What is the patient admission process. How are advance directives handled during admission. What rights do patients have when being admitted to a hospital. Which tests are typically conducted during hospital admission.

Understanding the Hospital Admission Process

The hospital admission process is a crucial first step in a patient’s healthcare journey. It involves several key components designed to ensure patient safety, comfort, and proper care. Let’s explore the essential elements of this process:

Pre-Admission Preparations

Before your scheduled admission day, it’s important to:

• Identify one or two trusted individuals as your support persons
• Review the list of items to bring for your hospital stay
• Ensure you have your insurance card(s) ready

These preparations can help streamline your admission and make your stay more comfortable.

Day of Admission Procedures

On the day of your admission:

1. The Admitting Office will contact you with your arrival time (usually after 11 a.m.)
2. Check-in at the appropriate location based on your admission time:
   • 8 a.m. to 5 p.m.: Strong Memorial Hospital Lab & Outpatient Services
   • After 5 p.m.: Directly to your assigned floor
3. For surgical patients, follow the specific instructions provided by the Strong Surgical Center

Is there a possibility of a wait time during admission? Yes, occasionally emergency situations may cause delays in the admission process. The hospital provides comfortable waiting areas to accommodate patients during these times.

The Importance of Advance Directives in Hospital Admissions

Advance directives play a crucial role in ensuring that a patient’s healthcare wishes are respected, even if they become unable to communicate those wishes themselves. During the admission process, hospitals typically address advance directives to ensure proper documentation and understanding.

Types of Advance Directives

Common types of advance directives include:

• Living Will: Specifies medical treatments you would or would not want to receive in certain situations
• Healthcare Power of Attorney: Designates someone to make medical decisions on your behalf if you’re unable to do so
• Do Not Resuscitate (DNR) Order: Instructs healthcare providers not to perform CPR if your heart stops or you stop breathing

How are advance directives handled during admission? Typically, hospital staff will ask if you have any existing advance directives and request copies for your medical record. If you don’t have one, they may provide information on creating an advance directive.

Patient Rights During Hospital Admission

Understanding your rights as a patient is essential for ensuring you receive the best possible care during your hospital stay. These rights are protected by federal and state laws, as well as hospital policies.

Key Patient Rights

Some fundamental patient rights include:

• The right to receive respectful and non-discriminatory care
• The right to privacy and confidentiality
• The right to informed consent for treatments and procedures
• The right to refuse treatment
• The right to access your medical records
• The right to file complaints or grievances

How are patients informed of their rights during admission? Hospitals typically provide a written document outlining patient rights and responsibilities, which is often reviewed with the patient or their representative during the admission process.

Common Tests and Assessments During Hospital Admission

Upon admission, various tests and assessments may be conducted to evaluate your health status and guide your treatment plan. These can vary depending on your specific condition and the reason for your admission.

Typical Admission Tests

Some common tests and assessments include:

• Vital signs check (blood pressure, temperature, pulse, respiratory rate)
• Blood tests (complete blood count, metabolic panel)
• Urinalysis
• Chest X-ray
• Electrocardiogram (ECG or EKG)
• Physical examination
• Medical history review

Why are these tests important? These initial tests provide crucial baseline information about your health status, help diagnose any underlying conditions, and guide your treatment plan during your hospital stay.

The Role of Insurance in Hospital Admissions

Understanding how your insurance affects your hospital admission can help you navigate the financial aspects of your healthcare more effectively.

Insurance Verification Process

During admission, the hospital will typically:

1. Verify your insurance coverage
2. Determine any pre-authorization requirements
3. Explain your financial responsibilities, including copays and deductibles

How can patients prepare for insurance-related aspects of admission? It’s advisable to contact your insurance provider before a planned admission to understand your coverage, potential out-of-pocket costs, and any pre-authorization requirements.

Special Considerations for Emergency Admissions

Emergency admissions often follow a different process than planned admissions due to the urgent nature of the situation.

Emergency Admission Process

In emergency situations:

• Immediate medical care takes priority over administrative procedures
• Admission paperwork may be completed after initial treatment
• A family member or designated representative may need to provide information if the patient is unable to do so

How do patient rights apply in emergency situations? While the immediate focus is on life-saving care, patient rights still apply. Hospitals strive to uphold these rights as much as possible, even in emergency scenarios.

The Importance of Accurate Medical History in Hospital Admissions

Providing a comprehensive and accurate medical history during admission is crucial for ensuring you receive appropriate care during your hospital stay.

Key Elements of Medical History

Important information to share includes:

• Current medications and dosages
• Allergies to medications or foods
• Previous surgeries or hospitalizations
• Chronic health conditions
• Family history of certain diseases
• Recent symptoms or health changes

Why is an accurate medical history so important? A complete medical history helps healthcare providers make informed decisions about your care, avoid potential medication interactions, and tailor your treatment plan to your specific needs.

Ensuring Patient Safety During Hospital Admission

Patient safety is a top priority during the admission process and throughout your hospital stay. Several measures are typically implemented to protect patients from potential harm.

Patient Safety Measures

Common safety practices include:

• Patient identification protocols (e.g., wristbands)
• Medication reconciliation to prevent drug interactions
• Fall risk assessments
• Infection control procedures
• Allergy alerts

How can patients contribute to their own safety during admission? Patients can actively participate in their safety by asking questions, providing complete and accurate information, and alerting staff to any concerns or unexpected changes in their condition.

Understanding the hospital admission process, including aspects such as advance directives, patient rights, and common tests, can help patients feel more prepared and empowered during their healthcare journey. By being informed and actively engaged in the admission process, patients can contribute to better communication with healthcare providers and potentially improved outcomes during their hospital stay.

Admission Process – Hospital Stay – Patients & Families – Strong Memorial Hospital

If you are looking for information regarding an unplanned admission please call the Strong Emergency Department at (585) 275-4551.

Below is a step-by-step guide and timeline to your day of admission so you know what to anticipate. If your admission is arranged through the Strong Surgical Center you will follow a different process than regularly scheduled patients. Please note, this guide is for patients who will be spending one or more nights at Strong Memorial Hospital.

1. Before Your Scheduled Day of Admission
   
   • Please think of one or two trusted individuals –family or friends – who you want to identify as your support person(s) and how much you would like them involved in your care. These individuals are welcome to visit you 24 hours/day, seven days a week.
   • Please review the list of what to bring for your hospital stay. You will learn what you should bring, what we provide for you during your stay, and what we kindly ask you to leave at home.
   • Don’t forget! It’s important to bring your insurance card(s) when you come to the hospital

2. The Day of Your Admission
   • On the day of your admission, the Admitting Office will contact you to let you know what time to arrive. Your call will usually come after 11 a.m. If you don’t receive a call by the late afternoon please call the Strong Memorial Hospital at Admitting Office at (585) 275-7081.
   • If you are admitted between 8 a.m. and 5 p.m. you will check-in through Strong Memorial Hospital Lab & Outpatient Services. This office is located in the hallway directly to the right of the Information Desk in the Main Lobby (when your back is to Elmwood Avenue).
   • If you are admitted after 5 p.m. you will go directly to your floor to check-in. Please don’t worry; at this point the Admitting Office will have already called you with specific instructions about where to go. If you need help finding your way when you arrive at the hospital please stop at the Information Desk, which is conveniently located in the lobby, and ask one of our volunteers who look forward to welcoming and assisting you.

3. Patients Scheduled through the Strong Surgical Center
   • If you are scheduled for surgery through the Strong Surgical Center your admission process is slightly different. The day before your admission you will receive a phone call from a Strong Surgical Center staff member who will confirm when you should arrive at the hospital. They will also provide any instructions you need to know and will be happy to answer your questions. If you are scheduled to arrive on Monday you will receive this phone call on Friday. If you aren’t contacted by the Strong Surgical Center please call (585) 275-8256.
   • On the day of your admission you will check in with the Strong Surgical Center.

Sometimes there is an admission wait time. Occasionally, situations demanding emergency care for other patients can happen between the time we call you and the time you arrive. When this occurs, your admission wait may be somewhat extended. We want you to be as comfortable as possible so our Strong Memorial Hospital Lab & Outpatient Service has a waiting room with a television and an area for children. If you prefer, you can wait in the lobby.

If you have more questions you may find the section on What to Expect helpful for finding answers.

If you need to reach the Admitting Office please call (585) 275-2273 and ask for the Strong Memorial Hospital Admitting Office.

The Healthcare Manager: Admission of patient: Policy and Procedure

Admission of patient is one of the main process followed in any hospital. It is the first step in providing healthcare to a patient as an in-patient. By admitting a patient, hospital undertakes a high level of responsibility for the care and well-being of the patient and hence it is essential to have relevant policy and procedure for admission in place to avoid any problems later on. It also ensures that the patients are admitted uniformly irrespective of their ethnicity, religion, caste, gender, financial class etc. This post describes relevant points that should be considered while formulating a policy and procedure of admission. (Also read – Registration of patient – Policy and Procedure)

Admission Policy

Right to admit a patient – Only those doctors (full time or on contract) who have been given privileges of admitting the patient in the hospital can recommend patient for admission. This is also applicable in case of patients from emergency. In case of patient being transferred from another facility the admission shall be ordered by a doctor having admission privileges. An updated list of such doctors shall be maintained at the admission department. Request for admission by any other doctor or from directly from patient or family members or by any other staff of the hospital shall not be considered. 

Responsibility of care – The doctor who orders for admission shall be considered as the primary doctor of the patient and he/she will be responsible for the medical care of the patient till the discharge or transfer of patient to any other doctor. Hospital shall be responsible for providing all facility and services necessary for patient’s stay and provision of medical care. 

Information to patient – Every patient shall be provided with all the necessary information before admission for him/her to make an appropriate decision. These information include following 

· Patients’ rights and responsibilities (A copy of patients’ rights shall be given) 

· Type of accommodation available along-with its amenities and charges for the same 

· Doctors round timing and how to contact doctors when required 

· Provision of food, timing and whether or not food from outside is allowed 

· Number of attendant who will be allowed to stay with the patient and arrangement for the attendant 

· Visitors timings and rules related to visiting patients 

· Keeping of valuables in the hospital 

· Payment timings and mode of payments (In case of insurance patient details related to insurance payments) 

· Code of conduct during stay 

Cost estimate – Each patient at the time of admission shall be provided with an estimate of total cost of treatment, based on hospital’s pricing policy. This shall be estimated with the help of the admitting doctor and by referring to the schedule of charges. The cost estimate shall be given to the patient in written. A disclaimer shall be made that the estimate may vary by certain percentage and may change significantly in case there is a change in treatment plan. In such cases a revised estimate will be given to the patient. 

General consent – A written general consent shall be obtained from each patient upon admission. This shall be as per the general consent policy. Standard general consent form shall be used for obtaining the consent. 

Identification of patient – Appropriate Idnetification mechanism of the patient shall be created as per patient identification policy In case of an un-identified patient (for eg. Patient is sub-conscious or mentally unstable) admission shall be done by generating a temporary identification details. This shall be corrected as soon as identity gets established.  

Behaviour with patient – During the entire admission process the admitting staff shall be courteous, helpful and maintain good behaviour towards the patient. Patient shall be given sufficient opportunity to ask questions and clarify doubts. Rude behaviour or neglect of patient shall not be tolerated and can lead to penal action. 

Privacy and confidentiality – The communication between patient and admitting staff shall be carried out with sufficient privacy. All information collected from patient shall be kept confidential. 

Non-discrimination – The admission policy and process shall be uniformly applied to all patient seeking admission. No discrimination shall be done on the basis of patient’s ethnicity, religion, caste, gender, financial class and any other background of the patient. 

Admission Procedure

· Admission process of a patient shall be carried out at the admission desk/admission chamber. The process starts as soon as the patient arrives to the desk with the admission order from the doctor.  

· Check the written admission order brought by the patient and ensure that it is from a doctor who has the admission privileges granted by the hospital. In case, patient do not have the appropriate written order, admission shall not be done and patient shall be appropriately guided. 

· Obtain necessary details of the patient. This can be done through the Unique ID number of the patient which was generated during registration. Additional details shall be obtained by asking the patient to fill up the admission form. In case of unidentified patient a temporary identification shall be provided for the purpose of completing admission. 

· Allocation of bed/room – Inform the patient about various categories of accommodation available, its features and cost. Help the patient in selecting an appropriate accommodation of his/her choice. In case the chosen category is not available, follow the policy and procedure of ‘Managing during non-availability of beds’ 

· Information provision – Provide all information to the patient as described in the policy above. Patient information booklet that contains all necessary information, along with patients’ rights shall be handed over to the patient 

· Cost estimate provision – The admission staff in consultation to the doctor should work out an estimate of the total cost that would be incurred to the patient, as per hospital’s pricing policy. This cost estimate shall be given to the patient in written. A copy of this estimate, duly signed by the patient shall be retained as an evidence. 

· Taking general consent – General consent shall be taken from the patient after provision of information and cost estimate and after final confirmation of admission. This should be done as per general consent policy and in the standardized format 

· Registering the admission– Patient’s admission shall be registered/recorded in the system as per the patient’s choice of accommodation and availability of beds. 

· Generation of Patient identifier – Patient identifier shall be generated which includes Patient ID band and patient’s identification labels (sheet of stickers with printed patient identification details) shall be generated. This shall be as per patient identification policy and procedure.

· Generation of medical record – A medical record shall be generated for the patient which should have patient details and basic formats within it. If the patient is an existing patient, who has been admitted in past, the previous medical record number shall be stated on the new medical record file created. 

· Payment of advance – Patient/family member shall be asked to pay the required advance amount at the billing counter and submit the receipt back. 

· Sending patient to ward – After successful payment, patient shall be directed towards the appropriate ward. An attendant should to escort the patient, if needed. The medical record and patient identifier (ID band and the identification labels) shall also be sent to the ward by the hands of attendant.

· Internal communication – Immediately after admission information shall be sent to the ward in-charge and to the accounts department 

· In the ward – The ward in-charge upon receiving the information shall allocate a primary nurse for the patient. As soon as the patient arrives, primary nurse shall help the patient to get into the room/bed. She should then make an entry in the ward’s admission/discharge register and sends an information of new admission to the medical officer on duty and the admitting doctor. 

· In case of any unforeseen event the Hospital Administrator shall be contacted who will take appropriate decision as per situation. 

Hospital admission Definition: 131 Samples

Related to

Hospital admission

Hospital means a facility that:

Hospital pharmacist means an Iowa-licensed pharmacist who meets the requirements for participating in a hospital practice protocol as determined by the hospital’s P&T committee.

Hospital Services means those acute care services furnished and billed by a Hospital which are authorized by a Participating Physician and set forth in Part IX.B.

Hospital pharmacy means a pharmacy providing pharmaceutical care to inpatients of a general acute hospital or specialty hospital licensed by the Department of Health under Title 26, Chapter 21, Health Care Facility Licensing and Inspection Act.

Competent and reliable scientific evidence means tests, analyses, research, studies, or other evidence based on the expertise of professionals in the relevant area, that has been conducted and evaluated in an objective manner by persons qualified to do so, using procedures generally accepted in the profession to yield accurate and reliable results.

biodiversity means the variability among living organisms from all sources including, inter alia, terrestrial, marine and other aquatic ecosystems and the ecological complexes of which they are part; this includes diversity within species, between species and of ecosystems;

Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual’s activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.

Patients means any person who was a previous or is a prospective or current patient of Medical Practice.

Licensed mental health professional or “LMHP” means a licensed physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, or certified psychiatric clinical nurse specialist.

Patient means a person who is undergoing medical or other treatment as an in-patient in any hospital or similar institution;

Inpatient means an Insured Person who is Confined.

Health professional means an individual licensed or otherwise authorized to engage in a health profession under article 15 of the public health code, 1978 PA 368, MCL 333. 16101 to 333.18838, and whose scope of practice includes the diagnosis and treatment of individuals with a substance use disorder.

Hospice means a health care program that provides a coordinated set of services rendered at home or in outpatient or institutional settings for individuals suffering from a disease or condition with a terminal prognosis.

Cosmetologist means any person who administers cosmetic treatments; manicures or pedicures the nails of any person; arranges, dresses, curls, waves, cuts, shapes, singes, waxes, tweezes, shaves, bleaches, colors, relaxes, straightens, or performs similar work, upon human hair, or a wig or hairpiece, by any means, including hands or mechanical or electrical apparatus or appliances unless such acts as adjusting, combing, or brushing prestyled wigs or hairpieces do not alter the prestyled nature of the wig or hairpiece, and practices cosmetology for compensation. The term “cosmetologist” shall not include hair braiding upon human hair, or a wig or hairpiece.

Admission Procedure – The Medical City Clark

Emergency Admission

Patients and their companion/s will be directed to the Department of Emergency Medicine (DEM) located at G/F Main Building for thorough medical evaluation. Upon the request of a DEM admitting physician, they will be instructed to proceed to the Admitting Office to coordinate the process of admission in detail.

Non-emergency Admission

For scheduled admission, patients and their companion/s are directed to the Admitting Section located at 2/F Main Building.

Before admission, our admitting staff will be requesting for the following:

• Doctor’s Order for Admission indicating directives of personal physician regarding the patient’s case
• Valid Identification Card with photo
• Accredited HMO-issued member’s ID
• Digitized SSS ID
• Driver’s License
• GSIS ID
• Healthcare insurance card or document
• Integrated Bar of the Philippines ID
• Passport
• Persons with Disability ID
• PhilHealth ID
• PRC ID
• Senior Citizen ID
• Unified Multi-Purpose ID
• HMO or Insurance Card
• Letter of Guarantee or Letter of Authorization (LOA) from company or HMO Coordinator

Patient Data Sheet

Patients and/or their companion/s will be asked to accomplish the Patient Data Sheet containing pertinent patient medical information. Patients must provide complete and truthful information about their health as these will be used as basis for medical assessment and treatment.

All patients are given identification tags indicating full name, date of birth, patient identification number, and the name of the attending physician. The identification tag must be worn throughout the duration of hospital stay.

Admission Fee

An initial deposit may be required before admission at Manila Doctors Hospital. For non-emergency cases, an initial payment/admission fee is required according to the prescribed schedule of fees.

Company or HMO-sponsored accounts may no longer be required to pay the deposit depending on what is indicated in the Letter of Guarantee or Letter of Authorization (LOA) presented. To contact an admission representative, call (02) 558 0888 locals 3410, 3411 and 3412.

Hospital Admission – an overview

Recipient Management

Waiting list mortality in pediatric patients is higher for heart transplantation than any other solid organ. The most important factor in predicting mortality is the level of invasive hemodynamic support.³¹ Management of patients on the waiting list can vary from standard heart failure therapy as an outpatient to MCS and mechanical ventilation and depends on a variety of factors, including severity of cardiac dysfunction, cardiac diagnosis, and end-organ dysfunction. The level of support required also factors into the listing status (Table 73.2). Overall, the goal is to maintain end-organ function, optimize nutrition, and deliver the patient to transplant with as few comorbidities as possible.

The goals of medical management are to reduce fluid overload, reduce afterload, and downregulate neurohormonal responses. When patients cannot be adequately managed with oral heart failure medications, a number of inotropic and vasoactive agents are available. Milrinone, dopamine, dobutamine, and epinephrine are all options.

Certain patients will continue to deteriorate despite maximal medical therapy and ultimately may require mechanical ventilator support. Positive intrathoracic pressure benefits patients with left ventricular systolic and diastolic dysfunction by reducing afterload, as well as working to improve pulmonary edema and atelectatic lung segments. However, positive pressure can have mixed effects on the right heart if there is pulmonary distention beyond functional residual capacity. High intrathoracic pressures also increase systemic venous pressures and can worsen systemic edema, inhibit ventricular filling, and worsen secondary organ injury due to elevation of central venous pressure.

For decades the mainstay of MCS has been extracorporeal membrane oxygenation (ECMO). More recently a growing number of support devices have become available for patients in need of only circulatory support. Device selection depends on support goals, patient size, and native cardiac anatomy among other factors. For small children the primary option outside of ECMO has been the Berlin EXCOR pulsatile ventricular assist device. This pneumatically driven extracorporeal device is the only one approved in the United States by the Federal Drug Administration for use in children as a bridge to transplantation. The Berlin EXCOR comes in multiple pump sizes and is capable of supporting children as small as 3 to 4 kg. The device allows for reliable support of either or both ventricles. Overall success rate for bridge to transplant or explant and recovery is roughly 75%, with superior survival after heart transplant when compared with ECMO.^32,33 It should be noted that in children under 10 kg at implantation, survival was lower than that of the entire group, predominantly due to patients with congenital heart disease, weight less than 5 kg, and evidence of biventricular failure through elevated bilirubin level.³⁴ Further analysis has revealed that end-organ function at device implantation predicts adverse outcomes, and that neonates and infants with congenital heart disease, particularly those with prior heart surgery and ECMO support, may have poorer outcomes when considering bridge to transplant or weaning.³⁵ When analyzing patients who went on to transplantation, posttransplant survival at 30 days, 1 year, and 5 years was equivalent between patients bridged with EXCOR and those who underwent transplant without MCS. ³⁶

Beyond the EXCOR, several other MCS options exist for pediatric and adolescent patients, with the latter being eligible for most of the devices available to adult patients.^37,38 Determination of the needed duration of support, patient size, one or two ventricular support, and native cardiac anatomy all effect the choice. Options include short-term versus long-term, extracorporeal versus implanted versus catheter-based, pulsatile versus continuous flow, and even options for complete cardiac replacement with a total artificial heart. Once a device is selected, advanced imaging techniques can be used to perform a virtual “fit test” to anticipate any anatomic or mechanical complications.³⁷ Management after placement is contingent on the device selected, but major themes emerge based on the most common complications: bleeding, thrombus formation, infection, and right heart failure in the case of isolated left heart support.³⁸ A growing body of literature supports successful use of these devices in congenital heart disease. ^39-44

Children who are listed for lung transplantation are frequently critically ill with a significant percentage requiring hospitalization with or without mechanical ventilation and pressor support before donor organs become available. As a result, aggressive maneuvers may be necessary in an attempt to maintain end-organ viability and transplant candidacy for as long as possible. Over the past decade, advances in mechanical ventilation with jet and high-frequency ventilators, the availability of prostacyclin and nitric oxide, and artificial lung devices have broadened the armamentarium available for use in these children. Despite these measures, mortality on the waiting list remains in the range of 20% to 25% for infants and children.⁵

The use of ECMO before lung transplantation has been less common than for heart transplantation; however, there has been experience reported in both the adult and pediatric populations. A recent systematic review of published data from 14 studies with adult patients bridged to lung transplant by ECMO found mortality rate of patients before lung transplant and 1-year survival ranged from 10% to 50% and 50% to 90%, respectively. ⁴⁵ In a single-center report of pediatric patients supported with ECMO, mechanical ventilation without ECMO, or neither, outcomes of transplanted patients were not statistically different regarding hospital discharge and 1-year survival.⁴⁶ Given the risks associated with ECMO, there has recently been interest in the use of paracorporeal lung assist devices as a bridge to lung transplantation in neonates and children, including reports of isolated successful cases.^47,48

Claim Inpatient Admission Type Code (FFS)

0	Blank
1	Emergency – The patient required immediate medical intervention as a result of severe, life threatening, or potentially disabling conditions. Generally, the patient was admitted through the emergency room.
2	Urgent – The patient required immediate attention for the care and treatment of a physical or mental disorder. Generally, the patient was admitted to the first available and suitable accommodation.
3	Elective – The patient’s condition permitted adequate time to schedule the availability of suitable accommodations.
4	Newborn – Necessitates the use of special source of admission codes.
5	Trauma Center – visits to a trauma center/hospital as licensed or designated by the State or local government authority authorized to do so, or as verified by the American College of Surgeons and involving a trauma activation.
6 THRU 8	Reserved
9	Unknown – Information not available.

Clinical Algorithms for Admission and Discharge

COVID19_Clinical Criteria for Discharge updated Dec 2, 2020

Main clinical criteria for discharge to home

1. Overall improvement in the fever curve without antipyretics. No fever spikes ≥ 101 F for ≥ 48 hours
2. Improved or stable respiratory symptoms (e.g. improved shortness of breath or cough) and improved or stable oxygen requirement for ≥ 48 hours
3. Improved or stable laboratory data including inflammatory markers if they were followed during the admission (especially C-reactive protein, ferritin and lactate dehydrogenase)

Additional comments

• When making a decision to discharge a patient, the team should include time since onset of initial symptoms. Patients within 6-9 days since symptom onset are at highest risk for
• All known COVID-infected patients with no PCP or with a BMC PCP who are discharged home will automatically receive at least one follow-up call within 24-48h of discharge to assess for symptoms. Community health centers (CHC) patients have a separate workflow; please notify the CHC in question at the time of discharge.

o	Working phone and up-to-date contact information on Epic (please note that clinicians can now modify the demographics section to update phone numbers)
	Information on primary care team up-to-date on Epic
	Appropriate home setting ·         Patient can adhere to home isolation (separate bedroom) ·         No household members are either pregnant, immunosuppressed, or have a history of end-stage renal disease ·         Appropriate caregivers are present in the home, if applicable ·         For patient experiencing homelessness, please follow separate guidelines providing guidance for this group
	Quarantine education provided at discharge to patient and family. Patient and family have access to face covering, and patient has surgical mask for transport.

Special considerations/populations

• COVID positive/high probability patients experiencing homelessness who leave against medical advice (AMA):

• • Monday through Friday from 7 AM to 7 PM: Contact Deanna Faretra (pager 0735) who will coordinate with Boston Public Health Commission (BPHC)’s Homeless Services Bureau and BMC Infection Control.  Deanna is also a resource for patients who are contemplating leaving AMA.
  • Nights and weekends: The floor team should call BPHC’s Homeless Services Bureau at 617-645-9680 as soon as possible and email BMC infection control (DG-HospitalEpidemiology and cc: [email protected]).

Testing considerations at Discharge

Please see the BMC protocol on “COVID-19 Removal of Isolation Precautions PUI and COVID-19 patients” for access to updated and full guidance.

Admission criteria updated Dec 2nd 2020

Consider hospital admission for the following findings:

• Any patient with dyspnea or increase respiratory rate (≥30 breaths per min)
• Any patient with oxygen saturation ≤ 94% on RA or decrease in saturation to < 90% with ambulation
• Overall clinical concern by ED attending for risk of outpatient failure based on high risk for complications from severe COVID-19

Patients at high risk for complications from severe COVID-19

• Established risk factors:

Age 65 years or older, serious cardiovascular disease (heart failure, coronary artery disease, cardiomyopathies), chronic obstructive pulmonary disease, diabetes, malignancy, obesity (BMI ≥30 kg/m²), chronic kidney disease, immunocompromised state with solid organ transplantation, recipient of immunosuppressive therapy, pregnancy and sickle cell disease.

Asthma (moderate to severe), cerebrovascular disease

Criteria for safe discharge to home from the ED:

None of admission criteria listed above AND

• Reliable phone number where the patient could be reached for post-discharge follow-up
• Ability to understand and follow self-isolation recommendations
  • Patient and family members with access to face covering at home
  • Food security (enough for time in isolation, or ability to have someone procure it)
  • Ability to care for own ADLS without assistance from someone outside their household
• No household members who are either pregnant, immunosuppressed or have a history of end-stage renal disease
• Meds-to-bed for required medications (new or chronic meds needing extra doses)

If the patient is being discharged and you would like the patient to be contacted by the COVID-infected follow up monitoring program, please select “COVID-19 Follow Up” under the “Nurse Follow Up” section of DISPO.

If the patient does not meet criteria for safe discharge home, please contact Social Work for help with disposition planning.

“Admission of a patient to the hospital. Records management”.

Lecture No. 1. Topic: “Admission of a patient to the hospital. Records management”.

Just as a theater begins with a coat rack, so any medical institution begins with an admission department.

Admission department (emergency room) – one of the main structural divisions of the hospital, treatment and diagnostic department, which operates around the clock.

Because of how professionally, quickly and orderly the medical staff of this department operates, to a certain extent the success of the patient’s subsequent treatment depends, and in case of emergency conditions, his life also depends.

Organization of placement of admission departments in hospitals.

1. With centralized planning system , all medical and diagnostic departments, incl. and reception, are located in the same building.

2. With the decentralized (pavilion) planning system, the admission department is located in a separate building, or in one of the medical buildings (usually where the intensive care and surgery departments are located).

3. In some hospitals (infectious, in small rural district hospitals), each medical department receives patients independently.

The main functions of the admissions office are as follows.

1. Reception and registration of patients.

2. Patient anthropometry (Greek anthropos – human, metreo – measure).Assessment of a person’s physique by measuring a number of parameters, of which the main ones are height, body weight and chest circumference.

3. Medical examination, initial examination and diagnosis of patients.

4. Provision of emergency qualified medical care.

5. Definition of an inpatient department for hospitalization or treatment on an outpatient basis.

6. Sanitary and hygienic treatment of newly admitted patients.

7. Preparation of the relevant medical documentation.

8. Transportation of patients to the treatment department of the hospital.

9. Consulting assistance to outpatients.

10. Reference services.

Tasks in the implementation of hospitalization of a patient in the emergency department:

– identification of patients with infectious diseases;
– distribution of patients to departments in accordance with their profile and severity of the condition;
– identifies non-core patients who should be treated in other health care facilities;
– provides emergency assistance to those to whom it is shown.

ETHICAL AND DEONTOLOGICAL SUPPORT

1. The nurse of the admission department is the first medical worker with whom the patient comes to inpatient treatment, therefore, the psychological state of the patient often depends on the behavior of the nurse.

2. When talking to a patient, the emergency nurse should be patient, asking questions that are correct in form and tactful in content.

3. The deontological aspects of the behavior of a nurse in the admission department imply the fastest provision of medical care to the patient (calling the doctor on duty, consultants, laboratory assistants, quick paperwork, and often the provision of emergency care).

4. When admitting patients, there should be no division according to social status (businessman or homeless person), all patients have the right to receive qualified medical care if necessary.

Ways of hospitalization of patients in a hospital.

• By ambulance: in case of accidents, injuries, acute diseases and exacerbation of chronic diseases requiring qualified emergency treatment in a hospital;

• In the case of an ineffective outpatient treatment by the district doctor, as well as in the direction of the military registration and enlistment office.

• Transfer from other medical institutions (by agreement with the administration).

• “Samotyokom”: in case of independent treatment of the patient in case of deterioration of his health on the street near the hospital.

Three types of hospitalization:

1) planned hospitalization;

2) emergency hospitalization;

3) hospitalization “by gravity”.

If a patient is delivered to the admission department in a state of moderate severity and even more so in a serious condition, then even before registration, the nurse is obliged to provide first aid, urgently invite a doctor on duty to the patient and quickly complete all medical appointments.

The doctor of the admission department examines the patient and decides whether he needs to be hospitalized in this medical institution. In the event of hospitalization, the nurse registers the patient and draws up the necessary medical documentation. After registering the patient, the nurse directs him to the examination room for examination by a doctor and performing the necessary diagnostic and treatment procedures.

If a patient is taken to the emergency department from the street unconscious and without documents, then the nurse after being examined by a doctor provides emergency medical assistance and fills in the necessary documentation.After that, she is obliged to give a telephone message to the police station. In the telephone message, the signs of the admitted are indicated (gender, approximately age, height, physique), lists what the patient was wearing. In all documents pending clarification; the personality of the patient should be listed as “unknown”.

In addition, in the following cases, the nurse is obliged to give a telephone message to the relatives and make a corresponding entry in the “Journal of telephone messages”:

• the patient was admitted to the hospital due to a sudden illness that occurred outside his home;

• the patient died in the admission department.

Arrangement of the admission department

The work of the admission department proceeds in a strict sequence:

1) registration of patients;

2) medical examination;

3) sanitary and hygienic processing.

4) transportation of the patient to the specialized department of the hospital.

The reception area is located in the same sequence.

In cases requiring emergency assistance, this sequence is not followed, the patient’s stay in the emergency department is reduced to a minimum, sanitization is either minimal (partial) or not performed.

The structure of the admission department of the hospital depends on its profile; it usually includes the following rooms:

• Waiting room: It accommodates patients who do not need bed rest and accompanying patients. There should be a table and a sufficient number of chairs here. On the walls are posted information about the operating hours of medical departments, hours of conversation with the attending physician, a list of products allowed to be handed over to patients.

• Reception room: in this room the registration of incoming patients and the preparation of the necessary documentation is carried out.

• Examination room (one or more): is intended for medical examination of patients with a preliminary diagnosis and determination of the type of sanitary and hygienic processing, anthropometry, thermometry and, if necessary, other studies, for example, electrocardiography (ECG).

• Sanitary inspection room with shower (bath), dressing room.

• Diagnostic room – for patients with an unknown diagnosis.

• Isolator – for patients with suspected infectious diseases.

• Treatment room – for emergency care.

• Operating room (dressing room) – for emergency assistance.

• X-ray room.

• Laboratory.

• Office of the doctor on duty.

• Office of the head of the admission department.

• Bathroom.

• Room for storing clothes of admitted patients.

• Manipulation cabinet.

In multidisciplinary hospitals in the admission department there may also be other offices, for example, gynecological, traumatological, cardiological (for patients with myocardial infarction), etc.

Basic medical documentation of the admission department

by the USSR Ministry of Health order No. 1030 dated 04. 10.80. “On approval of forms of primary medical documentation of healthcare institutions”

Medical records are documents of the established form intended for registration of the results of medical, diagnostic, preventive, rehabilitation, sanitary and hygienic and other measures.It allows you to summarize and analyze this information. Medical documentation is accounting and reporting, medical institutions act as its holder, therefore, medical workers are responsible for the incorrect execution of the relevant documents.

1. Register of patients admission and hospitalization refusals form No. 001 / y.

The register is used to register patients admitted to the hospital. The journal entries allow the development of data on admitted patients, the frequency and reasons for hospitalization denials.The journal is kept in the admission department in a single copy for the entire hospital. Infectious departments of the hospital should maintain independent journals of patient admission and refusals in hospitalization in cases where infectious patients are admitted directly to the appropriate department.

2. In connection with the opening in 1882 of the Alexander Barracks Hospital for admitting feverish, that is, febrile patients, Sergei Petrovich Botkin for the first time introduced a card system for registering patients.Accounting for each patient in the form of a “Sorrowful Leaf” (as the case history was then called), it made it possible to systematize diseases by forms, by profession, by clinical laboratory and many other parameters.

According to the order of the Ministry of Health of the USSR No. 55 of 1968, the medical history in hospitals began to be called the “Card of an inpatient patient”.

Medical card of an inpatient patient form No. 003 / y.

The inpatient’s medical record is the main medical document of the hospital, which is drawn up for each patient admitted to the hospital.The card contains all the necessary information characterizing the patient’s condition during the entire stay in the hospital, the organization of his treatment, data of objective studies and prescriptions.

The medical record of an inpatient is kept by a doctor, as well as at different stages of the patient’s stay in the hospital, filled in by the nursing staff.

3. Temperature sheet form 004 / y.

It is an operational document used to graphically display basic data characterizing the patient’s health condition

4.Emergency notification of an infectious disease, food, acute occupational poisoning, an unusual reaction to vaccination form No. 058 / y.

An emergency notification is drawn up by doctors and nurses of health care facilities of all departments, in the event of an infectious disease (suspicion of it), food poisoning, strictly occupational poisoning, incorrect reaction to vaccination, regardless of the conditions of detection. Serves for information of the SES at the place of detection of the disease in order to take the necessary anti-epidemic measures.

5. Register of infectious diseases form No. 060 / y.

Serves for personal registration of patients with infectious diseases and registration of information exchange between medical institutions and SES.

6. Statistical card of those who left the hospital form No. 066 / y.

The statistical card of a patient who left the hospital is drawn up on the basis of the medical card of an inpatient and is a statistical document containing information about a patient who has left the hospital (discharged, deceased).The admission nurse fills in the passport details and the left side.

7. Outpatient register form No. 074 / y.

The journal is used to register patients who applied for outpatient care in the admission departments of hospitals and at the emergency and emergency medical care station, in the feldsher-obstetric points, medical and feldsher health posts.

8. Alphabetical journal of admitted patients (for reference service).

9.Journal of telephone messages. The nurse records in the journal the text of the telephone message, the date, the time of its transmission, by whom it was received.

Characteristics of the main documents

Document name

Purpose of the document

Maintained by

Note

Hospitalization log

To register patients admitted to the hospital

Nurse 9000 the admission department maintains an alphabetical journal for admitted patients

Hospitalization refusal log

To register patients who are not hospitalized for various reasons

Nurse of the admission department

The journal must indicate the reason for the refusal to the hospital.

Statistical card of those who left the hospital

To register hospitalized. patients with various diseases. This is the main stat. hospital document on the basis of which the reports are drawn up

The passport part is filled in by the nurse of the admission department, the other part – by the doctor of the department

The statistical card is submitted to the medical statistics office

Emergency notification of an infectious disease, food, acute occupational poisoning, an unusual reaction to vaccination

To notify the SES about the detection of infection and head lice in order to carry out sanitary and epidemic measures in the outbreak

Nurse or doctor

It is also necessary to inform the SES by phone and write in the notification

Medical record of an inpatient (case history)

To register the treatment and diagnostic process that the patient undergoes in the hospital

The passport part is filled in by the nurse of the admission department

It is entered for each patient admitted to the hospital 90 005

FUNCTIONAL RESPONSIBILITIES OF THE MEDICAL PERSONNEL

OF THE RECEPTION DEPARTMENT OF THE HOSPITAL

The functional responsibilities of the nursing staff of the admission department correspond to the job description of the nurse of the admission department.
Subject to the job description of the admission department, the nurse is responsible for the indistinct or untimely performance of the functional duties provided for by the job description and the hospital’s internal labor regulations.

The functional duties of the hospital admission staff when admitting a patient are as follows:

1. The hospital admission nurse in the waiting room (lobby) gets acquainted with the patient’s referral (which indicates the preliminary diagnosis of the patient) or an accompanying sheet ( patient delivered by ambulance).

2. Listens to patient complaints and calls the doctor on duty.

3. Then accompanies the patient to the examination room to the doctor on duty for examination.

4. If an infectious disease is suspected, the nurse provides infectious safety and, with the permission of the doctor, invites an infectious disease doctor (to confirm the diagnosis), places the patient in the isolation ward, monitors the patient’s condition in the isolation ward.

5. With the permission of the doctor on duty, the nurse fills out the passport part of the inpatient’s medical record (title page), the patient presents his passport, medical policy.

6. Timely transmits emergency notifications: to the center of the State Sanitary and Epidemiological Surveillance about infectious diseases, calls to city polyclinics, telephone messages to police stations.

The functional responsibilities of the nursing staff of the admission department when performing manipulations on patients are as follows:

1. A nurse calls consultants by appointment (to confirm the diagnosis: infectious disease specialist, neuropathologist, cardiologist, etc.), and in case of a delay in urgent consultations, the nurse notifies the doctor on duty of the admission department about this in order to take appropriate measures.

2. The nurse calls a laboratory assistant for laboratory tests.

3. Performs manipulations as prescribed by a doctor: conducts anthropometry, and also measures: A / D, pulse, temperature, etc., supplies oxygen to the patient.

4. Helps the doctor during manipulations: puts a bandage around the stoma in the form of pants, provides emergency first aid (for example: in case of anaphylactic shock).

Patient admission procedure

The procedure for admitting patients to GBUZ NO “Shatkovskaya CRH”

List of structural subdivisions of GBUZ NO “Shatkovskaya CRH” providing primary health care

1. Planned reception of patients by district doctors and specialist doctors is carried out according to the approved schedule.

Making an appointment with the attending doctors and specialist doctors is carried out via the Internet (on the website of the medical organization or the portal of State Services), through the infomat, the polyclinic registration by phones: 4-11-45; 4-60-29 s 7. 30 to 19.00. Appointments via the Internet using the reception are made daily from 16 ⁰⁰ – 18 ⁰⁰ .
Patients who make an appointment with a doctor by electronic turn are admitted at the time specified in the ticket.
Patients who do not make an appointment by electronic queue and do not need emergency or urgent medical care are admitted on a first-come, first-served basis.
In the case of an electronic appointment, the patient’s medical record is kept in the attending physician’s office.

2 . The right to receive emergency medical care is enjoyed by:
– disabled children
– patients in need of emergency or urgent medical care.
3. Pre-registration (self-recording or recording through the registry) is made:
– for scheduled ultrasound;
– on ECG, Holter monitoring, ECHO-KG daily by a cardiologist;
– on EEG, REG, ECHO-ES – daily by a neurologist in room 5.
Terms of admission by district pediatricians should not exceed 24 hours from the moment the patient contacts the medical center.
Reception of specialist doctors within a medical organization (hereinafter – MO) is provided on the initiative of doctors providing primary health care, who issue a referral to the patient for a consultation indicating its goals and objectives, or upon self-referral, taking into account the patient’s right to choose.
The term for consultations of specialist doctors does not exceed 14 calendar days from the date of the patient’s appeal to the medical center.

The timing of diagnostic instrumental (X-ray examinations, functional diagnostics, ultrasound examinations) and laboratory examinations in the provision of primary health care should not exceed 14 calendar days from the date of appointment.

4. Receptions of children of the 1st year of life and healthy children who do not attend educational institutions are carried out mainly on Tuesdays and Thursdays in accordance with the working hours of the attending physicians.

5. Reception and examination of patients in need of emergency or urgent medical care are carried out on the day of treatment out of turn, according to the work schedule of the relevant offices and specialists.

6 . Patients with acute infectious diseases are served at home, in cases of self-referral, incl.h. in the provision of emergency medical care on an outpatient basis, – in box

7. If you have any questions about the procedure for receiving patients, prescribing prescriptions, etc., it is recommended to contact the polyclinic administration by phone: 4-11-04

8 . You can personally familiarize yourself with the “Program of state guarantees of free provision of medical care to the population of the Nizhny Novgorod region for 2017.”and on the website of MO

9. Patients’ medical records (child development histories f 112 / y) are kept strictly in the clinic’s registry. When referring patients for consultation or hospitalization to other medical organizations, a referral issued by the attending physician and an extract from the history of the child’s development are issued.

10 . A doctor’s home call is carried out from 7.30 to 17.00 daily, by contacting the registry in person or by phone: ______________

11. Calling a doctor at home on holidays and weekends is carried out from 8.00 to 14.00 by phone: _____________

Information about the activities of GBUZ NO “Shatkovskaya CRH” is posted on the clinic’s website: http://shatki-crb.zdrav-nnov.ru/

https://portal52.is-mis.ru portal of appointment with a doctor

information stands, registration of a medical organization.

Hotline phones: 4-11-04 c 8.00 to 17.00 daily, except Sat, Sun, holidays.

Patient admission

Patients are admitted to the MBUZ “City SGB” in the direction of antenatal clinics, diagnostic centers, ambulance, as well as paid admission, with a description of the patient’s condition, diagnosis of the alleged disease.

In urgent cases, patients are admitted to the hospital without a referral.

In the absence of indications for hospitalization or inappropriate admission to the hospital, the doctor on duty refuses to admit him.In doubtful cases, the issue of admission is resolved consultatively by inviting the doctor on duty to resolve the issue of the chief physician or the head of the department. Each case of refusal is registered by the doctor on duty in a special book with the subsequent notification of the institution that sent the patient.

When a newly admitted patient is admitted, the doctor on duty checks the medical referral and identity documents of the patient, examines, collects all the necessary anamnestic information from the patient himself.

Passport data on newly admitted patients with an indication of the time of admission are entered in the admission register and medical history, compiled in a special form approved by the Ministry of Health. The doctor on duty describes the medical history, the patient’s condition, detailed external examination data, anamnesis data, the diagnosis of the condition and the presumptive diagnosis of the disease.

In the absence of documents from the newly arriving patient and the impossibility of obtaining information about his identity, he is entered in the book of “unknowns” and his admission is immediately reported to the police with an accurate description of the signs.

In case of a patient’s visit to the hospital with signs of injury or violence, the doctor on duty immediately notifies the police and the health department, which is in charge of the MBUZ “City SGB”.

In addition to the first examination of an incoming patient, the doctor on duty at MBUZ “City SGB” carries out initial medical appointments, and also determines, guided by the patient’s condition, the department in which the incoming patient should be placed.

Upon hospitalization, the following documents are required: – passport (additional 3 photocopies), – compulsory medical insurance policy (additional 3 photocopies), – SNILS (additional 3 photocopies), – fluorographic examination for up to 1 year (except for pregnant women).Scheduled hospitalization is carried out before 15:00.

Hospitalization for planned surgical treatment is carried out by appointment.

Rules for the organization of patient admission

1 . These rules determine the conditions for organizing the reception of patients in a polyclinic.

2. When contacting a polyclinic, patients present a compulsory medical insurance policy and an identity document. Citizens who have the right to receive a set of social services additionally present SNILS.

3. During the initial visit, a medical record of an outpatient patient is entered into which the following information about the patient is entered: surname, name, patronymic (in full), date of birth (day, month, year), address according to registration (registration) on the basis of identity documents (passport) series and number of the passport, series and number of the patient’s medical insurance policy. Informed voluntary consent is filled in for the provision of medical services and for the processing of personal data.

4. Patients are served in the registry on a first come, first served basis, veterans of the Great Patriotic War, family members of the dead (deceased) war invalids, war veterans, participants in the liquidation of the consequences of the Chernobyl accident, people with disabilities due to the Chernobyl disaster, pregnant women, patients with high fever and acute pain of any localization, bleeding (in the direction of the emergency room).

5. Patients requiring emergency medical care or emergency medical care are referred to the emergency room.

6. An appointment with a doctor is carried out during his working hours according to the time indicated in the coupon or at the time agreed with the doctor. In case of delay, the patient can be admitted subject to availability in the schedule. The out-of-schedule patient is awaiting a personal invitation to the office. The date and time of the return visit is set by the doctor.

7. Patients who made an appointment with a doctor by appointment (via the multi-line telephone of the call center, via the Internet, etc.)no later than 20 minutes in advance are obliged to contact the registry to clarify the availability of an outpatient card and obtain a statistical coupon.

8. The right to extraordinary medical care in medical organizations is granted to the following categories of citizens:

• invalids of the Second World War;
• WWII participants;
• internationalist soldiers;
• Heroes of the Soviet Union, RF, full holders of the Order of Glory, Heroes of Socialist Labor;
• persons exposed to radiation as a result of the Chernobyl accident and similar facilities;
• former juvenile prisoners of Nazi concentration camps;
• citizens who suffered from political repression, rehabilitated;
• widows of the fallen (deceased) participants in the Second World War;
• persons awarded with the badge “Honorary Donor of Russia”;
• mothers with many children;
• for healthcare professionals

All persons eligible for an extraordinary appointment are invited to the doctor’s office by a nurse.

9. An extraordinary appointment for emergency indications is carried out in the presence of a special marked coupon issued in the office of the first-aid appointment.

10. Payment for medical services does not provide the right to extraordinary services to the detriment of citizens receiving free medical care under the Territorial Program of State Guarantees.

11. Examination and treatment of conscripts in the direction of the commission of the military enlistment office and patients undergoing medical examination are carried out as a matter of priority.

12. Persons recognized as legally incompetent in accordance with the current law shall receive medical assistance in the presence of their legal representatives. The powers of a representative must be expressed in a power of attorney issued and executed in accordance with the law. (Article 53 of the Code of Civil Procedure of the Russian Federation)

13. In the event of a long waiting period for a doctor’s appointment, the medical registrar is obliged to offer the citizen the opportunity to consult another doctor of the relevant specialty.

90,000 Patient referral procedure

Patient referral procedure

1. Registration of a patient for an outpatient appointment with doctors is carried out through the registration desk, information terminal, the clinic’s website on the Internet, the center for registering citizens for an appointment with a doctor by phone (573-99-03).
2. The issuance of a coupon for an outpatient appointment with a local therapist and specialist doctors is carried out at the registry, in order of priority, in the presence of an identity document and a medical insurance policy.
3. Patients for urgent indications (pain syndrome, high temperature, etc.) are admitted without the obligatory presentation of documents.
4. A necessary precondition for medical intervention is the giving of informed voluntary consent of a citizen or his legal representative to medical intervention on the basis of complete information provided by a medical worker in an accessible form about the goals, methods of providing medical care, the associated risk, possible options for medical intervention, and its consequences. , as well as the expected results of medical care.
5. Informed voluntary consent to medical intervention or refusal of medical intervention is made in writing, signed by a citizen or other legal representative, a medical professional and is contained in the patient’s medical records.
6. Reception of specialist doctors is carried out in the direction of the district general practitioner by appointment or on the day of treatment, taking into account the patient’s condition. If there is a priority, provided that the relevant service is fully staffed, the waiting time for a consultation is no more than 10 working days.If the waiting period for citizens of a medical service exceeds the deadline, the priority is fixed in the prescribed manner. The maximum waiting time for medical care in a day hospital is no more than one month, for the profile of “medical rehabilitation” – no more than three months.
7. The queue to see a general practitioner or general practitioner for routine assistance is no more than 5 working days.
8. Out of turn served Heroes of the Soviet Union, holders of three Orders of Glory, disabled people and participants in the Great Patriotic War, honorary donors of Russia and the USSR.
9. Medical assistance at home is carried out in case of acute sudden deterioration of the state of health; the need for a strict home regimen recommended by the attending physician; severe chronic diseases with the inability to move the patient. Home calls are accepted by phone – 497-73-15. The local therapist provides medical assistance at home on the day the call is received. The waiting time for a medical worker does not exceed 8 hours from the moment of the call. In case of an emergency, the waiting time for a medical worker does not exceed 2 hours from the moment of the call.Consultations at home by specialist doctors are carried out according to the appointment of a local therapist. The volume of medical care at home is determined by a doctor and performed by nurses.
10. If indicated, the attending physician directs the patient for inpatient treatment to inpatient facilities, a day hospital in a polyclinic or a home hospital.
11. Re-admission of the patient is carried out on the day and time appointed by the doctor. Failure to appear at the appointment on the appointed day is considered a violation of the regime.
12. Diagnostic services (clinical diagnostic laboratory, functional diagnostics department, X-ray department, ultrasound research room, etc.), auxiliary units (day hospital department, medical rehabilitation department, physiotherapy department, physiotherapy room) receive patients according to the referrals of therapists and doctors -specialists of SPb GBUZ “City polyclinic №32”.
13. If it is necessary to refer for consultation or hospitalization to other medical institutions, the patient is issued a referral of the established form and an extract from the medical record of an outpatient.

State budgetary healthcare institution “Kemerovo City Clinical Polyclinic No. 5”

Rights guaranteed by the Constitution of the Russian Federation
Part 2 of Article 21 : No one should be subjected to torture, violence, other cruel or degrading treatment or punishment. No one can be subjected to medical, scientific or other experiments without voluntary consent.

part 1 of article 41 : Everyone has the right to health protection and medical assistance. Medical assistance in state and municipal health care institutions is provided to citizens free of charge at the expense of the corresponding budget, insurance premiums, and other receipts.

The rights established by the Federal Law of 21.11.2011 N 323-FZ “On the basics of health protection of citizens in the Russian Federation”:
Part 5 of Article 19: The patient has the right to:
1) the choice of a doctor and the choice of a medical organization in accordance with this Federal Law;
2) prevention, diagnosis, treatment, medical rehabilitation in medical organizations in conditions that meet sanitary and hygienic requirements;
3) obtaining advice from specialist doctors;
4) relief of pain associated with the disease and (or) medical intervention, available methods and drugs;
5) obtaining information about their rights and obligations, the state of their health, the choice of persons to whom, in the interests of the patient, information about the state of his health can be transferred;
6) receiving medical food in the event of a patient being treated in an inpatient setting;
7) protection of information constituting a medical secret;
8) refusal from medical intervention;
9) compensation for harm caused to health in the provision of medical assistance;
10) admission of a lawyer or legal representative to him to protect his rights;
11) the admission of a clergyman to him, and in the case of a patient being treated in a stationary environment – to provide conditions for the administration of religious rituals, which can be carried out in stationary conditions, including the provision of a separate room, if this does not violate the internal order of the medical organization.
part 1,2 of article 19: the right to medical assistance
article 20: the right to give informed voluntary consent to medical intervention and the right to refuse medical intervention;
Part 2 of Article 21: the right to choose a doctor and a medical organization no more often than once a year.
Article 22: The right to information about the state of health
Article 23: The right to receive reliable and timely information about factors that contribute to the preservation of health or have a harmful effect on it

Responsibilities established by the Federal Law of 21.11.2011 N 323-FZ “On the basics of protecting the health of citizens in the Russian Federation”:
from Article 27: Responsibilities of citizens in the field of health care
1. Citizens are obliged to take care of the preservation of their health.
2. Citizens in cases stipulated by the legislation of the Russian Federation are obliged to undergo medical examinations, and citizens suffering from diseases that pose a danger to others, in cases provided for by the legislation of the Russian Federation, are obliged to undergo medical examination and treatment, as well as to prevent these diseases.
3. Citizens undergoing treatment are obliged to comply with the treatment regimen, including those determined for the period of their temporary incapacity for work, and the rules of patient behavior in medical organizations.

Rules of behavior for patients and visitors in GAUZ KGKP No. 5

The Rules of Conduct for Patients and Visitors (hereinafter the Rules) in GAUZ KGKP No. 5 and its structural units (hereinafter Polyclinic) are a local legal act governing the rights, obligations and rules of conduct while visiting the Polyclinic, its structural units, as well as other issues, arising between patients, their legal representatives, visitors (hereinafter – Patients), a medical organization and its employees.

The Rules are binding on Patients, staff and other persons who apply to Polyclinic .

The rules are posted on the website of the medical organization http://kem-pol5.ru/ in the information and telecommunication network “Internet”, at the information stands of the Polyclinic.

The patient has the right:

– to receive preliminary information about the services provided, the procedure for their provision and other information at the registration desk directly, by phone or on the Polyclinic website.

– make an appointment with a doctor in advance by calling the call center 78-09-81, in person when contacting the registration office or on the Polyclinic website, on the Doctor-42 portal, on the State Services portal.

– to receive a service without an appointment in case of indications for emergency care.

When visiting the Polyclinic, the Patient must:

– in the absence of a scheduled appointment, contact the registry, stating the purpose of the visit;

– with fever and signs of respiratory disease,

go to the “red” patient reception area;

– present a compulsory medical insurance policy, passport or other identity document, – in case of initial application, sign the “Consent to the processing of personal data”, “Informed voluntary consent to medical intervention” and other documents in accordance with the requirements of the legislation of the Russian Federation;

– if you make an appointment, go to the previously specified office;

– behave correctly in relation to medical personnel and enter the doctor’s office only by invitation;

– if it is impossible to come to an appointment on time, if you are late, or if the visit is canceled, inform the administrator about it in advance by phone.Late for the appointment of specialists and diagnostic tests is considered a time equal to 10 minutes or more. If the time of delay exceeds 10 minutes, the patient is given the opportunity to wait for an appointment in the nearest free time.

While in the premises of the polyclinic Patient is prohibited from:

– be in outerwear;

– smoking;

– talk loudly, make noise;

– use a mobile connection while at a doctor’s appointment, during procedures, manipulations, examinations;

– make phone calls using the “speakerphone” function and use the phone with the ringing on;

– to make photo-audio-video filming on the territory of the Polyclinic without the written permission of the chief physician (and in his absence – the deputy chief physician for the medical part).At the same time, filming is allowed only to the extent that it does not contradict the requirements of the legislation of the Russian Federation on the protection of medical secrets, personal data and / or does not violate the rights of other citizens;

The patient may be denied the provision of medical services in the following cases:

– if it is impossible to ensure the safety of medical services, including if the Patient has contraindications to a certain diagnostic method;

– when the Patient is in a state of alcoholic, drug or toxic intoxication;

– when the actions of the Patient threaten the life and health of medical personnel, or violate public order or these Rules.

If the Patient violates these Rules, the staff of the Polyclinic has the right to call Rosgvardia employees, a police outfit, or draw up an “Act on violation of the Patient’s Rules of Conduct”, with its subsequent transfer to law enforcement agencies.

The rules are developed in order to comply with the rights and obligations of the Patient provided for by law, to create the most favorable opportunities for the provision of timely medical care of adequate quality and in full, in accordance with Federal Law of 21.11.2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”, Federal Law No. 152-FZ dated 27.07.2006 “On personal data” and other regulatory legal acts in the field of health care.

Rights and obligations of insured persons

With changes and additions from:

June 14, November 30, December 3, 2011, July 28, December 1, 2012, February 11, July 2, 23, September 27, November 25, December 28, 2013, 12 March, 10, 21 July, 1 December 2014, 14, 30 December 2015, 3 July, 28 December 2016, 27 June, 29 July, 27, 28 November, 25 December 2018, 6 February, 26 July, 2 December 2019, 28 January, 1, 24 April, 8 December 2020, 24 February 2021

Adopted by the State Duma on November 19, 2010

Approved by the Federation Council on November 24, 2010

Article 16. Rights and obligations of insured persons

1.Insured persons are entitled to:

1) free provision of medical care to them by medical organizations in the event of an insured event:

a) throughout the territory of the Russian Federation in the amount established by the basic compulsory medical insurance program;

b) on the territory of the constituent entity of the Russian Federation in which the policy of compulsory medical insurance was issued, in the amount established by the territorial program of compulsory medical insurance;

2) selection of an insurance medical organization by submitting an application in the manner prescribed by the rules of compulsory medical insurance;

3) replacement of an insurance medical organization in which a citizen was previously insured, once during a calendar year no later than November 1, or more often in the event of a change of residence or termination of the contract on financial support of compulsory health insurance in the manner prescribed by the rules of compulsory health insurance, by submitting an application to a newly selected medical insurance organization;

4) selection of a medical organization from medical organizations participating in the implementation of compulsory medical insurance programs in accordance with the legislation in the field of health protection, including a medical organization subordinate to the federal executive body that provides medical care in accordance with paragraph 11 of Article 5 of this Federal Law …The procedure for sending insured persons to medical organizations subordinated to federal executive bodies for the provision of medical care is established by the authorized federal executive body;

5) the choice of a doctor by submitting an application personally or through his representative addressed to the head of a medical organization in accordance with the legislation in the field of health protection;

6) obtaining from the Federal Fund, a territorial fund, an insurance medical organization and medical organizations reliable information about the types, quality and conditions for the provision of medical care;

7) protection of personal data necessary for maintaining personalized records in the field of compulsory health insurance;

8) compensation by an insurance medical organization for damage caused in connection with non-fulfillment or improper fulfillment by it of its obligations to organize the provision of medical care, in accordance with the legislation of the Russian Federation;

9) compensation by a medical organization for damage caused in connection with non-fulfillment or improper fulfillment by it of its obligations to organize and provide medical care, in accordance with the legislation of the Russian Federation;

10) protection of rights and legitimate interests in the field of compulsory health insurance.

2. The insured persons are obliged to:

1) present a policy of compulsory medical insurance when applying for medical care, with the exception of cases of emergency medical care;

2) submit to an insurance medical organization personally or through a representative an application for choosing an insurance medical organization in accordance with the rules of compulsory medical insurance;

3) notify the medical insurance organization about the change in the last name, first name, patronymic, data of the identity document, place of residence within one month from the day when these changes occurred;

4) make a choice of an insurance medical organization at a new place of residence within one month in the event of a change of residence and the absence of an insurance medical organization in which the citizen was previously insured.

3. Compulsory medical insurance of children from the date of birth until the expiration of thirty days from the date of state registration of birth is carried out by an insurance medical organization in which their mothers or other legal representatives are insured. After thirty days from the date of state registration of the birth of a child and until he reaches the age of majority or until he acquires legal capacity in full, compulsory medical insurance is carried out by an insurance medical organization chosen by one of his parents or other legal representative.

4. The choice or replacement of an insurance medical organization is carried out by an insured person who has reached the age of majority or acquired legal capacity in full (for a child until he reaches the age of majority or until he acquires legal capacity in full – by his parents or other legal representatives), by submitting an application to the medical insurance an organization from among the insurance medical organizations included in the register, which is posted on a mandatory basis by the territorial fund on its official website on the Internet and can be additionally published in other ways.

5. To select or replace an insurance medical organization, the insured person personally or through his representative applies with an application for selection (replacement) of an insurance medical organization directly to an insurance medical organization or other organizations of his choice in accordance with the rules of compulsory medical insurance. On the basis of this application, the insured person or his representative is issued a policy of compulsory health insurance in the manner prescribed by the rules of compulsory health insurance.If the insured person has not submitted an application for the choice (replacement) of an insurance medical organization, such a person is considered insured by the insurance medical organization with which he was previously insured, except for the cases provided for in paragraph 4 of part 2 of this article.

6. Information about citizens who have not applied to an insurance medical organization for the issuance of compulsory health insurance policies to them, as well as who have not replaced the insurance medical organization in the event of termination of the contract on financial support of compulsory health insurance due to the suspension, revocation or termination of the license of medical insurance organizations, monthly by the 10th day, are sent by the territorial fund to medical insurance organizations operating in the field of compulsory health insurance in the constituent entity of the Russian Federation, in proportion to the number of insured persons in each of them to conclude agreements on the financial support of compulsory health insurance.The ratio of working citizens and non-working citizens who did not apply to an insurance medical organization, as well as who did not replace an insurance medical organization in the event of termination of the contract on financial support of compulsory medical insurance in connection with the suspension, revocation or termination of the license of an insurance medical organization, which is reflected in the information sent to medical insurance organizations should be equal.

7.Insurance medical organizations specified in part 6 of this article:

1) within three working days from the date of receipt of information from the territorial fund, inform the insured person in writing about the fact of insurance and the need to obtain a compulsory medical insurance policy;

2) ensure the issuance of a compulsory health insurance policy to the insured person in the manner prescribed by Article 46 of this Federal Law;

3) provide the insured person with information about his rights and obligations.

Patient Code of Conduct | Clinic “Doctor’s appointment”

Limited Liability Company
Clinical and Diagnostic Center “Doctor’s Appointment”
RF, Altai Territory, Barnaul, North-West d48b, pom N4
8 (3852) 774-751, 69-47-03
January 4 __2019 G. Barnaul

Rules for the provision of medical services of the Limited Liability Company CDC “Doctor’s appointment”

1. General provisions
1.1. The Rules for the Provision of Medical Services (hereinafter referred to as the Rules) of Reception of a Doctor LLC (hereinafter referred to as clinics) are an organizational and legal document stipulating:
the procedure for the patients’ treatment; 90,097 rights and obligations of Patients;
procedure for the provision of medical services; 90,097 rules of conduct for Patients and Visitors;
procedure for resolving conflict situations;
procedure for obtaining information about the patient’s health status;
responsibility for violation of the Rules.
1.2. The rules were developed in order to create the most favorable opportunities for providing patients with timely high-quality medical care in accordance with the internal regulatory legal acts of the clinic and the current legislation of the Russian Federation, including:
Federal Law of 21.11.2011 N 323-FZ “On the basics of protecting the health of citizens In Russian federation”;
Law of the Russian Federation of 07.02.1992 N 2300-1 “On Protection of Consumer Rights”;
Resolution of the Government of the Russian Federation of 04.10.2012 N 1006 “On approval of the Rules for the provision of paid medical services by medical organizations”;
Standards for specialized medical care approved by the Orders of the Ministry of Health of the Russian Federation;
Order of the Ministry of Health and Social Development of the Russian Federation dated 02.08.2010 No. 586n “On Amendments to the Procedure for Providing Emergency Medical Care, approved by order of the Ministry of Health and Social Development of the Russian Federation of November 1, 2004 No.No. 179 “;
Order of the Ministry of Health and Social Development of the Russian Federation of June 29, 2011 No. 624-N “On approval of the procedure for issuing certificates of incapacity for work”;
Order of the Ministry of Health and Social Development of the Russian Federation of 23.04.2012 N 390n “On the approval of 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.”
1.3. The rules are mandatory for all Patients and visitors, as well as third parties who have applied to the clinic.
1.4. The rules are available for general review on information boards, as well as on the clinic’s website in the information and telecommunications network “Internet”.
2. The procedure for the treatment of Patients
2.1. The organization of the preliminary registration of the Patients for an appointment with the doctors is carried out by their direct contact to the registry or to the contact center of the clinic by phone: 754-751, 699-206
2.2. The patient chooses the date and time of the scheduled appointment from the available free coupons. When making an appointment for a scheduled appointment, the Patient must provide the medical registrar with a contact phone number for feedback.
2.3. Patients with acute pathology make an appointment with a specialist on the day of treatment for the nearest free time, while the doctor provides the necessary amount of medical care. If it is necessary to continue the treatment, the recording is carried out in a planned manner. When the need for hospitalization of the Patient is identified, the doctor and staff will call an ambulance team with subsequent hospitalization.
2.4. In case of delay or inability to appear for a scheduled appointment, the Patient is obliged to notify the medical registrar in advance in any way convenient for him.
2.5. If the Patient is late for an appointment for more than 10 minutes, the medical registrar has the right to postpone the appointment to the next free time, and offer the free time to another Patient.
2.6. In the event of an unforeseen absence of the attending physician and other emergency circumstances, the medical registrar notifies the Patient about this by phone left by the Patient, and, in agreement with the Patient, postpones the appointment until the next free time.
2.7. Patients who have applied to the registry for a routine examination without making an appointment can be admitted on the day of the visit only if the doctors have free time in the schedule. In the absence of this condition, the medical registrar has the right to make an appointment for another day.
2.8. To draw up the necessary medical documents for a scheduled appointment, the Patient arrives at the registry at least 15 minutes before the appointed time.
2.9. When first contacting the registry, the Patient provides all the necessary information to draw up a medical card for an outpatient patient (form 025 / u-04).
The medical card is the property of a medical organization and is kept in the registry (Order of the Ministry of Health and Social Development of the Russian Federation No. 255 of 22.11.2004). Patients are not issued with a medical card, and it is not allowed to take out a medical card without the written consent of the head physician. Registration of the Patient’s appointment is carried out by doctors in the medical record
2.10. When first contacting the registry in accordance with the requirements of the current legislation of the Russian Federation, the Patient provides the necessary information, familiarizes himself with the signature with the notification of the patient about non-compliance with the doctor’s prescriptions (recommendations) when providing paid services and signs an agreement for the provision of medical services, consent to the processing of personal data, informed consent to medical interventions in accordance with the list of interventions approved by the Order of the Ministry of Health and Social Development of the Russian Federation of 23.04.2012 N 390n.
2.13. The patient waits for the appointment in the lobby of the clinic. The patient enters the doctor’s office at the invitation of the nurse.
2.14. If the planned appointment by the doctor is delayed for more than 10 minutes due to objective circumstances beyond the control of the attending physician, the Patient is offered:
treatment at the appointed time by another free specialist;
treatment on the appointed day with a delay of admission for the time of delay with your attending physician;
transfer of the time of reception to another day.
3. Rights and obligations of Patients
3.1. The patient has the right to: 90,097 the choice of a doctor;
diagnostics and treatment, in conditions that meet sanitary and hygienic requirements;
relief of pain associated with the disease and (or) medical intervention, available methods and drugs; 90 097 obtaining information about their rights and obligations, their state of health, 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;
written appeal to the attending physician with a request to organize and conduct a consultation of physicians; 90,097 selection of persons to whom information about the state of his health can be transferred in the interests of the Patient;
protection of personal data; information constituting a medical secret; 90,097 refusal of medical intervention;
compensation for harm caused to health in the provision of medical assistance;
other rights in accordance with the current legislation of the Russian Federation.
3.2. The patient is obliged:
to comply with these Rules for the provision of medical services; 90 097 to comply with the treatment regimen, including those determined for the period of his temporary incapacity for work;
to show tact, respect and goodwill in communication with the clinic staff;
not to take actions that could violate the rights of other Patients and clinic employees;
visit medical offices in accordance with the established schedule of their work;
to comply with the sanitary and anti-epidemiological regime;
to show a benevolent and courteous attitude towards other Patients, to observe the order of making an appointment with a doctor;
read and sign an agreement for the provision of medical services, informed consent to medical intervention or refusal of medical intervention, consent to the processing of personal data;
to issue in writing their refusal to receive information against their will about the state of health, the results of the examination, the presence of the disease, its diagnosis and prognosis, including in cases of an unfavorable prognosis of the development of the disease; refusal of hospitalization;
to provide the person providing medical assistance with reliable information about his health condition known to him;
Take good care of the property of the clinic;
to comply with fire safety requirements, if sources of fire or other threats are detected, immediately inform the clinic staff about it.
4. The procedure for the provision of medical services
4.1. At the reception, the patient informs the attending physician of all the information necessary for making a diagnosis, carrying out diagnostic and therapeutic measures; informs about medications taken, past illnesses, allergic reactions known to him and contraindications.
4.2. After receiving information from the attending physician, the Patient signs an informed voluntary consent for medical intervention or refusal of medical intervention for medical manipulations and procedures not provided for by the Order of the Ministry of Health and Social Development of the Russian Federation of 23.04.2012 N 390n. Voluntary informed consent to medical intervention is a prerequisite for the initiation of medical care. The patient is responsible for the consequences associated with the refusal of medical intervention.
4.3. The patient is obliged to familiarize himself with the recommended treatment plan and, if agreed with it, to comply with it in good faith.
4.4. If the state of health changes in the process of diagnosis and treatment, the Patient immediately informs the attending physician about this.
4.5. The patient does not have the right to interfere with the actions of the attending physician, to carry out other actions that contribute to the violation of the provision of medical care.
4.6. The presence of accompanying persons in the doctor’s office is prohibited, in exceptional cases, the presence of accompanying persons in the doctor’s office is allowed only with the permission of the attending physician and subject to all his instructions.
4.7. If there is no risk to the life and health of the Patient, the attending physician, in agreement with the chief physician, has the right to refuse to observe and treat the Patient if the Patient does not comply with these Rules for the provision of medical services, as well as if the treatment desired by the Patient does not meet the requirements of standards and technologies. the result of the intervention can cause undesirable consequences for the Patient.
5. Rules of Conduct for Patients and Visitors
Patients and visitors, in order to maintain public order, comply with the sanitary and epidemiological regime, are prohibited from:
to be in the office premises of a medical organization without the permission of the clinic administration; 90,097 to smoke on staircases, in the lobby and other premises of the clinic; 90 097 talking loudly, including on a mobile phone, making noise, slamming doors; 90,097 leave young children unattended;
to withdraw any documents from medical records; 90,097 to be in the premises of the clinic in outerwear and dirty shoes;
leave personal belongings unattended in the premises of the clinic;
to see a doctor in alcoholic, narcotic and other toxic intoxication.If there is no risk to life and health, such Patients are removed from the premises of the clinic by security and / or law enforcement officers;
to behave inappropriately towards visitors and staff of the clinic, to loudly and defiantly express their emotions;
use mobile devices (phones, tablets, players) in the doctor’s office.
6. The procedure for resolving conflict situations
6.1. In case of conflict situations, the Patient (legal representative of the Patient) has the right to contact the head physician directly
6.2. When applying in person, the Patient (legal representative of the Patient) is obliged to present an identity document (passport).
6.3. In case of oral appeal, the answer to the appeal, with the consent of the interested person, can be given orally during a personal reception. In other cases, a written answer is given on the merits of the questions raised in the written request.
6.5. The Patient (legal representative of the Patient) in his written request must indicate the name of the institution to which he sends the written appeal, the last name, first name, patronymic of the official, his position, as well as his last name, first name, patronymic (in full), the address to which an answer must be sent, a telephone number for contacting him, sets out the essence of the proposal, statement or complaint, puts a personal signature and date.If necessary, in support of his arguments, the patient or (the legal representative of the Patient) attaches documents and materials (or their copies) to the written request.
6.6. A written appeal is subject to registration and consideration within 30 days from the date of its registration in the manner prescribed by the current legislation of the Russian Federation (Federal Law dated 02.05.2006, No. 59-FZ “On the Procedure for Considering Appeals from Citizens of the Russian Federation”).
6.7. The answer to the written appeal is sent to the address indicated in the appeal.
7. The procedure for obtaining information about the patient’s health condition
7.1. Information about the state of health, including information about the results of a medical examination, the presence of a disease, about the established diagnosis and prognosis of the development of the disease, methods of providing medical care, the associated risk, possible types of medical intervention, its consequences and the results of providing medical care is provided to the Patient (the legal representative of the Patient) by the attending physician in a form accessible to him at his request.Information about the state of health cannot be provided to the Patient against his will.
7.2. The patient has the right to directly familiarize himself with the medical documentation reflecting his state of health, and to receive consultations from other specialists on the basis of such documentation.
7.3. The patient has the right, on the basis of a written application, to receive medical documents reflecting the state of health.
7.4. The disclosure of information constituting a medical secret to other citizens is allowed only with the written consent of the Patient or his legal representative, with the exception of cases provided for by the current legislation of the Russian Federation.
8. Responsibility for violation of the Rules
8.1. The Patient is responsible for non-compliance with these Rules, including the prescribed treatment regimen, which can reduce the quality of medical care, lead to the impossibility of completing it on time or adversely affect the patient’s health.
8.2. In case of violation by the Patients and other visitors of these Rules, public order, employees and security of the Company have the right to make appropriate comments to them, refuse to provide medical care in the absence of a risk to the life and health of the Patient, contact law enforcement agencies, apply other measures of influence provided for by the current legislation of the Russian Federation. Federation.
8.3. Obstructing the implementation of the process of providing medical care, disrespect for the Company’s employees, other Patients and visitors, causing moral harm to personnel, causing damage to business reputation and material damage to the Company, entails liability under the current legislation of the Russian Federation.

.