Order 1346 examination. Medical examinations of minors. Preventive medical examinations of minors instead of periodic and preliminary

From January 1, 2018, a new Procedure for conducting preventive medical examinations of minors, approved by Order of the Ministry of Health of Russia dated August 10, 2017 No. 514n, comes into force (the Procedure approved by Order of the Ministry of Health No. 1346n is valid until December 31, 2017)

How does the new Order differ from Order No. 1346n?

1. In the new Procedure, the List of studies during preventive medical examinations of minors has been significantly reduced (Appendix No. 1 to Procedure No. 514n).
Excluded from the list of studies of blood glucose and hormone levels in the blood (for all ages). Also, for many age groups, such studies as a general blood test and a general urine test were excluded (for example, for children 3, 6 and 9 months, 1 year and 6 months, 2 years, 4 years, 5, 8 and 9 years, etc. .).
What are the changes in the examinations of specialists by age:
We canceled preventive examinations by a neurologist at three and six months. From January 1, it will be held only in one month and in 12 months.
At 3 months - only an orthopedist and that's all, up to a year - no specialists, only a pediatrician.
It seems strange to introduce for children of the age of 1 month of examination by a dentist. And in general, since two years now every year (!) a dentist.
Extended examination by specialists before school will now be at 6 years old (previously it was at 7 years old).
For children aged 11-14, all studies were completely excluded and only some examinations by specialist doctors were left: at 11 and 12 years old - only a dentist, at 13 years old - an ophthalmologist and ... a dentist :)

2. Now “Informed voluntary consent” from parents will be taken in advance (no later than 5 working days before the start of the medical examination), that is, now it is not necessary for the parent to personally accompany the child, this can be done, for example, by the grandmother.

3. There are no lists of preliminary and periodic medical examinations in the new Procedure No. 514n. All
medical examinations of minors will be carried out in a unified manner, as preventive.
Let me explain that: Preliminary - these are examinations upon admission to educational institutions; Periodic - these are examinations during the period of study in educational institutions.
This means that the medical examinations that were previously required for admission and training in educational organizations will no longer be carried out (!) That is, it is not required to undergo a medical examination specifically before entering a kindergarten, school, secondary educational institution, university. It is enough to present the previous annual inspection.

How are you?
My opinion is that we are going by leaps and bounds to paid medicine. Although they write that there will be no glucose from 2018, it has been permanently absent in our kennel for half a year.
In general, I rarely went there without illness even up to a year, but the absence (almost complete) of a neurologist and a dentist in 1 month is ahem strange.

In 2018, order 514n of the Ministry of Health of Russia came into force, which changed the procedure for medical examination of the child population. This document explains in detail how often and with the participation of which specialists a medical examination of an infant, kindergarten pupil and schoolchild is carried out.

We will tell you more about the rules for organizing preventive examinations of children in 2018.

About order 514n

Order of the Ministry of Health 514n dated August 10, 2017 “On the procedure for conducting preventive medical examinations of minors” adjusted the rules for organizing measures to identify and prevent diseases in children and specified the age periods for examinations. Screenings are carried out in order to:

  • identify pathologies and risk factors at the initial stage;
  • find out if a teenager uses drugs;
  • define health groups.

Five appendices of the document approved:

  • rules for organizing medical examinations (Appendix 1);
  • medical examination card of a minor (form No. 030-PO/u-17) and the procedure for filling it out (appendices 2 and 3);
  • reporting form No. 030-PO/o-17 and the deadlines for providing information on the activities carried out (Appendices 4 and 5).

About changes

This regulatory act of the Ministry of Health - order 514n dated 10.08.2017 on preventive examinations is mandatory from January 1, 2018, from this date the previous directive of the department under the number 1346n dated 12.21.2012 became invalid.

The order of 2017 changed the rules for children's medical examination. The following innovations have been introduced:

  • preliminary and periodic examinations were abolished, they were replaced by preventive ones;
  • the list of studies has been adjusted;
  • the first stage (main) of medical examinations was extended by 2 times - up to 20 days;
  • consent to analyzes and other studies is issued in advance, the deadline is 5 days before the first day of the procedures;
  • canceled examination of a child aged 1 year 9 months and 2.5 years;
  • the procedure for enrolling in educational institutions has been simplified, now the results of a medical examination are sufficient;
  • a card with the conclusions of doctors is filled in in one copy (according to the previous rules, two were required).


Frequency of medical examinations

Order 514n on the procedure for conducting preventive medical examinations lists laboratory and other studies that are required to be performed under medical supervision. How often a child is examined at a certain year of life, and which specialists participate in it, Appendix 1 explains:

  • every month - from the birth of a child to a year. The standard of medical examination of infants requires constant supervision by a pediatrician. An expanded team of doctors examines the child a month after birth (among the studies - ultrasound internal organs) and at the age of one (ECG, blood and urine sampling);
  • once every three months - from 12 months to one and a half years, a pediatrician is examined;
  • once a year - from 2 to 17 years. The patient is seen annually by a pediatrician and a pediatric dentist, and when the student turns 14, also by an adolescent psychiatrist. A complete examination of the body with an examination by doctors of various specialties is carried out at the age of 6 and 15. At 7, 10 and 16 years old, a clinical analysis of blood and urine is prescribed, at 17 years old, in addition to these studies, an ECG.

Health groups

Based on the results of a comprehensive assessment of the state of the body, the minor is included in one of the health groups (there are five in total). According to what indications the division is made, the following appendix - No. 2 explains:

  • the first group includes healthy children;
  • to the second - prone to colds, overweight or underweight with normal growth. Order 514n dated August 10, 2017 also includes minors with physical disabilities in this group, if the functions of the body are preserved;
  • to the third - with chronic diseases with mild manifestations of symptoms;
  • to the fourth - children who require maintenance therapy, as well as with chronic diseases in the active stage or with periodic exacerbations;
  • to the fifth - with severe chronic diseases, frequent relapses.


Groups for physical education

Appendix 3 names the criteria for selecting children into one of three groups for physical education: basic, preparatory and special (includes two subgroups - A and B). The purpose of the distinctions is the choice of feasible physical activity.

So, included in the main - healthy children and their peers with minor health problems - undergo physical training according to the full curriculum.

The preparatory group gradually masters the program:

  • physically weak children;
  • predisposed to certain pathologies;
  • with chronic diseases without exacerbations long time- at least 3-5 years.

When planning a lesson with preparatory group the teacher should exclude contraindicated movements from the complex of exercises. Weakened children are allowed to pass the standards and participate in mass recreational activities only after an additional medical examination. There is a ban on participation in competitions.

Permitted classes for special groups:

  • for subgroup A (with congenital malformations, a state of the body requiring restriction of loads), recreational physical education is recommended according to special programs;
  • for subgroup B (with chronic diseases at the stage at which there is a risk of developing complications) - physiotherapy exercises in a medical facility and independent execution exercises at home.

Medical conclusions are entered into the medical examination card. Samples of this document, forms of medical reports and reporting forms are given in the regulatory act of the Ministry of Health. They must be filled out legibly, without corrections, requires order of the Ministry of Health of the Russian Federation 514n dated 08/10/2017).

To keep children healthy: the procedure for passing medical examinations has changed

Ministry of Health care Russian Federation approved a new procedure for minors to undergo medical examinations: preventive, preliminary (upon admission to educational institutions) and periodic (during the period of study in them). Olga Evgenievna Shitova, Deputy Chief Physician for Pediatrics, FGBUZ CB No. 172 of the FMBA of Russia, tells how they will now be carried out.

The new procedure establishes the rules for passing medical examinations, both during the period of children's education and during their admission to educational institutions, emphasizes Olga Evgenievna Shitova, Deputy Chief Physician for Pediatrics at Clinical Hospital No. 172 of the FMBA of Russia. - Surely, some parents may have a question - what is a medical examination? This is a complex of medical measures, interventions, which includes an examination by specialist doctors, as well as laboratory and instrumental studies. They are aimed at identifying pathological conditions, diseases, risk factors in minors in order to further conduct more effective preventive work or, if necessary, treatment.

Medical examinations are divided into three groups - preliminary, preventive and periodic.

Preliminary examinations are carried out when a child enters any organized group, whether it is a children's preschool, school, college, technical school, institute, - - Periodic medical examinations are carried out annually in various volumes during the child's education at school, attending kindergarten. Each age has its own scope of research. It may, for example, include only a pediatrician's examination and laboratory tests, or an examination by two or three specialists and laboratory tests. This list is specified in the appendix to the Order of the Ministry of Health of the Russian Federation dated December 21, 2012 No. 1346n.

Preventive medical examinations are carried out among minors of decreed ages (1, 3, 7, 10, 14, 15, 16 and 17 years). In this case, the child is examined by 8-10 specialists, in addition, laboratory tests are carried out (a general blood test, a blood test for sugar, urine) and instrumental studies (fluorography, ECG, ultrasound diagnostics, namely ultrasound of the heart, abdominal cavity, thyroid gland) and reproductive areas).

Before undergoing the listed medical examinations, in particular, preventive and periodic ones, the parent must issue an informed voluntary consent to medical intervention (to undergo an examination), - explains the Deputy Chief Physician for Pediatrics of the Clinical Hospital No. 172 of the FMBA of Russia Olga Evgenievna Shitova. - If a parent does not want his son or daughter to be examined, he has the right to refuse by making his decision in writing. The legal representative of the child has this right. In addition, we would like to remind you that from the age of 15, children can fill out informed voluntary consent on their own.

Periodic medical examinations will be carried out during the period of children's education. On schedule. Parents of schoolchildren will be notified in advance of the date of the start of the inspection through the class teacher, mothers and fathers of children visiting kindergartens will be warned.

An important point: the results of the examination will be entered in the child's medical record. By the way, during a preventive (extended examination), a medical card for a preventive examination of a minor will also be filled out, where all the results of the examination will be entered. One copy of such a card will be given to the parent so that he can get acquainted with the state of health of the child in a more detailed form.

If the child needs to undergo a preliminary examination upon enrollment, the parent must come to the children's polyclinic at the place of residence and write a statement addressed to the head of this unit that his son or daughter needs to undergo a preliminary medical examination before entering Kindergarten or school.

Previously, preventive examinations were carried out in a smaller volume and on the basis of an educational institution, - says Olga Evgenievna Shitova.- Now, by order of the Ministry of Health of the Russian Federation, all medical examinations must be carried out in children's clinics. In this case, the child must be accompanied by a legal representative, in most cases they are parents. We ask mothers and fathers to pay attention to this and, if possible, accompany the child to the medical examination. Since this practice is new, for the transitional period, in agreement with the Department of Education, we came to an agreement that for the time being schoolchildren will be accompanied by classroom teacher with members parent committee. Accompanying a child at a medical examination probably has pluses (you can ask a specialist a question of interest) and minuses (you have to take time off from work), but I think when it comes to the health of a child, a parent always makes the right decision. For our part, we, the doctors, will try to shorten the time for children to undergo a medical examination as much as possible. We will try to ensure that the medical examination does not take the child more than two days. To do this, on working days - from Monday to Friday, with the exception of Tuesday, from 8 to 9 o'clock, narrow specialists, laboratories, ultrasound and X-rays will work only for preventive medical examinations.

Why two days? The fact is that the results of laboratory tests, as a rule, arrive the next day, and without them, the diagnosis of specialists will be incorrect. The conclusion based on the results of the medical examination will be made by the district or school pediatrician. After that, the parent will be given one copy medical card preventive examination.

While the child will come with the class, but I remind you again, the presence of parents (or representatives of the parent committee) is necessary. From 2015, we may move to the fact that all parents will accompany their children to medical examinations. So far, we have chosen a softer option, that people are used to innovation, and we have understood how best to organize this process.

The purpose of the new procedure for medical examinations for minors is to change the approach to the prevention and treatment of diseases. It turns out that now the children will undergo certain medical examinations every year. Thus, the possibilities of detecting pathological conditions, diseases, risk factors in minors at an early stage increase. BUT early diagnosis disease or the risk of its occurrence - important point effective treatment or recovery. For example, according to the results of a medical examination, each parent of a child of decreed age will have a card in their hands, where the child's diagnosis will be identified during the examination. And he will have the opportunity to contact a specialist with the child at a convenient time in order to undergo, if necessary, additional examinations and rehabilitation. Doctors hope that the new order will increase the responsibility of the parent for the health of the child.

Also, according to the results of the medical examination, the health group will be determined, physical development, and a conclusion is issued on the physical education group that the child can attend.

In Dimitrovgrad, according to the new procedure, medical examinations will begin in October. Let's start with the social city. Children's polyclinic No. 1 expects the arrival of students of the fourth and eighth grades. The Department of Education is currently preparing the lists. After agreeing on the schedule of medical examinations, the information will be communicated to parents and children. On the parent meetings You will be asked to fill out an informed voluntary consent form for a medical examination. The same work will be carried out in kindergartens.

Grade 4 students are expected to have a preventive (extended) medical examination, and eighth graders - a periodic one.

A complete list of studies during medical examinations (Order of the Ministry of Health of the Russian Federation dated December 21, 2012 No. 1346n) can be found on the website of Clinical Hospital No. 172 of the FMBA of Russia (). For the convenience of users, this section is highlighted with a special icon "New procedure for medical examinations of minors."

We also invite parents who have questions on this topic to send them to the "Electronic Trust Box" FGBUZ KB No. 172 of the FMBA of Russia (This e-mail address is being protected from spambots, you need JavaScript enabled to view it) - says Olga Evgenievna Shitova. - Please include contact numbers for feedback in your messages. In addition, we plan to provide clarifications on incoming questions in the section "The new procedure for medical examinations of minors." To obtain more prompt information and resolve your issue "on the spot", we recommend contacting the heads of children's clinics. Informational explanations can be given to you medical workers educational institutions cities.

We hope that you, dear parents, will understand the new procedure for minors to undergo medical examinations. What could be more valuable than keeping children healthy?

On January 1, 2018, a new order “On preventive medical examinations of minors” No. 514n dated August 10, 2017 came into force. It replaced the order of 2012, in which, for each age of the child, a list of doctors and additional studies was prescribed that should be done free of charge to the child. Today we compare the tables with these data from two orders and pay attention to the differences between them and innovations.

The first examination of a newborn is a traditional examination of the baby by a pediatrician. Important: screenings are “timed” for this examination: neonatal screening for congenital hypothyroidism, phenylketonuria, adrenogenital syndrome, cystic fibrosis and galactosemia, as well as audiological screening. All these screenings are usually performed on the baby in the hospital. If they were not made in the maternity hospital, then neonatal screening for five hereditary syndromes should be done within 1 month of the baby's life, audiological - in the first three months.

AT 1 month the child should be examined by a pediatrician, neurologist, pediatric surgeon, ophthalmologist earlier. Now an examination by a pediatric dentist has been added to this list. The list of studies remained unchanged, it includes ultrasound of the abdominal cavity, kidneys, heart, hip joints and neurosonography.

AT 2 months the baby is examined by a pediatrician (this has not changed). Now, at this age, the clinic will still do a general blood and urine test - these are innovations in 2018.

AT 3 months now there is no obligatory consultation of a neurologist (but a pediatrician and an orthopedic traumatologist remained). A general blood and urine test was also excluded - they were transferred to the second month of the child's life.

AT 4 and 5 months both according to the old and the new standards, the baby is obligatory examined only by a pediatrician.

Now the pediatrician will be the only one to examine children also in 6, 7, 8, 9, 10 and 11 months. Consultations of a pediatric surgeon and a neurologist at 6 months, general blood and urine tests at 6 and 9 months from this year are excluded as mandatory.

AT 1 year Previously, children were examined by a whole team of specialists: a pediatrician, a neurologist, a pediatric surgeon, a dentist, an ophthalmologist, an ENT doctor and a psychiatrist. Starting this year, consultations with a dentist, an ophthalmologist and a psychiatrist for a year are not required, but an orthopedic traumatologist has been added to the mandatory list of doctors. The list of studies included general blood and urine tests, ECG. Glucose testing as mandatory from 2018 is excluded.

AT 1 year 3 months examination only by a pediatrician is obligatory (nothing has changed here).

AT 1 year 6 months- Also, the baby is examined only by a pediatrician. A complete blood and urine test has become optional.

AT 1 year 9 months From 2018, children will not undergo preventive examinations at all.

AT 2 years the list of examinations includes: a pediatrician, a pediatric dentist and a child psychiatrist. Also, the child gives a general analysis of blood and urine.

AT 2 years 6 months screenings have also been cancelled.

AT 3 years children are again examined by a team of doctors: a pediatrician, a neurologist, a pediatric surgeon, a pediatric dentist, an ophthalmologist, an ENT doctor, a urologist or a gynecologist. Seeing a child psychiatrist at this age is now out of the question. Among the studies: general blood and urine tests remained, and glucose level tests are no longer on the mandatory list.

AT 4 years children used to be examined by a pediatrician and a surgeon, now the surgeon has been replaced by a pediatric dentist and general blood and urine tests have been ruled out.

AT 5 years the child will also be examined only by a pediatrician and a pediatric dentist, and he will not take any tests.

AT 6 years- future schoolchildren will be examined by just a huge team of specialists: a pediatrician, a neurologist, a surgeon, a dentist, an orthopedic traumatologist, an ophthalmologist, an ENT doctor, a psychiatrist, a gynecologist or a urologist. Half of these professionals are new for 2018. Almost the entire spectrum of ultrasound was added to those studies that 6-year-olds passed earlier (general blood and urine tests): abdominal organs, kidneys and heart. An ECG was also added, and the study of glucose levels, on the contrary, was excluded from this year.

AT 7 years On the contrary, the number of specialists has decreased. Now the children will be examined by a pediatrician, a neurologist, a dentist, an ophthalmologist and an ENT doctor. Among the studies: the general analysis of blood and urine remained, all ultrasound and ECG will be done a year earlier.

AT 8 and 9 years old medical examination now includes only a consultation with a pediatrician and a pediatric dentist. There will be no other examinations and consultations at this age.

AT 10 years the child will be examined by: a pediatrician, a neurologist, a pediatric dentist, an endocrinologist, an orthopedic traumatologist and an ophthalmologist. Consultations of an ENT doctor and a psychiatrist "gone", as well as an ECG and a study of blood glucose levels. All that was left was a complete blood and urine test.

AT 11 and 12 years old only a pediatrician and a pediatric dentist are waiting for children for a check-up. All analyzes from the physical examination at this age were also excluded.

AT 13 years old Previously, children were only seen by pediatricians. Now consultations of children's dentists and ophthalmologists have been added to them. All analyzes, on the contrary, were excluded.

AT 14 years Previously, a team of doctors during a professional examination included 8 specialists. Now there are 4 left: a pediatrician, a pediatric dentist, a urologist or gynecologist, and an adolescent psychiatrist. All analyzes and studies, including ultrasound, are now canceled at the age of 14 during prophylactic examinations.

AT 15, 16 and 17 years old children will be examined by a full list of specialists, which has not changed much compared to previous years. This is a pediatrician, surgeon, dentist, urologist or gynecologist, endocrinologist, neurologist, orthopedic traumatologist, ophthalmologist, ENT doctor and adolescent psychiatrist. Only the number of studies has changed. At the age of 15: general blood and urine tests, as well as EC, to which were added ultrasound of the abdominal organs and kidneys. At the age of 16: only general blood and urine tests remained, at the age of 17 - the same plus an ECG without testing the glucose level, which was done before.

Summing up the material, we noted that now the professional examinations of children are even more “concentrated” in certain years, much more attention will be paid to dental problems in the development of babies, and children will be less likely to take tests for preventive purposes.

The medical examination procedure in Russia began in 2013. The new orders of the Ministry of Health were associated with an increase in the death rate in the Russian Federation and an increase in the number of people with oncology, venereal diseases, and advanced infectious diseases.

The new program of the ministry involved mass medical examinations of citizens of a certain age. This set of procedures had several goals:

  1. To help patients in time to diagnose diseases that lead to disability and death.
  2. Identify the age group of people who are most susceptible to certain dangerous diseases.
  3. Define risk groups.

Clinical examination is a voluntary service, it does not involve forcible examination of patients. But still, a visit to the doctor is desirable for people working, for example, in social sphere in education or health care. You can make an appointment with a doctor as part of a medical examination on any working day by visiting a local clinic. To confirm your identity, you must bring your passport with you (at the registry office they look at the year of birth and registration) and a policy of compulsory or voluntary medical insurance.

This procedure does not apply to those categories of citizens of the Russian Federation who have already been diagnosed with dangerous infectious diseases, disabled people of all groups, veterans of the Second World War, children of war, military personnel, disabled people from the Chernobyl accident.

What has changed in 2018?

In January 2018, a new decree of the Ministry of Health was issued, which amends the procedure for medical examinations in 2018.

The main changes were made to the paragraphs that relate to:

  • the age category of persons who fall under the medical examination procedure;
  • stages of medical examination;
  • the order of appointment of an additional examination;
  • the number of examinations that persons of a certain gender, age group, specific profession, etc. must undergo;
  • tests that must be taken by certain categories of citizens.

Significantly in the medical examination in 2018, compared with surveys of previous years, it affected those groups of analyzes that were previously considered mandatory for a free planned medical examination.

Yes, in 2018 excluded from the list of mandatory tests the following types of diagnostics:

  • abdominal ultrasound,
  • Ultrasound of the pelvis.

These points are the most discussed among supporters and opponents of the reform. A general blood test and a general urine test were excluded from the examination system because these samplings were recognized by the Ministry as ineffective: according to the results of these tests, it is not always possible to accurately diagnose or even identify minimal deviations in the functioning of certain organs.

Meanwhile, in the past, physicians prescribed OAC and OAM to detect early stages of serious infectious diseases, to diagnose hematological diseases and abnormalities in the functioning of the urinary system, to detect oncology of the kidneys, cervix, abdominal cavity, diseases Bladder and prostate, to detect diabetes mellitus.

These types of tests are supposed to be replaced by a fecal occult blood test (helps diagnose oncology at different stages) and a blood test for PSA. The problem is that the PSA blood test requires a significant financial outlay that the Ministry cannot afford to allocate. That is why this type of analysis will be carried out only for patients retirement age . How prostate cancer is going to be diagnosed in able-bodied patients is a matter of debate.

What years are undergoing medical examination in 2018?

Starting from 2013, the voluntary free medical examination procedure covered all categories of adult citizens, and medical examination-2018 was no exception. What years of birth are subject to mandatory examination?

Age intervals are calculated every three years from 1928 to 1997 inclusive, namely: 1928, 1931, 1934, 1937, 1940, 1943, 1946, 1949, 1952, 1955, 1958, 1961, 1964, 1967, 1970, 1973, 1973. 1979, 1982, 1985, 1988, 1991, 1997.

Since the medical examination procedure is not carried out every year, but every 3 years, 2018 captures the year of birth with steps of 3 years between 1928 and 1997.

Those categories of citizens who have already been identified as a risk group (military personnel, veterans of the Great Patriotic War, children of war, children under 18, invalids of the Chernobyl accident) are required to undergo a free medical examination not once every 3 years, but every year.

What examinations are carried out for different categories of citizens?

The new medical examination procedure in 2018 includes a system of mandatory tests included in the list of procedures only this year. Among them, as already mentioned, is a fecal occult blood test (for all categories of citizens) and a PSA blood test (for people of retirement age).

For women, mammography is mandatory. Ultrasound of the pelvis and ultrasound of the abdominal cavity is no longer a mandatory procedure. You can go through them no more than 1 time in 6 years (without a special appointment) at the request of the patient.

All citizens over the age of 38 are required to undergo a procedure for measuring intraocular pressure by an ophthalmologist (diagnoses inflammatory eye diseases, glaucoma, general dehydration, underdevelopment of the eyeballs, low blood pressure).

Citizens who have crossed the limit of 48 years must necessarily donate feces for occult blood of the gastrointestinal tract in order to exclude the defeat of the body by an oncological disease.

In general, the medical examination in 2018 differs little from the same procedure in previous years. Significant changes and clarifications are necessary only for the collection of general tests aimed at diagnosing a number of infectious and oncological diseases.