indication of:

a) medical indications for transfusion (transfusion) of donor blood and (or) its components;

b) passport data from the label of the donor container, containing information about the donor code, blood group according to the ABO system and Rhesus, donor phenotype, as well as the container number, date of procurement, name of the organization (after the end of the transfusion (transfusion) of donor blood and (or ) its components label or a copy of the label from the container with the blood component, obtained using photographic or office equipment, is pasted into the medical documentation reflecting the health status of the recipient);

c) the result of a control check of the recipient’s blood group according to the ABO system, indicating information (name, manufacturer, series, expiration date) about the reagents (reagents) used;

d) the result of a control check of the donor blood group or its erythrocyte-containing components taken from the container according to the ABO system;

e) the result of tests for individual compatibility of the blood of the donor and recipient;

f) the result of a biological test.

An entry in the medical documentation reflecting the health status of the recipient is drawn up with a protocol for the transfusion (transfusion) of donor blood and (or) its components according to the recommended sample given in Appendix No. 1 to these Rules.

19. After a transfusion (transfusion) of donor blood and (or) its components, the recipient must remain in bed for 2 hours. The attending or duty doctor monitors his body temperature, blood pressure, pulse, diuresis, urine color and records these indicators in the recipient’s medical record. The next day after transfusion (transfusion) of donor blood and (or) its components, a clinical analysis of blood and urine is performed.

20. When carrying out a transfusion (transfusion) of donor blood and (or) its components in an outpatient setting, the recipient after the end of the transfusion (transfusion) of donor blood and (or) its components must be under the supervision of a doctor conducting the transfusion (transfusion) of donor blood and (or) ) of its components, at least three hours. Only in the absence of any reactions, stable blood pressure and pulse, and normal diuresis can the recipient be released from the organization.

21. After the end of the transfusion (transfusion) of donor blood and (or) its components, the donor container with the remaining donor blood and (or) its components (5 ml), as well as the test tube with the recipient’s blood used for individual compatibility tests, are subject to mandatory preserved for 48 hours at a temperature of 2-6 C in refrigeration equipment.

IV. Rules for research during transfusion (transfusion) of donor blood and (or) its components

22. The following studies are carried out in adult recipients:

a) primary and confirmatory determination of blood group according to the ABO system and Rh (antigen D) (carried out using reagents containing anti-A, anti-B and anti-D antibodies, respectively);

b) upon receipt of results that raise doubts (weak reactions) during a confirmatory study, determination of the blood group according to the ABO system is carried out using reagents containing anti-A and anti-B antibodies and standard red blood cells O(I), A(II) ) and B(III) except for the cases provided for in subparagraph “a” of paragraph 68 of these Rules, and the determination of Rh (antigen D) - using reagents containing anti-D antibodies of a different series;

c) determination of erythrocyte antigens C, c, E, e, Cw, K and k using reagents containing appropriate antibodies (in children under 18 years of age, women of childbearing age and pregnant women, recipients with a history of transfusion, having antibodies to erythrocyte antigens , recipients in need of multiple (including repeated) transfusions (transfusions) of donor blood and (or) its components (cardiac surgery, transplantology, orthopedics, oncology, oncohematology, traumatology, hematology);

d) screening of anti-erythrocyte antibodies using at least three samples of erythrocytes, which together contain antigens C, c, E, e, Cw, K, k, Fy a, Fy b, Lu a, Lu b, Jk a and Jk b .

23. If anti-erythrocyte antibodies are detected in the recipient, the following is carried out:

a) typing of erythrocytes according to antigens of the Rhesus, Kell and other systems using antibodies of appropriate specificity;

b) identification of anti-erythrocyte antibodies with a panel of typed erythrocytes containing at least 10 cell samples;

c) individual selection of blood and red blood cell donors with an indirect antiglobulin test or its modification with similar sensitivity.

24. When conducting immunoserological studies, only equipment, reagents and research methods approved for use on the territory of the Russian Federation are used.

V. Rules and methods of research for transfusion (transfusion) of canned donor blood and erythrocyte-containing components

25. During a planned transfusion (transfusion) of canned donor blood and erythrocyte-containing components, the doctor conducting the transfusion (transfusion) of donor blood and (or) its components is obliged to:

a) according to the medical documentation reflecting the health status of the recipient and the data on the label of the container of preserved donor blood or erythrocyte-containing components, make sure that the phenotypes of the recipient and the donor are compatible. For heterozygous recipients (Cc, Ee, Kk), both hetero- and homozygous donors are considered compatible: Cc, CC and CC; Her, HER and hers; Kk, КК and кk respectively. For homozygous recipients (CC, EE, KK), only homozygous donors are compatible. The selection of blood donors and (or) its components compatible with the recipient for Rh-Hr and Kk, during transfusion (transfusion) of erythrocyte-containing components, is carried out in accordance with the table given in Appendix No. 2 to these Rules;

b) recheck the recipient’s blood group according to the ABO system;

c) determine the donor’s blood group in the container using the ABO system (the donor’s Rh status is determined by the designation on the container);

d) conduct a test for individual compatibility of the blood of the recipient and the donor using the following methods:

26. In case of emergency transfusion (transfusion) of canned donor blood and erythrocyte-containing components, the doctor conducting the transfusion (transfusion) of donor blood and (or) its components is obliged to:

a) determine the recipient’s blood group according to the ABO system and its Rh status;

b) determine the donor’s blood group in the container using the ABO system (the donor’s Rh status is determined by the designation on the container);

c) conduct a test for individual compatibility of the blood of the recipient and the donor using the following methods:

on a plane at room temperature;

one of three tests (indirect Coombs reaction or its analogues, conglutination reaction with 10% gelatin or conglutination reaction with 33% polyglucin);

27. If the recipient has anti-erythrocyte antibodies, the selection of donor blood components is carried out in a clinical diagnostic laboratory. If the red blood cell mass or suspension is selected individually for the recipient in a clinical diagnostic laboratory, the doctor conducting the transfusion (transfusion) of donor blood and (or) its components, before the transfusion, determines the blood group of the recipient and the donor and conducts only one test for individual compatibility on a plane at room room. temperature and biological sample.

VI. Rules and methods of research for transfusion (transfusion) of fresh frozen plasma and platelet concentrate (platelet)

28. When transfusing fresh frozen plasma, the doctor conducting the transfusion (transfusion) of donor blood and (or) its components is obliged to determine the recipient’s blood group according to the ABO system; when transfusing platelets - the blood group according to the ABO system and the Rhesus status of the recipient.

The doctor performing the transfusion (transfusion) of platelets determines the group and Rh affiliation of the donor according to the markings on the container with the blood component, while tests for individual compatibility are not carried out.

29. When transfusing fresh frozen plasma and platelets, erythrocyte antigens C, c, E, e, Cw, K and k are not taken into account.

VII. Rules for transfusion of canned donor blood and erythrocyte-containing components

30. The medical indication for transfusion (transfusion) of donor blood and erythrocyte-containing components in acute anemia due to massive blood loss is a loss of 25-30% of circulating blood volume, accompanied by a decrease in hemoglobin levels below 70-80 g/l and hematocrit below 25% and the occurrence of circulatory disorders .

31. When chronic anemia transfusion (transfusion) of donor blood or erythrocyte-containing components are prescribed only to correct the most important symptoms caused by anemia and not amenable to basic pathogenetic therapy.

32. Donor blood and erythrocyte-containing components are transfused only from the ABO group and the Rh and Kell affiliation that the recipient has. If there are medical indications, the selection of a donor-recipient pair is carried out taking into account antigens C, c, E, e, Cw, K and k.

During planned transfusion (transfusion) of preserved blood and erythrocyte-containing components, to prevent reactions and complications, as well as alloimmunization of recipients, compatible transfusions (transfusions) are carried out using donor erythrocytes phenotyped for 10 antigens (A, B, D, C, c, E, e , C w , K and k) for the groups of recipients specified in subparagraph “c” of paragraph 22 of these Rules.

33. According to vital indications, in emergency cases, recipients with blood group A(II) or B(III) in the absence of single blood or erythrocyte-containing components can be transfused with Rh-negative erythrocyte-containing components O(I), and AB(IV) recipients can be transfused Rh-negative erythrocyte-containing B(III) components, regardless of the Rh status of the recipients.

In emergency cases, if it is impossible to determine the blood group according to vital indications, the recipient is transfused with erythrocyte-containing components of the O(I) group Rh-negative in an amount of no more than 500 ml, regardless of the group and Rh affiliation of the recipient.

If it is impossible to determine antigens C, c, E, e, Cw, K and k, the recipient is transfused with erythrocyte-containing components compatible with the ABO blood group and Rh antigen D.

34. Transfusion (transfusion) of red blood cells depleted of leukocytes and platelets is carried out to prevent alloimmunization with leukocyte antigens and refractoriness to repeated platelet transfusions.

35. When transfusion (transfusion) of donor blood and erythrocyte-containing components, the criteria for the effectiveness of their transfusion are: clinical data, indicators of oxygen transport, quantitative increase in hemoglobin level.

36. Transfusion (transfusion) of donor blood and (or) erythrocyte-containing components should be started no later than two hours after removing the donor blood and (or) erythrocyte-containing components from refrigeration equipment and warming to 37 C.

Transfusion (transfusion) of erythrocyte-containing components of donor blood is carried out taking into account the group properties of the donor and recipient according to the ABO, Rh and Kell systems. It is prohibited to introduce any medications or solutions into the container with red blood cells other than 0.9% sterile sodium chloride solution.

37. For the prevention of graft-versus-host disease in recipients receiving immunosuppressive therapy, children with severe immune deficiency syndrome, newborns with low body weight, with intrauterine transfusions, as well as with related (father, mother, siblings) transfusion of components Before transfusion, donor blood erythrocyte-containing components are subjected to X-ray or gamma irradiation in a dose of 25 to 50 Gray (no later than 14 days from the date of receipt).

38. Storage of irradiated erythrocyte-containing components, with the exception of erythrocyte suspension (mass), depleted of leukocytes, before transfusion to newborns and children early age should not exceed 48 hours.

39. Storage of irradiated erythrocyte-containing components (erythrocyte suspension, erythrocyte mass, washed erythrocytes) before transfusion to an adult recipient should not exceed 28 days from the date of procurement of erythrocyte-containing components.

40. To carry out transfusion (transfusion) of donor blood and erythrocyte-containing components to alloimmunized recipients, the following is carried out:

a) if a recipient has extra-agglutinins anti-A1, he is transfused with erythrocyte-containing components that do not contain the A1 antigen, recipient A2(II) is transfused with erythrocyte-containing components A2(II) or O(I), and recipient A2B(IV) is transfused with erythrocyte-containing components B(III);

b) recipients with identified anti-erythrocyte antibodies or those recipients in whom antibodies were detected during a previous study are transfused with erythrocyte-containing components that do not contain antigens of the corresponding specificity;

c) if the recipient has nonspecifically reacting anti-erythrocyte antibodies (panagglutinins) or antibodies with unknown specificity, he is transfused with individually selected erythrocyte-containing components that do not react in serological reactions with the recipient’s serum;

d) for alloimmunized recipients, individual selection of blood and erythrocyte-containing blood components is carried out in a clinical diagnostic laboratory;

e) for recipients immunized with leukocyte system antigens (HLA), donors are selected according to the HLA system.

VIII. Rules for transfusion (transfusion) of fresh frozen plasma

41. The transfused fresh frozen plasma of the donor must be of the same ABO group as that of the recipient. Diversity according to the Rh system is not taken into account. When transfusing large volumes of fresh frozen plasma (more than 1 liter), the matching of the donor and recipient for antigen D must be taken into account.

42. In emergency cases, in the absence of single-group fresh frozen plasma, transfusion of fresh frozen plasma of group AB(IV) to a recipient with any blood group is allowed.

43. Medical indications for prescribing transfusions of fresh frozen plasma are:

a) acute disseminated intravascular coagulation syndrome, complicating the course of shocks of various origins(septic, hemorrhagic, hemolytic) or caused by other reasons (amniotic fluid embolism, crash syndrome, severe trauma with crushing tissue, extensive surgical operations, especially on the lungs, blood vessels, brain, prostate), massive transfusion syndrome;

b) acute massive blood loss (more than 30% of the circulating blood volume) with the development of hemorrhagic shock and disseminated intravascular coagulation syndrome;

c) liver diseases, accompanied by a decrease in the production of plasma coagulation factors and, accordingly, their deficiency in the circulation (acute fulminant hepatitis, cirrhosis of the liver);

d) overdose of anticoagulants indirect action(dicoumarin and others);

e) therapeutic plasmapheresis in patients with thrombotic thrombocytopenic purpura (Moschkowitz disease), severe poisoning, sepsis, acute disseminated intravascular coagulation syndrome;

f) coagulopathy caused by a deficiency of plasma physiological anticoagulants.

44. Transfusion (transfusion) of fresh frozen plasma is performed by stream or drip. In acute DIC with severe hemorrhagic syndrome transfusion (transfusion) of fresh frozen plasma is performed only as a jet. When transfusion (transfusion) of fresh frozen plasma, it is necessary to perform a biological test (similar to that carried out during transfusion (transfusion) of donor blood and erythrocyte-containing components).

45. For bleeding associated with DIC, at least 1000 ml of fresh frozen plasma is administered, while hemodynamic parameters and central venous pressure are monitored.

In case of acute massive blood loss (more than 30% of the circulating blood volume, for adults - more than 1500 ml), accompanied by the development of acute disseminated intravascular coagulation syndrome, the amount of transfused fresh frozen plasma should be at least 25-30% of the total volume of transfused blood and (or) its components, prescribed to replenish blood loss (at least 800-1000 ml).

In severe liver diseases accompanied by sharp decline level of plasma coagulation factors and developed bleeding or bleeding during surgery, transfusion (transfusion) of fresh frozen plasma is carried out at the rate of 15 ml/kg of the recipient’s body weight, followed (after 4-8 hours by repeated transfusion of fresh frozen plasma in a smaller volume (5-10 ml/ kg).

46. Immediately before transfusion (transfusion), fresh frozen plasma is thawed at a temperature of 37 C using specially designed thawing equipment.

47. Transfusion (transfusion) of fresh frozen plasma should begin within 1 hour after it is thawed and last no more than 4 hours. If there is no need to use thawed plasma, it is stored in refrigeration equipment at a temperature of 2-6 C for 24 hours.

48. To increase the safety of blood transfusions, reduce the risk of transferring viruses that cause infectious diseases, prevent the development of reactions and complications arising in connection with the transfusion (transfusion) of donor blood and (or) its components, use fresh frozen plasma, quarantined (or) fresh frozen plasma virus ( pathogen) inactivated.

IX. Rules for transfusion (transfusion) of cryoprecipitate

49. The main medical indications for transfusion (transfusion) of cryoprecipitate are hemophilia A and hypofibrinogenemia.

50. The need for transfusion (transfusion) of cryoprecipitate is calculated according to the following rules:

Body weight (kg) x 70 ml = circulating blood volume bcc (ml).

BCC (ml) x (1.0 - hematocrit) = volume of circulating plasma BCC (ml).

VCP (ml) x (required level of factor VIII - available level of factor VIII) = required amount of factor VIII for transfusion (in units).

Required amount of factor VIII (in units): 100 units. = number of doses of cryoprecipitate required for a single transfusion. For hemostasis, the level of factor VIII is maintained up to 50% during operations and up to 30% in the postoperative period. One unit of factor VIII corresponds to 1 ml of fresh frozen plasma.

51. Cryoprecipitate obtained from one unit of blood must contain at least 70 units. factor VIII. The donor's cryoprecipitate must be of the same ABO group as that of the recipient.

X. Rules for transfusion (transfusion) of platelet concentrate (platelets)

52. The therapeutic dose of platelets is calculated according to the following rules:

50-70 x 10 9 platelets for every 10 kg of the recipient’s body weight or 200-250 x 10 9 platelets per 1 m 2 of the recipient’s body surface.

53. Specific indications for platelet transfusion are determined by the attending physician based on an analysis of the clinical picture and causes of thrombocytopenia, the degree of its severity and the location of bleeding, the volume and severity of the upcoming operation.

54. Platelet transfusion is not performed in case of thrombocytopenia of immune origin, except in cases of vital indications in case of developed bleeding.

55. In case of thrombocytopathies, transfusion of platelets is carried out in urgent situations - during massive bleeding, operations, childbirth.

56. Clinical criteria for the effectiveness of platelet transfusion are the cessation of spontaneous bleeding, the absence of fresh hemorrhages on the skin and visible mucous membranes. Laboratory signs of the effectiveness of platelet transfusion are an increase in the number of circulating platelets 1 hour after the end of the transfusion (transfusion) and exceeding their initial number after 18-24 hours.

57. In case of splenomegaly, the number of transfused platelets should be increased compared to usual by 40-60%, with infectious complications- on average by 20%, with severe DIC, massive blood loss, and alloimmunization phenomena - by 60-80%. The required therapeutic dose of platelets is transfused in two doses with an interval of 10-12 hours.

58. Preventive platelet transfusions are mandatory if recipients have agranulocytosis and disseminated intravascular coagulation syndrome complicated by sepsis.

59. In emergency cases, in the absence of platelets of the same group, transfusion of platelets of O(I) group to recipients of other blood groups is allowed.

60. To prevent graft-versus-host disease, platelets are irradiated before transfusion at a dose of 25 to 50 Gray.

61. To increase the safety of platelet transfusions, platelets that are depleted of leukocytes, virus (pathogen), and inactivated are transfused.

XI. Rules for transfusion (transfusion) of granulocyte concentrate (granulocytes) obtained by apheresis

62. An adult therapeutic dose of apheresis granulocytes contains 1.5-3.0 x 10 8 granulocytes per 1 kg of recipient body weight.

63. Apheresis granulocytes are irradiated with a dose of 25 to 50 Gray before transfusion.

64. Apheresis granulocytes are transfused immediately after they are received.

65. The main medical indications for prescribing granulocyte transfusion are:

a) a decrease in the absolute number of granulocytes in the recipient to less than 0.5 x 10 9 / l in the presence of uncontrolled antibacterial therapy infections;

b) sepsis of newborns, uncontrolled by antibacterial therapy.

Granulocytes must be compatible with ABO and Rh antigens.

66. The criteria for assessing the effectiveness of transfusion (transfusion) of granulocytes is the positive dynamics of the clinical picture of the disease: decrease in body temperature, decrease in intoxication, stabilization of previously impaired organ functions.

XII. Rules for transfusion (transfusion) of donor blood and (or) its components to children

67. Upon admission to the organization of a child in need of transfusion (transfusion) of donor blood and (or) its components, an initial study of the group and Rh affiliation of the child’s blood is carried out medical worker in accordance with the requirements of paragraph 7 of these Rules.

68. It is mandatory for a child in need of transfusion (transfusion) of components of donor blood and (or) its components (after the initial determination of group and Rh affiliation) to be carried out in a clinical diagnostic laboratory: confirming determination of the ABO blood group and Rh affiliation , phenotyping for other erythrocyte antigens C, c, E, e, Cw, K and k, as well as detection of anti-erythrocyte antibodies.

These studies are carried out in accordance with the following requirements:

a) blood group determination according to the ABO system is carried out using reagents containing anti-A and anti-B antibodies. In children over 4 months of age, the blood type is determined, including by the cross method, using anti-A, anti-B reagents and standard erythrocytes O(I), A(II) and B(III);

b) determination of Rh (D antigen) is carried out using reagents containing anti-D antibodies;

c) determination of erythrocyte antigens C, c, E, e, Cw, K and k is carried out using reagents containing the corresponding antibodies;

d) screening of anti-erythrocyte antibodies is carried out by an indirect antiglobulin test, which detects clinically significant antibodies, using a panel of standard red blood cells, consisting of at least 3 cell samples containing in total clinically significant antigens in accordance with subparagraph “d” of paragraph 22 of these Rules. The use of a mixture (pool) of red blood cell samples for screening of anti-erythrocyte alloantibodies is not allowed.

69. If anti-erythrocyte antibodies are detected in a child, individual selection of donors of erythrocyte-containing components is carried out with an indirect antiglobulin test or its modification with similar sensitivity.

70. If there is a need for emergency transfusion (transfusion) of donor blood and (or) its components in the inpatient setting of an organization in the absence of round-the-clock immunoserological support, the doctor conducting the transfusion (transfusion) of donor blood is responsible for determining the blood group according to the ABO system and the child’s Rh status. and (or) its components.

71. The studies specified in paragraph 68 of these Rules are carried out using immunoserological methods: manually (applying reagents and blood samples to a flat surface or in a test tube) and using laboratory equipment (adding reagents and blood samples to microplates, columns with gel or glass microspheres and other research methods approved for use for these purposes on the territory of the Russian Federation).

72. For transfusion (transfusion) of donor blood of erythrocyte-containing components to alloimmunized recipients childhood the following rules apply:

a) if anti-A1 extraagglutinins are detected in a pediatric recipient, he is transfused with erythrocyte-containing components that do not contain the A1 antigen, fresh frozen plasma - one group. A pediatric recipient with A2(II) is transfused with washed red blood cells O(I) and fresh frozen plasma A(II), a pediatric recipient with A2B(IV) is transfused with washed red blood cells O(I) or B(III) and fresh frozen plasma AB(IV) ;

b) if a child recipient has nonspecifically reacting anti-erythrocyte antibodies (panagglutinins), he is transfused with erythrocyte-containing components O(I) Rh-negative, which do not react in serological reactions with the recipient’s serum;

c) for alloimmunized pediatric recipients, individual selection of donor blood and erythrocyte-containing components is carried out in a clinical diagnostic laboratory;

d) for HLA-immunized pediatric recipients, platelet donors are selected according to the HLA system.

73. In newborns, on the day of transfusion (transfusion) of donor blood and (or) its components (not earlier than 24 hours before the transfusion (transfusion), no more than 1.5 ml of blood is taken from a vein; in children infancy and older, 1.5-3.0 ml of blood is drawn from a vein into a test tube without an anticoagulant for mandatory control studies and compatibility tests. The tube must be labeled with the surname and initials of the recipient of childhood (in the case of newborns in the first hours of life, the surname and initials of the mother are indicated), the number of medical documentation reflecting the health status of the recipient of childhood, the name of the department, group and Rh affiliation, the date of taking the blood sample .

74. During a planned transfusion of erythrocyte-containing components, the doctor conducting the transfusion (transfusion) of donor blood and (or) its components is obliged to:

a) according to the medical documentation reflecting the health status of the recipient in childhood, and the data on the container label, compare the phenotype of the donor and recipient by erythrocyte antigens in order to establish their compatibility. It is prohibited to administer to a patient an erythrocyte antigen that is not present in his phenotype;

b) recheck the blood group of the pediatric recipient using the ABO system;

c) determine the donor’s blood group according to the ABO system (the donor’s Rh status is determined by the designation on the container);

d) conduct a test for individual compatibility of the blood of a child recipient and a donor using the following methods: on a plane at room temperature, one of three tests (indirect Coombs reaction or its analogues, conglutination reaction with 10% gelatin or conglutination reaction with 33% polyglucin). If donor blood or an erythrocyte-containing component is individually selected in a clinical diagnostic laboratory, this test is not performed;

d) conduct a biological test.

75. In case of emergency transfusion (transfusion) of erythrocyte-containing components to a pediatric recipient, the doctor conducting the transfusion (transfusion) of donor blood and (or) its components is obliged to:

a) determine the blood group of a child recipient according to the ABO system and his Rh status;

b) determine the donor’s blood group according to the ABO system (the donor’s Rh status is determined by the designation on the container);

c) conduct a test for individual compatibility of the blood of a donor and a pediatric recipient using the following methods: on a plane at room temperature, one of three tests (indirect Coombs reaction or its analogues, conglutination reaction with 10% gelatin or conglutination reaction with 33% polyglucin);

d) conduct a biological test.

If it is impossible to determine the phenotype of a childhood recipient based on erythrocyte antigens C, c, E, e, Cw, K and k, it is allowed to ignore these antigens when transfusing erythrocyte-containing components.

76. A biological test during transfusion (transfusion) of donor blood and (or) its components into a pediatric recipient is mandatory.

The procedure for conducting a biological test:

a) a biological test consists of a three-time administration of donor blood and (or) its components, followed by monitoring the condition of a child recipient for 3-5 minutes with the blood transfusion system clamped;

b) the volume of administered donor blood and (or) its components for children under 1 year is 1-2 ml, from 1 year to 10 years - 3-5 ml, after 10 years - 5-10 ml;

c) in the absence of reactions and complications, transfusion (transfusion) of donor blood and (or) its components continues under constant supervision of the doctor conducting the transfusion (transfusion) of donor blood and (or) its components.

Emergency transfusion (transfusion) of donor blood and (or) its components to a pediatric recipient is also carried out using a biological sample.

A biological test, as well as a test for individual compatibility, is mandatory in cases where a child recipient is transfused with donor blood or erythrocyte-containing components individually selected in the laboratory or phenotyped.

77. The criterion for assessing transfusion (transfusion) of donor blood and erythrocyte-containing components in children is comprehensive assessment clinical condition child and laboratory data.

For children under 1 year of age in critical condition, transfusion (transfusion) of donor blood and (or) erythrocyte-containing components is carried out when the hemoglobin level is less than 85 g/l. For older children, transfusion (transfusion) of donor blood and (or) erythrocyte-containing components - with a hemoglobin level of less than 70 g/l.

78. When transfusion (transfusion) of donor blood and (or) erythrocyte-containing components to newborns:

a) erythrocyte-containing components depleted of leukocytes are transfused (erythrocyte suspension, erythrocyte mass, washed erythrocytes, thawed and washed erythrocytes);

b) transfusion (transfusion) to newborns is carried out under the control of the volume of transfused components of donor blood and the volume of blood taken for testing;

c) the volume of transfusion (transfusion) is determined at the rate of 10-15 ml per 1 kg of body weight;

d) for transfusion (transfusion), erythrocyte-containing components are used with a shelf life of no more than 10 days from the date of preparation;

e) the rate of transfusion (transfusion) of donor blood and (or) erythrocyte-containing components is 5 ml per 1 kg of body weight per hour under mandatory monitoring of hemodynamics, respiration and renal function;

f) components of donor blood are pre-warmed to a temperature of 36-37 C;

g) when selecting donor blood components for transfusion, it is taken into account that the mother is an undesirable donor of fresh frozen plasma for the newborn, since the mother’s plasma may contain alloimmune antibodies against the newborn’s erythrocytes, and the father is an undesirable donor of erythrocyte-containing components, since it is against the father’s antigens in the newborn’s blood there may be antibodies that have penetrated from the mother’s bloodstream through the placenta;

h) the most preferable is to transfuse children with a cytomegalovirus-negative erythrocyte-containing component.

79. Selection of donor blood and (or) its components for transfusion (transfusion) to children under four months of age with hemolytic disease newborns under the ABO system or suspected hemolytic disease of newborns is carried out in accordance with the table given in Appendix No. 3 to these Rules.

In the case of transfusion (transfusion) of erythrocyte-containing components that differ in the ABO system from the child’s blood group, washed or thawed erythrocytes are used that do not contain plasma with agglutinins and, taking into account the recipient’s phenotype.

80. For intrauterine transfusion (transfusion) of donor blood and (or) its components, erythrocyte-containing components O(I) of the Rhesus D-negative group are used with a shelf life of no more than 5 days from the moment of procurement of the component.

81.3 Blood transfusions are carried out to correct anemia and hyperbilirubinemia in severe forms of hemolytic disease of the newborn or in hyperbilirubinemia of any etiology: disseminated intravascular coagulation syndrome, sepsis and other life-threatening diseases of the child.

82. For replacement blood transfusion, erythrocyte-containing components are used with a shelf life of no more than 5 days from the moment the component is prepared.

83. Donor blood and (or) its components are transfused at the rate of 160-170 ml/kg body weight for a full-term baby and 170-180 ml/kg for a premature baby.

84. The selection of donor blood components depending on the specificity of alloantibodies is carried out as follows:

a) for hemolytic disease of newborns caused by alloimmunization to the D antigen of the Rh system, single-group Rh-negative erythrocyte-containing components and single-group Rh-negative fresh frozen plasma are used;

b) in case of incompatibility with ABO system antigens, washed erythrocytes or erythrocyte suspension and fresh frozen plasma are transfused in accordance with the table given in Appendix No. 3 to these Rules, corresponding to the Rh affiliation and phenotype of the child;

c) in case of simultaneous incompatibility of antigens of the ABO and Rhesus systems, washed erythrocytes or an erythrocyte suspension of O(I) group Rh-negative and fresh frozen AB(IV) Rh-negative plasma are transfused;

d) in case of hemolytic disease of newborns caused by alloimmunization to other rare erythrocyte antigens, individual selection of donor blood is carried out.

85. Fresh frozen plasma is transfused into a pediatric recipient in order to eliminate the deficiency of plasma coagulation factors, in case of coagulopathies, in case of acute massive blood loss (more than 20% of the circulating blood volume) and when performing therapeutic plasmapheresis.

Transfusion of virus (pathogen) inactivated fresh frozen plasma to pediatric recipients undergoing phototherapy is not permitted.

XIII. Autodonation of blood components and autohemotransfusion

86. When carrying out autodonation, the following methods are used:

a) preoperative procurement of autologous blood components (autoplasma and autoerythrocytes) from a dose of preserved autologous blood or by apheresis;

b) preoperative normovolemic or hypervolemic hemodilution, which involves collecting 1-2 units of blood (600-800 ml) immediately before surgery or the start of anesthesia with mandatory replenishment of temporary blood loss with saline and colloid solutions while maintaining normovolemia or hypervolemia;

c) intraoperative hardware reinfusion of blood, which involves the collection of spilled blood from the surgical wound and cavities during surgery with the release of erythrocytes from it, followed by washing, concentration and subsequent return of autoerythrocytes to the recipient’s blood stream;

d) transfusion (transfusion) of drainage blood obtained under sterile conditions during postoperative drainage of body cavities, using specialized equipment and (or) materials.

Each of these methods can be used separately or in combination various combinations. Simultaneous or sequential transfusion (transfusion) of autologous blood components with allogeneic ones is allowed.

87. When performing autotransfusion of blood and its components:

a) the patient gives informed consent for the procurement of autologous blood or its components, which is recorded in medical documentation reflecting the recipient’s health status;

b) preoperative collection of autologous blood or its components is carried out at a hemoglobin level of not lower than 110 g/l, hematocrit - not lower than 33%;

c) the frequency of autologous donations of blood and (or) its components before surgery is determined by the attending physician together with the transfusiologist. The last autodonation is carried out no less than 3 days before the start of surgery;

d) with normovolemic hemodilution, the post-hemodilution hemoglobin level should not be lower than 90-100 g/l, and the hematocrit level should not be less than 28%; with hypervolemic hemodilution, the hematocrit level is maintained within 23-25%;

e) the interval between exfusion and reinfusion during hemodilution should not be more than 6 hours. Otherwise, containers with blood are placed in refrigeration equipment at a temperature of 4-6 C;

f) intraoperative reinfusion of blood collected during surgery from the surgical wound and cavities of shed blood, and reinfusion of drainage blood is not carried out if it is bacterially contaminated;

g) before transfusion (transfusion) of autologous blood and its components, the doctor conducting the transfusion (transfusion) of autologous blood and (or) its components performs a test for their compatibility with the recipient and a biological test, as in the case of using allogeneic blood components.

XIV. Post-transfusion reactions and complications

88. Identification and recording of reactions and complications that arose in recipients in connection with the transfusion (transfusion) of donor blood and (or) its components are carried out both in the current period of time after the transfusion (transfusion) of donor blood and (or) its components, and and after an indefinite period of time - several months, and with repeated transfusion - years after it was carried out.

The main types of reactions and complications that arise in recipients in connection with the transfusion (transfusion) of donor blood and (or) its components are indicated in the table given in Appendix No. 4 to these Rules.

89. When identifying reactions and complications that have arisen in recipients in connection with the transfusion (transfusion) of donor blood and (or) its components, the head of the transfusion department or transfusiology room of the organization, or a transfusiologist appointed by order of the head of the organization:

a) organizes and ensures the provision of emergency medical care to the recipient;

b) immediately sends to the head of the organization that procured and supplied the donor blood and (or) its components, a notification of reactions and complications that have arisen in recipients in connection with the transfusion (transfusion) of donor blood and (or) its components, according to the recommended sample given in Appendix No. 5 to these Rules;

c) transfers the remaining part of the transfused donor blood and (or) its components, as well as samples of the recipient’s blood taken before and after the transfusion (transfusion) of donor blood and (or) its components, to the organization that prepared and supplied the donor blood and (or) ) its Rh affiliation of donor blood and (or) its components, as well as for testing for the presence of anti-erythrocyte antibodies and markers of blood-borne infections;

d) analyzes the actions of medical workers of the organization in which the transfusion (transfusion) of donor blood and (or) its components was carried out, as a result of which a reaction or complication occurred.

XV. Formation of a supply of donor blood and (or) its components

90. The formation of a supply of donor blood and (or) its components is carried out in accordance with the procedure established in accordance with Part 6 of Article 16 of the Federal Law of July 20, 2012 N 125-FZ “On the Donation of Blood and Its Components”.

Regulations on the Ministry of Health of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 19, 2012 N 608 (Collected Legislation of the Russian Federation, 2012, N 26, Art. 3526; 2013, N 16, Art. 1970; N 20, Art. 2477 ; N 22, Art. 2812; N 33, Art. 4386; N 45, Art. 5822; 2014, N 12, Art. 1296), I order:

1. Approve the list of medicines for medical use, subject to subject-quantitative recording, in accordance with the appendix.

2. To recognize as invalid:

Minister
IN AND. SKVORTSOVA

<1>The medicinal products for medical use listed in this list are subject to subject-quantitative registration, regardless of their trade name.

I. Medicines - pharmaceutical substances and medicines containing narcotic drugs, psychotropic substances and their precursors (their salts, isomers, stereoisomers) and included in lists, III, of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation , approved by Decree of the Government of the Russian Federation of June 30, 1998 N 681<1>(hereinafter referred to as narcotic drugs, psychotropic substances and their precursors), in combination with pharmacologically inactive substances, as well as medications containing narcotic drugs, psychotropic substances and their precursors in combination with pharmacologically active substances: (as amended by Order of the Ministry of Health of the Russian Federation dated 04/05/2018 N 149n)

<1>Decree of the Government of the Russian Federation of June 30, 1998 N 681 “On approval of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation” (Collected Legislation of the Russian Federation, 1998, N 27, Art. 3198; 2004, N 8 , Art. 663; N 47, Art. 4666; 2006, N 29, Art. 3253; 2007, N 28, Art. 3439; 2009, N 26, Art. 3183; N 52, Art. 6572; 2010, N 3 , Art. 314; N 17, Art. 2100; N 24, Art. 3035; N 28, Art. 3703; N 31, Art. 4271; N 45, Art. 5864; N 50, Art. 6696, Art. 6720 ; 2011, N 10, Art. 1390; N 12, Art. 1635; N 29, Art. 4466, Art. 4473; N 42, Art. 5921; N 51, Art. 7534; 2012, N 10, Art. 1232 ; N 11, Art. 1295; N 19, Art. 2400; N 22, Art. 2864; N 37, Art. 5002; N 48, Art. 6686; N 49, Art. 6861; 2013, N 9, Art. 953; N 25, Art. 3159; N 29, Art. 3962; N 37, Art. 4706; N 46, Art. 5943; N 51, Art. 6869; 2014, N 14, Art. 1626; N 23, Art. 2987; N 27, Art. 3763; N 44, Art. 6068; N 51, Art. 7430; 2015, N 11, Art. 1593; N 16, Art. 2368; N 20, Art. 2914; N 28, Article 4232; N 42, Article 5805; 2016, N 15, art. 2088; 2017, N 4, art. 671, N 10, art. 1481, N 23, art. 3330; N 30, art. 4664; N 33, art. 5182). (as amended by Order of the Ministry of Health of the Russian Federation dated 04/05/2018 N 149n)

Allobarbital

Alprazolam

Aminorex

Amobarbital

Amfepramone

Bromazepam

Brotizolam

Buprenorphine

Buprenorphine + naloxone (medicines) (as amended by Order of the Ministry of Health of the Russian Federation dated October 31, 2017 N 882n)

Butalbital

Butobarbital

Butorphanol

Galazepam

Haloxazolam

4-hydroxybutyrate

Dextromoramide

Dextropropoxyphene

Delorazepam

Diazepam

Diazepam + cyclobarbital

Diphenoxylate

Diethyl ether (at a concentration of 45 percent or more)

Zolpidem

Kamazepam

Ketazolam

Clobazam

Clorazepate

Clotiazepam

Lefetamine

Loprazolam

Lorazepam

Lormetazepam

Mazindol

Medazepam

Mesocarb

Meprobamate

Methylphenobarbital

Mefenorex

Midazolam

Modafinil

Nalbuphine

Nimetazepam

Nitrazepam

Nordazepam

Oxazepam

Oxazolam

Oxycodone

Oxycodone + naloxone (medicines) (as amended by Order of the Ministry of Health of the Russian Federation dated October 31, 2017 N 882n)

Pentazocine

Potassium permanganate (at a concentration of 45 percent or more)

Pinazepam

Pipradrol

Piritramide

Prazepam

Prosidol

Pseudoephedrine (at a concentration of 10 percent or more)

Secbutabarbital

Sufentanil

Temazepam

Tetrazepam

Tianeptine

Triazolam

Trimeperidine

Phenylpropanolamine (at a concentration of 10 percent or more)

Phenobarbital

Fentanyl

Phentermine

Fludiazepam

Flunitrazepam

Flurazepam

Chlordiazepoxide

Cyclobarbital

Ergometrine (at a concentration of 10 percent or more)

Ergotamine (at a concentration of 10 percent or more)

Estazolam

Ethyl loflazepate

Ethylmorphine

Ephedrine (at a concentration of 10 percent or more)

<1>Collection of legislation of the Russian Federation, 2008, No. 2, art. 89; 2010, N 28, art. 3703; 2012, N 10, art. 1232; N 41, art. 5625; 2013, N 6, art. 558; N 9, art. 953; N 45, art. 5831.

Androstanolone

Aceclidine

Benactizine

Benzobarbital

Bromized

Hexobarbital

Hyoscyamine

Gestrinone

Snake venom (except for dosage forms for external use - creams, ointments, gels)

Zopiclone

Carbacholine

Clozapine

Clonidine

Clostebol

Levomepromazine

Mesterolone

Methandienone

Methandriol

Methenolone

Methyltestosterone

Nandrolone

Norclostebol

Bee venom (except for dosage forms for external use - creams, ointments, gels)

Sibutramine

Scopolamine

Ethyl alcohol (Ethanol) (as amended by Order of the Ministry of Health of the Russian Federation dated September 10, 2015 N 634n)

Total belladonna alkaloids (except for solid dosage form - suppositories) (as amended by Order of the Ministry of Health of the Russian Federation dated September 10, 2015 N 634n)

1-testosterone (except for dosage forms for external use - creams, ointments, gels)

Sodium thiopental

Tramadol

Tramadol 37.5 mg + paracetamol

Trihexyphenidyl

Ethyl chloride

III. Combined medicinal products containing, in addition to small quantities of narcotic drugs, psychotropic substances and their precursors, other pharmacological active substances<1>:

7) phenylpropanolamine in an amount up to 75 mg inclusive (per 1 dose of solid dosage form) or up to 300 mg inclusive (per 100 ml or 100 g of liquid dosage form for internal use);

8) phenobarbital in an amount up to 15 mg inclusive in combination with codeine (or its salts) regardless of the amount (per 1 dose of solid dosage form);

9) phenobarbital in an amount up to 20 mg inclusive in combination with ephedrine hydrochloride, regardless of the amount (per 1 dose of solid dosage form);

Order of the Ministry of Health of the Russian Federation dated April 22, 2014 N 183n
“On approval of the list of medicines for medical use, subject to subject-quantitative accounting”

With changes and additions from:

2. To recognize as invalid:

Registration N 33210

A new list of medicines (medicines) for medical use, subject to subject-quantitative accounting, has been approved.

It includes 3 groups of drugs.

The previous list was declared invalid.

Order of the Ministry of Health of the Russian Federation dated April 22, 2014 N 183n “On approval of the list of medicines for medical use, subject to subject-quantitative accounting”

Registration N 33210

This order comes into force 10 days after the day of its official publication

This document is amended by the following documents:

Order of the Ministry of Health of the Russian Federation (Ministry of Health of Russia) dated April 22, 2014 N 183n, Moscow “On approval of the list of medicines for medical use, subject to subject-quantitative accounting”

Registration N 33210

1. Approve the list of medicines for medical use, subject to subject-quantitative recording, in accordance with the appendix.

2. To recognize as invalid:

Appendix No. 1 to the Procedure for dispensing medicines, approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 14, 2005 No. 785 (registered by the Ministry of Justice of the Russian Federation on January 16, 2006, registration No. 7353);

paragraph 4 of the Amendments to the Procedure for Dispensing Medicines, approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 14, 2005 N 785, approved by order of the Ministry of Health and Social Development of the Russian Federation dated August 6, 2007 N 521 (registered by the Ministry of Justice Russian Federation August 29, 2007, registration N 10063).

Minister V. Skvortsova

List of medicines for medical use,

subject to subject-quantitative accounting 1

KGP at the Pavlodar Regional Cardiology Center

Order No. 183 “On approval of the Rules for the examination of temporary disability,”

In accordance with paragraph 2 of Article 59 of the Code of the Republic of Kazakhstan dated September 18, 2009 “On the health of the people and the healthcare system” I ORDER:
1. Approve the attached Rules for conducting an examination of temporary disability, issuing sheets and certificates of temporary disability to citizens.
2. The Department of Organization of Medical Care of the Ministry of Health and Social Development of the Republic of Kazakhstan shall provide:
1) state registration of this order with the Ministry of Justice of the Republic of Kazakhstan;
2) within ten calendar days after the state registration of this order with the Ministry of Justice of the Republic of Kazakhstan, direction for official publication in periodicals and the Adilet information and legal system;
3) placement of this order on the Internet resource of the Ministry of Health and Social Development of the Republic of Kazakhstan.
3. Control over the implementation of this order is entrusted to the Vice Minister of Health and Social Development of the Republic of Kazakhstan Tsoi A.V.
4. This order comes into force from the date of its first official publication.
Minister T. Duysenova

Approved
by order of the Minister of Health
and social development
Republic of Kazakhstan
dated March 31, 2015 No. 183

Rules
conducting an examination of temporary disability,
issuance of sheets and certificates of temporary incapacity for work
1. General Provisions
1. These Rules for conducting an examination of temporary disability, issuing sheets and certificates of temporary disability to citizens (hereinafter referred to as the Rules) were developed in accordance with paragraph 2 of Article 59 of the Code of the Republic of Kazakhstan dated September 18, 2009 “On the health of the people and the healthcare system” and determine the procedure for conducting examination of temporary disability, issuance by medical organizations of documents certifying temporary disability.
2. These Rules use the following concepts:
1) medical advisory commission (hereinafter referred to as the MAC) - a commission that is created in a medical organization, regardless of the form of ownership and departmental affiliation;
2) temporary disability - a condition of the human body caused by a disease or injury, in which the dysfunction is accompanied by the inability to perform professional work during the time necessary to restore working capacity or establish disability;
3) - a document certifying the temporary disability of persons and confirming the right to temporary release from work and receiving benefits for temporary disability;
4) certificate of temporary incapacity for work - a document certifying the fact of incapacity for work, which is the basis for release from work (study) without receiving benefits;
5) unclaimed form of a certificate of temporary disability - a certificate of temporary disability that was issued in accordance with the Rules, but the person to whom the certificate of temporary disability was issued did not appear for its extension or closure within three working days after the end of the period for extending the certificate of temporary disability temporary disability;
6) examination of temporary disability - a type of examination in the field of health care, the purpose of which is the official recognition of the disability of an individual and his temporary release from work duties for the period of illness;
7) medical and social examination(hereinafter referred to as ITU) - determining the needs of the person being examined in measures social protection, including rehabilitation, based on the assessment of disability caused by persistent impairment of body functions;
8) centralized medical advisory commission (hereinafter referred to as the CVAC), a commission created in the anti-tuberculosis organization.
3. A certificate of temporary disability in the form, in accordance with the appendix to these Rules, is issued when:
1) acute or exacerbation of chronic diseases;
2) injuries and poisonings associated with temporary disability;
3) artificial termination of pregnancy;
5) pregnancy and childbirth;
6) adoption of a newborn child (children);
7) after-care in sanatorium-resort organizations;
8) quarantine;
9) orthopedic prosthetics.
4. Certificate of temporary disability in the form approved by the order of the acting Minister of Health of the Republic of Kazakhstan dated November 23, 2010 No. 907 “On approval of forms of primary medical documentation of healthcare organizations” (registered in the Register of State Registration of Normative Legal Acts No. 6697) (hereinafter referred to as Order No. 907), issued when:
1) acute or exacerbation of chronic diseases, injuries and poisoning to persons studying in educational organizations;
2) injuries received while under the influence of alcohol or drugs, as well as during acute alcohol or drug intoxication;
3) treatment of chronic alcoholism, drug addiction, not complicated by other disorders and diseases;
4) caring for a sick child;
5) undergoing examination in consultative and diagnostic organizations for the period of conducting invasive examination methods;
6) artificial termination of pregnancy;
7) pregnancy and childbirth for persons studying in educational organizations;
8) adoption of a newborn child (children);
9) after-care in sanatorium-resort organizations;
10) quarantine;
11) orthopedic prosthetics;
12) if there are signs of disability until the end of the shift (issued by medical workers at medical centers of enterprises and organizations).
5. A certificate of temporary disability in the cases specified in paragraphs 3, 4 of these Rules is issued to citizens of the Republic of Kazakhstan, oralmans, foreign citizens permanently residing in the Republic of Kazakhstan, carrying out labor activities and studying in educational organizations for the period of their enrollment in paid jobs in period industrial practice.
6. A sheet and (or) certificate of temporary disability is issued by:
1) doctors of medical organizations of state and private ownership, as well as those engaged in private medical practice(hereinafter referred to as healthcare entities) if they have a license to carry out medical activities, including conducting an examination of temporary disability, issued in accordance with the Law of the Republic of Kazakhstan dated May 16, 2014 “On Permits and Notifications”;
2) medical workers with average medical education primary health care organizations (hereinafter referred to as PHC organizations) state form property when independently receiving patients and independently servicing initial calls at home.
7. A certificate of temporary incapacity for work is not issued:
1) passing medical examination, medical examination or treatment as directed by military authorities;
2) in custody or administrative arrest;
3) persons with chronic diseases without exacerbation (deterioration), undergoing examination, undergoing various procedures and manipulations in an outpatient setting;
4) those who seek medical help from a medical organization if they do not show signs of temporary disability.
In these cases, the patient is given an extract from the outpatient (inpatient) medical record.
8. Certificates of temporary incapacity for work are not issued by the following medical organizations:
1) organizations operating in the field of blood services;
2) organizations operating in the field of forensic medicine;
3) trauma centers and emergency departments of medical organizations providing inpatient care;
4) health resort organizations;
5) organizations of disaster medicine;
6) organizations carrying out activities in the field of organization, carrying out activities in the field of formation healthy image life and healthy eating;
7) medical and physical education clinics;
8) organizations operating in the field of sanitary and epidemiological welfare of the population;
9) emergency medical care organizations.
2. The procedure for conducting an examination of temporary disability,
issuance of sheets and certificates of temporary incapacity for work
9. A sheet and certificate of temporary disability are issued upon presentation of an identity document.
10. The issuance and extension of a sheet and certificate of temporary disability is carried out by a medical worker after examining a person and recording data on his health condition in the medical record of an outpatient (inpatient) patient, justifying the need for his temporary release from work.
11. A sheet and certificate of temporary disability are issued from the date of establishment of temporary disability, including holidays and weekends, for the entire period until the restoration of working capacity.
12. A sheet and certificate of temporary disability are not issued for the past days when the person was not examined by a medical professional, except for the cases specified in paragraph 24 of these Rules.
13. In case of illnesses and injuries, the doctor issues a sheet and certificate of temporary disability individually and at a time for three calendar days (based on the order of the head of the medical organization during the period of increased morbidity of the population with influenza, ARVI - up to six calendar days) and with a total duration of no more than six calendar days days.
Extension of the sheet and certificate of temporary disability for more than six calendar days is carried out jointly with the head of the department of the medical organization for a total duration of no more than twenty calendar days.
Extension of a certificate of temporary incapacity for work over twenty calendar days is carried out upon the conclusion of the High Commission for Work.
In medical organizations where one doctor works, a sheet and certificate of temporary incapacity for work is issued and extended by the physician alone for the entire period of incapacity for work with consultation of a specialized specialist.
Individuals engaged in private medical practice issue a sheet and certificate of temporary disability for a period of no more than six calendar days.
Medical workers with secondary medical education specified in subparagraph 2) of paragraph 7 of these Rules issue a sheet and certificate of temporary disability for a period of no more than three calendar days. Extension of the sheet and certificate of temporary disability for more than three days is carried out by the local doctor.
Paramedics in rural areas, in the absence of a doctor, on the basis of an order from the head of a medical organization during a period of increased incidence of influenza and ARVI, issue a sheet and certificate of temporary disability for a period with a total duration of no more than six calendar days.
14. A certificate of temporary disability is issued for a period of no more than sixty calendar days, with the exception of pregnancy and childbirth, as well as diseases specified in subparagraph 17) of paragraph 1 of Article 54 of the Labor Code of the Republic of Kazakhstan dated May 15, 2007.
If, according to the conclusion of the High Quality Commission, there are no grounds for sending a person to medical examination in order to establish disability, but the working conditions of the persons worsen the clinical course and prognosis of the disease, a conclusion of the High Quality Control Committee is issued on a temporary transfer to easier work for a period of two to six months. The period is set by the VKK depending on the profession (specialty), severity and complications of the disease.
15. For persons who seek medical help after the end of working hours (shift, study), the date of release from work is indicated on the sheet and certificate of temporary disability from the next day.
16. A sheet and certificate of temporary disability is issued in case of hospitalization - in a hospital from the day of hospitalization, in case of treatment on an outpatient basis - in a medical organization that provides outpatient care at the place of attachment (for a non-resident - at the place of application) on the day of his treatment with counting the day of visiting the trauma center and ambulance medical care on the basis of a certificate confirming their application to the specified medical organizations.
A person applies to a medical organization providing outpatient care the next day after being served by an ambulance and (or) at a trauma center.
If a person is served by an ambulance team and (or) at a trauma center on Friday, on weekends and holidays, then a sheet and certificate of temporary disability is issued by a medical organization providing outpatient care, with the day of application to the trauma center and emergency medical station taken into account. assistance and subsequent weekends and holidays on the basis of a certificate confirming their application to the specified medical organizations.
17. In the event of a person’s incapacity for work until the end of the shift, a certificate of temporary incapacity for work is issued by a medical worker at medical centers of enterprises and organizations with release from work until the end of the shift with subsequent referral to a medical organization. The issuance of a sheet and certificate of temporary disability is carried out by a medical worker of the medical organization to which the person is attached, with the day of application to the medical center of the enterprise being taken into account.
18. With established tuberculosis, mental, skin and venereal diseases, oncological diseases and those infected with the human immunodeficiency virus/acquired immunodeficiency syndrome (hereinafter referred to as HIV/AIDS), a sheet and certificate of temporary disability are issued by medical workers of the relevant specialized medical organizations (departments, offices). When persons with these diseases apply to general medical organizations, the medical worker issues a sheet and certificate of temporary disability for a period of no more than three calendar days, followed by referral of the persons to a specialized medical organization (department), and in the absence of such, to a specialized specialist.
19. When transferring persons to a sanatorium-resort organization for medical rehabilitation, as an integral component of treatment, the extension of the sheet and certificate of temporary disability is carried out by the medical organization to which the person is attached.
20. When inpatient treatment(including day hospitals, rehabilitation centers) a sheet and certificate of temporary disability are issued for the entire period of inpatient treatment by a medical professional on the day of discharge of persons.
If by the time of discharge from the hospital a person’s ability to work has been fully restored, the sheet and certificate of temporary disability are closed with the date of discharge.
For persons who continue to be temporarily disabled, the sheet and certificate of temporary disability is extended for a period, taking into account the time required for him to appear at a medical clinic or call a medical worker at home (but not more than one calendar day).
For persons who received treatment outside their region of residence, the time required to arrive at their place of permanent residence is taken into account (but not more than four calendar days).
Further extension and closure of the sheet and certificate of temporary disability is carried out to the person at the place of residence by a medical worker who carries out further monitoring of him after the conclusion of the medical examination, or by the medical organization to which the patient was sent for further treatment.
21. In case of injuries received while under the influence of alcohol or drugs, as well as acute alcohol or drug intoxication, a certificate of temporary disability is issued for the entire period of temporary disability.
If another disease occurs that is not related to the one for which the patient was issued a certificate of temporary disability, the certificate of temporary disability is closed and a sheet of temporary disability is issued. If, after restoration of working capacity for this disease, temporary disability caused by an injury received while under the influence of alcohol or drugs continues, a certificate of temporary disability is reopened.
22. In the treatment of chronic alcoholism, drug addiction, not complicated by other disorders and diseases, temporary disability is certified by a certificate. If during this period an illness or injury occurs with the onset of temporary disability and cessation of treatment for alcoholism (drug addiction) is required, a certificate of temporary disability is issued.
If chronic alcoholism (drug addiction) is complicated by other diseases and conditions that impair the ability to work, a certificate of temporary incapacity for work is issued for the entire period of incapacity, in accordance with these Rules.
23. Persons suffering mental illness, in case of untimely application to a medical organization, a sheet and certificate of temporary disability are issued for the past days upon the conclusion of the Higher Quality Committee of a psychoneurological dispensary or a medical worker (psychiatrist) together with the head of the medical organization.
Persons sent by court decision for a forensic medical or forensic psychiatric examination and recognized as incapable of work are issued a sheet and certificate of temporary disability from the date of admission for examination.
24. A person combining study with work is issued a sheet and a certificate of temporary incapacity for work at the same time.
25. If a person works for several employers, a certificate of temporary incapacity for work is issued for one place of work; copies of a certificate of temporary incapacity for work, certified by the head of the medical organization and sealed by the seal of the medical organization, are issued to other places of work of the person.
26. Pregnant women, women who have given birth to a child (children), women (men) who have adopted a newborn child (children) are issued a temporary disability certificate in two copies:
1) to make social payments in case of loss of income due to pregnancy and childbirth, adoption of a newborn child (children) from the State Fund social insurance;
2) to provide maternity leave to employees who have adopted a newborn child (children) at their place of work.
27. A sheet and certificate of temporary disability for non-resident persons are issued at the medical organization at the place of their temporary stay and are issued in agreement with the head of the relevant medical organization.
The extension of the specified sheet and certificate of temporary incapacity for work is carried out in the medical organization at the place of attachment of the person in the presence of the conclusion of the Higher Quality Committee of the medical organization that opened the sheet and certificate of temporary incapacity for work.
28. For persons sent to medical organizations outside their place of permanent residence, including outside the Republic of Kazakhstan, a sheet and certificate of temporary incapacity for work is issued by the sending medical organization upon the conclusion of the Medical Commission for the days required for travel, but not more than five calendar days.
The extension of this sheet and certificate of temporary disability is carried out at the medical organization to which the person was sent.
If a person was sent outside the Republic of Kazakhstan, the final execution of the sheet and certificate of temporary disability is carried out by the VKK upon his return on the basis of documents on consultation (treatment) in another country.
29. For persons who have received a sheet and certificate of temporary disability in a medical organization at the place of their attachment, their extension in another medical organization is carried out only if there is a conclusion from the Higher Quality Committee of the medical organization that issued the sheet and certificate of temporary disability.
30. Documents certifying the fact of illness, injury abroad of citizens of the Republic of Kazakhstan and oralmans, foreign citizens permanently residing and working in the territory of the Republic of Kazakhstan are the basis for issuing a sheet and certificate of temporary disability upon the conclusion of the High Quality Committee of the medical organization at the place of its attachment .
Documents certifying the fact of illness or injury must be translated into Kazakh or Russian and certified in the host country or in the Republic of Kazakhstan.
31. For foreign citizens Those staying in the Republic of Kazakhstan temporarily, in case of illness or injury, are issued a certificate of temporary disability.
32. Long-term ill, working persons with certificates of temporary incapacity for work are sent to ITU:
1) no earlier than four months from the date of onset of temporary disability or no later than five months of temporary disability during the last twelve months in case of repeated diseases (with the same disease);
2) no earlier than four months from the date of onset of temporary disability due to injuries, if there is a long-term prognosis for the course of the disease, by decision of the High Commission for Work, the certificate of incapacity for work is extended for two months;
3) no earlier than eight months from the date of onset of temporary disability due to tuberculosis.
33. For a person recognized as disabled, the sheet and certificate of temporary disability is closed with the date the disability group is established.
34. Working disabled people are sent to medical assistance if their health deteriorates due to a disabling disease no earlier than two months from the date of temporary incapacity for work. If the deterioration in the health of working disabled people is not associated with a disabling disease, then a certificate of temporary incapacity for work is issued in accordance with these Rules.
35. If a person refuses to be referred to ITU sheet about temporary incapacity for work is not extended from the date of refusal to be referred to medical examination; information about this is indicated in the sheet of temporary incapacity for work and in the medical record of the outpatient (inpatient) patient.
36. Forms of temporary disability sheets are documents of strict accountability.
37. The temporary disability certificate is filled out in the state or Russian languages.
38. Healthcare entities issuing a certificate of temporary disability fill out its front side. On the front side of the sheet of temporary incapacity for work, entitled “Sheet of temporary incapacity for work,” either the word “Primary” or the word “Continuation” is underlined, respectively. Then the name and address of the medical organization, the date of issue of the sheet, last name, first name, patronymic (if any), position and place of work of the patient are indicated, and the seal of the medical organization is affixed.
39. In the column “Type of temporary disability” the basis for issuing the sheet is indicated.
If a certificate of temporary incapacity for work is issued in connection with childbirth, the date of birth is indicated; for adoption, the date of adoption is indicated; for caring for a sick child, the date and year of birth of the child are indicated.
40. The line “Regime” indicates the type of prescribed medical and protective regime (inpatient, outpatient, sanatorium). In case of violations of the regime prescribed by the medical worker, cases of violation of the regime by the person are noted (alcohol abuse, failure to carry out the prescribed examination or treatment, failure to appear for an appointment with the medical worker within the specified period, travel to another area, etc.) and the medical worker’s signature is placed.
41. In the appropriate columns, notes are made about the duration of inpatient treatment, the date of referral to medical examination and their conclusion.
42. In the “Exemption from work” section, the column “From what date” is filled in in Arabic numerals, and the column “Up to what date inclusive” is filled in in words. Each line of this section indicates the position, surname and initials, and signature of the medical worker.
43. The line “Start work” is filled in in words (day and month) the next day after the person is examined and recognized as able to work. In case of continued temporary disability, a note is made: “Continues to be ill” and the number and date of issue of another certificate of incapacity for work is indicated. In other cases of termination of temporary disability, the following entries are made: “Disability established (date)”, “Died” (indicating the date of death).
In the event that a person, after issuing or extending a certificate of temporary incapacity for work, does not show up for an appointment, but at the next visit is recognized as able to work, in the line “Get to work” of the certificate of incapacity for work, the following entry is made: “Appeared to be able to work” (indicating the date of appearance), free lines The column “From what date” and “Up to what date inclusive” of the table “Exemption from work” are marked with the sign “Z”.
44. The certificate of temporary incapacity for work is not closed at the request of the administration from his place of work.
45. The numbers of temporary disability certificate forms, the date of their issue, the date of extension or discharge to work are recorded in the outpatient medical record (inpatient medical record).
46. The reverse side of the temporary disability sheet is filled out by the employer with a stamp at the person’s place of work, taking into account the allocation of working days during the period of temporary disability that are subject to payment.
47. Corrections are made by crossing out what is written incorrectly and signing on top correctly. The correction is indicated in the margins signed by a medical worker, certified by the seal of the healthcare entity.
48. The seal of the healthcare entity is affixed upon opening, with right side at the top in the first section of the temporary disability sheet and at the bottom - when being discharged to work or when issuing a continuation.
49. All sheets of temporary incapacity for work are issued to the temporarily disabled against a signature on the counterfoils, which serve as a document for reporting on forms of sheets of temporary incapacity for work.
50. Accounting for issued sheets of temporary disability is carried out in the book of registration of sheets of temporary incapacity for work, approved by Order No. 907.
51. Spoiled and unclaimed forms of temporary disability certificates are canceled by the medical workers who issued them in the following order: the form is crossed out and “spoiled” or “cancelled” is written in large letters.
The counterfoils of the forms, damaged and unclaimed forms are stored in the medical organization for two years, and then, based on the order of the manager, they are destroyed. An act (of any form) on the destruction of damaged and unclaimed forms is stored for five years.
52. If a certificate of temporary disability is lost, a duplicate is issued by the healthcare entity that issued the certificate of temporary disability, upon presentation of a certificate from the place of work stating that benefits for the lost certificate of temporary disability were not paid. On the front side of the duplicate, a mark is made at the top: “Duplicate”.
53. For a person who fails to show up for an appointment with a doctor on the appointed day, the certificate of temporary incapacity for work is extended from the date of application, without counting the missed days.
54. When the incapacity for work continues, the medical worker issues the person a “continuation” of the sheet of temporary incapacity for work, making a note about the violation of the regime in the primary sheet of temporary incapacity for work in the column “Notes about the violation of the regime.”
55. In cases of theft or loss of temporary disability certificate forms, medical organizations report these facts no later than three calendar days from the date of their discovery to the local authority government controlled healthcare.
3. Issuance of a sheet and certificate of temporary
disability due to pregnancy and childbirth
56. The procedure for issuing sheets and certificates of temporary disability due to pregnancy and childbirth:
1) a sheet and certificate of temporary disability for pregnancy and childbirth is issued by a medical worker (obstetrician-gynecologist), and in his absence - by a doctor, together with the head of the department after the conclusion of the VKK from thirty weeks of pregnancy for a period of one hundred twenty-six calendar days (seventy calendar days before birth and fifty-six calendar days after birth).
For women living in territories exposed to nuclear tests, a sheet and certificate of incapacity for work for pregnancy and childbirth is issued from twenty-seven weeks for a duration of one hundred and seventy calendar days at normal birth and one hundred eighty-four days - in case of complicated childbirth or the birth of two or more children;
2) for women who have temporarily left their permanent place of residence within the Republic of Kazakhstan, a sheet and certificate of temporary disability due to pregnancy and childbirth is issued (extended) in the medical organization where the birth took place or in antenatal clinic(office) at the place of observation according to the extract (exchange card) of the obstetric organization approved by Order No. 907.
For women who have temporarily left their permanent place of residence outside the Republic of Kazakhstan, when they apply during the period of maternity leave, a sheet and certificate of temporary disability for pregnancy and childbirth are issued (extended) at the medical organization at the place of attachment according to the conclusion of the VKK, upon presentation documents certifying the fact of birth of the child (children) in a medical organization and the child’s birth certificate. The provided documents are translated into Kazakh or Russian and certified in the host country or in the Republic of Kazakhstan;
3) in the case of complicated childbirth, the birth of two or more children, the sheet and certificate of temporary disability is extended for an additional fourteen calendar days in the antenatal clinic (office) at the place of observation according to the extract from the obstetric health care organization. In these cases, the total duration of prenatal and postnatal leave is one hundred and forty calendar days;
4) in case of birth of a live child between twenty-two and twenty-nine weeks and who has lived for more than seven days with a body weight of five hundred grams or more, the woman is issued a sheet and certificate of incapacity for work upon the fact of childbirth for seventy calendar days.
In the event of a stillborn child being born from twenty-two to twenty-nine weeks or dying before seven days of life with a body weight of five hundred grams or more, the woman is issued a sheet and a certificate of temporary disability upon the fact of childbirth for fifty-six calendar days;
5) for women living in territories exposed to nuclear tests, in the event of a birth between twenty-two and twenty-nine weeks as a live child and having lived for more than seven days with a body weight of five hundred grams or more, a sheet and certificate of temporary disability is issued for ninety-one day. In the event of a stillbirth or death of a child before seven days of life, a sheet and certificate of temporary disability are issued for seventy-seven calendar days;
6) when pregnancy occurs while the woman is on paid annual leave or unpaid leave wages for caring for a child until he reaches three years of age, a certificate of temporary incapacity for work is issued for all days of maternity leave;
7) in the event of the death of the mother during childbirth or postpartum period, sheet and certificate of temporary disability are issued to the person caring for the newborn;
8) during an operation for artificial termination of pregnancy, a sheet and certificate of temporary disability is issued by the doctor together with the head of the department for the duration of the stay in the hospital and outpatient clinic where the operation was performed, and in case of complications - for the entire period of temporary disability.
In case of spontaneous abortion (miscarriage), a sheet and certificate of temporary incapacity for work are issued for the entire period of temporary incapacity for work;
9) when carrying out an embryo transfer operation, a sheet and a certificate of temporary disability are issued by the medical organization that performed the operation from the day of embryo transfer until pregnancy is established.
Persons who have adopted a newborn child (children), as well as a biological mother during surrogacy, directly from the maternity hospital, are issued a sheet and certificate of temporary disability from the date of adoption until the expiration of fifty-six calendar days from the date of birth of the child.
4. Issuance of a sheet and certificate of temporary disability
caring for a sick child
57. A sheet and certificate of temporary disability to care for a sick child is issued by a medical worker to one of the child’s legal representatives or close relatives who is directly caring for them.
58. When caring for a sick child, a sheet and certificate of temporary disability is issued and extended for the period during which he needs care, but not more than ten calendar days. If a child falls ill and is with his mother or other legal representative of the child outside his place of permanent residence, a sheet and certificate of temporary disability to care for a sick child is issued as a nonresident (signed by the head of the medical organization).
59. During inpatient treatment of a child, including in a rehabilitation center, who, according to the conclusion of the Internal Health Commission, needs care, a sheet and certificate of temporary disability for care are issued to one of the parents or the person caring for him during treatment:
1) a child under three years of age - for the entire period of the child’s stay in the hospital;
2) seriously ill children over three years of age - for the period during which the child needs such care;
3) a disabled child - for the entire period of stay in the hospital according to the conclusion of the VKK;
4) upon referral by a medical organization outside their place of permanent residence, including outside the Republic of Kazakhstan, for the entire period of stay in the hospital, including the time required for round trip travel.
60. If a child needs care after discharge from the hospital, and before hospitalization there was no release from work to care for him, a sheet and certificate of temporary disability are issued by a medical organization at the place of residence for a period of up to ten calendar days. If, before hospitalization in a hospital for this disease If a sheet and certificate of temporary disability have already been issued, it is issued for the remaining days (up to ten days).
61. If a child develops another disease that is not related to the previous disease during the period of care leave, another sheet and a certificate of temporary disability for the mother (father or other family member) are issued.
62. If the child was sent for treatment outside the Republic of Kazakhstan, the final execution of the sheet and certificate of temporary disability is carried out by the VKK upon his return on the basis of documents on consultation (treatment) in another country.
63. If two or more children become ill at the same time, one sheet and a certificate of temporary disability are issued to care for them.
64. If a child falls ill during a period that does not require the mother (father) to be released from work (paid annual leave, maternity leave, leave without pay, weekends or holidays, as well as if the child develops another illness, not related to the previous one), a certificate of temporary incapacity for care is issued from the day on which she (he) must begin work, without taking into account the days from the onset of the child’s illness.
65. In case of illness of the mother (father), due to which she (he) cannot care for the child, a sheet and certificate of temporary disability are issued by the medical organization at the place of their treatment to one of the family members actually caring for the child for the duration of the illness mother (father).
66. In case of temporary incapacity for work of persons on leave to care for a sick child, working part-time or at home, a certificate of temporary incapacity for work is issued.
67. Sheets and certificates of temporary disability are not issued for caring for chronically ill children during the period of remission.
5. Issuance of a sheet and certificate of temporary disability
during quarantine
68. In case of temporary suspension from work of persons who have been in contact with infectious patients, or due to bacterial carriage, a sheet and certificate of temporary disability are issued by a medical worker (infectious disease doctor) of a medical organization upon the recommendation of an epidemiologist territorial body sanitary and epidemiological surveillance.
The duration of suspension from work in these cases is determined by the periods of isolation of persons who have had infectious diseases and have been in contact with them.
69. During quarantine, a sheet and certificate of temporary disability to care for a child under seven years old attending preschool educational institution, is issued to one of the working or studying family members for the entire quarantine period based on the recommendations of the epidemiologist of the territorial sanitary and epidemiological surveillance body.
70. Persons working in public catering organizations, water supply organizations, medical organizations, child care institutions, if they have helminthiasis, are issued a temporary disability certificate for the entire period of deworming.
6. Issuance of a sheet and certificate of temporary disability
for orthopedic prosthetics
71. A sheet and certificate of temporary disability for orthopedic prosthetics is issued when a person is hospitalized in a hospital of a prosthetic and orthopedic center by a medical worker of the hospital, together with the head of the medical organization upon discharge of the patient from the hospital, for the entire period of stay in the hospital and the time of travel to the place of treatment and back , but not more than thirty calendar days.
Persons receiving prosthetics in an outpatient setting are not issued a sheet or certificate of temporary incapacity for work.
7. Issuance of a sheet and certificate of temporary
disability for patients with tuberculosis
72. When persons with tuberculosis apply to a general medical organization, the issuance of a sheet and a certificate of temporary disability is carried out in the manner specified in paragraph 19 of these Rules.
73. For a person recognized as disabled, the sheet and certificate of temporary disability is closed with the date the disability group is established.
74. In case of temporary incapacity for work, the person retains his place of work (study) after completion of the course of treatment without loss of qualifications and wages.
75. For patients with tuberculosis without bacterial excretion and who have achieved stable conversion of the sputum smear upon restoration of working capacity, by decision of the Central Military Commission for Work, the sheet and certificate of temporary disability can be closed.
76. A person with a newly diagnosed tuberculosis process, as well as with a relapse, is considered temporarily disabled:
1) with a sensitive form of tuberculosis for 10 months;
2) with multidrug resistance for 12 months;
3) with extensive drug resistance for 15 months.
Persons with tuberculosis, in the absence positive effect from treatment (preservation of bacterial excretion in patients with pulmonary tuberculosis and persistent impairment of body functions in patients with extrapulmonary tuberculosis) are sent to MSE.

Enbekke uakytsha zharamsyzdykka
saraptama zhurgizu zhane enbekke
uakytsha zharamsyzdyk paragyn zhane
anyktamasyn take kaғidalaryna kosymsha
Form
Nysan
series No. 0000000
Enbekke uakytsha zharamsyzdyk paragy
Certificate of temporary incapacity for work
Algashky - zhalgasy / Primary - continuation
(tiіstіsіnѣ astyn syzu / underline accordingly)
Dariger
toltyrady
yes emdeu
Uyimynda
kaldyrady / Filled out by the doctor and
remains in the medical organization
(enbekke uakytsha zharamsyz adamnyn tagi aty zhane
әkesінің aty (bar bolgan zhaғdayda) / surname,
name and patronymic of the temporarily disabled person)
(if available)
(meken zhayy / home address)
(kyzmet orny - zandy tulganyn atauy / place
work - name legal entity)
Berildi _________________________________ 20__
Issued (kuni, ay, zhyly / day, month, year)

---------------- ___________
(darigerdin
tags/last name
doctor)
Syrkatnamany №_____
History No.
illness_________
Alushynyn Koly/
recipient's receipt)___________
Emdeu
Uyimynda
darigeri
toltyrady/
Filled out
doctor
medical organization Enbekke uakytsha zharamsyzdyk paragy
Certificate of temporary incapacity for work
Algashky - paraktyn zhalgasy / Primary -
continuation of leaflet No. __________
(tiistisinin astyn syzu - underline the appropriate)
Series No. 0000000
________________________________________________
(emdeu ұyymynyң atauy zәne meken zhayy /
name and address of the medical organization)
Berildi _______________ 20___ f. _____________
Issued kuni, ayy / day, month 20_______, KHAZH-10 codes
Zhasy ______________________
Age (tolyk zhasy / full years)
_________________________________________________
Enbekke uakytsha zharamsyz adamnyn tags, aty,
әkesінің aty (ol bolgan zhaғdayda)/ Last name, first name,
patronymic of a temporarily disabled person
(if available)
__________________________________________________
(kyzmet orny, zandy tulganyn atauy,
lauazymy/place of work, name of legal entity, position
HAZH-10 codes/ICD-10 code
Korytyndy KHAZH-10 codes/Final code ICD-10
_________________________________________________
(Kazakh nemese orys tilinde/in Kazakh or Russian) Emdeu mekemesinin mori
/ Seal of a medical organization
Er-Male/
Әyel-Women.
Tiistisinin
astyn syzu/
Relevant
emphasize
Enbekke uaqytsha zharamsyzdyktyn tұpi korsetіlsіn (zhiti nemes sozylmaly aurular askynuy, zharakattangan zhane ulangan, zhuktіliktі zhasandy uzgen, naukas balaga kүt Im zhasau, zhukti bolu zhane bosanu, zhana tugan balans (balalards) asyrap alu, sanatorium-resort yimdarda tolyk emdelu, quarantine, orthopedic prosthesis )/ Specify the type of temporary disability (acute or exacerbation chronic disease, injuries and poisonings, artificial termination of pregnancy, caring for a sick child, pregnancy and childbirth, adoption of a newborn child (children), after-care in sanatorium-resort organizations, quarantine, orthopedic prosthetics)
_________________________________________________________________
Balaga kutim zhasau boyynsha kezinde AKhZh-10 boyynsha naukastyn zhasy, diagnoses corsetilsin, quarantine kezinde AKhZh-10 boyynsha kezinde tuyndatakan aurudyn atauy korsetilsin
When caring for a sick child, indicate the patient’s age and diagnosis according to ICD-10; during quarantine, indicate the name of the disease according to ICD-10 that caused the quarantine________________________________________________________________________
Sanatorium resort emdelu kezinde zholdama merziminin bastalatyn
zhane bіtetin uakyty korsetіlsіn/
For sanatorium-resort treatment, indicate the start and end date of the stay
Mode: Modes for violation of modes
Darigerdin kola / Doctor’s signature _______________
Boldy hospital/Located in
hospital
20__ f.____ 20___ f. ____ day
from ____ 20___ to ____ 20___
Uakytsha baska zhumyska auystyrylsyn/
Transfer temporarily to another job with
20___ f. __ day 20__ f. ___ Dane
20___ to _____ 20_____
Bass darigerdin kola /Signature
chief physician _____________________ MӘS-ke zhiberildi/Sent to ITU
20____ f. _____ 20____
Darigerdin kola/Doctor’s signature
_____________________________
Kulandyryldy/Certified
20___ f. ____ 20____
Saraptama korytyndysy/Expert
conclusion _____________________
MӘS more bastygynyn kola
Signature of the head of the ITU department
____________________
MӘS-tin mori / Print
Zhumystan bosatylu/Exemption from work
Kay kunnen bastap/
From what date
(kuni, ayy/number,
month) Kay kundi kosa alganda kay
kunge dein/
Until what date inclusive?
(kuni men ay zhazumen/number and
month in words) Darigerdin
qizmeti men
tags/ Position
and last name
doctor Darigerdin kola/
Doctor's signature

Zhumyska kirisu/Get started
_______________________________________________
(kuni men ay zhazumen/day and month in words)
Zhana parak berildi (zhalgasy)/A new sheet has been issued (continued) No. ________
_______________________________________________
Darigerdin qizmeti, tags, koly/
Position, surname and signature of the doctor
Emdeu mekemesinin sea/
Stamp of the medical institution

Syrtky beti
(zagdy tulga atauy/name of legal entity)
Bolіm/department ______ Kyzmeti/Position _________ Tab/Tab No. _____
Turakty, uakytsha, mausymdy zhumys (tiistisinin asty syzylsyn).
Zhumys іstemedi 20__zh__ dan
20___f. ______ day
Work is permanent, temporary, seasonal (underline as appropriate).
Haven't worked since ___20__. By___
20____
Enbekke zharamsyz uakytyndagy demalys kunderi ______ Zhumyska
kiristi 20____zh.
______
deyin
Weekends during the period of incapacity (kun/date)
Bolim bastygynyn
Koly ___________ Table of contents ______ Koly
Signature of the department head _____ Signature of the timekeeper ____ Date ___
Mor/Seal

kardiocenter-pvl.kz

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MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ORDER

On approval of the list of medicines for medical use, subject to subject-quantitative accounting

Document with changes made:
(Official Internet portal of legal information www.pravo.gov.ru, 10/02/2015, N 0001201510020004);
(Official Internet portal of legal information www.pravo.gov.ru, 01/09/2018, N 0001201801090027);
(Official Internet portal of legal information www.pravo.gov.ru, 05/03/2018, N 0001201805030058);
(Official Internet portal of legal information www.pravo.gov.ru, 08/15/2018, N 0001201808150004).
____________________________________________________________________

In accordance with paragraph 5.2.171_1 of the Regulations on the Ministry of Health of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 19, 2012 N 608 (Collected Legislation of the Russian Federation, 2012, N 26, Art. 3526; 2013, N 16, Art. 1970; N 20, art. 2477; N 22, art. 2812; N 33, art. 4386; N 45, art. 5822; 2014, N 12, art. 1296),

I order:

1. Approve the list of medicines for medical use, subject to subject-quantitative recording, in accordance with the appendix.

2. To recognize as invalid:

Appendix No. 1 to the Procedure for Dispensing Medicines, approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 14, 2005 No. 785 (registered by the Ministry of Justice of the Russian Federation on January 16, 2006, registration No. 7353);

order of the Ministry of Health and Social Development of the Russian Federation dated October 13, 2006 N 703 “On amending the order of the Ministry of Health and Social Development of the Russian Federation dated December 14, 2005 N 785” (registered by the Ministry of Justice of the Russian Federation on November 7, 2006, registration N 8445 );

, approved by order of the Ministry of Health and Social Development of the Russian Federation dated February 12, 2007 N 109 (registered by the Ministry of Justice of the Russian Federation on March 30, 2007, registration N 9198);

paragraph 4 of the Amendments to the Procedure for Dispensing Medicines, approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 14, 2005 N 785, approved by order of the Ministry of Health and Social Development of the Russian Federation dated August 6, 2007 N 521 (registered by the Ministry of Justice of the Russian Federation August 29, 2007, registration N 10063).

Minister
V.Skvortsova

Registered
at the Ministry of Justice
Russian Federation
July 22, 2014,
registration N 33210

Application. List of medicines for medical use subject to subject-quantitative accounting

Application

_______________
The medicinal products for medical use listed in this list are subject to subject-quantitative registration, regardless of their trade name.

I. Medicines - pharmaceutical substances and medicines containing narcotic drugs, psychotropic substances and their precursors (their salts, isomers, stereoisomers) and included in lists II, III, IV of the list of narcotic drugs, psychotropic substances and their precursors subject to control in Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 1998 N 681 (hereinafter referred to as narcotic drugs, psychotropic substances and their precursors), in combination with pharmacologically inactive substances, as well as medicines containing narcotic drugs, psychotropic substances and their precursors in combination with pharmacologically active substances:
(Clause as amended, put into effect on May 14, 2018 by order of the Ministry of Health of Russia dated April 5, 2018 N 149n.
________________

Decree of the Government of the Russian Federation of June 30, 1998 N 681 “On approval of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation” (Collected Legislation of the Russian Federation, 1998, N 27, Art. 3198; 2004, N 8 , Art. 663; N 47, Art. 4666; 2006, N 29, Art. 3253; 2007, N 28, Art. 3439; 2009, N 26, Art. 3183; N 52, Art. 6572; 2010, N 3 , Art. 314; N 17, Art. 2100; N 24, Art. 3035; N 28, Art. 3703; N 31, Art. 4271; N 45, Art. 5864; N 50, Art. 6696, Art. 6720 ; 2011, N 10, art. 1390; N 12, art. 1635; N 29, art. 4466, art. 4473; N 42, art. 5921; N 51, art. 7534; 2012, N 10, art. 1232 ; N 11, art. 1295; N 19, art. 2400; N 22, art. 2864; N 37, art. 5002; N 48, art. 6686; N 49, art. 6861; 2013, N 9, art. 953; N 25, art. 3159; N 29, art. 3962; N 37, art. 4706; N 46, art. 5943; N 51, art. 6869; 2014, N 14, art. 1626; N 23, art. .2987; N 27, art. 3763; N 44, art. 6068; N 51, art. 7430; 2015, N 11, art. 1593; N 16, art. 2368; N 20, art. 2914; N 28, Art. 4232; N 42, Art. 5805; 2016, N 15, Art. 2088; 2017, N 4, Art. 671, N 10, Art. 1481, N 23, Art. 3330; N 30, art. 4664; N 33, art. 5182).
(Footnote as amended, put into effect on May 14, 2018 by order of the Ministry of Health of Russia dated April 5, 2018 N 149n.

Allobarbital

Alprazolam

Aminorex

Amobarbital

Amfepramone

Aprofen

Bromazepam

Brotizolam

Buprenorphine

Buprenorphine + naloxone (medicines)
by order of the Russian Ministry of Health of October 31, 2017 N 882n)

Butalbital

Butobarbital

Butorphanol

Galazepam

Haloxazolam

4-hydroxybutyrate

Hydromorphone

Dextromethorphan

Dextromoramide

Dextropropoxyphene

Delorazepam

Diazepam

Diazepam+cyclobarbital

Dihydrocodeine

Diphenoxylate

Diethyl ether (at a concentration of 45 percent or more)

Zolpidem

Kamazepam

Ketazolam

Ketamine

Clobazam

Cloxazolam

Clonazepam

Clorazepate

Clotiazepam

Codeine

Cocaine

Lefetamine

Loprazolam

Lorazepam

Lormetazepam

Mazindol

Medazepam

Mesocarb

Meprobamate

Methylphenobarbital

Mefenorex

Midazolam

Modafinil

Morphine

Nalbuphine

Nimetazepam

Nitrazepam

Nordazepam

Oxazepam

Oxazolam

Oxycodone

Oxycodone + naloxone (medicines)
(The position was additionally included from January 20, 2018 by order of the Russian Ministry of Health dated October 31, 2017 N 882n)

Omnopon

Pemolin

Pentazocine

Potassium permanganate (at a concentration of 45 percent or more)

Pinazepam

Pipradrol

Piritramide

Prazepam

Prosidol

Pseudoephedrine (at a concentration of 10 percent or more)

Remifentanil

Secbutabarbital

Sufentanil

Thebaine

Temazepam

Tetrazepam

Tianeptine

Tilidin

Triazolam

Trimeperidine

Phendimetrazine

Phenylpropanolamine (at a concentration of 10 percent or more)

Phenobarbital

Fentanyl

Phentermine

Fludiazepam

Flunitrazepam

Flurazepam

Chlordiazepoxide

Cyclobarbital

Ergometrine (at a concentration of 10 percent or more)

Ergotamine (at a concentration of 10 percent or more)

Estazolam

Ethyl loflazepate

Ethylmorphine

Ephedrine (at a concentration of 10 percent or more)

II. Medicines - pharmaceutical substances and medicinal preparations containing potent and toxic substances (their salts, isomers, ethers and esters, mixtures and solutions, regardless of concentration), included in the lists of potent and toxic substances for the purposes of Article 234 and other articles of the Criminal Code of the Russian Federation Federation, approved by Decree of the Government of the Russian Federation of December 29, 2007 N 964 (hereinafter referred to as potent and toxic substances), in combination with pharmacologically inactive substances, as well as medicines containing potent and toxic substances in combination with pharmacologically active substances (subject to inclusion them in the list as a separate item):
_______________
Collection of Legislation of the Russian Federation, 2008, No. 2, Art. 89; 2010, N 28, art. 3703; 2012, N 10, art. 1232; N 41, art. 5625; 2013, N 6, art. 558; N 9, art. 953; N 45, art. 5831.

Androstanolone

Aceclidine

Benactizine

Benzobarbital

Bromized

Hexobarbital

Hyoscyamine

Gestrinone

Danazol

Snake venom (except for dosage forms for external use - creams, ointments, gels)

Zopiclone

Carbacholine

Clozapine

Clonidine

Clostebol

Levomepromazine

Mesterolone

Methandienone

Methandriol

Methenolone

Methyltestosterone

Nandrolone

Norclostebol

Bee venom (except for dosage forms for external use - creams, ointments, gels)

Sibutramine

Scopolamine

Ethyl alcohol (Ethanol)
by order of the Ministry of Health of Russia dated September 10, 2015 N 634n.

Total belladonna alkaloids (except for solid dosage form - suppositories)
(Position as amended, put into effect on October 1, 2015 by order of the Ministry of Health of Russia dated September 10, 2015 N 634n.

1-testosterone (except for dosage forms for external use - creams, ointments, gels)

Sodium thiopental

Tramadol

Tramadol 37.5 mg + paracetamol

Trihexyphenidyl

Feprozidnin

Chloroform

Ergotal

Ethyl chloride

III. Combined medicinal products containing, in addition to small quantities of narcotic drugs, psychotropic substances and their precursors, other pharmacological active substances:
_______________
Clause 5 of the Procedure for dispensing to individuals medicinal products for medical use containing, in addition to small quantities of narcotic drugs, psychotropic substances and their precursors, other pharmacological active substances, approved by order of the Ministry of Health and Social Development of the Russian Federation dated May 17, 2012 N 562n (registered by the Ministry of Justice of the Russian Federation Federation on June 1, 2012, registration N 24438), as amended by order of the Ministry of Health of the Russian Federation dated June 10, 2013 N 369n (registered by the Ministry of Justice of the Russian Federation on July 15, 2013, registration N 29064).

2) pseudoephedrine hydrochloride in an amount exceeding 30 mg and up to 60 mg inclusive (per 1 dose of solid dosage form);

3) pseudoephedrine hydrochloride in an amount exceeding 30 mg, and up to 60 mg inclusive, in combination with dextromethorphan hydrobromide in an amount exceeding 10 mg, and up to 30 mg inclusive (per 1 dose of solid dosage form);
(Clause as amended, put into effect on October 1, 2015 by order of the Ministry of Health of Russia dated September 10, 2015 N 634n.

4) dextromethorphan hydrobromide in an amount up to 200 mg inclusive (per 100 ml or 100 g of liquid dosage form for internal use);

5) ephedrine hydrochloride in an amount exceeding 100 mg and up to 300 mg inclusive (per 100 ml or 100 g of liquid dosage form for internal use);

6) ephedrine hydrochloride in an amount up to 50 mg inclusive (per 1 dose of solid dosage form);

7) phenylpropanolamine in an amount up to 75 mg inclusive (per 1 dose of solid dosage form) or up to 300 mg inclusive (per 100 ml or 100 g of liquid dosage form for internal use);

8) phenobarbital in an amount up to 15 mg inclusive in combination with codeine (or its salts) regardless of the amount (per 1 dose of solid dosage form);

9) phenobarbital in an amount up to 20 mg inclusive in combination with ephedrine hydrochloride, regardless of the amount (per 1 dose of solid dosage form);

10) chlordiazepoxide in an amount exceeding 10 mg and up to 20 mg inclusive (per 1 dose of solid dosage form).

IV. Other medicines subject to subject-quantitative accounting:

Pregabalin (medicines)

Tapentadol (medicines)
(The position was additionally included from August 26, 2018 by order of the Russian Ministry of Health dated July 27, 2018 N 471n)

Tropicamide (medicines)

Cyclopentolate (medicines).
(The section was additionally included from October 1, 2015 by order of the Russian Ministry of Health dated September 10, 2015 N 634n)

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changes and additions prepared
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