Articles with tag: «medical organization»

    Technology management
  • 2016 № 5 Modern approaches to the development of medical and technological assignment and effective design of healthcare institutions

    Annotation. In the present paper a study of healthcare facilities design models is presented. It is shown how the functional and spatial diagramming, diagramming of flows and modelling/design of healthcare facilities (BIM) allow us to determine (as early as at the stage of medical and technological assignment) the possibility of application of modern medical technologies and equipment, arrangement of process flows, cost of the project and operating costs, construction period time, as well as to ensure the development of high-quality design and detailed documentation.

    Authors: Timofeev A. V. [1] Yeremin G. B. [2] Mozzhukhina N. A. [2] Karelin A. O. [1]

    Tags: 3-dimensional building information modeling1 design3 health care facility1 innovation approaches to healthcare facilities design1 medical and technological assignment1 medical care13 medical institution2 medical organization52 medical technology1 safety and quality of health care1 spatial diagrams1 werfau jsc1

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  • Staff management
  • 2016 № 4 Restrictions on medical stuff in the exercise of professional activity and the prevention of conflicts of their interests: medical organization actions

    Annotation. The article deals with the features of today for the healthcare organizations compliance with the restrictions placed on medical stuff in the exercise of professional activity and on prevention of conflict of their interests. Authors substantiate and emphasize the need for strict governance of this work in medical organizations local regulations. It is shown that the restrictions imposed on medical stuff in the exercise of professional activity and the prevention of conflict of interests of medical stuff is an integral component of ensuring and control of quality and safety of medical activities in a medical organization.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: conflicts of interests1 control of quality and safety of medical activities2 medical organization52 medical stuff1 professional activities1 restrictions1

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  • Quality of medical aid
  • 2014 № 5 The quality of medical care or the quality and safety of medical activity: what are still controlled medical organizations? (Saint Petersburg, Irkutsk, Russia)

    In the article the authors reason imperfect regulation of the Federal law dated November 21, 2011, №323-FZ internal quality control and safety of the medical activity. Given specific proposals on consolidation in the law of the concepts of quality of medical activity and safety of medical activity. In addition, the authors have defined the list of measures that must be implemented in a medical organization within the framework of internal control of quality and safety of medical activity.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: internal control7 medical activity5 medical organization52 quality and safety2

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  • Quality of health care management
  • 2016 № 6 Order for examination of quality of medical care

    The article deals with the factors that must be considered when establishing the order of examination of quality of medical care in the Russia with the exception of medical assistance provided in accordance with the Russian legislation on mandatory medical insurance. Analyzed and systematized information on the powers of constituent entities of control of quality and safety of medical activities in feald of examination of quality of medical care. Subject to the authority of constituent entities of control of quality and safety of medical activities proposed to allocate external and internal examination of quality of medical care. The content of examination of quality of medical care carried out by medical organizations.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: examination of quality of medical care1 medical activity5 medical organization52 quality control and safety of medical activity2 the expert of quality of medical care1

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  • Nominees
  • 2019 № 1 About inadmissibility of transfer of all chief physicians and their deputies to the status of non-medical workers and the admission to management of the medical organizations as the first heads of persons without medical education

    In the article, the authors show in detail and justify the very dramatic consequences that the country's health care will receive if the planned changes to the Regulation on the licensing of medical care are adopted the activities assuming exception of works (services) on "the organization of health care and public health" from the List of the works (services) making medical activity, and also the admission to the management of the medical organization as the first leaders of persons without higher medical education. The authors emphasize that the implementation of the planned changes will lead to the fact that the chief physicians and their deputies will cease to be medical workers, the manageability of medical organizations and the quality of medical care will decrease, the system of training of managers will degrade. This is totally unacceptable.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: certificate of specialist1 medical activity5 medical organization52 medical worker3 organization of health care and public health1 qualification requirements3 quality and safety of medical activity12 training4

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  • 2019 № 1 Methodological approaches to the assessment of compliance of activity of medical organizations order of rendering of medical care

    The article presents the results of the development, implementation and experimental testing of the conformity assessment system based on order of medical care, which can be used by any medical organization in order to improve the planning and management of its activities.

    Authors: Kitsul I. S. [58] Zapevalin P. V. [1]

    Tags: conformity assessment1 medical care13 medical organization52 order of medical care1 rate of compliance1

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  • Marketing in health care
  • 2022 № 2 A research of the impact of the call routing strategy on the call-centre work efficiency as a medical organisation providing primary hospital health care

    The article provides an estimation of the efficiency of a call-centre work when using two different strategies of targeting incoming calls. The authors clearly demonstrate a reduction in the waiting time for communication with the operator and the frequency of call cancellations, an increase in the number of processed requests and an increase in the level of service when using the strategy of interactive navigation of incoming calls, which generally creates favorable conditions for increasing the availability of medical care to the population.
    The purpose of the study is to study the effect of routing incoming calls on the efficiency of a medical call center in order to improve its operation.
    Materials and methods. The comparison of the effectiveness of the polyclinic call center was carried out according to the indicators according to GOST R 55540-2013 under the conditions of using the scheme of random and interactive navigation of incoming calls.
    The target values of quality indicators are established empirically, taking into account the accepted industrial standards. The analysis of statistical information was carried out using special software “Asternic call center stats”. A total of 72 statistical indicators were studied in both cases within the same seasonal period.
    Results. It was found that the organization of the scheme of interactive guidance of incoming calls helps to increase the productivity of a medical call center by optimizing the processing of calls without increasing the number of operators. The average waiting time for a patient to communicate with an operator has decreased by 2 times, the frequency of call cancellations has decreased by 3 times, the processing time for patient calls has decreased by 15.6%, the level of service has increased by 1.6 times. The practical significance of the proposed scheme for navigating incoming calls is due not only to the effective increase in the functionality of the medical call center, but also to the ease of scaling due to the unified IP telephony architecture in medical call centers.
    Conclusions. Thus, as a result of the study, a call routing strategy has been identified, which makes it possible to improve the performance indicators of the medical CC, to service more calls faster without attracting additional personnel, and to create conditions for increasing the availability of medical care to the population.

    Authors: Konyuhova S. G. [1] Orlov D. A. [1] Chuykova E. O. [1] Solov’yeva A. V. [1]

    Tags: medical call center1 medical call center management1 medical organization52 navigation of incoming calls1 new model of medical organization2 performance indicators and efficiency of the medical call center1 routing of patient calls1

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  • 2021 № 9 Health care organizers about the possibility of using outsourcing in medical organizations.

    I n t r o d u c t i o n . The ratio of the number of administrative and administrative and auxiliary personnel to the main staff, as well as the share of their remuneration in the total cost structure, is one of the criteria for the effective use of resources of medical organizations.
    The use of the outsourcing mechanism allows us to solve a number of problems that arise when such a ratio is observed, without reducing the quality and availability of medical care.
    T h e p u r p o s e o f t h e s t u d y is to study the opinion of health care organizers about the possibility of transferring certain areas of activity of a medical organization to outsourcing.
    M a t e r i a l s a n d m e t h o d s . The following methods were used in the study: statistical, sociological and analytical.
    R e s u l t s a n d d i s c u s s i o n . More than half of health care organizers believe that the introduction of outsourcing in a medical organization is necessary (66,1%). The study participants believe that it is possible to outsource such positions as cleaning of territories (94,4%), security of a medical organization (93,5%), laundry services (91,1%), maintenance of vehicles of a medical organization and maintenance of non-medical equipment and communications (87,1% each), etc. In their opinion, it is impossible to outsource such functions as planning and economic activities (69,4%), personnel records management (68,5%), procurement / contracts (58,1%), accounting (57,3%), legal support of the activities of a medical organization (37,9%), etc. Most often, the following functions have already been outsourced in medical organizations: laundry services (64,3%); maintenance of medical equipment (57,3%), motor transport of the Ministry of Defense (46,4%), non-medical equipment and communications (46,4%); cleaning of territories (35,7%).
    C o n c l u s i o n . Outsourcing allows you to focus on the profile activities of a medical organization and improve the quality of services provided to the population. Before transferring certain functions of a medical organization to outsourcing, the head needs to analyze the practical experience of regions and other medical organizations, which will help to avoid the negative aspects of outsourcing, expand its scope and the range of functions transferred to outsourcing companies.

    Authors: Menshikova L. I. [6] Ivanov A. V. [1] Burkovskaya Yu. V. [1]

    Tags: functions of a medical organization1 medical organization52 outsourcing4

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  • Manager of health care consults
  • 2019 № 9 Work with appeals of citizens and satisfaction of separate requirements of the consumer: what to consider medical organizations

    The article deaths with the features of working with citizens and to meet the individual requirements of the consumer, which are required to know medical organizations. The authors show and justify under what conditions the consumer’s demand is a citizen’s appeal, as well as how the terms of consideration of citizens ‘ appeals and the terms of satisfaction of individual consumer requirements are correlated with each other. In the article it is noted that in the medical organization work with citizens‘ appeals should be an integral component of ensuring and controlling the quality and safety of medical activities.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: citizens‘ appeals1 consumer requirements1 control issues1 medical organization52 quality  control  and  safety  of  medical  activities3

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  • 2019 № 2 How to arrange the provision of paid medical services anonymously

    he article proposes specific mechanisms for the implementation of the right of patients to receive paid medical services anonymously. The authors propose and justify the use in the provision of paid medical services anonymously as the patient’s name alias (fictitious name), which should be reflected in the documentation – in the contract, the patient’s medical record, informed voluntary consent to medical intervention, etc. The Implementation of the proposals expressed by the authors of the article will allow to provide medical care anonymously in compliance with all the requirements of the law.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: citizen’s name1 medical organization52 paid medical services21 patient13 patient’s rights1 provision of paid medical services anonymously1 pseudonym (fictitious name)1

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  • Management in healthcare
  • 2014 № 11 Сontents of internal control quality and safety of medical activities in medical organizations: what should it be and what hinders it (Saint Petersburg; Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)

    The issue deals with the fact that today in most medical organizations in the country is not built system of internal control quality and safety of medical activities, as provided by applicable law. In this context, the article presents and justified proposals for the filling of the internal control quality and safety of medical activities specific areas of work corresponding to the requirements of state control. The factors hindering the development of internal quality control and safety of medical activities.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: internal control7 medical organization52 quality and safety of medical activities9 quality inspection1

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  • 2021 № 1 Experience in using the staff management structure in a redesigned infectious diseases hospital to provide medical care to patients with a new coronavirus infection

    The article presents the experience of using the staff management structure in the conditions of redesigning
    a multi-specialty hospital into an infectious hospital for providing medical care to patients with a new coronavirus infection. For example, one of the largest hospitals providing specialized medical care during coronavirus infection, proven effectiveness staff management structure as the most optimal for the purposes of redesigning and further use against the growing epidemic Covid‑19.

    Authors: Kitsul I. S. [58] Vechorko V. I. [1] Gumenyuk S. A. [1] Zhenina E. A. [1]

    Tags: hospital3 medical care13 medical organization52 new coronavirus infection2 redesigning1 staff management structure1

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  • 2022 № 9 Identification of directions for improving the quality of medical services using SERVQUAL and IPA techniques

    Assessing patients’ expectations and perceptions of health care delivery is challenging. To understand the quality of health care delivery, a study was conducted related to how patients assess the expected and perceived quality of health care delivery in a district hospital. Modern methods of measuring patient satisfaction and its interpretation using statistical analysis methods allow solving problems of this type.
    P u r p o s e : development of approach to improvement of quality of medical services provision using results of measurement of satisfaction with quality of medical services provided to patients in inpatient conditions of regional level, using SERVQUAL technique; substantiation on built regression model of influence of certain aspects of patients’ perception of quality satisfaction.
    M a t e r i a l s a n d m e t h o d s . The materials of the study are presented in the form of the results of a medical and sociological study of 418 patients who received medical services in one of the medical organizations at the regional level. Methods of statistical analysis of patient questionnaire results, factor, regression analysis, Importance-Performance Analysis (IPA) were used.
    R e s u l t s . An analysis of the data showed that 54.3% of patients were quite satisfied with the services. A regression equation is constructed to calculate the degree of patient satisfaction depending on a number of aspects of health care delivery. According to the IPA method, a schedule of four-quadrant distributions of patient assessments has been drawn up, on the basis of which it is possible to form measures to increase patient satisfaction with medical services.
    F i n d i n g s . The use of the SERVQUAL technique allows you to measure satisfaction with the quality of medical services, and the use of the IPA technique allows you to interpret it and obtain useful information regarding the quality of medical services as an element of patient feedback in the quality management system of a medical organization

    Authors: Isaenkova E. A. [2]

    Tags: importance-performance analysis (ipa) technique1 medical organization52 patient satisfaction7 quality of services1 servqual technique1

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  • 2019 № 8 Modern management of medical organization based on the process approach in russian scientific publications

    The intensity and direction of development of the process approach in the management of medical organizations from the time of the first publications in the Russian literature to the present has been evaluated. 282 literary sources were studied, of which 235 were for managing a medical organization and 47 were papers that analyzed the construction of business processes in non-medical enterprises. It was found that to accelerate the pace of building business processes in medical organizations, it is necessary to use computer programs for building processes.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Danilova L. V. [4] Ekimov A. K. [10] Baygazina E. N. [6] Dmitrieva I. V. [3]

    Tags: medical organization52 process approach7 quality management system8

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  • Management in health care
  • 2013 № 7 The problems of realization of the patient rights for the choice of doctor and the ways of its solution in the medical organization (Saint-Petersburg, Irkutsk, Russia)

    The article considers the issues related to the implementation of the rights of the patient to choose a doctor. The authors emphasize that the need for compliance with the law in the medical organization requires the development and adoption of the relevant internal document regulating the procedure of choice of doctor it is in this medical organization. The article provides specific recommendations as to what should be reflected in the procedure of choice of doctor in the medical organization.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: choice of doctor1 medical organization52 patient rights3 replacement of a doctor1

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  • 2014 № 8 Circulation of medical products: numerous problems regulatory or what chief doctor have to do. Part 2 (Saint Petersburg; Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)

    In the article the characteristic of a number of issues in the sphere of medical products circulation: insufficient legislative regulation, absence of the system of training, lack of secure rights of a patient and, as a consequence, serious problems at the level of the medical organization. The authors offer concrete solutions as part of the normative regulation of the sphere of medical products circulation, and of the expanded operation algorithm at the level of medical organization in this area, namely those actions that must initiate the chief doctor.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: medical organization52 medical product2 quality and safety of medical practice4 the sphere of circulation of medical products2

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  • 2015 № 10 About formation of new content of work of the head of the medical organization to ensure and control the quality and safety of medical activity

    The article deals with the problems and issues that impede the implementation of legislative requirements on ensuring and monitoring the quality and safety of medical activities in medical organizations. The article presents and justifies a specific list of the main activities of the head of the medical organization to ensure and control the quality and safety of medical activity. Proposed and substantiated the areas of control that should be reflected in the internal control of quality and safety of medical activity. Reasonable changes in the activities of medical commissions. Emphasized the need for active and systematic participation of the health authorities and the territorial departments of Roszdravnadzor in the formation of a new content of the work of the head of the medical organization to ensure and control the quality and safety of medical activity.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: head of medical organization1 health authorities1 medical commission5 medical organization52 quality and safety of medical activity12 quality of medical care20 territorial departments of roszdravnadzor1

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  • 2015 № 2 Work with citizen's applications in a medical organization as one of the mostimportant indicators of quality and safety of medical practice

    The article presents the characteristics of modern features and challenges of working with citizens applications in a healthcare organization. Attention to the fact that this activity is often underestimated chief physicians. It is proved that work with citizens applications in a healthcare organization, being one of the most important indicators of the quality and safety of medical practice, requires allocation of this area in a separate section of the internal control quality and safety of medical practice.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: citizens applications1 internal control7 medical organization52 quality and safety of medical practice4

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  • 2020 № 9 A technique of the analysis of subjective and objective characteristics of medical services for design of quality of medical services

    In a control system of quality of medical services the important part is assigned to estimates of results of activity of the medical organization, in particular degree of satisfaction of patients with quality of the received services. Now
    the question of quality of medical services is extremely relevant, a need for development of instruments of improvement
    of quality of services is had.
    Methods: The technique of measurement of satisfaction with quality of SERVQUAL provided to medical care based on
    provisions of GOST “Quality Management …” and a technique of expansion of functions of quality of QFD which elements
    are defined in GOST “Quantitative methods of improvement of processes “Six sigma are used”.
    Results: Approach on the basis of integration of techniques of measurement of satisfaction of consumers of medical services of SERVQUAL and expansion of function of quality of QFD which realization allows to build the House of quality is
    stated and to create data for carrying out design of quality of medical services.
    Conclusion: The conducted research allowed to create tools for elaboration of the adjusting and warning operating influences directed to demanded change of quality of medical services and, as a result, the recipients of services increasing
    satisfaction.

    Authors: A.  V. Danilov [1]

    Tags: expansion of function of quality1 measurement of satisfaction1 medical organization52

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  • 2021 № 4 QUALIMETRIC ASSESSMENT OF THE EFFECTIVENESS OF IMPLEMENTING THE RESULTS OF PROJECT ACTIVITIES IN THE WORK OF MEDICAL ORGANIZATIONS AND HEALTH MANAGEMENT BODIES

    In addition to the economic assessment of the effectiveness of the implementation of the results of project activities in the practice of medical organizations and health management bodies, for a qualitative assessment of the implementation results, a qualimetric analysis of the implementation effectiveness can be carried out. A complex qualimetric indicator in a dimensionless form from 0 to 1,0 or as a percentage from 0 to 100% can be reflected by color symbols and at the same time has a certain logical meaning. It shows the degree of deviation of the value of the estimated indicator before and after the implementation of the project results from the original (normative or standard).

    Authors: Gurov A. N. [15] Trishkin D. V. [1]

    Tags: health management body1 medical organization52 qualimetric assessment of the effectiveness of the implementation of the results of project activities1

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  • 2014 № 6 Measures to prevent the entry of substandard and counterfeit medicines in medical organizations (Center for Quality Assurance and Certification of drugs <Trans-Baikal Territory, Chita, Russia; Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)

    The article presents practical approaches to implementation of individual measures on the safety of medicines in the medical organization. Shows the organizational technology to prevent receipt of substandard and counterfeit medicines in medical organization.

    Authors: Kitsul I. S. [58] Rezvikch U. A. [1] Kovalskaya G. N. [1]

    Tags: drug circulation1 drug safety1 falsification1 medical organization52 quality5

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  • 2014 № 7 Circulation of medical products: numerous problems regulatory or what chief doctor have to do. Part 1 (Saint Petersburg; Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)

    In the article the characteristic of a number of issues in the sphere of medical products circulation: insufficient legislative regulation, absence of the system of training, lack of secure rights of a patient and, as a consequence, serious problems at the level of the medical organization. The authors offer concrete solutions as part of the normative regulation of the sphere of medical products circulation, and of the expanded operation algorithm at the level of medical organization in this area, namely those actions that must initiate the chief doctor.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: medical organization52 medical product2 quality and safety of medical practice4 the sphere of circulation of medical products2

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  • 2015 № 6 The need for more continuity and cooperation the relationship between quality of medical care in the mandatory medical insurance system and control of quality and safety of medical activities

    The article shows the lack of continuity and the relationship between the quality of medical care in the mandatory medical insurance system (MMI) and control of the quality and safety of medical activity. Named a number of problems in this regard in public health practice, one of which is the absence in most of the medical organizations of the country internal control systems of quality and safety of medical activity. Asked to create one for the whole health of the Russian Federation the Order of evaluation of the quality and safety of medical care, regardless of whether this examination in a medical organization that is involved in the implementation of insurance programmes, or it is performed in a medical organization, in which the implementation of the programs of the MMI is not involved.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: control the quality and safety of medical activities1 mandatory medical insurance10 medical organization52 quality control of medical care1 quality examination1

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  • Law
  • 2016 № 8 Guarantee citizens‘ rights while using medical devices

    The article shows that in recent years the requirements in the sphere of medical products circulation not only increased in volume but also become more stringent. So it requires that medical organizations has to do targeting actions to improve the work to ensure the rights of citizens to use medical devices. It is proved that the rights of citizens in the use of medical devices has certain specifics. The proposed measures aimed at improving the provision of these rights of citizens and safety monitoring of medical devices.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: medical devices2 medical organization52 quality and safety of medical devices1 quality control and safety of medical practice1 rights of citizens2 safety monitoring of medical devices1

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  • 2017 № 6 Regulatory framework for providing high-technology ophthalmological medical care under outpatient treatment

    The article analyzes the existing legal basis for providing high-technology ophthalmological medical care through a systematic review of regulatory enactments that directly regulate this type of activity (14 regulatory enactments, including 2 federal laws).
    High-technology medical care is a separately licensed type of medical activity carried out by approved federal or regional medical organizations, financed by subsidy or directly from federal budget, provided for approved types of medical care in a hospital. The source of funding for healthcare determines essential conditions. The existing legal framework creates significant restrictions for providing high-technology ophthalmological medical care under outpatient treatment in the case of healthcare covered by Compulsory Health Insurance or an appropriate budget. The article outlines the ways of solving this problem proposed by the authors, including for a medical institution, without violating the current legislation. Healthcare covered by other sources of funding can be provided in any conditions, including outpatient

    Authors: Borshchuk E. L. [4] Chuprov A. D. [4] Lositskiy A. O. [1]

    Tags: compulsory medical insurance fund1 medical organization52 quality and safety of medical activity12 quality of medical care20 regulatory body of public health service1

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  • 2022 № 8 Organizational and legal issues of examination of minors in a gynecological hospital

    The organizational and legal aspects of gynecological care for minors remain a matter of debate, and the indicated topic requires further detailed study. Due to the limited scope of work, not all relevant aspects on the issue under consideration are considered, but only issues of providing information about a minor to law enforcement agencies without the consent of the patient and her legal representative. The relevance of the study is largely due to the fact that the answer to the indicated questions causes difficulties not only among medical professionals, but also among lawyers.
    The authors set out to substantiate the main features of the organization of gynecological care for minor patients, as well as provisions for the observance of their rights. To achieve the goal, the authors set the tasks of determining the legal status of minor patients of the gynecological hospital, the accompanying duties of medical workers and medical organizations, development of practical recommendations on the actions of a medical organization when examining a minor and establishing the fact of pregnancy, as well as interaction with law enforcement agencies.
    The study materials were the provisions of regulatory legal acts in the field of health protection and ensuring the rights of minors, as well as judicial practice on the issue under study.
    When conducting the study, the authors used general scientific and private scientific methods of cognition, such as analysis and synthesis, formal and legal, interpretations.
    During the examination of a minor in a gynecological hospital, doctors face the need to ensure the rights of minor patients both to sexual inviolability, sexual freedom and the normal moral and physical development of the minor’s personality, as well as to ensure the protection of personal data and medical secrets. I correspond to these rights the obligations of medical workers and medical organizations not only to transfer information about the patient to law enforcement agencies in cases established by law, but also to comply with the requirements of the law on the protection of information constituting a secret protected by law.
    As a result of the study, the authors came to the following conclusions. When establishing the fact of pregnancy of a minor or the entry of a minor into sexual intercourse (other sexual acts), if there are no sufficient grounds to believe that harm to her health was caused as a result of illegal actions, the medical professional (doctor) must explain to the minor (her legal representative) the possibility of transmitting relevant information to the internal affairs body; obtain written consent to the transfer of relevant information to the internal affairs body, which is stored in a medical organization; transfer relevant information to the medical officer responsible for timely informing the internal affairs bodies.
    The results of the study can be used by gynecological hospitals and other medical institutions in organizing the provision of gynecological care to minor patients, interaction with the internal affairs bodies to protect the rights and legitimate interests of minors.

    Authors: Samoilova Yu. B. [1] Paikov A. Yu. [1] Miroshnikova E. M. [1]

    Tags: doctor2 gynecological department1 informing1 internal affairs body1 medical organization52 minor1 patient13 pregnancy4

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  • 2016 № 5 Legal regulation of internal control of the quality and safety of medical activity

    The article shows and proves what the Federal legislation should be analyzed and used in medical organization in the field of internal control of the quality and safety of medical activity. Presents directions for internal control of quality and safety of medical activities with regard to regulation of each Federal legislation.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: internal control7 legislation4 medical organization52 quality and safety of medical activities9

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  • Information management
  • 2017 № 3 Experience of implementation of the call-center in activity of the budgetary medical organization (on the example of ICDC)

    This article presents a comparative analysis of two approaches for the telephone contacts management in a medical organization. The «traditional» model of the phone calls management in a medical institution and a model with the use of «call center» are considered. The advantages and disadvantages of these models are described. Specificity of the phone calls in a medical organization is disclosed. The «call center» activities analysis is carried out using the example of Interregional Clinical Diagnostic Center (ICDC), Kazan. The conclusion about the necessity of development of an information flow management system in a medical organization is drawn.

    Authors: Kupriyanov R. V. [6] Biktimirova O. R. [2] Zharkova E. V. [3] Khairullin R. N. [5]

    Tags: call center1 information flow1 leader1 medical organization52 phone contacts1 telephony1

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  • 2021 № 8 Evolution of information systems

    In medical organizations, information systems solve the following tasks: the ability to receive and store information, quick access to it and its transmission, the ability to generate various reports, the availability of specialized workplaces of medical workers, etc. Information systems are gradually evolving, turning from a tool capable of solving the simplest management tasks into a tool capable of solving the entire range of management tasks encountered in the practice of a medical organization at all levels of management. The purpose of the study is to describe the four stages of creating information systems, highlight the characteristic features of the functioning of information systems at each stage, as well as highlight the list of the main management tasks that are being developed at the selected stage and ways to solve them. The main attention was paid to the development of information systems of medical organizations working with the children’s population.
    Results. The first stage of the development of information systems began with the use of computer technology in the practice of medical organizations and was reduced to the fact that programmers of both medical and third-party organizations began to develop tasks, the totality of which later became known as “creating an information system” of a medical organization. The goal of the second stage is already the transformation of information systems of medical organizations in order to describe production processes in terms of a process approach and implement them in the form of software modules. The third stage of building information systems is the stage of describing the work of a medical organization based on mathematical models in order to justify the optimal solution of the production tasks available in it. The fourth stage of building information systems is the construction of an “information system that implements the functions of an intelligent management system of a medical organization”. The authors of the article give recommendations on the formalization of information available in a medical organization for the purpose of its
    effective use by artificial intelligence.
    Findings. Thus, an information system is a tool for solving management problems, its development as a tool for solving management problems requires knowledge of management theory, organization theory, process approach in management, methods of multidimensional statistical analysis and modeling methods, languages and modeling methods based on neural networks.

    Authors: Choloyan S. B. [11] Ekimov A. K. [10] Baigazina E. N. [3] Molodtsov N. S. [3] Kalinina E. A. [3] Posnov A. A. [3]

    Tags: artificial intelligence6 information system3 mathematical models2 medical organization52 neural networks1 process approach7

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  • Healthcare and law
  • 2014 № 5 Responsibilities of medical organizations (Penza State University, Penza, Russia)

    Аbstract. In the article obligations of the medical organizations (article 79 of the Federal law of November 21, 2011 № 323-FZ «About bases of health protection of citizens in the Russian Federation») are analyzed. The subject of duties is defined. The maintenance of such duties as is opened: to inform law-enforcement bodies on arrival of patients concerning whom there are sufficient bases to believe that harm to their health is done as a result of illegal actions; to carry out insurance on a case of infliction of harm of life and (or) to health of the patient when rendering a medical care. In article the maintenance of obligations of the medical organizations fixed in other statutiry sources (for example, in the Federal law of November 29, 2010 № 326-FZ «About obligatory medical insurance in the Russian Federation») is considered.

    Authors: Romanovskaya O. V. [6]

    Tags: duties1 insurance2 medical care13 medical organization52 responsibility1

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  • 2013 № 11 Legal representatives in the health care (Penza State University, Penza, Russia)

    This article analyzes the legal status of a legal representative in the various models of legal relations in the sphere of health care (with the consent to medical intervention prior to admittance to the patient). The basic challenges that may face a medical professional when determining the authority of the legal representative patient. Particular attention is paid to the guardianship authorities, as well as various organizations authorized to represent citizens under the law.

    Authors: Romanovskaya O. V. [6]

    Tags: health care24 legal representatives1 medical organization52 patient13

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  • Focus of the problem
  • 2015 № 4 Safety of medical activity: what is it and how the Chief doctor should provide it

    The article deals with the contents of medical organization working to support and monitor the safety of medical activity. Priorities that should be decided by each head of the medical organization in this field. Emphasized that the main body of the medical organization for addressing issues and making decisions on ensuring and monitoring the safety of medical practice must be a medical Commission.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: chief doctor1 medical commission5 medical organization52 quality of medical activity1 safety of medical activity1

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  • 2021 № 9 What has changed for medical organization with the adoption of the new regulation on federal state control (supervision) quality and safety of medical activity

    The article analyzes the Regulations on the Federal state control (supervision) of the quality and safety of medical activities, approved by the Decree of the Government of the Russian Federation № 1048 of June 29, 2021. The following is noted: The Regulation defines a broader list of issues that are now the subject of federal state control of the quality and safety of medical activities; The regulation ensures continuity with the Federal Law № 248-FZ of 31.07.2020 «On State Control (Supervision) and Municipal Control in the Russian Federation», on the one hand, and with the Requirements for the organization and Conduct of internal quality control and Safety of Medical Activities approved by the Decree of the Ministry of Health of the Russian Federation № 785n of 31.07.2020, on the other hand; for the first time, the risk profile of causing harm (damage) to the life and health of citizens is fixed for supervisory
    authorities as the most important area of work in the field of state control of the quality and safety of medical activities.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: federal state control (supervision)1 mandatory requirements3 medical organization52 quality and safety of medical activities9 supervisory authorities in the field of healthcare1

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  • 2023 № 4 Problematic issues of contractual relations between a medical worker and a medical organization: what needs to be paid attention to the head of a medical organization and a medical worker

    The “Guidelines for Compliance with Mandatory Requirements in Carrying Out Medical Activities” approved by Roszdravnadzor on November 11, 2022, noted that the most common violations include the licensee’s lack of employment contracts with employees performing work (services) permitted by the license. In this regard, the article substantiates in detail the need to conclude an employment contract with every medical worker working in a medical organization, regardless of whether this organization is his main place of work or not.
    The authors show that when a medical organization engages a medical worker from another medical organization to consult patients on a regular basis, it is also necessary to conclude an employment contract with him. At the same time, when a medical organization engages a medical worker of another medical organization on a paid basis for one-time/separate consultations, a civil law contract can be concluded with him. The article emphasizes that the concepts of “consultant” and “medical consultation” require their disclosure in the legislation, which determine the legal status of specialists involved in consultations and give a detailed description of medical consultations.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: civil law contract1 consultant2 consultation2 employment contract5 job duties2 labor function1 labor relations3 medical organization52 medical worker3

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  • 2023 № 7 New rules of paid medical services: is a medical organization required to have an official website.

    The Rules for the provision of paid medical services by medical organizations, approved by Government Decree No. 736 dated May 11, 2023, significantly expand the requirements that provide for an increase in the amount of information about the contractor and the paid medical services provided by him, which the medical provider must provide to the consumer. organization. Taking into account these requirements, the article considers in detail the question of whether medical organizations providing paid medical services are required to have their own official website. The authors substantiate that all medical organizations providing paid medical services, but not participating in the implementation of the State Guarantees Program, are required to post the information provided by law about themselves and about
    the paid medical services they provide on the Internet. At the same time, the specified information may be posted on the official website on the Internet and (or) in other information systems on the Internet. At the same time, all medical organizations providing paid medical services must take into account the risks associated with the use of information systems owned by foreign legal entities and citizens, the use of which is subject to the prohibitions established by Part 8 of Art. 10 of the Federal Law “On Information, Information Technologies and Information Protection”. One way to account for these risks is to create or develop your own official sites on the Internet.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: information systems on the internet1 informing the consumer1 medical organization52 official website1 paid medical services21 personal data3

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  • 2018 № 10 About terms and order of provision of information constituting a medical secret to the institution of inquiry and investigation, the court, on request of the prosecution and of the criminal-executive system

    The article shows and justifies which bodies in accordance with the legislation of the Russian Federation belong to the bodies of inquiry and investigation. The authors pay attention to a number of important features that need to be taken into account by medical organizations when working with requests for information constituting medical secrecy, the bodies of inquiry and investigation, the court, at the request of the Prosecutor’s office and the body of the penal system, as this activity is regulated not only by the legislation in the field of health, but also by regulatory legal acts regulating the activities of these bodies.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: inquiries of bodies of inquiry and investigation1 medical organization52 medical secrecy2 quality and safety of medical activity12 requests of bodies of prosecutor’s office1 requests of body of penal system1 requests of court1 rights of citizens2

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  • 2019 № 9 To the question of training of medical workers within internal control of quality and safety of medical activity

    Changes in the legislation concerning the organization of internal control of quality and safety of medical activity put forward new requirements to training of medical workers. These requirements concern the mandatory training on early detection of cancer, ensuring the provision of medical assistance to citizens in emergency form, the use and operation of medical devices. The article deals with the practical implementation of these requirements at the level of the medical organization.

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: internal control of quality and safety of medical activity1 medical activity5 medical care13 medical organization52 medical worker3 training4

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  • Focus of problem
  • 2017 № 10 Criteria for assessing the quality of health care: what to consider and how to ensure compliance in a healthcare organization

    The issue deals with the organization of work on the application of criteria to assess the quality of care in a medical organization. The authors pay attention to a number of characteristics that must be taken into account specified criteria, including note that work on their application not only largely concerned, but also overlap with the functions of the medical Commission of the medical organization. The article shows that the use in a medical organization criteria for evaluating the quality of medical care is one of the tools that ensures the continuity of inter¬nal control of the quality and safety of medical activities with the departmental and state control of the quality and security of medical activity

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: criteria6 medical commission5 medical organization52 quality and safety of medical activity12 quality control4

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  • 2017 № 2 New tasks and directions of work of the medical commision in the system of providing and controlling the quality and safety of medical activities

    The article deals with the reasons of insufficiently work of medical commissions of medical organizations. It was noted that today the medical Commission, continuing to be the third level of quality control of medical care in medical organization, often is the third level of quality control and safety of medical activities. In the publication of the proposals to improve the efficiency of the medical Commission, including revealed the contents of its work in accordance with the objectives and functions set by law, which often remain outside the purview of heads of medical organizations.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: medical commission5 medical organization52 quality and safety of medical activities9 quality of medical care20 safety of medical activities2

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  • 2017 № 5 A new control tool in healthcare: a control without interacting with legal entities and individual entrepreneurs

    The article deal with the emergence of a new monitoring tool in the health sector – organization and conduct of control measures without the cooperation of legal entities and individual entrepreneurs. The authors note that the legislation of the Russian Federation contains a significant amount of the requirements for medical organizations
    to embed and provide information. Thus compliance with these requirements will be validated by the Supervisory authorities by carrying out control activities without interaction with legal entities, individual entrepreneurs. All this increases the responsibility of medical organizations and confronts them with new challenges when conducting internal monitoring the quality and safety of medical activity.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: caution1 control without interaction with legal entities and individual entrepreneurs1 medical organization52 quality and safety of medical activity12 requirements1

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  • 2017 № 7 The duty of medical organizations inform about the doctors: what is informing and how to organize it

    The article deals with the responsibility of medical organizations to provide information on doctors, their level of education and qualifications. Presented and substantiated list of specific information about doctors who have to post every medical organization on the official site in a network “the Internet”, as well as on the stands. The authors demonstrated that even if the doctor your consent to the placing of personal data (information about the doctor), which in accordance with legislation, obliged to submit medical organization, the placement of these data on its official site in a network “the Internet”, as well as on the stands should be continued. Stressed that the problem of placing medical organizations and maintaining up to date information about doctors, including their level of education and qualification, necessary water supply amount, and in strict accordance with the established requirements is one of the most important ways of ensuring and monitoring the quality and safety of medical activity

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: certificate of accreditation1 graduate certificate1 information about the doctor1 level of education and qualifications1 medical organization52 medical organization site1 personal data3 the quality and safety of medical practice1

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  • 2017 № 8 Standards of medical care: whether they are mandatory for compliance with medical organizations?

    In the Federal legislation of public health has stated that «medical care is organized and is … on the basis of standards of medical care…». The phrase «on the basis of standards of medical care» is interpreted differently in medical institutions, in connection with which the question often arises: «do I have to perform the standards of care, or they are Advisory in nature?». In the article the authors substantiate and prove that is currently approved in the prescribed manner the standards of care mandatory for medical organizations and doctors

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: inspections1 medical organization52 monitoring3 quality and safety of medical practice4 standards of medical care5

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  • 2018 № 4 The role and importance of criteria for evaluating the quality of medical care, approved by order of ministry of health of Russia from 10.05.2017 n203n for healthcare organizations working in the mandatory health insurance system

    The article analyzes the regulatory framework governing the quality control of medical care in the system of mandatory health insurance (MHI) and the application of criteria for assessing the quality of medical care in a medical organization. It is noted that the criteria for assessing the quality of medical care are an integral tool for ensuring and controlling the quality of medical care for all medical organizations without exception, including those operating in the MHI system. The authors explain and emphasize that the legislation on compulsory medical insur¬ance in no way limits the use of these criteria medical organizations working in MHI. At the same time application of the specified criteria allows to prevent or reduce number of defects of medical care / violations at rendering medical care, and also number of defects of registration of primary medical documentation

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: control of the quality of medical care1 examination of the quality of medical care3 mandatory health insurance5 medical care13 medical organization52 quality assessment criteria1

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  • 2018 № 5 Checklists of healthcare quality control and safety of medical activity: new challenges of medical organizations

    The article substantiates the necessity of analysis and careful study by medical organizations Of checklists (lists of control issues), approved by the order of Roszdravnadzor of December 20, 2017 № 10450. To this end, the authors propose to identify in the test sheets four conditional groups of control issues that have certain features that need to be considered by medical organizations. The article contains a reasonable conclusion that the analysis and careful study of the test sheets should be pre-determined by medical organizations as a mandatory component of internal quality control and safety of medical activities, ensuring its real continuity with the state control of quality and safety of medical activities

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: checklists1 lists of control questions1 medical organization52 quality and safety of medical activity12

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  • 2019 № 6 Control purchase when providing paid medical services: what medical organizations must know

    The article deals with changes in legislation relating to the test purchase in order to verify compliance with the medical organization of the order and conditions of paid medical services. It is emphasized that control purchases in the provision of paid medical services is now one of the areas of state control of quality and safety of medical activity. The authors present the characteristics of the control purchase in conjunction with other forms and methods of control, including unscheduled inspections and control without interaction with legal entities, individual entrepreneurs. It is noted that the control purchase in the provision of paid medical services can be used by the relevant Supervisory authorities not only in the implementation of state quality control and safety of medical activities, but also in the implementation of supervision in the field of consumer protection, as well as in the implementation of the Federal state sanitary and epidemiological surveillance.
    Keywords: control purchase,  paid  medical  services,  medical  organization,  control  without  interaction  with  legal  entities,  unscheduled  on-site  inspections,  quality  control  and  safety  of  medical  activities,  separate  types  of  state  control  (surveillance)
    … Р. 6-10
    Abstract. The article deals with changes in legislation relating to the test purchase in order to verify compliance with the medical organization of the order and conditions of paid medical services. It is emphasized that control purchases in the provision of paid medical services is now one of the areas of state control of quality and safety of medical activity. The authors present the characteristics of the control purchase in conjunction with other forms and methods of control, including unscheduled inspections and control without interaction with legal entities, individual entrepreneurs. It is noted that the control purchase in the provision of paid medical services can be used by the relevant Supervisory authorities not only in the implementation of state quality control and safety of medical activities, but also in the implementation of supervision in the field of consumer protection, as well as in the implementation of the Federal state sanitary and epidemiological surveillance.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: control  without  interaction  with  legal  entities1 control purchase2 medical organization52 paid medical services21 quality  control  and  safety  of  medical  activities3 separate  types  of  state  control  (surveillance)1 unscheduled  on-site  inspections1

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  • 2020 № 1 Is the medical organization obliged to ask the patient for an identity document when applying for paid medical services?

    The article shows and proves that when a patient applies for paid medical services, a medical organization is obliged to ask him for an identity document. First of all, this is enshrined in the requirements for the maintenance of accounting and reporting documentation established by the legislation of the Russian Federation. At the same time, the authors emphasize that even if the patient does not have an identity document, the refusal to conclude a contract for the provision of paid medical services is unacceptable. The issue of presentation of an identity document by a patient when applying for the provision of paid medical services became particularly relevant after the introduction of such a control tool as the control purchase of paid medical services.

    Authors: Piven D. V. [58] Kitsul I. S. [58] Ivanov I. V. [29]

    Tags: control purchase2 identity document1 medical documentation2 medical organization52 paid medical services21 patient13 quality control and safety of medical activity2

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  • 2020 № 5 Is a medical organization required to provide medical documents of a deceased patient for review at the request of his / her spouse or close relatives

    The article presents a detailed analysis of the legal situation related to issues of medical confidentiality after the death of a patient. The publication brought to the attention of the medical organizations, now in accordance with the Decision of the constitutional Court of the Russian Federation of January 13, 2020, № 1-P the denial of a spouse (wife), close relatives of a deceased patient access to his medical records may be considered valid only if during the life of the patient expressed prohibition on disclosure of information constituting a medical secret.

    Authors: D.  V.  Piven [4] I.  S.  Kitsul [3] I.  V.  Ivanov [3]

    Tags: close relatives1 medical documentation2 medical organization52 medical secrecy2 patient13 quality  control  and  safety  of  medical  activities3

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  • 2019 № 4 Amendments to the Federal law “On the basics of public health in the Russian Federation” on matters of clinical guidelines: what to do and what to expect medical organizations

    The article deals with an analysis of certain provisions of the legislation on health care in connection with the changes made to the Federal law “on the basics of public health in the Russian Federation” on clinical guidelines.” In the context of the adopted changes, the authors consistently and clearly justify the obligation of medical organizations to comply with both the standards of medical care and the current clinical recommendations (treatment protocols). The sig- nificantly increased role of criteria for assessing the quality of medical care, approved by the Ministry of health of Russia, is emphasized and justified.

    Authors: D.  V.  Piven [4] I.  S.  Kitsul [3] I.  V.  Ivanov [3]

    Tags: clinical guidelines5 criteria for assessing the quality of medical care1 examination of the quality of medical care3 medical organization52 organization of medical care4 standards of medical care5

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  • Financial management
  • 2013 № 5 Business planning in commercial medical organization's practice (Baykal State University of Economics and Law; JSC "Doctor Bermental"; Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)

    The article is dedicated to the business planning technology as an instrument for management of a medical organization. Also there is analysis of the structure and function of a business plan. The article contains an example of the business plan's financial section of a commercial medical organization.

    Authors: Vinokurova A. M. [2] Pozdnyakov P. A. [2] Kitzul I. S. [3]

    Tags: break-even point1 business planning1 cost2 economic efficiency of the project1 medical organization52 net cost1 payback period1 profitability of investments1

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  • 2022 № 1 Analysis of medical organization website during the Covid-19 pandemic

    The Web site has become an integral part of organizations that use the power of the Internet and online communication platforms to build trust and strengthen relationships with stakeholders during and after a crisis.
    The COVID‑19 pandemic is an uncertain risk factor that requires ongoing analysis of interventions in order to make effective decisions.
    P u r p o s e of the study is to analyze user behavior pattern at medical organization website.
    M a t e r i a l s a n d m e t h o d s . The analysis of the website of the SamSMU Clinics performed using the web-analytics tool Yandex Metrics. The measurement periods has been done between January 2020 and June 2021.
    R e s u l t s . The results showed a change in visitor behavior during the pandemic in the direction of an increase in visits, a decrease in time and depth of browsing, and a change in the type of device used to access the site in favor of the smartphone. The main result was the need to make decisions to improve interaction with patients as part of the development of mobile health.
    F i n d i n g s . The COVID‑19 pandemic has had an impact on medical organization digital marketing. A behavioral shift of site visitors toward increased activity in the use of electronic registration and mobile devices has been revealed. To improve interaction with the target audience, it is necessary to categorize website content into different categories: for the patient, for medical students, and for medical staff.

    Authors: Arhipova S. V. [2] Dvoinikov S. I. [2]

    Tags: marketing analysis1 medical organization52 pandemic8 website1

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  • 2022 № 4 Features of the formation of the labor rationing system in medical organizations providing primary health care

    Labor rationing has a number of potential opportunities, with the competent implementation of which it is possible to solve many urgent management tasks, including stimulating employees.
    The purpose of the study is to evaluate the principles of the formation of the remuneration system through the applied elements of labor rationing for various categories of medical workers providing primary health care, taking into account the specialty of the medical worker and his activities.
    Materials and methods. A mechanism has been developed for the introduction of a remuneration system (an effective contract) through labor rationing in compliance with labor legislation and other regulatory documents based on the timing of the performance of the labor function (manipulation, procedure, examination, etc.), its quantitative and qualitative characteristics.
    Results. During the development of the labor rationing system in the polyclinic, timekeeping tables for load accounting were developed for all departments. Based on these data, the optimal accounting unit of labor costs was established and the required number of points was determined, which guarantees the receipt of an official salary with a full worked rate of hours per month. For each employee, the form “Performance of the load per month” was filled out, where the indicators “Number of patients/days per month” and “Average load per day” were calculated. Summary evaluation data were entered into labor passports, which reflected the rate of points per day, the actual number of points scored, the difference between the actual number and the norm, the percentage of the surcharge. As an example, several developed methods are presented for the development of criteria and the establishment of additional payments to polyclinic medical workers within the framework of an effective contract.
    Findings. Determining the workload of medical workers based on the study of labor processes and the cost of working time to perform various jobs, and then rationing their labor, in general, makes the requirements for the volume of work performed transparent, reasonable and understandable for the staff of medical organizations.

    Authors: Sochkova L. V. [2] Kim A. V. [2] Sharafutdinova L. L. [2] Guryeva N. A. [2]

    Tags: labor rationing2 medical organization52 timing of performance of labor function1 wage system1

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  • Feedback
  • 2017 № 9 The discussion about mandatory compliance with medical organizations standards of medical care

    The authors in the order of discussion into details justify and prove that currently approved and put into effect in the prescribed manner the standards of medical care mandatory for medical organizations and doctors

    Authors: Piven D. V. [58] Kitsul I. S. [58]

    Tags: clinical guidelines5 law enforcement agencies1 medical organization52 standards of medical care5

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