Informed voluntary consent to medical interventions. Informed voluntary consent of the patient to medical intervention

From the point of view of the law, informed voluntary consent to the intervention is the official basis for performing the manipulations provided for medical programs public and private institutions.

The article below contains information about exactly when it is necessary to write such a document, how to draw it up correctly, and also how the personnel of a medical organization will be punished for initiating assistance without an official permission signed by the "patient".

DIS features

Informed voluntary consent to medical intervention is a unified, partially completed form that requires certification by the patient himself or his guardian (in the event that treatment is initiated for a person under 18 years of age who is legally incapacitated as a citizen).

When contacting a medical organization, they offer to fill out a voluntary informed consent for medical intervention.

According to the law, it must be provided for review, filling out and signature immediately before medical procedures.

The consent in question is required to fill out not only with a one-time provision of medical care to a person during the initial or subsequent admission within the walls medical institution, but also at the moment when health workers start a card in a budget clinic, a private medical center, school or preschool institution.

In all cases, the patient should be explained the purpose, procedure and potential consequences of the intended medical manipulations.

Traditionally, writing DIS involves the following types assistance from the medical staff:

preventive assessments of the patient's health status by narrowly focused specialists;
routine vaccination;
passing complex medical commissions;
carrying out ultrasonic, magnetic resonance and computer studies;
first aid by medical staff under any circumstances (bruise, fracture, onset generic activity etc).

When a document is required

Informed consent to the intervention is required when initiating any medical services, which is a set of measures, including:

examination and questioning of the patient in order to collect complaints and describe the history of the current disease;
measuring the parameters of the patient's body at the current moment;
measurement of body temperature, as well as level blood pressure;
assessment of the patient's visual acuity and hearing;
state determination nervous system;
collection of analyzes, biomaterials and other similar manipulations for the diagnosis of diseases;
electrocardiogram;
electroencephalography;
X-ray studies;
computed tomography (CT);
Magnetic resonance imaging;
massage treatments;
physiotherapy;
use medicines, in accordance with the prescriptions of the attending physician.

In accordance with the law, any action on the part of doctors aimed at the slightest change in the mental or physical condition"Sick", in any case, presuppose the registration of permission from the patient himself, or his capable relatives.

Document submission rules

Informed voluntary consent to medical intervention is drawn up and certified by a person of legal age or his capable relative (when writing a permit in a preschool and school institution, and so on).

For the correct execution of the documentation, you must follow the established algorithm for submitting permission to initiate intervention by the medical staff:

Carefully review the information provided by healthcare professionals on the specific services required by the patient in this case: the purpose of the measures taken; ways of their implementation; expected result; possible complications due to the unpredictability of the reaction human body to outside interference.
Study the form of the document, in the vast majority of cases provided already in printed form by the administrators of the medical institution or by the doctors themselves.
Clarify the points that remained unclear after the "briefing".
If possible, take the consent form home and study it in a comfortable environment.
Write down with your own hand a list of manipulations allowed by the medical staff to address the patient himself or his ward, whose interests he represents.
Certify the document with a personal signature, indicating the date and decoding (surname, name, patronymic).

In addition, in the issued documentation, it is advisable to make sure that information is indicated (if it is absent, add it yourself) about:

place of registration or actual place of stay;
date of birth;
passport;
Name of the employee who took consent from the patient;
persons who, if necessary, are allowed to inform about the current stage of the patient's recovery;
information about the hospital (for planned hospitalization).

Also, the DIS must contain the personal signature of the employee's accepted application and the seal of the institution within which the patient provided this document.

Responsibility for providing medical intervention without DIS

Responsibility for the provision of medical intervention without the consent of the patient in the conditions of state budgetary institutions involves the involvement of the management and the doctor himself in administrative punishment in the form of a fine or temporary cessation of professional activity.

In a situation where the incident happened within the walls of a private organization, then in addition to the above consequences, paid institution will be forced to bear responsibility under article 14.8 of the Code of the Russian Federation for administrative violations.

In case of harm to human health as a result of medical activities that are not included in the list permitted by the patient himself or his guardian, the medical staff will be forced to fully compensate for the physical damage, in the amount required by the victim himself. In such situations, the proof of the guilt of the medical staff in the incident is not expedient.

Free form of filling is allowed

In a number of circumstances, informed voluntary consent to medical intervention is acceptable for drafting in an arbitrary way. Due to their circumstances, not wanting to fill out the unified form of the document, the patient or his parent (guardian) can independently print or write by hand a permission to carry out certain medical procedures.

However, even with a categorical refusal to use the standard application form, the resulting documentation should strictly comply with the legal requirements related to the writing of DIS.

Sample of filling out the form

A sample of the DIS form required to fill out in budgetary and paid medical institutions, as well as by parents in school and kindergarten:

When signing the above form adult citizen all columns should include personal information.

If the consent is filled out by a parent (guardian), the following rules should be observed:

three columns of the form located at the top of the form are filled in by an authorized person;
emphasizes the option “to receive primary health care by a person of whom I am a legal representative”;
in the column below the specified information about the medical institution, the data of the minor (surname, name, patronymic and date of birth) are indicated;
in the next free area, there is a place for the signature of the guardian;
in the column "Date of execution" the date of signing of this consent is indicated.

Consent to certain types of medical procedures

In view of certain features of a separate series of manipulations on the part of the medical staff, permission for them is drawn up each time immediately before they are carried out.

These most often include:

In this case, it is imperative before the intervention itself, to make sure that the doctor has given a sufficiently detailed briefing about the potential dangers and side effects procedures performed.

Equally important is the presence of the full name of the type of care from the medical staff, for the provision of which the permit is signed (as an option, during immunization against measles, rubella and mumps, all three components of the vaccine must be prescribed in the form of a document without abbreviations and abbreviations).

Additional information in the form

The indication of third-party information in the standard form of the document in question is not provided. However, if appropriate circumstances arise, the supervising physician may create a separate box to indicate the notes associated with obtaining this consent, or the characteristics of the potentially provided assistance to the human body.

It is worth emphasizing separately that the law does not prohibit the introduction of third-party marks into the unified DIS form.

The age at which the child is eligible for self-signature

On their own, a citizen over the age of 15 or prematurely recognized as legally capable has the right to issue a voluntary permit for the vast majority of types of assistance from the medical staff. However, there are also a number of exceptions that require a person to be of legal age to sign a unified form.

Such unique circumstances include:

donation in any form;
a condition check provoked by a suspicion of alcohol or drug intoxication;
provision of narcological assistance to drug addicts (the expediency of assistance to drug addicts, which is of a non-narcotic nature, is allowed to be determined for children from 16 years of age).

Document validity period

The validity period of the document of the type in question is unlimited. In most situations, the consent is filled out during the initial visit to the medical institution and is considered valid throughout the entire period of observation of the person by the medical staff within its walls. However, this does not mean that the patient does not have the opportunity to subsequently change his mind and revoke his earlier consent.

To change the list of permitted medical manipulations, you must fill out the appropriate standard form or draw up an application yourself addressed to the administration of the medical organization. At the same time, the citizen is not obliged to indicate the reasons for such actions.

Actions in case of refusal of treatment

Refusal to provide assistance by medical personnel, as well as permission for it, requires the patient to draw up documentation using a unified form of a medical institution or writing it in any form. The application should be sent to the administration of the institution, while observing all the recommendations on the legislation related to the preparation of such documentation.

In such a case, the health worker must explain to the citizen the possible negative consequences of his refusal from the offered assistance from the medical staff.

In circumstances that imply a continued reluctance to subject their body to treatment, the patient should complete an application in the same way with consent, indicating that he was previously instructed about the potential consequences.

Partial waiver of the procedures specified in the consent

According to the law, the patient, as well as his parent (guardian), can also make a partial waiver of the types of interventions by the medical staff mentioned earlier in the permit. To this end, he will need to fill out a standard form or draw up a document on his own, writing in it the full name of the prohibited procedures without abbreviations and other abbreviations.

On this form, traditionally, a column is provided for additional information prescribed by the attending physician, about the potential dangers of refusing to help the patient "by the medical staff, in a particular case.

DIS (informed voluntary consent to intervention) into the functioning of the human body from the outside medical staff, must be drawn up taking into account the instructions contained in the relevant legislation.

Having studied the above article, a citizen, and in some cases, his parent (guardian) will not only understand why this document is important, but will also learn how to correctly draw up it, as well as make specific adjustments, in case of partial or complete rejection from the provision of medical care.

Video of Informed Voluntary Consent to Medical Intervention

DIS features:

Article 20 of Law No. 323-FZ obliges doctors and other medical personnel to obtain consent to medical intervention. This procedure must complete the patient or his representative with his signature in a special form after the health worker tells him about the goals of treatment, the methods needed medical events and the expected result. In what situations should the patient allow treatment and why is it needed? How is the notification procedure carried out? In what cases is the intervention of a doctor allowed without the consent of a citizen? We will answer these questions in this article.

When is patient consent needed?

Medical intervention in medicine means any impact on a person. They include a method of treatment, procedures, operations and other medical manipulations, as well as a set of the listed measures. In this case, the effects can be exerted both on the body and on the human psyche. Any medical intervention requires the consent of the patient. In addition to the patient, consent to treatment or other manipulations can be given by:

Legal representatives;
Medical consultation;
Therapist.

Situations where decisions are made by others are strictly regulated by law. Doctors and medical staff are not exempt from obtaining the patient's consent when carrying out manipulations outside the medical institution, when treating without drugs and medical instruments, when carrying out operations for the purpose of prevention, diagnosis or scientific research... A number of requirements are imposed on consent to medical intervention, without the fulfillment of which the expression of will is considered illegal.

Requirements for consent to medical intervention

The patient's will is legitimate when it is presented before the start of the procedure and with an indication of a specific intervention. Is it possible to obtain consent for several manipulations? The law contains no restrictions. In addition, the Orders of the Ministry of Health No. 390n of 23.04.012 and No. 1177n of 20.12.12 contain a list of medical interventions for which a citizen gives a unified consent when signing the form established by Order No. 1177n.

Federal Law No. 323 requires informed consent, that is, the patient or representative makes a decision after providing all the information about the proposed interventions. In paragraph 1 of Art. 22 of the law indicates information that the patient has the right to know:

About the test results, laboratory research and other types of medical examinations;
About the diagnosis;
About the expected development of the disease;
On techniques and methodologies of treatment and their risks;
Possible medical effects, their consequences and the expected result.

Diagnosis or treatment should be carried out only with the consent of the patient himself or his legal representative, and the patient (his representative) has the right to receive from the doctor all the necessary information about possible options medical intervention, its risks and results. The patient can get acquainted with all the medical documentation contained in his file.

Doctor of Medical Sciences and medical lawyer A.V. Tikhomirov formulated the basic requirements for information provided to patients. In the medical community, they are called the "3-D & C Rule": "Information must be Accessible, Reliable and Sufficient, Provided in a Timely manner."

Although the law clearly stipulates the requirement to obtain informed consent for medical procedures, in practice, doctors often do not provide information to the patient. The patient signs papers without reading, which sometimes leads to trial after the manipulation.

If a person refuses treatment, doctors are obliged to explain to him the consequences of such an act. In addition to the right to receive information, a sick person has the right to refuse it. With a sad prognosis, information about the state of health can be provided to close relatives, if the patient does not interfere with such transfer. A person can independently determine the person or circle of persons who will receive such data.

Granting consent by a legal representative

Minors can independently dispose of their health from the age of 15. Before this age, all decisions are made legal representatives... If a teenager is sick with drug addiction, the age threshold moves up to 16 years. The legal representatives of children are:

Dear mom and dad;
Adoptive parents;
Persons who have issued guardianship or guardianship.

They are the ones who issue consent to medical procedures or refusal from them until the child turns 15. The signature of the guardian or trustee may also be required when treating a citizen who has been declared incapacitated if the person cannot express their will on their own. If a minor or an incapacitated citizen faces death, and the representative refuses therapy, the medical organization can go to court. In such a situation, the decision is made by the judge alone with the opportunity to appeal the resolution to a higher court.

When is a decision about a medical intervention made without the consent of the patient?

Legislation in a separate group highlights situations where medical intervention can be carried out without the consent of the patient. Cases in which medical interventions can occur without the will of the patient or his representative are prescribed in paragraph 9 of Art. 20 of Law No. 323-FZ. Such cases include:

The need for emergency intervention to save the patient if he cannot express his consent or there are no legal representatives nearby;
Human disease is dangerous to others;
Strong mental illness;
Committing a dangerous crime by a sick person;
Conducting forensic examinations.

In the first two cases, the decision is made by a council of doctors, and if it cannot be assembled, the attending physician. At mental illness or the commission of a crime, the decision is made in court.

Medical Consent Form

Since 2012 (after the entry into force of Law No. 323-FZ), the patient's consent is drawn up in writing and filed in medical records... Prior to this period, the main form of expression of the will of patients was verbal consent or refusal. The consent form, the refusal form, the procedure for obtaining consent for medical intervention are approved by Order of the Ministry of Health No. 1177n. The approved form is a permit for the whole complex medical manipulations as part of the initial examination and treatment. It is signed at the first visit to a medical institution and is valid for the entire period of primary treatment.

The consent form for Order No. 1177n is valid only if free help and carrying out operations corresponding to the list of interventions approved by Order of the Ministry of Health No. 390n. For commercial clinics, as well as operations that are not included in the list of Order No. 390n, forms of expression of the will of patients are being developed treatment organizations on one's own.

Providing primary care

Medical interventions in the provision of primary care can be carried out using a single consent form approved by Order of the Ministry of Health No. 1177n. The list of possible manipulations is contained in Order No. 390n. According to the latest document, all interventions are divided into 14 groups:

Interviewing the patient, collecting complaints about the state of health and information about the course of the disease;
Initial inspection;
Taking measurements of the patient's body;
Temperature check;
Pressure check;
Vision test;
Hearing test;
Nervous system research;
Taking tests and conducting other diagnostics;
Electrocardiogram, pressure monitoring and ECG;
X-ray;
Receiving medications as prescribed by your doctor;
Massage;
Physiotherapy.

Consent to carry out the listed medical procedures is given when choosing a medical institution and a doctor, that is, it is signed when concluding a contract. Subsequently, the patient can refuse all interventions or only some of them.

Responsibility of Medical Institutions for Failure to Obtain Consent

The lack of consent of the patient to carry out medical interventions is considered gross violation the patient's rights and is considered an infringement of his personal integrity. Even with correct treatment a person can file a claim to the court about the violation of his rights and claim compensation for the harm caused and payment of moral damage. However, for full benefit, evidence of the harm received and proof of the medical organization's guilt should be attached.

Conclusion

Obtaining voluntary consent to medical intervention from the patient is a mandatory and primary point in the treatment of any citizen. If the patient himself, due to his incapacity, cannot give such consent, this is done for him by legal representatives (parents, guardians). The doctor has the right to carry out treatment without consent only in cases strictly specified by law.

Appendix No. 1

INFORMED VOLUNTARY

___________________________

I, according to my will, have been given full and comprehensive explanations about the nature, severity and possible complications my illness (health represented).

I voluntarily give my consent to conduct:

1.Inquiry, including identification of complaints, collection of anamnesis.

2. Inspection, including palpation, percussion, auscultation, rhinoscopy, pharyngoscopy, indirect laryngoscopy, vaginal examination (for women), rectal examination.

3. Anthropometric research.

4. Thermometry.

5. Tonometry.

6. Non-invasive examinations of the organs of vision and visual functions.

7. Non-invasive examinations of hearing organs and auditory functions.

8. Research of the functions of the nervous system (sensory and motor spheres).

9. Laboratory methods of examination, including clinical, biochemical, bacteriological, virological, immunological.

10. Functional examination methods, including electrocardiography, 24-hour blood pressure monitoring, daily electrocardiogram monitoring, spirography, pneumotachometry, peakfluometry, reoencephalography, electroencephalography, cardiotocography (for pregnant women).

11. X-ray examination methods, including fluorography (for persons over 15 years old) and radiography, ultrasound examination, Doppler studies.

12. Introduction drugs as prescribed by a doctor, including intramuscularly, intravenously, subcutaneously, intradermally.

13. Medical massage.

14. Physiotherapy.

15.Invasive research methods: cystoscopy, fibrotracheobronchoscopy, esophagogastroduodenoscopy, fibrocolonoscopy, sigmoidoscopy

16. Intravesical instillations

The need for other methods of examination and treatment will be explained to me additionally;

______________________________________________________________

┌ - - - - ─┐

NOTE:

Additional Information: _________________________________________________________________

┌ - - - - ─┐

"___" _____________ 20__. Patient signature / X

Legal representative └ - - - - ─┘

Signed in my presence:

┌ - - - - ─┐

Doctor _______________________________________________ (signature) X

(Position, First Name Last Name) └ - - - - ─┘

A consultation of doctors consisting of:

Position, full name and signature ____________________________________

Appendix No. 1/2 (hospital)

^ INFORMED VOLUNTARY

CONSENT TO MEDICAL INTERVENTION

I AM __________________________________________________________________________________________

(surname, name, patronymic - in full)

Year of birth, resident at: ____________________________

_________________________________________________________________________________________

^ This section of the form is completed only by a legal representative of persons under the age of 15, or incapacitated citizens: I, passport: _____________, issued by: ________________________________ ______________________________________________________ I am the legal representative (mother, father, adoptive parent, guardian, guardian) of a child or a person who has been declared incapacitated:

_________________________________________________________________________________________

(Full name of a child or an incapacitated citizen, year of birth)

notified (supplied) that I (represented) was hospitalized (hospitalized) in the department _________________________________________________________________________________

(indicate the name or profile of the department)

I, according to my will, have been given full and comprehensive explanations about the nature, severity and possible complications of my disease (health);

I am familiar with (familiarized) with the order and rules of the medical and protective regime established in this medical and preventive institution and undertake to comply with them;

I voluntarily give my consent to conduct to me (represented), in accordance with the doctor's prescription, diagnostic research: general and biochemical blood tests, blood tests for the presence of human immunodeficiency virus, viral hepatitis, treponema pale, general urine analysis, electrocardiography; X-ray, ultrasound and endoscopic examinations and treatment measures: taking pills, injections, intravenous fluids, diagnostic and therapeutic punctures, physiotherapy procedures.

I voluntarily give my consent to:. Survey, including identification of complaints, collection of anamnesis, examination, including palpation, percussion, auscultation, rhinoscopy, pharyngoscopy, indirect laryngoscopy, vaginal examination (for women), rectal examination, anthropometric examination, thermometry, tonometry, non-invasive studies of the organs of vision and visual functions, non-invasive studies of the organs of hearing and auditory functions, studies of the functions of the nervous system (sensory and motor spheres), laboratory methods examinations, including clinical, biochemical, bacteriological, virological, immunological, functional examination methods, including electrocardiography, daily monitoring of blood pressure, daily monitoring of an electrocardiogram, spirography, pneumotachometry, peakfluometry, reoencephalography, electroencephalography, cardiotocography (for pregnant women) examination methods, including fluorography (for persons over 15 years old) and radiography, ultrasound examination, Doppler studies, drug administration as prescribed by a doctor, including intramuscularly, intravenously, subcutaneously, intradermally, medical massage... physiotherapy exercises.

It was explained to me that in the course of the execution of the medical action, it may be necessary to perform other studies and medical procedures not specified in the previous paragraph. I trust the attending physician to make the appropriate decision and perform other actions that the physician deems necessary to establish my diagnosis and determine the treatment tactics;

I am informed (informed) about the purposes and methods of providing medical care the risk associated with them, possible options for medical intervention, its consequences, as well as the expected results of medical care. I was given the opportunity to ask questions about the degree of risk of medical intervention and the doctor gave me clear, comprehensive answers. I am informed (informed) about the nature and adverse effects of diagnostic and treatment procedures, the possibility of unintentional harm to health, as well as what I (represented) have to do during these events;

I have been notified (notified) that I (the represented) need to regularly take prescribed medications and other methods of treatment, immediately inform the doctor about any deterioration in well-being, agree with the doctor to take any non-prescribed medications;

I have been warned (warned) and am aware that refusal of treatment, non-compliance with the medical and protective regime, recommendations of medical workers, the regimen of taking medications, unauthorized use of medical instruments and equipment, uncontrolled self-medication can complicate the treatment process and adversely affect the state of health;

I have been notified (notified) of the need to notify the doctor about all health problems, including allergic manifestations or individual intolerance to drugs, about all the injuries, operations, diseases that I have experienced and known to me, about environmental and production factors physical, chemical or biological nature affecting me (represented) during my life, about the medications taken. I have been notified (notified) of the need to report truthful information about heredity, as well as about the use of alcohol, drugs and toxic substances;

I ____________ agree (agree) to be examined by other medical professionals and students of medical universities and colleges solely for medical, scientific or educational purposes, taking into account the preservation of medical confidentiality;

I have read (read) and agree (agree) with all the points of this document, the provisions of which have been explained to me, I understand and voluntarily give my consent to the examination and treatment in the proposed volume;

I authorize, if necessary, to provide information about my diagnosis, the severity and nature of my disease to my relatives, legal representatives, citizens: ______________

______________________________________________________________

I authorize the following citizens to visit in the medical institution the child I represent or the person declared incapacitated: _____________________________________________________________________________________________________________________________________________________________________________

┌ - - - - ─┐

"___" _____________ 20__. Patient signature / X

Legal representative └ - - - - ─┘

Signed in my presence:

┌ - - - - ─┐

Doctor _______________________________________________ (signature) X

(Position, First Name Last Name) └ - - - - ─┘

NOTE:

Consent to medical intervention (treatment) in relation to persons under the age of 15 and citizens recognized in established by law legally incompetent, give their legal representatives (parents, adoptive parents, guardians or trustees) indicating the full name, passport data, family relations after informing them about the results of the examination, the presence of the disease, its diagnosis and prognosis, treatment methods related with them at risk, possible options for medical intervention, their consequences and the results of the treatment.

In the absence of legal representatives, the decision on the need for treatment is made by a council, and if it is impossible to assemble a council, by the attending (duty) doctor directly with the subsequent notification of the head of the Ministry of Defense, and on weekends, holidays, evening and night time - the responsible doctor on duty.

In cases where the condition of a citizen does not allow him to express his will, and the need for treatment is urgent, the issue of medical intervention in the interests of the citizen is decided by the council, and if it is impossible to collect the council, the doctor on duty directly with the subsequent notification of the head of the Ministry of Defense, and on weekends , holidays, evening and night time - the responsible doctor on duty and legal representatives.

Additional Information: ______________________________________________________________

┌ - - - - ─┐

"___" _____________ 20__. Patient signature / X

Legal representative └ - - - - ─┘

Signed in my presence:

┌ - - - - ─┐

Doctor _______________________________________________ (signature) X

(Position, First Name Last Name) └ - - - - ─┘

A consultation of doctors consisting of:

Position, full name and signature ____________________________________

"___" _________________ 20__

Appendix # 2

^ INFORMED VOLUNTARY CONSENT

FOR ANESTHETIC SUPPORT

MEDICAL INTERVENTION

I AM ________________________________________________________________________________________

(surname, name, patronymic - in full)

Year of birth, resident at: _____________________________

_________________________________________________________________________________________

^ This section of the form is completed only by a legal representative of persons under the age of 15, or incapacitated citizens: I, passport: ______________, issued by: __________________________________ ______________________________________________________ I am the legal representative (mother, father, adoptive parent, guardian, guardian) of a child or a person who has been declared incapacitated:

__________________________________________________________________________________________

(Full name of a child or an incapacitated citizen, year of birth)

being on treatment (examination) in the department _______________________________________________

_________________________________________________________________________________________

I voluntarily give my consent to conduct to me (represented):

__________________________________________________________________________________________

(name of the type of anesthesia, the possibility of changing anesthetic tactics)

I have been notified (notified) of the need to inform the doctor about all health problems, including allergic manifestations or individual intolerance to drugs, food, household chemicals, flower pollen; about all the injuries, operations, diseases, anesthetic aids that I have suffered (represented) and known to me; about the environmental and production factors of a physical, chemical or biological nature that affect me (represented) during my life, about the medicines taken. I have been notified (notified) of the need to report truthful information about heredity, alcohol, drugs and toxic substances;

I am informed (informed) about the goals, nature and adverse effects of anesthetic support of medical intervention, as well as about what I (represented) have to do during it;

I have been warned (warned) about the risk factors and I understand that carrying out anesthetic support of medical intervention is associated with the risk of disorders from the cardiovascular, nervous, respiratory and other systems of the body's vital activity, unintentional harm to health, and other unfavorable outcomes.

It has been explained to me and I am aware that unforeseen circumstances and complications may arise during anesthetic treatment. In this case, I agree (agree) that the type and tactics of anesthetic aid can be changed by doctors at their discretion.

I have read (familiarized) and agree (agree) with all the points of this document, the provisions of which have been explained to me, I understand and voluntarily give my consent to conduct anesthetic support of medical intervention in the proposed volume.

About the consequences ____________________________________________________________________________

(possible complications when performing anesthesia)

and the associated risk is informed (informed) by the doctor anesthesiologist-resuscitator:

__________________________________________________________________________________________

(surname, name, patronymic of an anesthesiologist-resuscitator)

┌ - - - - ─┐

"___" _____________ 20__. Patient signature / X

Legal representative └ - - - - ─┘

Signed in my presence:

┌ - - - - ─┐

Doctor _______________________________________________ (signature) X

(Position, First Name Last Name) └ - - - - ─┘

NOTE:

Consent to anesthetic provision of medical intervention for persons under the age of 15 and citizens recognized as legally incompetent is given by their legal representatives (parents, adoptive parents, guardians or trustees) indicating the full name, passport data , family relations after informing them about possible options for medical intervention, their consequences and the results of the treatment, taking into account the patient's state of health.

In the absence of legal representatives, the decision on the anesthesiological provision of medical intervention is made by the council, and if it is impossible to collect the council, the anesthesiologist-resuscitator and the attending (duty) doctor directly with the subsequent notification of the head of the Ministry of Defense, and on weekends, holidays, evening and night time - the responsible doctor on duty and legal representatives.

In cases where a citizen's condition does not allow him to express his will, and medical intervention is urgent, the issue of anesthesiological support during medical intervention in the interests of a citizen is decided by the council, and if it is impossible to collect a council, the anesthesiologist-resuscitator and the attending (duty) doctor with subsequent notification of the head of the Ministry of Defense, and on weekends, holidays, evening and night time - the responsible doctor on duty.

Additional Information: ___________________________________________________________________

_________________________________________________________________________________________

┌ - - - - ─┐

"___" _____________ 20__. Patient signature / X

Legal representative └ - - - - ─┘

Signed in my presence:

┌ - - - - ─┐

Doctor _______________________________________________ (signature) X

(Position, First Name Last Name) └ - - - - ─┘

A consultation of doctors consisting of:

Position, full name and signature ____________________________________

Appendix No. 3

^ INFORMED VOLUNTARY CONSENT FOR OPERATIONAL INTERVENTION

I AM ________________________________________________________________________________________

(surname, name, patronymic - in full)

Year of birth, resident at: _____________________________

__________________________________________________________________________________________

_________________________________________________________________________________________

(Full name of a child or an incapacitated citizen, year of birth)

being on treatment (examination) in the department __________________________________________________

(department name, room number)

I voluntarily give my consent to conduct my (represented) operation: ______________________

___________________________________________________________________________________________

(name of medical intervention)

And I ask the staff of the medical organization to conduct it.

I confirm that I am familiar with (familiarized) with the nature of the upcoming (submitted) operation. They explained to me, and I understand the features and the course of the forthcoming surgical treatment.

It was explained to me and I am aware that unforeseen circumstances and complications may arise during the operation. In this case, I agree (agree) that the course of the operation can be changed by the doctors at their discretion.

I have been warned (warned) about the risk factors and I understand that the operation is associated with the risk of blood loss, the possibility infectious complications, violations of the cardiovascular and other systems of the body's vital activity, unintentional harm to health and other unfavorable outcome.

I have been warned (warned) that in some cases it may be necessary reoperations, incl. in connection with possible postoperative complications or with the peculiarities of the course of the disease, and I give my consent to this.

I have been notified (notified) of the need to inform the doctor about all health problems, including allergic manifestations or individual intolerance to drugs, about all the injuries, operations, diseases that I have suffered (represented) and known to me, including ... carriage of HIV infection, viral hepatitis, tuberculosis, sexually transmitted infections, environmental and production factors of a physical, chemical or biological nature that affect me (represented) during my life, medications taken, previously transfused blood and its components. I have been notified (notified) of the need to report information about heredity, as well as about the use of alcohol, drugs and toxic substances.

I ___________________________ agree (agree) to record the progress of the operation on information carriers and demonstrate to persons with medical education exclusively for medical, scientific or educational purposes, taking into account the preservation of medical confidentiality.

I was given the opportunity to ask questions about the degree of risk and benefits of surgery, incl. transfusions of donor or auto (own) blood and / or its components, and the doctor gave me comprehensive answers that I could understand.

I have read (read) and agree (agree) with all the points of this document, the provisions of which have been explained to me, I understand and voluntarily give my consent to __________________________

_________________________________________________________________________________________

┌ - - - - ─┐

"___" _____________ 20__. Patient signature / X

Legal representative └ - - - - ─┘

Signed in my presence:

┌ - - - - ─┐

Doctor _______________________________________________ (signature) X

(Position, First Name Last Name) └ - - - - ─┘

NOTE:

Consent to medical intervention in relation to persons under the age of 15 and citizens recognized as legally incompetent is given by their legal representatives (parents, adoptive parents, guardians or trustees) indicating the full name, passport data, relatives relations after informing them about the results of the examination, the presence of the disease, its diagnosis and prognosis, the methods of treatment, the associated 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 is made by a council, and if it is impossible to collect a council, by the attending (duty) doctor directly with the subsequent notification of the head of the Ministry of Defense, and on weekends, holidays, evening and night time - by the responsible doctor on duty and legal representatives.

In cases where the condition of a citizen does not allow him to express his will, and medical intervention is urgent, the issue of its implementation in the interests of the citizen is decided by the council, and if it is impossible to collect the council, by the attending (duty) doctor with the subsequent notification of the head of the Ministry of Defense, and on weekends, holidays, evening and night time - the responsible doctor on duty.

Additional Information: __________________________________________________________________

__________________________________________________________________________________________

_________________________________________________________________________________________

__________________________________________________________________________________________

┌ - - - - ─┐

"___" _____________ 20__. Patient signature / X

Legal representative └ - - - - ─┘

Signed in my presence:

┌ - - - - ─┐

Doctor _______________________________________________ (signature) X

(Position, First Name Last Name) └ - - - - ─┘

A consultation of doctors consisting of:

Position, full name and signature ____________________________________

"___" _________________ 20___

Appendix No. 4

^ PATIENT CONSENT

FOR THE OPERATION OF BLOOD COMPONENTS TRANSFUSION

I ____________________________________________________________ received a clarification about the blood transfusion operation. The attending physician explained to me the purpose of the transfusion, its necessity, the nature and characteristics of the procedure, its possible consequences, in the case of the development of which I agree to carry out all the necessary therapeutic measures. I have been notified of the probable course of the disease in case of refusal to undergo a blood transfusion operation.

The patient had the opportunity to ask any questions he was interested in regarding his state of health, illness and treatment, and received satisfactory answers to them.

I received information about alternative methods treatment, as well as their approximate cost.

Interviewed by a doctor _____________ (doctor's signature)

"__" _______________ 20__

The patient agreed with the proposed treatment plan, which he signed with his own hand ___________________ (patient's signature),

Or that those present at the interview certify _____________ (signature of the doctor), ____________________________ (signature of the witness).

The patient did not agree (refused) the proposed treatment, for which he signed with his own hand _______________ (patient's signature),

Or signed (according to clause 1.7 of the Instructions for the use of blood components, approved by Order of the Ministry of Health of Russia dated November 25, 2002 N 363) _____________________________ (signature, full name),

Or that those present at the conversation certify ___________ (signature of the doctor), ____________________________ (signature of the witness).

Appendix 5

^ DISCLAIMER

MEDICAL INTERVENTION

I AM, ________________________________________________________________________________________

(surname, name, patronymic - in full)

Year of birth, resident at: _____________________________

__________________________________________________________________________________________

This section of the form is filled out only by the legal representative of persons under the age of 15, or incapacitated citizens: I, passport: _____________, issued by: ________________________________ ______________________________________________________ I am the legal representative (mother, father, adoptive parent, guardian, guardian) of a child or a person recognized as incapacitated:

_________________________________________________________________________________________

(Full name of a child or an incapacitated citizen, year of birth)

While undergoing treatment (examination) in the department ________________________________________________

(branch name)

According to my will, I refuse to carry out medical intervention for me (represented).

According to my will, I have been given complete and comprehensive information about the nature, severity and possible complications of my disease (the disease represented), including data on the results of the examination, the presence of the disease, its diagnosis and prognosis, treatment methods, associated risk, possible options for medical intervention , their consequences and the results of the treatment;

The possible consequences of my refusal (refusal of the submitted one) from the proposed medical intervention were explained to me in detail in a form accessible to me. I am aware that refusal of medical intervention (treatment) may adversely affect my health (health of the person represented) and even lead to an unfavorable outcome.

Possible consequences of refusing medical intervention:

__________________________________________________________________________________________

_________________________________________________________________________________________

(indicated by a doctor)

Additional Information: ________________________________________________________________

__________________________________________________________________________________________

I have read (familiarized) and agree (agree) with all the points of this document, the provisions of which have been explained to me, I understand and voluntarily, using my right provided for in Article 20 of the Federal Law No. 323 "On the Basics of Health Protection of Citizens in the Russian Federation" intervention (treatment).

┌ - - - - ─┐

"___" _____________ 20__. Patient signature / X

Legal representative └ - - - - ─┘

Signed in my presence:

┌ - - - - ─┐

Doctor _______________________________________________ (signature) X

(Position, First Name Last Name) └ - - - - ─┘

NOTE:

A citizen or his legal representative has the right to refuse medical intervention or demand its termination.

It is NOT ALLOWED to refuse treatment or medical intervention by persons suffering from diseases that pose a danger to others, persons suffering from severe mental disorders, or persons who have committed socially dangerous acts, on the grounds and in the manner prescribed by law Russian Federation.

Pursuant to article 17, paragraph 3 Federal law dated 09.01.1996 No. 3-FZ "On the radiation safety of the population" a citizen (patient) has the right to refuse medical X-ray and radiological procedures, with the exception of preventive studies carried out in order to identify diseases that are dangerous in epidemiological terms.

Based on paragraph 2 of Article 9 of the Federal Law of 18.06.2001 No. 77-FZ "On the Prevention of the Spread of Tuberculosis in the Russian Federation" dispensary observation for patients with tuberculosis is established regardless of the consent of such patients or their legal representatives.

On the basis of paragraph 1 of Article 5 of the Federal Law of September 17, 1998 No. 157-FZ, citizens in the implementation of immunization have the right to refuse preventive vaccinations... The lack of preventive vaccinations entails: a ban for citizens to travel to countries in which, in accordance with international medical and sanitary rules or international treaties of the Russian Federation, requires specific preventive vaccinations; temporary refusal to admit citizens to educational and health institutions in the event of mass infectious diseases or when there is a threat of epidemics; refusal to admit citizens to work or suspension of citizens from work, the performance of which is related to high risk diseases of infectious diseases.

In case of refusal from medical intervention, the possible consequences must be explained to the citizen or his legal representative in a form accessible to him. Refusal of medical intervention with an indication of the possible consequences is made out by an entry in the medical documentation and signed by the citizen or his legal representative, as well as by the medical worker.

If the parents or other legal representatives of a person under 15 years of age, or the legal representatives of a person recognized as legally incompetent, refuse medical assistance necessary to save the lives of these persons, medical institution has the right to go to court to protect the interests of these persons.

Refused to sign the voluntary informed consent form to refuse medical intervention:

A consultation of doctors consisting of:

Position, full name and signature ____________________________________

"___" _________________ 20___

Appendix No. 6

^ REFUSAL OF HOSPITALIZATION

I AM, ___________________________________________________________________________________________

(Full Name)

A patient __________________________________________________________________________________

(name of MO)

Or the patient's legal representative _________________________________________________________

_________________________________________________________________________________________

(surname, name, patronymic, details of the document confirming the right to represent the interests of the patient)

I refuse the hospitalization offered to me (the patient).

He was informed about his (patient's) disease and possible complications of its course, received recommendations for treatment.

I (the patient or his legal representative) will not have any claims against the medical organization in the event of development negative consequences due to my decision.

A patient

(legal representative) ____________________________________________________________________

(signature, surname, date)

Doctor _____________________________________________________________________________________

(signature, surname, date)

In this case, the doctor of the admission department is obliged to:

Checkout medical card inpatient;

Call in the emergency department for examination of the sick doctor-specialist of the profile department;

Record in detail the results of the examination in the medical history;

To inform about the refusal of hospitalization to the head of the specialized department, the deputy head of the Ministry of Defense for the medical part (in the evening, at night, on holidays and weekends - the responsible person on duty at the hospital);

Fill out the form "Refusal to carry out medical intervention".

The form is signed by the patient, the doctor of the admission department, the specialist of the specialized department and the head of the admission department (on weekends and holidays, in the evening and at night - by the person on duty at the hospital);

Issue to the patient a certificate of stay in admission department with an indication of the results of examination and research, diagnosis, medical and labor recommendations.

APPROVED BY:

By order of the Chief Physician of the OGBUZ

"Tomsk Regional Oncological Dispensary"

No. ___ dated "_____" _______________ 2012

INSTRUCTION

^ BY FILLING IN THE VOLUNTARY FORM

INFORMED CONSENT (REFUSAL)

General Provisions

1. Forms of informed voluntary consent (refusal) are filled in in accordance with these Instructions.

2. Forms of voluntary informed consent can be filled in with the patient's own hand or his legal representative, as well as in print, including using funds computing technology, except for the lines “signature of the patient / legal representative” and “Signed in my presence: Doctor”.

3. When filling out the voluntary informed consent (refusal) form, it is recommended to use the same type of fonts, ink (paste) in blue or black.

4. The patient has the right to refuse to complete these forms. In this case, it is allowed to obtain voluntary informed consent (refusal) not on a form, but in a simple written form in compliance with the requirements of the legislation of the Russian Federation. The attached forms of documents are of a recommendatory nature and can be supplemented taking into account the peculiarities of the work of a medical organization in accordance with the requirements of the legislation of the Russian Federation.

5. Forms of voluntary informed consent (refusal) must be used when providing outpatient, inpatient care as well as in the conditions day hospital.

6. Voluntary informed consent (refusal) for medical intervention, for anesthetic provision of medical intervention, for surgery, incl. transfusion of blood and its components, for vaccination and for refusal of medical intervention (hereinafter "voluntary informed consent (refusal)") is taken before the provision of medical care from each patient or his legal representative, upon admission to hospital treatment, in a day hospital, for invasive intervention in outpatient settings, as well as in other cases, regardless of gender, age, citizenship, national and religious affiliation, as well as belonging to the assigned contingent.

7. Each form must be certified by the patient's own handwritten signature or his legal representative, as well as the signature of the doctor who received the patient's voluntary informed consent (refusal).

For the patient's handwritten signature, his legal representative and the doctor, there is a rectangular field located in the lower part of the form, the boundaries of which are indicated by a dotted line:

┌ - - - - ─┐

└ - - - - ─┘

8. Capable persons who have reached the age of 15 (over 14 years 11 months 30 days) sign the forms on their own.

9. Consent (refusal) to medical intervention in respect of persons under the age of 15 and citizens recognized as legally incompetent is given by their legal representatives (parents: mother, father, adoptive parents, guardians or trustees), indicating F. I.O., passport data, family relations after informing them of the results of the examination, the presence of the disease, its diagnosis and prognosis, methods of treatment, the associated risk, possible options for medical intervention, their consequences and the results of the treatment.

10. In the absence of legal representatives of an incapacitated citizen or whose condition does not allow expressing his will, the decision on the need for treatment is made by a council (the reverse side of the forms is filled in), and if it is impossible to collect a council, by the attending (duty) doctor with subsequent notification of the head of the Ministry of Defense, and in weekends, holidays, evening and night time - the responsible doctor on duty and legal representatives.

11. In cases where the citizen's condition does not allow him to express his will, and the need for treatment is urgent, the issue of informed voluntary consent in the interests of the citizen is decided by the consultation (the back of the forms is filled in), and if it is impossible to collect the consultation, the attending (duty) doctor directly with the subsequent notification of the head of the Ministry of Defense, and on weekends, holidays, evening and night time - the responsible doctor on duty.

12. It is not allowed to refuse treatment or medical intervention by persons suffering from diseases that pose a danger to others, persons suffering from severe mental disorders, or persons who have committed socially dangerous acts, on the grounds and in the manner established by the legislation of the Russian Federation. Additional information regulating the cases in which the refusal of medical intervention is not allowed is specified on the back of the form in Appendix No. 4.

13. If the parents or other legal representatives of a person under 15 years of age, or legal representatives of a person recognized as legally incompetent, refuse medical assistance necessary to save the lives of these persons, the medical organization has the right to apply to the court to protect the interests these persons.

14. Filling out the forms of voluntary informed consent (refusal) may be postponed in war time, in a military and state of emergency, in case of mass admission to medical institutions of patients affected by factors of a physical, chemical or biological nature, in the event of an outbreak of especially dangerous infections.

II. Passport part of forms

The following data is indicated in the passport part of the forms:

1. Full name patient (in full), year of birth, registration address in accordance with the data of the identity document, in the absence of registration, indicate the actual place of residence; the name of the department where hospitalization is planned, the list of relatives or legal representatives to whom the patient is allowed to provide information about his diagnosis, the severity and nature of the disease, is filled in by the patient ONLY, and, if appropriate, by his legal representatives or guardians. If the patient's condition does not allow him to fill out the form, as well as when the form is filled in by printing, incl. and using computer technology, it is done by an authorized healthcare professional.

2. The "Additional Information" section is intended for the physician to enter any information related to obtaining voluntary informed consent from the patient.

3. When filling out a voluntary informed consent to persons under 15 years of age or citizens recognized as legally incompetent, in the line "I" indicate the surname, first name and patronymic (in full) of the legal representative of the child or the incapacitated person. The line "resident" indicates the address of residence of the legal representative. In the line "passport" the number of the identity document of the representative is recorded in accordance with the list of identity documents; by whom and when this document was issued.

4. In the line “I am a legal representative”, by underlining the appropriate word, the degree of kinship is indicated, for example: “mother, father, adoptive parent, guardian, trustee”. The line "child (full name)" indicates the surname, name and patronymic of the child (incapacitated person), as well as the year of his birth. The line “that I (represented) was hospitalized” indicates the name of the institution, the profile of the department, and the number of the ward.

List of identity documents:

1. Passport of a citizen of Russia (passport of a citizen of the Russian Federation, valid in the territory of the Russian Federation since 01.10.1997).

2. Passport of a citizen of the USSR (until its expiration date;).

3. Identity card of the officer (for active military personnel - officers, warrant officers, warrant officers).

4. Military ID (for military personnel - soldiers, sailors, sergeants, foremen, currently passing military service by call or contract).

5. Certificate of release from places of deprivation of liberty (for persons released from places of deprivation of liberty).

6. Passport of a foreign state (for foreign citizens located on the territory of the Russian Federation temporarily).

Foreign passport (for Russian citizens permanently residing abroad and temporarily in the territory of the Russian Federation).

7. Seaman's passport (identity card of a citizen working on foreign vessels or foreign vessels).

8. Residence permit in the Russian Federation.

9. Certificate of refugees of the Russian Federation (for refugees).

10. Certificate of registration of an immigrant's application for recognition as a refugee (for refugees without refugee status).

11. Temporary identity card of a citizen of the Russian Federation (in the form of 2P).

12. Birth certificate (for persons under 15 years of age).

III. The procedure for filling out the forms

1. Filling out the informed voluntary consent form for medical intervention. Appendix No. 1/1 and 1/2.

1.1. The form must be completed and signed by the doctor and patient prior to treatment. The form "Appendix No. 1/1" is filled in once by the patient, upon initial appeal to a medical organization that provides primary health care (outpatient) care. The form "Appendix No. 1/2" is filled in by the patient at each hospitalization in a hospital (day hospital).

1.2. It is filled, as a rule, upon admission (at the admission department or reception), and pasted into the medical record of the outpatient / inpatient. Filling in the passport part of the form is carried out in accordance with clause II.1 of this manual... The form is pasted into the medical card of an inpatient (F. 003 / y), birth history (F. 096 / y), outpatient card(F. 025 / y) or other medical documentation.

1.3. When filling out this form, the patient gives permission to be examined by other medical professionals and students medical universities and colleges. If the patient does not agree to be examined by other specialists, then in the paragraph "I ___ agree (agree) to be examined by other medical professionals", the patient writes a "NOT" particle between the words "I" and "agree".

2. Filling in the informed voluntary consent form for anesthetic provision of medical intervention. Appendix No. 2.

2.1. It is advisable to fill out the form during the preoperative examination of the patient by an anesthesiologist-resuscitator and in other cases when anesthesia is required.

2.2. After filling out the passport part in accordance with paragraph II.1 of this instruction, in the line "I voluntarily give my consent to carry out to me (represented):" the planned type of anesthetic treatment recommended by the anesthesiologist-resuscitator is indicated, and the possibility of changing anesthesiological tactics is indicated.

2.3. In lines:

- "About the consequences" - the word "warned" is indicated,

- "Anesthesiologist-resuscitator" - the full name is indicated. anesthesiologist-resuscitator (completely).

2.4. The patient or his legal representative indicates on the form the date, month and year of filling out the form and personally signs in the corresponding column. The form is endorsed by an anesthesiologist-resuscitator who has received consent, and is pasted into the medical documentation.

3. Filling out the informed voluntary consent form for surgery. Appendix No. 3.

3.1. The passport part of the form is filled out in accordance with clause II.1 of this instruction. In the line: "I voluntarily give my consent to carry out the operation for me (represented):" the name of the medical intervention is indicated. In the line "- I have read (familiarized) with all the points of this document, the provisions of which have been explained to me, I understand and voluntarily give my consent to:" the word "operation" or another type of intervention is indicated. The patient or his legal representative puts on the form the date, month and year of filling it in and signs in the appropriate box with his own hand. The form is endorsed by a doctor who has received voluntary informed consent for surgery, incl. transfusion of blood and its components. The form is pasted into the medical record of an inpatient (F. 003 / y), birth history (F. 096 / y), an outpatient card (F. 025 / y) or other medical documentation together with a preoperative epicrisis, an operation protocol, consent to anesthesia allowance ...

3.2. In the event that the patient or his legal representative does not agree to record the progress of the operation on information media in order to demonstrate the intervention to persons with medical education for use exclusively for medical, scientific or educational purposes or transfusion of blood or its components, in the lines “I ___ agree ( I agree) to record the progress of the operation on information media ... "," ___ I give my consent to transfusion of blood and its components "the particle" NOT "is added. For example: "I DO NOT agree (agree) to record a move ..."

4. Filling in the patient's consent form for the operation of blood components transfusion. Appendix No. 4.

The plan for the operation of the transfusion of blood components is discussed and agreed upon with the patient in writing, and, if necessary, with his relatives. The patient's consent is drawn up in accordance with the sample given in the appendix and is attached to the inpatient card or outpatient card.

5. Completion of the medical intervention refusal form. Appendix No. 5.

5.1. This type of form is used in case of patient refusal from medical intervention: surgery, taking medications, transfusion of blood and its components, refusal of hospitalization, from continuing the course of treatment in a hospital, day hospital, polyclinic and in other cases not specified in this instruction. ...

5.2. In accordance with the current legislation, in case of refusal from medical intervention, the citizen or his legal representative must be explained in a form accessible to him the possible consequences of the refusal.

5.3. When filling out the form for refusing medical intervention, first the passport part of the form is filled in in accordance with paragraph II.1 of this instruction. Indicate the name of the medical institution, department and the number of the ward where he is being treated.

In the section “Possible consequences of refusal”, the DOCTOR or FELDSHER briefly indicates the main possible consequences of refusing treatment, for example: the development of encephalopathy, death, etc.

5.4. The patient or his legal representative indicates on the form the date, month and year of filling in the form and signs in the corresponding box. The form is endorsed by a doctor who has received voluntary informed consent to refuse medical intervention. The form is pasted into the hospital card (F. 003 / y), birth history (F. 096 / y), outpatient card (F. 025 / y) and other medical documentation. If the patient refuses to continue treatment and insists on being discharged from the hospital, the form is pasted into the hospital patient's medical record along with the discharge summary. If the patient is an incapacitated person and his condition does not allow him to express his legal will, then the form is signed by his guardians or legal representatives.

Note: Article 20. Federal Law of the Russian Federation of November 21, 2011 No. 323-FZ "On the basics of protecting the health of citizens in the Russian Federation"

Informed voluntary consent to medical intervention and to refuse medical intervention

1. A necessary precondition for medical intervention is the giving of informed voluntary consent of the citizen or his legal representative to medical intervention on the basis of the accessible form full information about the goals, methods of providing medical care, the associated risk, possible options for medical intervention, about its consequences, as well as about the expected results of medical care.

2. Informed voluntary consent to medical intervention is given by one of the parents or other legal representative in relation to:

1) a person under the age established by Part 5 of Article 47 and Part 2 of Article 54 of this Federal Law, or a person recognized as legally incompetent, if such a person, due to his condition, is not capable of giving consent to medical intervention;

2) a minor patient with drug addiction during the provision of drug treatment or medical examination a minor in order to establish a state of narcotic or other toxic intoxication (with the exception of cases established by the legislation of the Russian Federation when minors acquire full legal capacity before they reach the age of eighteen).

3. A citizen, one of the parents or other legal representative of the person specified in part 2 of this article have the right to refuse medical intervention or demand its termination, with the exception of the cases provided for in part 9 of this article. The legal representative of a person recognized as legally incapable exercises this right if such a person, due to his condition, is unable to refuse medical intervention.

4. In case of refusal of medical intervention to a citizen, one of the parents or other legal representative of the person specified in part 2 of this article, the possible consequences of such refusal must be explained in an accessible form for him.

5. If one of the parents or other legal representative of the person specified in part 2 of this article, or the legal representative of a person recognized as legally incompetent, refuses medical intervention necessary to save his life, the medical organization has the right to apply to the court for protecting the interests of such a person. The legal representative of a person recognized as legally incompetent shall notify the guardianship and trusteeship authority at the place of residence of the ward about the refusal of medical intervention necessary to save the life of the ward, not later in the day following the day of this refusal.

6. The persons specified in parts 1 and 2 of this article, in order to receive primary health care when choosing a doctor and a medical organization for the period of their choice, give informed voluntary consent to certain types of medical intervention, which are included in the list established by the authorized federal executive body. authorities.

7. Informed voluntary consent to medical intervention or refusal of medical intervention is made in writing, signed by a citizen, one of the parents or other legal representative, a medical professional and is contained in the patient's medical records.

8. The procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types medical intervention, the form of informed voluntary consent to medical intervention and the form of refusal from medical intervention are approved by the authorized federal executive body.

9. Medical intervention without the consent of a citizen, one of the parents or other legal representative is allowed:

1) if medical intervention is necessary for emergency indications to eliminate the threat to a person's life and if his condition does not allow him to express his will or there are no legal representatives (in relation to the persons specified in part 2 of this article);

2) in relation to persons suffering from diseases that pose a danger to others;

3) in relation to persons suffering from severe mental disorders;

4) in relation to persons who have committed socially dangerous acts (crimes);

5) when conducting a forensic medical examination and (or) a forensic psychiatric examination.

10. A decision on medical intervention without the consent of a citizen, one of the parents or other legal representative is taken:

1) in the cases specified in clauses 1 and 2 of part 9 of this article - by a consultation of doctors, and if it is impossible to collect a consultation - directly by the attending (duty) doctor with the introduction of such a decision into the patient's medical documentation and subsequent notification of medical officials an organization (the head of a medical organization or the head of a department of a medical organization), a citizen in respect of whom medical intervention has been carried out, one of the parents or other legal representative of the person specified in part 2 of this article and in respect of whom the medical intervention has been carried out;

2) in relation to the persons specified in clauses 3 and 4 of part 9 of this article - by the court in the cases and in the manner established by the legislation of the Russian Federation.

11. Compulsory measures may be applied to persons who have committed crimes medical nature on the grounds and in the manner established by federal law.

Appendix N 2

Russian Federation

Informed voluntary consent

for 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 to receive primary health care

I AM, __________________________ Ivanova Elena Ivanovna ____________________________

______________________________January 10, 1980 year of birth , ______________________

registered at: ___________ 614000 Perm, st. Ivanova 1 sq. 1 _________

(address of the citizen's place of residence or

legal representative)

I give informed voluntary consent to the types of medical interventions included in the List of certain types of medical interventions, to which citizens give informed voluntary consent when choosing a doctor and a medical organization to receive primary health care (see overleaf) approved by 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 me to receive primary health care / receive primary health care by a child whose legal representative I am (cross out unnecessary)

_________________________Ivanov Alexander Sergeevich, 05.05.2005, year of birth _______________

(Name of the child, date of birth)

in the State budgetary institution of health care of the Perm Territory "Medical and physical dispensary"

The goals, methods of providing medical care, the associated risk, possible options for medical interventions, their consequences, including the likelihood of complications, as well as the expected results of medical care were explained to me in an accessible way. It has been explained to me that I have the right to refuse one or more types of medical interventions included in the List, or to demand its (their) termination, except for the cases provided for by part 9 of Article 20 of the Federal Law of November 21, 2011 N 323-FZ " On the basics of protecting the health of citizens in the Russian Federation "(Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724; 2012, N 26, Art. 3442, 3446).

Information about the persons I have chosen who, in accordance with paragraph 5 of part 3 of article 19 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation", information about my health or the health of a child can be transferred , of which I am a legal representative (cross out unnecessary)

_____________________ Ivanov Sergey Yurievich, 89020000001 ________________________

FULL NAME. citizen, contact phone number

Personal signature ____________________Ivanova Elena Ivanovna _____________________

(signature) (full name of a citizen or legal representative of a citizen)

Personal signature ___________________ Petrova Olga Ivanovna _____________________

(signature) (full name medical worker)

"__20 __" ___april ___2016 G.

(date of issue)

A sample of filling out the IDS by a person over the age of 15

Appendix N 2

By order of the Ministry of Health

Russian Federation

State state-financed organization health care of the Perm Territory

"Medical and physical dispensary"

Order of the Ministry of Health of the Russian Federation of December 20, 2012 N 1177n "On approval of the procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types of medical interventions, forms of informed voluntary consent to medical intervention and forms of refusal of medical intervention" ( with changes and additions)

Appendix No. 1. The procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types of medical interventions Appendix No. 2. Informed voluntary consent to the types of medical interventions included in the List of certain types of medical interventions to which citizens give informed voluntary consent when choosing a doctor and a medical organization for receiving primary health care Appendix N 3. Refusal from types of medical interventions included in the List of certain types of medical interventions to which citizens give informed voluntary consent when choosing a doctor and medical organization for receiving primary health care help

Order of the Ministry of Health of the Russian Federation of December 20, 2012 N 1177n
"On approval of the procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types of medical interventions, forms of informed voluntary consent to medical intervention and forms of refusal of medical intervention"

With changes and additions from:

a form of informed voluntary consent for the types of medical interventions included in the List in Appendix No. 2;

a form of refusal from the type of medical intervention included in the List of certain types of medical interventions for which citizens give informed voluntary consent when choosing a doctor and a medical organization to receive primary health care, in accordance with Appendix No. 3.

IN AND. Skvortsova

Registration N 28924

In order to receive primary health care, when choosing a doctor and medical organization, citizens (their legal representatives) give informed voluntary consent to medical intervention.

The forms of consent to medical intervention and refusal from it are given.

Consent is drawn up at the first contact with a medical organization. Before receiving it, the patient is provided with an available full information about the goals and methods of providing medical care, about the risk associated with it, possible options for medical intervention, about its consequences, including the likelihood of complications. The estimated results of medical care are also reported.

If a citizen refuses to intervene, the possible consequences of such a decision are explained to him, including the likelihood of complications of the disease (condition).

Informed voluntary consent is filed in the patient's medical documentation and is valid for the entire period of primary health care in the selected medical organization.

Citizens have the right to refuse one or several types of medical interventions or demand their termination (with the exception of some cases: for example, this does not apply to persons suffering from severe mental disorders and criminals).

Order of the Ministry of Health of the Russian Federation of December 20, 2012 N 1177n "On approval of the procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types of medical intervention, forms of informed voluntary consent to medical intervention and forms of refusal of medical intervention"

Registration N 28924

This order comes into force 10 days after the day of its official publication.