Tatiana Solomatina

Features of the sanatorium spa treatment: all truths and lies

Hello, dear readers! I have long been meaning to write what features of sanatorium and resort treatment should be taken into account before choosing this type of vacation. And finally I got my hands on it.

In this article I will try to explain in detail all the pros and cons. This will dispel the misconceptions of people who have little idea of ​​the regulations for such a holiday. I’ll tell you how to choose a sanatorium and what documents you need to come there with, I’ll give you practical advice upon arrival at the sanatorium, based on your experience and personal impressions.

I’ll say right away that I go to the sanatorium regularly, at least once a year (I have certain health problems), and I recommend this type of treatment to everyone suffering from chronic diseases.

This article will be of interest to people who go to a sanatorium primarily for treatment, and consider rest as a pleasant addition.

I think that it will be useful for them to understand in advance the specifics of treatment in sanatoriums, so that later there will be no such conversations:

“I paid a lot of money, but they didn’t cure anything, they fed me boiled food, they prescribed few procedures, although there are a whole bunch of them on the website, I couldn’t get enough sleep, I was tired of such a rest, etc.”

Have you heard such speeches from friends, relatives and acquaintances? I think yes. And people don’t lie, that’s how it happened. However, they are wrong. Why - as you read, you will understand this.

The impetus for writing this article was the example of a close friend of mine who has back problems. Before that, she used the services of a competent chiropractor, but doctors are people too, they can get sick, which is what happened in her case.

A friend, unable to find a suitable replacement, urgently bought a ten-day ticket to a sanatorium and, with the joy of someone who has successfully found a solution to the problem, told me about it. Oh, how I didn’t want to disappoint her, but I had to tell her about the features of the sanatorium and resort treatment.

That’s when I realized that there are people who do not understand the specifics of these institutions. They think something like this: “I’ll come to the sanatorium, go through full examination, they will find the sores and cure them, I will return from there and the health problem will disappear.”

However, this is a misconception. And not because the sanatoriums are bad, there is no treatment there, there are no doctors and equipment (this is also a misconception). But because you need to know the features of sanatorium-resort treatment and purchase a voucher, understanding that this is not an emergency hospital and the task of such an institution is completely different.

How to choose a sanatorium?

90% of the success of treatment depends on the right sanatorium. Therefore, take this issue seriously. Moreover, it is not necessary to rely only on living conditions, although this is also important. First of all, pay attention to the profile of the institution and the direction of treatment.

Ideally, the main profile should be your disease, but it is not always possible to find a sanatorium that deals only with a narrow specialization, it is especially difficult when you have a rare disease.

Pay attention to the location of the institution. In some cases this is important. For example, if you suffer from chronic urological disease, That the best place treatment – ​​. Because it is there that there are mineral springs that help well with this illness.

The second thing you need to pay attention to is the availability of the specialists you need (I’ll write about this in more detail below) and the necessary medical equipment. A very important point, because the absence of this will lead to ordinary recovery, and not serious treatment.

And only in third place would I put comfort, accommodation, food, etc.

Look for the official website of the sanatorium, read all the information in detail, and do not neglect to call there if you have questions. Try to buy tours directly on the website or book by phone.

Be sure to read the latest reviews, preferably on other resources. In this way, you can find out the features of sanatorium-resort treatment in the specific region you have chosen.

Required documents

Upon arrival at the sanatorium you must present documents

1. Passport
2. A voucher or reservation (sometimes a paid receipt)
3. Medical insurance policy
4. Sanatorium resort card

It is advisable to have an extract from your medical card; in some places they require a certificate for the swimming pool.

This list is basic for all sanatoriums. Be sure to check the list necessary documents before the trip (sometimes additional documents are required, and for people discounted vouchers– the list is slightly different, as for families with children).

Basic misconceptions of beginners

So that you understand everything and do not take rash steps, I will dispel myths about sanatorium-resort treatment and reveal the whole truth, which is better to know before making a decision about such a trip.

The disease has worsened - I’ll go to a sanatorium

Imagine this situation. A chronic disease has worsened. You run to doctors, take course after course of medications, but it doesn’t get any better. acute condition cannot be removed. Tired of knocking around the thresholds of different offices, you take the last of your money and buy a ticket to a sanatorium, hoping for rest, daily observation by doctors, consultation and competent treatment.

Unfortunately, this scenario always ends in disappointment. The thing is that the sanatorium does not treat diseases in acute form, they undergo rehabilitation here when remission occurs.

Simply put, one of the contraindications to treatment in such institutions is precisely diseases of the acute stage development.

You need to come here in a state of remission. Then you will complete the full course of treatment. And during an exacerbation, the procedures are contraindicated; you can only rest and receive minimal drug treatment.

I will buy a full ticket, everything is included in it

However, if you look closely at the long list, you can see that 10% of them are done only for men or only for women, another 20% are generally accepted by type - climate therapy, health path, drinking cure, herbal medicine, etc.

Or, for example, everyone sees a massage, but no one pays attention to the fact that 1.5 units is written next to it, this only means a massage of one and a half zones (for example, the neck), and all other zones are no longer included in the price of spa treatment.

I give these examples so that you understand that despite the fact that the list is quite large, especially valuable procedures are not included there, and the doctor usually prescribes not the entire list, but one of the areas (mud therapy, physiotherapy , hydrotherapy, etc.), and you are not always allowed to choose, usually at the discretion of the doctor.

All this is neither bad nor good, you just need to know that in a sanatorium you can really improve your health in a qualitative manner, but you must immediately focus not only on the cost of the sanatorium resort package, and also have funds in the amount of at least 30% of the cost of the voucher for additional paid procedures (a firm conclusion based on rich personal experience).

If you accept this fact in advance, then there will be no disappointments regarding the cost of treatment and the number of procedures.

I’ll come and go through all the specialists

Another misconception that can ruin all plans. The fact is that there are almost no sanatoriums in which all specialized specialists work for permanent basis. As a rule, there are therapists and 2-4 highly specialized doctors. Everyone else goes to work under a contract.

It’s good if they work twice a week for 4 hours, then there is a chance to get to them in a week, there is also an appointment and a queue. And if they come less often, then they will be able to consult only before departure.

To understand how the situation is in the place you have chosen, you need to look on the institution’s website for such headings as “Our employees” or “Sanatorium staff.” Usually there are photographs of the staff, their specializations and working hours are published. From which you can roughly understand how staffed the institution is.

If there is no such data on the official website of the sanatorium, then read the latest reviews or call the sanatorium and talk to one of the doctors.

Don’t forget that the price of the tour includes a maximum of three specialists (including a therapist); the rest will have to be paid for consultation.

I will make a sanatorium and resort map on the spot

Of course, no one wants to stand in line at a local physician, take referrals, take tests, do fluorography and undergo specialist examinations. Practice free medical institutions Nowadays, it takes more than one day to get a health resort card.

Buying one is also not an option, because the topic of our article implies that you do not need treatment for show. Therefore, it is not in your interests to go to a sanatorium with drawn up tests and fictitious doctor’s reports.

Based on the above, many people make the mistake of expecting to get a health resort card upon arrival. The point is not that not all sanatoriums have such a service, but that in this case, you will spend at least two days on all the manipulations. After all, there you will also have to collect anamnesis and take tests.

Accordingly, you will lose paid days, because during this time the doctor will not prescribe you any treatment. Plus you will have to pay for a sanatorium and resort card, because such a service is not included in the price of the tour. Perhaps money doesn’t matter to someone, but the lost 2-5 days (sometimes you won’t get to a specialist quickly) should make you think.

Two weeks is enough

I often hear the following words: “They refused to do 10 sessions of procedures and prescribed only 6, although I came for 14 days.” Next comes resentment and complaints about bad attitude. Who is guilty? Definitely not a sanatorium. Surprised? I'll explain now.

The fact is that in all sanatoriums the number of prescribed procedures directly depends on the number of days of the voucher you purchased.

10 pieces of each procedure are offered only if the trip is 18-20 days. If you come for two weeks, then most likely such a course includes 6-7 procedures, for 16-17 days - 7-8 procedures. And it's not about harmful nature doctor, it’s just such an official regulation, and it’s physically impossible to do more. Below, you will see this.

Six procedures are not enough for a full-fledged spa treatment - a fact. If your goal is treatment, not wellness, then you need to come to the sanatorium for at least 21 days, preferably out of season, fewer people, not delayed staff, no queues. I wrote about this in detail.

There is one more point that confirms these features.

It should be borne in mind that many procedures cannot be combined, so they are prescribed every other day. That is, today you go to mud, and tomorrow to physio, then again to mud, etc. Accordingly, if you need to do ten of each, it will take 20 days, add another day of arrival and departure. How much will it be?

Well, when can you carve out a couple more days for your sanatorium and resort card, I wrote about it above. Don't forget that Sunday falls, most often the medical building is closed. So consider for yourself, I have discovered the real state of affairs.

Usually, all this is written on the official website, but not everyone goes there, or does not read all the information, hence the resentment and disappointment.

I'll finally get some sleep

It’s not at all misleading if your goal is only relaxation and recovery. However, for those who go for treatment, everything is a little different.

As a rule, many procedures are prescribed, they go one after another, start at seven o’clock in the morning, the schedule is so tight that even for breakfast and lunch there is limited time. The rushing around the offices ends around three o'clock in the afternoon, and even then, if there is no evening reception specialist or ultrasound examination.

It becomes a little easier over time after ten days, when the daily procedures have already been done and those that are done every other day remain.

Therefore, get ready for the fact that the first half of your stay at the sanatorium will be very eventful and you will hardly be able to sleep longer in the morning.

But in the second half of your vacation, you will have an excellent opportunity not only to sleep more, but also to devote time to walks and sightseeing, if, of course, you come for 21 days.

How does everything really happen?

We talked about misconceptions and features, if I remember anything else, I’ll definitely add it to the article. Now I’ll try to briefly tell you how everything actually happens. In any case, this was the case in the places I visited (six different sanatoriums). Of course, there are differences everywhere, but they are minor.

You arrive at the sanatorium, register at the reception, where they give you the keys to your room and a food card. Sometimes they immediately tell you which office and what time the doctor will see you. If not, they will inform you later.

Come to the doctor, give your medical documents, they examine you and make prescriptions. It is advisable at this moment to resolve the issue of paid procedures and communicate your preferences. The doctor will immediately add them to the list of appointments and there will be no need to come again.

Then you will go to the head nurse or another employee (sometimes at the reception), give the papers with the appointments and after some time you will be given a book (slider) where your spa treatment is scheduled by day and time for the entire period.

As a rule, this is not the final version. Procedures can be cancelled, replaced or added after tests, new appointments from specialists or at your request, if a certain type of procedure is not suitable (for example, it is poorly tolerated).

However, the changes are made by the attending physician, so you must go to him for this.

Meals take place depending on the schedule (during the allotted hours).

Keep in mind that food at the sanatorium is also part of the sanatorium-resort treatment. The food is strictly balanced according to diets. Nothing fried or smoked. But this is only for the benefit of your body; you can endure it for three weeks.

They usually take place in the evening entertainment programs in the spirit of the USSR. Singing to the accordion, discos - for those over 50, performances by local amateur groups, watching films, etc. Please note that some events may require entry fees, so add these costs to your holiday budget.

Conclusions based on my example

After reading the article, you might have formed the feeling: “I’ve never been there, and there’s nothing to do there.” As a person who regularly visits sanatoriums, let me disagree with you and prove the effectiveness of sanatorium-resort treatment using my own example. Believe me, the benefits are enormous. Read my story.

Having an unpleasant chronic illness, I for a long time ignored this type rehabilitation. Seven years ago, after a long and complex treatment in the hospital, the head of the department told me upon discharge: “You have a chronic disease and in order not to bring your body to such a state, you must undergo sanatorium and resort treatment in Zheleznovodsk once a year. Try Tatyana, I guarantee you will forget about your illness for a long time.”

At that moment I was so tired of feeling unwell and the endless taking of pills that cure one thing and cripple another, that she took his words seriously. And I was right. Spa treatment really helps me. But on condition regular visits resort and strict implementation of all procedures.

If it’s as difficult for you as it once was for me, try it, it definitely won’t make you worse, but you’ll feel the benefits right away. And if treatment in a sanatorium is initially perceived not as relaxation, but as hard work (early getting up, not always pleasant procedures, unusual food, etc.), then there will be no disappointments and grievances, which I wrote about above, reality will be perceived completely differently , with understanding of the situation and humor.

Dear readers! With all my heart I wish you health and long happy years of life!

I wrote practical information for guests planning to go on vacation and treatment to Mineralnye Vody for the first time in an article.

If you have your own experience of visiting a sanatorium, share it with readers, write a story, send it to me, I will definitely publish it in the new section “Readers’ Travels”. Read more about this.

Now I say goodbye to you for a while, see you soon!

Tatiana Solomatina

Spa treatment;

medical rehabilitation of patients;

restorative treatment of persons with severe forms and conditions of diseases;

recreation and disease prevention;

cultural, educational and entertaining.

The first three functions of resorts form the basis of spa therapy - the therapeutic use of natural physical factors.

Sanatorium-resort treatment has proven the effectiveness of using natural physical factors, which has made it possible to successfully treat at resorts patients who were not previously sent to resorts, including patients with severe forms of coronary heart disease, patients after cardiac surgery, after cerebral vascular crises, with severe bronchopulmonary pathology systems, etc.

One of the most important principles is the connection between sanatorium-resort treatment and the pre-sanatorium stage. Doctors at clinics are very ignorant in matters of spa therapy, indications and contraindications for it. In this regard, 4-9% of patients arrive at health resorts for whom sanatorium-resort treatment is not only not indicated, but is also contraindicated.

Types of spa treatment for various diseases.

balneotherapy-use mineral water for medicinal purposes;

climatotherapy - the use of climate for medicinal and health purposes;

heliotherapy-use sun rays for medicinal and health purposes;

aerotherapy - the use of air for medicinal and health purposes;

thalassotherapy (Greek thalassa - sea) - treatment with a marine climate and swimming in combination with sunbathing;

diet therapy - the use of nutrition for therapeutic and health purposes;

kinesitherapy - treatment with movement, Physical Culture- active recreation and therapeutic physical education (therapeutic physical education);

physiotherapy - the use of preformed physical factors (artificial factors) for therapeutic purposes.

Diseases of the circulatory system

For a long time, diseases of the heart and blood vessels were considered contraindicated for spa treatment. For the first time, the doctor of the German resort of Nauheim, F. Beneke, reported on the successful treatment of heart patients and the beneficial effects of carbonic waters. He believed that warm carbon dioxide baths calmed cardiac activity, helped compensate for circulatory disorders, and also significantly improved the general condition of patients.

The main resort factors for the treatment of diseases of the circulatory system: balneotherapy with carbon dioxide, hydrogen sulfide and radon waters, hydrotherapy, as well as climatotherapy, preformed physical factors against the background of adequate drug therapy. All programs are tailored individually, taking into account concomitant diseases. When prescribing therapeutic exercises, the level of physical activity and exercise tolerance are taken into account. IN Spa treatment diseases of the circulatory system includes balneotherapy using carbon dioxide, sulfide, hydrogen sulfide, sodium chloride, iodine-bromine, nitrogen, and radon baths. Exercise therapy using cardio equipment is also included. The main effect is aimed at strengthening the cardiovascular and respiratory systems of the body. The training regime is developed individually.

In accordance with articles 5.2.11. and 5.2.101. Regulations on the Ministry of Health and social development Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 2004 N 321 (Collection of Legislation of the Russian Federation, 2004, N 28, Art. 2898), Article 6.2. Federal Law dated July 17, 1999 N 178-FZ "On State social assistance"(Collected Legislation of the Russian Federation, 1999, No. 29, Art. 399; 2004, No. 35, Art. 3607) and in order to improve the procedure for medical selection and referral of patients for sanatorium treatment I order:

1. Approve:

1.1 The procedure for medical selection and referral of patients for sanatorium treatment (Appendix No. 1).

1.2. Form N 070/у-04 “Certificate for obtaining a voucher” (Appendix No. 2).

1.3. Form N 072/у-04 “Sanatorium-Resort Card” (Appendix No. 3).

1.4. Form N 076/у-04 “Sanatorium-resort card for children” (Appendix No. 4).

1.5. Instructions for filling out form N 070/у-04 “Certificate for obtaining a voucher” (Appendix No. 5).

1.6. Instructions for filling out form N 072/у-04 “Sanatorium-Resort Card” (Appendix No. 6).

1.7. Instructions for filling out form N 076/u-04 “Sanatorium and resort card for children” (Appendix No. 7).

2. Recognize the order of the Ministry of Health of the Russian Federation dated June 14, 2001 N 215 “On the referral of patients to sanatorium-resort and outpatient-resort treatment” as invalid*.

3. Control over the implementation of this order is entrusted to the Deputy Minister of Health and Social Development of the Russian Federation V.I. Starodubova.

Minister M. Zurabov

____________
* Registered with the Ministry of Justice of Russia on July 10, 2001, registration N 2800.

Appendix No. 1

The procedure for medical selection and referral of patients for sanatorium treatment

I. The procedure for medical selection and referral to sanatorium-resort treatment for adults (except for patients with tuberculosis)

1.1. This Procedure defines the basic principles of medical selection and referral of patients for sanatorium treatment.

1.2. Medical selection and referral of patients in need of sanatorium-resort treatment is carried out by the attending physician and the head of the department, and where there is no head of the department, chief physician(deputy chief physician) of a medical institution (outpatient clinic (at the place of residence) or a medical unit (at the place of work, study) of the patient when referring him for preventive sanatorium treatment and hospital facility when referring a patient for follow-up treatment).

1.3. The attending physician determines the medical indications for spa treatment and the absence of contraindications for its implementation, primarily for the use of natural climatic factors, based on an analysis of the patient’s objective condition, the results of previous treatment (outpatient, inpatient), laboratory, functional, radiological and other data research.

In complex and conflict situations upon the recommendation of the attending physician and the head of the department, a conclusion on the indications for sanatorium-resort treatment is issued by the medical commission (hereinafter referred to as the MC) of the medical institution.

Sanatorium-resort treatment, in accordance with the doctor’s recommendation and the patient’s application, can also be provided on an outpatient basis (hereinafter referred to as sanatorium-resort treatment).

1.4. When deciding on the choice of a resort, in addition to the disease for which sanatorium-resort treatment is recommended for the patient, one should take into account the presence of concomitant diseases, travel conditions to the resort, contrasting climatic and geographical conditions, features of natural healing factors and other treatment conditions at the recommended resorts.

Patients who are indicated for sanatorium-resort treatment, but are burdened with concomitant diseases, or with age-related health problems, in cases where a trip to distant resorts can adversely affect their general health, should be sent to nearby health resort institutions, organization (hereinafter referred to as OCO) of the required profile.

1.5. If there are medical indications and there are no contraindications for sanatorium-resort treatment, the patient is given a certificate for obtaining a voucher in the form N 070/u-04 (hereinafter referred to as a certificate for obtaining a voucher) (Appendix No. 2) with a recommendation for sanatorium-resort treatment, about which The attending physician of the medical institution makes an appropriate entry in medical card outpatient. The certificate is valid for 6 months.

1.6. The certificate must be completed by the attending physician in all mandatory sections using the information on back side certificates

The darkened field of the certificate is filled out and marked with the letter “L” in the organizational and methodological office of the medical institution (hereinafter referred to as the organizational and methodological office) only for citizens entitled to receive the kit social services.

The certificate is of a preliminary informational nature and is presented to patients along with an application for a voucher for sanatorium treatment at the place where the voucher was provided, where it is stored for three years.

1.7. Having received a voucher, the patient is obliged, no earlier than 2 months before the start of its validity, to visit the attending physician who issued him a certificate to obtain a voucher, in order to carry out the necessary additional examination. If the SCO profile specified in the voucher corresponds to the previous recommendation, the attending physician fills out and issues to the patient a sanatorium-resort card in the form N 072/u-04 (hereinafter referred to as the sanatorium-resort card) (Appendix No. 3) of the established form, signed by him and the head department.

The darkened field of the sanatorium-resort card is filled out and marked with the letter “L” in the organizational and methodological office only for citizens entitled to receive a set of social services.

About the issuance of a sanatorium-resort card, the attending physician of a medical institution makes an appropriate entry in the medical record of the outpatient (in the medical history when referred for follow-up treatment).

1.8. The organizational and methodological office monitors the timely provision of sanatorium and resort treatment and keeps records of the following documents issued to citizens entitled to receive a set of social services:

The number of certificates issued to obtain a voucher;

Number of health resort cards issued;

Number of return coupons for sanatorium and resort cards.

1.9. Attending physicians and heads of departments should be guided by the following mandatory list diagnostic studies and consultations with specialists, the results of which must be reflected in the sanatorium-resort card:

A) clinical analysis blood and urine analysis;

b) electrocardiographic examination;

V) X-ray examination organs chest(fluorography);

d) for diseases of the digestive organs - their X-ray examination (if more than 6 months have passed since the last X-ray examination) or ultrasound, endoscopy;

e) in necessary cases are carried out additional research: determination of residual blood nitrogen, fundus examination, gastric juice, liver, allergy tests, etc.;

f) when sending women to sanatorium-resort treatment for any disease, a conclusion from an obstetrician-gynecologist is required, and for pregnant women - an additional exchange card;

g) certificate-conclusion from a psychoneurological dispensary if there is a patient’s medical history neuropsychiatric disorders;

h) with the main or concomitant diseases(urological, skin, blood, eyes, etc.) - conclusion of relevant specialists.

1.10. The chief doctors of treatment and preventive institutions monitor the implementation of this Procedure and the organization of medical selection and referral of patients (adults and children) to sanatorium-resort treatment.

II. The procedure for medical selection and referral of children to sanatorium-resort treatment

2.1. Medical selection of children for treatment in sanatorium-resort organizations is carried out by treatment and preventive institutions, which must provide:

Registration of children in need of sanatorium-resort treatment;

Control of the completeness of the examination of patients before referral to sanatorium-resort treatment and the quality of registration medical documentation;

Accounting for defects in selection, referral of children to sanatorium-resort treatment and analysis of its effectiveness.

2.2. The need to refer a child to sanatorium-resort treatment

determined by the attending physician of the medical institution with the issuance of a certificate for obtaining a voucher for the child (to be provided at the place of request) and a sanatorium-resort card for children in form N 076/u-04 (hereinafter referred to as the sanatorium-resort card for children) (Appendix N 4).

In the organizational and methodological office, mark with the letter “L” and fill out the darkened field of the certificate for obtaining a voucher and a sanatorium-resort card for children, only for children from among citizens entitled to receive a set of social services.

2.3. Referral of children to sanatorium-resort treatment is carried out in a manner similar to that for adult patients.

2.4. Medical selection of adult patients sent together with children to sanatoriums for children with parents is carried out in the manner established in sections I and III of this Procedure. When determining the CODE profile, the child’s illness and the absence of contraindications for sanatorium-resort treatment for his accompanying person are taken into account.

2.5. Before sending a child for sanatorium-resort treatment, the attending physician organizes his clinical and laboratory examination depending on the nature of the disease, as well as the sanitation of chronic foci of infection, anthelmintic or anti-giardiasis treatment.

2.6. When referring a child for sanatorium treatment, you must have the following documents:

Voucher;

Sanatorium-resort card for children;

Compulsory health insurance policy;

Analysis for enterobiasis;

Conclusion from a dermatologist confirming the absence of contagious skin diseases;

A certificate from a pediatrician or epidemiologist confirming that the child has no contact with infectious patients at the place of residence, in kindergarten or school.

2.7. At the end of the sanatorium-resort treatment, the child is issued a return coupon of the sanatorium-resort card for submission to the medical institution that issued the sanatorium-resort card, as well as a sanatorium book with data on the treatment carried out in the SKO, its effectiveness, and medical recommendations.

This documentation is handed over to the parents or accompanying person.

III. Procedure for admission and discharge of patients

3.1. Upon arrival at the SKO, the patient presents a voucher and a sanatorium-resort card, which is stored in the SKO for three years. In addition, the patient is recommended to have a compulsory health insurance policy.

3.2. After initial examination The attending physician of the SKO issues a sanatorium book to the patient, in which the prescribed healing procedures and other appointments. The patient presents it to the medical departments of the SKO to mark the treatment or examination performed.

3.3. When providing health resort assistance types and volumes medical services are provided in accordance with the standards recommended by the Ministry of Health and Social Development of the Russian Federation.

3.4. Upon completion of the course of sanatorium-resort treatment, the patient is given a return coupon of the sanatorium-resort card and a sanatorium book with data on the treatment carried out in SKO, its effectiveness, recommendations for healthy image life, which the patient is obliged to submit to the medical institution that issued the sanatorium-resort card or to the outpatient clinic at the patient’s place of residence after completing the course of follow-up treatment.

3.5. Return coupons for sanatorium-resort cards are filed in the medical record of an outpatient patient and are stored in a medical institution for three years.

3.6. Documents certifying the temporary disability of citizens due to acute illness, injury or exacerbation of a chronic disease that arose during the period of their stay at a sanatorium-resort treatment, are issued, as a rule, by medical institutions at the patient’s place of stay, in accordance with current regulatory legal documents.

IV. The procedure for identifying and evacuating patients who are contraindicated for sanatorium treatment

4.1. Staying in a medical facility, which entails a deterioration in the patient’s health, is considered contraindicated for him.

4.2. When determining a contraindication to sanatorium-resort treatment, doctors of a medical institution and health care institution must be guided by contraindications approved in the established manner, excluding the referral of patients to sanatorium-resort treatment, taking into account in each individual case not only the form and stage of the disease, but also the degree of danger of the stay at a resort or sanatorium for him, as well as for those around him.

4.3. Contraindications for the referral and stay of a patient in a medical treatment facility are established by the attending physician, and in conflict cases - by the Institutional Institution of the medical institution, the medical treatment facility.

The attending physician or the Institutional Inspectorate of the medical institution, SKO determines:

Presence of contraindications for treatment;

The possibility of leaving the patient in the SKO for balneological, climatic, medicinal or other treatment;

The need to transfer the patient to a hospital or transport with an accompanying person at the place of residence;

The need to provide assistance in purchasing travel tickets, etc.

4.4. The period for identifying a contraindication for a patient’s stay in a medical facility, as a rule, should not exceed 5 days from the moment of his admission.

4.5. If a patient has contraindications to the HC, the SKO draws up a report on the patient’s contraindication to sanatorium-resort treatment in 3 copies: one of which is sent to the health care authority of a constituent entity of the Russian Federation, the second to the medical institution that issued the sanatorium-resort card for review. on VK, and the third copy of the act remains in SKO.

4.6. Health authorities of the constituent entities of the Russian Federation annually analyze the selection and referral of patients for sanatorium-resort treatment and, if necessary, take appropriate measures.

Appendix No. 5

Instructions for filling out form N 070/у-04 "Certificate for obtaining a voucher"

The certificate for obtaining a voucher is of a preliminary informational nature, does not replace a sanatorium-resort card and does not give the right to enter the SKO for sanatorium-resort treatment, which can also be provided on an outpatient basis.

A certificate for obtaining a voucher is filled out by attending physicians of medical institutions providing outpatient care.

The darkened field of the certificate for obtaining a voucher (items 6-13) is filled out and marked with the letter “L” in the organizational and methodological office only for citizens entitled to receive a set of social services.

On title page on the certificate for obtaining a voucher, the full name of the medical institution is indicated in accordance with the registration document.

The certificate number for obtaining a voucher is the individual registration number of the certificate for obtaining a voucher, established by the medical institution.

In the item “Region of residence” the code of the subject of the Russian Federation in which the patient lives is indicated, in accordance with the list of subjects of the Russian Federation located on the reverse side of the certificate for obtaining a voucher.

The item “Nearest region” is filled in only if the patient lives in a territory located near the border of another subject of the Russian Federation, indicating the code of this subject of the Russian Federation.

In the paragraphs "Climate in the place of residence" and "Climatic factors in the place of residence" indicate digital codes in accordance with the list of climates in the place of residence given on the back of the certificate for obtaining a voucher.

The “Diagnosis” item is filled out in accordance with ICD-10 (International Classification of Diseases) according to medical documentation about the forms, stages, and nature of the disease.

In the paragraph “Disease for the treatment of which the patient is sent to a sanatorium,” the diagnosis of the disease for the treatment of which the patient is sent to a sanatorium is indicated.

The paragraph “Main disease or disease that causes disability” indicates the diagnosis of the main disease, and for disabled people and disabled children - the diagnosis of the disease that causes disability.

In the “Concomitant diseases” section, diagnoses of concomitant diseases are indicated.

The items “Preferred treatment location” and “Recommended treatment seasons” are optional.

The certificate is certified by the signatures of the attending physician, the head of the department or the chairman of the Institution and the round seal of the medical institution.

Appendix No. 6

Instructions for filling out form N 072/u-04 "Sanatorium-resort card"

A sanatorium-resort card is issued by the attending physician upon presentation by the patient of a voucher for sanatorium-resort treatment, which can also be provided on an outpatient basis (hereinafter referred to as sanatorium-resort treatment).

Sanatorium-resort card;

Return coupon.

The sanatorium-resort card is filled out by attending physicians of medical institutions providing outpatient care.

The darkened field of the sanatorium-resort card (items 8-11) is filled out and marked with the letter “L” in the organizational and methodological office only for citizens entitled to receive a set of social services.

On the title page of the sanatorium-resort card, the full name of the medical institution is indicated, in accordance with the registration document.

Last name, first name, patronymic, gender, date of birth, address of permanent residence in the Russian Federation are filled in in accordance with the citizen’s identity document.

In paragraph “N of the medical history or outpatient card”, the registration number of these documents, established by the medical institution, is indicated.

In the paragraph "Identification number in the compulsory medical insurance system" for medical insurance compulsory medical insurance policy the identification number is indicated in accordance with the form of the submitted policy, where twelve characters are determined for the series and policy number.

The “Benefit Code” item is filled out in accordance with Chapter 2 of the Federal Law of July 17, 1999 N 178-FZ “On State Social Assistance”. A list of categories of citizens entitled to receive a set of social services, indicating the codes, is given on the back of the certificate for obtaining a voucher. The specified item is filled in by placing zeros before the first significant digit.

Example: if a citizen who has the right to receive a set of social services belongs to the second category, “002” is entered in the “Benefit Code” item.

In the paragraph “Document certifying the right to receive a set of social services,” an entry is made according to the details of the submitted document (number, series, date).

In the paragraph “Insurance number of an individual personal account (SNILS)” the insurance number of an individual personal account is indicated on the document certifying the right to receive a set of social services. The “Accompaniment” item is filled in if the patient is one of the citizens with limited ability to labor activity III degree.

The items “Place of work, study” and “Position held, profession” are filled out from the patient’s words.

The item “Complaints, duration of illness, medical history, previous treatment, including sanatorium-resort treatment” is filled out on the basis of medical documentation and from the patient’s words.

The item “Data of clinical, laboratory, radiological and other studies” is filled in on the basis medical documents with the obligatory indication of the date of the study.

The “Diagnosis” item is filled out in accordance with ICD-10, according to medical documentation about the forms, stages, and nature of the disease.

The return coupon is filled out by the attending physician sanatorium-resort organization for presentation to patients at the medical institution that issued the sanatorium-resort card (after completion of the course of follow-up treatment - to the outpatient clinic at the place of residence).

Last name, first name, patronymic are filled in in accordance with the citizen’s identity document recognized on the territory of the Russian Federation.

The item “Diagnosis upon admission” is filled out in accordance with ICD-10 according to the information specified in the sanatorium card.

The subparagraph “Disease for the treatment of which the patient is sent to a sanatorium” indicates the diagnosis of the disease for the treatment of which the patient is sent to a sanatorium.

The subparagraph “Main disease or disease causing disability” indicates the diagnosis of the main disease, and for disabled people - the diagnosis of the disease causing disability.

The subparagraph “Concomitant diseases” indicates diagnoses of concomitant diseases.

The subparagraph “Main disease or disease causing disability” indicates the diagnosis of the main disease, and for disabled people - the diagnosis of the disease causing disability.

The subparagraph “Concomitant diseases” indicates diagnoses of concomitant diseases.

Appendix No. 7

Instructions for filling out form N 076/u-04 "Sanatorium-resort card for children"

A sanatorium-resort card for children is issued by the attending physician upon presentation to the patient of a voucher for sanatorium-resort treatment, which can also be provided on an outpatient basis (hereinafter referred to as sanatorium-resort treatment).

The health resort card form consists of:

Sanatorium-resort card;

Return coupon.

The sanatorium-resort card is filled out by attending physicians of medical institutions providing outpatient care to children.

The darkened field of the sanatorium-resort card (items 8-11) is filled out and marked with the letter “L” in the organizational and methodological office only for children from among citizens entitled to receive a set of social services.

On the title page of the sanatorium-resort card, the full name of the medical and preventive institution is indicated in accordance with the registration document.

The health resort card number is the individual registration number of the health resort card established by the health care institution.

Last name, first name, patronymic, gender, date of birth, address of permanent residence in the Russian Federation are filled in in accordance with the citizen’s identity document.

In paragraph “N of the history of development (disease)” the registration number of this document, established by the medical institution, is indicated.

In the section "Identification number in the compulsory medical insurance system" for the insurance medical policy Compulsory medical insurance indicates the identification number in accordance with the form of the submitted policy, where twelve characters are determined for the series and policy number.

The “Benefit Code” item is filled out in accordance with Chapter 2 of the Federal Law of July 17, 1999 N 178-FZ “On State Social Assistance”. A list of categories of citizens entitled to receive a set of social services, indicating the codes, is given on the back of the certificate for obtaining a voucher. The specified item is filled in by placing zeros before the first significant digit.

Example: if a citizen who has the right to receive a set of social services belongs to the second category, “002” is entered in the “Benefit Code” item.

In the paragraph “Document certifying the right to receive a set of social services,” an entry is made according to the details of the submitted document (number, series, date).

In the paragraph “Insurance number of an individual personal account (SNILS)” the insurance number of an individual personal account is indicated on the document certifying the right to receive a set of social services.

The “Accompaniment” item is filled in if the patient is a disabled child.

Items " Educational institution" and "Place of work of parents" are filled in according to the person accompanying the child.

Items "Anamnesis", "Heredity", " Preventive vaccinations", "Anamnesis of the present illness", "Have you used sanatorium-resort treatment before", "Name of the previously visited sanatorium-resort organization, date of visit", "Data of clinical, laboratory, radiological and other studies (dates)" are filled in based on the history data development (illness) of the child and other medical documentation.

The “Diagnosis” item is filled out in accordance with ICD-10 based on information from medical documentation about the forms, stages, and nature of the disease.

The subparagraph “Disease for the treatment of which the patient is sent to a sanatorium” indicates the diagnosis of the disease for the treatment of which the patient is sent to a sanatorium.

The subparagraph “Concomitant diseases” indicates diagnoses of concomitant diseases.

The sanatorium-resort card is certified by the signatures of the attending physician, the head of the department or the chairman of the Institution and the round seal of the medical institution.

The return coupon is filled out by the attending physician of the sanatorium-resort organization for presentation to the medical institution that issued the sanatorium-resort card.

The full name of the sanatorium and resort organization is indicated on the title page of the return coupon in accordance with the registration document.

The child's last name, first name and patronymic are filled in in accordance with the citizen's identity document recognized on the territory of the Russian Federation.

The item “Diagnosis upon discharge from the sanatorium” is filled out in accordance with ICD-10 according to the medical documentation of the sanatorium organization about the forms, stages, and nature of the course of the disease.

The subparagraph “Main disease or disease causing disability” indicates the diagnosis of the main disease, and for disabled children - the diagnosis of the disease causing disability.

The subparagraph “Concomitant diseases” indicates diagnoses of concomitant diseases.

In the section “Treatment carried out”, information from the sanatorium book is indicated. If the types of treatment or number of procedures did not meet the corresponding recommended standard of sanatorium-resort care, the attending physician makes a note indicating the reasons in the paragraph “Reasons for deviation from the standard of sanatorium-resort care.”

The “Epicrisis” item indicates information about the treatment received by the patient in a sanatorium-resort organization and his condition at the time of discharge based on the data of the sanatorium book, medical documentation and the objective condition of the patient.

Items “Treatment results”, “Presence of exacerbations that required cancellation of procedures” and “Recommendations for further treatment" are filled in based on the data specified in the "Epicrisis" paragraph.

If there is contact with infectious patients during a stay in a sanatorium-resort organization, a note is made in the paragraph “Contacts with patients with infectious diseases” indicating the date and diagnosis of the disease.

The item “Transferred intercurrent diseases and exacerbation of the main and concomitant diseases” is filled out on the basis of medical documentation data.

The return coupon is certified by the signatures of the attending physician, the chief physician and the round seal of the sanatorium-resort organization.

An important issue in the activities of a local doctor is the selection and referral of patients for sanatorium-resort treatment. Regulatory document for this section of work is the order of the Ministry of Health of the Russian Federation No. 256 dated November 22, 2004 “On the procedure for medical selection and referral of patients for sanatorium-resort treatment” with amendments approved by order of the Ministry of Health No. 3 dated January 9, 2007. Medical selection and referral of patients those in need of sanatorium-resort treatment are provided by the attending physician and the head of the department (if there is a benefit, the attending physician and the chairman of the VC).

If there are indications (healthy people cannot recommend treatment at a resort) and there are no contraindications for sanatorium-resort treatment, the doctor issues the patient a certificate (070/u-04) about the need for treatment, which is valid for 6 months, which is noted in the outpatient’s medical record. Beneficiaries are issued a certificate to receive a voucher by the VK, and disabled people - if they have a recommendation from individual program rehabilitation issued by ITU authorities.

In complex and conflict cases, upon the recommendation of the attending physician and the head of the department, a conclusion on the indications for sanatorium-resort treatment is issued by the Institutional Clinical Hospital.

Patients with concomitant diseases or age-related health problems for whom sanatorium-resort treatment is indicated, in cases where a trip to distant resorts can adversely affect their general health, should be sent to nearby sanatorium institutions.

When receiving a voucher (course), the patient is obliged to visit the attending physician no earlier than two months before the start of its validity period for the necessary additional examination. Attending physicians and heads of departments must be guided by the following mandatory list of diagnostic studies and consultations with specialists, the results of which must be reflected in the sanatorium-resort card (form 072/u-04):

• clinical blood and urine analysis;
• fluorography;
• for diseases of the digestive system - x-ray examination (if more than 6 months have passed since the last examination), ultrasound, endoscopy;
• in necessary cases, additional studies are carried out to clarify the diagnosis: biochemical, instrumental and others;
• when sending women to the resort, a conclusion from an obstetrician-gynecologist is required; for pregnant women, an additional exchange card is required;
• if there is a history of neuropsychiatric disorders, a psychiatrist’s opinion;
• in case of primary or concomitant diseases (urological, skin, blood, eyes and others) - the conclusion of relevant specialists.

Inspection data and research results are entered into outpatient card. The health resort card is certified by the head of the department. If a person entitled to a set of social services is registered for treatment, the sanatorium-resort card is certified by the attending physician, the head of the department or the chairman of the VC.

If contraindications to treatment are identified in the patient during the first five days of his stay at the resort, the VC of the resort (sanatorium) decides on the possibility of the patient’s continued stay there, transfer to a hospital or transportation to his place of residence. When a patient makes a claim against a healthcare facility, all material costs are reimbursed by the attending physician.

Indications for spa treatment

Diseases of the cardiovascular system— Heart defects Diseases of the heart muscle (myocarditis, myocardial dystrophy) Hypertonic disease AMI

Obliterating vascular diseases– Thrombophlebitis, Obliterating atherosclerosis of the vessels of the extremities. Thrombangitis.

Digestive diseases — Chronic gastritis. Functional diseases of the stomach. Peptic ulcer stomach and duodenum in the stage of remission or fading exacerbation, as well as illness of the operated stomach due to an ulcer. Chronic inflammatory diseases of the small and large intestine: enteritis, enterocolitis, typhlitis, sigmoiditis, colitis. Cholelithiasis; dyskinesia biliary tract And gallbladder, chronic pancreatitis

Kidney and urinary tract diseases - Glomerulonephritis of infectious and toxic origin in subacute and chronic stage with preserved renal function, without anemia and cachexia. Urolithiasis disease, chronic pyelonephritis, chronic cystitis. Chronic prostatitis.

Diseases of metabolism and endocrine glands— Hypothyroidism and myxedema, Diabetes mild degree and moderate severity, Gout, Graves' disease and hyperthyroidism, Nutritional obesity.

Non-tuberculous respiratory diseases - Chronic bronchitis, tracheitis. Pneumosclerosis, pneumoconiosis, silicosis. Bronchial asthma in remission or with infrequent and mild attacks without severe symptoms of cardiopulmonary failure. Emphysema.

Diseases of joints, bones and muscles Rheumatic polyarthritis, Chronic spondyloarthritis, ankylosing spondylitis, fractures with delayed consolidation or with painful callus, infectious and traumatic osteitis and periostitis.

General contraindications.

1. All diseases in the acute stage, chronic diseases in the acute stage or complicated by an acute purulent process.

2. Spicy infectious diseases until the end of the isolation period.

3. All sexually transmitted diseases in acute or contagious form.

4. All blood diseases in the acute and acute stages.

5. Cachexia of any origin.

6. Malignant neoplasms.

7. All diseases and conditions requiring hospital treatment, including surgical intervention, all diseases in which patients are not capable of independent movement and self-care, requiring constant care (except for persons subject to treatment in specialized sanatoriums for spinal patients).

8. Echinococcus of any localization.

9. Frequently recurring or heavy bleeding.

10. Pregnancy at all times at balneotherapy and mud resorts, and at climatic resorts - starting from the 26th week.

11. All forms of tuberculosis in the active stage.

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: (mineral spring waters), 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. Important role allocated to local resorts, most often intended for patients for whom, after treatment, climate change is contraindicated for health reasons.

The sanatorium is intended for the treatment of patients primarily with natural medicinal products in combination with physiotherapy, physical therapy, And therapeutic nutrition in conditions active rest and 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 spa treatment is 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, outpatient treatment is also provided for 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 JSC, you must write an application for the provision of a voucher addressed to the chairman of the commission (authorized) for social insurance at the place of work. Pensioners contact authorities social security(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 is no more than a month old, x-ray examination(FLG or chest X-ray) no more than six months ago, for women, a gynecologist’s conclusion regardless of the diagnosis of the disease, 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.