Referral for a medical examination form 302n: certificate on form No. 004-P/U (health passport)

DIRECTION for preliminary (periodic) medical examination (examination)

Heading to __________________________________________________________________

(name of medical organization, registration address, OGRN code)

1. Full name _______________________________________________________________

2. Date of birth ________________________________________________________________________________________________

(day month Year)

3. Applying for a job/working (underline as appropriate)

4. Workshop, area______________________________________________________________

5. Type of work in which the employee is examined__________________________

6. Work experience in the type of work in which the employee is examined__________________________________________________________

7. Previous professions (jobs), position and length of service in them _________________________________________________________________________

8. Harmful and (or) hazardous substances and production factors:

8.1. Chemical factors ___________________________________________________

(number of item or items of the List[*], list)

8.2. Physical factors ___________________________________________________

(line number, item or items of the List*, list)

8.3. Biological factors ________________________________________________

(number of item or items of the List*, list)

8.4. Severity of work (physical overload) ___________________________________

(number of item or items of the List*, list)

9. Profession (work) _____________________________________________________

(number of item or items of the List*, list)

(position of authorized representative)

(signature of authorized representative)

(FULL NAME.)

[*] List of harmful and (or) dangerous production factors, in the presence of which mandatory preliminary and periodic medical examinations (examinations) are carried out.

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Procedure and contents of the form

Any types of medical examinations are carried out on the direction of the employer. All mandatory medical examinations, preliminary or periodic, are carried out in accordance with the Procedure for conducting medical examinations, approved by the above-mentioned Order of the Ministry of Health and Social Development. In particular, paragraph 8 of the Procedure determines that the employer is obliged to draw up a list of contingents, on the basis of which referrals for a medical examination are issued.

The document form must contain information about:

full name of the enterprise that issued the referral;
the full name of the medical institution where employees will undergo a medical examination, indicating the details (OGRN code), the actual address of location;
the form of an upcoming medical examination;
last name, first name and patronymic of the employee;
date of his birth;
the name of the department, service, division of the employer;
specialty, profession of the employee, or name of the work he performs;
working conditions: degree of danger, hazardous production, other health risk factors.

The document must have the signature of the responsible person appointed by the employer, his full name, as well as information about his position.
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Periodic medical examination

This type of inspection is carried out on the basis of lists of names. They include all employees who have worked for 5 years in hazardous or harmful work (subclasses 3.1-3.4, class 4), indicating their position and harmful factor. Workers with occupational diseases or persistent consequences of industrial accidents undergo examinations at occupational pathology centers every 5 years. If there are no such centers in the regions of the Far North and equivalent centers, they turn to mobile teams of medical specialists from occupational pathology centers.

The list of subjects to be examined is prepared no later than two months before the start of the inspection.

Immediately before starting periodic medical examinations under order 302n, the employer gives employees directions, which are drawn up in the same way as during a preliminary examination.

The medical organization with which the employer has an agreement prepares a schedule of examinations, which is provided to the employer no later than 14 days before the start of the examination. The process follows the same procedure as the preliminary one and ends with the issuance of conclusions to employees. Then the medical organization summarizes the results obtained and reflects them in the final report. This document states:

number of employees who underwent inspection;
number of employees with contraindications;
how many employees need treatment and additional examination, and so on.

The act is drawn up electronically and on paper in five copies, which are certified by the head of the commission. One copy is sent to the enterprise, the second remains in the medical institution, the third - in the center of occupational pathology, the fourth - in the territorial executive body responsible for the sanitary and epidemiological situation, the fifth - in the Social Insurance Fund.

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conclusions

There are several types of medical examinations to which the employer must send some working citizens. There are categories of workers who must undergo mandatory examinations.

The characteristics of his or her activities play a key role in determining what kind of medical examination an employee will undergo. For example, drivers are required to undergo examination before and after the trip. Employees working in an office are examined every few years (medical examinations of office workers).