Unofficial translation
In accordance with subparagraph 82) of article 7 of the Code of the Republic of Kazakhstan "On the health of the people and the healthcare system" and subparagraph 1) of article 10 of the Law of the Republic of Kazakhstan "On public services" DECREE:
1. Approve the Rules for the provision of primary health care in accordance with the annex to this order.
2. The Department of Organization of Medical Assistance of the Ministry of Health of the Republic of Kazakhstan, in the manner prescribed by the legislation of the Republic of Kazakhstan, shall ensure:
1) state registration of this order with the Ministry of Justice of the Republic of Kazakhstan;
2) placement of this order on the Internet resource of the Ministry of Health of the Republic of Kazakhstan after its official publication;
3) within ten working days after the state registration of this order with the Ministry of Justice of the Republic of Kazakhstan, providing information to the Legal Department of the Ministry of Health of the Republic of Kazakhstan on the implementation of the measures provided for in subparagraphs 1) and 2).
3. To impose control over the execution of this order on the supervising Vice Minister of Health of the Republic of Kazakhstan.
4. This order shall be enforced ten calendar days after the day of its first official publication.
|
Minister of Health of the Republic of Kazakhstan |
A. Tsoy |
" AGREED"
Ministry of Digital Development,
Innovation and Aerospace
Industry of the Republic of Kazakhstan
| Appendix to the order of the Minister of Health of the Republic of Kazakhstan dated August 24, 2021 No. RK HM-90 |
Rules for the provision of primary health care
Chapter 1. General Provisions
1. These Rules for the provision of primary health care (hereinafter referred to as the Rules) are developed in accordance with subparagraph 82) of Article 7 of the Code of the Republic of Kazakhstan "On the health of the people and the healthcare system" (hereinafter referred to as the Code) and subparagraph 1) of Article 10 of the Law of the Republic of Kazakhstan " On public services” and determine the procedure for providing primary health care to the population.
2. Basic concepts used in these Rules:
1) a specialized specialist - a medical worker with a higher medical education who has a certificate in the field of healthcare;
2) pre- medical care - medical care provided by paramedical workers independently or as part of a multidisciplinary team, including health promotion, assessment of the patient's condition, pre-medical diagnosis, appointment of a pre-medical intervention plan, pre-medical manipulations and procedures and care for the sick, disabled and dying people
3) the authorized body in the field of healthcare (hereinafter - the authorized body) - the central executive body that manages and intersectoral coordination in the field of protecting the health of citizens of the Republic of Kazakhstan, medical and pharmaceutical science, medical and pharmaceutical education, sanitary and epidemiological welfare of the population, circulation of medicines and medical devices, the quality of medical services (assistance);
4) dynamic monitoring - systematic monitoring of the patient's state of health, as well as the provision of necessary medical care based on the results of this monitoring;
5) clinical protocol - scientifically proven recommendations for prevention, diagnosis, treatment, medical rehabilitation and palliative care for a specific disease or condition of the patient;
6) service recipient - individuals and legal entities, with the exception of central state bodies, foreign missions of the Republic of Kazakhstan, local executive bodies of regions, cities of republican significance, the capital, districts, cities of regional significance, akims of districts in the city, cities of district significance, towns, villages, rural districts;
7) service provider - central state bodies, foreign institutions of the Republic of Kazakhstan, local executive bodies of regions, cities of republican significance, the capital, districts, cities of regional significance, akims of districts in the city, cities of district significance, towns, villages, rural districts, as well as physical and legal persons providing public services in accordance with the legislation of the Republic of Kazakhstan;
8) primary health care (hereinafter - PHC) - the place of first access to medical care focused on the needs of the population, including the prevention, diagnosis, treatment of diseases and conditions provided at the level of an individual, family and society;
9) public service - one of the forms of implementation of certain state functions, carried out on an individual basis at the request or without the request of service recipients and aimed at realizing their rights, freedoms and legitimate interests, providing them with appropriate material or intangible benefits;
10) compulsory social health insurance (hereinafter - CSHI) - a set of legal, economic and organizational measures to provide medical care to consumers of medical services at the expense of the assets of the social health insurance fund;
11) system of compulsory social health insurance - a set of norms and rules established by the state, regulating relations between participants in the system of compulsory social health insurance;
12) medical care in the system of compulsory social health insurance - the volume of medical care provided to consumers of medical services at the expense of the assets of the social health insurance fund;
13) family doctor - a doctor who has undergone special multidisciplinary training in providing primary health care to family members and has a certificate of a healthcare specialist;
14) patronage - carrying out preventive and informational activities at home by medical workers (patronage of a newborn, patronage of a pregnant woman, puerperal, dispensary patient);
15) guaranteed volume of free medical care (hereinafter referred to as GVFMC) - the volume of medical care provided at the expense of budgetary funds.
3. PHC is provided to the population:
1) within the framework of the GVFMC ;
2) in the CSHI system;
3) within the framework of voluntary medical insurance in accordance with the Law of the Republic of Kazakhstan "On Insurance Activities".
4. The PHC organization ensures the provision of medical care in accordance with the standards for organizing the provision of medical care, approved by the authorized body in accordance with paragraph 3 of Article 138 of the Code, in compliance with the anti-epidemic regime of work on the basis of the current regulatory legal acts in the field of sanitary and epidemiological welfare of the population.
5. The PHC organization maintains primary medical documentation and submits reports in the forms and in the manner established by the authorized body in accordance with the order of the Acting Minister of Health of the Republic of Kazakhstan dated October 30, 2020 No. RK HM-175/2020 "On approval of forms of accounting documentation in the healthcare” (hereinafter - Order No. RK HM-175/2020) (registered in the Register of State Registration of Regulatory Legal Acts under No. 21579), including through medical information systems.
Chapter 2. The procedure for providing primary health care
6. PHC is provided by general practitioners (family doctors), district therapists, pediatricians, paramedics, obstetricians, extended practice (general practice) nurses, district nurses, social workers, health psychologists in accordance with paragraph 3 of Article 123 of the Code.
7. According to paragraph 2 of Article 123 of the Code, PHC organizations operate according to the following principles:
1) family principle of service;
2) territorial accessibility of PHC;
3) free choice of a medical organization within the territorial accessibility;
4) patient satisfaction with the quality of medical care;
5) equality and fair competition regardless of the form of ownership and departmental affiliation;
6) PHC services, covering prevention, diagnosis and treatment, available to all patients regardless of their location.
8. In the PHC organization, a site is formed with the assignment of site specialists to serve the assigned population.
The number of assigned population per general practitioner, with the exception of rural medical organizations providing PHC, does not exceed 1,700 people of a mixed population, a district therapist 2,200 people, a district pediatrician - 500 children from 0 to 6 years old, 900 children from 7 to 18 years old.
9. In accordance with Article 117 of the Code, PHC is provided in the following forms:
1) emergency - medical care provided in case of sudden acute diseases and conditions, exacerbation of chronic diseases requiring urgent medical intervention to prevent significant harm to health and (or) eliminate the threat to life, regardless of the fact of attachment;
2 ) emergency - medical care provided in case of sudden acute diseases and conditions , exacerbation of chronic diseases that do not pose a clear threat to the patient's life;
3) planned - medical care provided for diseases and conditions that are not accompanied by a threat to the life of the patient, the delay in the provision of which for a certain time will not entail a deterioration in the patient's condition, as well as when carrying out preventive measures at the place of attachment by appointment or appeal.
10. PHC is provided under the conditions provided for in subparagraphs 1), 3), 4), 5), 6) of paragraph 1 of Article 118 of the Code.
11. PHC includes the services defined in paragraph 1 of Article 123 of the Code.
12. PHC includes:
1) pre-hospital medical care, which is provided by paramedical workers (district nurse (general practice nurse), paramedic, obstetrician) in case of diseases or in cases that do not require the participation of a doctor according to the list of medical services provided by PHC medical workers (paramedic, obstetrician, nurse with secondary and (or) higher medical education) in accordance with Appendix 1 to these Rules;
2) qualified medical care, which is provided by a general practitioner, a local general practitioner and (or) a pediatrician according to the list of medical services provided by PHC doctors (general practitioner, a local therapist and (or) a local pediatrician) in accordance with Appendix 2 to these Rules ;
3) medical and social assistance, which is provided by a social worker and a psychologist in the field of health according to the list of services of a social worker and a psychologist of a PHC organization in accordance with Appendix 3 to these Rules.
13. The PHC organization provides the attached population with the provision of specialized medical care in accordance with paragraph 2 of Article 124 of the Code, including through the conclusion of a co-execution agreement by the supplier with co-executors included in the database of healthcare subjects.
Paragraph 1. The procedure for organizing diagnostics and treatment in primary health care organizations
14. During the initial application to the PHC organization, the registry is issued in electronic format in medical information systems, the medical card of the outpatient in the form No. 052 / y, approved by Order No. RK HM-175/2020.
In the absence of technical feasibility, the medical record of an outpatient patient is issued in paper form, with subsequent entry into the medical information system.
The PHC organization ensures the safety of primary medical records, including in electronic form.
15. Persons apply to PHC organizations regarding the appeal in accordance with Appendix 4 to these Rules.
16. In the event of a patient applying for an acute disease (condition) or exacerbation of a chronic disease specialists of the PHC organization determine the methods of diagnosis and treatment in accordance with clinical protocols .
When a patient contacts a PHC organization for an emergency, acute illness (condition), a receptionist or medical worker (district nurse (general practice nurse), paramedic, obstetrician) directs the patient to the pre-medical office (filter).
In the pre-medical office (filter), a medical worker (district nurse (general practice nurse), paramedic, obstetrician) after examining the patient provides the necessary pre-hospital medical care.
In conditions requiring the provision of qualified and specialized medical care, the medical worker calls the doctor on duty or the district doctor. If there are indications, the medical worker provides a call for an ambulance team and sends the patient in an emergency form to a round-the-clock hospital according to the profile.
In conditions that do not require emergency hospitalization, further monitoring of the patient is carried out on an outpatient basis, including through remote counseling through information and communication technologies.
If it is necessary to provide specialized medical care to patients with suspected coronavirus infection and patients with coronavirus infection, remote consultations of specialized specialists are organized.
17. Specialists of the PHC organization refer the patient to a day hospital or a round-the-clock hospital in a planned form through the Portal of the Bureau of Hospitalization.
18. Calls for emergency medical care of the fourth category of urgency in PHC organizations are carried out in accordance with the Rules for the provision of emergency medical care, including with the involvement of medical aviation, approved by order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2020 No. RK HM-225/2020 (registered in the Register of State Registration of Normative Legal Acts under No. 21713).
19. The PHC organization provides the following services with home visits:
patronage ;
active visitation of the patient;
house call ;
hospital at home;
medical rehabilitation 3 stages;
family planning, safe abortion , reproductive health services ;
healthy lifestyle activities;
medical and social support;
psychological help;
issuing prescriptions ;
dynamic monitoring of persons with chronic diseases ;
dynamic monitoring of persons with socially significant diseases ;
departure of the palliative mobile team;
departure of a mobile team for patients with suspected coronavirus infection and patients with coronavirus infection.
20. Patronage is carried out:
1) children under 5 years old, including newborns;
2) pregnant women and puerperals;
3) families with children under 5 years of age, pregnant women or women in childbirth, where medical or social risks have been identified that pose a threat to their life, health and safety;
4) patients with chronic diseases without exacerbation with restriction of movement;
5) patients in need of palliative care.
21. Patronage of children under 5 years of age, including newborns, is carried out in accordance with the standard for organizing the provision of pediatric care in the Republic of Kazakhstan, approved by the authorized body in accordance with subparagraph 32) of Article 7 and paragraph 3 of Article 138 of the Code.
22. Patronage of pregnant women and puerperas is carried out in accordance with the standard for organizing the provision of obstetric and gynecological care in the Republic of Kazakhstan, approved by the authorized body in accordance with subparagraph 32) of Article 7 and paragraph 3 of Article 138 of the Code.
23. Under patronage, the PHC organization conducts mandatory scheduled visits, in cases of identifying medical or social risks to the life, health or development of the child, additional active visits are carried out according to an individual plan for pregnant women, newborns and children in need of special support.
Patronage supervision is provided to all pregnant women and children under 5 years of age and consists of 2 prenatal visits to a pregnant woman (up to 12 weeks and 32 weeks of pregnancy) and 9 visits to children according to the general scheme of observation of pregnant women, newborns and children under 5 years of age by a doctor or paramedic, or paramedical worker at home and at the reception in PHC organizations.
Patronage supervision is provided to pregnant women and children who have identified medical or social risks that pose a threat to their life, health, development and safety under the scheme of a universally progressive approach to patronage of pregnant women and children under 5 years of age (patronage visits at home by a paramedical worker ), in accordance with the standards organizations provision of pediatric and obstetric-gynecological care in the Republic of Kazakhstan, approved by the authorized body in accordance with subparagraph 32) of Article 7 and paragraph 3 of Article 138 of the Code.
24. Information about the recipient (last name, first name, patronymic, address of residence, phone numbers of the patient or legal representative) of services is entered into the information system of the Ministry of Health of the Republic of Kazakhstan "Unified Payment System".
25. The results of the patronage of pregnant women by the district nurse are entered into the individual card of the pregnant woman and the puerperal in the form 077 / y, and newborns and children under 5 years old are entered into the medical record of the outpatient patient and form an individual plan for working with the family in the form 052 / y, approved by the Order No. RK HM-175/2020, including through medical information systems.
In the absence of technical feasibility, it is issued in paper form, with subsequent entry into the medical information system.
26. When performing patronage, a PHC specialist uses: a centimeter tape, thermometers for measuring body temperature and room temperature, a phonendoscope and a tonometer, hand disinfectant, a minimum first aid kit, and information materials. In cases of introducing medical information systems, including mobile applications, a PHC specialist uses a tablet or smartphone with a mobile application.
27. The head nurse of the PHC organization or in her absence, the district doctor (general practitioner) coordinates the organization of patronage.
28. An active visit to the patient at home by a specialist of the PHC organization, including through door-to-door (door-to-door) rounds, is carried out when:
1) discharge from a hospital or transfer of information (assets) from an ambulance station, in patients with a serious condition with movement restrictions;
2) non-appearance of pregnant women and puerperals for an appointment within 3 days after the appointed date;
3) the arrival of the puerperal to the service area according to the information received from the healthcare organizations providing obstetric and gynecological care, regardless of the attachment status;
4) the threat of an epidemic of an infectious disease, including persons who refused to be vaccinated or identifying patients with an infectious disease, persons in contact with them and persons suspected of an infectious disease by door-to-door visits.
Active visits to the patient at home are mainly carried out by the district nurse or paramedic.
29. The service of calls at home by the specialists of the PHC organization is coordinated by the head of the department of the district (general medical) service, in his absence, the district doctor (general practitioner, district therapist (pediatrician)).
Reception of calls to the house is carried out by the registry of the PHC organization and (or) the district nurse or paramedic.
30. Indications for servicing calls at home are appeals to the PHC organization, with the exception of emergency calls of the fourth category of urgency , by persons who, due to health reasons and the nature of the disease, are unable to visit the PHC organization.
Indications for home care of a district nurse or paramedic:
1) body temperature up to 38°C at the time of the call;
2) increase in arterial pressure without disturbances of health;
3) conditions, diseases, injuries (without loss of consciousness, without signs of bleeding, without a sharp sudden deterioration in condition), requiring medical care and consultation at home;
Indications for servicing calls at home by a local doctor:
1) conditions assessed by the PHC registry when receiving a call, by the district nurse or paramedic who served the call, as requiring a medical examination at home.
2) deterioration after vaccination.
Children under 5 years of age, pregnant women and women in childbirth with any deterioration in their health are served at home. Persons over 65 years of age are served at home with restriction of movement.
31. The results of active visits to pregnant women and puerperals are entered into the individual card of the pregnant woman and the puerperal in the form No. KR HM-175/2020.
32. In cases of medical procedures and manipulations and the absence of the possibility of visiting the organization, the services of a hospital at home are provided for medical reasons.
33. The management of patients in a hospital at home and in a day hospital is carried out by medical workers of the PHC organization in accordance with the Rules provision of specialized medical care in hospital-replacing conditions, approved in accordance with subparagraph 47) of paragraph 16 of the Regulation on the Ministry of Health of the Republic of Kazakhstan approved by the Decree of the Government of the Republic of Kazakhstan dated February 17, 2017 No. 71 (hereinafter referred to as the Regulation).
34. The PHC organization ensures the provision of special social services in accordance with the standard for the provision of special social services in the field of healthcare, approved by the authorized body in accordance with subparagraph 32) of Article 7 and paragraph 3 of Article 138 of the Code.
35. In the case of determining outpatient treatment and prescribing medical procedures, the patient is issued a prescription in accordance with the Rules for issuing, recording and storing prescriptions, approved by order of the Minister of Health of the Republic of Kazakhstan dated October 2, 2020 No. RK HM-112/2020 (registered in the Register of State Registration normative legal acts under No. 21493) for medicines and referral to the treatment room of the PHC organization or the appointment of medical procedures at home. Evaluation of the effectiveness of outpatient treatment and its correction is carried out by the PHC doctor who referred for treatment.
36. The issuance of medicines by medical workers of PHC organizations is not allowed, with the exception of specialists certified for this type of activity with medical education (medical outpatient clinics, medical and feldsher-obstetric stations in settlements that do not have pharmacy facilities).
37. In PHC organizations, drug provision of the attached population within the framework of the guaranteed volume of free medical care and (or) in the compulsory health insurance system is carried out in accordance with the list medicines and medical devices for free and (or) preferential outpatient provision of certain categories of citizens of the Republic of Kazakhstan with certain diseases (conditions), approved by the authorized body in accordance with subparagraph 47) of Article 7 of the Code.
Paragraph 2. The procedure for organizing prevention and rehabilitation in primary health care organizations
38. Prevention of diseases in the PHC organization includes:
1) preventive medical examinations of target population groups;
2) early detection and monitoring of behavioral risk factors for diseases of the attached population and training in skills to reduce identified risk factors;
3) immunization;
4) formation and promotion of a healthy lifestyle;
5 ) measures to protect reproductive health;
6) antenatal monitoring of pregnant women and monitoring of puerperas in the late postpartum period;
7) sanitary - anti -epidemic and sanitary - preventive measures in the centers of infectious diseases;
39. Preventive medical examinations of target groups and early detection of behavioral risk factors are carried out with the frequency, frequency and volume of diagnostic services in accordance with the order of the Minister of Health of the Republic of Kazakhstan dated December 15, 2020 No. RK HM-264/2020 "On approval of the rules, volume and frequency conducting preventive medical examinations of target groups of the population, including children of preschool, school age, as well as students of technical and vocational, post-secondary and higher education organizations” (registered in the Register of State Registration of Normative Legal Acts under No. 21820).
40. In order to conduct preventive consultations and provide detailed recommendations on changing the behavior of persons with behavioral risk factors, the organization of primary health care for the attached population provides training in skills to reduce identified risk factors. This training is conducted by a specialist of the PHC organization in prevention rooms or specially designated areas, including through remote counseling through information and communication technologies.
41. Activities to raise awareness and literacy of the population, as well as consult PHC specialists on the formation of a healthy lifestyle, nutrition and other topical issues of maintaining health, are carried out by health organizations that carry out activities in the field of promoting a healthy lifestyle, healthy nutrition.
42. The PHC organization provides reproductive health services by:
1) conducting prenatal training for pregnant women in preparation for childbirth, including for partner childbirth, informing pregnant women about alarming signs, effective perinatal technologies, the principles of safe motherhood, and breastfeeding;
2) counseling and provision of services on family planning;
3) prevention and detection of sexually transmitted infections for referral to specialized specialists;
4) prevention of unwanted pregnancy and safe abortion.
5) prevention of cancer of the reproductive organs (cancer of the cervix and breast).
43. The PHC organization provides antenatal monitoring of pregnant women, monitoring of puerperas in the late postpartum period, dynamic monitoring of women of childbearing age with extragenital pathology in accordance with the standard for organizing the provision of obstetric and gynecological care in the Republic of Kazakhstan, approved by the authorized body in accordance with subparagraph 32) of Article 7 and paragraph 3 articles 138 of the Code.
44. The PHC organization ensures the conduct of preventive examinations of the oral cavity of children in preschool educational institutions and the training of children in sanitary and hygienic skills in caring for the teeth and oral mucosa on their own or by concluding a co-execution agreement with healthcare organizations providing dental care.
45. The prevention of infectious diseases at the level of the PHC site includes:
timely detection of patients;
conducting preventive vaccinations ;
sanitary - anti -epidemic and sanitary - preventive measures in the centers of infectious diseases.
Active detection of infectious diseases among the attached population is carried out upon receipt of an official notification of an outbreak of an infectious disease by actively visiting the patient at home by a medical worker of PHC organizations, including by house-to-house (door-to-door) rounds.
46. The organization of primary health care for the prevention of infectious diseases ensures the conduct of preventive vaccinations in accordance with the list of diseases against which mandatory preventive vaccinations are carried out within the guaranteed volume of medical care and the Rules the timing of their mandatory preventive vaccinations within the guaranteed volume of medical care, approved by the Decree of the Government of the Republic of Kazakhstan dated September 24, 2020 No. 612 “On approval of the list of diseases against which mandatory preventive vaccinations are carried out within the guaranteed volume of medical care, rules, timing of their implementation and population groups subject to preventive vaccinations.
47. The PHC organization conducts preventive vaccinations for the population in accordance with the requirements of regulatory legal acts in the field of sanitary and epidemiological welfare of the population, approved in accordance with subparagraph 3) of paragraph 16 of the Regulations.
48. Accounting for preventive vaccinations is carried out by the relevant records in the registration forms that are stored at health facilities at the place of vaccination, at the facilities of preschool education and training, education: a register of preventive vaccinations in the form 066 / y, a card of preventive vaccinations in the form No. 065 / y , an outpatient medical record in the form No. 052 / y, approved by Order No. RK HM-175/2020, including through medical information systems.
In the absence of technical feasibility, it is issued in paper form with subsequent entry into the medical information system.
49. Specialists of the PHC organization carry out explanatory work among the attached population on the issues of immunoprophylaxis, including with persons who refuse vaccination.
50. The PHC organization organizes work in the centers of infectious diseases and carries out sanitary and anti-epidemic and sanitary and preventive measures in accordance with regulatory legal acts in the field of sanitary and epidemiological welfare of the population, approved in accordance with subparagraph 3) of paragraph 16 of the Regulations.
51. In case of detection of diseases, according to the list of infectious, parasitic diseases and diseases that pose a danger to others, in the treatment of which specialized medical care is provided in a hospital within the framework of the guaranteed volume of medical care, approved by order of the Acting Minister of Health of the Republic of Kazakhstan dated October 28, 2020 No. RK HM-162/2020 (registered in the Register of State Registration of Normative Legal Acts under No. 21537) and the list of diseases that pose a danger to others and the amount of medical care in which foreigners and stateless persons temporarily staying in the Republic of Kazakhstan, asylum seekers, have the right to receive a guaranteed volume of free medical care, approved by order of the Minister of Health of the Republic of Kazakhstan dated October 9, 2020 No. RK HM-121/2020 (registered in the Register of State Registration of Normative Legal Acts under No. 21407), PHC specialists implement take measures in accordance with sanitary rules approved in accordance with subparagraph 3) of paragraph 16 of the Regulations.
52. The PHC organization organizes and conducts a set of measures for prevention, active early detection and diagnosis of tuberculosis in accordance with the Rules for carrying out measures for the prevention of tuberculosis, approved by order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2020 No. RK HM-214/2020 (registered in the Register state registration of regulatory legal acts under No. 21695) (hereinafter - Order No. RK HM-214/2020), including through medical information systems.
53. The PHC organization organizes and conducts an examination according to epidemiological indications for the presence of HIV infection in accordance with the Rules for mandatory confidential medical examination for the presence of HIV infection, approved by order of the Minister of Health of the Republic of Kazakhstan dated November 27, 2020 No. RK HM-211/2020 (registered in the Register of State Registration of Normative Legal Acts under No. 21692).
54. The PHC organization organizes and conducts a set of measures for the prevention and active early detection of precancerous and oncological diseases in accordance with the standard for organizing oncological care for the population of the Republic of Kazakhstan, approved by the authorized body in accordance with subparagraph 32) of Article 7 and paragraph 3 of Article 138 of the Code.
55. The PHC organization organizes and conducts a set of measures for the prevention and active early detection of patients with mental and behavioral disorders in accordance with the standard for organizing the provision of medical and social assistance in the field of mental health to the population of the Republic of Kazakhstan, approved by order of the Minister of Health of the Republic of Kazakhstan dated November 30, 2020 No. RK HM-224/2020 (registered in the Register of State Registration of Regulatory Legal Acts under No. 21712) (hereinafter - Order No. RK HM-224/2020).
Paragraph 3. The procedure for organizing dynamic monitoring, medical rehabilitation and palliative care, examination of temporary disability in primary health care organizations
56. Specialists of the PHC organization carry out dynamic monitoring of patients with chronic diseases in accordance with the order of the Minister of Health of the Republic of Kazakhstan dated September 23, 2020 No. RK HM-109/2020 "On approval of the list of chronic diseases subject to dynamic monitoring" (registered in the Register of State Registration of Regulatory Legal acts under No. 21262).
The patient is registered for dynamic observation in the PHC organization at the place of attachment on the basis of one of three documents:
1 ) conclusions of a PHC doctor ;
2) advisory opinion of a specialized specialist;
3) extracts from the medical record of the inpatient.
57. When registering a patient taken for dynamic observation for the first time, the district nurse fills out sheet 5 to the outpatient medical record in the form 052 / y “dynamic observation”, approved by Order No. RK HM-175/2020, including through medical information systems.
In the absence of technical feasibility, it is issued in paper form, with subsequent entry into the medical information system.
58. Dynamic monitoring of persons with chronic diseases is carried out by specialists of PHC organizations: PHC doctors (general practitioner, district physician and (or) district pediatrician), paramedical workers (district nurse or paramedic).
If there are indications, social workers in the field of health, psychologists and specialists from healthy lifestyle cabinets are involved.
59. The list, volumes, frequency of examinations of the district nurse, PHC doctor, specialized specialists, laboratory and instrumental studies, observation periods, deregistration criteria are determined in accordance with the order of the Minister of Health of the Republic of Kazakhstan dated October 23, 2020 No. RK HM-149 /2020 “On approval of the rules for organizing the provision of medical care to people with chronic diseases, the frequency and timing of observation, the mandatory minimum and frequency of diagnostic studies” (registered in the Register of State Registration of Regulatory Legal Acts under No. 21513) (hereinafter - Order No. RK HM-149 / 2020).
60. Dynamic monitoring of patients with chronic diseases within the framework of the Disease Management Program is carried out in accordance with Order No. RK HM-149/2020.
61. Dynamic monitoring of patients who have had tuberculosis, persons of group III with an increased risk of tuberculosis is carried out in accordance with order No. RK HM-214/2020.
Dynamic observation of oncological patients is carried out for patients of group Ia with a disease suspected of malignant neoplasms, group Ib with precancerous diseases, group IV with common forms of malignant neoplasms subject to palliative or symptomatic treatment in accordance with the standard for organizing the provision of oncological care to the population of the Republic of Kazakhstan, approved by the authorized body in accordance with subparagraph 32) of Article 7 and paragraph 3 of Article 138 of the Code.
62. For persons with chronic diseases, if indicated, the PHC organization provides medical rehabilitation , palliative care and nursing care services with the provision of special social and medical services.
63. The PHC organization ensures the provision of medical rehabilitation, palliative care and nursing care services in accordance with the standards medical care organizations approved by the authorized body in accordance with subparagraph 32) of Article 7 and paragraph 3 of Article 138 of the Code.
64. The organization of PHC ensures the provision in accordance with the standard organization of the provision of palliative care to the population, approved by order of the Minister of Health of the Republic of Kazakhstan dated November 27, 2020 No. KR HM-209/2020 (registered in the Register of State Registration of Regulatory Legal Acts under No. 21687) and the standard for organizing the provision of nursing care to the population of the Republic of Kazakhstan, approved by the authorized body in accordance with subparagraph 32) of Article 7 and paragraph 3 of Article 138 of the Code.
65. The PHC organization performs an examination of temporary disability in accordance with the Rules for the examination of temporary disability, as well as the issuance of a sheet or certificate of temporary disability, approved by order of the Minister of Health of the Republic of Kazakhstan dated November 18, 2020 No. legal acts under No. 21660).
Chapter 3. The procedure for organizing the provision of public services provided by organizations of primary health care
66. In accordance with subparagraph 1) of Article 10 of the Law of the Republic of Kazakhstan “On Public Services” (hereinafter referred to as the Law), PHC organizations provide the following public services:
1) making an appointment with a doctor;
2) calling a doctor at home;
3) issuance of a certificate from a medical organization providing PHC;
4) attachment to a medical organization providing PHC.
67. The PHC organization provides the patient with the state service "Making an appointment with a doctor" upon self-treatment, by telephone or through the "electronic government" web portal (hereinafter referred to as the EGP).
Information about identity documents or an electronic document from the digital document service (for identification ), the PHC organization receives from the relevant state information systems through the PEG.
The list of basic requirements for the provision of the public service "Making an appointment with a doctor", including the characteristics of the process, the form, content and result of the provision, as well as other information, taking into account the specifics of the provision of the public service, is given in Appendix 5 to these Rules.
When the patient contacts the PHC organization on his own or by telephone, PHC specialists make an entry in the journal “Preliminary appointment for an appointment with a doctor” and provide an oral response indicating the free time and date of the doctor’s appointment, in accordance with the doctor’s appointment schedule.
When a patient applies through the PEG, the patient receives a notification in the form of the status of an electronic application in the "Personal Account". After accepting the request for the provision of the state service " Make an appointment with a doctor", medical assistance to the patient is provided at the scheduled time.
The PHC organization ensures the entry of data on the provision of the public service “Making an appointment with a doctor” into the information system in order to monitor the provision of public services in accordance with subparagraph 11) of paragraph 2 of Article 5 of the Law.
68. The PHC organization provides the patient with the state service " Calling a doctor at home" upon self-treatment, by telephone or through a PEG.
Information about identity documents or an electronic document from the digital document service (for identification ), the PHC organization receives from the relevant state information systems through the PEG.
The list of basic requirements for the provision of the public service "Calling a doctor at home", including the characteristics of the process, the form, content and result of the provision, as well as other information, taking into account the specifics of the provision of the public service, is given in Appendix 6 to these Rules.
When the patient contacts the PHC organization independently or by telephone, PHC specialists make an entry in the Call Log and provide an oral response indicating the date and time of the visit to the doctor. After accepting the request for the provision of the state service "Calling a doctor at home", medical care at home is provided at the set time.
When a patient applies through the PEG, the patient receives a notification in the form of the status of an electronic application in the "Personal Account". After accepting the request for the provision of the state service " Calling a doctor at home", medical care is provided to the patient at the scheduled time.
The organization providing PHC ensures the entry of data on the provision of the public service "Calling a doctor at home" into the information system in order to monitor the provision of public services in accordance with subparagraph 11) of paragraph 2 of Article 5 of the Law.
69. To receive the state service " Issuance of a certificate from a medical organization providing primary health care", patients independently apply to the PHC organization or through the PEG.
Information about identity documents or an electronic document from the digital document service (for identification), the PHC organization receives from the relevant state information systems through the PEG .
The list of basic requirements for the provision of the public service " Issuance of a certificate from a medical organization providing primary health care", including the characteristics of the process, the form, content and result of the provision, as well as other information, taking into account the specifics of the provision of the public service, is given in Appendix 7 to these Rules .
When the patient directly contacts the PHC organization, PHC specialists check the medical information system about the patient’s condition / not condition on dynamic observation, then a certificate is issued in the form No. 027 / y, approved by Order No. "Medical report" with the name of the diagnosis, and is certified by the personal signature and seal of the local doctor or general practitioner and the seal of the primary care organization, with the exception of socially significant diseases (tuberculosis, disease caused by the human immunodeficiency virus (HIV), mental, behavioral disorders ( disease)).
When a patient applies through the PEG, a certificate is generated from the medical organization in the form of an electronic document, with an electronic digital signature (hereinafter referred to as the EDS) of the PHC organization, which is sent to the "Personal Account".
As a result, a certificate is issued from the PHC organization on the status and (or) not the status on dynamic observation.
The PHC organization ensures that data on the provision of the public service "Issuance of a certificate from a medical organization providing primary health care" is entered into the information system in order to monitor the provision of public services in accordance with subparagraph 11) of paragraph 2 of Article 5 of the Law.
70. Attachment to a PHC organization at the place of permanent or temporary residence is carried out in accordance with the state service " Attachment to a medical organization providing primary health care" in accordance with the Rules for attaching individuals to health organizations providing primary health care, approved by order of the Minister health care of the Republic of Kazakhstan dated November 13, 2020 No. RK HM-194/2020 (registered in the Register of State Registration of Regulatory Legal Acts under No. 21642).
Chapter 4. The procedure for appealing decisions, actions (inaction) of the service provider and (or) its officials on the provision of public services
71. A complaint against the decision, actions (inaction) of the service provider on the provision of public services is submitted to the head of the service provider and (or) to the authorized body for assessing and monitoring the quality of the provision of public services in accordance with the legislation of the Republic of Kazakhstan.
The complaint of the service recipient received by the service provider in accordance with paragraph 2 of Article 25 of the Law is subject to consideration within five working days from the date of its registration.
The complaint of the service recipient, received by the authorized body for the assessment and control over the quality of the provision of public services, is subject to consideration within fifteen working days from the date of its registration.
72. In cases of disagreement with the results of the rendered public service, the service recipient applies to the court in accordance with the procedure established by the legislation of the Republic of Kazakhstan.
| Appendix 1 to the Rules for the provision of primary health care |
List of medical services provided by
primary health care workers (paramedic, obstetrician, nurse
with secondary and (or) higher medical education)
No. p / p | Service code | Name of service |
1. | A01.008.000 | Reception: Paramedic |
2. | A01.008.002 | Education of the population on disease prevention: Paramedic |
3. | A01.008.003 | Teaching the patient self-management: Paramedic |
4. | A01.008.008 | Pre-medical examination in the examination room: Paramedic |
5. | A01.008.009 | Preventive oral examination: Paramedic |
6. | A01.008.010 | Teaching children sanitary and hygienic skills for caring for teeth and oral mucosa: Paramedic |
7. | A01.008.012 | Complex of medical rehabilitation services: Paramedic |
8. | A01.008.013 | Providing emergency medical care: Paramedic |
9. | A01.009.000 | Admission: Graduate Nurse |
10. | A01.009.002 | Education of the population on disease prevention: Nurse with higher education |
11. | A01.009.003 | Teaching the patient self-management: Nurse with higher education |
12. | A01.009.008 | Pre-medical examination in the examination room: Nurse with higher education |
13. | A01.009.009 | Preventive oral examination: Nurse with higher education |
14. | A01.009.010 | Teaching children sanitary and hygienic skills for caring for teeth and oral mucosa: Nurse with higher education |
15. | A01.009.012 | Complex of medical rehabilitation services: Nurse with higher education |
16. | A01.010.000 | Reception: Nurse with secondary education |
17. | A01.010.002 | Education of the population on disease prevention: Nurse with secondary education |
18. | A01.010.003 | Teaching Patient Self-Management: Nurse with Secondary Education |
19. | A01.010.008 | Pre-medical examination in the examination room: Nurse with secondary education |
20. | A01.010.009 | Preventive oral examination: Nurse with secondary education |
21. | A01.010.010 | Teaching children sanitary and hygienic skills for caring for teeth and oral mucosa: Nurse with secondary education |
22. | A01.010.012 | Complex of medical rehabilitation services: Nurse with higher education |
23. | A01.011.000 | Reception: Midwife |
24. | A01.011.003 | Patient self-management education: Midwife |
25. | A01.011.008 | Pre-medical examination in the examination room: Midwife |
26. | A01.011.013 | School of preparation for childbirth of a pregnant woman and family members: Midwife |
Laboratory diagnostics (first aid) | ||
27. | B03.866.003 | Determination of urine parameters (pH, leukocytes, erythrocytes, urobilinogen, nitrites, protein) by express method |
28. | B03.401.003 | Determination of total cholesterol in blood serum by express method |
29. | B03.335.003 | Determination of glucose in blood serum by express method |
30. | B03.486.003 | Determination of triglycerides in blood serum by express method |
31. | B03.517.003 | Determination of human chorionic gonadotropin (hCG) in urine by express method (pregnancy test) |
32. | B03.860.003 | Determination of total antibodies to HIV-1,2 and p24 antigen by express method |
33. | B03.861.003 | Determination of antibodies to Treponema Pallidum in blood serum by express method (quick test for syphilis) |
34. | B03.862.003 | Determination of total antibodies to hepatitis C virus in blood serum by express method |
35. | B03.863.003 | Determination of HBsAg in blood serum by express method |
36. | B03.870.003 | Examination of a smear for the presence of amniotic fluid by the express method |
Procedures and manipulations | ||
37. | D99.293.012 | Taking blood from a vein |
38. | D99.296.013 | Finger blood sampling |
39. | D91.496.105 | Taking a smear for oncocytology |
40. | D91.496.106 | Taking a smear for the degree of purity of the vagina |
41. | D99.293.012 | Collection of material for microbiological studies |
42. | D99.296.013 | Conducting a Mantoux test |
43. | D91.496.105 | Carrying out Diaskintest |
44. | D96.330.014 | Gastric lavage |
45. | D96.390.015 | Enema |
46. | A01.009.018 | Carrying out inhalation |
47. | A01.009.019 | Sanitation of the respiratory tract with an electric suction |
48. | A01.009.020 | Washing of sulfur plugs |
49. | A01.009.021 | Sanitation of the nasal sinuses |
50. | A01.009.022 | Placement of a nasogastric tube |
51. | A01.009.023 | duodenal sounding |
52. | A01.009.024 | Bladder catheterization |
53. | A01.009.025 | Catheterization of peripheral veins |
54. | A01.009.026 | Transport immobilization |
55. | A01.009.027 | Sanitation of the vagina |
56. | A01.009.028 | Eye wash (excluding the cost of medicines) |
57. | A01.009.029 | Washing the tympanic cavity |
58. | A01.009.030 | Dezo dressing |
59. | A01.009.031 | Subconjunctival injection (excluding the cost of medicines) |
Procedures and manipulations of nursing care | ||
60. | D93.891.018 | Nursing procedures for the elderly patient |
61. | D93.891.019 | Teaching the patient's family members the elements of care and hygiene |
62. | D93.891.020 | Prevention and treatment of bedsores |
63. | D93.571.415 | dressing |
64. | D93.891.022 | Care of hair, nails, shaving of a seriously ill patient |
65. | D93.891.023 | Oral care for a critically ill patient |
66. | D93.891.024 | Suction of mucus from the oropharynx |
67. | D93.891.025 | Help with orostomy, esophagostomy |
68. | D93.891.026 | Help with tracheostomy |
69. | D93.891.027 | Caring for your nasogastric tube, nasal prongs, and catheter |
70. | D93.891.028 | Suction of mucus from the upper respiratory tract |
71. | D93.891.029 | Suction of mucus from the nose |
72. | D93.891.030 | Help with pharyngostomy |
73. | D93.891.031 | Administration of drugs intranasally |
74. | D93.891.032 | Help with gastrostomy |
75. | D93.891.033 | Caring for your nasogastric tube |
76. | D93.891.034 | Feeding a seriously ill patient through a gastrostomy |
77. | D93.891.035 | Help with ileostomy |
78. | D93.891.036 | Caring for your intestinal tube |
79. | D93.891.037 | Feeding a seriously ill patient through an intestinal tube |
80. | D93.891.038 | Ileostomy Care Training |
81. | D93.891.039 | Colon Stoma Assistance |
82. | D93.891.040 | Colostomy care training |
83. | D93.891.041 | Assistance for defecation of a seriously ill patient |
84. | D93.891.043 | Installing a gas tube |
85. | D93.891.044 | Coprolite removal |
86. | D93.891.045 | Help for fecal incontinence |
87. | D93.891.046 | Setting a siphon enema |
88. | D93.891.047 | Insertion, removal of the vaginal support ring (PEGsary) |
89. | D93.891.048 | Caring for the external auditory canal |
90. | D93.891.049 | Eye Care for a Seriously Ill Patient |
91. | D93.891.050 | Instillation of medicinal substances into the conjunctival cavity |
92. | D93.891.051 | Urination aid for the critically ill patient |
93. | D93.891.052 | Caring for your urinary catheter |
94. | D93.891.053 | Cystostomy and Urostomy Care |
95. | D93.891.054 | Help for urinary incontinence |
96. | D93.891.055 | Moving and (or) placing a seriously ill patient in bed |
97. | D93.891.056 | Transportation of a seriously ill patient within the facility |
98. | D93.891.057 | Feeding a critically ill patient by mouth and/or nasogastric tube |
99. | D93.891.058 | Preparation and change of bed linen for a seriously ill patient |
100. | D93.891.059 | Benefit for changing linen and clothes for a seriously ill patient |
101. | D93.891.060 | Care of the perineum and external genitalia of a seriously ill patient |
102. | D93.891.061 | Drainage Care |
103. | D93.891.062 | Benefit for parenteral administration of drugs |
104. | D93.891.063 | Pressure ulcer risk assessment |
105. | D93.891.064 | Assessment of severity of bedsores |
106. | D93.891.065 | Pain Intensity Assessment |
107. | D93.891.066 | Training of family members of the patient in the technique of transfer and (or) placement in bed |
108. | D93.891.067 | Teaching the patient self-help when moving in bed and (or) chair |
109. | D93.891.068 | Teaching the patient to walk on crutches |
110. | D93.891.069 | Teaching the patient self-help when moving with an additional support |
111. | D99.590.019 | Vaccination without the cost of the drug |
112. | D97.311.050 | Removal of sutures, removal of ligatures |
113. | D04.001.000 | Training in preventive offices, health improvement schools |
114. | D04.002.000 | Education of patients and their families in self-management, self-help and mutual assistance in accordance with chronic disease management programs |
115. | D04.003.000 | Hot line consultation |
List of treatment room services provided by primary health care providers | ||
116. | D99.590.022 | Intramuscular injection (excluding the cost of medicines) |
117. | D99.590.023 | Intravenous injection (excluding the cost of medicines) |
118. | D99.590.024 | Subcutaneous injection (excluding the cost of medicines) |
| Appendix 2 to the Rules for the provision of primary health care |
List of medical services provided by primary
health care physicians (general practitioner, district physician and (or) district pediatrician)
No. p / p | Service code | Name of service |
1. | A01.001.000 | Reception: Therapist |
2. | A01.001.002 | Drawing up a plan for the recovery of the patient: District therapist |
3. | A01.001.005 | Family Planning and Safe Abortion Counseling: Community Therapist |
4. | A01.001.006 | Teaching the patient self-management: District therapist |
5. | A01.001.007 | Assessment of the social status of the patient's family: District therapist |
6. | A01.002.000 | Reception: Pediatrician |
7. | A01.002.002 | Drawing up a plan for the improvement of the patient: District pediatrician |
8. | A01.002.007 | Assessment of the social status of the patient's family in case of socially significant diseases: District pediatrician |
9. | A01.003.000 | Reception: Family doctor (General practitioner) |
10. | A01.003.002 | Drawing up a plan for the recovery of the patient: General practitioner |
11. | A01.003.005 | Family Planning and Safe Abortion Counseling: General Practitioner |
12. | A01.003.006 | Patient Self-Management Training: General Practitioner |
13. | A01.003.007 | Assessment of the social status of the patient's family in case of socially significant diseases: General practitioner |
Laboratory diagnostics (qualified medical care) | ||
14. | B02.061.002 | Measurement of erythrocyte sedimentation rate (ESR) in blood by manual method |
15. | B03.864.003 | Determination of hemoglobin in the blood by express method |
16. | B03.865.003 | Determination of leukocytes in the blood by express method |
17. | B03.867.003 | Determination of troponin by express method |
18. | B03.868.003 | Determination of glycated hemoglobin by express method |
19. | B03.869.003 | Determination of prothrombin time, INR on a portable analyzer by express method |
20. | B06.672.012 | Determination of the blood group according to the ABO system with standard sera |
21. | B06.673.012 | Determination of the blood group according to the ABO system with monoclonal reagents (zoliclones) |
22. | B06.677.012 | Determination of the Rh factor of blood |
Functional and instrumental diagnostics | ||
23. | C02.001.000 | Electrocardiographic study (in 12 leads) with decoding |
24. | C02.033.000 | Spirography when recording on automated devices |
25. | C02.048.000 | Dynamometry |
26. | C02.054.000 | Pulse oximetry |
| Appendix 3 to the Rules for the provision of primary health care |
The list of services of a social worker and a psychologist of the organization of primary health care
No. p / p | Service code | Name of service |
Psychologist services | ||
1. | A01.005.000 | Reception: Psychologist |
2. | A01.005.001 | Conducting child suicide prevention classes: Psychologist |
3. | A01.005.002 | Appointment for suspected behavioral and psychoactive disorders: Psychologist |
4. | A01.005.003 | Counseling on social issues, including age adaptation: Psychologist |
5. | A01.005.009 | Teaching the patient self-management with chronic diseases: Psychologist |
Services of a social worker | ||
6. | A01.006.000 | Admission: Graduated social worker |
7. | A01.006.001 | Organization and conduct of medical and social examination: Social worker with higher education |
8. | A01.006.002 | Teaching the patient's family members the basics of home health care: Graduate Social Worker |
9. | A01.006.003 | Consulting on social issues, including on issues of age adaptation: Social worker with higher education |
10. | A01.007.000 | Reception: Social worker with secondary education |
11. | A01.007.001 | Organization and conduct of medical and social examination: Social worker with secondary education |
12. | A01.007.002 | Teaching the patient's family members the basics of home health care: Social worker with a secondary education |
13. | A01.007.003 | Counseling on social issues, including age adaptation: Social worker with secondary education |
| Appendix 4 to the Rules for the provision of primary health care |
Reasons for applying to the organization of primary health care
No. p / p | Group of reasons for applying | Name of the reasons for the appeal |
1. | Disease | Emergency conditions |
Acute disease (condition) and (or) exacerbation of a chronic disease | ||
Suspicion of a socially significant disease | ||
Assets | ||
Medical rehabilitation (stage 3) | ||
Planned dental care | ||
Emergency Dental Care | ||
Orthodontic care for children with congenital pathology of the maxillofacial region | ||
Orthodontic care for children from low-income families | ||
Services for diseases that pose a danger to others, in which foreigners and stateless persons temporarily staying in the Republic of Kazakhstan, asylum seekers are entitled to receive a guaranteed amount of free medical care | ||
2. | Injury | Acute trauma (trauma center, outpatient organizations) |
Consequences of trauma (outpatient organizations) | ||
Consequences of trauma (youth health centers) | ||
3. | Prevention | Examination of a patient with a coronavirus infection |
Prophylactic treatment (other than screening) | ||
Immunoprophylaxis | ||
Screening (Prophylactic medical examinations) | ||
Patronage | ||
Family planning, safe abortion, reproductive health services | ||
Admission for antenatal care | ||
Reception at postnatal observation | ||
Student health services (school medicine) | ||
Healthy lifestyle activities | ||
Paid medical examinations | ||
4. | Dynamic Surveillance | Follow-up with chronic diseases (including the Disease Management Program) |
Dynamic observation with socially significant diseases | ||
Dynamic observation with chronic diseases subject to observation by specialized specialists | ||
5. | Medical and social services | Medical and social support |
Psychological help | ||
6. | Administrative | Administrative |
Preparation of documents for medical and social examination | ||
Issuing prescriptions | ||
7. | Screening for coronavirus infection | Suspicion of coronavirus infection |
Examination for coronavirus infection during planned hospitalization (pre-hospital examination), including pregnant women for delivery at 37 weeks, patients on hemodialysis |
| Appendix 5 to the Rules for the provision of primary health care |
Standard of the state service "Make an appointment with a doctor"
| Appendix 6 to the Rules for the provision of primary health care |
Standard of the state service "Calling a doctor at home"
| Appendix 7 to the Rules for the provision of primary health care |