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Lecture theme:Lecture theme:«Medical labour examination» «Medical labour examination»

The lecturer д.м.н. G.M.Muldaeva The lecturer д.м.н. G.M.Muldaeva

Discipline «The general medical practice»Discipline «The general medical practice»

Speciality 051301 «the General medicine»Speciality 051301 «the General medicine»

Course 5 Course 5

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The lecture purpose: The lecture purpose: Acquaint students with Acquaint students with organizational bases and problems of medical organizational bases and problems of medical labour examination .labour examination .

The lecture plan: The basic concepts MLE: medical criterion, work capacity, the

time invalidity, proof invalidity, the clinical forecast, the labour forecast, physical inability.

Organisation MLE principles. Problems MLE. Technique MLE. ВН and its kinds. The documentation certifying time invalidity.

The indication to delivery of a leaf of invalidity. Proof disability. The reasons. The characteristic of groups of

physical inability. Duties of the attending physician in questions of examination of

work capacity. The work and function VKK organisation.

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The concepts reflecting The concepts reflecting essence of examination of essence of examination of work capacitywork capacity

Object of researchObject of research Work capacityWork capacity InvalidityInvalidity Physical inabilityPhysical inability

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Work capacityWork capacity

The socially-legal category reflecting The socially-legal category reflecting ability of the person to work, defined ability of the person to work, defined by level of its physical and spiritual by level of its physical and spiritual development, and also a state of development, and also a state of health, professional knowledge, health, professional knowledge, ability and experienceability and experience

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Criteria of examination Criteria of examination Work capacityWork capacity

The medicalThe medical– The diagnosis of degree of The diagnosis of degree of

infringements, weight of illness, infringements, weight of illness, декомпенсация, complicationsдекомпенсация, complications

The social The social – The organisation, periodicity and The organisation, periodicity and

work rhythm, loading, working work rhythm, loading, working conditions, professional harmconditions, professional harm

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Work capacity classificationWork capacity classification

Трудоспособность

По специализации По функциональности

Общая

Профессиональная

Полная

Частичная

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Work capacity on specialisationWork capacity on specialisation

Work capacity the generalWork capacity the general– Ability of the person to Ability of the person to

неквалифицированному in usual неквалифицированному in usual conditionsconditions

Work capacity professional Work capacity professional – Ability of the worker to work by the trade Ability of the worker to work by the trade

or another, to it equalor another, to it equal

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Work capacity on functionalityWork capacity on functionality

Work capacity full the generalWork capacity full the general– Ability to perform not qualified work Ability to perform not qualified work

in normal working conditions in normal working conditions Work capacity the full professionalWork capacity the full professional

– Ability to carry out all labour Ability to carry out all labour functions by a trade or posts in functions by a trade or posts in those conditions where the worker those conditions where the worker workedworked

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Work capacity partialWork capacity partial Work capacity the general partialWork capacity the general partial

– Ability of the worker to carry out in the limited Ability of the worker to carry out in the limited volume or the facilitated conditions the volume or the facilitated conditions the qualified workqualified work

Work capacity the professional partialWork capacity the professional partial– Ability to professional or Ability to professional or

неквалифицированному, remained at the неквалифицированному, remained at the persons who have transferred disease or a persons who have transferred disease or a mutilation, the worker can carry out labour mutilation, the worker can carry out labour operations on the qualification or equal to itoperations on the qualification or equal to it

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InvalidityInvalidity

It is impossibility owing to It is impossibility owing to medical or social contra-medical or social contra-indications to continue indications to continue habitual professional workhabitual professional work

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Kinds of invalidity depending on degree Kinds of invalidity depending on degree of its lossof its loss

Invalidity fullInvalidity full– The condition at which the person owing to The condition at which the person owing to

disease or a mutilation cannot perform disease or a mutilation cannot perform work and needs a special modework and needs a special mode

Invalidity partialInvalidity partial– Condition at which the person without Condition at which the person without

infringement of process of treatment, infringement of process of treatment, without damage to health can perform without damage to health can perform former work, but not in full volume or in former work, but not in full volume or in the facilitated conditionsthe facilitated conditions

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Standard documentsStandard documents Rules of delivery to citizens of sheet and Rules of delivery to citizens of sheet and

the invalidity inquirythe invalidity inquiry The order of Republic Kazakhstan MZ from The order of Republic Kazakhstan MZ from

October, 23rd, 2010 N 556. October, 23rd, 2010 N 556. About the statement of the List of kinds of About the statement of the List of kinds of

diseases at which term of time invalidity diseases at which term of time invalidity can be established more than two monthscan be established more than two months

The governmental order of Republic Kazakhstan The governmental order of Republic Kazakhstan from August, 7th, 2000 N 1213from August, 7th, 2000 N 1213

Law РК «About social security of invalids in Law РК «About social security of invalids in Republic Kazakhstan» Republic Kazakhstan»

Law РК «About health protection» Law РК «About health protection» The law «About system public health services» The law «About system public health services»

(04.06.2003г.) (04.06.2003г.)

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Principles of the organisation of medical Principles of the organisation of medical labour examinationlabour examination

The first principle – The first principle – The state character. The state character. ВТЭ carry out uniform state structures to which ВТЭ carry out uniform state structures to which

the right the decision of all questions connected the right the decision of all questions connected with invalidity - treatment-and-prophylactic with invalidity - treatment-and-prophylactic establishments of system Ministry of Health and establishments of system Ministry of Health and some other establishments of the ministries and some other establishments of the ministries and departments is necessary. Questions of proof departments is necessary. Questions of proof invalidity solve МСЭК, being all without an invalidity solve МСЭК, being all without an exception under the authority of the Ministry of exception under the authority of the Ministry of Social Welfare. The decision of these questions of Social Welfare. The decision of these questions of examination of work capacity is spent according examination of work capacity is spent according to the legislative and instructive installations to the legislative and instructive installations confirmed by the higher state, trade-union confirmed by the higher state, trade-union bodies.bodies.

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The second principle – The second principle – Preventive Preventive direction. The main task of medical labour direction. The main task of medical labour examination is as much as possible fast examination is as much as possible fast restoration of work capacity, preventive restoration of work capacity, preventive maintenance of decrease in work capacity maintenance of decrease in work capacity and physical inability prevention.and physical inability prevention.

The third principle The third principle – Collective nature in – Collective nature in the decision of all questions of the decision of all questions of examination of work capacity. It is reached examination of work capacity. It is reached by participation in it simultaneously by participation in it simultaneously several experts, and also representatives several experts, and also representatives of public organisations, administration, of public organisations, administration, etc.etc.

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Problems of medical labour Problems of medical labour examinationexamination

The scientifically-proved estimation a work The scientifically-proved estimation a work capacity condition at various diseases, capacity condition at various diseases, traumas;traumas;

Studying of the reasons of physical inability;Studying of the reasons of physical inability; The establishment of the scientifically-The establishment of the scientifically-

proved labour recommendations allowing proved labour recommendations allowing them is effective and with advantage for them is effective and with advantage for health to participate in socially useful work;health to participate in socially useful work;

Definition of indications to various kinds of Definition of indications to various kinds of the social help: pensions, to prosthetics, the social help: pensions, to prosthetics, regenerative treatment, the right to regenerative treatment, the right to reception of motor vehicles and other reception of motor vehicles and other privileges.privileges.

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Categories of persons to which are Categories of persons to which are authorised to give out invalidity sheetauthorised to give out invalidity sheet

Stand out to the persons occupied Stand out to the persons occupied on any work on any work

To citizens at which invalidity or To citizens at which invalidity or holiday on pregnancy and sorts holiday on pregnancy and sorts have come during monthly term have come during monthly term after dismissal from work for good after dismissal from work for good reasonsreasons

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Categories of persons which does not Categories of persons which does not stand outstand outInvalidity sheetInvalidity sheet

The military man of all categories, employee КНБ The military man of all categories, employee КНБ and the Ministry of Internal Affairsand the Ministry of Internal Affairs

To the persons who are carrying out short-term To the persons who are carrying out short-term and odd jobs for private employersand odd jobs for private employers

The pupil of all categories (schoolboys and The pupil of all categories (schoolboys and students etc.), and also to post-graduate students etc.), and also to post-graduate students, магистрантам and to residentsstudents, магистрантам and to residents

Idle, discharged from office and not consisting on Idle, discharged from office and not consisting on the account in territorial bodies of work and the account in territorial bodies of work and population employmentpopulation employment

To the persons who are in custody or on To the persons who are in custody or on compulsory treatment by definition of courtcompulsory treatment by definition of court

For the period of invalidity which is necessary for For the period of invalidity which is necessary for holiday without maintenance preservationholiday without maintenance preservation

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Category of persons which does not Category of persons which does not stand outstand out Invalidity sheet Invalidity sheet For the period of carrying out of medical inspections of For the period of carrying out of medical inspections of

workers and serving certain tradesworkers and serving certain trades For inspection in the conditions of a hospital at an appeal For inspection in the conditions of a hospital at an appeal

on military serviceon military service For a finding under arrest and forensic medical examination For a finding under arrest and forensic medical examination

carrying outcarrying out For inspection in out-patient conditions or in a hospitalFor inspection in out-patient conditions or in a hospital To workers and the employees who have deliberately To workers and the employees who have deliberately

harmed the health for the purpose of evasion from work or harmed the health for the purpose of evasion from work or other duties, or pretending to be sick (simulator)other duties, or pretending to be sick (simulator)

To the persons which time invalidity has come at the To the persons which time invalidity has come at the traumas received in a condition of alcoholic or narcotic traumas received in a condition of alcoholic or narcotic intoxicationintoxication

To the persons which time invalidity has come owing to the To the persons which time invalidity has come owing to the traumas received at fulfilment by them of crimestraumas received at fulfilment by them of crimes

To persons, at treatment of chronic alcoholism, a To persons, at treatment of chronic alcoholism, a narcotism, not complicated by other frustration and narcotism, not complicated by other frustration and diseases diseases

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The medical workers who do not have the The medical workers who do not have the rights of delivery of sheets of invalidityrights of delivery of sheets of invalidity

Medical workers of stations (branches) of Medical workers of stations (branches) of the first help the first help

Receptions of hospitals Receptions of hospitals Blood transfusionsBlood transfusions Forensic medical examination Forensic medical examination

establishmentsestablishments бальнеогрязелечебниц and city resort бальнеогрязелечебниц and city resort

water mud bathswater mud baths Rest houses, tourist basesRest houses, tourist bases Establishments of sanitary-and-Establishments of sanitary-and-

epidemiologic supervision epidemiologic supervision

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The reasons time The reasons time InvalidityInvalidity

DiseasesDiseases Accident Accident Sanatorium treatment and medical Sanatorium treatment and medical

rehabilitationrehabilitation Quarantine Quarantine Pregnancy and childbirthPregnancy and childbirth Prosthetics Prosthetics

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Invalidity sheet on leaving Invalidity sheet on leaving For the patient does not stand outFor the patient does not stand out

For chronic patients in remissionFor chronic patients in remission In the next holiday and holiday without In the next holiday and holiday without

maintenance preservationmaintenance preservation In holiday on pregnancy and sortsIn holiday on pregnancy and sorts In partial paid holiday on care of the In partial paid holiday on care of the

child child

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The work and function ВКК The work and function ВКК organisationorganisation

ВКК it will be organised in treatment-and-prophylactic ВКК it will be organised in treatment-and-prophylactic establishments (hospitals, out-patient-polyclinic establishments (hospitals, out-patient-polyclinic establishments). establishments).

Chairman ВКК – the unique constant committee-man, Chairman ВКК – the unique constant committee-man, the others change depending on disease of the person the others change depending on disease of the person presented on the commission. presented on the commission.

The head physician or the assistant to the head The head physician or the assistant to the head physician on medical work can be the chairman of the physician on medical work can be the chairman of the commission. commission.

If in medical institution there is only one expert, for If in medical institution there is only one expert, for example, the neuropathologist the second member example, the neuropathologist the second member ВКК is the therapist or managing therapeutic branch. ВКК is the therapist or managing therapeutic branch.

If necessary on ВКК corresponding experts of given or If necessary on ВКК corresponding experts of given or other medical institution can be invited. other medical institution can be invited.

On ВКК patients go the attending physician managing On ВКК patients go the attending physician managing branch.branch.

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The schedule of work The schedule of work VKKVKK is defined by is defined by loading, features of the given medical loading, features of the given medical institution and made so that the maximum institution and made so that the maximum possibility of representation of patients on possibility of representation of patients on VKKVKK with the attending physician and with the attending physician and managing branch was provided. managing branch was provided. Expediently sessions Expediently sessions VKKVKK to spend not less to spend not less often than 3 times a week or daily, often than 3 times a week or daily, including Saturday days, on a joint including Saturday days, on a joint II--IIII Changes or under the sliding schedule.Changes or under the sliding schedule.

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The work and function ВКК The work and function ВКК organisationorganisation

Consulting workConsulting work Control over validity of delivery and Control over validity of delivery and

sick-list prolongation.sick-list prolongation. Delivery and sick-list prolongation Delivery and sick-list prolongation Direction on МСЭКDirection on МСЭК Employment on conclusion ВККEmployment on conclusion ВКК Delivery of conclusions ВКК on various Delivery of conclusions ВКК on various

questionsquestions

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Examination by a rack Examination by a rack Invalidity Invalidity

Long either constant invalidity or the Long either constant invalidity or the considerable restriction of work considerable restriction of work capacity caused by chronic disease (a capacity caused by chronic disease (a trauma, anatomic defect), led to trauma, anatomic defect), led to considerable infringement of function considerable infringement of function of an organism. Depending on of an organism. Depending on disability degree physical inability is disability degree physical inability is establishedestablished

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Definition of concept of physical Definition of concept of physical inabilityinability

Physical inability – Physical inability – Degree of Degree of restriction of ability to live of the restriction of ability to live of the person owing to infringement of person owing to infringement of health with proof frustration of health with proof frustration of functions of an organism.functions of an organism.

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Definition Definition II Physical inability groups Physical inability groups

II The physical inability group characterises the The physical inability group characterises the higher degree of disability.higher degree of disability.

The basis for an establishment of the first group of The basis for an establishment of the first group of physical inability is sharply expressed restriction physical inability is sharply expressed restriction of ability to live caused by diseases, of ability to live caused by diseases, consequences of traumas, the congenital defects consequences of traumas, the congenital defects leading sharply expressed social дезадаптации leading sharply expressed social дезадаптации owing to impossibility of training, dialogue, owing to impossibility of training, dialogue, orientation, control over the behaviour, orientation, control over the behaviour, movement, self-services, participation in labour movement, self-services, participation in labour activity if the specified infringements cause activity if the specified infringements cause constant extraneous leaving, the help or constant extraneous leaving, the help or supervision.supervision.

At maintenance with means of indemnification of At maintenance with means of indemnification of anatomic defects or the broken functions of an anatomic defects or the broken functions of an organism, creation of special working conditions organism, creation of special working conditions on manufacture or in-home performance of some on manufacture or in-home performance of some kinds of work is possible.kinds of work is possible.

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Definition Definition IIII Physical inability groups Physical inability groups

IIII The physical inability group characterises considerably The physical inability group characterises considerably expressed degree of infringement of the functions, expressed degree of infringement of the functions, almost full invalidity (only at not many invalids almost full invalidity (only at not many invalids possibility to work in specially created conditions possibility to work in specially created conditions remains). Invalids remains). Invalids IIII Groups keep ability to self-service Groups keep ability to self-service and do not need constant extraneous leaving (the help, and do not need constant extraneous leaving (the help, supervision).supervision).

The basis for an establishment of the second group of The basis for an establishment of the second group of physical inability is sharply expressed restriction of physical inability is sharply expressed restriction of ability to live caused by diseases, consequences of ability to live caused by diseases, consequences of traumas, the congenital defects which are not traumas, the congenital defects which are not demanding constant extraneous leaving or the help, but demanding constant extraneous leaving or the help, but leading expressed social дезадаптации owing to leading expressed social дезадаптации owing to sharply expressed difficulty of training, dialogue, sharply expressed difficulty of training, dialogue, orientation, control over the behaviour, movement, orientation, control over the behaviour, movement, self-service, participation in labour activity or not self-service, participation in labour activity or not possibility of labour activity, but at creation specially possibility of labour activity, but at creation specially created a working condition and maintenance with created a working condition and maintenance with indemnification means in cases of anatomic defects indemnification means in cases of anatomic defects probably performance of separate kinds of work on probably performance of separate kinds of work on manufacture or in-home. manufacture or in-home.

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Definition Definition IIIIII Physical inability groups Physical inability groups

III III The physical inability group characterises The physical inability group characterises partial disability. Invalids partial disability. Invalids IIIIII Groups can Groups can and should work, and МСЭК takes out it and should work, and МСЭК takes out it the labour recommendation which the labour recommendation which contains the conclusion about conditions contains the conclusion about conditions and character of the work shown to and character of the work shown to invalids on a state of health.invalids on a state of health.

The basis for definition The basis for definition IIIIII Physical inability Physical inability groups considerable decrease in work groups considerable decrease in work capacity owing to the infringements of capacity owing to the infringements of functions of an organism caused by functions of an organism caused by chronic diseases or anatomic defects is. chronic diseases or anatomic defects is.

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Contingents of persons, subjectsContingents of persons, subjectsTo survey in МСЭКTo survey in МСЭК

Workers, employees and citizens on whom the state Workers, employees and citizens on whom the state social insurance extendssocial insurance extends

Pupils of the higher, average educational institutions, Pupils of the higher, average educational institutions, courses on a professional training, post-graduate courses on a professional training, post-graduate students, clinical internsstudents, clinical interns

Citizens at whom work capacity infringement has arisen Citizens at whom work capacity infringement has arisen in connection with performance of the state duties or a in connection with performance of the state duties or a debt of the citizen on rescue of human life, on protection debt of the citizen on rescue of human life, on protection of state ownership and the state law and orderof state ownership and the state law and order

The workers serving, stopped work, the former military The workers serving, stopped work, the former military men, the members of the families who have lost the men, the members of the families who have lost the supporter, at presence at them the rights to pension supporter, at presence at them the rights to pension appointmentappointment

Invalids since the childhoodInvalids since the childhood Members of a family of idle pensioners for an extra Members of a family of idle pensioners for an extra

charge establishment to pension charge establishment to pension

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The workers serving, sustained injuries or other The workers serving, sustained injuries or other damage of health connected with their work, for damage of health connected with their work, for an establishment of degree of disability with a an establishment of degree of disability with a view of definition of the size of compensation by view of definition of the size of compensation by the enterprises of the caused damage, disability the enterprises of the caused damage, disability degree is defined in percentage termsdegree is defined in percentage terms

Farmers and members of their familiesFarmers and members of their families Invalids for re-examinationInvalids for re-examination Invalids since the childhood Invalids since the childhood II And And IIII Groups and Groups and

other persons not having the rights to pension other persons not having the rights to pension and addressing for appointment of the grant, the and addressing for appointment of the grant, the right, to which reception is caused by physical right, to which reception is caused by physical inability presence inability presence

The persons directed to nursing homes and a The persons directed to nursing homes and a boarding schoolboarding school

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The literatureThe literature

Rules of delivery to citizens of sheet and the invalidity Rules of delivery to citizens of sheet and the invalidity inquiryinquiry

The order of Republic Kazakhstan MZ from October, 23rd, The order of Republic Kazakhstan MZ from October, 23rd, 2010 N 556. 2010 N 556.

About the statement of the List of kinds of diseases at About the statement of the List of kinds of diseases at which term of time invalidity can be established more than which term of time invalidity can be established more than two monthstwo months

The governmental order of Republic Kazakhstan from The governmental order of Republic Kazakhstan from August, 7th, 2000 N 1213August, 7th, 2000 N 1213

Law РК «About social security of invalids in Republic Law РК «About social security of invalids in Republic Kazakhstan» Kazakhstan»

Law РК «About health protection» Law РК «About health protection» The law «About system public health services» The law «About system public health services»

(04.06.2003г.)(04.06.2003г.)

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QuestionsQuestions

What medical критериWhat medical критериAndAnd ВТЭ? ВТЭ? In what difference of time invalidity In what difference of time invalidity

from proof invalidity?from proof invalidity? What is the clinical forecast? What is the clinical forecast? What is the labour forecast?What is the labour forecast? What functions ВКК? What functions ВКК? How many physical inability groups How many physical inability groups

allocate?allocate?