Combined with hospitals;

Unintegrated (independent).

The structure of the city clinic includes the following divisions:

clinic management;

registry;

first aid room; .

prevention department;

treatment and prophylactic units:

therapeutic departments;

rehabilitation treatment department;

departments for the provision of specialized types of medical care (surgical, gynecological) with offices of relevant specialists (cardiology, rheumatology, neurology, urology, ophthalmology, otorhinolaryngology);

paraclinical services (physiotherapeutic and x-ray rooms, laboratories, functional diagnostics room, ultrasound room);

day hospital at the clinic and hospital at home;

administrative and economic part;

medical and paramedic health centers at attached enterprises.

Objectives of the clinic:

1. Providing qualified specialized care to the population in the clinic and at home.

2. Carrying out comprehensive preventive measures in the service area.

3. Organization of dispensary observation of the population - adolescents, workers, cancer patients, CVD patients.

4. Organization of san - gig. education and training of the population, promotion of a healthy lifestyle.

5. Study of the causes of morbidity in the population, causes of disability, and mortality.

Work in the clinic is organized according to local principle. For one local therapist – 1,700 adults. Advantages of the local principle: observation over time, timely diagnosis, adequate treatment, knowledge of the social conditions of the population.

Tasks of the local therapist:

· Providing assistance in the clinic and at home (20-30%)

· Providing emergency assistance to everyone in need

· Timely hospitalization of patients

· Using consultations with doctors of other specialties, head. departments, other medical institutions

· Conducting an examination of temporary disability

· A set of measures for medical examination of the population of your site

· Carrying out anti-epidemic measures at the site - early detection of infectious diseases, emergency notification of acutely contagious diseases to the SES

· San - enlightenment. Job.

For every 8 therapeutic areas, a head position is allocated. department. Now doctors of other specialties are also starting to work on a local basis. This is the brigade method. In this case, a doctor of a narrow specialty can be called to the patient’s home, and you can get a ticket for an appointment with a specialist without going to the therapist. The volume of home care is increasing, and a specialist doctor is monitoring patients over time. The team is led by a local therapist. It is important to create a work schedule. Therapist 4 hours in the clinic, 2 hours at home. Surgeon, neurologist - the same. ENT, ophthalmologist 5 hours. in the clinic, 1.5 hours at home.

Prevention department for medical examination of the population:

1. Pre-medical reception room.

2. Anamnesis room.

3. Women's examination room and prof. inspections. was minimal

waiting time for patients to receive an appointment, the workload on doctors is uniform, refusals to see a patient are eliminated, the impersonality of monitoring a patient is eliminated, and timely access of the patient to a specialist is ensured.

Department of Faculty Pediatrics.
Ph.D. Mitskevich S. E.
2013

Convention on the Rights of the Child

The child has the right to medical
assistance corresponding to the highest
standards that can really be
secured. States must do
special emphasis on providing primary
health care, prevention
diseases, sanitary propaganda and
reduction in child mortality. They
must do everything necessary to
one child was not denied access to
effective healthcare services.

Outpatient pediatrics

Is a section of preventive
pediatrics.
Concept of childhood origins of chronic
diseases of adults and elderly people.
Primary prevention determines the final results of the activities of pediatricians.
A pediatrician is a single specialist in all
problems that arise in healthy and
sick child.
Prospective health monitoring
children's population, prevention
infectious and somatic diseases.

The importance of outpatient services

The importance of outpatient services
For
states
For society
For system
health in general
One of
Primary
Continuity
priority prevention and coordination areas
one of
ness in observation modern
most important Denia, coordinating reforms in
conditions
nation of all health care interests
health of national parties, optimal
control for
health

Children's city clinic (legislative basis)

An institution of the municipal health care system that provides primary health care
help
Medical care in the state and municipal health care systems is
free
Outpatient care includes:
first and emergency medical aid; primary preventive measures; diagnostics and
treatment of various diseases and conditions; clinical expert activities; dispensary observation of healthy people, risk groups and patients... etc. (Order
Ministry of Health and Social Development of the Russian Federation dated July 29, 2005 No. 487 “On approval of the procedure
organization of primary health care")

Activities and structure of the children's clinic Order of the Ministry of Health of the Russian Federation dated January 23, 2007 No. 56 “On approval of the approximate procedure for organizing activities and with

Activities and structure of the nursery
clinics
Order of the Ministry of Health of the Russian Federation dated January 23, 2007 No. 56 “On approval
approximate order of organization of activities and structure
children's clinic"
The children's clinic is being created as an independent medical and preventive institution to provide primary health care on a territorial basis.
children's population
Assistance is provided by local pediatricians
medical and preventive department, medical specialists of the consultative and diagnostic department, doctors
emergency departments, rehabilitation treatment,
medical and social assistance, as well as in educational
institutions
Interaction with territorial institutions
health and education
The chief physician is appointed and dismissed by the local authority
self-government

Types of activities of the children's clinic

Types of children's activities
clinics
Diagnosis and treatment of various diseases and conditions
Antenatal fetal care
Patronage of newborns and young children
First and emergency medical aid
Dynamic medical observation of the physical and neuropsychic development of children, of children with chronic pathology,
disabled children
Prof. measures to prevent and reduce morbidity, disability, mortality
Dispensary observation of healthy and sick children and adolescents
Medical and social examination
Work in educational institutions
Reproductive health care for adolescents, professional
orientation, preparation of young men for military service
Medical assistance in rehabilitation medicine
Preservation and promotion of breastfeeding

Approximate structure of a children's clinic

Head of Inform Pediatrician Cons.Laborat Dept.
quality
ationpolikli no- ananiki
lytic
some department
ical
dept.
diag.
dept.
Adminis
tative
farms.
Part
Cabinet
s pediatricians, healthy
reb.,
priv.,
proc.
Cabin
doctors
special.,
functional
diagnostician.
Registry
Statistics
ka
Oriya
Dept.
inex.
help
Rehabil.
dept.
Dept.
medical social
help
medical assistance
cabbage soup in
images
establishment
Day hospital
Hospital at
home

Organization of activities of a local pediatrician Order of the Ministry of Health of the Russian Federation dated January 18, 2006 No. 28 “On the organization of activities of a local pediatrician”

Organization of activities of a local pediatrician
Order of the Ministry of Health of the Russian Federation dated January 18, 2006 No. 28 “On the organization
activities of a local pediatrician"
A specialist with a higher medical education in pediatrics or general medicine
business" and a specialist certificate in the specialty
"pediatrics".
A local pediatrician provides primary care
medical and sanitary care to the contingent formed primarily by territorial
principle and based on the free choice of a doctor
patients.
Operates in medical
organizations of the municipal health care system providing primary health care
helping children.

Conducts dynamic medical monitoring of
physical and neuropsychic development of children
Carries out work to protect the reproductive health of adolescents, antenatal prevention
Conducts primary patronage of newborns and young children in a timely manner
Organizes and takes part in preventive examinations of young children, as well as
children at decreed ages
Develops a complex of therapeutic and recreational
activities, provides control over the implementation
regime, rational nutrition, measures to prevent nutritional disorders in children, rickets,
anemia and other diseases

Functional responsibilities of a local pediatrician in the preventive unit

Provides immunization for children
Provides preparation for children to enter educational institutions
Provides information about children and
families at social risk in the department of medical and social assistance of the children's clinic, authorities
guardianship and trusteeship
Provides activities for the prevention and early detection of hepatitis B and C in children,
HIV infections
Provides medical care to young men during
preparation for military service

Conducts diagnostic and therapeutic work at home and on an outpatient basis
Ensures timely referral of children to
consultation with medical specialists, if appropriate indications - for hospitalization
Conducts dynamic monitoring of children with chronic pathology who are at the dispensary
observation, their timely recovery and analysis
effectiveness of dispensary observation
Provides hospital work at home
Provides implementation of individual programs
rehabilitation of disabled children

Functional responsibilities of a local pediatrician - treatment unit

Functional responsibilities of a local pediatrician - treatment block
Ensures additional drug provision for children eligible to receive a set of social services
Issues a conclusion on the need to refer children
to sanatorium-resort institutions
Provides clinical observation of children with hereditary diseases identified as a result of neonatal screening
Sends notifications in a timely manner as prescribed
okay in the territory. Rospotrebnadzor authorities
cases of infectious diseases and post-vaccination complications
Provides medical consultation and
professional guidance taking into account the condition
children's health

Functional responsibilities of a local pediatrician - organizational block

Forms a medical area from the attached
contingent
Maintains medical documentation as prescribed
order, analyzing the health status of the contingent assigned to the pediatric pediatric
area and activities of the pediatric pediatric
plot
Prepares medical documentation for
transfer of children upon reaching the appropriate age to a city (district) clinic
Manages the activities of secondary medical
personnel providing primary health care

Criteria for assessing the performance of a local pediatrician (Order of the Ministry of Health of the Russian Federation dated April 19, 2007 No. 283)

Criteria for assessing performance
local pediatrician
(Order of the Ministry of Health of the Russian Federation dated April 19, 2007 No. 283)
The purpose of introducing criteria for evaluating the effectiveness of operational analysis within a medical institution of diagnostic, treatment, preventive and organizational work in the pediatric area to improve the quality of medical care for the assigned contingent and monitoring the health status of children
Basic medical records for assessment
work efficiency:
-history of child development (No. 112-u)
- passport of the medical department (pediatric) (No. 030u-ped)
- a record sheet of medical visits in outpatient clinics, at home (No. 039-u-02)

Criteria for assessing the effectiveness of preventive work

Coverage of pregnant women with antenatal care
Coverage of patronage for children in the first year of life
Complete coverage of preventive examinations of children
(at least 95% of the total number of children of the corresponding
age subject to preventive examinations;
in the first year of a child’s life - 100% at 1 month, 3 months, 6
months, 9 months, 12 months)
Complete coverage of preventive vaccinations in accordance with the National Calendar (at least 95%
of the total number of children subject to vaccination)
The share of the number of children in the first year of life who are breastfed (at 3 months - at least
80%, at 6 months. - at least 50%, at 9 months. - at least 30%)

Indicators of preventive work of a local pediatrician

“Health Index” of children (for unorganized children
certain decreed age)
Coverage of pregnant women with prenatal care (early and
late)
Enrollment of pregnant women in full-time mothers' school
Early medical coverage of newborns with observation
Systematic monitoring by a doctor and nurse
children of the first year of life
Completeness of coverage with medical examinations (for maternity leave
age groups)
Share of preventive visits to the local pediatrician
Breastfeeding frequency
Child immunization coverage rate

Prenatal care

Early - at 8-13 weeks
The main goal is to identify all risk factors and
predicting the formation of a particular pathology in the fetus and drawing up a plan for correction
influence of unfavorable factors (somatic and
woman's genital status, previous obstetric history, heredity and health status
previous children, occupational hazards,
lifestyle, bad habits)
Preparing for breastfeeding
Prevention of vitamin and mineral deficiency

Prenatal care

Late - at 30-32 weeks
The main goal is to analyze the impact of all
possible risk factors for future health
child and the effectiveness of measures to correct them
Preparing for breastfeeding (technique
feeding, pumping, prevention of mastitis,
lactostasis and hypogalactia)
Preparing the apartment, crib, care items
for a newborn
Rational nutrition, prevention of vitamin-mineral deficiency, image change
life

Primary care of a newborn

It is carried out on the first day after discharge from the maternity hospital (in
the first three days, if the newborn is healthy)
Clarify and evaluate social, genealogical and biological history using data from a maternal, prenatal survey
patronage and information from the newborn’s exchange card (f-
113-u)
Questions and problems of feeding a newborn
Objective examination of the newborn
Conclusion on diagnosis, health group and risk group
Medical examination plan for the first month
Recommendations for feeding, routine issues,
care issues
Prevention of hypogalactia, vitamin and micronutrient
insufficiency, nutrition of a nursing woman
Maximum compliance with the principle of professional
ethics, internal culture, goodwill and
solemnity of the situation

Objective examination of the newborn

General condition, cry, sucking activity
Condition of the skin, mucous membranes, the presence of edema, pastiness, cyanosis, “transitional states”, traces of BCG
Body type and nutrition
Posture, muscle tone, motor activity
Condition of the skeletal system
Respiratory condition
Condition of the cardiovascular system
Examination of the abdomen (umbilical ring and umbilical wound,
size of the liver, spleen, genitals, frequency and
character of the stool)
Neurological status (position, posture, reactions to
stimuli, spontaneous motor activity,
scream, unconditioned reflexes in the supine position, in
upright and prone position)

Observation of a newborn child Order of the Ministry of Health of the Russian Federation dated April 28, 2007 No. 307 “On the standard of dispensary (preventive) observation of a child during

Observation of a newborn baby


during the first year of life
Visits from a local pediatrician on the 14th and 21st days of life, according to
indications (health group) - on the 10th, 14th, 21st day of life
Nurse visits at least 2 times a week
During the first month of life, medical care
children are provided with care by a pediatrician and pediatric specialists
clinics only at home
Commission examination at 1 month of life in the clinic
(neurologist, pediatric surgeon, orthopedic traumatologist, ophthalmologist,
pediatrician, head pediatric department, audiology
screening, ultrasound of the hip joints)
Assessment of physical development based on anthropometric indicators, neuropsychic development,
determination of health group, identification of risk groups
Follow-up plan for the first year
life

Newborn risk groups

Determined by the neonatologist of the maternity hospital and reflected in
f-113-u, persist in the neonatal period,
transform into risk groups for young children
age
Group 1 - risk of developing central nervous system pathology
Group 2 - risk of intrauterine infection
Group 3 - risk of developing trophic disorders and
endocrinopathies
Group 4 - risk of developing birth defects
organs and systems
Group 5 - social risk

Observation of children in the first year of life Order of the Ministry of Health of the Russian Federation dated April 28, 2007 No. 307 “On the standard of dispensary (preventive) observation of a child during

Observation of children in the first year of life
Order of the Ministry of Health of the Russian Federation dated April 28, 2007 No. 307 “On the standard
dispensary (preventive) observation of the child in
during the first year of life
Pediatrician - monthly: assessment of medical history, identification of risk groups, prognosis of health status, direction of risk, assessment of information from the previous period, physical development, neuropsychic development, assessment of resistance, diagnosis and evaluation
functional state of the body, conclusion on
health status, recommendations.
Neurologist-3, 6, 12 months, pediatric dentist and pediatric
surgeon - 9 and 12 months, orthopedist, ophthalmologist, otorhinolaryngologist - 12 months, pediatric gynecologist - up to 3 months. and v12
months girls.
Registration and observation at the dispensary
accounting form No. 030-u.

Dispensary observation of healthy disorganized children

Pediatrician - in the 2nd year - once a quarter, in the 3rd year - once every 6 months, in the 4th,
5th, 6th years of life - once a year in the month of your birth.
At each examination, the pediatrician must: examine the condition
health according to accepted criteria, conduct a comprehensive assessment
health status with definition of health group and group
risk, give recommendations depending on health status,
draw up an epicrisis in the history of the child’s development.
In the 2nd year of life - dentist.
At 3, 5, 6, 7 years old - surgeon, orthopedist, ophthalmologist, otolaryngologist,
neurologist, dentist.
From the age of 4, all children are consulted by a speech therapist or, if indicated, by a psychiatrist.
When registering at a preschool educational institution, a dermatologist, psychologist and speech therapist.

Laboratory and instrumental research

Neonatal screening for adrenogenital syndrome,
galactosemia, congenital hypothyroidism, cystic fibrosis,
phenylketonuria (order of the Ministry of Health and Social Development of the Russian Federation dated March 22, 2006 No. 185 “On
mass examination of newborns for hereditary diseases") - on the 4th day of life in a full-term baby and on the 7th day
in a premature baby.
At the age of 1 month - audiological screening and ultrasound of the hip joints.
At 3 months - blood and urine tests, at 12 months. - blood and urine analysis,
ECG.
In risk groups - additionally every 1 month. and 9 months - analysis
blood and urine, at 9 months - ECG.
Annual blood, urine, and stool tests for worm eggs.
From 4 years old - determination of visual acuity, hearing, plantography,
blood pressure measurement.

Risk groups for young children

Children at risk of developing central nervous system pathology
(who have suffered perinatal damage to the central nervous system).
Children at risk for anemia, VDS, convalescents of anemia.
Children at risk of developing chronic eating disorders.
Children with constitutional anomalies.
Children suffering from rickets 1st and 2nd degree.
Children born with large body weight. ("large
fetus").
Children who have suffered purulent-inflammatory diseases, intrauterine infection.
Frequently and long-term ill children.
Children from priority families.

Principles of monitoring children at risk

Identification of leading risk factors. Definition
observation tasks (prevention of the development of pathological conditions and diseases)
Preventive examinations by a pediatrician and doctors
other specialties (terms and frequency)
Laboratory diagnostic, instrumental
research.
Features of carrying out preventive examinations,
preventive and therapeutic
activities (nutrition, regimen, massage, gymnastics,
non-drug and drug rehabilitation)
Criteria for the effectiveness of observation.
The observation plan is reflected in form 112-u.

Criteria for determining health groups

Presence or absence of functional impairment
and/or chronic diseases (taking into account the clinical variant and phase of the pathological process)
Level of functional state of the main systems
body
The degree of resistance of the body to adverse external influences
The level of development achieved and the degree of its harmony
Order of the Ministry of Health of the Russian Federation dated December 30, 2003 No. 621 “On comprehensive
assessment of children's health status"

Newborn health groups

Group 1 - healthy children (without deviations in
health status and risk factors)
Group 2 - depending on the number and direction of risk factors, as well as their potential
or actual implementation, is divided into options: A
iB
Group 3 - the presence of a chronic disease at the stage
compensation
4 and 5 Groups - by analogy with the corresponding
groups of older children
At the end of the neonatal period, it enters
health group for young children (Order No.
621)

Vaccination. Legal basis.

-
-
Federal Law No. 157 of September 17, 1998 “On
immunoprophylaxis of infectious diseases.”
Decree of the Government of the Russian Federation No. 885 dated 2.08.99 “List of post-vaccination
complications, complications
caused by
preventative
vaccinations,
included
V
National
calendar
And
preventive vaccinations according to epidemiological indications, giving the right
citizens to receive state one-time benefits.”
Russian Government Decree No. 1013 dated December 27, 2000 “On the procedure
payments of state one-time benefits and monthly
monetary compensation to citizens if they experience post-vaccination complications.”
-Order of the Ministry of Health of the Chelyabinsk Region and
Office of the Federal Service for Supervision of Rights Protection
consumers and human well-being in the Chelyabinsk region No.
1011/360 of September 17, 2009 “On approval of the main provisions
immunization of the population of Chelyabinsk
region".
- Order of the Ministry of Health and Social Development of the Russian Federation
dated January 26, 2009 N 19n “On the recommended sample of voluntary
informed consent for preventive
vaccinations for children or refusal of them"

Rights and responsibilities of citizens

Rights: - receive free vaccinations with all types of vaccines,
-
-
-
included in the national calendar
be familiar with all possible reactions and complications
due to the vaccination process, as well as the consequences of those
infectious diseases that may occur due to lack of
vaccinations
voluntarily refuse vaccination (by formalizing this refusal in
in writing) and not be prosecuted for it under the law
citizens and their children cannot be denied admission to children's
preschool, school or health institutions, summer camps and
etc.
(due to lack of vaccinations), except in cases
unfavorable epidemiological situation
receive social benefits and compensation in case of post-vaccination
reactions, complications. In case of death, disability,
disability - pensions and benefits.
Responsibilities: in the absence of immunoprophylaxis, strictly carry out
instructions from medical professionals
confirm in writing the refusal of preventive vaccinations

Vaccination documentation

f.112 (outpatient card)
- form 63 (card of preventive maintenance
vaccinations)
- IES – f. No. 58 (for all strong reactions and
complications)
- Vaccination certificate
- Journal of preventive vaccinations
Site passport

Post-vaccination reactions and complications

Vaccine reaction is a symptom complex of changes in
the body (in the functioning of its individual systems),
caused by the vaccine process and associated with it
time.
Post-vaccination reactions are the same for each species
vaccines, and when using live vaccines - specific.
Post-vaccination
reactions
are characterized
short-term and cyclical course and do not bring
serious disorders of the body's functioning.
Reactions are classified into general and local, weak,
medium strength and strong. Strong reactions - temperature >
40° and/or swelling and hyperemia at the injection site > 8 cm in
diameter
Post-vaccination complication – severe and/or persistent
impairment of health status due to preventive
vaccinations.

Post-vaccination complications

Post-vaccination complications:
- anaphylactic shock
- severe generalized allergic reactions (angioedema), Lyell's syndrome, Stevens-Johnson, serum
damn)
- encephalitis
- vaccine-associated polio
- damage to the central nervous system with generalized or focal residual manifestations leading to disability; encephalopathy, serous meningitis, neuritis, manifestations of convulsive syndrome
- generalized infection, osteitis, osteomyelitis caused by
BCG
- chronic arthritis caused by the rubella vaccine.
Severe reactions and post-vaccination complications are medical contraindications for all types of vaccines.

Time frame for reactions and complications

-
-
-
-
-
General reactions occur no later than 48 hours after DTP, ADS, ADSM.
Specific reactions to live vaccines - no earlier than 4-5 and no later
12-14 days for measles, and 21 days for mumps vaccine.
Allergic reactions of immediate type occur within 2-4 days
hours.
Meningeal phenomena may occur 3-4 weeks after administration
mumps vaccine and are not typical for reactions after DTP, ADS and
measles vaccine.
Encephalitis (encephalopathy) after DTP occurs no later than the first 7
days. Encephalitis after measles vaccination - at the end of the 2-3rd week.
Catarrhal syndrome is a specific reaction to measles
vaccine, occurs from 4-5 to 12-14 days after vaccination, for others
vaccines are not typical.
Intestinal, renal syndromes and DN are not typical for complications and
reactions to any vaccinations.
A typical complication of the polio vaccine is
vaccine-associated poliomyelitis, flaccid paresis and paralysis without
sensitivity disorders.
A typical complication of the BCG vaccine is osteitis,
osteomyelitis of BCG etiology and generalized BCG infection.

Principles of vaccination

- Only healthy children are subject to vaccination
- Maximum compensation of all deviations in
state of health at the time of vaccination
- Optimal choice of time and timing of vaccination
- Sanitation of all foci of infection by the time
vaccinations
- Vaccination under “medicinal cover”
children with chronic diseases
- Tracking
child
V
post-vaccination
period
- The first day of medical withdrawal should be the first day
preparation for vaccination
- Home
target
vaccinationformation
quality immunity

Preparing children for preschool education

Begins from the first days of a child’s life
General training - systematic preventive
observation
Special training (saprosvet work with parents of the district nurse, staff of the office for raising a healthy child, dispensary observation
local pediatrician, medical specialists,
conducting laboratory tests 2-3 months before
receipts)
Health improvement and treatment depending on the condition
health and results of the last medical examination
Forecasting the severity of adaptation based on medical history and health status
Referral to the adaptation commission
Filling out a medical card (F-026-u)

Assessing the severity of adaptation

Periods of adaptation: acute (disadaptation), subacute (adaptation) and adaptation itself.
Severity: mild, moderate and severe
two variants of the course (A - development of chronic
somatic pathology, B- development of neuroses, neurotic reactions, neurological disorders)
Severity criteria: speech and emotional
activity, contact with adults and peers,
rates of weight gain and growth or lag in
indicators of physical development, frequency and severity of acute diseases, presence of complications
Duration from 10-20 to 60 days or more

Quality of dispensary observation of children - completeness of coverage
dispensary observation according to nosological forms
must be at least 90%; proportion of children removed
for recovery, as well as improvement of health status
must be at least 10% for each indicator;
dynamics of the number of disabled children.
Complete coverage of treatment and preventive care for children,
those under dispensary observation - proportion
children hospitalized on a planned basis,
sent as planned to sanatoriums and resorts
institutions that received anti-relapse treatment;
share of completed individual programs
rehabilitation of disabled children; validity of appointment
medications and compliance with prescribing rules
recipes

Criteria for assessing the effectiveness of medical work

Assessment of morbidity dynamics dynamics of primary
morbidity (in % of the number of children per
area); general morbidity indicator
(prevalence)
Analysis of cases of death of children at home, including
number of children in the first year of life
Analysis of daily mortality cases
children in hospital

Other indicators of medical work

General morbidity, morbidity by
by age, by nosology.
Mortality in the area of ​​activity, by age group.
Precinct service at home, at the reception.
Home visiting activity.
Structure (composition) of dispensary patients.
Completeness and timeliness of dispensary observation coverage, share again
taken under dispensary observation, coverage
patients receiving anti-relapse treatment.
The average annual workload per doctor is 1 hour.

Monitoring a sick child

A sick child should not visit the clinic.
Standards for a local pediatrician to work at home: 2
visits per hour.
Continuity of monitoring a sick child at home and active visits.
Newborn children with acute illnesses are required to be hospitalized.
Infants are examined at home daily until complete recovery.
Children over one year old are examined depending on
severity of the condition.
Only convalescents are invited to the clinic.
Providing emergency care at home.
Referral to hospital due to severity of condition or
epidemiological indications.

Monitoring of children with chronic diseases

Registration after detection of the disease
inpatient or outpatient.
Preparation of documentation: statistics certificate (F-025-u),
control card of a dispensary patient (F-030-u).
Drawing up a dispensary observation plan for
calendar year.
Epicrisis at the end of each calendar year.
At each clinical examination: identification of complaints,
specific symptoms, objective examination taking into account the nature of the pathology, conclusion on the diagnosis (period and severity of the disease, complications), concomitant pathology, assessment of physical and sexual development, health group, physical activity group,
recommendations for rehabilitation.

Objectives of dispensary observation of children with chronic diseases

Prevention of exacerbations of the underlying disease.
Prevention of acute intercurrent diseases,
which can affect the weight of the main one.
To prevent the development of complications and transition to more
severe form of the disease.
Sanitation of chronic foci of infection.
Social and physical adaptation (preschool educational institution, school,
daily physical activity, sports
sections)
Prevention of disability.
Possibility of full vaccination.
Improving quality of life.
Adequate psycho-physical development of the child.

Dispensary observation scheme

Pediatrician immediately after an exacerbation of any disease, 1 time every 1.5-3 months for 6-12 months, and then at least 1
once every 6 months for all subsequent years of observation.
ENT doctor and dentist at least once every 6 months (sanitation
foci of infection).
Medical specialists in the profile of the disease at least 1
once every 6-12 months.
General clinical tests (blood, urine, feces for eggs
helminths) - at least once every 6 months.
Laboratory and instrumental studies on
disease profile - at least once every 6-12 months.
Dietary and regimen recommendations, anti-relapse, basic treatment, treatment of concomitant
pathologies,

Rehabilitation activities.

Regime restrictions, the possibility of visiting preschool educational institutions,
schools, extra classes.
Diet characteristics.
Non-drug methods (physical therapy, massage, physiotherapy), organization of summer recreation.
Medication methods (anti-relapse,
basic, eradication therapy, other types of pathogenetic and symptomatic treatment).
Pre-season preparation - prevention of ARVI.
Prevention of vitamin and mineral deficiencies
conditions (calcium, iodine, iron).
Increased nonspecific immunobiological
resistance.
Determination of indications for sanatorium-resort treatment
recovery.

Rehabilitation activities.

Use of rehabilitation departments
for rehabilitation.
Educational programs for parents and children
(training in symptom control methods,
treatment and emergency care algorithms) - purpose:
improve quality of life.
Planning vaccinations according to the calendar and additional vaccines, preparation, tracking
post-vaccination period.
Assessment of effectiveness and possibility of deregistration.
Resolving issues of professional guidance.
Determination of indications for disability.
Determination of physical education group, exemption from
exams, homeschooling.

Documentation forms

Documentation forms
N shape
Form name
1. 112 History of child development.
2. 030-u Control card of dispensary observation.
3. 063-u Card of preventive vaccinations.
4. 064- Journal of preventive vaccinations.
5. 025-у Statistical coupon for registration
final (refined) diagnoses.
6. 076-y Sanatorium-resort card for children and teenagers.
7. 079-u Medical certificate of a schoolchild leaving for
health Camp.
8. 058-у Emergency notification of an infectious disease,
food poisoning, acute occupational poisoning, unusual
reactions to vaccination.
9. 026 Child’s medical record.
10. 039-u - Diary of a doctor at a clinic.
11. 060-Register of infectious diseases.
12. 113-u
Maternity hospital exchange card.

Documentation forms

Registration form No. 030|U-ped “Passport of the medical site
(pediatric)" and instructions for filling it out were approved by order of the Ministry of Health and Social Development of the Russian Federation dated February 9, 2007 No. 102.
The passport is filled out and maintained regularly throughout the calendar year by a local pediatrician based on
child development history (form No. 112-u) and other approved forms of medical documentation. At the end of the calendar year, the Passport is signed by a pediatrician
to the local police officer and submitted to the statistics department of the healthcare institution, where it is stored for 3 years.
Based on the data from the Passport, the local pediatrician
plans monthly, quarterly and annual work on
medical station and prepares an explanatory note for the report on the work done. Analysis of the Passport data will allow you to plan work at the medical site and evaluate
the effectiveness of the work of a local pediatrician.

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Presentation on the topic: Organization and principles of operation of a children's clinic

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Presentation on the topic: Organization and principles of operation of a children's clinic

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Convention on the Rights of the Child The child has the right to medical care of the highest standards that can reasonably be provided. States should place special emphasis on the provision of primary health care, disease prevention, health promotion and reduction of infant mortality. They must do everything necessary to ensure that no child is denied access to effective health care.

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Polyclinic pediatrics is a section of preventive pediatrics. The concept of childhood origins of chronic diseases in adults and the elderly. Primary prevention determines the final results of the activities of pediatricians. A pediatrician is a single specialist in all problems that arise in a healthy and sick child. Prospective monitoring of the health of the children's population, prevention of infectious and somatic diseases.

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Children's city clinic (legislative basis) An institution of the municipal health care system that provides primary health care. Medical care in the state and municipal health care systems is free. Outpatient care includes: first and emergency medical care; primary preventive measures; diagnosis and treatment of various diseases and conditions; clinical expert activities; dispensary observation of healthy people, risk groups and patients... etc. (Order of the Ministry of Health of the Russian Federation dated July 29, 2005 No. 487 “On approval of the procedure for organizing the provision of primary health care”)

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Activities and structure of a children's clinic Order of the Ministry of Health of the Russian Federation dated January 23, 2007 No. 56 “On approval of the approximate procedure for organizing the activities and structure of a children's clinic” The children's clinic is created as an independent medical and preventive institution to provide primary health care to children on a territorial basis to the population Assistance is provided by local pediatricians of the treatment and preventive department, specialist doctors of the consultative and diagnostic department, doctors of emergency departments, rehabilitation treatment, medical and social care, as well as in educational institutions Interaction with territorial health and education institutions The chief physician is appointed and is released by the local government

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Types of activities of the children's clinic Diagnosis and treatment of various diseases and conditions Antenatal fetal care Patronage of newborns and young children First and emergency medical care Dynamic medical observation of the physical and neuropsychic development of children, children with chronic pathologies, disabled children Prof. measures to prevent and reduce morbidity, disability, mortality Dispensary observation of healthy, sick children, adolescents Medical and social examination Work in educational institutions Protecting the reproductive health of adolescents, vocational guidance, preparing young men for military service Medical assistance in rehabilitation medicine Preservation and promotion of breastfeeding feeding

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Organization of the activities of a local pediatrician Order of the Ministry of Health of the Russian Federation dated January 18, 2006 No. 28 “On the organization of activities of a local pediatrician” A specialist with a higher medical education in the specialty “pediatrics” or “general medicine” and a certificate of a specialist in the specialty “pediatrics” . A local pediatrician provides primary health care to a contingent formed primarily on a territorial basis and on the basis of the free choice of a doctor by patients. Carries out its activities in medical organizations of the municipal health care system that provide primary health care to children.

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Functional responsibilities of a pediatrician in a local preventive unit Conducts dynamic medical observation of the physical and neuropsychic development of children Carries out work to protect the reproductive health of adolescents, antenatal prevention Conducts primary patronage of newborns and young children in a timely manner Organizes and takes part in carrying out preventive examinations of young children, as well as children of decreed age periods. Develops a complex of therapeutic and health measures, ensures control over the implementation of the regime, balanced nutrition, measures to prevent nutritional disorders, rickets, anemia and other diseases in children.

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Functional responsibilities of a pediatrician in the local preventive unit Ensures the implementation of immunoprophylaxis for children Ensures the preparation of children for admission to educational institutions Ensures the flow of information about children and families at social risk to the medical and social care department of the children's clinic, guardianship and guardianship authorities Ensures the implementation of preventive measures -tic and early detection of hepatitis B and C and HIV infection in children Provides medical care to young men during preparation for military service

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Functional responsibilities of a local pediatrician - medical unit Conducts diagnostic and therapeutic work at home and on an outpatient basis Ensures timely referral of children for consultation with specialist doctors and, if appropriate, hospitalization Conducts dynamic monitoring of children with chronic pathology patients undergoing dispensary observation, their timely recovery and analysis of the effectiveness of dispensary observation Ensures the work of the hospital at home Ensures the implementation of individual rehabilitation programs for disabled children

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Functional responsibilities of a pediatrician in a local medical unit Ensures additional drug provision for children entitled to receive a set of social services Issues a conclusion on the need to refer children to sanatorium-resort institutions Provides dispensary observation of children with hereditary diseases identified in the result of neonatal screening Sends notifications in a timely manner to the territory in accordance with the established procedure. Rospotrebnadzor authorities on cases of infectious diseases and post-vaccination complications Conducts work on medical consultation and professional guidance taking into account the health status of children

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Functional responsibilities of a local pediatrician - organizational unit Forms a medical department from the attached contingent Maintains medical documentation in the prescribed manner, analyzing the health status of the contingent assigned to the pediatric medical department and the activities of the pediatric medical department Prepares medical documentation for the transfer of children upon reaching the appropriate age rasta to the city (district) clinic Manages the activities of paramedical personnel providing primary health care

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Criteria for assessing the effectiveness of the work of a local pediatrician (Order of the Ministry of Health of the Russian Federation dated April 19, 2007 No. 283) The purpose of introducing criteria for assessing effectiveness is operational analysis within a medical institution of diagnostic, treatment, preventive and organizational work in the pediatric area for improving the quality of medical care provided to the assigned contingent and monitoring the health status of children. Basic accounting medical documents when assessing the effectiveness of work: - history of the child’s development (No. 112-u) - passport of the medical department (pediatric) (No. 030-u-ped) - a record sheet of medical visits in outpatient clinics, at home (No. 039-u-02)

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Criteria for assessing the effectiveness of preventive work Coverage of pregnant women with prenatal patronage Coverage of children in the first year of life with patronage Completeness of coverage with preventive examinations of children (at least 95% of the total number of children of the corresponding age subject to preventive examinations; in the first year of a child’s life - 100% at 1 month, 3 months, 6 months, 9 months, 12 months) Complete coverage of preventive vaccinations in accordance with the National Calendar (at least 95% of the total number of children subject to vaccination) Proportion of the number of children in the first year of life who are breastfeeding (at 3 months - at least 80%, at 6 months - at least 50%, at 9 months - at least 30%)

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Indicators of the preventive work of the local pediatrician “Health Index” of children (for unorganized children of a certain maternity age) Coverage of pregnant women with prenatal care (early and late) Coverage of pregnant women with full-time classes for mothers Early medical coverage of newborns with observation Systematic observation by doctors and nurses of children in the first year of life Completeness of coverage medical examinations (for decreed age groups) Proportion of preventive visits to the local pediatrician Frequency of breastfeeding Immunization coverage of children

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Prenatal care Early - at a period of 8-13 weeks The main goal is to identify all risk factors and predict the formation of one or another pathology in the fetus and draw up a plan for correcting the influence of unfavorable factors (somatic and genital status of the woman, previous obstetric history, heredity and health status of previous children, occupational hazards, lifestyle, bad habits) Preparation for breastfeeding Prevention of vitamin and mineral deficiency

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Prenatal care Late - at 30-32 weeks The main goal is to analyze the influence of all possible risk factors on the health of the unborn child and the effectiveness of measures to correct them Preparation for breastfeeding (feeding techniques, pumping, prevention of mastitis, lactostasis and hypogalactia) Preparation of the apartment , cribs, newborn care items Rational nutrition, prevention of vitamin and mineral deficiency, lifestyle changes

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Primary patronage of a newborn Conducted on the first day after discharge from the maternity hospital (in the first three days if the newborn is healthy) Clarify and evaluate the social, genealogical and biological history using data from a survey of the mother, prenatal patronage and information from the newborn’s exchange card (f-113 -y) Questions and problems of feeding a newborn Objective examination of a newborn Conclusion on the diagnosis, health group and risk group Medical examination plan for the first month Recommendations on feeding, routine issues, care issues Prevention of hypogalactia, vitamin and micronutrient deficiency, nutrition of a nursing woman Maximum adherence to the principle of professional ethics , internal culture, friendliness and solemnity of the atmosphere

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Objective examination of the newborn General condition, cry, sucking activity Condition of the skin, mucous membranes, the presence of edema, pastosity, cyanosis, “transitional states”, traces of BCG Body build and nutrition Posture, muscle tone, motor activity Condition of the skeletal system Condition of the respiratory organs Cardiovascular condition -vascular system Examination of the abdomen (umbilical ring and umbilical wound, size of the liver, spleen, genitals, frequency and character of stool) Neurological status (position, posture, reactions to stimuli, spontaneous motor activity, cry, unconditioned reflexes in the supine position, in upright and prone position)

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Observation of a newborn child Order of the Ministry of Health of the Russian Federation dated April 28, 2007 No. 307 “On the standard of dispensary (preventive) observation of a child during the first year of life Patronage of a local pediatrician on the 14th and 21st days of life, according to indications (health group) - by 10, 14, 21st day of life Nurse patronage at least 2 times a week During the first month of life, children are provided with medical care by a pediatrician and specialists from the children's clinic only at home Commission examination at 1 month of life in the clinic (neurologist, pediatric surgeon, traumatologist) orthopedist, ophthalmologist, pediatrician, head of the pediatric department, audiological screening, ultrasound of the hip joints) Assessment of physical development based on anthropometric indicators, neuropsychic development, determination of health group, identification of risk groups Plan of clinical observation during the first year of life

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Risk groups of newborns Determined by the neonatologist of the maternity hospital, reflected in f-113-u, preserved in the neonatal period, transformed into risk groups of young children Group 1 - risk of developing central nervous system pathology Group 2 - risk of intrauterine infection Group 3 - risk of developing trophic disorders and endocrinopathies 4 group - risk of developing congenital malformations of organs and systems; group 5 - social risk

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Observation of children in the first year of life Order of the Ministry of Health of the Russian Federation dated April 28, 2007 No. 307 “On the standard of dispensary (preventive) observation of a child during the first year of life Pediatrician - monthly: assessment of medical history, identification of risk groups, prognosis of health status, direction of risk , assessment of information from the previous period, physical development, neuropsychic development, assessment of resistance, diagnosis and assessment of the functional state of the body, conclusion on health status, recommendations. Neurologist - 3, 6, 12 months, pediatric dentist and pediatric surgeon - 9 and 12 months, orthopedist, ophthalmologist, otorhinolaryngologist - 12 months, pediatric gynecologist - up to 3 months. and at 12 months. girls. Registration and observation at the dispensary according to registration form No. 030-u.

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Dispensary observation of healthy disorganized children Pediatrician - in the 2nd year - once a quarter, in the 3rd year - once every 6 months, in the 4th, 5th, 6th years of life - once a year per month of his birth. At each examination, the pediatrician must: examine the state of health according to accepted criteria, conduct a comprehensive assessment of the state of health with determination of the health group and risk group, give recommendations depending on the state of health, draw up an epicrisis in the history of the child’s development. In the 2nd year of life - dentist. At 3, 5, 6, 7 years old - surgeon, orthopedist, ophthalmologist, otolaryngologist, neurologist, dentist. From the age of 4, all children are advised by a speech therapist and, if indicated, by a psychiatrist. When registering at a preschool educational institution, a dermatologist, psychologist and speech therapist.

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Laboratory and instrumental studies Neonatal screening for adrenogenital syndrome, galactosemia, congenital hypothyroidism, cystic fibrosis, phenylketonuria (order of the Ministry of Health and Social Development of the Russian Federation dated March 22, 2006 No. 185 “On mass examination of newborn children for hereditary diseases”) - on the 4th day of life in a full-term baby and on the 7th day in a premature baby. At the age of 1 month - audiological screening and ultrasound of the hip and femoral joints. At 3 months - blood and urine tests, at 12 months. - blood and urine tests, ECG. In risk groups - additionally every 1 month. and 9 months - blood and urine analysis, at 9 months - ECG. Annual blood, urine, and stool tests for worm eggs. From 4 years old - determination of visual acuity, hearing, plantography, blood pressure measurement.

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Risk groups for young children Children at risk for the development of central nervous system pathology (who have suffered perinatal damage to the central nervous system). Children at risk for anemia, VDS, convalescents of anemia. Children at risk of developing chronic eating disorders. Children with constitutional anomalies. Children suffering from rickets 1st and 2nd degree. Children born with large body weight. (“large fruit”). Children who have suffered purulent-inflammatory diseases, intrauterine infection. Frequently and long-term ill children. Children from priority families.

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Principles of monitoring children at risk. Identification of leading risk factors. Determination of observation tasks (prevention of the development of pathological conditions and diseases) Preventive examinations of a pediatrician and doctors of other specialties (timing and frequency) Laboratory diagnostic, instrumental studies. Features of conducting preventive examinations, preventive and therapeutic measures (nutrition, regime, massage, gymnastics, non-drug and drug rehabilitation) Criteria for the effectiveness of observation. The observation plan is reflected in form 112-u.

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Criteria for determining health groups Presence or absence of functional disorders and (or) chronic diseases (taking into account the clinical variant and phase of the pathological process) Level of functional state of the main systems of the body Degree of resistance of the body to adverse external influences Level of development achieved and the degree of its harmony importance Order of the Ministry of Health of the Russian Federation dated December 30, 2003 No. 621 “On a comprehensive assessment of the health status of children”

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Newborn health groups 1 Group - healthy children (without deviations in health status and risk factors) 2 Group - depending on the number and direction of risk factors, as well as their potential or actual implementation, is divided into options: A and B 3 Group - the presence of a chronic disease in the stage of compensation 4 and 5 Groups - by analogy with the corresponding groups of older children. At the end of the neonatal period, it moves to the health group of young children (Order No. 621)

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Vaccination. Legal basis. Federal Law No. 157 of September 17, 1998 “On immunoprophylaxis of infectious diseases.” Decree of the Government of the Russian Federation No. 885 of August 2, 1999 “List of post-vaccination complications caused by preventive vaccinations included in the national calendar and preventive vaccinations for epidemiological indications, entitling citizens to receive state one-time benefits.” Decree of the Government of Russia No. 1013 of December 27, 2000 “On the procedure for paying state one-time benefits and monthly cash compensation to citizens if they experience post-vaccination complications.” -Order of the Ministry of Health of the Chelyabinsk Region and the Office of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in the Chelyabinsk Region No. 1011/360 dated September 17, 2009 “On approval of the main provisions of immunization of the population of the Chelyabinsk Region.” - Order of the Ministry of Health and Social Development of the Russian Federation dated January 26, 2009 N 19n “On the recommended model of voluntary informed consent for preventive vaccinations for children or refusal of them”

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Rights and responsibilities of citizens Rights: - receive free vaccinations with all types of vaccines included in the national calendar; be familiar with all possible reactions and complications due to the vaccination process, as well as the consequences of those infectious diseases that may occur due to lack of vaccination; voluntarily refuse vaccination ( having formalized this refusal in writing) and not be prosecuted for this by law, citizens and their children cannot be denied admission to pre-school, school or health care institutions, summer camps, etc. (due to lack of vaccinations), except in cases of unfavorable epidemiological situation, receive social benefits and compensation in case of post-vaccination reactions and complications. In case of death, loss of ability to work, disability - pensions and benefits. Responsibilities: in the absence of immunoprophylaxis, strictly follow the instructions of medical workers, confirm in writing the refusal of preventive vaccinations

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Post-vaccination reactions and complications A vaccine reaction is a symptom complex of changes in the body (in the functioning of its individual systems) caused by the vaccine process and associated with it in time. Post-vaccination reactions are the same for each type of vaccine, and when using live vaccines, they are specific. Post-vaccination reactions are characterized by a short-term and cyclical course and do not cause serious disorders of the body’s vital functions. Reactions are classified into general and local, weak, moderate and strong. Severe reactions – temperature > 40°C and/or swelling and hyperemia at the injection site > 8 cm in diameter. Post-vaccination complication is a severe and/or persistent health disorder resulting from preventive vaccinations.

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Time periods of reactions and complications General reactions occur no later than 48 hours after DTP, ADS, ADSM. Specific reactions to live vaccines - no earlier than 4-5 days and no later than 12-14 days for measles, and 21 days for mumps vaccine. Allergic reactions of the immediate type occur within 2-4 hours. Meningeal phenomena can occur 3-4 weeks after administration of the mumps vaccine and are not typical for reactions after DTP, DPT and measles vaccines. Encephalitis (encephalopathy) after DTP occurs no later than the first 7 days. Encephalitis after measles vaccination - at the end of the 2-3rd week. Catarrhal syndrome is a specific reaction to measles vaccine; it occurs from 4-5 to 12-14 days after vaccination; it is not typical for other vaccines. Intestinal, renal syndromes and DN are not typical for complications and reactions to any vaccinations. A characteristic complication of the polio vaccine is vaccine-associated poliomyelitis, flaccid paresis and paralysis without loss of sensitivity. For the BCG vaccine, a characteristic complication is osteitis, osteomyelitis of BCG etiology and generalized BCG infection.

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Principles of vaccination Only healthy children are subject to vaccination Maximum compensation for all deviations in the state of health at the time of vaccination Optimal choice of time and timing of vaccination Sanitation of all foci of infection at the time of vaccination Vaccination under “medicinal cover” of children with chronic diseases Tracking the child in the post-vaccination period The first day of medical treatment should be the first day of preparation for vaccination. The main goal of vaccination is the formation of high-quality immunity.

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Preparing children for preschool education Begins from the first days of the child's life General training - systematic preventive observation Special training (sanitary education work with parents of the district nurse, staff of the office for raising a healthy child, clinical observation by the local pediatrician, medical specialists, laboratory tests within 2 -3 months before admission) Improvement and treatment depending on the state of health and the results of the last medical examination Forecast of the severity of the course of adaptation based on medical history and health status Referral to the adaptation commission Filling out a medical record (F-026-u)

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Assessment of the severity of adaptation Periods of adaptation: acute (disadaptation), subacute (adaptation) and adaptation itself. Degree of severity: mild, moderate and severe, two variants of the course (A - development of chronic somatic pathology, B - development of neuroses, neurotic reactions, neurological disorders) Severity criteria: speech and emotional activity, contact with adults and peers, rate of weight gain and growth or lag in terms of physical development, frequency and severity of acute diseases, presence of complications Duration from 10-20 to 60 days or more

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Criteria for assessing the effectiveness of medical work The quality of dispensary observation of children - the completeness of dispensary observation coverage for nosological forms should be at least 90%; the proportion of children removed after recovery, as well as with an improvement in their health, should be at least 10% for each indicator; dynamics of the number of disabled children. Completeness of coverage of medical and preventive care for children under dispensary observation - the proportion of children hospitalized on a planned basis, sent on a planned basis to sanatorium-resort institutions, who received anti-relapse treatment; the share of completed individual rehabilitation programs for disabled children; validity of prescribing medications and compliance with prescription rules

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Other indicators of medical work General morbidity, morbidity by age, by nosology. Mortality in the area of ​​activity, by age group. Precinct service at home, at the reception. Home visiting activity. Structure (composition) of dispensary patients. Completeness and timeliness of dispensary observation coverage, the proportion of those newly taken under dispensary observation, coverage of patients with anti-relapse treatment. The average annual workload per doctor is 1 hour.

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Monitoring a sick child A sick child should not visit the clinic. The standard for a local pediatrician to work at home: 2 visits per hour. Continuity of monitoring a sick child at home - active visits. Newborn children with acute illnesses are hospitalized without fail. Infants are examined at home every day until complete recovery. Children older than one year are examined depending on the severity of the condition. Only convalescents are invited to the clinic. Providing emergency care at home. Referral to hospital based on the severity of the condition or epidemiological indications.

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Observation of children with chronic diseases Registration after detection of the disease on an inpatient or outpatient basis. Preparation of documentation: statistical certificate (F-025-u), control card of a dispensary patient (F-030-u). Drawing up a dispensary observation plan for the calendar year. Epicrisis at the end of each calendar year. At each dispensary examination: identification of complaints, specific symptoms, objective examination taking into account the nature of the pathology, conclusion on the diagnosis (period and severity of the disease, complications), concomitant pathology, assessment of physical and sexual development, health group, physical activity group, recommendations for rehabilitation.

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Objectives of dispensary observation of children with chronic diseases Prevention of exacerbations of the underlying disease. Prevention of acute intercurrent diseases that can affect the severity of the underlying disease. Prevent the development of complications and transition to a more severe form of the disease. Sanitation of chronic foci of infection. Social and physical adaptation (preschool education, school, everyday physical activity, sports clubs) Prevention of disability. Possibility of full vaccination. Improving quality of life. Adequate psycho-physical development of the child.

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Dispensary observation scheme: Pediatrician immediately after an exacerbation of any disease - once every 1.5-3 months for 6-12 months, and then - at least once every 6 months for all subsequent years of observation. ENT doctor and dentist at least once every 6 months (sanitation of foci of infection). Medical specialists in the profile of the disease at least once every 6-12 months. General clinical tests (blood, urine, feces for helminth eggs) - at least once every 6 months. Laboratory and instrumental studies on the profile of the disease - at least once every 6-12 months. Dietary and regimen recommendations, anti-relapse, basic treatment, treatment of concomitant pathologies, rehabilitation measures.

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Rehabilitation activities. Regime restrictions, the possibility of visiting preschool educational institutions, schools, and additional classes. Diet characteristics. Non-drug methods (physical therapy, massage, physiotherapy), organization of summer recreation. Medication methods (anti-relapse, basic, eradication therapy, other types of pathogenic and symptomatic treatment). Pre-season preparation - prevention of ARVI. Prevention of vitamin and mineral deficiency conditions (calcium, iodine, iron). Increased nonspecific immunobiological resistance. Determination of indications for sanatorium-resort treatment.

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Rehabilitation activities. Use of rehabilitation treatment units for rehabilitation. Educational programs for parents and children (training in methods of monitoring symptoms, treatment algorithms and emergency care) - goal: to improve the quality of life. Planning vaccination according to the calendar and additional vaccines, preparation, tracking in the post-vaccination period. Assessment of effectiveness and possibility of deregistration. Resolving issues of professional guidance. Determination of indications for disability. Determination of a physical education group, exemption from exams, training at home.

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Documentation forms Form N Name of form 1. 112 History of child development. 2. 030-u Control card of dispensary observation. 3. 063-u Card of preventive vaccinations. 4. 064- Journal of preventive vaccinations. 5. 025-у Statistical coupon for registration of final (updated) diagnoses. 6. 076-y Sanatorium-resort card for children and teenagers. 7. 079-u Medical certificate of a schoolchild leaving for a health camp. 8. 058-у Emergency notification of an infectious disease, food poisoning, acute occupational poisoning, unusual reaction to vaccination. 9. 026 Child’s medical record. 10. 039-u - Diary of a doctor at a clinic. 11. 060-Register of infectious diseases. 12. 113-у Exchange card of the maternity hospital.

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Galina Aleksandrovna Gurzhiy

I would like to express my deep gratitude and deep bow to Doctor with a capital letter S.V. Kuzmina. for an attentive, sensitive and caring attitude towards patients, the patient’s problem, empathy, humanity and most importantly, a sincere desire to help. Please give an honorable mention to S.V. Kuzmina. for high professionalism and provision of qualified care to patients. Thank you!

Cherkashina Galina Aleksandrovna

After several months, which for me turned into moments of despair and hope, I would like to express my sincere recognition and gratitude to the ultrasound doctor Natalya Vladimirovna Matveeva. I can’t even imagine whether I would be healthy now if I had not had an appointment with doctors at clinic No. 121 (branch No. 2) on open day. I was urgently provided with assistance in undergoing tests and other procedures in preparation for the operation. After the operation I feel fine. Immediately after the operation, I expressed gratitude to the doctor who saw me. Now I also think: you need to be fair and grateful in order to also mention the doctor Natalya Vladimirovna Matveeva. Thank you!

Burenkova Olga Borisovna

Good afternoon. I would like to express my deep gratitude to the nurses of polyclinic 121 branch 2. I would like to note the well-organized work of the nurses, the constant desire to qualitatively improve the level of performance of services for patients. There are practically no queues at nursing stations; nurses work very harmoniously and competently. I would like to wish them health, patience and success in their difficult work!

Shandorin Oleg Alexandrovich

Hello! I would like to express my deep gratitude to the urology doctor Timirkhan Avalievich Bakhoev for his highly professional approach both to the initial examination and during the treatment process itself. He consulted, prescribed examinations to identify the cause of the anxiety, and then prescribed treatment, which of course helped with a complete recovery. A specialist in his field, many thanks to him!!

Romanov Artem Yurievich

Hello! I would like to express my deep gratitude to Timirkhan Avalievich Bakhoev for his professional approach, sensitive and attentive attitude towards the patient. Thank you very much! There should be more doctors like this!

Kasyanova Olga

Good afternoon I would like to express my gratitude to nurse G.K. Abdulyan for her attention and kindness. A calm, positive woman, always ready to help. Thank you very much that such employees work at your clinic No. 121.

Sumenkov Anton Olegovich

I would like to express my gratitude to the head of the branch, Li Veranika Vladimirovna! Veranika Vladimirovna thank you for your help! Veranika Vladimirovna is ready to help everyone who comes to her, she doesn’t hide from visitors, and this is very important! I am glad and calm that our clinic is managed by a sympathetic person!

Kolyaskina Ekaterina Vladimirovna

Good afternoon I would like to express my deep gratitude to the help desk! I called the helpline just to clarify the available slots for an appointment with a surgeon, I was offered all open appointments for two weeks. The girl on the phone was friendly and polite, and after listening to my question, she offered several options for solving it. She offered to clarify the necessary information for making an appointment and call back later. After calling the line back, I got to the same girl and made an appointment. Thus saving time. For which thank you very much, because... I work and there is no way to come and make an appointment. Thank you very much, good quality service, keep it up! I was very pleased, there are more employees like this!