ÌÈÍÈÑÒÅÐÑÒÂÎ ÇÄÐÀÂÎÎÕÐÀÍÅÍÈß
ÐÎÑÑÈÉÑÊÎÉ ÔÅÄÅÐÀÖÈÈ
ÏÐÈÊÀÇ
30 äåêàáðÿ 2002 ã.
N 413
ÎÁ ÓÒÂÅÐÆÄÅÍÈÈ Ó×ÅÒÍÎÉ È ÎÒ×ÅÒÍÎÉ
ÌÅÄÈÖÈÍÑÊÎÉ
ÄÎÊÓÌÅÍÒÀÖÈÈ
 öåëÿõ óïîðÿäî÷åíèÿ âåäåíèÿ ó÷åòà
è îò÷åòíîñòè â óñëîâèÿõ
âçàèìîäåéñòâèÿ îðãàíîâ óïðàâëåíèÿ çäðàâîîõðàíåíèåì ñóáúåêòîâ
Ðîññèéñêîé Ôåäåðàöèè è òåððèòîðèàëüíûõ ôîíäîâ îáÿçàòåëüíîãî
ìåäèöèíñêîãî ñòðàõîâàíèÿ â ó÷ðåæäåíèÿ
çäðàâîîõðàíåíèÿ ñèñòåìû
Ìèíçäðàâà Ðîññèè áûëà ââåäåíà
âðåìåííàÿ, ñðîêîì íà 1 ãîä, ó÷åòíàÿ
è
îò÷åòíàÿ ìåäèöèíñêàÿ äîêóìåíòàöèÿ, óòâåðæäåííàÿ ïðèêàçîì
Ìèíçäðàâà Ðîññèè îò 20.02.2002 N 60 "Î
ââåäåíèè âðåìåííîé ó÷åòíî -
îò÷åòíîé ìåäèöèíñêîé äîêóìåíòàöèè".
Àíàëèç ðàáîòû ñ äàííûìè ôîðìàìè
ïîäòâåðäèë íåîáõîäèìîñòü
ïåðåõîäà ó÷ðåæäåíèé çäðàâîîõðàíåíèÿ íà
ñèñòåìó ó÷åòà, îòâå÷àþùóþ
òðåáîâàíèÿì ðàáîòû îòðàñëè â ñîâðåìåííûõ ýêîíîìè÷åñêèõ óñëîâèÿõ è
âíåäðåíèåì â äåÿòåëüíîñòü ó÷ðåæäåíèé çäðàâîîõðàíåíèÿ
ðåñóðñîñáåðåãàþùèõ òåõíîëîãèé.
 ñâÿçè ñ âûøåóêàçàííûì
ÏÐÈÊÀÇÛÂÀÞ:
1. Ââåñòè â äåéñòâèå ñ ÿíâàðÿ 2003 ãîäà
ñëåäóþùóþ ìåäèöèíñêóþ
ó÷åòíóþ è îò÷åòíóþ äîêóìåíòàöèþ:
1.1. Ó÷åòíóþ ôîðìó N 039/ó-02
"Âåäîìîñòü ó÷åòà âðà÷åáíûõ
ïîñåùåíèé
â àìáóëàòîðíî - ïîëèêëèíè÷åñêèõ
ó÷ðåæäåíèÿõ, íà äîìó"
(ïðèëîæåíèå N 1).
1.2. Ó÷åòíóþ ôîðìó N 007/ó-02
"Ëèñòîê åæåäíåâíîãî ó÷åòà
äâèæåíèÿ
áîëüíûõ è êîå÷íîãî
ôîíäà ñòàöèîíàðà êðóãëîñóòî÷íîãî
ïðåáûâàíèÿ, äíåâíîãî
ñòàöèîíàðà ïðè áîëüíè÷íîì
ó÷ðåæäåíèè"
(ïðèëîæåíèå N 2).
1.3. Ó÷åòíóþ ôîðìó N 016/ó-02
"Ñâîäíàÿ âåäîìîñòü äâèæåíèÿ
áîëüíûõ è êîå÷íîãî ôîíäà ïî ñòàöèîíàðó,
îòäåëåíèþ èëè ïðîôèëþ êîåê
ñòàöèîíàðà
êðóãëîñóòî÷íîãî ïðåáûâàíèÿ, äíåâíîãî
ñòàöèîíàðà ïðè
áîëüíè÷íîì ó÷ðåæäåíèè" (ïðèëîæåíèå N
3).
1.4. Ó÷åòíóþ ôîðìó N 007äñ/ó-02
"Ëèñòîê åæåäíåâíîãî ó÷åòà
äâèæåíèÿ
áîëüíûõ è êîå÷íîãî
ôîíäà äíåâíîãî ñòàöèîíàðà ïðè
àìáóëàòîðíî - ïîëèêëèíè÷åñêîì ó÷ðåæäåíèè,
ñòàöèîíàðà íà äîìó"
(ïðèëîæåíèå N 4).
1.5. Ó÷åòíóþ ôîðìó N 066/ó-02 "Ñòàòèñòè÷åñêàÿ êàðòà âûáûâøåãî
èç ñòàöèîíàðà êðóãëîñóòî÷íîãî
ïðåáûâàíèÿ, äíåâíîãî ñòàöèîíàðà ïðè
áîëüíè÷íîì
ó÷ðåæäåíèè, äíåâíîãî ñòàöèîíàðà
ïðè àìáóëàòîðíî -
ïîëèêëèíè÷åñêîì ó÷ðåæäåíèè, ñòàöèîíàðà íà
äîìó" (ïðèëîæåíèå N 5).
1.7. Îò÷åòíóþ ôîðìó N 14-äñ
"Ñâåäåíèÿ î äåÿòåëüíîñòè äíåâíûõ
ñòàöèîíàðîâ ëå÷åáíî - ïðîôèëàêòè÷åñêîãî ó÷ðåæäåíèÿ"
(ïðèëîæåíèå
N 6).
2. Ðóêîâîäèòåëÿì îðãàíîâ óïðàâëåíèÿ
çäðàâîîõðàíåíèåì ñóáúåêòîâ
Ðîññèéñêîé Ôåäåðàöèè îáåñïå÷èòü:
2.1. Ââåäåíèå âûøåïåðå÷èñëåííûõ ó÷åòíûõ
è îò÷åòíîé ôîðì âî âñå
ïîäâåäîìñòâåííûå ó÷ðåæäåíèÿ çäðàâîîõðàíåíèÿ.
2.2. Ïðåäñòàâëåíèå ãîäîâîãî îò÷åòà çà 2002
ãîä ïî
ôîðìå N 14-äñ Ìèíçäðàâó Ðîññèè â
óñòàíîâëåííîì ïîðÿäêå.
3. Äåïàðòàìåíòó îðãàíèçàöèè
è ðàçâèòèÿ ìåäèöèíñêîé
ïîìîùè
íàñåëåíèþ
(Õàëüôèí Ð.À.) ïîäãîòîâèòü äî 20.02.2003 èíñòðóêòèâíî -
ìåòîäè÷åñêèå ìàòåðèàëû ïî
çàïîëíåíèþ âûøåóêàçàííîé ìåäèöèíñêîé
äîêóìåíòàöèè.
4. Ïðèêàç Ìèíçäðàâà Ðîññèè îò 20.02.2002
N 60 "Î ââåäåíèè
âðåìåííîé
ó÷åòíî - îò÷åòíîé
ìåäèöèíñêîé äîêóìåíòàöèè"
ñ÷èòàòü
óòðàòèâøèì ñèëó.
5. Êîíòðîëü çà èñïîëíåíèåì íàñòîÿùåãî
ïðèêàçà âîçëîæèòü íà
Ïåðâîãî çàìåñòèòåëÿ Ìèíèñòðà
çäðàâîîõðàíåíèÿ Ðîññèéñêîé Ôåäåðàöèè
À.È.Âÿëêîâà.
Ìèíèñòð
Þ.Ë.ØÅÂ×ÅÍÊÎ
Ïðèëîæåíèå N
1
ê
ïðèêàçó Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
Ìèíèñòåðñòâî çäðàâîîõðàíåíèÿ Ìåäèöèíñêàÿ äîêóìåíòàöèÿ
Ðîññèéñêîé Ôåäåðàöèè Ôîðìà N 039/ó-02
____________________________ Óòâåðæäåíà ïðèêàçîì
íàèìåíîâàíèå ó÷ðåæäåíèÿ Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
ÂÅÄÎÌÎÑÒÜ
Ó×ÅÒÀ ÂÐÀ×ÅÁÍÛÕ
ÏÎÑÅÙÅÍÈÉ
 ÀÌÁÓËÀÒÎÐÍÎ - ÏÎËÈÊËÈÍÈ×ÅÑÊÈÕ
Ó×ÐÅÆÄÅÍÈßÕ, ÍÀ ÄÎÌÓ
Ô.È.Î. è äîëæíîñòü âðà÷à
________________________________________
________________________________________
ïðîôèëü
ñïåöèàëüíîñòè
çà ____ 20... ã.
Ó÷àñòîê: òåððèòîðèàëüíûé N ________
öåõîâîé N ________
--------------------------------------------------------------------------------------------------------------------
|Äàòà|
×èñëî |â òîì ÷èñëå | èç îáùåãî
÷èñëà |ïðîôè-|×èñëî|èç îáùåãî ÷èñëà
ïîñåùåíèé íà äîìó| ×èñëî ïîñåùåíèé |
|
| ïîñåùåíèé | â âîçðàñòå |
ïîñåùåíèé â
|ëàêòè-|ïîñå-|---------------------------------| ïî âèäàì îïëàòû |
|
| â |(èç ãðàôû 2)|
ïîëèêëèíèêå ïî |÷åñêèõ|ùåíèé|ïî
ïîâîäó çàáîëåâàíèé |èç ÷èñëà
|------------------|
|
|ïîëèêëèíèêå| |ïîâîäó
çàáîëåâàíèé| |íà
|-----------------------|ïðîôèëàê-|ÎÌÑ|áþä-|ïëàò-|ÄÌÑ|
|
|-----------+------------+------------------| |äîìó |âñå-|â ò.÷. â âîçðàñòå |òè÷åñêèõ | |æåò |íûå
| |
|
|âñå-|èç íèõ|0-17|60 ëåò |âñåãî|â ò.÷. ÷èñëå| |(âñå-|ãî
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| | â âîçðàñòå | |ãî)
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9 | 10 | 11 | 12 |
13 | 14 | 15 | 16 |17 | 18 |
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| 4
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| 5
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| 6
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| 7
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| 8
| | | | |
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| 9
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| 10 |
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|
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| 11 |
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|----+----+------+----+-------+-----+----+-------+------+-----+----+----+------+------+----+----+---+----+-----+---|
| 12 |
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| 13 |
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îáîðîòíàÿ ñòîðîíà ô. N 039/ó-02
--------------------------------------------------------------------------------------------------------------------
| 1
| 2 |
3 | 4 | 5 |
6 | 7 | 8 |
9 | 10 | 11 | 12 |
13 | 14 | 15 | 16 |17 | 18 |
19 |20 |
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| 14 |
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| 15 |
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| 16 |
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| 17 |
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| 18 |
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|----+----+------+----+-------+-----+----+-------+------+-----+----+----+------+------+----+----+---+----+-----+---|
| 19 |
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| 20 |
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| 21 |
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| 22 |
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| 23 |
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| 24 |
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| 25 |
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| 26 |
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| 27 |
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| 28 |
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|----+----+------+----+-------+-----+----+-------+------+-----+----+----+------+------+----+----+---+----+-----+---|
| 29 |
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| 30 |
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| 31 |
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|
--------------------------------------------------------------------------------------------------------------------
Ïîäïèñü
âðà÷à ________________
Ïðèëîæåíèå N
2
ê
ïðèêàçó Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
Ìèíèñòåðñòâî çäðàâîîõðàíåíèÿ Ìåäèöèíñêàÿ äîêóìåíòàöèÿ
Ðîññèéñêîé Ôåäåðàöèè Ôîðìà N 007/ó-02
____________________________ Óòâåðæäåíà ïðèêàçîì
íàèìåíîâàíèå ó÷ðåæäåíèÿ Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
ËÈÑÒÎÊ
ÅÆÅÄÍÅÂÍÎÃÎ Ó×ÅÒÀ ÄÂÈÆÅÍÈß ÁÎËÜÍÛÕ È
ÊÎÅ×ÍÎÃÎ ÔÎÍÄÀ
ÑÒÀÖÈÎÍÀÐÀ ÊÐÓÃËÎÑÓÒÎ×ÍÎÃÎ ÏÐÅÁÛÂÀÍÈß, ÄÍÅÂÍÎÃÎ
ÑÒÀÖÈÎÍÀÐÀ ÏÐÈ ÁÎËÜÍÈ×ÍÎÌ
Ó×ÐÅÆÄÅÍÈÈ
(ïîä÷åðêíóòü)
_________________________________________________
íàèìåíîâàíèå îòäåëåíèÿ,
ïðîôèëÿ êîåê
---------------------------------------------------------------------------------------------------------------------------------
|
|Êîä|Ôàêòè-|Â òîì |
Äâèæåíèå áîëüíûõ çà èñòåêøèå ñóòêè |Íà
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|
| |÷åñêè |÷èñëå
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|
| |ðàç- |êîåê, |Ñîñòî-| Ïîñòóïèëî áîëüíûõ <*>
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|
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| |åê, |íà ðå-|íûõ íà|---------------------------|
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| |ìîíò |
| | |ñòà-|
| | |äå- |ëåíèÿ|
|ãèå |ñòà- |íàð |
| | | | |
|
| | | | |
|öèî-| | |
|ëå- | | |ñòà- |öèî- | | | |
| | |
|
| | | | |
|íàðà| | |
|íèé | | |öèî- |íàð | | |
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|
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| | | | |
| | |íàðû | | |
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|
1 | 2 | 3 | 4
| 5 | 6 | 7 |
8 | 9 | 10 | 11 | 12
| 13 | 14 | 15 | 16
| 17 | 18 | 19
| 20 | 21 |
|-----------+---+------+------+------+----+----+-----+----+------+----+-----+----+-----+-----+-----+-----+-----+-----+----+-----|
|Âñåãî
| | | | |
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| | | | |
|
|-----------+---+------+------+------+----+----+-----+----+------+----+-----+----+-----+-----+-----+-----+-----+-----+----+-----|
|â òîì ÷èñëå| | | |
| | | | |
| | | | |
| | | | |
| |
|ïî êîéêàì
| | | | |
| | | | |
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| | | | |
|
|-----------+---+------+------+------+----+----+-----+----+------+----+-----+----+-----+-----+-----+-----+-----+-----+----+-----|
|-----------+---+------+------+------+----+----+-----+----+------+----+-----+----+-----+-----+-----+-----+-----+-----+----+-----|
|-----------+---+------+------+------+----+----+-----+----+------+----+-----+----+-----+-----+-----+-----+-----+-----+----+-----|
|-----------+---+------+------+------+----+----+-----+----+------+----+-----+----+-----+-----+-----+-----+-----+-----+----+-----|
|-----------+---+------+------+------+----+----+-----+----+------+----+-----+----+-----+-----+-----+-----+-----+-----+----+-----|
|-----------+---+------+------+------+----+----+-----+----+------+----+-----+----+-----+-----+-----+-----+-----+-----+----+-----|
|-----------+---+------+------+------+----+----+-----+----+------+----+-----+----+-----+-----+-----+-----+-----+-----+----+-----|
---------------------------------------------------------------------------------------------------------------------------------
Ôîðìàò À4 Ïîäïèñü ìåäèöèíñêîé ñåñòðû ___________
--------------------------------
<*> Ïðè ïîñòóïëåíèè áîëüíîãî èç
êðóãëîñóòî÷íîãî ñòàöèîíàðà â
äíåâíîé è
íàîáîðîò ñ÷èòàòü áîëüíîãî
êàê âûïèñàííîãî è
âíîâü
ïîñòóïèâøåãî.
îáîðîòíàÿ ñòîðîíà ô. N 007/ó-âð
---------------------------------------------------------------------------------------------------------------------------------
|
Ôàìèëèÿ, è., î | Ôàìèëèÿ, è., î. | Ôàìèëèÿ, è., î. |
Ôàìèëèÿ, è., î. | Ôàìèëèÿ, è., î. | Ôàìèëèÿ, è., î. |
|
ïîñòóïèâøèõ | ïîñòóïèâøèõ èç | âûïèñàííûõ |
ïåðåâåäåííûõ | óìåðøèõ | áîëüíûõ, |
| |
êðóãëîñóòî÷íîãî | |--------------------| | íàõîäÿùèõñÿ |
| |
ñòàöèîíàðà | |â äðóãèå | â äðóãèå | | âî âðåìåííîì |
| | | |îòäåëåíèÿ|ñòàöèîíàðû| | îòïóñêó <*> |
| | | | äàííîé
| | | |
| | | |áîëüíèöû | |
| |
|----------------------+-----------------------+-------------------+---------+----------+-------------------+-------------------|
|
1 | 2 | 3 |
4 | 5 | 6 | 7 |
|----------------------+-----------------------+-------------------+---------+----------+-------------------+-------------------|
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|----------------------+-----------------------+-------------------+---------+----------+-------------------+-------------------|
| | | | | | | |
|----------------------+-----------------------+-------------------+---------+----------+-------------------+-------------------|
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|----------------------+-----------------------+-------------------+---------+----------+-------------------+-------------------|
| |
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|----------------------+-----------------------+-------------------+---------+----------+-------------------+-------------------|
| | | |
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|----------------------+-----------------------+-------------------+---------+----------+-------------------+-------------------|
|
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--------------------------------
<*> Ó÷èòûâàþòñÿ ïðè ïîäñ÷åòå
êîéêî - äíåé.
Ëèñòîê ó÷åòà áîëüíûõ è êîå÷íîãî ôîíäà
ñòàöèîíàðà çàïîëíÿåòñÿ â
êàæäîì îòäåëåíèè, âûäåëåííîì â ñîñòàâå áîëüíèöû â ñîîòâåòñòâèè ñî
ñìåòîé
è ïðèêàçàìè âûøåñòîÿùåãî îðãàíà óïðàâëåíèÿ
çäðàâîîõðàíåíèåì.
Ïî îòäåëåíèÿì, èìåþùèì â ñâîåì ñîñòàâå âûäåëåííûå ïðèêàçîì
ïî
áîëüíèöå êîéêè óçêîãî ïðîôèëÿ
(íàïðèìåð, îíêîëîãè÷åñêèå êîéêè
â
ñîñòàâå õèðóðãè÷åñêîãî èëè
ãèíåêîëîãè÷åñêîãî îòäåëåíèÿ, êîéêè äëÿ
äåòåé â ñîñòàâå íåâðîëîãè÷åñêîãî
îòäåëåíèÿ è ò.ä.),
â ëèñòêå
çàïèñûâàþòñÿ ïåðâîé ñòðîêîé ñâåäåíèÿ
î ÷èñëå êîåê è äâèæåíèè
áîëüíûõ â öåëîì ïî îòäåëåíèþ (âêëþ÷àÿ ñâåäåíèÿ
ïî êîéêàì óçêèõ
ñïåöèàëüíîñòåé), â ïîñëåäóþùèå ñòðîêè
ñâåäåíèÿ î êîéêàõ è äâèæåíèè
áîëüíûõ ïî óçêèì ñïåöèàëüíîñòÿì.
Ïðè çàïîëíåíèè ñòðîê,
îòíîñÿùèõñÿ ê êîéêàì
óçêèõ
ñïåöèàëüíîñòåé, âûäåëåííûì â ñîñòàâå
êàêîãî-ëèáî îòäåëåíèÿ,
ïîêàçûâàåòñÿ äâèæåíèå áîëüíûõ ñ
çàáîëåâàíèÿìè, ñîîòâåòñòâóþùèìè
ïðîôèëþ âûäåëåííûõ êîåê â äàííîì îòäåëåíèè
íåçàâèñèìî îò òîãî, íà
êàêèõ
êîéêàõ ýòîãî îòäåëåíèÿ
îíè ëåæàëè. Íàïðèìåð, â ñîñòàâå
õèðóðãè÷åñêîãî îòäåëåíèÿ âûäåëåíû ïðèêàçîì
ïî áîëüíèöå 3 êîéêè äëÿ
óðîëîãè÷åñêèõ áîëüíûõ; ôàêòè÷åñêè â
îòäåëüíûå äíè â îòäåëåíèè
íàõîäèëîñü íå 3, à 5 è áîëåå óðîëîãè÷åñêèõ
áîëüíûõ - äâèæåíèå ýòèõ
áîëüíûõ
ïîêàçûâàåòñÿ ïî óðîëîãè÷åñêèì êîéêàì.  òî
æå âðåìÿ
áîëüíûå ñ óðîëîãè÷åñêèìè çàáîëåâàíèÿìè
ìîãëè ãîñïèòàëèçèðîâàòüñÿ è
â
äðóãèå îòäåëåíèÿ, â
ñîñòàâå êîòîðûõ óðîëîãè÷åñêèå êîéêè íå
âûäåëåíû.
Ñâåäåíèÿ îá ýòèõ áîëüíûõ ïîêàçûâàþòñÿ
ïî êîéêàì òîãî
îòäåëåíèÿ,
â êîòîðîå îíè
áûëè ïîìåùåíû, è íå
ñóììèðóþòñÿ ñî
ñâåäåíèÿìè îá óðîëîãè÷åñêèõ áîëüíûõ, ëåæàùèõ â îòäåëåíèè, èìåâøåì
óðîëîãè÷åñêèå êîéêè.
Äëÿ ïîëó÷åíèÿ ñóììàðíûõ äàííûõ ïî
áîëüíèöå ñâåäåíèÿ èç ëèñòêîâ
îòäåëåíèé, ïîëó÷åííûõ è ïðîâåðåííûõ
â êàáèíåòå ñòàòèñòèêè,
âíîñÿòñÿ â äíåâíèê ó÷åòà áîëüíûõ è
êîå÷íîãî ôîíäà, âåäóùèéñÿ
ïî
áîëüíèöå â öåëîì.
 ãð.
3 ëèñòà ïîêàçûâàþòñÿ ôàêòè÷åñêè ðàçâåðíóòûå â ïðåäåëàõ
ñìåòû
êîéêè, âêëþ÷àÿ è
êîéêè, âðåìåííî ñâåðíóòûå
â ñâÿçè ñ
ðåìîíòîì,
êàðàíòèíîì è äðóãèìè
ïðè÷èíàìè.  ýòî
÷èñëî íå
âêëþ÷àþòñÿ ïðèñòàâíûå êîéêè, ðàçâåðòûâàåìûå
â ïàëàòàõ, êîðèäîðàõ è
ò.ä. â ñâÿçè ñ ïåðåïîëíåíèåì îòäåëåíèÿ.
Èç ÷èñëà êîåê, ïîêàçàííûõ â ãð. 3 âûäåëÿþòñÿ â ãð. 4
êîéêè,
âðåìåííî ñâåðíóòûå â ñâÿçè ñ ðåìîíòîì è
äðóãèìè ïðè÷èíàìè.
 ãðàôàõ 5-17 äàþòñÿ ñâåäåíèÿ î
äâèæåíèè áîëüíûõ çà èñòåêøèå
ñóòêè,
ñ 9 ÷àñîâ óòðà ïðåäûäóùåãî äî 9 ÷àñîâ óòðà òåêóùåãî äíÿ (î
÷èñëå
ñîñòîÿâøèõ è ïîñòóïèâøèõ
áîëüíûõ, â ò.÷.
èç äíåâíûõ
ñòàöèîíàðîâ ïåðåâåäåííûõ èç îòäåëåíèÿ
â îòäåëåíèå, âûïèñàííûõ â
ò.÷.
â äíåâíûå ñòàöèîíàðû è
óìåðøèõ) â ãð. 18 è 19 - î ÷èñëå
áîëüíûõ, ñîñòîÿùèõ â îòäåëåíèè íà 9 ÷àñîâ
óòðà òåêóùåãî äíÿ. ×èñëî
áîëüíûõ,
ïîêàçàííîå â ãð.
18 ïðåäûäóùåãî äíÿ,
äîëæíî áûòü
ïåðåïèñàíî â ãð. 5 òåêóùåãî äíÿ.
Íåîáõîäèìî åæåäíåâíî ñëåäèòü
çà òåì, ÷òîáû
÷èñëà áîëüíûõ
áàëàíñèðîâàëèñü, ò.å. ÷èñëî áîëüíûõ,
ïîêàçàííîå íà íà÷àëî òåêóùåãî
äíÿ (ãð.
18) áûëî ðàâíî ñóììå ÷èñåë áîëüíûõ, ñîñòîÿâøèõ íà íà÷àëî
ïðåäûäóùåãî äíÿ (ãð. 5),
ïîñòóïèâøèõ (ãð. 6) è ïåðåâåäåííûõ (ãð.
11)
çà ìèíóñîì ÷èñåë, ïåðåâåäåííûõ â
äðóãèå îòäåëåíèÿ (ãð. 12),
âûïèñàííûõ (ãð. 13) è óìåðøèõ
(ãð. 17), ò.å.
÷èñëàì â ãð.
5 + 6 + 11 - 12 - 13 - 17 = ãð. 18.
Ïðèëîæåíèå N
3
ê
ïðèêàçó Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
Ìèíèñòåðñòâî çäðàâîîõðàíåíèÿ Ìåäèöèíñêàÿ äîêóìåíòàöèÿ
Ðîññèéñêîé Ôåäåðàöèè Ôîðìà N 016/ó-02
____________________________ Óòâåðæäåíà ïðèêàçîì
íàèìåíîâàíèå ó÷ðåæäåíèÿ Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
ÑÂÎÄÍÀß ÂÅÄÎÌÎÑÒÜ
ÄÂÈÆÅÍÈß ÁÎËÜÍÛÕ È ÊÎÅ×ÍÎÃÎ ÔÎÍÄÀ
ÏÎ ÑÒÀÖÈÎÍÀÐÓ,
ÎÒÄÅËÅÍÈÞ ÈËÈ ÏÐÎÔÈËÞ ÊÎÅÊ ÑÒÀÖÈÎÍÀÐÀ
ÊÐÓÃËÎÑÓÒÎ×ÍÎÃÎ
ÏÐÅÁÛÂÀÍÈß, ÄÍÅÂÍÎÃÎ ÑÒÀÖÈÎÍÀÐÀ
ÏÐÈ ÁÎËÜÍÈ×ÍÎÌ
Ó×ÐÅÆÄÅÍÈÈ (íóæíîå
ïîä÷åðêíóòü)
__________________ íàèìåíîâàíèå îòäåëåíèÿ,
ïðîôèëü êîåê _________
çà 20__ ãîä
---------------------------------------------------------------------------------------------------------------------------------
|
| ×èñëî êîåê â |Ñðåä-|Ñîñ- | Çà îò÷åòíûé ïåðèîä |Ñîñ- |Ïðîâå-| Êðîìå òîãî |
|
|ïðåäåëàõ
ñìåòû|íåìå-|òîÿëî|---------------------------------------------------------------|òîÿëî|äåíî |-------------|
|
|--------------|ñÿ÷- |áîëü-|
Ïîñòóïèëî áîëüíûõ
|Ïåðåâåäåíî| Âûïèñàíî áîëüíûõ
|óìåð-|áîëü-|áîëü- |÷èñëî |ïðîâå-|
|
|Âñåãî |Â ò.÷.|íûõ |íûõ
|--------------------------| áîëüíûõ
|-------------------|ëî
|íûõ |íûìè |êîéêî |äåíî |
|
|ôàêò. |ñâåð- |êîåê |íà |Âñå-|â
| èç íèõ |
âíóòðè |âñå-| â ò.÷.
| |íà |êîéêî |- äíåé|êîéêî |
|
|ðàçâåð-|íóòû | |íà÷à-|ãî |ò.÷.| (èç ãð. 6) | áîëüíèöû |ãî |--------------|
|êîíåö|- äíåé|çàêðû-|- äíåé|
|
|íóòûõ |íà ðå-| |ëî
| |èç |----------------+----------| |â
|â |ïå- | |îò-
|â |òèÿ |ïî
|
|
| |ìîíò |
|îò- | |äíå-|ñåëü-|0-17|60
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|
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|
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|
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|
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|äå- |ëåíèÿ| |íàð |íûé |â |
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|
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|
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| 4 | 5 | 6
| 7 | 8 | 9 | 10
| 11 | 12 | 13 | 14 | 15 | 16 |
17 | 18 | 19 |
20 | 21 |
|---------+-------+------+-----+-----+----+----+-----+----+-----+----+-----+----+----+----+----+-----+-----+------+------+------|
|ßíâàðü
| | |
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|Ôåâðàëü
| | |
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|Ìàðò
| | |
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|Àïðåëü
| | |
| | | | |
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| | | | |
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|Ìàé
| | |
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| | | | |
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|---------+-------+------+-----+-----+----+----+-----+----+-----+----+-----+----+----+----+----+-----+-----+------+------+------|
|Èþíü
| | |
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| | |
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|Èþëü
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|Àâãóñò
| | |
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|Ñåíòÿáðü | | | |
| | | | |
| | | | |
| | | | |
| |
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|Îêòÿáðü
| | |
| | | | |
| | | | |
| | | | |
| | |
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|Íîÿáðü
| | |
| | | | |
| | | | |
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|Äåêàáðü
| | |
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|çà
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| | | | |
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Ïîäïèñü
Ïðèëîæåíèå N
4
ê
ïðèêàçó Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
Ìèíèñòåðñòâî çäðàâîîõðàíåíèÿ Ìåäèöèíñêàÿ äîêóìåíòàöèÿ
Ðîññèéñêîé Ôåäåðàöèè Ôîðìà N 007äñ/ó-02
____________________________ Óòâåðæäåíà ïðèêàçîì
íàèìåíîâàíèå ó÷ðåæäåíèÿ Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
ËÈÑÒÎÊ
<*>
ÅÆÅÄÍÅÂÍÎÃÎ Ó×ÅÒÀ ÄÂÈÆÅÍÈß ÁÎËÜÍÛÕ È
ÊÎÅ×ÍÎÃÎ ÔÎÍÄÀ
ÄÍÅÂÍÎÃÎ ÑÒÀÖÈÎÍÀÐÀ ÏÐÈ ÀÌÁÓËÀÒÎÐÍÎ -
ÏÎËÈÊËÈÍÈ×ÅÑÊÎÌ
Ó×ÐÅÆÄÅÍÈÈ, ÑÒÀÖÈÎÍÀÐÀ ÍÀ
ÄÎÌÓ
___________________________________________________
íàèìåíîâàíèå îòäåëåíèÿ,
ïðîôèëÿ ìåñò
-----------------------------------------------------------------------------------------------------------
|
|Êîä|×èñëî |Ñðåä-|
Äâèæåíèå áîëüíûõ çà èñòåêøèå ñóòêè | íà íà÷àëî |Ñîñ- |Ïðî- |â ò.÷.|
|
| |ìåñò |íåìå-|--------------------------------------------------|
òåêóùåãî |òîÿëî|âåäå-|ñåëü- |
|
| |(ïàöè-|ñÿ÷- |ñîñ- | Ïîñòóïèëî áîëüíûõ | âûïèñàíî |óìåð-| äíÿ |áîëü-|íî |ñêèìè |
|
| |åíòî -|íûõ |òîÿëî|--------------------------| áîëüíûõ
|ëî |-----------|íûõ |áîëü-|æèòå- |
|
| |ìåñò |(ãî- |áîëü-|Âñå-|â |
èç íèõ |-----------| |
ñîñòîèò |íà |íûìè |ëÿìè |
|
| |â ñòà-|äî- |íûõ
|ãî |ò.÷.| (èç ãð. 6) |âñå-|â ò.÷.| | áîëüíûõ
|êîíåö|äíåé | |
|
| |öèîíà-|âûõ) |íà |
|èç |----------------|ãî |â êðó-|
|-----------|îò- |ëå÷å-| |
|
| |ðå íà |ìåñò |íà÷à-| |êðó-|ñåëü-|0-17|60 |
|ãëîñó-| |âñå-|â ò.÷.|÷åò-
|íèÿ | |
|
| |äîìó) | |ëî
| |ãëî-|ñêèõ |ëåò |ëåò è| |òî÷íûå| |ãî |ñåëü- |íîãî
| | |
|
| | | |èñ- |
|ñó- |æèòå-| |ñòàð-| |ñòàöè-| | |ñêèõ |ïåðè-|
| |
|
| | | |òåê- | |òî÷-|ëåé
| |øå |
|îíàðû | | |æèòå- |îäà | | |
|
| | | |øèõ |
|íûõ | | |
| | | | |ëåé
| | | |
|
| | | |ñóòîê| |ñòà-|
| | | | |
| | | | |
|
|
| | | |<*> |
|öèî-| | |
| | | | |
| | | |
|
| | | | |
|íà- | | |
| | | | |
| | | |
|
| | | | |
|ðîâ | |
| | | | |
| | |
| |
|------+---+------+-----+-----+----+----+-----+----+-----+----+------+-----+----+------+-----+-----+------|
|
1 | 2 | 3
| 4 | 5 | 6
| 7 | 8 | 9 | 10
| 11 | 12 | 13
| 14 | 15 | 16
| 17 | 18 |
|------+---+------+-----+-----+----+----+-----+----+-----+----+------+-----+----+------+-----+-----+------|
|------+---+------+-----+-----+----+----+-----+----+-----+----+------+-----+----+------+-----+-----+------|
|------+---+------+-----+-----+----+----+-----+----+-----+----+------+-----+----+------+-----+-----+------|
|------+---+------+-----+-----+----+----+-----+----+-----+----+------+-----+----+------+-----+-----+------|
|------+---+------+-----+-----+----+----+-----+----+-----+----+------+-----+----+------+-----+-----+------|
|------+---+------+-----+-----+----+----+-----+----+-----+----+------+-----+----+------+-----+-----+------|
|------+---+------+-----+-----+----+----+-----+----+-----+----+------+-----+----+------+-----+-----+------|
-----------------------------------------------------------------------------------------------------------
Äàòà _________ Ïîäïèñü ìåäèöèíñêîé ñåñòðû
_______________
--------------------------------
<*> Ïðè íåîáõîäèìîñòè ñâîäíûõ
ñâåäåíèé âîñïîëüçîâàòüñÿ ýòîé æå
ôîðìîé,
â ñâîäíîé ôîðìå óêàçàòü ìåñÿö,
ñðîê. Ïðè èñïîëüçîâàíèè
ôîðìû äëÿ äíåâíîãî ó÷åòà - â ãðàôå 1
ïåðå÷èñëèòü ïðîôèëè êîåê; äëÿ
ñâîäíîé âåäîìîñòè - ìåñÿöû ãîäà, à â ãðàôå 5 - "ñîñòîÿëî áîëüíûõ
íà íà÷àëî îò÷åòíîãî ïåðèîäà".
îáîðîòíàÿ
ñòîðîíà ô. N 007äñ/ó-02
-----------------------------------------------------------------------------------------------------------
|
Ôàìèëèÿ, È., Î. |â ò.÷. èç
êðóãëîñóòî÷íîãî| Ôàìèëèÿ, È., Î. |â ò.÷. â êðóãëîñóòî÷íûå |
|
ïîñòóïèâøèõ | ñòàöèîíàðà |
âûïèñàííûõ | ñòàöèîíàðû |
|--------------------------+-------------------------+---------------------------+------------------------|
|--------------------------+-------------------------+---------------------------+------------------------|
|--------------------------+-------------------------+---------------------------+------------------------|
|--------------------------+-------------------------+---------------------------+------------------------|
|--------------------------+-------------------------+---------------------------+------------------------|
|--------------------------+-------------------------+---------------------------+------------------------|
|--------------------------+-------------------------+---------------------------+------------------------|
|--------------------------+-------------------------+---------------------------+------------------------|
-----------------------------------------------------------------------------------------------------------
Ïðèëîæåíèå N
5
ê
ïðèêàçó Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
Ìèíèñòåðñòâî çäðàâîîõðàíåíèÿ Ìåäèöèíñêàÿ äîêóìåíòàöèÿ
Ðîññèéñêîé Ôåäåðàöèè Ôîðìà N 066/ó-02
____________________________ Óòâåðæäåíà ïðèêàçîì
íàèìåíîâàíèå ó÷ðåæäåíèÿ Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
ÑÒÀÒÈÑÒÈ×ÅÑÊÀß ÊÀÐÒÀ
ÂÛÁÛÂØÅÃÎ ÈÇ ÑÒÀÖÈÎÍÀÐÀ
ÊÐÓÃËÎÑÓÒÎ×ÍÎÃÎ ÏÐÅÁÛÂÀÍÈß,
ÄÍÅÂÍÎÃÎ ÑÒÀÖÈÎÍÀÐÀ ÏÐÈ
ÁÎËÜÍÈ×ÍÎÌ Ó×ÐÅÆÄÅÍÈÈ,
ÄÍÅÂÍÎÃÎ ÑÒÀÖÈÎÍÀÐÀ ÏÐÈ ÀÌÁÓËÀÒÎÐÍÎ -
ÏÎËÈÊËÈÍÈ×ÅÑÊÎÌ
Ó×ÐÅÆÄÅÍÈÈ, ÑÒÀÖÈÎÍÀÐÀ ÍÀ
ÄÎÌÓ
N ìåäèöèíñêîé êàðòû
________
1. Êîä ïàöèåíòà: <*> ____________________________ 2.
Ô.È.Î.: _________________________
3. Ïîë: ìóæ. - 1; æåí. - 2 4. Äàòà ðîæäåíèÿ _
_._ _._ _ _ _
5. Äîêóìåíò, óäîñòîâ. ëè÷íîñòü: íàçâàíèå,
ñåðèÿ, íîìåð _______________________________
6. Àäðåñ: ðåãèñòðàöèÿ ïî ìåñòó æèòåëüñòâà
____________________________________________
7. Êîä òåððèòîðèè ïðîæèâàíèÿ: ___ Æèòåëü:
ãîðîä - 1; ñåëî - 2.
8. Ñòðàõîâîé ïîëèñ (ñåðèÿ, íîìåð):
___________________________________________________
Âûäàí: êåì
__________________________________________________________ Êîä òåðð.: _ _ _
9. Âèä îïëàòû: ÎÌÑ - 1; Áþäæåò - 2;
Ïëàòíûå óñëóãè - 3; â ò.÷. ÄÌÑ -
4; Äðóãîå - 5.
10. Ñîöèàëüíûé ñòàòóñ: äîøêîëüíèê - 1: îðãàíèçîâàí - 2;
íåîðãàíèçîâàí - 3;
ó÷àùèéñÿ
- 4; ðàáîòàåò - 5; íå
ðàáîòàåò - 6; ÁÎÌÆ
- 7; ïåíñèîíåð - 8;
âîåííîñëóæàùèé - 9; Êîä _ _ _; ×ëåí ñåìüè
âîåííîñëóæàùåãî - 10.
11. Êàòåãîðèÿ ëüãîòíîñòè: èíâàëèä ÂÎÂ - 1;
ó÷àñòíèê ÂΠ- 2; âîèí - èíòåðíàöèîíàëèñò
- 3;
ëèöî, ïîäâåðãøååñÿ ðàäèàöèîííîìó îáëó÷åíèþ - 4; â
ò.÷. â ×åðíîáûëå - 5;
èíâ. I ãð. - 6; èíâ. II ãð. - 7; èíâ. III ãð. - 8; ðåáåíîê - èíâàëèä - 9;
èíâàëèä ñ äåòñòâà - 10; ïðî÷èå - 11.
12. Êåì íàïðàâëåí __________________ N
íàïð. ___________________ Äàòà: _ _._ _._ _ _ _
13. Êåì äîñòàâëåí
_____________________________ Êîä _ _ Íîìåð íàðÿäà _________________
14. Äèàãíîç íàïðàâèâøåãî ó÷ðåæäåíèÿ
__________________________________________________
______________________________________________________________________________________
15. Äèàãíîç ïðèåìíîãî îòäåëåíèÿ
______________________________________________________
______________________________________________________________________________________
16. Äîñòàâëåí â ñîñòîÿíèè îïüÿíåíèÿ:
<**> Àëêîãîëüíîãî - 1; Íàðêîòè÷åñêîãî - 2.
17. Ãîñïèòàëèçèðîâàí ïî ïîâîäó äàííîãî
çàáîëåâàíèÿ â òåêóùåì ãîäó:
ïåðâè÷íî - 1; ïîâòîðíî - 2; ïî
ýêñòðåííûì ïîêàçàíèÿì - 3; â ïëàíîâîì ïîðÿäêå - 4.
18. Äîñòàâëåí â ñòàöèîíàð îò
íà÷àëà çàáîëåâàíèÿ (ïîëó÷åíèÿ
òðàâìû): â ïåðâûå 6
÷àñîâ - 1; â òå÷. 7-24 ÷àñîâ - 2; ïîçäíåå
24-õ ÷àñîâ - 3.
19. Òðàâìà: - ïðîèçâîäñòâåííàÿ: ïðîìûøëåííàÿ - 1; òðàíñïîðòíàÿ - 2, â ò.÷.
ÄÒÏ - 3;
ñ/õîç - 4; ïðî÷èå - 5;
- íåïðîèçâîäñòâåííàÿ: áûòîâàÿ
- 6; óëè÷íàÿ - 7;
òðàíñïîðòíàÿ - 8,
â
ò.÷. ÄÒÏ - 9;
øêîëüíàÿ - 10; ñïîðòèâíàÿ
- 11; ïðîòèâîïðàâíàÿ òðàâìà
- 12;
ïðî÷èå - 13.
20. Äàòà ïîñòóïëåíèÿ â ïðèåìíîå îòäåëåíèå:
_._._ _ _ _ Âðåìÿ _ _. _ _
21. Íàçâàíèå îòäåëåíèÿ
____________________ Äàòà ïîñòóïëåíèÿ __________ Âðåìÿ _______.
Ïîäïèñü âðà÷à ïðèåìíîãî îòäåëåíèÿ
______________________ Êîä _ _
22. Äàòà âûïèñêè (ñìåðòè):_ _._ _._ _ _
_ Âðåìÿ _ _._ _
23. Ïðîäîëæèòåëüíîñòü ãîñïèòàëèçàöèè
(êîéêî - äíåé): _ _ _
24. Èñõîä ãîñïèòàëèçàöèè: âûïèñàí
- 1; â ò.÷. â
äíåâíîé ñòàöèîíàð - 2;
â êðóãëîñóòî÷íûé ñòàöèîíàð - 3; ïåðåâåäåí
â äðóãîé ñòàöèîíàð - 4;
24.1. Ðåçóëüòàò ãîñïèòàëèçàöèè: âûçäîðîâëåíèå - 1; óëó÷øåíèå - 2; áåç ïåðåìåí - 3;
óõóäøåíèå - 4; çäîðîâ - 5; óìåð - 6.
25. Ëèñòîê íåòðóäîñïîñîáíîñòè: îòêðûò _
_._ _._ _ _ _ çàêðûò:_ _._ _._ _ _ _
25.1. Ïî óõîäó çà áîëüíûì Ïîëíûõ ëåò: _ _ Ïîë: ìóæ. 1 æåí. 2
--------------------------------
<*> Èäåíòèôèêàöèîííûé íîìåð
ïàöèåíòà èëè èíîé, ïðèíÿòûé â ËÏÓ.
<**> Îïðåäåëåíèå ñîñòîÿíèÿ îïüÿíåíèÿ
îñóùåñòâëÿåòñÿ â
ñîîòâåòñòâèè ñ ïîðÿäêîì, óñòàíîâëåííîì
Ìèíçäðàâîì Ðîññèè.
26. Äâèæåíèå ïàöèåíòà ïî îòäåëåíèÿì:
----------------------------------------------------------------------------------------------
|N |
Êîä |Ïðîôèëü| Êîä | Äàòà
| Äàòà |Êîä äèàãíîçà| Êîä
| Êîä | Âèä
|
|
|îòäåëåíèÿ| êîåê
|âðà÷à|ïîñòóïëåíèÿ|âûïèñêè,| ïî
ÌÊÁ |ìåäèöèíñêîãî|ïðåðâàííîãî|îïëàòû|
|
| | |
| |ïåðåâîäà| | ñòàíäàðòà |
ñëó÷àÿ | |
|
| | |
| | <***> |
| <*> |
<**> | |
|--+---------+-------+-----+-----------+--------+------------+------------+-----------+------|
|1 |
2 | 3 | 4
| 5 | 6 |
7 | 8
| 9 | 10 |
|--+---------+-------+-----+-----------+--------+------------+------------+-----------+------|
|1.| | | | | | | |
| |
|--+---------+-------+-----+-----------+--------+------------+------------+-----------+------|
|2.| | | | | | | |
| |
|--+---------+-------+-----+-----------+--------+------------+------------+-----------+------|
|3.| | | | | | | |
| |
|--+---------+-------+-----+-----------+--------+------------+------------+-----------+------|
|4.| | | | | | | |
| |
|--+---------+-------+-----+-----------+--------+------------+------------+-----------+------|
|5.| | | | | | | |
| |
|--+---------+-------+-----+-----------+--------+------------+------------+-----------+------|
|6.| | | | | | | |
| |
----------------------------------------------------------------------------------------------
--------------------------------
<*> Ïðîñòàâëÿåòñÿ â ñëó÷àå
óòâåðæäåíèÿ â ñóáúåêòå Ðîññèéñêîé
Ôåäåðàöèè â óñòàíîâëåííîì ïîðÿäêå.
<**> Çàïîëíÿåòñÿ ïðè
èñïîëüçîâàíèè â ñèñòåìå îïëàòû.
<***> Ïðè
âûïèñêå, ïåðåâîäå èç îòäåëåíèÿ ðåàíèìàöèè óêàçàòü
âðåìÿ ïðåáûâàíèÿ â ÷àñàõ.
27. Õèðóðãè÷åñêèå îïåðàöèè
(îáîçíà÷èòü: îñíîâíóþ îïåðàöèþ,
èñïîëüçîâàíèå ñïåö.
àïïàðàòóðû):
----------------------------------------------------------------------------------------------
|Äàòà,|
Êîä | Êîä | Îïåðàöèÿ | Îñëîæíåíèå |Àíåñòåçèÿ| Èñïîëüç. ñïåö. | Âèä
|
| ×àñ
|õèðóðãà|îòäåëåíèÿ|----------------+----------------| <*> | àïïàðàòóðû |îïëàòû|
|
| |
|íàèìåíîâàíèå|êîä|íàèìåíîâàíèå|êîä| |-----------------|
|
|
| | | | | | |
|ýíä.|ëàçåð|êðèîã.| |
|-----+-------+---------+------------+---+------------+---+---------+----+-----+------+------|
|
1 | 2 | 3
| 4 | 5 | 6 | 7 |
8 | 9 | 10
| 11 | 12 |
|-----+-------+---------+------------+---+------------+---+---------+----+-----+------+------|
|
| | | | | | | |
| | | |
|-----+-------+---------+------------+---+------------+---+---------+----+-----+------+------|
|
| | | | | | | | |
| | |
|-----+-------+---------+------------+---+------------+---+---------+----+-----+------+------|
|
| | | | | | | | |
| | |
----------------------------------------------------------------------------------------------
--------------------------------
<*> Àíåñòåçèÿ: îáùàÿ - 1, ìåñòíàÿ
- 2.
----- -----
28. Îáñëåäîâàí: RW 1 ----- AIDS 2 -----
29. Äèàãíîç ñòàöèîíàðà (ïðè âûïèñêå):
------------------------------------------------------------------
|
Êëèíè÷åñêèé | Îñíîâíîå |Êîä|Îñëîæíåíèå|Êîä|Ñîïóòñòâóþùåå|Êîä|
|çàêëþ÷èòåëüíûé|çàáîëåâàíèå |ÌÊÁ| |ÌÊÁ| çàáîëåâàíèå |ÌÊÁ|
| |------------+---+----------+---+-------------+---|
| |
| | | | | |
|--------------+------------+---+----------+---+-------------+---|
|Ïàòîëîãî- | | |
| | | |
|àíàòîìè÷åñêèé | | | |
| | |
------------------------------------------------------------------
30.  ñëó÷àå ñìåðòè óêàçàòü îñíîâíóþ
ïðè÷èíó _________________________________________
________________________________________________________
êîä ïî ÌÊÁ __________________
31. Äåôåêòû äîãîñïèòàëüíîãî ýòàïà:
íåñâîåâðåìåííîñòü ãîñïèòàëèçàöèè - 1; íåäîñòàòî÷íûé
îáúåì êëèíèêî - äèàãíîñòè÷åñêîãî
îáñëåäîâàíèÿ - 2; íåïðàâèëüíàÿ òàêòèêà
ëå÷åíèÿ - 3;
íåñîâïàäåíèå äèàãíîçà - 4.
Ïîäïèñü ëå÷àùåãî âðà÷à
_______________________
Ïîäïèñü çàâåäóþùåãî îòäåëåíèåì
______________________
Ïðèëîæåíèå N
6
ê
ïðèêàçó Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
Ìåäèöèíñêàÿ äîêóìåíòàöèÿ
Ôîðìà N
14äñ
Óòâåðæäåíà ïðèêàçîì
Ìèíçäðàâà Ðîññèè
îò 30.12.2002 ã. N 413
------------------------------------------------------------------
| ÎÒÐÀÑËÅÂÎÅ
ÑÒÀÒÈÑÒÈ×ÅÑÊÎÅ ÍÀÁËÞÄÅÍÈÅ |
------------------------------------------------------------------
------------------------------------------------------------------
|
ÑÂÅÄÅÍÈß Î ÄÅßÒÅËÜÍÎÑÒÈ ÄÍÅÂÍÛÕ ÑÒÀÖÈÎÍÀÐÎÂ |
| ËÅ×ÅÁÍÎ - ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÎÃÎ Ó×ÐÅÆÄÅÍÈß |
| ÇÀ 20__ Ã. |
------------------------------------------------------------------
------------------------------------------------------- -------------------------
|
Ïðåäñòàâëÿþò: | Ñðîêè
| | Ôîðìà N 14äñ |
| | ïðåäñòàâëåíèÿ | -------------------------
|-------------------------------------+---------------|
|Ó÷ðåæäåíèÿ çäðàâîîõðàíåíèÿ, èìåþùèå | |
|äíåâíûå ñòàöèîíàðû âñåõ òèïîâ: | |
Óòâåðæäåíà
|- öåíòðàëüíîé ðàéîííîé (ãîðîäñêîé) |5 ÿíâàðÿ | ïðèêàçîì Ìèíçäðàâà
Ðîññèè
|
áîëüíèöå, ðàé(ãîð)çäðàâîòäåëó
| | îò ______ N ____
| | |
|öåíòðàëüíàÿ ðàéîííàÿ (ãîðîäñêàÿ) | |
-------------------------
|áîëüíèöà, ðàé(ãîð)çäðàâîòäåë îò÷åò | | | Ãîäîâàÿ |
|êàæäîãî ïîäâåäîìñòâåííîãî
ó÷ðåæäåíèÿ:| | -------------------------
|- îðãàíó óïðàâëåíèÿ çäðàâîîõðàíåíèåì |â
óñòàíîâëåííûå|
|
ñóáúåêòà Ðîññèéñêîé Ôåäåðàöèè
|ïîñëåäíèì ñðîêè|
|- òåððèòîðèàëüíîìó ôîíäó ÎÌÑ
ñóáúåêòà| |
|
Ðîññèéñêîé Ôåäåðàöèè
| |
| | |
|îðãàíû óïðàâëåíèÿ çäðàâîîõðàíåíèåì | |
|ñóáúåêòà Ðîññèéñêîé Ôåäåðàöèè, ãîðîä
| |
|ôåäåðàëüíîãî çíà÷åíèÿ: | |
|- Ìèíçäðàâó Ðîññèè |â óñòàíîâëåííûå|
| |ïîñëåäíèì ñðîêè|
-------------------------------------------------------
-------------------------------------------------------------------------------
|Íàèìåíîâàíèå îò÷èòûâàþùåéñÿ îðãàíèçàöèè
____________________________________ |
|-----------------------------------------------------------------------------|
|Ïî÷òîâûé àäðåñ
_____________________________________________________________ |
|-----------------------------------------------------------------------------|
| Êîä | Êîä (ïðîñòàâëÿåò îò÷èòûâàþùàÿñÿ îðãàíèçàöèÿ) |
|ôîðìû|-----------------------------------------------------------------------|
| ïî
|îò÷èòûâàþùåéñÿ| âèäà
|îòðàñëè|òåððèòîðèè|ìèíèñòåðñòâà|êîíòðîëüíàÿ|
|ÎÊÓÄ | îðãàíèçàöèè |äåÿòåëüíîñòè| ïî | ïî ÎÊÀÒÎ
|(âåäîìñòâà),| ñóììà |
|
| ïî ÎÊÏÎ |
ïî ÎÊÄÏ | ÎÊÎÍÕ | |
îðãàíà |(ñòð. 1-6) |
|
| | | | |
óïðàâëåíèÿ | |
|
| | | | | ïî ÎÊÎÃÓ
| |
|-----+--------------+------------+-------+----------+------------+-----------|
|
1 | 2 | 3
| 4 | 5 |
6 | 7
|
|-----+--------------+------------+-------+----------+------------+-----------|
|
| | | | | | |
-------------------------------------------------------------------------------
I. Îáùèå ñâåäåíèÿ
(1000) Äíåâíîé ñòàöèîíàð
ïðè áîëüíè÷íîì ó÷ðåæäåíèè ______ 1,
ìåñò ________ 2, ÷èñëî ñìåí _______
3; äíåâíîé ñòàöèîíàð ïðè
àìáóëàòîðíî - ïîëèêëèíè÷åñêîì ó÷ðåæäåíèè
______ 4, ìåñò _______ 5;
÷èñëî ñìåí ______ 6; ñòàöèîíàð íà äîìó
_______ 7, ìåñò _______ 8;
(1001) Äíåâíîé ñòàöèîíàð
ïðè áîëüíè÷íîì ó÷ðåæäåíèè äëÿ äåòåé
(0-17 ëåò) ______ 1, ìåñò ______ 2, ÷èñëî ñìåí _______ 3; äíåâíîé
ñòàöèîíàð ïðè àìáóëàòîðíî -
ïîëèêëèíè÷åñêîì ó÷ðåæäåíèè _______ 4,
ìåñò _______ 5, ÷èñëî ñìåí ______ 6;
ñòàöèîíàð íà äîìó ______ 7,
ìåñò _______ 8.
Ðàçäåë I. Èñïîëüçîâàíèå
êîå÷íîãî ôîíäà
(1100)
-----------------------------------------------------------------------------------------------------------------------------
| N
| Ïðîôèëü |
Äíåâíîé ñòàöèîíàð ïðè áîëüíè÷íîì
| Äíåâíîé ñòàöèîíàð ïðè àìáóëàòîðíî -
| Ñòàöèîíàð íà äîìó <***>
|
|ñòð.|
ìåñò | ó÷ðåæäåíèè <**> |
ïîëèêëèíè÷åñêîì ó÷ðåæäåíèè <***>
| |
|
| |--------------------------------------+--------------------------------------+--------------------------|
|
| |÷èñëî|÷èñëî|ïîñ-
|âû-|èç |â |ïðî- |÷èñëî|÷èñëî|ïîñ- |âû-|èç |â |ïðî-
|÷èñëî|âû-|â |â |ïðî- |
|
| |ìåñò
|ñðåä-|òóïè-|ïè-|íèõ |ò.÷. |âåäå-|ìåñò |ñðåä-|òóïè-|ïè-|íèõ |ò.÷. |âåäå-|ìåñò
|ïè-|ò.÷.|ò.÷. |âåäå-|
|
| | |íåãî-|ëî |ñà-|äå- |â |íî |
|íåãî-|ëî |ñà-|äå- |â |íî
| |ñà-|äå- |â |íî
|
|
| | |äîâûõ|áîëü-|íî |òåé |êðóã-|áîëü-| |äîâûõ|áîëü-|íî |òåé |êðóã-|áîëü-| |íî |òåé |êðóã-|áîëü-|
|
| | |ìåñò |íûõ | |(0- |ëîñó-|íûìè
| |ìåñò |íûõ |
|(0- |ëîñó-|íûìè | | |(0- |ëîñó-|íûìè |
|
| | |<*> | | |17
|òî÷- |äíåé | |<*> |
| |17 |òî÷- |äíåé | | |17
|òî÷- |äíåé |
|
| | |
| | |ëåò)|íûé |ëå÷å-| |
| | |ëåò)|íûé |ëå÷å-| |
|ëåò)|íûé |ëå÷å-|
|
| | |
| | | |ñòà- |íèÿ |
| | | | |ñòà- |íèÿ | | |
|ñòà- |íèÿ |
|
| | |
| | | |öèî- |<**>
| | | | |
|öèî- |<**> | | |
|öèî- |<**> |
|
| | |
| | | |íàð |
| | | | |
|íàð | | | |
|íàð | |
|
| | |
| | | |(èç |
| | | | |
|(èç | | | |
|(èç | |
|
| |
| | | | |ãð.
| | | | |
| |ãð. |
| | | |ãð. |
|
|
| | |
| | | |6) |
| | | | |
|13) | | | |
|18) | |
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
| 1
| 2 |
3 | 4 | 5 |
6 | 7 | 8 | 9 |
10 | 11 | 12 |13 |14 | 15
| 16 | 17 |18 | 19 | 20 | 21 |
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
|
|Âñåãî: | |
| | | | |
| | | | |
| | | | |
| | |
|
| â òîì ÷èñëå| |
| | | | |
| | | | |
| | | | |
| | |
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
|----+-------------+-----+-----+-----+---+----+-----+-----+-----+-----+-----+---+----+-----+-----+-----+---+----+-----+-----|
-----------------------------------------------------------------------------------------------------------------------------
--------------------------------
<*> Ïðè óòâåðæäåíèè ãðàôèêà ðàáîòû
äíåâíîãî ñòàöèîíàðà â 2
ñìåíû,
ïðè ðàñ÷åòå ñðåäíåãîäîâûõ ìåñò - îäíî
ìåñòî ñ÷èòàòü
ýêâèâàëåíòíûì äâóì ìåñòàì.
<**> Ñâåäåíèÿ çàïîëíÿþòñÿ íà
îñíîâå ô. N 016/ó-âð.
<***> Ñâåäåíèÿ çàïîëíÿþò íà
îñíîâå ô. N 007/äñ-âð (ñâîäíûé).
(1101) Èç ÷èñëà âûáûâøèõ: óìåðëî
â äíåâíîì ñòàöèîíàðå ïðè
áîëüíè÷íûõ ó÷ðåæäåíèÿõ ______ 1, ïðè
àìáóëàòîðíî - ïîëèêëèíè÷åñêîì
ó÷ðåæäåíèè _____ 2, ïðè äíåâíîì ñòàöèîíàðå
íà äîìó _______ 3.
(1102) Èç ÷èñëà âûáûâøèõ ñåëüñêèå
æèòåëè: â äíåâíîì ñòàöèîíàðå
ïðè
áîëüíè÷íûõ ó÷ðåæäåíèÿõ
_________ 1, ïðè àìáóëàòîðíî -
ïîëèêëèíè÷åñêîì ó÷ðåæäåíèè _______ 2, ïðè äíåâíîì
ñòàöèîíàðå íà
äîìó _______ 3.
Ðàçäåë II. Ñîñòàâ áîëüíûõ â
äíåâíîì ñòàöèîíàðå,
ñðîêè è èñõîäû
ëå÷åíèÿ
(18 ëåò è ñòàðøå)
(2000)
----------------------------------------------------------------------------------------------------------------
| |N
| Êîä |Äíåâíîé ñòàöèîíàð ïðè |Äíåâíîé ñòàöèîíàð ïðè | Ñòàöèîíàð íà äîìó |
| |ñòðî-|
ïî |áîëüíè÷íûõ ó÷ðåæäåíèÿõ| àìáóëàòîðíî - | |
| |êè
| ÌÊÁ Õ | | ïîëèêëèíè÷åñêèõ | |
| |
| | | ó÷ðåæäåíèÿõ |
|
| |
|
|----------------------+----------------------+----------------------|
| |
| |âûïè-|èç |ïðî- |óìåð-|âûïè-|èç |ïðî- |óìåð-|âûïè-|èç |ïðî- |óìåð-|
| |
| |ñàíî |íèõ |âåäå-|ëî |ñàíî |íèõ |âåäå-|ëî |ñàíî |íèõ |âåäå-|ëî |
| |
| |áîëü-|íà- |íî |
|áîëü-|íà- |íî | |áîëü-|íà- |íî | |
| |
| |íûõ |ïðà-|âûïè-| |íûõ |ïðà-|âûïè-| |íûõ
|ïðà-|âûïè-| |
| |
| | |âëå-|ñàí- | | |âëå-|ñàí- | |
|âëå-|ñàí- | |
| |
| | |íî
|íûìè | | |íî
|íûìè | | |íî
|íûìè | |
| |
| | |â
|áîëü-| | |â
|áîëü-| | |â
|áîëü-| |
| |
| | |êðó-|íûìè | | |êðó-|íûìè | |
|êðó-|íûìè | |
| |
| | |ãëî-|äíåé | | |ãëî-|äíåé | |
|ãëî-|äíåé | |
| |
| | |ñó- |ëå÷å-| | |ñó- |ëå÷å-| |
|ñó- |ëå÷å-| |
| | | |
|òî÷-|íèÿ | |
|òî÷-|íèÿ | |
|òî÷-|íèÿ | |
| |
| | |íûé | | | |íûé | | | |íûé | | |
| |
| | |ñòà-| | | |ñòà-| | | |ñòà-| | |
| |
| | |öèî-| | | |öèî-| | | |öèî-| | |
| |
| | |íàð | | |
|íàð | | |
|íàð | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
| 1
| 2 | 3 |
4 | 5 | 6 |
7 | 8 | 9 | 10
| 11 | 12 | 13 | 14
| 15 |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Âñåãî: |
1 |A00-T98| |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Èíôåêöèîííûå è ïàðàçèòàðíûå| 2
|À00-Â99| | |
| | | | |
| | | | |
|áîëåçíè |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Íîâîîáðàçîâàíèÿ | 3 |Ñ00-D48| | | |
| | | | |
| | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè êðîâè è | 4 |D50-D89| | | |
| | | | |
| | | |
|êðîâåòâîðíûõ îðãàíîâ |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Á-íè ýíäîêðèííîé ñèñòåìû, |
5 |Å00-Å90| |
| | | | |
| | | | |
|
|ðàññòðîéñòâà ïèòàíèÿ è |
| | |
| | | | |
| | | | |
|
|íàðóøåíèÿ îáìåíà â-â è ... | |
| | | | |
| | | | |
| | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Ïñèõè÷åñêèå ðàññòðîéñòâà è | 6
|F00-F99| | |
| | | | |
| | | | |
|ðàññòðîéñòâà ïîâåäåíèÿ |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè íåðâíîé ñèñòåìû |
7 |G00-G99| |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè ãëàçà è åãî |
8 |Í00-Í59| |
| | | | |
| | | | |
|
|ïðèäàòî÷íîãî àïïàðàòà |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè óõà è ñîñöåâèäíîãî | 9
|Í60-Í95| | |
| | | | |
| | | | |
|îòðîñòêà |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè ñèñòåìû | 10
|I00-I99| | |
| | | | |
| | | | |
|êðîâîîáðàùåíèÿ | | |
| | | | |
| | | | |
| |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè îðãàíîâ äûõàíèÿ | 11
|J00-J99| | |
| | | | |
| | | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè îðãàíîâ ïèùåâàðåíèÿ| 12 |Ê00-Ê93| | | |
| | | | |
| | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè êîæè è ïîäêîæíîé | 13
|L00-L99| | |
| | | | |
| | | | |
|êëåò÷àòêè |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè êîñòíî - ìûøå÷íîé | 14
|Ì00-Ì99| | |
| | | | |
| | | | |
|ñèñòåìû ... | |
| | | | |
| | | | |
| | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè ìî÷åïîëîâîé ñèñòåìû| 15 |N00-N99| | | |
| | | | |
| | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áåðåìåííîñòü, ðîäû è | 16
|Î00-Î99| | |
| | | | | | |
| | |
|ïîñëåðîäîâûé ïåðèîä |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Âðîæäåííûå àíîìàëèè ïîðîêè | 17 |Q00-Q99| | | |
| | | | |
| | | |
|ðàçâèòèÿ ... | | |
| | | | |
| | | | |
| |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Ñèìïòîìû, ïðèçíàêè è | 18
|R00-R99| | |
| | | | |
| | | | |
|îòêëîíåíèÿ îò íîðìû ... |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Òðàâìû, îòðàâëåíèÿ ...... | 19
|S00-T98| | |
| | | | |
| | | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Êðîìå òîãî ôàêòîðû, | 20
|Z00-Z99| | X |
| X | | |
| X | X | X
| X | X |
|âëèÿþùèå íà ñîñòîÿíèå |
| | |
| | | | |
| | | | |
|
|çäîðîâüÿ íàñåëåíèÿ è |
| | |
| | | | |
| | | | | |
|îáðàùåíèÿ â ó÷ðåæäåíèÿ |
| | |
| | | | |
| | | | |
|
|çäðàâîîõðàíåíèÿ | | |
| | | | |
| | | | |
| |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Îïåðèðîâàíî áîëüíûõ (èç | 21
| X | | |
X | | | |
X | | | |
X | |
|÷èñëà âûïèñàííûõ è óìåðøèõ)| |
| | | |
| | | | |
| | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|×èñëî ïðîâåäåííûõ îïåðàöèé | 22 |
X | | X | X
| X | | X |
X | X | | X
| X | X |
----------------------------------------------------------------------------------------------------------------
2001) Èç îáùåãî ÷èñëà âûïèñàííûõ
(ãð. 4, 8) - íàïðàâëåííûå
ÐÂÊ ___________ 1.
(2002) Ëèöà, ãîñïèòàëèçèðîâàííûå
äëÿ îáñëåäîâàíèÿ è
îêàçàâøèåñÿ çäîðîâûìè _______________ 1,
èç íèõ ïðèçûâíèêè
___________ 2.
Ñîñòàâ áîëüíûõ â äíåâíîì
ñòàöèîíàðå,
ñðîêè è èñõîäû ëå÷åíèÿ
<*>
(äåòè 0-17 ëåò
âêëþ÷èòåëüíî)
(2003)
----------------------------------------------------------------------------------------------------------------
| |N
| Êîä |Äíåâíîé ñòàöèîíàð ïðè |Äíåâíîé ñòàöèîíàð ïðè | Ñòàöèîíàð íà äîìó |
| |ñòðî-|
ïî |áîëüíè÷íûõ ó÷ðåæäåíèÿõ| àìáóëàòîðíî - |
|
| |êè
| ÌÊÁ Õ | | ïîëèêëèíè÷åñêèõ | |
| |
| | | ó÷ðåæäåíèÿõ |
|
| |
|
|----------------------+----------------------+----------------------|
| |
| |âûïè-|èç |ïðî- |óìåð-|âûïè-|èç |ïðî- |óìåð-|âûïè-|èç |ïðî- |óìåð-|
| |
| |ñàíî |íèõ |âåäå-|ëî |ñàíî |íèõ |âåäå-|ëî |ñàíî |íèõ |âåäå-|ëî |
| |
| |áîëü-|íà- |íî |
|áîëü-|íà- |íî | |áîëü-|íà- |íî | |
| |
| |íûõ |ïðà-|âûïè-| |íûõ |ïðà-|âûïè-| |íûõ
|ïðà-|âûïè-| |
| |
| | |âëå-|ñàí- | |
|âëå-|ñàí- | | |âëå-|ñàí- | |
| |
| | |íî
|íûìè | | |íî
|íûìè | | |íî
|íûìè | |
| |
| | |â
|áîëü-| | |â
|áîëü-| | |â
|áîëü-| |
| |
| | |êðó-|íûìè | | |êðó-|íûìè | |
|êðó-|íûìè | |
| |
| | |ãëî-|äíåé | | |ãëî-|äíåé | | |ãëî-|äíåé | |
| |
| | |ñó- |ëå÷å-| | |ñó- |ëå÷å-| |
|ñó- |ëå÷å-| |
| |
| | |òî÷-|íèÿ | | |òî÷-|íèÿ | | |òî÷-|íèÿ | |
| |
| | |íûé | | | |íûé | | | |íûé | | |
| |
| | |ñòà-| | | |ñòà-| | | |ñòà-| | |
| | | |
|öèî-| | |
|öèî-| | |
|öèî-| | |
| |
| | |íàð | | | |íàð | | | |íàð | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
| 1
| 2 | 3 |
4 | 5 | 6 |
7 | 8 | 9 | 10
| 11 | 12 | 13 | 14
| 15 |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Âñåãî: |
1 |A00-T98| |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Èíôåêöèîííûå è ïàðàçèòàðíûå| 2
|À00-Â99| | |
| | | | |
| | | | |
|áîëåçíè |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Íîâîîáðàçîâàíèÿ | 3 |Ñ00-Ñ48| | | |
| | | | |
| | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Á-íè êðîâè è êðîâåòâîðíûõ |
4 |D50-D89| |
| | | | |
| | | | |
|
|îðãàíîâ |
| | | | |
| | | | |
| | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Á-íè ýíäîêðèííîé ñèñòåìû, |
5 |Å00-Å90| |
| | | | |
| | | | |
|
|ðàññòðîéñòâà ïèòàíèÿ è |
| | |
| | | | |
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|
|íàðóøåíèÿ îáìåíà â-â è ... | |
| | | | |
| | | | |
| | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Ïñèõè÷åñêèå ðàññòðîéñòâà è | 6
|F00-F99| | |
| | | | |
| | | | |
|ðàññòðîéñòâà ïîâåäåíèÿ |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè íåðâíîé ñèñòåìû | 7 |G00-G99| | | |
| | | | |
| | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè ãëàçà è åãî |
8 |Í00-Í59| |
| | | | |
| | | | |
|
|ïðèäàòî÷íîãî àïïàðàòà |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè óõà è ñîñöåâèäíîãî | 9
|Í60-Í95| | |
| | | | |
| | | | |
|îòðîñòêà |
| | |
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| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè ñèñòåìû | 10
|I00-I99| | |
| | | | |
| | | | |
|êðîâîîáðàùåíèÿ | | |
| | | | |
| | | | |
| |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè îðãàíîâ äûõàíèÿ |
11 |J00-J99| | |
| | | | |
| | | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè îðãàíîâ ïèùåâàðåíèÿ| 12 |Ê00-Ê93| | | |
| | | | |
| | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Á-íè êîæè è ïîäêîæíîé |
13 |L00-L99| | |
| | | | |
| | | | |
|êëåò÷àòêè |
| | |
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| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè êîñòíî - ìûøå÷íîé | 14
|Ì00-Ì99| | |
| | | | |
| | | | |
|ñèñòåìû ... | | |
| | | | |
| | | | |
| |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áîëåçíè ìî÷åïîëîâîé ñèñòåìû| 15 |N00-N99| | | |
| | | | |
| | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Áåðåìåííîñòü, ðîäû è |
16 |Î00-Î99| | |
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|ïîñëåðîäîâûé ïåðèîä |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Îòäåëüíûå ñîñòîÿíèÿ, |
17 |Ð00-Ð96| | |
| | | | |
| | | | |
|âîçíèêàþùèå â ïåðèíàòàëüíîì| |
| | | | |
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| | |
|ïåðèîäå ... | | |
| | | | |
| | | | |
| |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Âðîæäåííûå àíîìàëèè ïîðîêè | 18 |Q00-Q99| | | |
| | | | |
| | | |
|ðàçâèòèÿ... | |
| | | | |
| | | | |
| | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Ñèìïòîìû, ïðèçíàêè è |
19 |R00-R99| | |
| | | | |
| | | | |
|îòêëîíåíèÿ îò íîðìû ... |
| | |
| | | | |
| | | | |
|
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Òðàâìû, îòðàâëåíèÿ ...... | 20
|S00-T98| | |
| | | | |
| | | | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Êðîìå òîãî ôàêòîðû, |
21 |Z00-Z99| | X |
| X | | |
| X | X | X
| X | X |
|âëèÿþùèå íà ñîñòîÿíèå |
| | |
| | | | |
| | | | |
|
|çäîðîâüÿ íàñåëåíèÿ è |
| | |
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|
|îáðàùåíèÿ â ó÷ðåæäåíèÿ |
| | |
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|
|çäðàâîîõðàíåíèÿ | | |
| | | | |
| | | | |
| |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|Îïåðèðîâàíî áîëüíûõ (èç |
22 | X |
| | X | |
| | X | |
| | X | |
|÷èñëà âûïèñàííûõ è óìåðøèõ)| |
| | | | |
| | | | |
| | |
|---------------------------+-----+-------+-----+----+-----+-----+-----+----+-----+-----+-----+----+-----+-----|
|×èñëî ïðîâåäåííûõ îïåðàöèé | 23 |
X | | X | X
| X | | X |
X | X | | X
| X | X |
----------------------------------------------------------------------------------------------------------------
(2004) Èç îáùåãî ÷èñëà âûïèñàííûõ
(ãð. 4, 8) - íàïðàâëåííûå
ÐÂÊ ___________ 1.
(2005) Ëèöà, ãîñïèòàëèçèðîâàííûå
äëÿ îáñëåäîâàíèÿ è
îêàçàâøèåñÿ çäîðîâûìè _______________ 1,
èç íèõ ïðèçûâíèêè
___________ 2.
Âèäû îïëàòû
(4000)
-----------------------------------------------------------------------------------
|
Âèä | N | ×èñëî âûáûâøèõ áîëüíûõ | ×èñëî äíåé ëå÷åíèÿ, ïðîâåäåííîå |
|îïëàòû |ñòðîêè| (âûïèñàíî + óìåðëî)
| âûáûâøèìè èç äíåâíîãî ñòàöèîíàðà |
|ëå÷åíèÿ| | | (âûïèñàíî + óìåðëî)
|
|
|
|-------------------------------+----------------------------------|
|
| | ïðè
| ïðè | íà |
ïðè | ïðè
|íà äîìó|
|
| |ñòàöèîíàðå| àìáóëàòîðíî -
|äîìó|ñòàöèîíàðå|àìáóëàòîðíî - | |
|
| | |ïîëèêëèíè÷åñêèõ| |
|ïîëèêëèíè÷åñêèõ| |
|
| | |
ó÷ðåæäåíèÿõ | |
| ó÷ðåæäåíèÿõ |
|
|-------+------+----------+---------------+----+----------+---------------+-------|
|
1 | 2 | 3
| 4 | 5
| 6 | 7 |
8 |
|-------+------+----------+---------------+----+----------+---------------+-------|
|ÎÌÑ
| 1 | | | | | | |
|-------+------+----------+---------------+----+----------+---------------+-------|
|áþäæåò |
2 | | | |
| | |
|-------+------+----------+---------------+----+----------+---------------+-------|
|ïëàòíîå|
3 | | | |
| | |
|â òîì
| | | | | | | |
|÷èñëå
| | | | | | | |
|-------+------+----------+---------------+----+----------+---------------+-------|
|ÄÌÑ
| 4 | | | | | | |
-----------------------------------------------------------------------------------
Ðóêîâîäèòåëü îðãàíèçàöèè
_________________
Äîëæíîñòíîå ëèöî,
îòâåòñòâåííîå çà ñîñòàâëåíèå ôîðìû
_____________________
Íîìåð òåëåôîíà _________________ Äàòà ___________