Answers to pressing questions about changes in connection with the release of Order No. 29n from a representative of MedProf

We are starting a series of publications dedicated to answering pressing questions about changes in connection with the release of Order No. 29n.

Our articles will provide answers from representatives of relevant organizations:

• State Labor Inspectorate;
• City Center for Occupational Pathology;
• Rospotrebnadzor;
• medical centers MedProf.

This publication will be a valuable resource if you would like clarification on completing medical examinations under the new Order.

When is fluorography done?

Fluorographic examination is the only type of radiographic screening that is not done according to indications. Regardless of how the patient feels, he needs to take a photo of the lungs.

If the first signs of tuberculosis appear - cough, fever, malaise, weight loss and difficulty breathing, then in case of such complaints the doctor will prescribe an early X-ray of the lungs, despite the expiration date of the fluorography in the patient.

How to store a fluorography image at home

X-ray images are stored at home subject to the following rules:

1. It is best to use paper envelopes, this protects the top layer of film from mechanical damage.
2. Do not bend the photograph. If it is large, it can be rolled up into a tube during transportation.
3. Films in envelopes should be placed in a hard box. Exposure to light causes the image to darken.
4. The room temperature is allowed from 16 to 27 degrees Celsius, and air humidity is 30 - 50%.
5. The most reliable way to store photographs is to digitize them.

Fluorography expires in 2021

When performing fluorography, the patient receives a document in his hands or a note in the medical record about when the study was done.

This spine is kept by the patient and, if necessary, he can provide it to medical centers. The main question for many people is how long fluorography is valid and when the next screening is required.

This aspect of the issue is regulated by Order of the Ministry of Health No. 124 of March 21, 2021, according to which it is necessary to undergo a study at least once a year. This is a standard prescription for most categories of the population.

Questions from listeners to the representative of MedProf medical centers

Question 1:

Is it now necessary to request the Compulsory Medical Insurance/VHI policy from employees and candidates as a mandatory document?

Answer:

The employee provides this document to the medical organization. Responsibility for the presence/absence of information lies with the medical center. The employer indicates in the direction of information according to the documents provided to him

Question 2:

Is it necessary to undergo a medical examination again under Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, if the employee has already passed a medical examination this year under Order No. 302n of the Ministry of Health of the Russian Federation dated April 12, 2011?

Answer:

No, there is no such need

Question 3:

Is it possible to undergo a further medical examination on individual points?

Answer:

If the question is about crediting the results of previous examinations, then the medical organization that issued the conclusion based on the examination results is responsible both for the quality of the examination performed and for the objectivity of the conclusion of the medical commission, incl. and for determining the presence or absence of contraindications to the performance of the assigned work by the employee or candidate for the position. The procedure for the activities of the medical commission is determined by Order of the Ministry of Health and Social Development of Russia No. 502n dated 05/05/2012 (as amended on 12/02/2013) “On approval of the procedure for the creation and activities of the medical commission of a medical organization” (Registered with the Ministry of Justice of Russia on 06/09/2012 No. 24516 ). In this vein, the medical commission reserves the right to confirm the results of medical examinations provided from another organization based on an assessment of these results, incl. and by sending official requests. Response to request is 30 days

Question 4:

On what point is it necessary to conduct preliminary and periodic medical examinations for employees selling non-food products (no products), class of working conditions - acceptable (2)?

Answer:

The medical examination is carried out according to paragraph 26 of Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, on public utility services

Question 5:

Order No. 302n of the Ministry of Health of the Russian Federation dated April 12, 2011, Appendix 1, clause 1.1.4.4 (Aerosols of metals (iron, aluminum) and their alloys formed during the process of dry grinding, obtaining metal powders) - in Order No. 29n of the Ministry of Health of the Russian Federation dated January 28 .2021 there is nothing related to this item, can we include item 3.1.2?

Answer:

Yes, you can relate. There are no contradictions in the scope of examination and contraindications

Question 6:

Order No. 302n of the Ministry of Health of the Russian Federation dated April 12, 2011, Appendix 2, clause 23 (Work in hotels, hostels, passenger cars (conductors), as a flight attendant) - in Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, the clause was excluded, There are clauses 23 and 26, which clause should be included?

Answer:

The medical examination is carried out according to paragraph 26 of Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, on public utility services

Question 7:

How to calculate length of service in hazardous working conditions? Should I count experience in general by profession or only from work in our organization?

Answer:

When changing jobs, the employee begins work under new working conditions. The length of service is calculated from the date of conclusion of the new employment contract.

Question 8:

How to work with Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021? According to Order No. 302n of the Ministry of Health of the Russian Federation dated April 12, 2011, Appendix No. 1, clause 1.2.15, clause 1.2.21.1, clause 1.2.32.1. And in Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, what are the points? Only point 1.2? From Order No. 302n of the Ministry of Health of the Russian Federation dated April 12, 2011, paragraph 1.2.21.1, now in Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, paragraph 1.19.1?

Answer:

Clause 1.2.15 - in Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021 1.15.; clause 1.2.21.1 - in Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021 1.19.1

Question 9:

In connection with the introduction of Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, does the employer need to enter into a separate agreement and send workers with hazardous working conditions, SOUT class 3.1, to the occupational pathology center once every 5 years?

Answer:

An employer can sign an additional agreement with the current medical organization to conduct examinations together with the occupational pathology center once every 5 years, if the medical organization has a partnership agreement with the occupational pathology center. These medical examinations will be organized for your organization by a medical center. If the current provider of medical examination services does not have such an agreement/agreement with the occupational pathology center, then it is necessary to enter into an agreement with the occupational pathology center and send workers for a medical examination to the City Occupational Pathology Center

Question 10:

Based on the requirements, periodic examinations of employees can be carried out by mobile medical teams of medical specialists from a medical organization. Before periodic examinations by mobile medical teams of medical specialists, workers undergo diagnostic tests in medical organizations. Which specialists must be seen at the diagnostic center before a medical examination by mobile teams? How long are survey data valid?

Answer:

Diagnostic studies include: FLG, ECG, ultrasound, EEG, FVD, audiometry, incl. and a number of laboratory tests. The validity period of the research results is determined by the medical organization performing the examination by creating an internal Order. Currently, the current legislation determines only the validity period of the FLG - 12 months. Other types of diagnostics are determined individually by each medical institution independently

Question 11:

Under what point should the client undergo a medical examination under the new order? According to the old order there was paragraph adj. 2, p. 15. according to OKVED work in trade. According to the SOUTH there are no harmful points and the need for a medical examination is not reflected. According to production control, there is no harmfulness. No permanent standing work, not office employees

Answer:

If an organization operates in the field of trade, then the food trade medical examination is carried out according to paragraph 23 of Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, non-food trade medical examination is carried out according to paragraph 26 of Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, according to public utility services is a requirement for a decreed category of workers

Question 12:

Is it allowed to conduct a medical examination on the territory of an organization if the production is related to public catering?

Answer:

The medical examination is carried out in compliance with sanitary standards and rules, as well as current legislation regarding the conduct of a medical examination - Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, in accordance with clause 4 of the General Provisions

Question 13:

Is it necessary to conduct an extraordinary medical examination of all employees who underwent a medical examination before 04/01/2021, and who do not have medical specialists identified as of 04/01/2021?

Answer:

There is no need to undergo an extraordinary medical examination, because for conclusions issued before 04/01/2021, the volume of research is sufficient. For periodic inspection, it is necessary to draw up a final report in accordance with Order No. 302n of the Ministry of Health of the Russian Federation dated 04/12/2011, and from 04/01/2021 a final report in accordance with the requirements of Order No. 29n of the Ministry of Health of the Russian Federation dated 01/28/2021.

Question 14:

Explain in more detail the conditions for conducting medical examinations by a mobile team

Answer:

The medical examination is carried out in compliance with the requirements of the current legislation, including paragraph 4 General provisions of Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021. Accordingly, diagnostic studies (FLG, ECG, FVD, audiometry, EEG) must be provided to a medical organization (medical center) before the departure of the mobile medical team of medical specialists

Question 15:

Are the Final Acts sent to Rospotrebnadzor or should the act contain the signature of a RPN representative?

Answer:

Final acts are sent to Rospotrebnadzor. It is important that there is a mark/fixation of the document sent either through EDI, or by mail, or a note about the incoming number

Question 16:

Have the requirements for the medical report form for private security guards changed for periodic medical examinations? How now to act in accordance with Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, if the guard is unarmed?

Answer:

The form of the medical report within the framework of Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021 has not changed

Question 17:

In the new Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, there is an obligation for the employer to indicate the compulsory medical insurance or voluntary medical insurance policy. Will a medical examination be denied to an employee if he is admitted to a medical institution with a referral in which the insurance policy is not specified? If a medical examination is allowed, what should be indicated in the column? Refusal to provide?

Answer:

This question implies an individual approach from the medical organization that is the service provider, namely: will the patient be refused employment, and will a referral be accepted without information about the compulsory medical insurance or voluntary health insurance policy of the medical organization. This issue is subject to agreement between the employer and the medical examination service provider

Question 18:

Who should draw up a sample of referrals for a medical examination: the employer or the medical center to which the employee is sent?

Answer:

Depends on the conditions specified in the Agreement between the organization sending employees for a medical examination and the medical center. As a rule, medical organizations create referral templates themselves. This is due to the convenience of processing referrals by patient reception administrators

Question 19:

At what point should preliminary and periodic medical examinations be carried out: trade in non-food products (no products), working conditions class 2?

Answer:

Clause 26 of Order No. 29n of the Ministry of Health of the Russian Federation dated January 28, 2021, public utility services, in accordance with sanitary standards and rules

When the certificate is valid for 1 year

Some people unknowingly neglect to undergo fluorographic examination in a timely manner and delay the next shots. Why additional irradiation if fluorography is not required?

In order to attract large masses of the population to regular screening, there are restrictions that force the patient to undergo research in a timely manner.

For example, to obtain a certificate for a swimming pool, fluorography must be no older than one year. The same deadlines apply to medical examinations at educational institutions and at work - here a special service strictly monitors the expiration of the examination.

With an expired fluorography, the general doctor will not be able to refer the patient to a specialist or give an opinion for surgery. These situations create as much control as possible over fluorography among the population.

When the certificate is valid for 6 months

In some cases, diagnosis is carried out unscheduled. For example, this is recommended for men whose wives will give birth to children in six months. No later than this period, the future father must undergo a lung examination and provide a certificate for the maternity hospital.

An X-ray of the lungs is the norm.
The same six-month principle applies to young people conscripted into the army - they must provide the military registration and enlistment office with a certificate indicating fluorography for the last six months.

The study is done twice a year and the certificate is valid only for six months for the following categories of patients:

• people with diagnosed tuberculosis;
• employees of medical institutions;
• patients with severe respiratory pathologies;
• workers in the education sector and social institutions.

What can be seen in the photographs?

Tuberculosis has ceased to be a social disease. The incidence of pulmonary forms of the disease increases every year. X-ray examination is one of the screening methods for identifying this pathology of the respiratory system. The image shows lesions formed both due to tuberculosis and formations of cancer etiology. In addition, changes resulting from pneumonia, fibrosis, and benign tumors are visualized. Foreign bodies, evidence of parasitic infestation, and so on will be noticeable in the image. Fluorography often makes it possible to diagnose diseases in early, treatable stages.

Is fluorography required?

Chest examination is mandatory screening for the majority of the working age population.
For young children, the Mantoux test or Diaskintest are performed - unique alternative methods for detecting tuberculosis. The importance of conducting regular fluorographic examinations is evidenced by the fact that this provision is enshrined in legislation. There is a special law regulating the rules for undergoing screening. There are also contraindications for fluorography.

The study is not performed on women during pregnancy, children under fifteen years of age, or patients with serious illnesses, but in this case, the responsibility for refusing an x-ray lies with the doctor.

How often do you need to undergo the procedure?

As a rule, the validity period of an extract from a fluorography journal in Russia is one year. A two-year period, although determined by law, does not allow timely detection of the early stage of tuberculosis, therefore the requirement to undergo examination annually is more reasonable. Thus, clinics may refuse to issue a medical card if fluorography is “older” than one year.

For an adult

There are no specific age requirements for the adult population regarding the timing of the examination in the legislation. One strict requirement applies to all residents of the Russian Federation - it is mandatory to do FLG once every 2 years. This requirement applies when passing a medical examination for employment; it applies to pensioners, students and citizens of all other categories.

The following are required to be examined annually:

• employees of educational and medical spheres, as well as health organizations and additional educational institutions;
• people from a high-risk group (immigrants, homeless people, dysfunctional families), as well as employees of mining enterprises or those with high levels of radioactive and other harmful substances;
• patients suffering from pulmonary, genitourinary diseases, having problems with the gastrointestinal tract, as well as undergoing aggressive treatment (chemotherapy, radiation therapy, etc.).

For children

Children under 15 years of age are a contraindication for examination with a fluorograph, except in certain cases, for example, if pneumonia, pulmonary tuberculosis is suspected, or after contact with an infected person. The results are usually stored in the clinic, because children do not need to present them anywhere.

comparison table

The risk of developing lung diseases is several times higher than the danger of radiation received during the operation of a fluorograph. Tuberculosis is an insidious disease, and the lesion can grow for a long time without obvious symptoms. X-ray or fluorographic examination allows you to notice the process at an early stage and begin treatment in a timely manner.

The radiologist decides to order an examination in accordance with the data on the calculated radiation dose. These indicators can be presented in a table:

Both X-rays of the lungs and FLG are informative methods for identifying not only tuberculosis, but also other diseases of the chest organs (pneumonia, lung cancer, the effects of parasites on internal organs, and the like). The patient has the right to refuse any type of examination due to excess radiation doses.

What will happen if you refuse fluorography?

Refusal to undergo the study is an extremely reckless step. Some people deliberately do this - some out of inner convictions, while others are simply too lazy to go to the clinic and stand in line. Will they be punished by law for this?

The legislation does not provide for punishment; a person will not be fined for failing to undergo a lung examination. And the same law specifies under what circumstances a certificate stub may be required.

This gives freedom to certain structures and the right to demand the spine. For example, in a kindergarten, a teacher may not be allowed to work without undergoing fluorography. To work in such an institution, a certificate is required.

How long are fluorography results valid by law, and where may they be required?

According to the order of the Ministry of Health, the examination period is valid for 2 years and applies to all citizens, with the exception of representatives of certain professions who have a health certificate (health workers, teachers, educators and others) and carriers of certain diseases (HIV, diabetes mellitus and others). In clinics, hospitals and maternity hospitals, it is mandatory to have a valid result at the time of treatment. Along with the standard package of documents (passport, SNILS, compulsory medical insurance policy), the registry also asks for an extract about the FLH.

A certificate is also required when applying for a job as part of a medical examination, and persons over 18 years of age must present it upon request. This is due to the fact that the adult population is at greater risk than minors.

Why is the certificate valid for 1 year?

The requirement that the shelf life of fluorography results is one year is due to the fact that the ionizing radiation used in the fluorograph can adversely affect health. The period during which the development of pulmonary tuberculosis can begin lasts 3-12 months, therefore an annual one-time examination is sufficient to detect the disease in the average resident of the country.

When the expiration date is six months

There is a certain circle of people whose profession, social status or health condition obliges them to undergo fluorography once every six months:

• medical workers at tuberculosis clinics and maternity hospitals;
• military personnel;
• HIV-infected people and citizens with drug addiction and mental illnesses;
• convicts staying in a colony even after serving their sentence.

The risk of developing tuberculosis and lung cancer in a healthy person and people not associated with hazardous working conditions is lower than that of the above-mentioned citizens.

Fluorography for the university

Educational institutions also fall under the category of places with large crowds of people, so universities require a certificate and examination. Upon admission and every year, students undergo a medical examination.

Fibrous-cavernous tuberculosis

If screening is refused or a counterfeit is missing, the university has the right not to admit the student as having failed the medical examination. This is a legal decision of the subject of the educational process, since the university takes responsibility for the life and health of students, including those who may become infected with tuberculosis.

The role of diagnostics in the fight against tuberculosis

It is extremely important to undergo monitoring for tuberculosis, because all it takes is one Koch bacilli excretor, which can infect others.

Therefore, the spine is required at work, at school, it is taken upon discharge from the maternity hospital, i.e. they carry out disease prevention in places where there are active crowds of people.

Regular examination of the chest for the purpose of prevention is an important procedure of civil and public importance.

It is the duty of every person to observe the expiration dates of fluorography and undergo the study as soon as the expiration date of the stub expires. This helps to timely identify and treat tuberculosis of the lungs - a dangerous infectious disease that can reach epidemic proportions.

Important! When undergoing fluorography, pay attention to the X-ray machine; it must be digital, or digital scanning. In this case, fluorography is absolutely safe, in contrast to the established stereotype of the harmfulness of the film apparatus.