World patient safety day

Patient Safety is a fundamental principle of medical care.

Each type, form and condition of medical care is accompanied by certain risks for patients.

Undesirable events in the course of medical activities can occur as a result of any medical interventions, even if they are performed correctly (regardless of whether they are diagnostic, therapeutic or rehabilitative).

improving patient safety requires comprehensive solutions within the healthcare system -a wide range of measures to improve the organization of activities, including infection control, safe use of medicines and medical devices, safe clinical practice and safe conditions for care.

Safety of medical activity is the absence of preventable harm, risks of its occurrence and(or) the degree of reduction of permissible harm to the life and health of citizens, medical and pharmaceutical workers, and the environment when performing medical activities.

At the same time, an important component is not only the safety of patients, but also the safety of medical workers. This is particularly important when organizing medical care in the context of a pandemic, as a guarantee of stable and effective work of medical organizations.

Everyone strives to provide quality and safe medical care,and yet, according to the world health organization, who:

• undesirable events caused by unsafe medical care are one of the top 10 causes of death and disability worldwide;

• harm caused by a number of undesirable events can be prevented in almost 50% of cases;

* worldwide, 4 out of 10 patients are harmed in primary and outpatient care;

• non-compliance with safety rules during surgical care is the cause of complications in almost 25% of patients;

• in the Organization for economic cooperation and development (OECD) member countries, 15% of all hospital costs and workloads are a direct result of undesirable events.

The results of Roszdravnadzor inspections also indicate problems in ensuring the safety of medical care provided.

So, in 2019, within the framework of state control of quality and safety of medical activities conducted 5895 inspections, during which revealed 3064 cases of violation of rights of citizens in the field of health, 1998 violations of orders of medical care, 1952 violations of orders for medical examinations, inspections and examinations, 143 violations of the organization and implementation of departmental and 2320 violations of the organization and implementation of internal control of the quality and safety of medical activities.

Recognizing patient safety as a key health priority,the world health Assembly, at its 72nd session, adopted resolution WHA72.6 "Global action for patient safety"on may 25, 2019, and declared September 17 as world patient safety day.

the goal of world patient safety day is to raise global awareness of patient safety and encourage international solidarity in actions aimed at improving patient safety and reducing harm to patients around the world, both the professional community, patients themselves, their relatives, and various organizations representing the interests of patients.

on September 17, 2020, the Ministry of health of the Russian Federation, together with Roszdravnadzor and in cooperation with the who representative office in Russia, planned events dedicated to the world patient safety day.

Key message of this year's world patient safety day: "Speak out in support of health workers 'safety!"

ensuring the maximum level of health security is an urgent task on a national scale, which requires the joint efforts of all stakeholders, including state, departmental, and public (including patient)organizations.

As part of the world patient safety day in 2020 in the Russian Federation, it is planned to:

• holding the all-Russian Olympiad on safety in healthcare - to identify the level of competence in various areas of ensuring the safety of medical activities;

• interactive voting for patients and medical professionals on current issues of patient safety, the purpose of which is to analyze awareness of priority issues related to safety in receiving and providing medical care;

• holding the regional stage of the all-Russian competition "quality Leader in healthcare" - the competition is held for teams of healthcare professionals who have implemented successful projects aimed at improving the quality and safety of medical activities;

• holding thematic press conferences and briefings on patient safety with the participation of who representatives in the Russian Federation, representatives of the Ministry of health of the Russian Federation, Roszdravnadzor, health authorities of the Russian Federation, as well as leading medical, scientific and educational organizations in the field of health;

* conducting thematic events dedicated to the world patient safety day: interactive workshops, lectures, thematic meetings, "open days" and other events, including initiatives to draw the attention of patients and their relatives to the issues of responsibility for their own health.

we are confident that world patient safety day will draw public attention to safety issues, encourage joint work of all stakeholders, and serve as a basis for developing programs to improve the safety and quality of life and health of citizens in the Russian Federation.

All events within the framework of the world patient safety day can be held under the slogan "patient safety Culture-everyone's responsibility!"

For all questions related to the preparation and support of events dedicated to the world patient safety day, we recommend contacting the contact center of the Federal state budgetary institution"national Institute of quality" of Roszdravnadzor by phone +7(495)980-29-35 (EXT. 0) or e-mail info@nqi-russia.ru.

Information and methodological materials, as well as an interactive map of events planned within the framework of the world patient safety day in the regions of the Russian Federation are available on the website of the Federal state budgetary institution "national Institute of quality" of Roszdravnadzorhttp://nqi-russia.ru/ in the "world patient safety day" section.

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Prevention of myocardial infarction

"There are no wrinkles on the heart, but only scars"

(Sidonia Gabrielle Colette)

Myocardial Infarction - is a cardiovascular disaster that leads to the death of any part of the heart muscle. Death (necrosis) of part of the myocardium occurs as a result of acute cessation of blood supply and, accordingly, oxygen starvation of the heart tissue. "Infarctus" - in Latin means "stuffed, stuffed, stuffed". What kind of filling are we talking about? This is a blood clot that accidentally broke off from the wall of a large vessel or an atherosclerotic plaque that clogged the lumen of the coronary artery (the artery that supplies blood to the heart muscle). Myocardial necrosis - the process is not reversible, a scar is subsequently formed at the site of damage. This leads to the fact that the heart will never be able to perform its function at the same level.

Myocardial Infarction life-threatening condition. According to world statistics, the death rate at the pre-hospital stage is at least 50%, that is, the disease proceeds so quickly that every second patient dies before the arrival of doctors. Complications are also very dangerous, both early and late, and they account for another 30% of deaths.

According to who statistics, mortality due to cardiovascular diseases is in the first place among all other causes. Among them, myocardial infarction takes the first place, it is the cause of death in 4.2 million people every year – this is 47% of the total death statistics. Men of working age from 35 to 50 years are 50 times more likely to have a heart attack than women who have a peak incidence during the menopause, after fifty years. However, "female heart attacks" are more likely to end in death 53% versus 43% of "male heart attacks".

It is Extremely important to form a lifestyle so as to minimize the risk of myocardial infarction. It is important to know that there are risk factors that we cannot influence,such as male gender,old age, heredity (close relatives have already suffered a stroke or myocardial infarction). However, there are factors that can and should be influenced by changing your lifestyle and following all your doctor's recommendations. These risk factors include Smoking, overweight, high blood pressure, high blood sugar and cholesterol levels,hypodynamia, and alcohol abuse.

In the first place in the prevention of cardiovascular disasters are regular and reasonable aerobic physical training, which gradually leads to the opening and formation of additional small vessels that improve blood supply to the heart muscle. In a significant number of cases, this will avoid the risk of developing a myocardial infarction, improve the tolerance of physical activity, and thus improve the quality of life of a person. The load should be training, it is individual for each person, and it can be determined with the help of a specialist who can help find out individual resistance to physical exertion. Physical training should be regular and systematic

It Should be understood that people who smoke have a myocardial infarction about 10 years earlier than non-smokers. Unfortunately, passive smokers also have twice the risk of dying from heart disease than other people. In people who smoke, blood density increases, platelets more easily form clots and blood clots, inflammatory processes in the arteries are provoked, the inner layer of the arteries is damaged, thereby accelerating the formation of atherosclerotic plaques on the walls of the arteries, as well as reducing the strength of plaques already available. Arterial vessels, "feeders" of organs, in smokers narrow, their walls become less malleable, the movement of blood in them slows down. It is also proven that the heart muscle itself is affected in smokers. One cigarette smoked increases the heart rate by 8-10 beats per minute, and yet it is proven that it is necessary to reduce the heart rate to the desired limits, which doctors achieve by taking certain medications.

It is Extremely important to monitor blood pressure figures, which should be less than 140/90 mmHg. At high blood pressure, the arteries gradually thicken, they are tense, prone to micro-damage, and cholesterol easily penetrates the walls of the arteries, forming atherosclerotic plaques. The heart muscle, which has already suffered, works with an additional load, overcoming the additional resistance of blood vessels, while getting tired and wearing out.

It is equally important to determine your blood sugar level. In diabetes, as a rule, initially there is an excess of insulin in the blood, and later an excess of glucose is added. The body's cells lose their ability to perceive insulin. Excess insulin and glucose contribute to the development of atherosclerosis. The arteries thicken, become less elastic, and the blood becomes more viscous, less fluid, and clots form faster, creating all the conditions for the development of a myocardial infarction.

In the absence of a healthy diet and inactivity, a person inexorably increases the volume of adipose tissue, which requires additional nutrition, creates an excessive load on the heart. Fat deposits raise the diaphragm, restrict the movement of the chest, interfere with the heart. An excess of carbohydrate and fatty foods in the food leads to increased insulin production, carbohydrates are converted into fats, and the amount of fatty acids increases, thereby creating all the conditions for the formation of atherosclerotic plaques. It is not surprising that obese people have a myocardial infarction 4 times more often. Obesity, diabetes, high levels of lipids in the blood all these are sometimes links in a "single chain reaction", which is usually based on an incorrect lifestyle.

Joining one risk factor for each new one increases the risk of myocardial infarction exponentially: four, nine, and so on. The output is not complicated...

Prevention of atherosclerosis and myocardial infarction consists largely in the normalization of cholesterol levels. But it is not enough to change the diet. We must remember that most of the cholesterol in our body does not come with food, but is formed in the liver. Therefore, the diet is not a panacea. In the 80-ies of the last century, new drugs appeared in medicine - statins. These products help lower cholesterol.

These drugs reduce the risk of heart attack not only by lowering cholesterol levels, but also by using additional mechanisms. For example, they reduce inflammation of the arteries, slow down atherosclerotic processes, strengthen the tires of the atherosclerotic plaque, and so on. You should not cancel any medications yourself without consulting your doctor. But only because a friend said "that it is harmful".

There is no Doubt that a favorable psychological state of a person is a necessary condition for success. Walking in the fresh air, contemplation of flowers and forests, healthy sleep will help to acquire a harmonious state. All this creates an excellent base for normalization of blood PRESSURE, strengthens the necessary skills for a healthy lifestyle.

Be healthy and remember, Your heart beats not only for You!

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Stroke prevention

Stroke is an acute disorder of cerebral circulation, characterized by the appearance of neurological symptoms that persist for more than 24 hours or lead to the death of the patient at an earlier date.

Stroke ranks third in the mortality rate of the population.

There are 2 types of stroke - ischemic and hemorrhagic.

The cause of ischemic stroke is thrombus formation, clots of blood substances enter the vessels of the brain and cause clogging. The cause of hemorrhagic stroke in 80% of cases is arterial hypertension.

Stroke is easier to prevent than to deal with complications and death, and for this it is necessary to fight risk factors:

  1. Arterial hypertension is the most significant risk factor for stroke. You should try to reach a blood pressure level below 140/90 mm Hg. In patients with diabetes or renal insufficiency - below 130/90 mm Hg. Therapy is selected by a general practitioner, cardiologist. It is necessary to constantly take antihypertensive therapy and regularly monitor blood pressure. It is better to keep a diary, then it will be easier for you and your doctor to adjust the dose of the drug.
  2. Atrial fibrillation is a risk factor for stroke and is the most common rhythm disorder hearts. For atrial fibrillation, aspirin or oral anticoagulants are recommended to prevent stroke.
  3. Diabetes mellitus - increases the risk of stroke by 1.5 times. Strict control of blood sugar, adherence to diet, in combination with antihyperglycemic drugs or insulin is necessary.
  4. Lipid disorders - statin use reduces the risk of stroke by 24%. Currently, statins are recommended for all patients with coronary artery disease and dyslipidemia.
  5. Smoking - increases the risk of stroke by 1.5-2 times. Stopping smoking leads to a decrease in the risk of stroke after 2-4 years. Now there is an active promotion of a healthy lifestyle and a life without smoking. Cigarette packs are printed with horrifying pictures, BUT don't forget about secondhand smoke. One hour in a smoky room is equal to smoking 10 cigarettes. And one hour of hookah smoking is equal to smoking 100 cigarettes. It's never too late to quit smoking, think about it!
  6. Alcohol abuse - alcohol restriction has been proven to reduce systolic and diastolic blood pressure by 3 and 2 mm Hg, respectively. A complete rejection of alcohol in a month by 7.3 / 6.5 mm Hg.
  7. Fight obesity - Eat a healthy, balanced diet. It has been proven that abdominal obesity is considered the most dangerous. Avoid drastic weight loss. Proper nutrition should be a way of life.
  8. Physical inactivity - regular exercise reduces the risk of stroke. The loads should be dynamic (swimming, walking, jogging). Exercise should be started with a minimum load, gradually increasing it. The regularity of classes and the instructor's control are important, at least in the first 5-10 classes. When increasing the load, you should pay attention to health, sleep, appetite, body weight.
  9. Get medical check-ups annually - don't self-medicate!

In prevention, medical literacy of the population is important, because danger often lies in wait for us when we are at home, at work or just walking down the street.

What to look out for if a stroke is suspected?

There is a simple text FACE-HAND-SPEECH.

If:

  • The patient cannot smile. The corner of the mouth is down.
  • The patient cannot raise two hands
  • The patient cannot pronounce his name

Call an ambulance urgently, it is important to hospitalize the patient in the first 3-4 hours after the onset of stroke symptoms.

Doctor-neurologist Makieva K.S.

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Cavigioli – the challenge of our time. How to cope and live a full life?

Hungry for a rest, after  two months of inactivity forced a break in work, my colleagues and I are ready to provide new programs of rehabilitation and treatment.

Many people in his life experienced a sense of fear. Millions of people around the world experience a panic fear of the coronavirus and are taking unprecedented security measures and precautions. Person captured the fear of Contracting mers are struggling to evaluate and establish which situations are dangerous and life-threatening.

Where to find help?

to cope with bouts of fear of this new coronavirus infection is almost impossible.

Many make the right decision. In order to break the vicious circle of thoughts and worries, and at least for a while to get out of the situation - going out of town closer to nature, to the resort. This allows you to disconnect from worries and improve your health.

the Sanatorium "Beautiful", balneo – climatic resort, located in the heart of the Belgorod land. Pine  boron, crystal water of the river Vorskla, sandy beach,  squeaky  clean  the air, saturated with oxygen – all this creates an unforgettable atmosphere of natural harmony and man-made beauty.

Psychotherapy is the beauty that cheer up, and back down the disease is not just a slogan, it is practiced in the sanatorium method.

Not surprisingly, improvement of  patients with diseases of the heart, bronchi, lungs, and nervous system occurs in the first days of stay in a sanatorium. Customers who suffer from fear of Contracting coronavirus, in the REGIONAL "Sanatorium "Beautiful" is doctors and psychologists. 

Terms  of our resorts ensure the best use of therapies and successfully implement psychological intervention programmes. In addition, tourists included additional  factor – the place of the usual  situation that gives a new resource and the opportunity to get out of the "vicious circle" of thoughts and concerns significantly increases the efficiency of the methods of psychotherapy and psychocorrection.

We consider the active nature of psychotherapy, a combination of her holiday factors.

the resort has several well-equipped offices for psychotherapy and psycho-correction work with the tourists. The room of psychological unloading, a sensory room, allow psychocorrection group sessions with different groups of people, including those with kovalevojj and fear of Contracting coronavirus.

Offices for individual work with the client  is always ready to welcome tourists with its comfort and coziness. Experienced and competent professionals develop and implement psychotherapeutic and psycho-correction programs for different groups of people. But in today's reality, special attention is paid to the vacationers with diseases of the  respiratory and fear of getting sick.

One  of  the best methods of increasing stress resistance and counteraction of cavitatii is psychological self-regulation. It is based on the use of various psychological techniques to achieve a state of neuromuscular relaxation, relaxation. The most famous are: progressive muscle relaxation, autogenic training, breathing relaxation training. From our experience we can say that the complex effect of these methods gives excellent results, which is very important to prevent stress and fear of Contracting coronavirus, choke and stop breathing.

Breathing – relaxation method will include elements of meditation techniques that help to reduce the level of anxiety and tension among tourists.

auditory training is an effective alternative to tranquilizers and sleeping pills drugs. It not only helps in a great way the treatment of any chronic condition, but also is one of the most effective "antidote" from  stress and sex.

the resort operates a sensory room, which resembles a "life raft". Psycho sessions in the sensory room to remove the disturbing neurotic experiences, fears, to create an emotionally calm state, to intensify  tourists, to cause a pleasant and even aesthetically significant experiences.

In the sanatorium "Beautifully" perfectly built system of education with the tourists. Each camper should take away from sanatorium precious gift – the knowledge and skills of caring for their welfare.

guests of the institution systematically psychologists and doctors give lectures on healthy lifestyle and disease prevention. Conducted interviews, regular roundtable meeting with doctors and psychologists, organized a psychological lecture.

the Sanatorium "Beautiful has a wonderful cinema room where you can view and discuss popular science, documentary films about health. And in a situation coronavirus infection we picked up a quality lineup of popular scientific and documentary films on human health that will expand the horizons  tourists and will help to cope with kovalevojj.

health resort Wellness programs significantly enhance the therapeutic effect of conventional medical procedures and prescriptions, which allows travelers in the short term to deal effectively with the problems of fear coronavirus infection.

the Search for peace of mind and enjoyment of life and oneself is achievable as for a person.

Vasilchenko, Lydia V.,

psychologist, of REGIONAL "Sanatorium "Beautiful"

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How to prevent the FLU

Coming cold season is a traditional time of growth in the incidence of ARI and INFLUENZA.

Flu – acute respiratory viral infection that has a worldwide distribution, affects all age group people.

the Flu and SARS are 95% of all infectious diseases.

How do you get infected?

Getting on the mucous membrane of the upper respiratory tract, the virus is introduced in their epithelial cells, enters the bloodstream and causes intoxication. The conditions for activation of other types of bacteria, and penetrate from the outside, the new bacteria that cause secondary infection – pneumonia, bronchitis, otitis, aggravation of chronic diseases can affect the heart, joints.

Who is the source of the infection?

the Only source and distributor of infection is a sick person. The main way of the spread of flu viruses from person to person is droplet infection when talking, coughing, sneezing. The spread of influenza viruses may occur and contact-household by failure to comply with the sick person and the surrounding individuals the rules of personal hygiene, including the use of care items (towel, handkerchiefs, utensils, etc.), not subjected to treatment and disinfection. It must be remembered that the infection is easily transmitted through dirty hands. Special observations have shown that the hands up to 300 times contact with discharge from nose and eyes, with saliva. When shaking hands, using doorknobs, and other objects moving on the hands healthy and thence to him in the nose, eyes, mouth.

what is the flu?

In typical cases the disease begins abruptly: fever up to 38-40 degrees, there is a fever, severe headache, dizziness, pain in the eyeballs and muscles, watery eyes, and pain in the eyes.

What to do if you got sick?

At the first symptoms should consult a doctor. Rest and follow all the doctor's recommendations. Self-treatment for the flu is unacceptable. Indeed, to predict the course of influenza is impossible, and complications can be very different.

HOW to PROTECT YOURSELF FROM the FLU?

the Most effective means in preventing influenza is vaccination. The vaccine everyone needs people who care about their health and the health of others. 70-80% of Teens were vaccinated employees in the team create immune layer, which protects against flu. Timely vaccination reduces the incidence of influenza several times, softens the disease, shorten its duration, prevent complications. A flu shot is best done in October-November, when the epidemic had not yet begun. The immune system is produced in about 2 weeks. Vaccinating during the epidemic also effective, however, in the period before the development of immunity (7-15 days after vaccination) should be prevented by other means.

it Must be remembered that any drug in the treatment of flu side effects, which are not comparable to the allowable reactions to the vaccine. In addition, prophylactic antiviral medication must be taken during the whole period of the epidemic that prolonged use reduces their effectiveness and contributes to the formation of resistant forms of the virus.

  • it is Recommended to increase the protective forces of the body: physical exercise, eat right, on time and to get enough rest, take vitamin-mineral complexes.
  • Regularly and carefully to wash hands with soap and water, especially after coughing or sneezing. Alcohol for cleaning hands also effective.
  • Avoid touching your hands to your nose and mouth. The infection spreads in this way.
  • Cover your mouth and nose with a disposable handkerchief when sneezing or coughing. After use throw the handkerchief into the wastebasket.
  • Use individual or disposable towels.
  • try to avoid close contact with people with flu-like symptoms (possible to keep them at a distance of approximately 1 meter).
  • Regularly ventilate the room, do wet cleaning.
  • how to avoid hypothermia and overheating.
  • During an epidemic of influenza and SARS, it is not recommended to use public transport and walk-in guests.
  • in the flu and colds, stay home, call a physician. To avoid possible contact with other family members, wear a medical mask, follow the rules of personal hygiene. It is necessary not to infect others or spread any viral infection.

it Should be remembered that the observance of all the measures of prevention will protect against flu and its adverse effects.

Our health is in our hands

Always and at all times the problem with nutrition was relevant. From time to time in magazines, TV,  the Internet is increasingly dredge up too many new-fangled diets, the effectiveness of which is supported by interviews or photographs of famous personalities. In fact, diet is only a temporary restriction in the diet, which was sure to happen sooner or later breakdown. To avoid this make far more sense just to go to a proper and healthy lifestyle. What is proper nutrition?  the number  of the rules, in the observance of which , not only can achieve the desired results in the transformation, as well as to prevent many diseases such as coronary heart disease, diabetes mellitus type 2, obesity, hypertension, arthritis, gastritis and many other diseases.

the basics of proper nutrition following:

  1. the Food should not be a cult. Food is a way to sustain the body, but neither a source of joy and even more happiness.
  2. Products should be fresh and natural. Should try to eat only freshly prepared foods.
  3. Balanced diet. the Diet should include all the available food groups (proteins, fats, carbohydrates), it's best to replace and not to exclude any of the groups.
  4. Frequent meals in moderate amounts. the Best feeding schedule is three main meals and two snacks. You need to eat every three to four hours, and preferably at the same time and same amount of servings. For a snack it is better to prefer fruits, dried fruits. Not snacking on chips, crackers, sweet biscuits, sandwiches or chocolates.
  5. Correct drinking regime. A day on average we should consume at least 1.5-2 liters. it is Also very important when you're drinking water. Best of all, if it is for 20-30 minutes before meal or an hour or two after eating.
  6. dietary Restrictions. Should be possible to eat low fat, limit or eliminate the consumption of sugar, alcohol, salt, to give up chips, soda, mayonnaise, ketchup, sausages and pastry products.
  7. Variety in food. There is no one universal product, which would contain all necessary for our body nutrients. Therefore, the variety of products ensures that the body receives all necessary nutrients.
  8. Seasonal food. Try to consume seasonal products, they have more benefits and vitamins.
  9. Method of cooking. first eliminate fried, spicy, smoked food. Better if it is boiled or steamed food. Also a good option — the food is baked in the oven. And, of course, the best option is a fresh food which has not undergone heat treatment.
  10. Read the labels on products in supermarkets. Be careful, pay attention to the composition of the products and their shelf life. Try to choose more natural products, without additives and artificial flavor.
  11. Daily caloric. Follow calorie a day diet – calories consumed must be exactly as many "burned" by the body per day.
  12. And, of course, physical activity. This is very important! If you have no time for gym or any physical exercise, just start to move more! Walk often, walk the stairs, do Nordic walking. Daily loads must be at least 40 minutes.

Keeping  these simple rules, You'll not only feel comfortable and cheerful, but also increase his health. Eat right!

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The procedure for recognizing a person disabled

"Rules of recognition of disabled persons", approved by decree of the Government of the Russian Federation of 20.02.2006 №95.

Medico-social examination of the citizen is held to the Bureau of residence (by place of residence, at the location of pension business of the invalid who have left for permanent residence outside the Russian Federation).

Medical-social examination can be carried out home in the case that a citizen cannot be at the Bureau of health, which supported the conclusion of the organisation providing therapeutic care, or in hospital where a person is on treatment, or in absentia by the decision of the appropriate office.

Medico-social examination is carried out at the request of a citizen (his legal representative).

the Application is submitted to the Bureau in writing with a direction on mediko-social examination, issued by the organization that provides therapeutic care (body responsible for the provision of pensions, body of social protection of the population), and medical documents confirming the violation of health.

Medico-social examination is carried out by specialists of the Bureau by examination of the citizen, studying of the submitted documents, analysis of social, vocational, psychological and other data of the citizen.

the Decision on recognition of the citizen the invalid or about refusal in recognition of its disabled by a simple majority of votes of the specialists who conducted medico-social examination, on the basis of the discussion of results of medico-social examination.

In cases requiring necessary additional tests in the medical, rehabilitation organizations, obtaining the opinion of the chief of the Bureau, request the necessary information, examination conditions and character of professional activity, social situation of a citizen, can be accounted for by a programme of additional surveys, which are communicated to the citizen in an intelligible form.

After receiving data provided by the program additional tests, experts shall decide on the recognition of the citizen by the disabled person or the refusal of the recognition it invalid.

In case of failure of the citizen (his legal representative) of additional examination and submission of the required documents, the decision on recognition of the citizen by the disabled person or the refusal of recognition its invalid is accepted on the basis of the available data.

For the citizens recognized as disabled, specialists of the Bureau conducting medico-social examination, an individual program of rehabilitation or habilitation (INRA), which is approved by the head of the relevant Bureau.

the Citizen recognized as the invalid (its lawful representative), issued the certificate confirming the fact of establishment of disability, as well as YPRES disabled person (a disabled child).

the Citizen are not recognized as disabled at his request issued a certificate of results of medico-social examination.

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