ЭВН. АНГЛ..ppt

EXAMINATION OF TEMPORARY
DISABILITY
E.Y. Zangerova, Candidate of Medical Science
Translated from Russian: N.E. Bastrakova
Mari State University

THE MAIN REGULATORY LEGALACTS REGULATING THE
EXAMINATION OF TEMPORARY DISABILITY
 Federal Law No. 323-FZ of 21.11.2011 "On the Basics of Public
Health protection in the Russian Federation";
 Federal Law No. 255-FZ of 29.12.2006 "On Compulsory Social
insurance in case of temporary disability and in connection with
maternity";
 Order of the Ministry of Health and the SR of the Russian
Federation No. 624n dated 29.06.2011 "On Approval of the
Procedure for issuing Disability Certificates" (as amended on
01.05.2017 No. 86-FZ);
Federation dated 24.01.2012 No. 31n "On Amendments to the
Procedure for Issuing Disability Certificates, approved by the
Order of the Ministry of Health and the SR of the Russian
Federation dated 29.06.2011 No. 624n";
 Order of the Ministry of Health of the Russian Federation of
23.08.2016 N 625n "On approval of the Procedure for the
examination of temporary disability";

Federation No. 347n dated 04/26/2011 "On approval of the form
of the disability certificate form";
Federation No. 502n dated 05.05.2012 "On approval of the
procedure for the establishment and operation of the medical
commission of a medical organization";
 Order of the Ministry of Health of the Russian Federation and
the FSS of the Russian Federation dated 06.10.1998 No. 291/167
"On approval of the Instructions on the procedure for
monitoring the organization of the examination of temporary
disability";
Federation and the FSS of the Russian Federation dated
29.01.2004 No. 18/29 "On approval of the instructions on the
procedure for providing forms of disability sheets, their
accounting and storage";
 Approximate terms of temporary disability in the most common
diseases and injuries (guidelines, 2000)

Basic concepts
 Expertise is the study by a specialist or a group of specialists of a
question that requires special knowledge in any field of science,
technology, art, etc. for its solution.
 Expert (exspertus, lat. - experienced) - a specialist who gives an
opinion (conclusion) when considering any issue.
 Medical examination is a study aimed at establishing the state of
health of a citizen, in order to determine his ability to carry out
labor or other activities, as well as to establish a causal
relationship between the impact of any events, factors and the
state of health of a citizen.

5
A medical examination is a study conducted in accordance with the established
procedure in order to establish the state of health of citizens, as well as a causal
relationship between the impact of any events, factors and the state of health of a
citizen.
Types of medical examinations
Examination of temporary
disability
Medical and social expertise
Military medical
examination and
independent military
medical examination
Forensic medical and forensic
psychiatric examinations
Examination of professional
suitability and connection of the
disease with the profession
ON THE BASICS OF PUBLIC HEALTH PROTECTION IN THE RUSSIAN
FEDERATION
Quality expertise

 Examination of temporary disability is carried out in order to determine
the ability of a citizen to carry out labor activity, the need and timing of
transfer for health reasons to another job, making a decision on referral for
medical and social examination;
 A medical and social examination is carried out in order to determine the
needs of the examined person in social protection measures, including
rehabilitation, based on an assessment of the limitations of vital activity
caused by a persistent disorder of body functions;
 Military medical examination is carried out in order to :
1) determination of fitness for military service (equivalent service), training
(service) in specific military accounting specialties;
2) establishing the causal relationship of injuries (wounds, injuries,
contusions), diseases in military personnel (persons equated to them,
citizens called up for military training) and citizens discharged from
military service (service equated to it, military training), with the passage of
military service (service equated to it);

 Forensic medical and forensic psychiatric examinations are carried out in
order to establish the circumstances to be proved in a particular case;
 The examination of professional suitability is carried out in order to :
1) determining the compliance of the employee's health status with the
possibility of performing certain types of work;
2) establishing a causal relationship of the disease with professional activity;
 The examination of the quality of medical care is carried out in order to
identify violations in the provision of medical care, including assessing the
timeliness of its provision, the correctness of the choice of methods of
prevention, diagnosis, treatment and rehabilitation, the degree of
achievement of the planned result.

Temporary disability is a condition of the human body caused by illness, injury and
other causes in which functional disorders are accompanied by the inability to
perform professional work in normal production conditions for a certain period of
time, i.e. they are reversible.
Temporary disability is established
!!! Illness and disability are not always identical concepts. In addition, the cause of
disability is not always the disease of the patient himself.
with a favorable forecast with an unfavorable
prognosis
For the entire period of
illness, until recovery
Before the identification of
persistent disability
(disability)

Causes of temporary disability :
 Medical indications for the inability to work (illness, injury, accident at
work and at home);
 Spa treatment, rehabilitation;
 Preventive measures (pregnancy, childbirth);
 Social activities (care for a sick family member, a healthy child, a disabled
child, quarantine, prosthetics)
!!!! Each of the reasons has its own peculiarities of definition and
registration, and some of them entail a special payment according to a
document confirming the fact of disability (sick leave).

The examination of temporary disability is carried out in order to determine:
- the ability of an employee to carry out labor activity,
- The need and timing of temporary or permanent transfer of an employee for
health reasons to another job;
- making a decision on sending a citizen for a medical and social examination.
The examination of temporary disability includes:
 determination of signs of temporary disability based on an assessment of health
status, nature and working conditions, social factors;
 fixation in primary medical documents of the patient's complaints, anamnestic
and objective data, prescriptions, formulation of the diagnosis of the disease and
the degree of functional disorders of organs and systems, the presence of
complications causing disability, the dynamics of the condition;

 appointment of therapeutic and health-improving
measures, therapeutic and protective regime,
diagnostic procedures, consultations;
 determination of the terms of disability, taking into
account the individual characteristics of the course of
the main and concomitant diseases, the presence of
complications and approximate terms of disability in
various diseases and injuries;
 issuance of disability certificates (certificate);
 identification of signs of persistent disability and
permanent disability, referral of the patient to the
clinical expert commission and medical and social
expertise;
 when restoring the ability to work and being
discharged to work, fixation in primary medical
documents of the objective status and reasoned
justification for closing the disability certificate;

Examination of temporary disability is carried out by:
 by the attending physician;
 a paramedic in cases of assigning to him certain functions of the
attending physician;
 a dentist for dental diseases in the absence of a dentist in a
medical organization providing primary health care or its
structural subdivision;
 by the medical commission of a medical organization;
Examination of temporary disability is carried out on the day of a
citizen's application to a medical organization.
According to the results of the examination of temporary disability,
if a decision is made on the temporary inability of a citizen to carry
out work, he is issued a disability certificate.

The procedure for registration, accounting and storage of documents
certifying temporary disability
 The documents certifying temporary disability and confirming temporary release
from work (study, service) are a certificate of disability (DC), and in some cases,
certificates of the prescribed form.
 The disability certificate performs the following functions:
 legal (exemption from work in case of temporary disability);
 financial (accrual of temporary disability benefits);
 medical (prescribes a certain type of medical and protective regime);
 statistical (is the primary medical document for the analysis of the a disease
associated with temporary loss of legal capacity ).

The issuance of disability certificates is carried out by
employees of organizations that, in accordance with the
legislation of the Russian Federation on licensing, have a
license for medical activities, including work on the
examination of temporary disability.
Medical workers who do not issue disability certificates:
 organizations of emergency medical care;
 blood transfusion organizations;
 reception (admission) departments of hospital institutions;
 balneological hospitals and mud baths;
 medical organizations of a special type (centers of disaster medicine,
medical prevention, bureau of forensic medical examination);
 healthcare institutions for supervision in the field of consumer
protection and human well-being

A disability certificate is issued to insured persons who are:
 persons working under employment contracts;
 state civil servants, municipal employees;
 persons holding public positions of the Russian Federation, public
positions of a constituent entity of the Russian Federation, as well
as municipal positions filled on a permanent basis;
 members of a production cooperative who take personal labor
participation in its activities
 ;to the clergy;
 lawyers, individual entrepreneurs, members of peasant (farmer)
farms, individuals who are not recognized as individual
entrepreneurs (notaries engaged in private practice, other persons
engaged in private practice in accordance with the procedure
established by the legislation of the Russian Federation), members
of family (tribal) communities of indigenous minorities of the
North, voluntarily entered into legal relations on compulsory social
maternity and paying for themselves insurance contributions to the
Social Insurance Fund of the Russian Federation;

 other categories of persons who are subject to compulsory social
maternity, compulsory social insurance against industrial accidents and
occupational diseases in accordance with federal laws, provided that
they pay or for them insurance contributions to the Social Insurance
Fund of the Russian Federation;
 persons whose illness or injury occurred within 30 calendar days from
the date of termination of work under an employment contract,
performance of official or other activities, or in the period from the
date of conclusion of the employment contract to the date of its
cancellation;
 women dismissed in connection with the liquidation of organizations, in
connection with the termination of their activities as an individual
entrepreneur, the termination of their powers by a notary engaged in
private practice, the termination of the status of a lawyer, whose
pregnancy occurred within 12 months before they were recognized as
unemployed in accordance with the established procedure

 citizens recognized as unemployed and registered in state institutions of
the employment service of the population, in case of illness, injury,
poisoning and other conditions associated with temporary disability,
during prosthetics in a hospital, pregnancy and childbirth, when
adopting a child;
 insured persons from among foreign citizens and stateless persons
temporarily residing in the territory of the Russian Federation who
have lost their ability to work due to an industrial accident or
occupational disease;

A disability certificate is not issued to citizens:
 those who have applied for medical assistance to a medical organization, if
they have no signs of temporary disability;
 undergoing medical examination, medical examination or treatment in the
direction of military commissariats;
 being in custody or administrative arrest;
 undergoing periodic medical examinations (examinations), including in
occupational pathology centers;
 with chronic diseases without exacerbation (deterioration), undergoing
examination, taking various procedures and manipulations in outpatient
conditions;
 students of educational institutions of primary vocational, secondary
vocational and higher vocational education and institutions of
postgraduate vocational education.
In these cases, at the request of a citizen, an extract from the medical card of
an outpatient (inpatient) patient is issued.

Procedure for issuing disability certificates
Centralized issuance of
LN
The employee (m/n -
medical nurse) draws up
on the basis of the
certificate (coupon) of
the attending physician
with registration in the
"DC Registration Book"
Decentralized issuance of
LN
DC is issued by the
attending physician

Electronic disability sheets
The employee gives written consent to
the registration of an electronic leaflet
The company pays for sick
leave
A worker
The company fills out its
part of the leaflet through
the personal account of
the SSF
A company
A doctor
The doctor includes the sick
leave in the SSF database
SSF
electronic
system
The Fund receives
information about
sick leave ФСС

Procedure for registration of documents certifying temporary disability
 Disability certificates are issued upon presentation of the patient's identity document.
 The issuance and extension of a document certifying temporary disability is carried
out by a doctor after a personal examination and is confirmed by an entry in the
medical documentation justifying temporary release from work.
 Forms of disability sheets are registered in the primary medical documentation
indicating their number, date of issue and extension, discharge of a citizen to work,
information about the direction of a citizen to another medical organization.
 A document certifying temporary disability is issued and closed, as a rule, in one
medical and preventive institution and, if indicated, can be extended in another.
 A certificate of incapacity for work is issued to a citizen by a medical organization at
his request on the day of application or on the day of closure of the certificate of
incapacity for work

Article 59. Examination of temporary disability (Federal Law-323)
2. The examination of temporary disability is carried out by the attending physician, who
alone issues disability sheets to citizens for up to fifteen calendar days inclusive.
The examination of temporary disability can be carried out by a paramedic or a dentist,
who alone issues disability sheets to citizens for up to ten calendar days inclusive.
3. The extension of the disability certificate for a longer period, but not more than fifteen
calendar days at a time, is carried out by the decision of the medical commission
appointed by the head of the medical organization from among the doctors who have
been trained in the examination of temporary disability.
4 . In case of an obvious unfavorable clinical and labor prognosis, no later than four
months from the date of the beginning of temporary disability, the patient is sent to
undergo a medical and social examination in order to assess disability, and in case of
refusal to undergo a medical and social examination, the disability sheet is closed.
With a favorable clinical and labor prognosis no later than ten months from the date of
the beginning of temporary disability;
in the condition after injuries and reconstructive operations ,
in the treatment of tuberculosis, no later than twelve months, the patient is either
discharged for employment, or sent for a medical and social examination.
!!!!! with the frequency of extension by the decision of the medical commission at least 15
calendar days.
24

 In case of long-term treatment, the medical organization issues a new
disability certificate (continued) and at the same time draws up the
previous disability certificate for the appointment and payment of
temporary disability, pregnancy and childbirth benefits.
 Citizens who are outside their permanent place of residence, a certificate of
disability is issued (extended) by the attending physician who has
established the fact of disability, with the permission of the administration
of a medical and preventive institution, taking into account the days
required for travel to the place of residence.
 When a citizen is discharged after inpatient treatment, a disability
certificate is issued on the day of discharge from the hospital for the entire
period of inpatient treatment. If temporary disability continues, the
disability certificate may be extended up to 10 calendar days.
 In case of temporary disability due to an illness (occupational disease,
injury, including those resulting from an industrial accident, poisoning) of
a citizen who has occurred during the annual paid vacations, a disability
certificate is issued in accordance with the applicable regulatory
documents

The procedure for issuing a disability certificate for the period of sanatorium
treatment
 When referring patients for further treatment to specialized
sanatorium-resort institutions, immediately after inpatient treatment,
the disability certificate is extended by a medical worker by decision of
the VC of the sanatorium-resort institution for the entire period of
further treatment, but not more than 24 calendar days.
 When referring persons injured in connection with a serious
accident at work to sanatorium treatment during the period
of temporary disability (before referral to the MSE), a
disability certificate is issued for the entire period of
treatment and travel by decision of the medical commission
 When referring tuberculosis patients by medical organizations to
specialized (antituberculous) sanatorium-resort institutions for
treatment in the case when sanatorium-resort treatment replaces
inpatient treatment, as well as for follow-up after inpatient treatment,
a disability certificate is issued by the decision of the MC of the
tuberculosis dispensary and is extended by the medical commission of
the specialized (antituberculous) sanatorium-resort institution for the
entire period of treatment, follow-up and travel.

Procedure for issuing a disability certificate for prosthetics
Citizens sent by a medical organization for prosthetics to an
inpatient specialized institution, a disability certificate is issued
by this medical organization for the time of travel to the place of
prosthetics. The issued disability certificate is extended to
medical workers of a stationary specialized institution for the
entire period of prosthetics and the time of travel to the place of
registration at the place of residence (at the place of stay,
temporary residence).

The procedure for issuing a disability certificate for caring for a sick
family member
Issued:
 one of the family members (guardian, trustee, other relative) who actually provides
care.
A disability certificate is issued for the care of a sick family member:
 a child under the age of 7 years: with outpatient treatment or joint stay in an
inpatient medical facility - for the entire period of acute illness or exacerbation of a
chronic disease, but not more than 60 calendar days. in a calendar year;
 a child aged 7 to 15 years: with outpatient treatment or a joint stay of one of the
family members in an inpatient medical facility for up to 15 days for each case of
the disease, unless a longer period is required according to the conclusion of the
MC;
 a disabled child under the age of 15: with outpatient treatment or a joint stay of one
of the family members with a child in an inpatient medical facility - for the entire
period of acute illness or exacerbation of a chronic disease;ребенком старше 15
лет:
 for outpatient treatment - for up to 3 days, according to the decision of the MC - up
to 7 days for each case of the disease.
 In case of illness of two children, one disability certificate is issued at the same time
to care for them. If more than two children are ill at the same time, a second
disability certificate is issued.

 In case of illness of the second (third) child during the illness of the first child, the
disability certificate issued for the care of the first child is extended until all children
recover, without counting the days coinciding with the days of release from work for
the care of the first child. At the same time, the disability sheet indicates the dates of
the beginning and end of the disease, the names and ages of all children.
 in other cases of caring for a sick family member during outpatient treatment - no
more than 7 calendar days for each case of the disease, but no more than 30
calendar days in a calendar year for all cases of caring for this family member.
!!!A certificate of incapacity for work is not issued for care:
 for a sick family member over 15 years of age with inpatient treatment;
 for chronic patients in remission;
 during the period of annual paid leave and leave without pay;
 during maternity leave;
 during the period of parental leave until the child reaches the age of 3 years, except
in cases of performing work during the specified period on a part-time basis or at
home.
 in case of a child's illness during the period when the family member actually caring
for the child does not need to be released from work (annual paid leave, maternity
leave, parental leave until they reach the age of 3 years, leave without pay), a child
care disability certificate is issued from the day when the family member actually
caring for the child should start work.

The procedure for issuing a certificate of disability for pregnancy and childbirth
A certificate of disability for pregnancy and childbirth is issued by an obstetrician-
gynecologist, in his absence - by a general practitioner (family doctor), and in the absence
of a doctor - by a paramedic.
 A maternity disability certificate is issued at 30 weeks of pregnancy for a one-time period
of 140 calendar days (70 calendar days before delivery and 70 calendar days after
delivery).
 In case of multiple pregnancies, a maternity disability certificate is issued at 28 weeks of
pregnancy for a one-time duration of 194 calendar days (84 calendar days before delivery
and 110 calendar days after delivery).
 In the case when the diagnosis of multiple pregnancy is established in childbirth, a
maternity disability certificate is issued for an additional 54 calendar days by the medical
organization where the birth took place.
 In case of complicated childbirth, a maternity disability certificate is issued for an
additional 16 calendar days by the medical organization where the birth took place.
 In case of childbirth that occurred during the period from 22 to 30 weeks of pregnancy, a
maternity disability certificate is issued by the medical organization where the birth took
place for a period of 156 calendar days.
 In case of termination of pregnancy for up to 21 full weeks of pregnancy, a disability
certificate is issued for the entire period of disability, but for a period of at least three
days.
 Upon the onset of maternity leave during the period when a woman is on annual basic or
additional paid leave, parental leave until the age of 3 years, a maternity disability
certificate is issued on a general basis.

Functions of the head of the department of the hospital, polyclinic at ETD:
 carries out constant monitoring of the performance by attending physicians
of the functions of conducting the therapeutic and diagnostic process and
examination of the TD, the publication of documents certifying the VN,
timely and correct referral of patients to the MC and MSE;
 carries out an expert assessment of the quality of medical care to patients at
different periods of treatment with mandatory personal examination and
entry in primary medical documents;
 conducts an expert assessment of medical documentation at the end of the
period of ND or when transferring the patient to another stage of
treatment;
 together with the attending physician, he directs the patient to the TD and
MSE;
 analyzes monthly the causes and timing of temporary disability, primary
disability and clinical and expert errors.

The main tasks of the Deputy head for expertise (Deputy Head of the Medical
Establishment for the medical part are:
 control over the organization and examination of temporary disability in a medical
organization;
 conducting an analysis of the morbidity of the population with temporary disability, the
initial exit of patients to disability, ensuring the development and implementation of
measures to reduce them;
 participation in the preparation of documents regulating the organization and examination
of temporary disability;
 assessment of the expert activity of attending physicians and organization of work on the
examination of temporary disability of heads of departments of a medical organization;
 control over the validity of the issuance and extension of disability certificates;
 control over the maintenance of medical records, statistical accounting and reporting on
supervised work sections;

The Medical Commission performs the following functions:
 decision-making on prevention, diagnosis, treatment, medical
rehabilitation and sanatorium treatment of citizens in the most difficult
and conflict situations requiring commission consideration;
 determination of the working capacity of citizens;
 extension of disability certificates in cases established by the legislation of
the Russian Federation;
 making a decision on the referral of a patient for medical and social
examination in accordance with the legislation of the Russian Federation;
 conducting an examination of the professional suitability of certain
categories of employees;
 assessment of the quality, validity and effectiveness of therapeutic and
diagnostic measures, including prescribing medicines;
 assessment of compliance with the established procedure for maintaining
medical records in a medical organization;

ЭВН. АНГЛ..ppt

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