In accordance with Article 37 Federal Law dated November 21, 2011 No. 323-FZ “On the basics of protecting the health of citizens in Russian Federation"(ed. dated 07/03/2016) Spa treatment must be organized in accordance with the Order of the Ministry of Health of Russia dated 05.05.2016 No. 279n “On approval of the Procedure for organizing sanatorium and resort treatment” (registered with the Ministry of Justice of Russia on 06.21.2016 No. 42 580). This procedure was approved by the authorized federal executive body - the Ministry of Health of the Russian Federation. The procedure for organizing sanatorium-resort treatment is mandatory for execution on the territory of the Russian Federation. Spa treatment includes medical care carried out medical organizations(sanatorium and resort organizations) for preventive, therapeutic and rehabilitation purposes.
Sanatorium-resort treatment is aimed at activating the body’s protective and adaptive reactions in order to prevent diseases, improve health, restore and/or compensate for body functions impaired due to injuries, operations and chronic diseases, to reduce the number of exacerbations, lengthen the period of remission, slow down the development of diseases and prevent disability as one of the stages of medical rehabilitation.
When organizing spa treatment, nutritional therapy is part of complex therapy.
Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (as amended on July 3, 2016), Article 39 “Therapeutic nutrition”:
"1. Therapeutic nutrition is nutrition that ensures the satisfaction of the physiological needs of the human body in nutrients and energy, taking into account the mechanisms of development of the disease, the characteristics of the course of the main and concomitantdiseases and performing preventive and therapeutic tasks.”
Medical nutrition must be organized in accordance with the norms of medical nutrition and the requirements of Russian legislation for the organization of dietary therapeutic and dietary preventive nutrition.
New requirements
Order of the Ministry of Health of Russia dated 05.05.2016 No. 279n “On approval of the Procedure for organizing sanatorium and resort treatment” (registered with the Ministry of Justice of Russia on 06.21.2016 No. 42 580), paragraph 18:
“The organization of therapeutic nutrition is one of the main therapeutic measures (8) when providing sanatorium-resort treatment in sanatoriums, sanatoriums for children, including for children with parents, sanatoriums and year-round sanatorium health camps.
Medical nutrition is carried out in compliance with established standards (9).
(8) Order of the Ministry of Health of the Russian Federation dated 05.08.2003 No. 330 “On measures to improve therapeutic nutrition in medical preventive institutions Russian Federation" (registered by the Ministry of Justice of the Russian Federation on September 12, 2003, registration No. 5073), as amended by orders of the Ministry of Health and social development Russian Federation dated October 7, 2005 No. 624 (registered by the Ministry of Justice of the Russian Federation on November 1, 2005, registration No. 7134), dated January 10, 2006 No. 2 (registered by the Ministry of Justice of the Russian Federation on January 24, 2006, registration No. 7411), dated April 26, 2006 No. 316 (registered by the Ministry of Justice of the Russian Federation on May 26, 2006, registration No. 7878) and by order of the Ministry of Health of the Russian Federation dated June 21, 2013 No. 395n (registered by the Ministry of Justice of the Russian Federation July 5, 2013, registration No. 28 995).
(9) Order of the Ministry of Health of the Russian Federation dated June 21, 2013 No. 395n “On approval of clinical nutrition standards” (registered by the Ministry of Justice of the Russian Federation on July 5, 2013, registration No. 28 995).”
Six standard diets
Cancellation of old norms
features of the application of regulatory documents
Purpose of diets
Specialty Products - Order Requirement
Vitamins in the diet
Individual therapeutic nutrition program
Drawing up an individual program
Summary
Rice. 1. Standard diets used in health resort organizations
Rice. 2. Modern chronological classification of law enforcement and by-laws on the organization of medical nutrition in sanatorium and resort organizations
Table 1. Prescribing diets (part 1)
Table 1.2. Prescribing diets (part 2)
Layout card No. 5.4
- Name of the dish: cottage cheese casserole with sugar with the addition of a dry protein composite mixture (SBKS) 9 g
- Indicated for diets: OVD, ShchD, VBD, VKD, NKD
- Finished dish weight (g): 110
Table 2. Protein correction of standard diets (in accordance with the norms of therapeutic nutrition approved by order of the Ministry of Health of the Russian Federation No. 395n)
Table 3. Fortification of the therapeutic diet (in accordance with the norms of therapeutic nutrition approved by order of the Ministry of Health of the Russian Federation No. 395n)
It occupies a major place in the system of treatment and preventive measures, primarily in the rehabilitation of patients.
The resort inpatient treatment and prevention facility is sanatorium. Most sanatoriums are organized in resort areas in order to make maximum use of the natural features of the area.
Resorts and sanatoriums
Resort- an area whose natural features make it possible to effectively treat and prevent diseases. Based on the nature of these features, resorts are divided into three groups: (water mineral springs), mud (therapeutic mud) and climatic (seaside, mountain, plain, forest and steppe). Three sanitary protection zones have been established for resorts, within which it is prohibited. An important role is given to local resorts, most often intended for patients for whom, after treatment, climate change is contraindicated for health reasons.
The sanatorium is intended to treat patients primarily with natural remedies in combination with physiotherapy, physical therapy, And therapeutic nutrition in conditions of active recreation and a specially organized regime. Drug treatment and bed rest are not typical for a sanatorium, although they can be prescribed. Patients with the most severe illnesses are treated in sanatoriums. various diseases. In this regard, there are sanatoriums with diseases of the circulatory system, digestive system, gynecological diseases etc. Depending on the age of the patients, sanatoriums are divided into children's, adolescent and adult.
The basis of sanatorium-resort treatment is the sanatorium regime, which provides the most favorable conditions for treatment and relaxation. Patients are provided with treatment in mud baths, solariums, swimming pools, etc. At most resorts, along with sanatorium treatment, ambulatory treatment patients coming on course vouchers.
Sanatoriums and dispensaries are also widely used - organized under industrial enterprises medical and preventive institutions supported by state insurance funds. Workers of this enterprise, on the recommendation of the attending physician, have the opportunity, without interruption from work, to undergo treatment at a dispensary for 24 days after work, where they are delivered by special transport. In addition, sanatorium institutions include resort clinics, hydropathic clinics, mud baths, etc.
The procedure for referral to sanatorium-resort treatment
The effectiveness of sanatorium-resort treatment depends on the correct referral of patients to the resort and sanatorium.
To be able to receive sanatorium-resort treatment, you must contact a doctor at the clinic at your place of residence. The doctor gives a referral to the sanatorium selection commission (SSC), which determines the need for sanatorium treatment, the profile of the sanatorium and the time of year for treatment. After receiving the conclusion of the SOC, you must write an application for a voucher addressed to the chairman of the commission (commissioner) for social insurance at the place of work. Pensioners contact social security authorities (district offices social protection population) at place of residence. The Social Insurance Commission must review the application and make a decision within 10 days. If you disagree with the decision of the commission, you can appeal its decision through the department (branch department) of the social protection institution. In addition to deciding on the allocation of a voucher, the social insurance commission has the right to decide on the payment of 50% of the cost of travel to the sanatorium and back, depending on the patient’s earnings and marital status. Vouchers are issued only during the employee's vacation period. Participants of the Great Patriotic War and persons equated to them have the right to receive a voucher free of charge.
Upon arrival at the sanatorium, the patient submits a sanatorium-resort card, which is filled out at the clinic at the place of residence: a clinical blood and urine test no more than month period prescription, ECG no more than a month old, X-ray examination (FLG or fluoroscopy of organs chest) no more than six months ago, for women, a gynecologist’s conclusion, regardless of the diagnosis of the disease, the conclusions of other specialists, depending on the profile of the disease. Registration and issuance of medical documents and vouchers is carried out 15-20 days before the start of the voucher period. The voucher must be properly issued and certified by the seal of the institution that issued it. In addition to the voucher and sanatorium-resort card, upon admission to the sanatorium you must have a passport, and for children under 16 years of age a birth certificate or a copy thereof. Military personnel present an identification card, and military pensioners - a pension certificate, where in the section for special marks it must be indicated that the pensioner enjoys the right to sanatorium-resort treatment in sanatoriums of the Ministry of Defense of the Russian Federation.
In the sanatorium book handed over to the patient, the sanatorium doctor notes the change in the patient’s well-being, the treatment and research performed, and at the end of the stay - the results of treatment and recommendations on the work schedule and therapeutic measures. Upon returning from the sanatorium, the patient presents the sanatorium book to the attending physician, who transfers all the necessary information to the outpatient card for the development of further treatment and preventive measures.
The effectiveness of sanatorium-resort treatment is evidenced by the long-term absence of exacerbations of the underlying disease, persistent restoration of working capacity, improvement general condition health and well-being of the patient.
According to the order of the Ministry of Health and Social Development of the Russian Federation dated November 22, 2004 No. 256 “On the procedure medical selection and referral of patients for sanatorium-resort treatment" medical selection and referral for sanatorium-resort treatment of citizens is carried out by the attending physician and the head of the department or a medical commission (for citizens entitled to receive state social assistance in the form of a set of social services) of a medical institution at the place of residence.
If there are indications and no contraindications for referral to sanatorium-resort treatment, the patient is issued a certificate to receive a voucher for sanatorium-resort treatment" (form No. 070/u). Medical indications and contraindications for sanatorium-resort treatment are determined by order of the Ministry of Health of Russia dated May 5, 2016 No. 281n “On approval of lists medical indications and contraindications for spa treatment.” If the patient has diseases included in the list of medical indications for sanatorium-resort treatment of the child population, on the basis of a certificate for obtaining a voucher for sanatorium-resort treatment (form No. 070/u), an application is made in the sanatorium-resort treatment monitoring subsystem of the Russian Ministry of Health.
In accordance with the letter of the Ministry of Health and Social Development of the Russian Federation dated May 29, 2009 No. 14-5/10/2-4265 “On sending children for sanatorium-resort treatment to sanatorium-resort institutions under the jurisdiction of the Ministry of Health and Social Development of Russia” to sanatorium-resort Institutions under the jurisdiction of the Ministry of Health of the Russian Federation send children from 4 to 14 years of age inclusive, including accompanied by a legal representative, from 15 to 18 years of age unaccompanied, unless the need for accompaniment is due to medical indications. Children aged 2 years and older are sent to sanatorium-resort institutions with a psychoneurological profile, accompanied by a legal representative.
When contacting the Moscow City Health Department regarding referral of a child for sanatorium-resort treatment in a sanatorium under the jurisdiction of the Ministry of Health of the Russian Federation, the following documents must be provided:
- application from the legal representative of a minor to send the child to a sanatorium-resort treatment;
- statement from the legal representative of the minor regarding consent to the processing of personal data;
- a copy of the passport of the legal representative of the minor with information on registration at the place of residence;
- a copy of the child's birth certificate;
- copy of the mandatory policy health insurance;
- a document confirming the child’s registration in the city of Moscow;
- a copy of the certificate for obtaining a voucher for sanatorium treatment (form No. 070/u);
- copy of SNILS (if available).
The structure of Moscow city healthcare includes sanatoriums for children: general, bronchopulmonary, orthopedic, cardio-rheumatological, nephrological and gastroenterological profiles. All sanatoriums provide for the stay of children throughout the year.
In accordance with the order of the Ministry of Health and Social Development of Russia dated November 22, 2004 No. 256 “On the procedure for medical selection and referral of patients for sanatorium-resort treatment,” medical selection and referral of patients in need of sanatorium-resort treatment are carried out by the attending physician and the head of the department. The presence of medical indications for sanatorium-resort treatment and the absence of contraindications for its implementation is within the competence of the attending physician and is determined in accordance with the order of the Ministry of Health of Russia dated 05.05.2016 No. 281n “On approval of lists of medical indications and contraindications for sanatorium-resort treatment.” The decision is made based on an analysis of the patient’s objective condition, the results of previous treatment (outpatient, inpatient), data from laboratory, functional, radiological and other studies. If there are indications and there are no contraindications for treatment, the following will be issued to the sanatorium: a voucher to the sanatorium; sanatorium-resort card for children (registration form N 076/u) and a certificate from a pediatrician or epidemiologist confirming no contact with patients infectious diseases(for those attending educational institutions, a certificate of no contact with patients with infectious diseases from educational institution(kindergartens, schools).
In addition, the following documents of the child must be submitted to the sanatorium: birth certificate and compulsory health insurance policy (it is advisable to provide a photocopy of these documents).
Considering individual characteristics child, as well as the profile (specialization) of the sanatorium; in some cases, the decision on the possibility of a child’s stay is decided by a commission at the sanatorium.
