Examination of temporary incapacity for work (ETI)

 

The organization and conduct of ETI is carried out in accordance with the requirements of current legislation, in particular the Regulations on ETI, the Instructions on the Procedure for Issuing Documents Certifying the Temporary Incapacity of Citizens, approved by the Order of the Ministry of Health of November 13, 2001 No. 455 (hereinafter - Instructions No. 455), as well as the Instructions on the Procedure filling in the disability sheet, approved by the order of the Ministry of Health of Ukraine, the Ministry of Labor and Social Policy of Ukraine, the Social Insurance Fund for Temporary Disability, the Social Insurance Fund against Industrial Accidents and Occupational Diseases of Ukraine dated 03.11.2004 No. 532/274/136 -os/1406.

 

I. Tasks of ETI

1. Establishing the fact of temporary incapacity for work (hereinafter - TI), determining its terms, providing recommendations on appropriate working conditions for patients who do not have a disability group, but need, temporarily or permanently, special working conditions due to their health.
2. Conducting a complete and timely examination, treating patients and providing appropriate recommendations.
3. Resolving the issue of referring patients to a medical and social expert commission if they have a persistent or irreversible disease, an unfavorable labor prognosis, regardless of the period of temporary incapacity, in case of long-term temporary incapacity within the terms specified by Instruction No. 455.
4. Resolution of the issue of referral to the MSEC of insured persons from among former employees of the Ukrainian Armed Forces, in the presence of data confirming a persistent violation of body functions caused by diseases, consequences of injuries (related to the completion of service in the Ukrainian Armed Forces or related to the performance of official duties ), which cause restrictions on vital activities. 

 

II. Levels of conducting ETI

1.  the first - treating doctor;
2. the second - the head of the specialized department, the deputy head of the hospital (with a polyclinic) from the polyclinic division of work and ETI;
3. the third - medical and advisory commission (hereinafter - MAC);
4. the fourth is the head of the MAC

 

III. The procedure for conducting ETI by levels

1. First level.

Treating doctor:

1. Resolves the issue of issuing documents certifying the TI of citizens in case of illness or injury, for the care of a sick family member, a sick child, a disabled child under the age of 18 in the event of illness of the mother or another person who cares for the child, when quarantine based on the data of a comprehensive medical examination of the patient, taking into account the degree of functional disorders of organs and systems, the nature and course of the pathological process, working conditions.
2. Issues a document certifying the TI of citizens to persons who are found to be unable to work when visiting their homes.
3. Together with the head of the specialized department, issues documents certifying the TI of citizens for the period of treatment in the hospital.
4. Displays in the medical records of the outpatient (inpatient) patient complaints, history, including insurance (for the last 12 months), objective examination data, additional examination methods and other information that is the basis for determining the diagnosis and issuing documents certifying TI citizens, a list of necessary medical and health-improving measures, consultations in accordance with the standards of medical technologies of the medical and diagnostic process and protocols for the provision of medical care by specialty, the recommended regimen; the number of the document certifying the TI, the date from which and until which it was issued, the date of the patient's next appointment, referral to the MAC.
5. During regular examinations of the patient, the medical record of the outpatient (inpatient) patient reflects the dynamics of the disease, substantiates the correction of treatment and the appointment of additional examinations, taking into account the standards of medical technologies of the treatment and diagnostic process and protocols for the provision of medical assistance by specialty; determines the term of the TI and its extension, indicating the number of the document certifying the TI, the date from which it is extended, and the date of the next review. When resuming work capacity, he enters the data of the patient's clinical examination, which is the basis for closing the document certifying the TI, indicating its number and the date from which the patient should start working. In the case of discharge of a patient from a hospital upon restoration of working capacity, the statement from the hospital patient's medical card (f. 027/o) must it is mandatory to indicate the date of the conclusion of the MAC (if available), medical and labor recommendations, the date of closing the disability certificate, the date from which it is necessary to start work, the numbers of documents certifying the TI of citizens. If the patient continues to be ill, the discharge notes the date of the appointment with the polyclinic doctor, substantiates the extension of the sick leave and referral to outpatient treatment after the patient is discharged from the hospital.
6. In the case of a patient's application for an accident, indicate the date and time of the patient's application in the medical record of the outpatient patient; date, time, place and circumstances of the injury; the type of injury (industrial or domestic) according to the patient, which cannot be corrected or changed in the future; describes in detail the nature of the damage and prepares the appropriate documentation (in accordance with the Procedure for the investigation and accounting of accidents, occupational diseases and accidents that occurred in the bodies and units of the system of the Ministry of Internal Affairs of Ukraine, approved by the order of the Ministry of Internal Affairs of Ukraine dated 27.12.2002 No. 1346 (as amended), the Procedure for conducting investigating and keeping records of accidents, occupational diseases and accidents at work, approved by the Resolution of the Cabinet of Ministers of Ukraine dated 30.11.2011 No. 1232, and the Procedure for investigating and recording non-industrial accidents,
7. Formulates a diagnosis that causes TI, in accordance with the International Statistical Classification of Diseases and Related Health Care Problems of the Tenth Revision (ICX-10), reflecting the degree of functional disorders of organs and systems, complications, and their severity.
8. Ensures the registration of documents certifying the TI of citizens on the day of establishing the TI of the patient from the day of admission; and when issuing documents certifying the TI of citizens, when visiting them at home - no later than 10:00 a.m. the next day.
9. Provides medical recommendations regarding further treatment, employment, dietary nutrition, sanatorium-resort treatment, etc.
10. Ensures timely referral of patients for treatment to inpatients, at the same time provides an extract from the outpatient patient's medical card about the conducted preliminary examination, treatment, TI terms for the last 12 months.
11. Represents patients to the deputy head of the hospital (with a polyclinic) from the polyclinic division of work or to the head of the department in complex cases on issues of diagnosis and treatment, issuance, extension and registration of disability certificates, referral to the MAC; to carry out a commission examination of patients and to resolve the issue of the state of incapacity of patients if the duration of the illness exceeds 10 days before the time of their referral to the MAC, as well as in the case of the patient's application to the doctor the next day or on weekends after the closing of the previous document certifying the TI , marked "working".
12. Forms dispensary groups, including from the number of patients who are often and long-term ill (persons who in the last 12 months were unable to work due to one disease at least four times with a total number of days of incapacity for work - 40 or more or due to various diseases at least six cases in the last 12 months with a total number of days of incapacity for work exceeding 60).
13. Together with the deputy head of the hospital (with a polyclinic) from the polyclinic division of work or the head of the department, he presents to the MAC:
14. Outpatients or inpatients, if their incapacity for work lasts for 30 days or more, to resolve the issue of continuation of treatment, its correction, issuance of certificates for sanatorium-resort treatment or rehabilitation;
15.  Patients with signs of persistent loss of work capacity regardless of the duration of the illness, to resolve the issue of their referral to the VLK (for certified employees) for the purpose of determining suitability for further service, or to resolve the issue of their referral to the MSEC (for civilians);
16. Analyzes the causes of TI among employees of the OVS, especially the dispensary group of patients, as well as persons who are often and long-term ill, working disabled people; indicators of disability; implements measures for their reduction and prevention.
17. Involves patients in the examination to clarify the diagnosis, treatment plan and determine the cause of incapacity of specialists of other specialties.
18. Refers to the examination of the deputy head of the hospital (with a polyclinic) from the polyclinic division of work or the head of the department and the MAC of patients with diseases that are difficult in terms of diagnosis, treatment, labor recommendations, etc.
19. Makes proposals to the management regarding the improvement of the ETI organization in the institution.

2. The second level.

The head of the specialized department, the deputy head of the hospital (with a polyclinic) from the polyclinic division of work and ETI: 

1. Performs organizational and methodical guidance on ETI issues.
2. Consults patients with diseases difficult to determine work capacity, long periods of treatment and signs of permanent loss of work capacity, together with the MAC initiates their referral to the MMC (for certified employees) in order to determine suitability for further service and to the MSEC (for civilians).
3. Analyzes the quality of medical care at the level of doctors of the polyclinic (department) on the basis of the expert evaluation of the medical documentation of patients and the analysis of errors and shortcomings regarding the quality of medical care, the causes of medical care, the procedure for issuing and extending sick leave, the duration of treatment with discussion at medical conferences, meetings, etc.
4. Analyzes the reasons for the increase in the number of cases of TI, their duration in terms of nosologies, by doctors of the subordinate unit and days of the week, on a monthly basis. He studies the causes of negative indicators, develops and implements measures to reduce the level of TI.
5. Analyzes the state of primary disability and develops measures for its prevention.
6. Together with treating doctors, issues sanatorium-resort cards (form No. 072/o).
7. Performs commission examination of patients with the attending physician and resolves the issue of incapacity for work if the illness lasts more than 10 days before the terms of their referral to the MAC.
8. Controls:

• the timeliness and completeness of the examination, diagnosis and treatment of patients at the pre-hospital and hospital stages, their compliance with the standards of medical technologies of the medical and diagnostic process and protocols for the provision of medical care by specialty;
• timeliness of referral and quality of submitted medical accounting documentation to the MAC;
• compliance by doctors with the procedure for issuing documents certifying the TI of citizens, in accordance with the current normative legal acts on TI issues;
• approximate terms and quality of treatment of patients during TI in outpatient (inpatient) conditions;
• the quality of entries in the medical record of an outpatient (inpatient) patient, namely the completeness of the display of complaints and their correspondence to the specified diagnosis; the quality of the patient's collected insurance anamnesis and disease anamnesis; compliance of the records with the patient's objective condition; sufficient justification of the diagnosis given to the patient; availability of a patient examination and treatment plan; availability and correctness of treatment and labor recommendations; availability of records of the issuance of a sick leave certificate, the extension period (from which date and until which date) and the date of the next visit to the doctor, when the sick leave certificate is closed, a record of its closure indicating the date from which it is necessary to start work;
• substantiation of the extension of the sick leave in case of need for continuation of treatment in outpatient conditions after inpatient treatment in the medical record of the inpatient patient and an extract from it;
• the timeliness of referring the patient to a hospital in the presence of medical indications, taking into account the profile of the disease;
• correctness of registration of medical accounting documentation;
• correctness of selection when referring patients to sanatoriums, rehabilitation facilities and specialized health care facilities;
• the quality of the provision of medical care with the inclusion in the medical card of an outpatient (inpatient) patient of the correction of the diagnosis, plan of examination, treatment, state of working capacity;
• effectiveness of dispensary observation, recovery of patients who are often and for a long time ill;
• the quality of periodic medical examinations and detection of diseases, registration of patients at the dispensary, and their rehabilitation, including the disabled, for whom MSEC has developed an individual program for the rehabilitation of the disabled;
• making a note about a violation of the patient's prescribed treatment regimen in the incapacity sheet (certificate) and medical card of an outpatient (inpatient) patient;
• the date of closing the disability certificate when establishing a disability group and carrying out rehabilitation measures;
• the work of attending physicians in the study and prevention of morbidity and disability.

       9. Refers patients in cases difficult to diagnose and (or) treat for consultations to other specialized and highly specialized health care institutions.

      10. Makes proposals to the management of the institution regarding the prosecution of medical workers who have committed violations in establishing a diagnosis, prescribing appropriate examination and treatment, issuing, extending and filling out documents certifying TI, and drawing up medical accounting documentation.

      11. Makes suggestions to the management of the institution regarding the improvement of the ETI organization.

3. The third level.

The medical and advisory commission carries out its activities in accordance with the Regulations on the MAC of the SE "TMA", approved by the order of the SE "TMA"

 

Office hours: From Monday to Friday from 1:30 p.m. to 3:00 p.m.
Office No. 22

4. The fourth level.

Chairman of the MAC:

1) Heads the MAC and ensures its work in accordance with the order of the head of the SE "TMA".

2) Performs work on improving the qualifications of doctors on ETI issues.

3) Ensures timely study by doctors of the current legal acts on ETI.

4) Organizes activities aimed at improving the quality of ETI.

5) Conducts training on ETI with doctors who are employed by SE «TMA» and have permission to issue documents certifying the temporary incapacity of citizens.

6) Consults patients with cases that are difficult to determine the capacity for work and after a personal examination of the patient at the request of the deputy head of the hospital (with a polyclinic) from the polyclinic division of work and ETI or the head of the department and the attending physician, with the involvement of the necessary specialists, determines the further tactics of the patient's treatment and his condition working capacity

7) Ensures constant control and verification of compliance by doctors of SE «TMA» with current legislation and other regulatory and legal documents related to ETI:

• the correctness and timeliness of establishing the diagnosis, the conducted examination, the prescribed treatment, the validity of the issuance and continuation of documents certifying temporary incapacity;
• periods of temporary incapacity for work, taking into account the severity of the disease, the approximate duration of treatment of patients (by hospital (with a polyclinic), departments, offices; by days of the week, doctors, nosological forms of diseases, etc.);
• reasonableness of selection and referral to sanatorium-resort and rehabilitation institutions, specialized health care institutions;
• implementation of medical and social rehabilitation measures;
• compliance with the standards of medical technologies of the treatment and diagnostic process and protocols for the provision of medical assistance by specialty;
• carrying out an examination of the quality of primary medical accounting documentation at different levels of examination and at different periods of temporary incapacity and according to the result of the treatment with an assessment of the effectiveness of the medical and diagnostic process;
• compliance with the procedure for accounting, storage, distribution and use of documents certifying temporary incapacity.

8) Provides interaction with:

• by social insurance funds - regarding compliance by doctors with legal acts on examination of temporary incapacity for work;
• by the medical and social expert commission - on issues of the quality of examination and treatment of patients, their rehabilitation, study of the causes of disability.

 9) Analyzes identified deficiencies that affect the quality of ETI and decision-making based on the results of the analysis within the limits of its competence. It resolves the issue of the need for additional examination of patients with difficult to diagnose pathology.
10) Organizes the work of doctors to study the causes of morbidity with temporary loss of working capacity, participates in the implementation of a system of measures for prevention and reduction of morbidity. Summarizes materials and prepares analytical reports on this issue for consideration at operational meetings, the medical council.
11) Considers appeals of citizens regarding the determination of their capacity for work, complex and conflict cases, claims of citizens and interested organizations, insurance companies, social insurance funds.
12) According to the plan, conducts operational meetings on ETI issues with medical workers of the institution, meetings involving representatives of social insurance funds.
13) Makes a decision on conducting a repeated ETI with an examination of the patient in cases of detection of unjustified issuance of documents certifying temporary incapacity.
14) Makes suggestions to the management of the SE "TMA" about bringing to justice medical workers who have violated the procedure for issuing, extending documents certifying the temporary incapacity of citizens, and issuing medical accounting documentation.
15) Submits the issue of ETI for consideration by the Medical Council of the SE "TMA".
16) Submits suggestions on improving ETI to the head of SE "TMA".