Appendix N 2.

Russian Federation

Informed voluntary consent

on the types of medical interventions included in the list

certain types of medical interventions for which

citizens give informed voluntary consent when choosing

doctor and Medical Organization for Primary Health Aid

I, __________________________ Ivanova Elena Ivanovna ____________________________

______________________________"10" January 1980 g. Birth , ______________________

registered at the address: ___________ 614000 Perm, ul. Ivanova 1 square. one_________

(address of the residence of a citizen or

legal Representative)

i give informed voluntary consent to the types of medical interventions included in the list of certain types of medical interventions, which citizens give informed voluntary consent when choosing a doctor and a medical organization for obtaining primary health care (see on the back), approved by the Order of the Ministry of Health and Social Development of the Russian Federation of April 23, 2012 N 390N (registered by the Ministry of Justice of the Russian Federation on May 5, 2012 N 24082) (hereinafter - the list), for the primary health care / receipt of primary medicine - Sanitary assistance by the child, whose legal representative I am (unnecessary to cross)

_________________________Ivanov Alexander Sergeevich, 05.05.2005_______________

(Full name of the child, date of birth)

in the State Budgetary Institution of Health of the Perm Territory "Medical and Physical Dispensary"

I am included in the available goals, methods for providing medical care associated with them the risk, it is possible for the options for medical interventions, their consequences, including the likelihood of the development of complications, as well as the intended results of medical care. I am explained that I have the right to refuse one or more types of medical interventions included in the list, or require its (of them) termination, except for the cases provided for by paragraph 9 of Article 20 of the Federal Law of November 21, 2011 N 323-FZ " On the basis of the health of citizens' health in the Russian Federation "(Meeting of the legislation of the Russian Federation, 2011, N 48, Art. 6724; 2012, N 26, Art. 3442, 3446).

Information about the faces chosen by me, in accordance with paragraph 5 of Part 3 of Article 19 of the Federal Law No. 323-FZ "On the Fundamentals of the Health of Citizens in the Russian Federation", information on the state of my health or a state of child health can be transferred , legal representative of which I am (unnecessary cross)

_____________________ Ivanov Sergey Yuryevich, 89020000001________________________

FULL NAME. Citizen, contact phone

Personal signature ____________________Ivanova Elena Ivanovna_____________________

(Signature) (Full name. Citizen or legal representative of a citizen)

Personal signature ___________________ Petrova Olga Ivanovna_____________________

(signature) (Full name Medical worker)

"__20 __" ___april___2016 g.

(design date)

Sample filling ids face over the age of 15

Appendix N 2.

To the order of the Ministry of Health

Russian Federation

State Budgetary Institution of Health of the Perm Territory

"Medical and Physical Dispensary"

Informed voluntary consent to medical intervention is a documentary confirmation of the patient or a legal representative of the rights and interests to receive timely assistance through operational or conservative intervention. This formality is necessary, as in the case of appointing treatment with antibiotics, the child is required by the parent's consent to such a type of care. According to Federal Law No. 323, in the new edition of 2018, "On the Fundamentals of Health Protection of Citizens of the Russian Federation", the patient must in some cases give a written permission to conduct operations.

Informed voluntary agreement on the types of medical interventions allows you to disappoint a physician from the consequences when the operation may have a deplorable outcome. Allowing a medical institution to conduct a number of measures stipulated by the staff of the doctor, the patient encourages himself to success and recovery or on urgent measures that can save his life, or this is an attempt to make something that is required for salvation. In other cases, when it requires an emergency, the doctor has the right to contact the opinion of relatives and the patient himself to operate a citizen, referring to the moral and ethical code of the doctor.

On the other hand, without having an informational permission from a patient or a relative, many believe that medical personnel acts at their own risk. Is it worth talking about the moral code, when sometimes life can be saved, and the patient or his relatives do not agree on the right of a citizen to compete for the chance of salvation? There are a number of regulated relationships between the two parties of a possible conflict, and it is reflected in the law "On the Fundamentals of Health Protection of Citizens of the Russian Federation."

The main provisions are the following:

1. A person who has not achieved adulthood is obliged to inform medical personnel about its age. If a doctor's intervention is required, the operation, the written consent of the parent or guardian on the basis of Part 5 of Art is required. 47 and part 2 art. 54 of this Law of the Russian Federation. In other words, the parents are responsible for his life and her salvation are. If parents do not want operations to be conducted, they should also inform the medical instance by writing a refusal. This is their right, however, in exceptional cases, doctors may contact the police to determine the circumstances. It is worth noting that the unauthorized refusal to help is a criminal offense against the health of the child. Having received a refusal, the doctor, without having a different opportunity to help, does not accept the patient by virtue of the impossibility of salvation of life.
2. The written consent of the parents may be required for the treatment of drug addiction regarding a minor, when it requires the law and social position of the patient. Suppose his behavior is considered socially dangerous for others, then parents or sign consent to treatment or control the process independently. However, it is impossible to allow unauthorized statement - the doctor is obliged to register a child and notify the educational institution that this citizen needs urgent emergency in the field of narcotic healing. Toxic intoxication, which can affect life, the doctor is obliged to eliminate, and only then take for treatment. Emergency measures are carried out without the consent of their parents on the basis of 9 of the federal law.
3. If the parent of a dependent or an adult citizen does not want to receive medical care, he is in simple and clear form, sometimes and written, the possible consequences that may occur during the refusal of medical intervention. Also explained the complications to which the late emergency medical care can lead. It is also indicated by all the consequences that may come after interventions - it is necessary that the person understands and gives himself a report in that even after manipulation by a doctor or at the time of their implementation, unforeseen events may come. The doctor insures himself from uninsured situations.
4. If parents represent the interests of children who have not reached the age of 14 years, refuse to urgent help, the medical staff can cause the police or transfer documents to court to clarify the circumstances of the case. Legal representatives of the child's interests are obliged to explain in an affordable form in court or during the pre-trial proceedings of the guardianship authorities, if the arguments are considered respectful, they will leave the right to act at their own risk and risk, contacting, for example, in a private organization. If this does not happen, parents will coordinate for the obstacle to the child on the basis of the Criminal Code.

The list of manipulation types is established and approved by the Order of the Russian Federation from 2011 FZ-№48 Article 6724. The new edition entered into force in June 2013, which states that after choosing a certain type of interventions, a citizen is provided with a sample form of an application with the right signature, which means Consent to the adoption of established medical measures for its treatment. In some cases, it can partially agree to a number of measures taken, as well as to specify a typical list of changes - admissible, the presence of an allergic reaction to drugs with an artificial element. It will be necessary to replace it so that in the aggregate with the rest of the drugs there is no imbalance, and they harmoniously and cooled "worked" among themselves.

A citizen may agree to interfere with the doctor's intervention, without the permission of which it is impossible to conduct an operation or other types of planned actions, with the exception of a number of cases. All species are indicated in the internal documents of medical personnel on established by law No. 1 (DOU).

This list is an open document, and can be obtained to familiarize yourself with any patient in the hospital and undergoing treatment in a particular institution. Failure to submit positions and internal statutes is bordered by administrative responsibility.

In exceptional measures, a representative-translator may be needed, for example, when treating abroad, to establish contact with the attending physician:

1. To begin with, choose a medical institution that conducts one or another type of interventions.
2. Further, to implement this kind of service, the specialist in the art is chosen.
3. He is obliged to clarify the patient - how much time will need for the operation, rehabilitation, which consequences are possible.
4. If the patient gives consent, he signs a voluntary agreement for medical interventions in form No. 2.
5. To compile failure, the patient fills in form No. 3, which is proof of possible subsequent conflicts.

The doctor also has the right to refuse to the patient in the treatment, if he does not have the relevant equipment for the diagnosis, knowledge and complex of drugs for the start of treatment. It is impossible to refuse the absence of the policy if a citizen appeals to the public institution. In a private clinic, an identification system may operate, after which the measures that are possible at the time of the patient's design will be carried out.

As a rule, the main types of interventions are:

1. Provision of sanitary and medical care for primary and emergency access to the medical institution. Regulated the situation of FZ-№390 from 2012.
2. The provision of urgent treatment at human intoxication on the basis of FZ-№323 from 2011.
3. The provision of urgent medical care in the form of hospitalization on the basis of FZ-№48 from 2011.
4. Based on FZ-№54 of 2012 (new edition) - providing emergency operating assistance for children under 16 years old with the consent of the parents without their presence.

It is worth noting that the child has the right to get help being minor if parents are at work or abroad. Thus, the right from other relatives is not required if there is a connection with the parents. Otherwise, it is necessary to confirm the consent to the operation, for example, for a grandson, if you can come and sign all the papers. This legal average is considered to be salvation for doctors when serious consequences arise, and parents are considered guilty of the death of close medical personnel.

In the event of disputes and conflict situations, an opening of the corpse may be prescribed to establish the cause of death. If the doctor is guilty, he will incur a strict punishment for the non-appearance of the appropriate assistance. The same applies to emergency cases, when permission from citizens is not required, and doctors refuse to take responsibility for the salvation of human life.

When is informed of informed consent?

There are a number of cases when I need urgent medical care, and a person cannot have it not because the absence of a medical insurance policy.

Of course, it is best to know in advance about the symptoms of the disease, however, not always a person far from medicine can understand why he does not turn out to be operational intervention in the same second:

1. Consent needs to be given orally when collecting anamnesis - the procedure for consideration of complaints, symptoms. If the disease is running, a patient's survey should be conducted to detect syndromes in the speakers.
2. Palpation of the patient is permissible in exceptional cases, but consent is required if need percussion, auscultation, rhinoscopy, pharyngoscopy, indirect laryngoscopy, vaginal examination, rectal study. These procedures are optional, directed only to the compilation of a complete inspection picture. The more fully it is, as well as the tests, delivered to the sick, will become more clear than the patient is sick.
3. Anthropometric studies - for example, a child need to measure the trigger of the chest, the weight, the size of body parts. If the mother does not inspect the local clinic, it should agree to the "approach" to the child. At the same time, the standards of etiquette are complied with infants permitted by the charter to approach after sanitary safety regulations (shoe covers, washing hands, gloves, mask).
4. Thermometry is also included in the list of manipulations that require permission. If a person entered the department, signing permission to a number of actions, then measuring the temperature, the surrender of the tests is already permissible within the Medical Institution.
5. Tonometry is the procedure for measuring the pressure inside the eye. It is permissible to do the manipulation with the permission of the patient if he came to the advice to the ophthalmologist. In the clinic for such actions, permission is required from parents, since moms with children come to the doctor on a planned inspection. Adults take a direction to specialized clinics, where permission is not required due to the alleged symptoms of the appeal.
6. Not invasive studies of hearing and vision organs. All actions must be implemented strictly on the basis of this consent of the citizen.
7. Survey of the nervous system of a person - it is impossible to simply conduct a study in this area. Otherwise, when using some techniques, it is possible not to detect the existing disease, but to disrupt its consequence and the course of the disease.
8. Laboratory studies are clinical, biochemical, virological, bacteriological and immunological. If the mother came to the planned vaccination, she is obliged to give consent or refusing such manipulation.
9. Functional methods of surveys to which electrocardiography also relates. Being in the hospital, the patient is obliged to give an additional agreement to carry out arterial / daily monitoring of electrocardiogram, spinography, cardiotockography for pregnant women.
10. The implementation of radiography and fluorography for people over 15 years old, as well as an ultrasound study, is carried out with voluntary oral consent. They can recording in the journal of patient accounting. Doppler studies are possible with the consent of the written type.
11. The introduction of intramuscularly, intravenously and subcutaneously medical drugs, even by appointing a doctor, occurs according to the written consent of patients. Even if in time it is necessary to introduce a medicine, and the patient is sleeping, it should be woken and ask for permission to conduct such actions regarding his health.
12. Massotherapy. This is not a palpation, but direct impact on the human body, and for belief in his health requires written consent, especially when it comes to massage therapy for infants.

If the child is healthy, the parents do not plan him at all, the doctor has the right to contact the guardianship authorities - the absence of a vaccine without a ban on the basis of medical testimony is equal to strengthening the chance to infect serious diseases.

If the doctor is going to make the child in vaccination, and has a consent from the mother, before it is carried out in the implementation of the Mantu sample, it is obliged to notify the parent of the possible consequences and only after that carry out a test vaccination to identify allergic reactions. Diskin-test is introduced intraderially, therefore allergic reactions and manifestations of the body temperature of the body are inevitable. To save the life, the child should be held twice a sample to see the dynamics of the reaction.

Some institutions require an informed voluntary agreement for medical interventions. Informed voluntary consent to medical intervention Sample provided below:

Based on the List on the NZ of the Russian Federation at the time of the choice of medical and medical education institutions for the implementation of relevant assistance:

I, _____________ (FULL NAME), ____________ (date of birth), prescribed at ____________ I give written consent to:

The implementation of the necessary and emergency interventions that are specified in this Regulations. I understand the possible consequences that can happen, but I do not refuse the appointed treatment. I also give the right to the doctor to implement legitimate acts regarding my health and life for preservation and salvation.

The physician ______ (Name of the doctor) explained the goals and methods of assistance, as well as their consequences, the likelihood of the onset of complications in the absence of assistance. I know that I can refuse them or require their termination during treatment, except in the cases specified in Part 9 of Art. 20 FZ-№323 dated 11/21/2011.

Signatures of the parties and the date of the compilation of the document __________.

This document is drawn up directly with the doctor who is authorized on duty or by the nature of its capabilities and obligations to conduct manipulation against patients with regard to participation in the hospital or a course of treatment and rehabilitation into a medical institution.

If the services provided by the doctor will not fully reflect the possibilities for conducting operations and treatment:

• the patient may refuse services;
• demand to change the doctor to another;
• other, if provided for by the agreement.

As a rule, children received in the resuscitation branches and hospitals of children's hospitals do not need to be resolved by parents to receive medical care. However, in some cases, if the types of interventions can cause irreparable consequences, complications, then parents are informed, introduced into the course of the case, and only then a decision on further treatment is made.

Patients may also make a refusal of some types of medical services, if they are not really vital, but lead to strong complications, after which urgent hospitalization will be required, rehabilitation.

Sometimes it concerns operations unplanned by the institution, and relatives or parents are afraid of "urgency" of help, because it may not save, but lead to death:

1. By giving agreement, it is unlikely that the autopsy will specify the doctor's objective guilt.
2. Many citizens refuse to "live" to a critical point, and not to leave due to the incurable disease ahead of time.

Refusal to all possible types of therapeutic interventions specified by this Law of the Russian Federation, when choosing a doctor and a medical institution to obtain emergency medical and sanitary assistance. Coordinated and read by me, it was written and drawn up personally, I understand and give the report that the refusal may harm my health, but because of my personal subjective prejudices, without being based on the specifics of medicine, I take responsibility for the consequences of what is happening, I do not want to receive This institution ______________ manipulation with respect to my health of psychological or physiological. I ask the present statement to recognize me by the patient, so that in the future all the diseases were on my responsibility.

I, _____________ (FULL NAME), ____________ (date of birth), prescribed at ____________, with the provision of ___________ (Name of services) in ___________ (clinic name), I refuse the following manipulations, on the basis of FZ-№390, registered by the Ministry of Justice of the Russian Federation from 5.05 .2012 №24082 (unnecessary cross).

_________________ (Intervention name).

________________________________________ (explanations).

_______________________________ (doctor's opinion).

The physician _____________ in an affordable form is explained the essence and methods of assistance, as well as their consequences, including the probability of occurrence of complications in unrelazing assistance, the possibility of complications and expected results of inaction or acts. It is explained and clear to me that when risk factors occur, there may be serious consequences for me. Therefore, I refuse to be necessary in conducting ______________ (the name of the intervention), confirming the fact a real refusal according to the Federal Law.

Signature ___________ (parent).

Signature ___________ (Name of the doctor).

Date of registration _______.

Even after such a refusal, a person can give a voluntary agreement for intervention, the sample of which is presented above. Refusal to him are not entitled if a citizen appeals to a medical institution.

Every year, according to the National Statistics of the Ministry of Health, 76% of people draw up a refusal of services. Of the 2677 people only 3 sign this Agreement. Part of the remaining "agree" with the doctor to get extraordinary consultation. As a rule, a simple health check, palpation, inspection or ultrasound - does not pose a threat, so many doctors do not even ask for consent patients to carry out their direct duties.

There are only exceptional cases relating to ultrasound, and they include pregnant women:

• the permissible maximum number of surveys is reduced to 10;
• the minimum number cannot be below 3;
• before admission, a woman must inform the doctor about the passage of ultrasound.

For example, the typical situations when a woman for 30 weeks of pregnancy falls with an acute crushing pain in an ambulance hospital. Suspicion of pancreatitis due to the location of the fetus. Ultrasound is needed, but 3 days ago she was on a planned examination. Is it permissible to conduct a re-audio study? No, without its consent, the doctor can only take a refusal in writing, establishing the cause of palpation pain and other means, since the re-examination may adversely affect the state of the fetus. The impact is safe for the embryo only at the post of customs control and when registering with flights in airlines. Uzi devices are equipped with a powerful beam, which can provoke an enhanced cell shape exchange and issue the reaction of the mother's body as rejection of the fetus.

There are cases where consent from patients is not required, but this should also be recognized from the laws:

1. Preceding emergency testimony, which indicate a threat to the patient's life. If a person's condition does not allow the will of consent or refusal to express the will, the doctor has the right on the basis of Part 2 of this Law to apply a number of urgent measures.
2. If there are existing diseases that are dangerous to others.
3. Persons suffering from mental disorders.
4. Persons who commit atrocities regarding the health and life of other people.
5. At the time of the forensic examination, which affects the scope of psychiatric studies in the PND (psychoneurological dispensary).

Based on the data, the patient cannot accuse the doctor to the misunderstanding of actions, since cases relate to urgent effects of impacts to save human life.

For example, the ambulance car brought victims as a result of an explosion in a public place. A child in need was 5-7 years old, the person was not installed. Sharal injuries, blood transfusion is required and an emergency operation to remove fragments and imposing seams to the place of breaks. Operation is not excluded for the removal of foreign parts that came inside the organism. If time is spent on searching for parents, guardians, the doctor will lose time allotted for the salvation of the child. In such situations, the consultation of doctors is not even assembled, and an unscheduled surgical intervention is carried out, which will help the patient to survive either lead to the same outcome, which was assumed in the case of non-appearance of medical care.

It is also not considered necessary to require consent from parents, or to make a refusal if a preschooler or schoolboy passes a specialized medical commission for its definition to a kindergarten or summer camp. This is a natural check procedure that is aimed at clarifying and establishing the health level of a child for admission to a preschool educational institution or to school. Nowadays, this is a mandatory procedure, since all children should be vaccinated, annual surveys and planned inspections from family doctors.

Disagreements between parents

There is a checked rule - the doctor is obliged to notify the state of the child of both parents. If one of them is "for", another "against" - medical intervention is carried out without challenging. If the second parent is unavailable, is divorced, separately lives with the patient, then all responsibility for the IDF lies on the shoulders of the first parent. In medical practice, there are no problems, since both the Father, and the mother understand the importance of the services provided. If this contradicts the law, the norms of ethics and the principles of morality, the rights of the child are violated, then all the responsibility is for the consequences, one who gives consent. All values \u200b\u200bare displayed in the attachment to the DOW - documentation management of medical services.

At the same time, the Consilium doctors can be collected - the head physician is obliged to notify the heads of departments on the possible legal aspects of the coming after intervention. In rare cases, an inspector from the guardianship authorities will be invited to consider the issue of the child's rights.

When complications occurred in the cases described above, the second parent cannot participate in the process of election of punishment for the first parent, since he was not present at the time of establishing a child's disease, and could not know the right outcome of events. In the most deplorable cases, an opening of the body is carried out to establish the cause of death.

This moment includes several stages:

1. Submitting an application for review of medical detention.
2. Drawing up a claim to determine the adverse outcome of treatment.
3. If the doctor's misconceptions are revealed, the systemic and complex examination continues to establish complications that could be caused by incorrect treatment, which provoked a heart stop.
4. Medical error can be taken into account in the medical and legal assessment of the action of all personnel.
5. The lack of negligence does not speak of the legality of actions - negligence and ignorance is allowed.
6. A diagnostic error can provoke further incorrect treatment.
7. Tactical disorders - incorrect readings for the operation.
8. The technical error most often leads to the appointment of improper treatment, during which the disease is progressing, and there is no conservatism at all.

Also show hidden atypical symptoms of diseases that cannot be diagnosed due to the patient's condition, or on unauthorized reasons - the position of the kidney stones, the hide of pathologies, the location of the fetus in the womb, the impact of anesthesia at the time of the testing of the heartbeat and rhythm of the heart.

The most difficult to diagnose diseases are: inflammation of the lungs among children from 1 to 4 years old, the granule of the skin and mucous covers (from the area of \u200b\u200bdentistry), when it is impossible to determine the degree of propagation of infection, the heart arrhythmia - the dynamics does not establish deviations from the norm and rarely when The primary symptoms of the disease are manifested. It should be said that the fewest disorders and medical errors are recorded in the area of \u200b\u200bunscheduled surgery.

Despite the large number of distrust and negative feedback from patients, emergency medicine "works" better than planned surgical intervention. However, in both areas of work it is impossible to say in advance what the outcome will be. During the operation, a failure may occur, and no one is insured against "typical" not holding the load on the body.

When applying the document, it should be borne in mind that the order of the Ministry of Health of Russia dated 20.12.2012 N 1177n approved the procedure for presenting informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types of medical interventions, as well as forms of documents.

Order of the FMBA of the Russian Federation of 30.03.2007 N 88 "On voluntary informed consent to medical intervention" (together with "Instructions for filling the blanks of voluntary informed consent")

Appendix N 3.

Approved

Order of the FMBA of Russia

Federal Medical Biological Agency CMS / MSH / KB / Institute _______________________ Informed voluntary consent on operational intervention, incl. blood transfusion and its components I ________________________________________________________________ (surname, name, patronymic - fully) ____________ years of birth, living (Aya) at: ___________ ┌────────────────────────────────────────────────────────────────┐ │This section of the form is filled only on persons who have not achieved │ Congratulations 15 years, or incapable citizens: I, Passport: ______, │ │Stand: _____________________________________________________ │ I am going to legal representative (mother, father, adopter, │ │Pecene, trustee) child or person recognized │Name: ____________________________________________ │ │ (Full name of a child or an incompetent citizen -│ │ Fully, year of birth) │ └────────────────────────────────────────────────────────────────┘ being on the treatment (examination, delivery) in the department __________________________________________________________________ (Department name, chamber number) __________________________________________________________________ i will voluntarily give my consent to I (represented): operations: ____________________________________________________ __________________________________________________________________ __________________________________________________________________ (Name of medical intervention) and I ask the staff of a medical institution about its holding. I confirm that I have familiarized (familiarized) with the character upcoming to me (represented) operations. I clarified, and I i understand the features and course of the upcoming surgical treatment. - I clarified and I realize that during the operation can there are unforeseen circumstances and complications. In such case I agree (agree) to the fact that the operation of the operation may be changed by doctors at their discretion. - I warned (warned) about risk factors and understand that operation is associated with risk of blood loss, the possibility infectious complications, violations from cardiovascular and other livelihoods of the body, unintentional causing harm to health and even unfavorable outcome. - I warned (warned) that in some cases can repeated operations, incl. In connection with the possible postoperative complications or with flow features diseases, and give your consent to it. - I set (put) notifying a doctor about all the problems associated with health, including allergic manifestations or individual intolerance of drugs, obo all after me (represented) and the injuries known to me, operations, diseases, incl. carriage of HIV infection viral hepatitis, tuberculosis, sex transmitted infections by, on environmental and industrial factors, physical chemical or biological nature affecting me (represented) during vital activity taken medicines previously conducted blood transfusions and its components. Reported (reported) truthful information about heredity, as well as about alcohol use, narcotic and toxic means. - I know that during the operation it is possible blood loss and ________ i give consent to the transfusion of donor or auto (own) blood and its components. - I am _______________ I agree (agree) to record the operation of the operation on information media and demonstration to persons with medical education exclusively in medical, scientific or training goals taking into account the preservation of medical mystery. - I was given the opportunity to ask questions about risk and benefits of operational intervention, incl. Perelivans donor or auto (own) blood and / or its components and doctor i gave me comprehensive answers. - I have been acquainted (acquainted) and agrees (agree) with all items of this document, whose provisions explained to me i understand and voluntarily give my consent to ___________________ __________________________________________________________________ __________________________________________________________________ ---- "__" ___________ 20__ year patient signature / legitimate | x | Representative ---- Scribed in my presence: ---- Doctor ___________________________________________ (signature) | x | (Position, I.O. Family) ---- See Blanca NOTE: Consent to medical intervention in relation to persons not age of 15 years, and citizens recognized in the established the law is incapable, they give their legal representatives. (parents, adoptive parents, guardians or trustees) indicating Full name, passport data, related relationships after the message they have information about the results of the survey, the presence of the disease, its diagnosis and forecast, methods of treatment associated with their risk, possible options for medical intervention, their consequences and the results of the treatment. In the absence of legal representatives, the decision on medical intervention takes a concilium, and if it is impossible to collect consilium - directly attending (duty) doctor followed notice of the chief physician / head of the CMS / MSH / CB / Institute, and weekend, holidays, evening and night time - responsible duty doctor and legitimate representatives.

Voluntary informed consent to medical intervention, the sample of which we will look at in the material, should correspond to a certain form and be obtained before providing medical assistance.

What should be considered when developing such a sample? Why can not reduce the form of consent? How to arrange a document on a child?

See and download in the article ready-made IDS for various types of interventions.

↯ More articles in the magazine

Article 8 of consent samples for different types of medical interventions for downloading. At the end of the article, video recording for forms and regulations for the design of the IDF from the lawyer Alexei Panova.

In what form consent is taken

The patient's IDC for medical intervention is sampled in our material, health workers should receive from patients when complying with several conditions:

• The form of consent is always written, it is not allowed to obtain orally.
• The patient of the medical institution informed about medical intervention must sign personally.
• Consciousness is allowed by a relative of the patient in cases determined by the legislator.

All health workers should be familiar with how they should receive voluntary consent to the beggar. The sample of the document at the level of the Ministry of Health is not approved.

This is due to the fact that there are many options for the provision of medical services, and collect all requirements in one document is not possible.

Features of the cottages of such consent:

• a medical worker must be obtained permission from the parents of a child under the age of 15;
• parents act legitimate representatives of the child;
• when organizing different types of medical interventions, it is enough to get from one of the parents of the child;
• if the dispute arose between the parents, and one of them against the provision of medical services - the conflict solve the guardianship authorities;
• if parents cannot come to a common opinion - they must solve the dispute in court. The medical institution does not interfere in this dispute.

Informed voluntary agreement on the types of medical interventions, the form of which applies to minor children, it is often difficult to arrange if parents are divorced.

Very often, parents conflict among themselves, and health workers are in a difficult situation.

What a lawyer should know in such situations:

• if parents are divorced, but none of them are deprived of parental rights - they have equal rights to receive information about the progress of the treatment of their child. At the same time, it doesn't matter with whom the child lives at the moment;
• if one of the parents appeals to the doctor in order to obtain information about the health of the child - it is impossible to refuse him;
• IDC, the sample of which is used in the medical institution, acts equally for all legal representatives. It is impossible to refuse them in providing the requested information - this is an important condition for their awareness. Exception - when the behavior of one parent threatens the life and health of a small patient, he can refuse. This refusal can be canceled in court.

Where to inscribe a foot of a minor in the form of informed voluntary consent

Consent to the begging (a form for minors) was approved in an approximate form in the order of the Ministry of Health No. 1177N of December 20, 2012.

Text button

Can I make anonymously

The legislator does not give an accurate answer to the question whether medical care can be anonymously. On the one hand, anonymous help is not illegal. It is allowed to conduct anonymously test for HIV infection.

This is determined by SP 3.1.5.2826-10 "Prevention of HIV infection". In addition, there are anonymously paid medical services (Part 5 of Art. 84 of Law No. 323-FZ), if this does not prohibit legislation. Watch the explanation of the expert on this topic in the System Chief Doctor, Read Recommendation \u003e\u003e

Voluntary informed consent to the medical intervention 323 FZ allows medical institutions to develop independently.

Many organizations at the same time, wanting to simplify the form of the form, make it very brief and low-informative.

From a formal point of view, this does not contradict the current legislation.

However, a lawyer of medical institutions should understand that such an approach threatens sanctions by the supervisory authorities, since in this case the medical insurance does not use the ability to protect themselves from the following points of view:

• The IDC on the medical intervention of the form of which is reduced to a minimum, does not allow to determine whether the patient was provided with all information about the upcoming intervention. Recall that it is awareness that is a key sign of voluntary consent;
• a brief form of the document does not allow to evaluate whether the patient was the necessary information provided in an affordable and understandable form.

How to avoid this situation: develop information consent to medical intervention, the sample of which will contain all the necessary information on various types of medical services.

In addition, there are other reasons why informed voluntary consent to the types of medical interventions is required:

1. Having agreement on medical care is one of the criteria for high-quality medical care. If the document does not meet the criteria of informativeness - this will be reflected in the examination of the quality of medical care and can be considered as a defect.
2. When conducting inspections by insurance companies, the lack of consent will be considered as a significant defect - as a result, medical institutions may not pay medical services or reduce payment.

There are cases when a medical organization has the right to make medical intervention without the consent of the patient. Such a medical intervention is not a violation of the patient's right to his personal (physical) inviolability and the right to preliminary informing.

Medical intervention without IDC is held:

• according to emergency testimony to eliminate the threat of a person's life and if its condition does not allow to express his will or there are no legitimate;
• in relation to persons suffering from diseases that are dangerous to others;
• in relation to persons suffering from severe mental disorders;
• in relation to persons who have committed socially dangerous acts (crimes);
• when conducting and (or) forensic psychiatric examination.

In other cases, the patient's refusal from IDC design may cause a legitimate refusal of a medical organization in the provision of medical services. However, there are situations where a medical organization is more advisable to have a patient with medical care without issuing an IDC, rather than refuse to him. We are talking about the situation when the patient categorically insists on conducting medical intervention, but refuses to sign the relevant documents. In such a situation, it is definitely a certificate of the patient from the design of the IDF, indicating the causes of such a refusal and an indication of the act that the patient himself insists on conducting medical intervention. This is due to the fact that in the future it may turn out that the patient was not in himself from pain, fear (other reasons) and could not understand the meaning of his actions and guided them that from a simple wave of aggression against the bureaucratic element of medical care, he was not in State is aware of your behavior. Each such situation should be assessed by a physician in an individual format and the decision to conduct medical intervention without IDC should be taken weigly and reasonable.

The procedure for medical intervention without the consent of the patient

Cases of medical intervention without the consent of the patient	Who makes a decision	The procedure for making a decision
medical intervention is necessary on emergency testimony to eliminate the threat of human life and if the patient's condition does not allow to express his will or there are no legal representatives (in cases established by law); medical intervention in relation to persons suffering from diseases of danger to others	the attending physician (if it is impossible to collect a consultation of doctors)	If the decision is made directly attending (duty) by the doctor, the attending physician contributes such a decision in the patient. The attending physician later should notify the officials of the medical organization, the patient (his representative) on the conduct of medical intervention.
medical intervention in relation to persons suffering from severe mental disorders; medical intervention in relation to persons who committed socially dangerous acts (crimes);	Court	The procedure for the provision of medical intervention is determined by the Criminal Code of the Russian Federation and the Code of Criminal Procedure, as well as Law of the Russian Federation of 02.07.1992 No. 3185-1 "On psychiatric care and guarantees of citizens' rights in its provision"
When conducting forensic examination and (or) forensic psychiatric examination	Court	The procedure for the provision of medical intervention is determined by the Code of Civil Procedure of the Russian Federation, the Code of Criminal Procedure, as well as the Federal Law of 31.05.2001 No. 73-FZ "On State Forensic Expert Activities in the Russian Federation"

For non-fulfillment of responsibilities for informing patients on medical services in accordance with the legislation of the Russian Federation, in particular for not the design of the forms of harmonies or failures of patients from medical interventions. Not registration of the IDC may be considered a violation (paragraph 5 a., C. Decisions of the Government of the Russian Federation of 04/16/2012 № 291 "On licensing of medical activities"), which will entail an offensive in accordance with Part 3, 4 Art. 14.1 Administrative Code.

Also, such a violation can be qualified and simply as a violation of paragraph 28 Decisions of the Government of the Russian Federation of 04.10.2012 № 1006 "On approval of rules for the provision of paid medical services with medical organizations", which will entail an advent of administrative responsibility in accordance with Art. 14.8 of the Administrative Code.

A medical organization for not the provision of information, as well as the provision of inaccurate or insufficient information, may suffer responsibility in accordance with the Civil Code of the Russian Federation and the Law of the Russian Federation of 07.02.1992 No. 2300-1 "On Consumer Protection". The patient has the right to be due to unreliable or insufficient information about the medical service, regardless of the guilt of the medical organization (Art. 1095 of the Civil Code of the Russian Federation, Art. 12 ZozPP). Also providing medical care without IDC may be the criterion of unlawful harm (ch. 59 of the Civil Code of the Russian Federation).

1. Budarin G.Yu., Ertel L.A. The realization of the right of citizens to informed voluntary agreement within the framework of the current legislation of the Russian Federation // Medical law. 2013. No. 4. P. 30 - 34.