Order 298 n dated 31 05. On approval of the procedure for the provision of medical care in the profile "plastic surgery

On approval of the Classification of reserves and forecast resources of oil and combustible gases

In accordance with the Law Russian Federation dated February 21, 1992 N 2395-I "On the subsoil" (Bulletin of the Congress of People's Deputies of the Russian Federation and the Supreme Council of the Russian Federation, 1992, N 16, item 834; Collection of Legislation of the Russian Federation, 1995, N 10, item 823; 1999, N 7, item 879; 2000, N 2, item 141; 2001, N 21, item 2061; 2001, N 33, item 3429; 2002, N 22, item 2026; 2003, N 23, 2174; 2004, N 27, item 2711; 2004, N 35, item 3607), Regulations on the Ministry of Natural Resources of the Russian Federation, approved by Decree of the Government of the Russian Federation of July 22, 2004 N 370 (Collected Legislation of the Russian Federation, 2004, N 31, item 3260; 2004, N 32, item 3347), I order:

1. Approve the attached Classification of reserves and probable resources of oil and combustible gases.

By Order of the Ministry of Natural Resources of Russia dated December 9, 2008 N 329, paragraph 2 of this order is set out in a new edition

2. To put into effect the Classification of reserves and probable resources of oil and combustible gases specified in paragraph 1 of this Order from January 1, 2012.

Minister Yu.P. Trutnev

Registration N 7296

Classification of reserves and forecast resources of oil and combustible gases

I. General provisions

1. This Classification of reserves and probable resources of oil and combustible gases (hereinafter referred to as the Classification) was developed in accordance with the Law of the Russian Federation of February 21, 1992 N 2395-1 "On Subsoil" (hereinafter referred to as the Law of the Russian Federation "On Subsoil") (Vedomosti Congress of People's Deputies of the Russian Federation and the Supreme Council of the Russian Federation, 1992, N 16, article 834; Collection of Legislation of the Russian Federation, 1995, N 10, article 823; 1999, N 7, article 879; 2000, N 2, article 141; 2001, N 21, item 2061, 2001, N 33, item 3429; 2002, N 22, item 2026; 2003, N 23, item 2174; 2004, N 27, item 2711; 2004, N 35, art. 3607), and clause 5.2.4 of the Regulations on the Ministry of Natural Resources of the Russian Federation, approved by Decree of the Government of the Russian Federation of July 22, 2004 N 370 (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2004, N 31, art. 3260; 2004 , N 32, art. 3347), and establishes principles for the classification of reserves and resources of oil, combustible gases (free gas , gas cap gas, gas dissolved in oil, and gas containing condensate).

2. Oil and combustible gases located in the subsoil, based on the analysis of geological knowledge and the degree of readiness for industrial development, are divided into:

The amount of oil, combustible gases and associated components contained in them, which is located in the subsoil in the deposits studied by drilling (hereinafter referred to as geological reserves);

The amount of oil, combustible gases and associated components contained in traps, oil and gas or promising oil and gas bearing formations, horizons or complexes (hereinafter referred to as geological resources) that have not been discovered by drilling.

3. Oil and combustible gas reserves are calculated based on the results of geological exploration and field development. Data on the reserves of oil and combustible gas fields are used in the planning and implementation of their production, in the development and implementation of investment projects for the exploration and development of deposits, the design of transportation and complex processing of oil and combustible gases, in the development of concepts of economic and social development subjects of the Russian Federation and the Russian Federation as a whole and in solving scientific problems related to the forecast of oil and gas content.

4. Oil and combustible gas resources are estimated separately for oil and gas within oil and gas provinces, regions, districts, zones, areas and individual traps. Data on the resources of oil and combustible gases are used in planning prospecting and exploration work.

5. The object of calculation of reserves is a deposit (parts of deposits) of oil and combustible gases with a proven commercial oil and gas potential. The object of resource assessment is accumulations of oil, combustible gases in oil and gas bearing complexes, horizons and traps, the presence of which in the bowels is predicted based on the results of geological, geophysical and geochemical studies.

6. Groups of oil and combustible gas reserves are distinguished by industrial significance and economic efficiency.

7. Groups of reserves are allocated according to the industrial significance of the deposit and the amount of net present value, determined by the predicted development indicators at fixed discount rates.

8. According to economic efficiency, groups of oil and combustible gas resources are distinguished.

9. Resource groups are allocated according to the expected value of reserves.

10. According to the degree of geological knowledge and industrial development, geological reserves and geological resources are divided into categories.

11. The allocation of categories of reserves according to geological knowledge is carried out according to the degree of geological structure and oil and gas potential of the deposit by drilling, geophysical methods, field and analytical studies, which make it possible to carry out a reliable calculation of reserves and draw up a development project based on the geological and filtration models of the deposit.

12. The allocation of categories of resources according to geological knowledge is carried out according to the knowledge of the geological structure and oil and gas content of the subsoil area by area and section by parametric and exploratory drilling, geophysical, geochemical and other types of prospecting and exploration, the detail of building a geological model of a promising trap and the reliability of resource assessment for designing prospecting and exploration work.

14. Calculation of reserves and estimation of resources can be carried out by deterministic and probabilistic methods.

When using deterministic methods, it is recommended to evaluate the error in the calculation of reserves and resource estimates, based on the accuracy of determining the calculation parameters.

If probabilistic methods are used, then the following boundaries for the assessment of reserves and resources can be determined:

1) Minimum (P90) - the estimated value of reserves and resources is confirmed with a probability of 0.9;

2) Optimal or basic (P50) - the estimated value of reserves and resources is confirmed with a probability of 0.5;

3) Maximum (P10) - the estimated value of reserves and resources is confirmed with a probability of 0.1.

15. When determining the reserves of deposits, the reserves of oil, combustible gases and the components contained in them (condensate, ethane, propane, butanes, sulfur, helium, metals), the expediency of extraction of which is substantiated by technological and technical and economic calculations, are subject to mandatory separate calculation and accounting.

16. Calculation and accounting of reserves of oil, combustible gases and components contained in them that are of industrial importance, is carried out for each deposit separately and for the deposit as a whole, according to their presence in the subsoil, without taking into account losses during field development.

17. In accordance with Article 31 of the Law of the Russian Federation "On Subsoil", in order to take into account the state of the mineral resource base, the State Balance of Oil and Combustible Gas Reserves is maintained on the basis of the Classification. The state balance sheet should contain information on the quantity, quality and degree of exploration of the reserves of each type of minerals for deposits of industrial importance, on their location, on the degree of industrial development, production, losses and on the availability of industrial explored mineral reserves.

18. Reserves of oil, gas condensate, as well as the components contained in them, are calculated and taken into account, and the resources of oil and gas condensate are estimated and taken into account in units of mass.

19. Gas and helium reserves are calculated and accounted for, and prospective and forecast gas and helium resources are estimated and accounted for in units of volume. Counting, evaluation and accounting are carried out under conditions reduced to standard ones (at a pressure of 0.1 MPa and a temperature of 20°C).

20. The assessment and accounting of the quality of oil and combustible gases is carried out in accordance with the established requirements, taking into account the technology of production and processing, which ensures their integrated use.

21. Deposits (deposits) of oil and combustible gases for the purposes of keeping records of oil and gas reserves are subdivided according to the phase state and composition of hydrocarbon compounds, according to the size of the reserves and the complexity of the geological structure.

22. Upon receipt of groundwater inflows from wells in oil and combustible gas fields, the temperature is determined, chemical composition groundwater, the content of iodine, bromine, boron and other useful components in them to justify the feasibility of conducting special geological exploration in order to assess groundwater reserves and determine the possibility of using them to extract useful components or for thermal power, balneological and other needs.

23. When calculating and accounting for reserves and resources of oil and gas, measures are provided for the protection of subsoil, conservation and improvement environment in the development of oil and gas fields.

II. Groups of reserves and resources of oil and gas by economic efficiency

24. According to the degree of economic efficiency and the possibility of their industrial development and use, oil and gas reserves and the components contained in them are divided into two groups subject to separate calculation and accounting - industrially significant and non-industrial.

25. Industrially significant reserves are subdivided into normally profitable and conditionally profitable.

25.1. Reserves of deposits (deposits) whose involvement in development at the time of assessment according to technical and economic calculations is economically efficient in a competitive market when using equipment and technology for the extraction and processing of raw materials that ensure compliance with the requirements for the rational use of subsoil and environmental protection (normally profitable) ;

25.2. Reserves of fields (deposits) whose involvement in development at the time of the assessment, according to technical and economic calculations, does not provide acceptable efficiency in a competitive market due to low technical and economic indicators, but the development of which becomes economically possible when oil and gas prices change or new optimal sales markets and new technologies (conditionally profitable).

26. Non-commercial reserves include reserves of deposits (deposits), the involvement of which in development at the time of assessment is not economically feasible or technically or technologically impossible. This group includes reserves of oil and combustible gases of deposits (deposits) that are economically unprofitable for development at the present stage, as well as mothballed deposits, deposits located within water protection zones, settlements, structures, agricultural facilities, nature reserves, monuments of nature, history and crops and deposits, which are significantly remote from transport routes and territories with a developed infrastructure for oil production.

27. At industrially significant deposits, on the basis of technological and economic calculations, recoverable reserves are calculated and taken into account.

Recoverable reserves include a part of geological reserves, the extraction of which from the subsoil as of the date of calculation is economically efficient in a competitive market with the rational use of modern technical means and production technologies, taking into account compliance with the requirements for the protection of subsoil and the environment.

28. At deposits and deposits with non-commercial reserves, geological reserves are calculated and taken into account.

29. Resources for economic efficiency are divided into two groups: profitable and indefinitely profitable.

Cost-effective resources include resources that have a positive preliminary (or expert) expected value of reserves.

Indefinitely cost-effective resources are resources that, at the date of valuation, have an uncertain expected cost of reserves.

30. Recoverable resources stand out in economic resources.

Recoverable resources include the portion of geological resources that are economically viable to extract from the subsurface at the date of the estimate.

31. In indefinitely profitable resources, recoverable resources are not allocated.

III. Categories of reserves and resources of oil and gas by geological knowledge and degree of industrial development

32. The reserves of oil and combustible gases are divided into categories according to geological knowledge and the degree of industrial development: A (verifiable), B (established), C_1 (estimated), C_2 (estimated).

33. Category A (reliable)- developed reserves of the deposit or its part, drilled by the operational grid of wells in accordance with the design document for development. The geological structure of the deposit, the shape and dimensions are determined, and the fluid contacts are substantiated according to drilling, sampling and well logging data. Lithological composition, type of reservoirs, effective and oil and gas saturated thicknesses, reservoir properties and oil and gas saturation, composition and properties of hydrocarbons in reservoir and standard conditions and technological characteristics of the reservoir (operation mode, oil, gas, condensate flow rates, well productivity ) are established according to well operation data, reservoir hydraulic conductivity and piezoconductivity, reservoir pressure, temperature, displacement factors are studied with sufficient detail to build multidimensional geological and filtration models of the deposit with a high degree of reliability. Profitable development of the deposit is determined by the design process document for development and confirmed by actual production.

1) reserves of industrially developed deposits (or parts thereof) drained by production wells with implemented development technologies in accordance with the design document for development;

2) reserves of industrially developed deposits (or parts thereof) that are not drained for various reasons as of the date of calculation (in the area of ​​idle wells), the introduction of which into development is economically justified and will not require significant additional capital costs;

3) reserves of the developed deposit (or part of it), which can be additionally extracted economically from the geological reserves of this deposit through the use of industrially developed methods of enhanced oil recovery (EOR);

4) reserves that can be extracted additionally from the geological reserves of this deposit due to the compaction of the primary grid of production wells.

34. Category B (installed)- reserves of an explored, prepared for development deposit (or part thereof), studied by seismic surveys or other high-precision methods and drilled by prospecting, appraisal, exploration and advance production wells that have produced commercial oil or gas inflows. The geological structure of the deposit, the porosity and reservoir properties of reservoir rocks, the composition and properties of fluids, hydrodynamic characteristics, well flow rates are well studied based on the results of geological and field studies and trial operation of single wells. The degree of knowledge of reservoir parameters is sufficient to build reliable geological and filtration models of the reservoir. The cost-effective development of the deposit is confirmed by test operation data, well surveys and substantiated by the design technological document for development.

35. Category C_1 (assessed)- reserves of a part of a deposit studied by reliable seismic survey or other high-precision methods in the zone of possible drainage of untested wells and adjacent to the reserves of categories A and B, provided that the available geological and geophysical information with a high degree of probability indicates the commercial productivity of the penetrated reservoir in this part of the deposit. The degree of geological knowledge of the geological and field parameters of the deposit is sufficient to build a preliminary geological model and calculate reserves.

Technological parameters of the development of the deposit are determined by analogy with the studied areas of the deposit or using analogies for other developed fields;

The profitability of development is determined by analogy with the studied part of the deposit.

1) the undrilled part of the deposit, directly adjacent to the reserves of category A + B at a distance equal to the zone of possible drainage;

2) parts of the deposit in the area of ​​untested wells, if the productivity of this deposit is proven by testing or operation in other wells.

36. Category C_2 (alleged)- reserves in parts of the deposit not explored by drilling and in the drainage zone of transit untested wells. Knowledge about the geological and field parameters of the deposit is taken by analogy with the studied part of the deposit, and, if necessary, with deposits of a similar structure within the given oil and gas region. The available information is sufficient to build a preliminary geological model and calculate reserves. Technological parameters and economic efficiency of the development of reserves are determined by analogy with the studied areas of the deposit or using analogies for developed deposits.

1) reservoir sections between the proven contour of the reservoir and the boundaries of the reserves of higher categories, if there is enough geological and geophysical information to conclude on the continuity of the reservoir;

2) formations with unproven productivity, but studied on the basis of well logging data in transit production wells, while there is reasonable confidence that, according to well logging data, they can be productive;

3) undrilled tectonic blocks on deposits with established productivity. At the same time, the available geological information indicates that it is possible that the productive strata within the blocks are similar in terms of lithofacies characteristics to the studied part of the deposit.

37. When keeping records, reserves of categories A, B and C_1 are not recommended to be summed up with reserves of category C_2.

38. Resources of oil and combustible gases are subdivided into categories D_1 (localized); D_2 (prospective) and D_3 (forecast).

39. Category D_1 (localized)- resources of oil and combustible gases of possibly productive formations in traps identified and prepared for drilling. The shape, size and conditions of occurrence of the proposed deposits are determined based on the results of geological and geophysical studies, the thickness and reservoir properties of the reservoirs, the composition and properties of oil and gas are taken by analogy with explored deposits.

40. Category D_2 (promising)- resources of oil and combustible gases of lithological-stratigraphic complexes and horizons with proven commercial oil and gas potential within large regional structures. Quantitative assessment of forecast resources is carried out based on the results of regional geological, geophysical, geochemical studies and by analogy with discovered deposits within the estimated region.

41. Category D_3 (forecast)- oil and gas resources of lithological-stratigraphic complexes, estimated within large regional structures, the commercial oil and gas potential of which has not yet been proven. The prospects for the oil and gas potential of these complexes are predicted on the basis of data from geological, geophysical, and geochemical studies. Quantitative assessment of the predicted resources of these categories is carried out according to the estimated parameters based on the available geological concepts and by analogy with other, more studied regions, where explored deposits of oil and combustible gases have been established.

IV. Characteristics of deposits (deposits) of oil and combustible gases by phase state

42. Depending on the phase state and composition of the main hydrocarbon compounds in the subsoil, deposits (deposits) of oil and combustible gases are divided into:

1) oil (H), containing only oil saturated in varying degrees gas;

2) gas-oil (GN), in which the main part of the deposit is oil, and the gas cap does not exceed the oil part of the deposit in terms of reference fuel;

3) oil and gas (NG), which include gas deposits with an oil rim, in which the oil part is less than 50% by volume of reference fuel;

4) gas (G), containing only gas;

5) gas condensate (GC) containing gas with condensate;

6) oil and gas condensate (NGC) containing oil, gas and condensate.

43. In gas deposits, the following groups of gas condensate deposits are distinguished by the content of C_5+v:

1) low condensate - with a condensate content of less than 25 g/m3;

2) medium condensate - with condensate content from 25 to 100 g/m3;

3) high condensate - with condensate content from 100 to 500 g/m3;

4) unique condensate - with a condensate content of more than 500 g/m3.

V. Gradation of deposits (deposits) of oil and combustible gases by the size of recoverable reserves

44. Oil and gas fields in terms of recoverable oil reserves and geological gas reserves are divided into:

1) unique - more than 300 million tons of oil or 500 billion m3 of gas;

2) large - from 30 to 300 million tons of oil or from 30 to 500 billion m3 of gas;

3) medium - from 3 to 30 million tons of oil or from 3 to 30 billion m3 of gas;

4) small - from 1 to 3 million tons of oil or from 1 to 3 billion m3 of gas;

5) very small - less than 1 million tons of oil, less than 1 billion m3 of gas.

VI. Distribution of oil and combustible gas deposits according to the complexity of the geological structure

45. According to the complexity of the geological structure, deposits are distinguished:

1) simple structure- single-phase deposits associated with undisturbed or slightly disturbed structures, productive formations are characterized by consistency of thicknesses and reservoir properties in area and section;

2) complex structure- single- and two-phase deposits, characterized by uneven thicknesses and reservoir properties of productive formations in terms of area and section, or the presence of lithological replacements of reservoirs with impermeable rocks, or tectonic disturbances;

3) very complex structure- single- and two-phase deposits, characterized by both the presence of lithological replacements or tectonic disturbances, and uneven thicknesses and reservoir properties of productive formations, as well as deposits of a complex structure with heavy oils.

How will the new law on plastic surgery, which came into force on May 31, 2018, affect the activities of clinics? What will change for patients and medical staff, according to Order No. 298n? What will need to be changed in the internal structure and complex equipment of the classrooms?

First, it should be noted that the Order “On Approval of the Procedure for the Provision of medical care profile " plastic surgery"replaced the old document No. 555n of the Ministry of Health of the Russian Federation dated 10/30/2012 due to the fact that the mortality rate from such operations remains at a fairly high level. Order No. 298n dated May 31, 2018 is designed to protect clients of aesthetic medicine and plastic surgery centers. It is planned that the quality of services with latest introductions will improve significantly.

Features and changes

The orders apply to individual rooms, blocks and entire centers of plastic surgery. Now complex equipment is more strictly regulated, which should oblige the owners of medical centers to comply with quite certain standards, to purchase everything necessary for the licensing procedure.

Measures for the purchase of equipment and medical equipment intended for examinations will be strictly controlled, surgical operations and maintaining the condition of patients during rehabilitation period. Those clinics that do not introduce the required changes in their work, in accordance with Order No. 298n of May 31, 2018, will be forced to stop their activities.

What points are corrected by the new law?

The document covers the most important aspects of plastic surgery clinics, from equipping rooms, departments and comprehensive centers to staffing standards and the organization of the work of medical personnel. Based on the changes provided in the new law on plastic surgery, MEDMART LLC has streamlined the section Turnkey solutions for clinics of this career guidance.

Order No. 298n dated May 31, 2018 approves the procedure for the provision of services. Types of medical care that a modern plastic surgery center should provide:

• urgent, emergency and planned;
• primary specialized and specialized. Health care in this case means services involving high-tech equipment and technology.

The new law also regulates inpatient and outpatient conditions. The conditions under which assistance should be provided to patients under round-the-clock control or staying in a day hospital have been worked out in more detail.

The activities of a surgeon who is allowed before surgical interventions are also regulated. A certified specialist must provide services only in an office that fully complies with this order. Presence in hospital staff plastic surgeon does not mean the possibility of conducting a full-fledged activity. Operations in the field of "plastic surgery" can and should be carried out only in those rooms / offices that comply with the new law in absolutely all respects.

Indications for plastic surgery - a fresh look

What has changed dramatically is the influence of the desires of the clinic patients themselves. Now ambitions about one's own appearance and demands for its correction are not the primary impetus for the surgeon's actions. New law, which entered into force on May 31, 2018 in Russia, restricts specialists in their activities if there are no compelling medical indications for performing one or another intervention.

All changes compared to the previous document are described in detail in paragraph 2 of the law. Maintaining and restoring human health has become a priority. The purpose of the services that aesthetic medicine centers should offer is to return the patient to normal life after an accident, injury, due to a complex illness and the use of potent drugs. You can briefly describe the activities of the clinics as follows:

• elimination of functional defects;
• return of primary anatomical data lost for various reasons;
• correction of iatrogenic abnormalities, genetic congenital or acquired during life;
• adjustment appearance, as close as possible to generally accepted ideas about the appearance of a person;
• traumatic amputation of various limbs for medical reasons;
• reconstructive plastic, which makes it possible to build up bones and soft parts in places of damage;
• fight against aging. Here, it is permissible to affect different parts of the head and body of a person who has applied for professional help;
• a change in the anatomy of individual structures, underlying and integumentary tissues, which contributes to the return of the patient to his usual way of life.

If the desire of any person who applied to a graduate was previously put at the forefront, today such a wording has been completely removed from the regulatory document. It will no longer be possible to change your appearance without any need and for obvious reasons. The doctor himself will determine the need for a particular operation, based on the positive aspects that his patient will acquire after a particular event or procedure.

Plastic surgery will get as close as possible to traditional medicine aimed at improving and maintaining health, prolonging the normal life of citizens. Changing the shape of the nose or ears, succumbing to fashion trends or your own mood, will not work!

It is precisely the transition of plastic surgery and the sector of aesthetic medicine into the mainstream of a purely medical direction and is the most valuable change that should occur with the introduction of the new law into practice in Russia.

Order No.298n dated May 31, 2018 and a new plastic surgeon

Who will be the new doctors, how will they work? The obsolete Order was in many ways imperfect. Experts believe that his main mistake was permission to conduct complex operations that can lead to fatal consequences for people's lives, by surgeons who have undergone short-term training in performing certain surgical interventions.

With the innovations, the circle of those doctors, albeit long-term practicing surgeons, who will be allowed to conduct specific surgical interventions, will sharply narrow. The competence of plastic surgeons remains the whole range of measures to change the anatomical and structural changes in different parts of the patient's body. And surgeons who have specialized in other areas, but who have completed retraining courses, will have to return to conducting activities in their main profile. Full-fledged training lasts for several years, and the skills acquired in practice provide the basis for error-free conduct of activities.

Thus, the new law, with all its amendments, will help remove from the segment of the provision of services in plastic and aesthetic surgery centers those doctors who do not have sufficient competence in this matter.

Considering the transition from the patient's desire to improve their appearance to all kinds of assistance in maintaining the health of citizens, the centers should conduct consultations in various branches of medicine. This means that the staff should be increased. And clients of plastic surgery centers will now be able to receive information before any operation from:

• pediatrician and neonatologist (for pediatric surgery), internist;
• ENT doctor;
• gynecologist;
• neurologist and neuropathologist;
• urologist;
• orthopedist-traumatologist;
• ophthalmologist;
• cosmetologist and dermatovenereologist;
• surgeon involved in the restoration of the maxillofacial apparatus.

This approach is designed to eliminate the mistakes that were made in practice earlier. Patients will be informed in advance about the quality, volume, types of activities. They will receive advice on possible changes in the work of various organs and life support systems, both negative and positive. Every citizen who decides to have plastic surgery of their own free will or for medical reasons will be familiarized with the possible risks and the consequences arising from them. This is what should reduce the flow of patients who conduct experiments with appearance and decide on anatomical changes without good reason.

How will clinics change?

Not everything is as confusing and complicated as it seems at first glance! The new law and the Order on Plastic Surgery do not force the centers to significantly increase the costs of training and hiring specialized specialists in various fields. If there is no doctor in the staff, he can be attracted to work under a part-time contract. The main thing here is getting patients information about the state of their own health, its possible improvement or deterioration as a result of the provision of certain services within the plastic surgery center.

Important points in the complex equipment of offices

State regulations do not apply to private clinics. The equipment of the offices is described in Appendix No. 1, which indicates that now such premises should be included in the centers of medical complexes. Surgeons who do not meet the qualification requirements for the plastic surgery profile will not be allowed to practice.

The second appendix to the Order dated 05/31/2018 regulates the joint activities of surgeons and nurses, who must be at least one per doctor. At least 1 sanitary worker must be allocated for every 3 rooms. Appendix No. 6 is devoted to the preparation of the department of plastic surgery for licensing. At the same time, the operating unit has its own amendments and a list of equipment.

The office should be clearly zoned - a dressing room and a place for primary and scheduled examinations with all the necessary equipment. Invasive activities should not be carried out in the general room. Only dressings after operations are allowed if the patient's condition is stable. Among the types of anesthesia, only application is allowed, other types of anesthesia are carried out in the office of a plastic surgeon.

The third appendix of the new Order is devoted to the correct equipment standards. It contains tables with a list of mandatory and additional (recommended) equipment, consumables, etc.

The following annexes govern the operation of plastic surgery centers and departments within general hospitals. All premises of the department in which plastic surgery operations are performed must be located in the same building or part of the building. When moving a patient, it is impossible to take out / take out of the same building, it is allowed to move from building to building through warm equipped transitions.

New offices in the center of plastic surgery:

• x-ray room with modern equipment. A tomograph or X-ray is optional only for dental clinics. In general clinics, where a variety of operations are performed, MRI and mammographs should be installed to examine the mammary glands;
• anesthesia room/department.;
• resuscitation with ICU for the necessary equipment, depending on the focus - a children's or adult center;
• laboratory for diagnostic and clinical studies;
• dressing room;
• operating block;
• office or department of transfusiology with devices for blood transfusion.

Conclusions on the implementation of the new law

If earlier there was no room for transfusiology and blood transfusion, now it is mandatory. A round-the-clock hospital is being introduced, in addition to a working day hospital and an outpatient clinic. The cabinet with X-ray equipment is equipped in strict accordance with the list. You can forget about redirecting patients to third-party centers for such studies.

Surgeons who have completed advanced training will not be involved in plastic surgery. All serious manipulations can be performed only by specialized specialists who have undergone full training and received a diploma with qualifications in the appropriate profile.

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ORDER
dated May 31, 2018 No. 298n

ON APPROVAL OF THE PROCEDURE FOR PROVIDING MEDICAL CARE
FOR THE PROFILE "PLASTIC SURGERY"

Registered with the Ministry of Justice of Russia on June 22, 2018 No. 51410

In accordance with Article 37 of the Federal Law of November 21, 2011 No. 323-FZ "On the Basics of Protecting the Health of Citizens in the Russian Federation" (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2011, No. 48, Art. 6724; 2015, No. 10, Art. 1425 ; 2017, No. 31, item 4765), I order:

1. Approve the attached Procedure for the provision of medical care in the field of "plastic surgery".

2. Recognize invalid the order of the Ministry of Health of the Russian Federation dated October 30, 2012 No. 555n "On approval of the Procedure for the provision of medical care in the field of" plastic surgery "(registered by the Ministry of Justice of the Russian Federation on February 18, 2013, registration No. 27150).

Minister
V.I. Skvortsova

Approved
by order
dated May 31, 2018 No. 298n

ORDER
RENDERING MEDICAL ASSISTANCE ON THE PROFILE
"PLASTIC SURGERY"

1. This Procedure establishes the rules for the provision of medical care to adults and children in the field of "plastic surgery" (hereinafter referred to as medical care) in medical organizations and other organizations engaged in medical activities (hereinafter referred to as medical organizations).

2. Medical assistance includes a set of measures aimed at maintaining and (or) restoring health and including the provision medical services, the purpose of which is:

• elimination of anatomical and (or) functional defects of the integumentary and underlying tissues of any localization resulting from hereditary and congenital malformations, injuries and their consequences, diseases and surgical interventions, including iatrogenic defects, as well as traumatic amputations of limbs, their segments and others fragments human body any localization by methods of reconstructive plastic surgery;
• changing the appearance, shape and relationships of the anatomical structures of any areas of the human body in accordance with generally accepted aesthetic standards and ideas of a particular patient, including the correction of age-related changes, the correction of the consequences of eliminating anatomical and (or) functional defects of the integumentary and underlying tissues of any localization with the help of plastic surgery, leading to improving the quality of life by methods of aesthetic plastic surgery.

3. Medical assistance is provided in the form of:

• primary specialized health care;
• specialized, with the exception of high-tech, medical care.

4. Medical assistance is provided under the following conditions:

• on an outpatient basis (in conditions that do not provide for round-the-clock medical supervision and treatment);
• stationary (in conditions providing round-the-clock medical supervision and treatment).

5. Medical assistance is provided in the following forms:

• emergency - medical care provided in case of sudden acute diseases, conditions, exacerbation chronic diseases that pose a threat to the life of the patient;
• emergency - medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life;
• planned - medical care that is provided in the treatment and prevention of diseases and conditions that are not accompanied by a threat to the life of patients that do not require emergency and emergency care, the delay in the provision of which for a certain time will not entail a deterioration in the condition of patients, a threat to their life and health.

6. Primary specialized health care for patients in the field of "plastic surgery" is provided by plastic surgeons on an outpatient basis (in the office of a plastic surgeon) and provides for the following activities:

• to identify anatomical and (or) functional defects of the integumentary and underlying tissues of any localization resulting from hereditary and congenital malformations, injuries and their consequences, diseases and surgical interventions (iatrogenic defects), as well as traumatic amputations of limbs, their segments and other fragments human body of any localization;
• to identify aesthetic defects in the appearance, shape and relationships of the anatomical structures of any areas of the human body, including age-related changes, the consequences of the elimination of anatomical and (or) functional defects of the integumentary and underlying tissues of any localization with the help of plastic surgery and associated with the patient's desire to bring their appearance in line with generally accepted aesthetic standards and their own ideas;
• for the provision of medical care in accordance with clinical guidelines.

If it is impossible to provide medical care within the framework of primary specialized health care and there is a provider of specialized medical care in the profile of "plastic surgery".

7. Specialized, with the exception of high-tech, medical care is provided by plastic surgeons in stationary conditions(in departments of plastic surgery or plastic surgery centers) and provides for a set of measures for the prevention, diagnosis and provision of medical care, as well as medical rehabilitation in accordance with the procedures for providing medical care and based on standards of medical care.

8. If there are medical indications, medical care is provided with the involvement of specialist doctors in the specialties provided for by the Nomenclature of Specialties of Specialists with Higher Medical and Pharmaceutical Education<1>.

<1>Order of the Ministry of Health of the Russian Federation of October 7, 2015 No. 700n "On the nomenclature of specialties of specialists with higher medical and pharmaceutical education" (registered by the Ministry of Justice of the Russian Federation on November 12, 2011, registration No. 39696), as amended by order of the Ministry of Health of the Russian Federation dated October 11, 2016 No. 771n (registered by the Ministry of Justice of the Russian Federation on December 26, 2016, registration No. 44926).

9. In order to ensure the availability and quality of medical care, medical organizations use telemedicine technologies<2>.

<2>Order of the Ministry of Health of the Russian Federation dated November 30, 2017 No. 965n "On approval of the procedure for organizing and providing medical care using telemedicine technologies" (registered by the Ministry of Justice of the Russian Federation on January 9, 2018, registration No. 49577).

10. Medical assistance is provided in accordance with Annexes No. 1 - 9 to this Procedure.

Application No. 1

approved by order
Ministry of Health of the Russian Federation
dated May 31, 2018 No. 298n

RULES OF ORGANIZATION OF ACTIVITIES

1. These Rules establish the procedure for organizing the activities of the office of a plastic surgeon (hereinafter referred to as the Cabinet), which is a structural unit medical organization or another organization carrying out medical activities (hereinafter referred to as medical organizations).

2. The office is organized to provide medical care to the population in the field of "plastic surgery".

3. A specialist who meets the Qualification requirements for medical and pharmaceutical workers with higher education in the direction of training "Health care and medical sciences" is appointed to the position of a plastic surgeon of the Cabinet<1>specializing in plastic surgery.

<1>

4. The structure and staffing of the Cabinet are established by the head of the medical organization in which the Cabinet is created, based on the volume of medical care provided, taking into account the recommended staffing standards provided for in Appendix No. 2 to the Procedure for providing medical care to the adult population in the "plastic surgery" profile, approved by this order .

• room for examination of patients;
• room for medical manipulations(dressing).

6. The equipment of the Cabinet is carried out in accordance with the equipment standard provided for in Appendix No. 3 to the Procedure for the provision of medical care to the adult population in the field of "plastic surgery", approved by this order.

7. The main functions of the Cabinet are:

• provision of advisory, diagnostic and therapeutic assistance to patients in need of medical assistance in the field of "plastic surgery";
• dispensary observation and medical rehabilitation of patients in need of medical care in the field of "plastic surgery";
• activities for primary prevention the development of diseases and conditions related to the profile of "plastic surgery", as well as the secondary prevention of complications and the progressive course of these diseases and conditions;
• solution of organizational issues of providing medical care in the profile of "plastic surgery";
• referral of patients with diseases and conditions requiring the provision of medical care in the field of "plastic surgery" for the provision of medical care in the inpatient conditions of a medical organization;
• development and implementation of measures for sanitary and hygienic education;
• introduction into practice of new methods of prevention, diagnosis and treatment of patients with diseases and conditions related to the profile of "plastic surgery";
• <2> <3>.

<2>

8. In the Cabinet, it is allowed to perform postoperative dressings without anesthesia or with the use of application anesthesia. Any other types of invasive medical interventions, including infiltrative, conduction and other types of anesthesia, are not allowed.

Application No. 2
to the Procedure for the provision of medical care
in the field of "plastic surgery",
approved by order
Ministry of Health of the Russian Federation
dated May 31, 2018 No. 298n

RECOMMENDED STAFF STANDARDS
PLASTIC SURGEON'S OFFICE

Application No. 3
to the Procedure for the provision of medical care
in the field of "plastic surgery",
approved by order
Ministry of Health of the Russian Federation
dated May 31, 2018 No. 298n

STANDARD OF EQUIPMENT OF A PLASTIC SURGEON'S OFFICE

Application No. 4
to the Procedure for the provision of medical care
in the field of "plastic surgery",
approved by order
Ministry of Health of the Russian Federation
dated May 31, 2018 No. 298n

RULES FOR ORGANIZING THE ACTIVITIES OF THE DEPARTMENT OF PLASTIC SURGERY

1. These rules establish the procedure for organizing the activities of the department of plastic surgery (hereinafter referred to as the Department), which is a structural unit of a medical organization or other organization engaged in medical activities (hereinafter referred to as medical organizations).

2. The department is created as a structural subdivision of a medical organization providing medical care in an inpatient setting.

3. The department is organized if there are round-the-clock functioning in the medical organization:

• X-ray department (office) equipped with a stationary X-ray diagnostic apparatus (with the exception of dental ones) and (or) a stationary X-ray apparatus computed tomography(with the exception of dental), as well as a mammographic x-ray machine and (or) a magnetic resonance imaging machine with the ability to perform magnetic resonance imaging of the mammary glands rooms with X-ray machines);
• <1>
• <2>
• dressing.

<1>

<2>

The X-ray department (office), the anesthesiology-reanimation department, the clinical diagnostic laboratory, the transfusion room (blood transfusion room), the operating room (operating unit) should be located within the property complex, functionally and technologically integrated with the plastic surgery department. Functional and technological association means the placement of these departments within the same building or complex of buildings connected by warm transitions, ensuring the movement and transportation of patients without leaving the premises used by the medical organization.

4. In the medical organization, in the structure of which the Department is created, the possibility of providing advisory assistance specialist doctors in the following profiles: "therapy", "neurology", "dermatovenereology", "pediatrics", "otorhinolaryngology", "ophthalmology", "obstetrics and gynecology", "surgery", "urology". In the absence of the necessary specialist doctors in a medical organization, it is possible to attract specialist doctors from other medical organizations under an agreement, provided that such medical organizations have a license for the relevant work (services).

5. The department is headed by a head appointed and dismissed by the head of the medical organization in which it is organized.

6. A specialist who meets the Qualification requirements for medical and pharmaceutical workers with higher education in the direction of training "Health care and medical sciences" is appointed to the position of the head of the Department<3>(hereinafter - Qualification requirements), majoring in plastic surgery.

<3>Order of the Ministry of Health of the Russian Federation of October 8, 2015 No. 707n "On Approval of Qualification Requirements for Medical and Pharmaceutical Workers with Higher Education in the Field of Training "Health Care and Medical Sciences" (registered by the Ministry of Justice of the Russian Federation on October 23, 2015, registration No. 39438 ), as amended by the order of the Ministry of Health of the Russian Federation of June 15, 2017 No. 328n (registered by the Ministry of Justice of the Russian Federation on July 3, 2017, registration No. 47273).

7. A specialist who meets the Qualification requirements in the specialty "plastic surgery" is appointed to the position of a plastic surgeon of the Department.

8. The structure of the Department and its staffing are established by the head of the medical organization in which it is organized, based on the volume of medical and diagnostic work and recommended staffing standards, in accordance with Appendix No. 5 to the Procedure for the provision of medical care in the profile "plastic surgery".

9. The Department must ensure the availability of a round-the-clock duty team consisting of a plastic surgeon and nurse ward for continuous monitoring of patients.

10. During all surgical interventions performed in the provision of medical care in the profile of "plastic surgery", the constant presence of an anesthesiologist-resuscitator in the operating room for any type of anesthesia should be ensured.

11. The duration of the patient's stay in hospital after surgery is determined by his attending physician, taking into account medical indications.

12. The structure of the Department includes:

• examination room;
• doctor's office;
• chambers;
• dressing room;
• procedural;
• sisterly.

13. The equipment of the Department is carried out in accordance with the standard for equipping the department of plastic surgery in accordance with Appendix No. 6 to the Procedure for the provision of medical care in the profile "plastic surgery", approved by this order.

14. The department performs the following functions:

• provision of specialized, with the exception of high-tech, medical care by performing reconstructive and (or) aesthetic plastic surgery using surgical (including microsurgical) methods in accordance with clinical recommendations, based on medical care standards;
• taking measures to prevent diseases and conditions requiring medical care in the field of "plastic surgery";
• preparation and conduct diagnostic procedures in stationary conditions;
• development and implementation of new medical technologies related to the profile of "plastic surgery";
• development and implementation of measures aimed at improving the quality of medical and diagnostic work in the field of "plastic surgery";
• carrying out examination of temporary incapacity for work;
• improving the professional qualifications of medical workers on issues of specialized medical care in the profile of "plastic surgery";
• provision of advisory assistance to specialist doctors of other departments of a medical organization on issues of prevention, diagnosis, treatment and rehabilitation in the provision of medical care in the field of "plastic surgery";
• maintaining medical records;
• reporting in the prescribed manner<4>, collection and provision of primary data on medical activities for information systems in healthcare<5>.

<4>Clause 11 of Part 1 of Article 79 of the Federal Law of November 21, 2011 No. 323-FZ "On the Basics of Protecting the Health of Citizens in the Russian Federation" (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2011, No. 48, Art. 6724; 2013, No. 48, Art. 6165; 2014, No. 30, Art. 4257) (hereinafter - the Federal Law of November 21, 2011 No. 323-FZ).

15. The Department, in order to ensure its activities, uses the capabilities of the medical diagnostic and auxiliary units of the medical organization, within which the Department is organized.

16. The department can be used as a clinical base of professional educational organizations, educational organizations of higher education and organizations of additional vocational education and scientific organizations.

Application No. 5
to the Procedure for the provision of medical care
in the field of "plastic surgery",
approved by order
Ministry of Health of the Russian Federation
dated May 31, 2018 No. 298n

RECOMMENDED STATE STANDARDS OF THE DEPARTMENT OF PLASTIC SURGERY

<*>In plastic surgery departments that perform reconstructive plastic surgery on maxillofacial area, in the absence of such in the state of the medical organization.

Application No. 6
to the Procedure for the provision of medical care
in the field of "plastic surgery",
approved by order
Ministry of Health of the Russian Federation
dated May 31, 2018 No. 298n

STANDARD OF EQUIPMENT OF THE DEPARTMENT OF PLASTIC SURGERY

1. Equipment standard for the plastic surgery department (except for the operating room (operating unit)

2. Standard for additional equipment of the operating room (operating unit) of the medical organization, in the structure of which the department of plastic surgery is being created (the operating room is retrofitted in the absence of the listed items of equipment in it)

<*>In the departments of plastic surgery, which perform reconstructive plastic surgery on the bones.

<**>In the departments of plastic surgery in which reconstructive plastic surgery is performed.

<***>In plastic surgery departments that perform reconstructive plastic surgery on the hand.

<****>In departments of plastic surgery in which reconstructive plastic surgery is performed using microsurgical techniques.

Application No. 7
to the Procedure for the provision of medical care
in the field of "plastic surgery",
approved by order
Ministry of Health of the Russian Federation
dated May 31, 2018 No. 298n

RULES FOR ORGANIZING THE ACTIVITIES OF THE CENTER OF PLASTIC SURGERY

1. These rules determine the procedure for organizing the activities of the Center for Plastic Surgery (hereinafter referred to as the Center).

2. The Center is created as an independent medical organization or as a structural subdivision of a medical organization or other organization engaged in medical activities (hereinafter referred to as medical organizations), or on a functional basis.

3. The center is organized if there are round-the-clock functioning in the medical organization:

• X-ray department (office) equipped with a stationary X-ray diagnostic apparatus (with the exception of dental ones) and (or) a stationary X-ray computed tomography apparatus (with the exception of dental ones), as well as a mammographic X-ray apparatus and (or) a magnetic resonance imaging apparatus with the ability to perform magnetic resonance tomography of the mammary glands (in the structure of the X-ray service necessary for the provision of medical care in the field of plastic surgery, dental offices with an X-ray machine are not taken into account);
• anesthesiology-reanimation department for the adult population or anesthesiology-reanimation department with resuscitation wards and intensive care for the adult population, organized in accordance with the Procedure for the provision of medical care to the adult population in the profile "anesthesiology and resuscitation"<1>(in the provision of medical care to the adult population);
• anesthesiology-resuscitation department or anesthesiology-resuscitation center organized in accordance with the Procedure for providing medical care to children in the field of "anesthesiology and resuscitation"<2>(when providing medical care to children);
• clinical diagnostic laboratory;
• transfusion room (blood transfusion room);
• operating room (operating unit);
• dressing.

<1>Order of the Ministry of Health of the Russian Federation dated November 15, 2012 No. 919n "On approval of the Procedure for providing medical care to the adult population in the field of "anesthesiology and resuscitation" (registered by the Ministry of Justice of the Russian Federation on December 29, 2012, registration No. 26512).

<2>Order of the Ministry of Health of the Russian Federation dated November 12, 2012 No. 909n "On approval of the Procedure for providing medical care to children in the field of "anesthesiology and resuscitation" (registered by the Ministry of Justice of the Russian Federation on December 29, 2012, registration No. 26514), as amended by the order Ministry of Health of the Russian Federation of July 9, 2013 No. 434n (registered by the Ministry of Justice of the Russian Federation on August 2, 2013, registration No. 29236).

The X-ray department (office), the department of anesthesiology and resuscitation, the clinical diagnostic laboratory, the transfusiological room (the blood transfusion room), the operating room (surgical unit) should be located within the property complex, functionally and technologically integrated with the department (s) of plastic surgery of the Center. Functional and technological association means the placement of these departments within the same building or complex of buildings connected by warm transitions, ensuring the movement and transportation of patients without leaving the premises used by the medical organization.

4. In the medical organization, in the structure of which the Center was created, it should be possible to provide consultative assistance by specialist doctors in the following profiles: "therapy", "neurology", "dermatovenereology", "pediatrics", "otorhinolaryngology", "ophthalmology", " obstetrics and gynecology", "surgery", "urology", "maxillofacial surgery", "traumatology and orthopedics". In the absence of the necessary medical specialists in a medical organization, it is possible to attract specialists from other medical organizations under a contract, provided that these medical organizations have a license for the relevant types of work (services).

5. The Center is headed by a head appointed and dismissed by the founder of the medical organization or the head of the medical organization in the case when the Center is organized as a structural unit.

A specialist who meets the Qualification requirements for medical and pharmaceutical workers with higher education in the direction of training "Health care and medical sciences" is appointed to the position of the head of the Center<3>majoring in Health Organization and Public Health.

<3>Order of the Ministry of Health of the Russian Federation dated October 8, 2015 No. 707n "On Approval of Qualification Requirements for Medical and Pharmaceutical Workers with Higher Education in the Field of Training "Health Care and Medical Sciences" (registered by the Ministry of Justice of the Russian Federation on October 23, 2015 No. 39438), as amended by Order of the Ministry of Health of the Russian Federation dated June 15, 2017 No. 328n (registered by the Ministry of Justice of the Russian Federation on July 3, 2017 No. 47273).

6. The structure of the Center and its staffing is established by the founder of the medical organization or the head of the medical organization in cases where it is organized as its structural unit, based on the volume of medical and diagnostic work and recommended staffing standards, in accordance with Appendix No. 8 to the Procedure for the provision of medical care by profile "plastic surgery".

7. The equipment of the Center is carried out in accordance with the standard for equipping the Center for Plastic Surgery, in accordance with Appendix No. 9 to the Procedure for the provision of medical care in the field of "plastic surgery", approved by this order.

8. The Center performs the following functions:

• provision of specialized, with the exception of high-tech, medical care, by performing reconstructive plastic and (or) aesthetic plastic surgery using surgical (including microsurgical) methods of treatment in accordance with clinical recommendations, based on medical care standards;
• development and implementation in clinical practice modern methods prevention, diagnosis, treatment and rehabilitation in the provision of medical care in the profile of "plastic surgery";
• development and implementation of new medical technologies for the provision of medical care in the field of "plastic surgery";
• assessment of new medical technologies developed in other medical organizations;
• development and implementation of measures aimed at improving the quality of medical care;
• implementation of the first stage of medical rehabilitation of patients in the field of "plastic surgery" in stationary conditions;
• carrying out examination of temporary incapacity for work;
• professional development of medical workers of the Center, as well as other medical organizations on the provision of specialized medical care in the profile of "plastic surgery";
• provision of consultative assistance to medical specialists of other departments of the medical organization, in the structure of which the Center is organized, as well as other medical organizations on the issues of prevention, diagnosis, treatment and rehabilitation in the provision of medical care in the field of "plastic surgery";
• participation in the organization and improvement of medical care in the field of "plastic surgery";
• maintaining medical records;
• reporting in the prescribed manner<4>, collection and provision of primary data on medical activities for health information systems<5>.

<4>Clause 11 of Part 1 of Article 79 of the Federal Law of November 21, 2011 No. 323-FZ "On the Basics of Protecting the Health of Citizens in the Russian Federation" (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2011, No. 48, Art. 6724; 2013, No. 48, Art. 6165; 2014, No. 30, Art. 4257) (hereinafter - the Federal Law of November 21, 2011 No. 323-FZ).

9. The Center can be used as a clinical base of professional educational organizations, educational organizations of higher education and organizations of additional professional education, as well as scientific organizations.

Application No. 8
to the Procedure for the provision of medical care
in the field of "plastic surgery",
approved by order
Ministry of Health of the Russian Federation
dated May 31, 2018 No. 298n

Recommended staffing standards of the plastic surgery center
surgery (with the exception of departments of plastic surgery,
included in the structure of the center of plastic surgery)

Recommended staffing standards for plastic surgery departments,
part of the center of plastic surgery

2. To ensure round-the-clock work of the Department, based on the volume of medical care provided, in addition to the positions of plastic surgeons provided for by the recommended staffing standards of the Department of Plastic Surgery, an additional 4.75 positions of a plastic surgeon and 4.75 positions of a nurse are established.

Application No. 9
to the Procedure for the provision of medical care
in the field of "plastic surgery",
approved by order
Ministry of Health of the Russian Federation
dated May 31, 2018 No. 298n

STANDARD OF EQUIPMENT OF THE CENTER OF PLASTIC SURGERY

1. Equipment standard for the Center for Plastic Surgery (except for the departments of plastic surgery included in the structure of the Center for Plastic Surgery)

2. The standard for additional equipment of the operating room (surgery unit) of the medical organization, in the structure of which the Center for Plastic Surgery is being created (in addition to equipping the operating room (surgery unit) of the plastic surgery departments that are part of the structure of the medical organization)

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