Order of the Minister of Healthcare and Social Development of the Republic of Kazakhstan dated December 12, 2016 № 1054. Registered with the Ministry of Justice of the Republic of Kazakhstan on January 11, 2017 № 14662. Abolished by Order of the Minister of Health of the Republic of Kazakhstan dated June 12, 2023 No. 115
Unofficial translation
Footnote. Abolished by Order of the Minister of Health of the Republic of Kazakhstan dated June 12, 2023 No. 115 (effective ten calendar days after the date of its first official publication).In accordance with subparagraph 6 of paragraph 1 of Article 7 of the Code of the Republic of Kazakhstan dated September 18, 2009 “On public health and the health system, I hereby ORDER:
1. To approve the attached Standard for the organization of otolaryngology and surdology in the Republic of Kazakhstan.
2. The Department of Standardization of Medical Services of the Ministry of Healthcare and Social Development of the Republic of Kazakhstan, in accordance with the procedure established by the legislation, shall:
1) ensure the state registration of this order with the Ministry of Justice of the Republic of Kazakhstan;
2) send a copy of this order in print and electronic form within ten calendar days from the date of its state registration in one copy in the state and Russian languages of the Republican State Enterprise on the Right of Economic Management "Republican Legal Information Center" for inclusion in the Reference Control Bank of regulatory legal acts of the Republic of Kazakhstan and for official publication in periodicals;
3) place this order on the website of the Ministry of Healthcare and Social Development of the Republic of Kazakhstan;
4) within ten working days after the state registration of this order with the Ministry of Justice of the Republic of Kazakhstan, submit to the Department of Legal Service of the Ministry of Healthcare and Social Development of the Republic of Kazakhstan information on the execution of measures provided for in subparagraphs 1), 2) and 3) of this paragraph.
3. Control over the execution of this order shall be entrusted to the Vice Minister of Healthcare and Social Development of the Republic of Kazakhstan E.A. Birtanov
4. This order shall be enforced upon expiry of ten calendar days after the date of its first official publication.
| Minister of Healthcare | |
| and Social Development | |
| of the Republic of Kazakhstan | T. Duissenova |
| Approved by order of the Minister of Healthcare and Social Development of the Republic of Kazakhstan dated December 12, 2016 № 1054 |
Standard
for the organization of otorhinolaryngology and surdology care in the Republic of Kazakhstan
Chapter 1. General provisions
1. The Standard for the Organization of Otorhinolaryngology and Surdology Care in the Republic of Kazakhstan (hereinafter referred to as the Standard) shall have been developed in accordance with subparagraph 6 of paragraph 1 of Article 7 of the Code of the Republic of Kazakhstan dated September 18, 2009 “On public health and the health system” (hereinafter referred to as the Code).
2. This Standard shall establish general principles and requirements for the organization of medical care for patients with ear, throat and nasal diseases (hereinafter - diseases of ENT organs) and patients with hearing disorders at non-hospital-polyclinic, hospital and hospital replacing levels, regardless of the form of property and departmental identity.
3. Definitions used in this Standard:
1) specialized specialist - a medical worker with higher medical education, having a certificate in the specialty "otorhinolaryngology (surdology) (adult and child)";
2) dynamic observation - systematic observation of the state of health of the population, as well as provision of necessary medical care on the basis of the results of this observation;
3) hearing prosthetics - restoration of human communicative capabilities by strengthening audible signals through hearing aids or electrode hearing prosthetics;
4) the portal of Bureau of hospitalization (referred to as the Portal) - the unified system of electronic registration, account, processing and storage of the directions of patients for planned hospitalization in a hospital within the guaranteed volume of free medical care;
5) otorhinolaryngology care - a complex of medical services, including diagnosis, treatment, prevention and medical rehabilitation, provided to patients with diseases of ENT organs;
6) patient – an individual who is (was) a consumer of medical services;
7) prevention - a complex of medical and non-medical measures aimed at preventing the occurrence of diseases, progression in the early stages of diseases and control of already developed complications, injuries of organs and tissues;
8) surgical care - a complex of medical, social, psychological and pedagogical services aimed at prevention, timely detection, diagnosis, treatment, hearing prothesis and rehabilitation of persons with hearing disorders;
9) The guaranteed volume of free medical care (hereinafter referred to as the GVFMC) - the unified scope of medical care provided to citizens of the Republic of Kazakhstan and oralmans according to the list of medical services.
4. Medical organizations, as well as structural subdivisions within the medical organizations providing otorhinolaryngology and surdology care in the Republic of Kazakhstan (hereinafter referred to as MO), shall be established in order to carry out timely measures aimed at prevention, diagnosis, treatment and medical rehabilitation of patients with diseases of ENT organs, as well as to carry out hearing prosthesis, hearing rehabilitation and special corrective and pedagogical care to persons with hearing organ pathology.
5. MO shall be organized as:
1) the otorhinolaryngology cabinet in the structure of district, city hospitals, medical organizations and departmental medical organizations and medical organizations with private property, in accordance with measures to improve the provision of surdology to the population of the Republic of Kazakhstan, approved by order No. 263 of the Acting Minister of Healthcare of the Republic of Kazakhstan dated April 15, 2010 "On measures to improve the provision of surdology care to the population of the Republic of Kazakhstan” (Registered in the Register of State Registration of Regulatory Legal Acts No. 6231);
2) non-hospital and clinic department of otorhinolaryngology consultation and diagnostic center, non-hospital and clinic organizations, hospitals, departmental medical organizations and medical organizations having private form of property;
3) specialized cabinet (phoniatric, surdology) of non-hospital and clinic organizations, consultation and diagnostic centers (departments), departmental medical organizations and medical organizations with private property;
4) a hospital department of otorhinolaryngology, including children's, with a center of otorhinolaryngology care.
Chapter 2. Organization of otorhinolaryngology care in the Republic of Kazakhstan
6. Medical care to the population with diseases of ENT organs and patients with hearing disorders shall be provided within the framework of the GVFMC in accordance with the list of the guaranteed volume of free medical care approved by the resolution of the Government dated December 15, 2009 No. 2136 "On approval of the list of the guaranteed volume of free medical care".
7. The staff of the MO shall be established in accordance with the staff standards and staff standards of healthcare organizations approved by the order No. 238 of the Minister of Health of the Republic of Kazakhstan dated April 7, 2010 "On approval of staff standards and staff standards of healthcare organizations" (registered in the Register of State Registration of Regulatory Legal Acts No. 6173).
8. Otorhinolaryngology and surdology shall be provided in the following forms:
1) non-hospital and clinic care, including primary healthcare (hereinafter referred to as PHC) and consultation and diagnostic care (hereinafter referred to as CDA);
2) hospital care;
3) hospital-replacing care.
9. The main objectives and the MO functions and also rendering the otorhinolaryngology care and complex of medical services in the otorhinolaryngology care to patients it shall be regulated by the Regulation on activity of the organizations of healthcare rendering the otorhinolaryngology care to the population of the Republic of Kazakhstan, approved by the order of the Minister of Healthcare of the Republic of Kazakhstan dated November 16, 2012 No. 801 "On approval of the Regulation on activity of the organizations of healthcare rendering the otorhinolaryngology care to the population of the Republic of Kazakhstan" (Registered in the Register of State Registration of Regulatory Legal Acts No. 8196).
10. The provision of surdology care and a range of medical services for surdology care for patients shall beregulated by the Rules for the provision of surdology care to the population of the Republic of Kazakhstan, approved by order No. 338 of the Minister of Healthcare and Social Development of the Republic of Kazakhstan dated May 12, 2015 "On approval of the Rules for the provision of surdology care to the population of the Republic of Kazakhstan" (Registered in the Register of State Registration of Regulatory Legal Acts No. 11406)A and shall be also provided with measures to improve the provision of surdology care to the population of the Republic of Kazakhstan, approved by order No. 263 of the Acting Minister of Healthcare of the Republic of Kazakhstan dated April 15, 2010 "On measures to improve the provision of surdology care to the population of the Republic of Kazakhstan" (Registered in the Register of State Registration of Regulatory Legal Acts No. 6231).
11. In accordance with the Rules for the provision of primary health care and the Rules for the attachment of citizens to primary health care organizations approved by order No. 281 of the Minister of Healthcare and Social Development of the Republic of Kazakhstan dated April 28, 2015 “On approval of the Rules for the provision of primary health care and the Rules for the attachment of citizens to primary health care organizations”. (registered in the Register of State Registration of Regulatory Legal Acts No. 11268).
12. The provision of otorhinolaryngology and surdology care at the non-hospital and clinic level shall include:
1) preventive ENT-examinations, including (target population groups), organization and conduct of screening examinations of hearing organs of newborns and children of early age;
2) diagnostic laboratory and instrumental studies;
3) therapeutic measures, including emergency and emergency medical care, therapeutic manipulations in accordance with clinical protocols for diagnosis and treatment of diseases of ENT organs;
4) Selection and referral to medical organizations for the provision of specialized medical care and high-tech medical services for routine hospitalization within the framework of the GVFMC shall be carried out through the Portal in accordance with the Rules for the provision of hospital care approved by order No. 761 of the Minister of Healthcare and Social Development of the Republic of Kazakhstan dated September 29, 2015 "On approval of the Rules for the provision of hospital care" (Registered in the Register of State Registration of Regulatory Legal Acts No. 12204) (hereinafter referred to as Order No. 761);
5) dynamic observation of patients with diseases of ENT organs and patients with hearing disorders;
6) medical rehabilitation of patients with diseases of ENT organs and patients with hearing disorders;
7) registration and maintenance of primary medical documentation in accordance with order No. 907 of the Acting Minister of Healthcare of the Republic of Kazakhstan dated November 23, 2010 "On approval of forms of primary medical documentation of healthcare organizations" (registered in the Register of State Registration of Regulatory Legal Acts for No. 6697) (hereinafter referred to as Order No. 907).
8) carrying out an examination of temporary incapacity for work in accordance with the Rules for conducting an examination of temporary incapacity for work, issuing a sheet and a certificate of temporary incapacity for work approved by order No. 183 of the Minister of Healthcare and Social Development of the Republic of Kazakhstan dated March 31, 2015 "On approval the Rules for conducting an examination of temporary incapacity for work, issuing a sheet and a certificate of temporary incapacity for work” (Registered in the Register of State Registration of Regulatory Legal Acts No. 10964);
9) referral of patients with diseases of ENT organs and patients with hearing disorders to medical and social expertise to establish disability and disability in accordance with the Rules for carrying out medical and social examination approved by order No. 44 of the Minister of Healthcare and Social Development of the Republic of Kazakhstan dated January 30, 2015 "On approval of the Rules for carrying out medical and social examination" (Registered in the Register of State Registration of Regulatory and Legal Acts No. 10589) (hereinafter referred to as Order No. 44);
10) promoting a healthy lifestyle.
13. The CDA for patients with ENT diseases and hearing disorders shall be provided in accordance with the Rules for the provision of consultation and diagnostic care approved by order No. 626 dated July 28, 2015 of the Acting Minister of Healthcare and Social Development of the Republic of Kazakhstan “On approval of the Rules for the provision of consultation and diagnostic care (registered in the Register of State Registration of Regulatory Legal Acts for No. 11958).
14. The CDA shall be performed by otorhinolaryngology and surdology doctors and shall include:
1) provision of consultation and diagnostic, therapeutic and rehabilitation medical care to patients with diseases of ENT organs and hearing disorders;
2) providing emergency and emergency medical care in case of acute conditions and diseases of ENT organs (injuries, foreign bodies, thermal and chemical burns, acute purulent inflammatory diseases), requiring urgent medical intervention, and in cases requiring medical care in hospital conditions, sending patients to the otorhinolaryngology department, where 24-hour emergency medical care shall be provided;
3) detection of oncological pathology of ENT organs in the population;
4) provision of medical care to patients discharged from the hospital departments of the medical organization under the supervision of a doctor, including after operative interventions, in case of necessity to carry out medical measures requiring observation by medical workers for several hours in the conditions of the medical organization;
5) providing medical care to patients with chronic diseases requiring repeated treatment courses;
6) surgical treatment of patients;
7) involvement of doctors of related specialties in case of concomitant pathology in patients;
8) dynamic and dispensary observation of patients with diseases of ENT organs and patients with hearing disorders;
9) participation in preventive examinations of the attached population;
10) carrying out medical rehabilitation aimed at restoring the functional state of ENT-organs;
11) organization of rehabilitation treatment, carrying out measures aimed at preventing the development of hearing loss and deafness among the attached population;
12) referral of patients with diseases of ENT organs and patients with hearing disorders for medical and social examination to establish disability and disability to work in accordance with the Rules for carrying out medical and social examination approved by Order No. 44;
13) registration and maintenance of primary medical documentation in accordance with Order No. 907.
15. Hospital care for patients with diseases of ENT organs and patients with hearing disorders shall be provided in accordance with Order No. 761.
16. Stationary otorhinolaryngology and surdology care shall include:
1) provision of specialized medical care, including high-tech medical services, otorhinolaryngology and surdology care for patients with diseases of ENT-organs in accordance with clinical protocols of diagnosis and treatment of diseases of ENT-organs;
2) daily examination by a doctor, correction of treatment;
3) inspection of the head of the department at arrival and in the following inspection - not less than once a week;
4) organization of consultations of patients by doctors of related specialties (if there are indications);
5) organization of case conference in case of difficulty in identification of diagnosis, inefficiency of the conducted treatment with additional examination of the patient, determination of treatment tactics in order to clarify the diagnosis and prognosis of the disease with the involvement of (at least three) specialists of higher qualification or other profile, including the consultant of the republican level;
6) examination of the hearing organ of newborns in perinatal centers (maternity units of multidisciplinary hospitals), timely detection of hearing disorders, referral to earlier treatment and rehabilitation in compliance with continuity at all stages of medical care;
7) carrying out anti-epidemic measures and prevention of intra-hospital infection;
8) carrying out sanitary and educational work, hygienic education of the population and promotion of a healthy lifestyle;
9) analysis of morbidity according to its profile and development of measures to reduce it;
10) registration and maintenance of medical documentation in accordance with Order No. 907.
17. Hospital replacing care for patients with diseases of ENT organs and patients with hearing disorders shall be provided in accordance with the Rules for the provision of hospital replacing care approved by order No. 669 of the Minister of Healthcare and Social Development dated August 17, 2015 "On approval of the Rules for the provision of hospital replacing care" (registered in the Register of State Registration of Regulatory Legal Acts No. 12106).
18. Hospital replacement care within the framework of the GVFMC shall be provided in the conditions of day hospital.
19. Hospital replacement care for patients with ENT organ diseases and patients with hearing disorders shall include:
1) diagnosis and treatment of ENT-diseases subject to be treated in conditions of day hospital (do not require round-the-clock observation);
2) registration of medical documentation in accordance with the forms of primary medical documentation of healthcare organizations approved by Order No. 907.
20. Emergency medical care for patients with diseases of ENT organs shall be provided in accordance with the Rules for the provision of emergency medical care and medical care in the form of sanitary aviation, approved by order No. 269 of the Minister of Healthcare and Social Development of the Republic of Kazakhstan dated April 27, 2015 "On approval of the Rules for the provision of emergency medical care and medical care in the form of sanitary aviation" (registered in the Register of State Registration of Regulatory Legal Acts No. 11263).
21. Emergency medical care for patients with diseases of ENT organs shall be provided when:
1) immediate threat to life, which without timely medical care shall lead to a heavy condition or a fatal outcome;
2) no immediate threat to life, but based on the pathological condition when the threatening moment shall come at any time;
3) a condition not dangerous to the patient's life, but posing an immediate danger to others.
22. Emergency medical care for patients with diseases of ENT organs shall be provided by medical visiting teams of emergency medical care, trained in the specialty "medical assistant of emergency medical care teams";
medical emergency teams;
specialized emergency medical teams of intensive care, trained in ambulance and emergency medical care.
23. Patients with diseases of ENT organs and patients with hearing disorders, if there are medical indications, are sent for rehabilitation measures to specialized medical and sanatorium-resort organizations.
24. Medical support for patients with diseases of ENT organs and patients with hearing disorders in MO within the framework of the GVFMC shall be provided on the basis of drug forms developed and approved in accordance with the Rules for the development and approval of drug forms of healthcare organizations, approved by order No. 762 of the Minister of Healthcare of the Republic of Kazakhstan dated November 23, 2009 "On approval of the Rules for the development and approval of drug forms of healthcare organizations" (registered in the Register of State Registration of Regulatory Legal Acts No. 5900).
Chapter 3. Main directions of medical organization activity providing otorhinolaryngology and surdology care
25. Medical care for patients with ENT organ diseases and patients with hearing disorders shall be provided within the framework of the GVFMC.
26. The main activities of MO shall be:
1) provision of qualified, specialized medical care and high-tech medical services to patients with diseases of ENT organs and patients with hearing disorders;
2) creation of an effective system ensuring access to medical care and quality of medical services.
27. Qualified medical care for patients with diseases of ENT organs shall be provided by medical workers with higher medical education (doctors with a specialty "therapy" (hereinafter referred to as the therapist), "pediatrics" (hereinafter referred to as the pediatrician), "general medical practice" (hereinafter referred to as GMP), "general surgery") in cases of diseases that do not require specialized methods of diagnosis, treatment and medical rehabilitation).
28. Specialized medical care with diseases of ENT organs and patients with hearing disorders shall be provided by specialized specialists and shall include prevention, diagnosis, treatment of diseases and conditions requiring the use of special methods and complex medical technologies, as well as medical rehabilitation.
29. High-tech medical services shall be provided by otorhinolaryngology and surdology doctors and include prevention, diagnosis, treatment of diseases and conditions requiring the use of innovative, minimally invasive, special methods and complex medical technologies, as well as medical rehabilitation.
30. The consultation of the otorhinolaryngology and surdology doctors shall be carried out on the direction of specialties of the PHC (therapist, pediatrician, GMP) with indication of the preliminary (or final) diagnosis, concomitant diseases, as well as the available data of laboratory and functional studies or on self-return to the MO.
31. If the disease of the vocal apparatus is detected, the patient shall be sent to the otorhinolaryngology office providing phoniatric care for diagnosis, necessary therapeutic and rehabilitation measures and dynamic observation.
32. In case of detection of cancer of ENT organs, otorhinolaryngology doctor shall send the patient to oncological clinic for verification of diagnosis and determination of subsequent tactics of patient's observation. Further treatment and observation of the patient shall be carried out with the interaction of the doctor in the specialty "oncology" (adult, child) and the otorhinolaryngology doctor.
33. If specific infections of ENT organs (tuberculosis, syphilis, scleroma, human immunodeficiency virus, human papilloma virus and others) are detected, patients should be referred to specialized departments of medical organizations for additional differential diagnosis.
34. In case of detection of hearing disorder requiring surgical care, the patient is sent to the doctor by the surgical physician for diagnosis, determination of treatment tactics, carrying out necessary therapeutic and rehabilitation measures and dynamic observation.
35. The MO, providing specialized medical care or high-tech medical services to patients with hearing pathology, shall conduct a preliminary consultation with the participation of specialized specialists with the subsequent selection of patients subject to cochlear implantation surgery.
36. After completion of specialized care or high-tech medical service in stationary conditions, the patient shall be issued an extract from the medical card of the non-hospital, hospital patient according to form No. 027/y approved by Order No. 907, with the results of the examination and treatment carried out, recommendations for further tactics of patient management at the non-hospital and clinic level and if the patient has indications for active dynamic observation, information on them shall be transmitted to the PMSC organization at the place of their attachment.
37. Hospitalization of the patient to the hospital department of the MO shall be carried out:
1) in the planned order on the direction of specialists of the PHC or medical organization within the framework of the GVFMC through the Portal, taking into account the right of the patient to free choice of medical organization in accordance with Order No. 761;
2) in the planned order in the direction of MO regardless of the forms of property;
3) by emergency indications regardless of the presence of the direction.
38. After the course of basic medical treatment, the patient shall be sent to rehabilitation treatment carried out in the conditions of medical organizations providing hospital and clinic care.
39. Upon discharge from the hospital of the MO, the patient shall be given a release from the medical card of the non hospital, hospital patient according to the form No. 027/y approved by Order No. 907, indicating the full clinical diagnosis, the volume and results of the examination, treatment (indicating the peculiarities of the surgery technique - if any) and recommendations for its further monitoring.
40. After providing emergency otorhinolaryngology care, patients shall be referred for non-hospital treatment to an otorhinolaryngology doctor in their place of residence, who needs hospitalization - to the hospital of the MO.
41. The quality of medical services provided in the MO, regardless of the form of property and departmental affiliation, shall be carried out in accordance with the Rules for the organization and conduct of internal and external examinations of the quality of medical services approved by order No. 173 of the Minister of Healthcare and Social Development of the Republic of Kazakhstan dated March 27, 2015 "On approval of the Rules for the organization and conduct of internal and external examinations of the quality of medical services" (registered in the Register of State Registration of Regulatory Legal Acts No. 10880).
42. The analysis of the effectiveness of the healthcare organization subdivisions providing otolaryngology and surdology care in assessing their own processes and procedures, introducing healthcare standards, using internal and external indicators shall be carried out by assessing the compliance of indicator thresholds in dynamics.
43. Paid medical services for patients with diseases of ENT organs and hearing disorders shall be provided by public and private medical organizations in accordance with the Rules and conditions for the provision of paid services in healthcare organizations approved by order No. 304 of the Minister of Healthcare and Social Development of the Republic of Kazakhstan dated April 30, 2015 "On approval of the Rules and conditions for the provision of paid services in healthcare organizations" (registered in the Register of State Registration of Regulatory Legal Acts No. 11341).
