Electronic medical references

2020

Date of start of issue of medical references in electronic form

Since January 1, 2020 medical certificates and the conclusions in Russia will be issued in electronic form along with paper carriers. It is said in the order of the Russian Ministry of Health registered in Ministry of Justice at the beginning of December of the 2020th.

In the explanatory note it is told that for obtaining the digital medical document will need to create the request electronically signed with use the strengthened qualified electronic signature or the simple electronic signature by means of the portal of state services or through IT systems of the medical organization.

Since January 1 medical references in the Russian Federation will be issued in electronic form

Medical documents in that order will have to be provided at the consent of the patient or his legal representative and also make sure the strengthened qualified electronic signature of the medic. The electronic document will be sent to a personal account of the citizen on the portal of state services.

The references issued in electronic form may contain the following data:

• about the fact of the request of the patient for medical care;
• about rendering medical care to the patient in the medical organization;
• about the fact of passing by the patient of medical examination, medical examinations, physical examination and (or) treatment, routine medical examination or medical examination;
• about presence (absence) at the patient of a disease, results of physical examination and (or) treatment;
• about release from visit of educational and other organizations, implementation of separate types of activity, study in connection with a disease, a status;
• about existence (absence) of medical indications or medical contraindications for application of methods of physical examination and (or) treatment, sanatorium treatment, visit of educational and other organizations, implementation of separate types of activity, study;
• about the preventive inoculations which are carried out to the patient;
• about existence (absence) of contact with sick infectious diseases;
• about release of the donor from work in day of blood donation and its components and also in day of the physical examination connected with it;
• other data concerning the state of health of the patient and rendering medical care to the patient in the medical organization.^[1]

The Russian Ministry of Health permitted to issue references and the medical conclusions in an electronic format

At the end of July, 2020 the Russian Ministry of Health submitted the order which department permits references and the medical conclusions electronically.

References and medical certificates are made out (form) in any form … and can be issued on paper carrier and (or) with the consent of the patient or his legal representative in electronic form using the strengthened qualified electronic signature, the document says.

References and medical certificates in the form of electronic documents are issued to citizens or their legal representatives at the personal address or on demand.

References may contain data, in particular, on the fact of the request of the citizen for medical care, about rendering the help in the medical organization to it, about existence or absence of diseases, about the inoculations which are carried out to the citizen and about existence or lack of contact with infected. Medical certificates should be issued in time, not exceeding 3 working days after the end of medical actions.

The Russian Ministry of Health permitted issue of references and medical conclusions in an electronic format

Besides, at execution of medical certificates in the organizations rendering mental health, narcological, medical care to HIV-positive citizens special printings, stamps or electronic signatures without indication of a profile of medical aid can be used.

Acceptance of a new order is caused by introduction of amendments to the law "About Bases of Protection of Public Health" regarding introduction of the concept "telemedicine technologies". The Ministry of Health updated the Order of issue by the medical organizations of references and medical certificates. The similar document of 2012 will soon become invalid.

It is not the first initiative about transition of medical institutions to electronic document management. The law on electronic sick leave notes existing since 2017 allocates paper and digital formats with equal legal force. According to the government decree, in case of a quarantine incapacity allowances are granted and paid only on the basis of the electronic sick-list.^[2]

Notes