Dental beauty and health 

Terms of mandatory examinations of children by specialists. Medical examinations of minors. Reducing the volume of medical research during preventive medical examinations

The older a person becomes, the more often he needs to undergo a preventive examination to identify hidden diseases and risk factors. And once every three years, every citizen of our country can do it for free - at the expense of the state, which assumes all the costs of general medical examination. Alexander Ivanov, candidate of medical sciences, osteopath, neurologist, spoke about why this opportunity should not be neglected, and about various aspects of medical examination in his new article.

PREVENT EASIER THAN TO TREAT!

One of the measures of the state's concern for the health of the population is clinical examination, that is, a preventive examination of people who have no complaints.

In our country, clinical examination resumed in 2012. In 2015, the Order of the Ministry of Health of the Russian Federation No. 36 was published, which declares the right of all citizens of the Russian Federation who have reached the age of 21 to free medical examination once every three years.

The idea is undoubtedly great and is aimed at identifying the first signs of diseases that a person does not even know about. It is easier to prevent than to cure. In Russia, there is a high mortality rate from diseases of the cardiovascular system, oncology, diabetes mellitus and lung diseases. The general medical examination of the country's population is aimed at preventing these socially significant diseases.

WHERE IS THE DISPENSERIZATION, WHO HAS THE RIGHT

According to the order of the Ministry of Health of the Russian Federation No. 36, clinical examination is a voluntary matter, no one will punish you if suddenly you do not pass it. But it is important to remember that this year people born in the following years (see Figure 1) have the right to go through the list of approved studies and consultations free of charge, according to the order of the Ministry of Health. So, in 2018, citizens of the Russian Federation born in:

1919, 1922, 1925, 1928, 1931, 1934, 1937, 1940, 1943, 1946, 1949, 1952, 1955, 1958, 1961, 1964, 1967, 1970, 1973, 1976, 1979, 1982, 1985, 1988, 1991, 1994, 1997.

To undergo medical examination, you can contact the polyclinic at the place of residence (where you are attached), and the medical institution has no right to refuse you. The referral is issued with a passport and an OMS policy. If you work, then the employer, according to the legislation of the Russian Federation, has no right to interfere with your medical examination.

HOW IS THE DISPENSERIZATION

Clinical examination takes place in two stages. At the first stage, possible chronic diseases and their risk factors are identified in a person: a survey and questioning of the patient is carried out in order to identify bad habits and risk factors (smoking, alcohol consumption, taking psychotropic and narcotic substances, assessing the nature of nutrition, physical activity). In addition, it is carried out:

  • Anthropometry (measurement of height, weight, waist circumference and determination of BMI - body mass index).
  • Measurement of blood pressure.
  • Rapid method for determining the level of total cholesterol and blood glucose; measurement of intraocular pressure (after 60 years).
  • Electrocardiography (men 35 and older, women 45 and older).
  • Cytological examination of a smear from the cervix (for women from 30 to 60 years old).
  • Fluorography.
  • Mammography (for women from 39 to 48 years old - once every 3 years, for women from 50 to 70 years old - once every 2 years).
  • Study of feces for occult blood by the immunochemical method (once every 2 years from 49 to 73 years).
  • Determination of PSA in the blood of men at the age of 45 and at 51.
  • HIV testing (from 21 years old).

This year, clinical and biochemical blood tests, urinalysis, and ultrasound of the abdominal organs were removed from the primary stage of clinical examination. They will be done if there are complaints.

The first stage ends with an examination and consultation of a therapist, a health group is determined, recommendations on nutrition, physical activity are given, and indications for the second stage of clinical examination are determined.

Based on the results of the primary screening stage, all patients are divided into three health groups: the first group is relatively healthy, the second group is people with a high risk of developing heart and vascular diseases, and the third group is sick. The third group is subject to compulsory dispensary observation and treatment.

The second stage of clinical examination is carried out to clarify the state of human health using additional examination methods. It may include consultations with narrow specialists.

So, the second stage is:

  • Examination by a neurologist with suspected acute cerebrovascular accident.
  • Duplex scanning of brachycephalic arteries.
  • Consultation with a urologist or surgeon with an elevated PSA in the blood of more than 1 nanogram per milliliter.
  • Examination by a coloproctologist or surgeon with a positive fecal occult blood test with a referral for further examination - sigmoidoscopy, fibrocolonoscopy.
  • Spirometry for suspected respiratory diseases and in smokers.
  • Examination by a gynecologist when changing a cervical smear or mammography.
  • Examination by an ENT doctor and an ophthalmologist.

The second stage ends with an examination by a therapist. If necessary, a person is sent for further examination on the recommendation of a specialist doctor.

HOW TO PREPARE FOR DISPENSERIZATION

Before you come to the clinic on the appointed day, you must not eat for several hours (take tests on an empty stomach) and not have intense physical activity. Take a jar of morning urine (150 milliliters) with you. If you are over 45 years old, then you need to prepare a fecal occult blood test. If there are test results from earlier, do not forget to take them with you. The second stage of clinical examination takes place more individually, based on the results of the first stage. Don't forget your compulsory medical insurance policy and passport!

HEALTH SYSTEM "SEVEN D" ACCORDING TO IVANOV

In my author's system of health improvement "Seven D", clinical examination is mandatory, and the frequency of its conduct is at least once a year, starting from the age of 25. In addition to the above analyzes and studies on the mandatory medical examination program in 2018, I recommend supplementing the picture of your health with information on the following parameters (of course, these procedures are paid for independently):

  • Serum iron levels, ferritin.
  • Microelements and macronutrients (zinc, selenium, magnesium, calcium, sulfur, chromium, iodine).
  • Heavy metals (mercury, lead, aluminum, cadmium)
  • Vitamin D.
  • Vitamin B12.
  • Folic acid.
  • Omega-3 index.

These indicators can significantly affect the level of your health and the prognosis of the duration and quality of life.

SUMMARY

2. Clinical examination is aimed at identifying chronic diseases and risk factors for their formation, which ultimately increases the quality and duration of human life.

3. You can undergo medical examination in the clinic at the place of residence, for this you need a compulsory medical insurance policy and a passport.

4. Clinical examination takes place in two stages, according to the results of which health groups are formed, diseases are detected and treatment and dispensary observation are carried out.

5. You can supplement information about your health with additional research (microelements, macronutrients, vitamins, heavy metals), but this is no longer included in the standard paid by the state, however, knowledge of these data and their correction can significantly affect human health.

Take care of yourself and be healthy!

Alexander Ivanov

The clinical examination procedure in Russia began in 2013. The new orders of the Ministry of Health were associated with an increase in the mortality rate in the Russian Federation and an increase in the number of people with oncology, sexually transmitted diseases, infectious diseases in an advanced form.

The new program of the ministry assumed mass medical examinations of citizens of a certain age. This set of procedures pursued several goals:

  1. Help patients diagnose diseases leading to disability and death in time.
  2. Identify the age group of people who are most susceptible to certain dangerous diseases.
  3. Identify risk groups.

Clinical examination is a voluntary service, it does not imply a forced examination of patients. But still, a visit to a doctor is desirable for people who work, for example, in the social sphere, in the field of education or in the health sector. You can make an appointment with a doctor as part of a medical examination on any working day by visiting a local clinic. To confirm your identity, you must take your passport with you (in the registry they look at the year of birth and residence permit) and a policy of compulsory or voluntary medical insurance.

This procedure does not apply to those categories of citizens of the Russian Federation who have already been diagnosed with dangerous infectious diseases, disabled people of all groups, WWII veterans, children of war, military personnel, disabled people from the Chernobyl accident.

What has changed in 2018?

In January 2018, a new decree of the Ministry of Health was issued, which amends the procedure for medical examination in 2018.

The main changes were made to the points that relate to:

  • the age category of persons who fall under the prophylactic medical examination procedure;
  • stages of medical examination;
  • the procedure for appointing an additional examination;
  • the number of examinations that people of a certain gender, age group, specific profession, etc. must undergo;
  • tests that need to be passed to certain categories of citizens.

Essentially, in the clinical examination in 2018, in comparison with the surveys of previous years, it affected those groups of analyzes that were previously considered mandatory for a free routine medical examination.

So, in 2018 excluded from the list of mandatory tests the following types of diagnostics:

  • Abdominal ultrasound,
  • Ultrasound of the small pelvis.

These points are the most discussed among the supporters and opponents of the reform. A general blood test and a general urine test were excluded from the examination system because these fences were recognized by the Ministry as ineffective: according to the results of these tests, it is not always possible to accurately diagnose or even identify minimal deviations in the system of functioning of certain organs.

Meanwhile, earlier therapists prescribed OAC and OAM to identify the early stages of serious infectious diseases, to diagnose hematological diseases and abnormalities in the functioning of the urinary system, to detect oncology of the kidneys, cervix, abdominal cavity, diseases of the bladder and prostate, to detect sugar diabetes.

Replacing these types of tests involves an analysis of feces for occult blood (helps to diagnose oncology at different stages) and a blood test for PSA. The problem is that PSA blood tests require significant financial costs, for which the Ministry cannot afford to allocate money. That is why this type of analysis will be carried out only for patients of retirement age... How are they going to diagnose prostate cancer in able-bodied patients is a matter of debate.

What years are undergoing medical examination in 2018?

Since 2013, the procedure of voluntary free medical examination has covered all categories of adult citizens, and the medical examination-2018 was no exception. Which birth years are subject to mandatory examination?

Age intervals are calculated every three years from 1928 to 1997 inclusive, namely: 1928, 1931, 1934, 1937, 1940, 1943, 1946, 1949, 1952, 1955, 1958, 1961, 1964, 1967, 1970, 1973, 1976, 1979, 1982, 1985, 1988, 1991, 1997.

Since the clinical examination procedure is not carried out every year, but every 3 years, 2018 captures the year of birth from steps of 3 years between 1928 and 1997.

Those categories of citizens who have already been identified as a risk group (military personnel, veterans of the Great Patriotic War, children of war, children under 18, disabled people from the Chernobyl accident) are required to undergo a free medical examination not once every 3 years, but every year.

What surveys are carried out for different categories of citizens?

The new procedure for clinical examination in 2018 includes a system of mandatory tests that were included in the list of procedures only this year. Among them, as already mentioned, is a fecal occult blood test (for all categories of citizens) and a blood test for PSA (for people of retirement age).

For women, a mandatory examination is mammography. Ultrasound of the pelvis and ultrasound of the abdominal cavity is now optional. You can pass them no more than 1 time in 6 years (without special purpose) at the request of the patient.

All citizens over 38 years old are required to undergo the procedure for measuring intraocular pressure by an ophthalmologist (diagnoses inflammatory eye diseases, glaucoma, general dehydration, underdevelopment of the eyeballs, low blood pressure).

Citizens who have stepped over the 48-year-old limit must necessarily donate feces for the occult blood of the gastrointestinal tract in order to exclude the defeat of the body by cancer.

In general, the medical examination in 2018 differs little from the same procedure in previous years. Significant changes and clarifications are needed only for general analyzes aimed at diagnosing a number of infectious and oncological diseases.

The creation of the necessary conditions for the protection and strengthening of the health of students is one of the activities of educational organizations. In turn, health protection includes the passage of students in accordance with the legislation of the Russian Federation of periodic medical examinations. However, minors may also be subject to other types of examinations. Let's consider the order of carrying out each of them.

Types of medical examinations of minors

The legislation on health care establishes the obligation to conduct preliminary medical examinations of minors entering educational organizations, as well as periodic medical examinations of students. This requirement is contained in clauses 2, 3, part 2 of Art. 46 of the Federal Law of November 21, 2011 No. 323-FZ "On the Fundamentals of Health Protection of Citizens in the Russian Federation" (as amended on December 28, 2013; hereinafter - Federal Law No. 323-FZ).

Medical checkup is a complex of medical interventions aimed at identifying pathological conditions, diseases and risk factors for their development (part 1 of article 46 of the Federal Law No. 323-FZ). A prerequisite for medical intervention is the giving of informed voluntary consent of a minor or his legal representative to medical intervention in compliance with the requirements established by Art. 20 of Federal Law No. 323-FZ. The procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types of medical interventions, the form of informed voluntary consent to medical intervention and the form of refusal to medical intervention were approved by Order of the Ministry of Health of Russia dated 20.12.2012 No. 1177n.

For your information

In accordance with Art. 26, 28 of the Civil Code of the Russian Federation, Art. 64 of the Family Code of the Russian Federation, the legal representatives of minors are parents, adoptive parents, guardians (trustees).

The procedure for minors to undergo medical examinations, including upon admission to educational institutions and during the period of study in them(hereinafter referred to as the Procedure), approved by Order of the Ministry of Health of Russia dated December 21, 2012 No. 1346n. The document is valid from 06.05.2013. Clause 1 of the Procedure provides for the following types of medical examinations of minors :

  • preventive;
  • preliminary for admission to educational institutions;
  • periodic during the period of study in educational institutions.

Preventive medical examinations of minors are carried out at established age periods for the purpose of early (timely) detection of pathological conditions, diseases and risk factors for their development, as well as in order to form groups of health status and develop recommendations for minors (clause 3 of the Procedure).

Preliminary medical examinations of minors are carried out upon admission to educational institutions in order to determine the student's compliance with the educational requirements (clause 4 of the Procedure).

Periodic medical examinations of minors are carried out in order to dynamically monitor the state of health of students, to timely identify the initial forms of diseases, early signs of the impact of harmful and (or) dangerous factors of the educational process on their health and to identify medical contraindications to continuing their studies (clause 5 of the Procedure). Periodic inspection is carried out at intervals established by law.

It is important! All types of examinations of minors can only be carried out by medical organizations, regardless of their organizational and legal form, providing primary health care to minors and licensed to carry out medical activities.

The procedure for conducting preventive examinations

As a general rule, the license of medical organizations in which preventive examinations can be carried out must provide for the performance of work (provision of services):

  • preventive medical examinations;
  • pediatrics or general medical practice (family medicine);
  • neurology;
  • ophthalmology;
  • traumatology and orthopedics;
  • pediatric surgery;
  • psychiatry;
  • pediatric dentistry or dentistry;
  • pediatric urology-andrology or urology;
  • pediatric endocrinology or endocrinology;
  • otorhinolaryngology or otorhinolaryngology (excluding cochlear implantation);
  • obstetrics and gynecology or obstetrics and gynecology (excluding the use of assisted reproductive technologies);
  • laboratory diagnostics;
  • clinical laboratory diagnostics;
  • functional diagnostics;
  • ultrasound diagnostics;
  • radiology.

A prerequisite for conducting preventive examinations of minors is that a medical organization has a license to carry out medical activities, which provides for the performance of work (provision of services) for preventive medical examinations, pediatrics or general medical practice (family medicine). However, a medical organization may not have a license for certain types of medical activities from the above. In this case, she attracts specialists from other medical organizations who are licensed to perform the required work (services). For this, appropriate agreements are concluded between medical organizations.

In addition, clause 11 of the Procedure provides the possibility of interchangeability of medical specialists conducting preventive examinations. For example, if a medical organization does not have a pediatric urologist-andrologist, then a urologist or a pediatric surgeon who has been trained in additional professional education programs in terms of the features of urological diseases in children is involved in the preventive examination. At the same time, the medical organization must have a license to carry out medical activities, providing for the performance of work (provision of services) in urology or pediatric surgery, respectively.

In the absence of a pediatric dentist in a medical organization, a dentist who has completed training in additional professional education programs in terms of the characteristics of dental diseases in children is involved in the preventive examination. At the same time, a medical organization must have a license to carry out medical activities, providing for the performance of work (provision of services) in dentistry.

If the medical organization does not have the services of a pediatric endocrinologist, then an endocrinologist who has completed training in additional professional education programs in terms of the characteristics of endocrinological diseases in children is involved in the preventive examination, provided that the medical organization has a license to carry out medical activities, providing for the implementation of works (provision of services) in endocrinology.

In the absence of a child psychiatrist (adolescent psychiatrist) in a medical organization, a psychiatrist who has completed training in additional professional education programs in terms of the characteristics of mental disorders and behavioral disorders in children is involved in a preventive examination. In this case, the medical organization must have a license to carry out medical activities, providing for the performance of work (provision of services) in psychiatry.

It is important! The list of studies carried out during preventive examinations depends on the age of the minor.

Information about the passage of a preventive examination is entered in medical records of a minor(developmental history of the child). It should contain the following information:

1) history data:

- about previous diseases (conditions), the presence of functional disorders, chronic diseases, disability;

- on the results of dispensary observation (if any) indicating the diagnosis of the disease (condition), including the code according to the International Statistical Classification of Diseases and Related Health Problems (ICD);

2) data obtained during a preventive examination:

- objective data and results of examinations by specialist doctors;

- results of laboratory, instrumental and other studies;

- the results of additional consultations and studies not included in the list of studies during preventive examinations and assigned during the preventive examination;

- the diagnosis of a disease (condition) identified (established) during a routine examination, indicating the ICD code, was it detected for the first time or not;

3) assessment of physical development;

4) minor health status group;

- on the formation of a healthy lifestyle, daily regimen, nutrition, physical development, immunoprophylaxis, physical education;

- on the need to establish or continue dispensary observation, including the diagnosis of the disease (condition) and the ICD code, for treatment, medical rehabilitation and sanatorium treatment, indicating the type of medical organization (sanatorium organization) and the specialty (position) of the doctor.

Such requirements for the preparation of medical documentation are contained in clause 21 of the Procedure. In addition, according to the results of a preventive examination in a medical organization, registration form No. 030-PO / y-12 "Card for preventive medical examination of a minor" is filled out, given in Appendix 2 to the Order of the Ministry of Health of Russia No. 1346n dated December 21, 2012.

The procedure for conducting preliminary examinations

A prerequisite for preliminary examinations of minors is that a medical organization has a license to carry out medical activities, which provides for the performance of work (provision of services) for medical examinations (preliminary, periodic), pediatrics or general medical practice (family medicine). Other types of work (services) are similar to those provided for by the license required for conducting preventive examinations. However, for certain types of medical activities from among them, a medical organization may not have a license. In this case, she attracts specialists from other medical organizations who are licensed to carry out medical activities in terms of performing the required work (services). Cooperation between medical organizations is carried out on the basis of relevant agreements.

It is important! According to clause 29 of the Procedure, when conducting preliminary examinations, the interchangeability of medical specialists is also possible.

To pass a preliminary examination upon admission to an educational institution, a minor (his legal representative) must write statement addressed to the head of a medical organization. According to clause 31 of the Procedure, the following information must be indicated in an application for a preliminary examination of a minor:

  • type of medical examination (preliminary);
  • surname, name, patronymic of a minor entering an educational institution; date of birth and address of residence;
  • the full name of the medical organization providing primary health care to a minor, the address of its location;
  • the full name and type of educational institution in which the minor will study, the address of his location;
  • details (series, number, medical insurance organization) of the compulsory medical insurance policy;
  • contact information (for example, home and mobile phone numbers, e-mail).

The application must be signed and indicated by the surname, initials and date of completion by the minor himself or his legal representative. If the application is drawn up by the legal representative of the minor, then it shall indicate the details of the documents confirming the powers of the representative, and copies of the above documents are attached to the application. It is subject to registration with a medical organization and is the basis for registration directions for a preliminary inspection. The following information is indicated in the direction:

  • list of examinations and examinations by specialist doctors;
  • date and place of inspections;
  • information about a pediatrician, a district pediatrician, a general practitioner (family doctor) of a medical organization responsible for conducting a preliminary examination.

According to clause 32 of the Procedure, the direction drawn up in the prescribed manner is handed to the applicant by an authorized official within 5 working days from the date of registration of the application.

To undergo a preliminary examination, a minor must independently arrive at a medical organization within a specified time, present a referral and a policy of compulsory medical insurance. A minor under the age of 15 arrives at a medical organization accompanied by a parent or other legal representative.

Preliminary examinations of minors are carried out in two stages... At the first stage, specialist doctors conduct examinations, perform laboratory, instrumental and other studies provided for in section. 2 List of studies during preliminary medical examinations. Those entering the kindergarten are examined by 8 specialists, including a psychiatrist and a gynecologist (urologist), and are tested for urine, feces and blood, including for glucose levels. Before entering school, you will additionally need to undergo an examination by an orthopedic traumatologist, do an ultrasound of the abdominal cavity, reproductive system, heart, thyroid gland, as well as electrocardiography. In the absence of suspicion that the minor has an undiagnosed disease (condition) and (or) the need to obtain information about the minor's health from other medical organizations in accordance with paragraph 8 of Part 4 of Art. 13 Federal Law No. 323-FZ the preliminary inspection is considered complete... The duration of the first stage of the preliminary examination should be no more than 10 working days (clause 38 of the Procedure).

At the second stage, additional consultations, studies are carried out, which are prescribed in accordance with clause 36 of the Procedure, and (or) information is requested about the health of the minor from other medical organizations. This stage is carried out only in case of suspicion of the presence of a disease (condition) in a minor, the diagnosis of which cannot be established during examinations by specialist doctors and studies included in section. 2 The list of studies during preliminary medical examinations, and (or) the need to obtain information about the health of a minor from other medical organizations.

The total duration of the two stages of the preliminary examination should be no more than 30 working days (clause 38 of the Procedure).

Preliminary inspection data entered in the medical documentation of the minor (history of the child's development). The nature of the information is similar to that indicated when registering the results of a preventive examination. Based on the data on the preliminary examination, the doctor responsible for its conduct determines the group of the minor's health status and the medical group for physical education, and also draws up a medical opinion on the minor's belonging to the medical group for physical education (in relation to minors entering educational institutions in which physical education is provided). In addition, when registering the results of a preliminary examination, it is required to issue a child's medical card for educational institutions of preschool, primary general, basic general, secondary (complete) general education, institutions of primary and secondary vocational education, orphanages and boarding schools and (or) a medical certificate. on minors entering institutions of primary, secondary and higher vocational education. The medical record (certificate) contains information about the state of health and an assessment of the minor's compliance with the educational requirements. These documents are drawn up in one copy, which is issued to the minor or his legal representative.

The procedure for conducting periodic inspections

According to clause 42 of the Procedure, periodic inspections are organized educational organizations... Such examinations are carried out annually and only for minors studying full-time. The license of a medical organization in which periodic examinations are carried out must provide for the performance of work (provision of services) for medical examinations (preliminary, periodic), pediatrics or general medical practice (family medicine). At the same time, the educational institution has the right to organize conducting periodic examinations in a structural unit carrying out medical activities(for example, in a medical center, medical unit, etc.). In this case, the educational organization must have a license to carry out medical activities, providing for the performance of work (provision of services) in pediatrics.

Periodic inspections are carried out on the basis of lists, drawn up in an educational institution, in which minors are listed by name, subject to periodic examination in the coming calendar year. The list contains the following information:

  • surname, name, patronymic, age (date, month, year of birth) of the student;
  • the full name and address of the medical organization in which the minor receives primary health care.

The list is approved by the head (authorized official) of the educational institution, after which it is sent to a medical organization with which an agreement has been concluded on conducting periodic examinations. This must be done no later than 2 months before the beginning of the calendar year. When the number of minors subject to periodic examinations changes, the head (authorized official) of the educational institution must submit an updated list to the medical organization by the 20th day of the current month.

Based on the list in a medical organization, periodic inspection schedule... Responsibilities for its compilation are assigned to the head (authorized official) of the medical organization. This document contains the following information:

  • pediatrician, district pediatrician, general practitioner (family doctor) of a medical organization, responsible for conducting periodic examination;
  • laboratory tests, date and time of their conduct;
  • number of minors for each age group.

The plan must be agreed with the head (authorized official) of the educational institution, and also approved by the head (authorized official) of the medical organization no later than one month before the beginning of the calendar year. After that, the plan is communicated to the medical professionals involved in the periodic examination.

Note!

If periodic examinations are carried out in a structural unit of an educational institution carrying out medical activities, the list and plan are drawn up by the pediatrician of this institution and agreed with its head (authorized official).

To undergo a periodic examination, each student is issued direction... It must indicate the date, time and place of the inspection. Referrals are handed over to minors or their legal representatives by an authorized official no later than 5 working days before the start of the periodic examination. Obligation to ensure the attendance of minors to undergo periodic medical examination assigned to the head (authorized official) of the educational institution.

To undergo a periodic examination, a minor must independently come to a medical organization or to a structural unit of an educational institution that carries out medical activities, within the prescribed period and present a referral and a policy of compulsory medical insurance. Periodic examinations of minors are carried out in accordance with Sec. 3 The list of studies during periodic medical examinations, given in Appendix 1 to the Procedure.

The data on the passage of the periodic examination is entered into the medical documentation of the minor - the history of the child's development and the medical record of the child for educational institutions. These documents contain information about the state of health of the minor and the conclusion about the presence (absence) of medical contraindications to continue their studies. If a periodic examination is carried out in a structural unit of an educational institution, then the data on its passage is entered only in the child's medical record for educational institutions.

Will the Ministry of Health save money on analyzes?

Since April of this year, there have been tough discussions on the draft of the new rules for clinical examination. In the State Duma, the initial draft was considered flawed. Some deputies expressed the opinion that the Ministry of Health is trying to save money on analyzes, since the Draft provided for a reduction in the list of mandatory studies.

For example, let's take blood and urine tests. It was suggested not to conduct them to those citizens who do not have obvious symptoms. As the Ministry of Health commented, the benefits of these tests are not scientifically substantiated, and nowhere in the world are they performed in screening examinations. Thirdly, WHO has not included them in the list of recommended ones.

The list of tests within the framework of clinical examination since 2018

Women 39 -51 years: fluorography, mammography

Citizens 49 - 74 years old: study of feces for occult blood for citizens (additional tests for the detection of intestinal cancer).

Men (over 35 years old) and women (over 45 years old) - electrocardiography.

Citizens (from 75 years old): reception of an otolaryngologist after examination by a therapist.

Preventive medical examinations of minors instead of periodic and preliminary

Until the end of 2017, Order No. 1346 dated December 21, 2012 is in force. From January 1, the Order of the Ministry of Health of Russia of 08/10/2017 N 514n "On the Procedure for Conducting Preventive Medical Examinations of Minors" begins. This Order also includes a new accounting form №030-PO / u17 and a stat. reporting.

As mentioned above, the volume of medical examinations will be reduced only nominally. If earlier it was supposed 3 types of medical examinations: preliminary, periodic and preventive. Now everything together bears one common name - preventive medical examinations of minors. It remains only to guess how educational institutions that work according to the old rules will adapt to the new rules: Order of the Ministry of Education and Science of April 08, 2014 No. 293 (The procedure for admitting children to kindergartens), the requirements of SanPiN 2.4.1.3049-13 (Resolution of the Chief Sanitary Doctor of 15 May 2013 # 26). The need to undergo preliminary medical examinations is also indicated by the Order of the Ministry of Health of March 3, 2000 No. 241, which approved the form of the child's medical record. In this card, it is necessary to enter data on routine medical examinations.

Bottom line, the data for a medical report upon admission to an educational institution will be entered based on the results of a preventive examination.

Explanations of the Ministry of Health regarding the cancellation of preliminary medical examinations

According to Federal Law 323-FZ "On Health Protection", preliminary medical examinations are required for employees who get a job in institutions. This law does not mention preliminary medical examinations of children.

The main goals of preventive medical examinations

Activities allow to identify diseases and determine the health group. The intention is especially emphasized to identify children prone to the use of narcotic and psychotropic substances. It is important to note that for the early detection of drug addiction in children, a separate Order of the Ministry of Health of 06.10.2014 No. 581n was developed. And for the detection of tuberculosis - Order of March 21, 2017 No. 124n.

Reducing the volume of medical research during preventive medical examinations

Excluded from the list:

Blood glucose level,

Blood hormone levels

Fluorography of the lungs (regulated by Order 124n)

Reception of a neurologist - children 3 months.

11-14 years old - only receptions of some specialists are left.

Medical examinations of children 1 year and 9 months, children 2 years 6 months.

Complete blood count and total. urine analysis for children 3,6,9 months, 2,4,5,8,9 years.

Newclarifications: In January 2018, the Ministry of Health clarified the list of studies, and also changed a number of provisions for clinical examination. Read about it

What is included in the list of medical examinations for children?

For children aged 1 month. - dentist,

For children aged 1 year - traumatologist-orthopedist.

What other changes?

Introduced for examination by a surgeon. If the institution does not have a pediatric surgeon, then the surgeon can conduct the appointment, but first he must.

Now medical examinations can be carried out on the territory of an educational institution.

Previously, for the examination of children under 15 years old, the presence of a parent (legal representative) was required. Now a signed consent is enough. This consent is issued by an authorized person (pediatricians, district pediatricians, general practitioners) 5 days before the routine examination.

In 2018, order 514n of the Ministry of Health of Russia came into force, which changed the procedure for medical examination of the child population. This document explains in detail how often and with the participation of which specialists a medical examination of an infant, a kindergarten pupil and a schoolchild is carried out.

Let us tell you more about the rules for organizing preventive examinations of children in 2018.

About order 514n

Order of the Ministry of Health 514n dated 08/10/2017 "On the procedure for conducting preventive medical examinations of minors" has adjusted the rules for organizing measures to identify and prevent diseases in children and clarified the age periods for examinations. Professional examinations are carried out in order to:

  • to identify pathologies and risk factors at the initial stage;
  • find out if the teenager is using drugs;
  • define health groups.

Five annexes of the document approved:

  • rules for organizing medical examinations (Appendix 1);
  • medical examination card of a minor (form №030-PO / u-17) and the procedure for filling it out (Appendices 2 and 3);
  • reporting form №030-PO / o-17 and terms for providing information on the activities carried out (Appendices 4 and 5).

About changes

This regulatory act of the Ministry of Health - order 514n of 08/10/2017 on preventive examinations is mandatory from January 1, 2018, from this date the previous department directive under the number 1346n of 12/21/2012 became invalid.

The order from 2017 changed the rules for children's medical examination. The following innovations have been introduced:

  • abolished preliminary and periodic examinations, they were replaced by preventive;
  • the list of studies has been adjusted;
  • the first stage (main) of medical examinations was extended 2 times - up to 20 days;
  • consent for tests and other studies is drawn up in advance, the deadline is 5 days before the first day of the procedures;
  • the examination of a child at the age of 1 year 9 months and 2.5 years was canceled;
  • the procedure before enrolling in educational institutions has been simplified, now the results of the professional examination are enough;
  • the card with the medical conclusions is filled in one copy (according to the previous rules, two were required).


Frequency of medical examinations

Order 514n on the procedure for conducting preventive medical examinations lists laboratory and other tests that are required to undergo medical supervision. How often a child is examined at a certain year of life, and which specialists are involved in it, explains Appendix 1:

  • every month - from the birth of a child to one year. The standard of medical examination of infants requires constant supervision by a pediatrician. An expanded team of doctors examines the child one month after birth (including ultrasound of internal organs) and at the age of one year (ECG, blood and urine sampling);
  • every three months - from 12 months to one and a half years, an examination is carried out by a pediatrician;
  • once a year - from 2 to 17 years old. The patient is monitored annually by a pediatrician and a pediatric dentist, and when a schoolchild turns 14, also a teenage psychiatrist. A complete examination of the body with examination by doctors of various specialties is carried out at the age of 6 and 15 years. At 7, 10 and 16 years old, a clinical analysis of blood and urine is prescribed, at 17 years in addition to these studies - an ECG.

Health groups

Based on the results of a comprehensive assessment of the state of the body, a minor is included in one of the health groups (there are five of them in total). According to what indications the division is made, the following appendix explains - No. 2:

  • the first group includes healthy children;
  • to the second - susceptible to colds, overweight or underweight with normal growth. Order 514n of 08/10/2017 refers to this group and minors with physical disabilities, if at the same time the functions of the body are preserved;
  • to the third - with chronic diseases with mild symptoms;
  • to the fourth - children who require supportive therapy, as well as with chronic diseases in the active stage or with periodic exacerbations;
  • to the fifth - with severe chronic diseases, frequent relapses.


Physical education groups

Appendix 3 names the selection criteria for children in one of three groups for physical education: basic, preparatory and special (includes two subgroups - A and B). The purpose of the distinction is to select a feasible physical activity.

So, included in the main - healthy children and their peers with minor health problems - undergo physical training according to the full curriculum.

The preparatory group is gradually mastering the program:

  • physically weak children;
  • predisposed to certain pathologies;
  • with chronic diseases without exacerbations for a long time - at least 3-5 years.

When drawing up a lesson plan with a preparatory group, the teacher should exclude contraindicated movements from the set of exercises. Weakened children are allowed to pass standards and participate in mass recreational activities only after an additional medical examination. A ban is imposed on participation in competitions.

Permitted activities for special groups:

  • for subgroup A (with congenital malformations, a state of the body that requires restriction of loads), health-improving physical education is recommended according to special programs;
  • for subgroup B (with chronic diseases at the stage at which there is a risk of complications) - physiotherapy exercises in a medical facility and independent exercise at home.

The conclusions of the doctors are entered into the medical examination card. Samples of this document, forms of medical reports and reporting forms are given in the normative act of the Ministry of Health. They must be filled in legibly, without corrections, order of the Ministry of Health of the Russian Federation 514n of 08/10/2017 requires).