Ãîëîâíà ñòîð³íêà á³çíåñ-ïîðòàëó "Ëåîíîðì"

ÊÎÍÒÀÊÒÈ

ÍÎÂÈÍÈ ÐŪÑÒÐÀÖ²ß ÌÀÃÀÇÈÍ ÑÈÑÒÅÌÈ ÏÎØÓÊ (RUS)

 

̲ͲÑÒÅÐÑÒÂÎ ÎÕÎÐÎÍÈ ÇÄÎÐÎÂ'ß ÓÊÐÀ¯ÍÈ

ÍÀÊÀÇ

25.09.2026

ì. Êè¿â

N 1427

Çàðåºñòðîâàíî â ̳í³ñòåðñòâ³ þñòèö³¿ Óêðà¿íè
13 æîâòíÿ 2026 ð. çà N 1377/46771

Ïðî âíåñåííÿ çì³í äî íàêàç³â ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè â³ä 10 ñ³÷íÿ 2006 ðîêó N 1 òà â³ä 28 ëèïíÿ 2014 ðîêó N 527

²ç çì³íàìè ³ äîïîâíåííÿìè, âíåñåíèìè
 íàêàçîì ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè
 â³ä 16 æîâòíÿ 2026 ðîêó N 1595

 

³äïîâ³äíî äî ÷àñòèí ïåðøî¿ òà äðóãî¿ ñòàòò³ 35 Çàêîíó Óêðà¿íè "Ïðî çàõèñò íàñåëåííÿ â³ä ³íôåêö³éíèõ õâîðîá", ïóíêòó 8 Ïîëîæåííÿ ïðî ̳í³ñòåðñòâî îõîðîíè çäîðîâ'ÿ Óêðà¿íè, çàòâåðäæåíîãî ïîñòàíîâîþ Êàá³íåòó ̳í³ñòð³â Óêðà¿íè â³ä 25 áåðåçíÿ 2015 ðîêó N 267 (â ðåäàêö³¿ ïîñòàíîâè Êàá³íåòó ̳í³ñòð³â Óêðà¿íè â³ä 24 ñ³÷íÿ 2020 ðîêó N 90), ç ìåòîþ âäîñêîíàëåííÿ ôîðì ïåðâèííî¿ îáë³êîâî¿ äîêóìåíòàö³¿

ÍÀÊÀÇÓÞ:

1. Âíåñòè çì³íè äî ïóíêòó 1 íàêàçó ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè â³ä 10 ñ³÷íÿ 2006 ðîêó N 1 "Ïðî çàòâåðäæåííÿ Ôîðì ïåðâèííî¿ îáë³êîâî¿ äîêóìåíòàö³¿ ç ³íôåêö³éíî¿, äåðìàòîâåíåðîëîã³÷íî¿, îíêîëîã³÷íî¿ çàõâîðþâàíîñò³ òà ³íñòðóêö³é ùîäî ¿õ çàïîâíåííÿ", çàðåºñòðîâàíîãî â ̳í³ñòåðñòâ³ þñòèö³¿ Óêðà¿íè 08 ÷åðâíÿ 2006 ðîêó çà N 686/12560, äîïîâíèâøè ï³ñëÿ ï³äïóíêòó 1.4 ï³äïóíêòàìè 1.5, 1.6 òàêîãî çì³ñòó:

"1.5. Ôîðìó ïåðâèííî¿ îáë³êîâî¿ äîêóìåíòàö³¿ N 058-2/î "Åêñòðåíå ïîâ³äîìëåííÿ ïðî ï³äîçðó íà ñêàç ó ëþäèíè N _____", ùî äîäàºòüñÿ.

"1.6. ²íñòðóêö³þ ùîäî çàïîâíåííÿ ôîðìè ïåðâèííî¿ îáë³êîâî¿ äîêóìåíòàö³¿ N 058-2/î "Åêñòðåíå ïîâ³äîìëåííÿ ïðî ï³äîçðó íà ñêàç ó ëþäèíè N _____", ùî äîäàºòüñÿ.".

Ó çâ'ÿçêó ç öèì ï³äïóíêòè 1.5 - 1.16 ââàæàòè ï³äïóíêòàìè 1.7 - 1.18 â³äïîâ³äíî.

2. Çàòâåðäèòè, òàê³ ùî äîäàþòüñÿ:

1) ôîðìó ïåðâèííî¿ îáë³êîâî¿ äîêóìåíòàö³¿ N 058-2/î "Åêñòðåíå ïîâ³äîìëåííÿ ïðî ï³äîçðó íà ñêàç ó ëþäèíè N _____";

2) ²íñòðóêö³þ ùîäî çàïîâíåííÿ ôîðìè ïåðâèííî¿ îáë³êîâî¿ äîêóìåíòàö³¿ N 058-2/î "Åêñòðåíå ïîâ³äîìëåííÿ ïðî ï³äîçðó íà ñêàç ó ëþäèíè N ____".

3. Ïóíêò 3 ²íñòðóêö³¿ ùîäî çàïîâíåííÿ ôîðìè ïåðâèííî¿ îáë³êîâî¿ äîêóìåíòàö³¿ N 058/î "Åêñòðåíå ïîâ³äîìëåííÿ ïðî ³íôåêö³éíó õâîðîáó, õàð÷îâå îòðóºííÿ", çàòâåðäæåíî¿ íàêàçîì ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè â³ä 10 ñ³÷íÿ 2006 ðîêó N 1, çàðåºñòðîâàíî¿ â ̳í³ñòåðñòâ³ þñòèö³¿ Óêðà¿íè 08 ÷åðâíÿ 2006 ðîêó çà N 686/12560 (ó ðåäàêö³¿ íàêàçó ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè â³ä 15 âåðåñíÿ 2023 ðîêó N 1642), âèêëàñòè ó òàê³é ðåäàêö³¿:

"3. Íà êîæíèé âèïàäîê ï³äîçðè íà íàÿâí³ñòü âèïàäêó ³íôåêö³éíî¿ õâîðîáè â³äïîâ³äíî äî Ïåðåë³êó ³íôåêö³éíèõ õâîðîá, ùî ï³äëÿãàþòü ðåºñòðàö³¿, çàòâåðäæåíîãî íàêàçîì ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè â³ä 30 ëèïíÿ 2020 ðîêó N 1726, çàðåºñòðîâàíîãî ó ̳í³ñòåðñòâ³ þñòèö³¿ Óêðà¿íè 30 ãðóäíÿ 2020 ðîêó çà N 1333/35616, êð³ì ï³äîçðè íà ñêàç, ãðèïó òà ãîñòðèõ ³íôåêö³é âåðõí³õ äèõàëüíèõ øëÿõ³â, çàïîâíþºòüñÿ ôîðìà N 058/î, ÿêà ïðîòÿãîì 18 ãîäèí íàäñèëàºòüñÿ äî öåíòðó êîíòðîëþ òà ïðîô³ëàêòèêè õâîðîá ÌÎÇ (äàë³ - ÖÊÏÕ) â³äïîâ³äíî¿ àäì³í³ñòðàòèâíî-òåðèòîð³àëüíî¿ îäèíèö³ çà ì³ñöåì ðåºñòðàö³¿ õâîðîáè".

4. Âèçíàòè òàêèì, ùî âòðàòèâ ÷èíí³ñòü, ï³äïóíêò 4 ïóíêòó 1 íàêàçó ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè â³ä 28 ëèïíÿ 2014 ðîêó N 527 "Ïðî çàòâåðäæåííÿ ôîðì ïåðâèííî¿ îáë³êîâî¿ äîêóìåíòàö³¿ òà ³íñòðóêö³é ùîäî ¿õ çàïîâíåííÿ, ùî âèêîðèñòîâóþòüñÿ ó çàêëàäàõ îõîðîíè çäîðîâ'ÿ, ÿê³ íàäàþòü àìáóëàòîðíî-ïîë³êë³í³÷íó äîïîìîãó íàñåëåííþ, íåçàëåæíî â³ä ï³äïîðÿäêóâàííÿ òà ôîðìè âëàñíîñò³", çàðåºñòðîâàíîãî â ̳í³ñòåðñòâ³ þñòèö³¿ Óêðà¿íè 13 ñåðïíÿ 2014 ðîêó çà N 959/25736.

5. Äåïàðòàìåíòó ìåäè÷íèõ ïîñëóã (Âàëå𳿠Ñîðó÷àí) çàáåçïå÷èòè:

1) ïîäàííÿ öüîãî íàêàçó â óñòàíîâëåíîìó çàêîíîäàâñòâîì ïîðÿäêó íà äåðæàâíó ðåºñòðàö³þ äî ̳í³ñòåðñòâà þñòèö³¿ Óêðà¿íè;

2) îïðèëþäíåííÿ öüîãî íàêàçó íà îô³ö³éíîìó âåáñàéò³ ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè ï³ñëÿ çä³éñíåííÿ äåðæàâíî¿ ðåºñòðàö³¿ â ̳í³ñòåðñòâ³ þñòèö³¿ Óêðà¿íè.

6. Êîíòðîëü çà âèêîíàííÿì öüîãî íàêàçó ïîêëàñòè íà çàñòóïíèêà ̳í³ñòðà îõîðîíè çäîðîâ'ÿ Óêðà¿íè - ãîëîâíîãî äåðæàâíîãî ñàí³òàðíîãî ë³êàðÿ Óêðà¿íè ²ãîðÿ Êóç³íà.

7. Öåé íàêàç íàáèðຠ÷èííîñò³ ç 01 ñ³÷íÿ 2027 ðîêó, àëå íå ðàí³øå äíÿ éîãî îô³ö³éíîãî îïóáë³êóâàííÿ.

 

̳í³ñòð

³êòîð ËߨÊÎ

ÏÎÃÎÄÆÅÍÎ:

 

Óïîâíîâàæåíèé Âåðõîâíî¿ Ðàäè
Óêðà¿íè ç ïðàâ ëþäèíè

Äìèòðî ËÓÁ²ÍÅÖÜ

Ãîëîâà Äåðæàâíî¿
ñëóæáè ñòàòèñòèêè Óêðà¿íè

Àðñåí ÌÀÊÀÐ×ÓÊ

Ãîëîâà Äåðæàâíî¿
ðåãóëÿòîðíî¿ ñëóæáè Óêðà¿íè

Îëåêñ³é ÊÓ×ÅÐ

Ãîëîâà Äåðæàâíî¿ ñëóæáè
Óêðà¿íè ç ïèòàíü áåçïå÷íîñò³ õàð÷îâèõ
ïðîäóêò³â òà çàõèñòó ñïîæèâà÷³â

Ñåðã³é ÒÊÀ×ÓÊ

 

ÇÀÒÂÅÐÄÆÅÍÎ
Íàêàç ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè
25 âåðåñíÿ 2026 ðîêó N 1427

Íàéìåíóâàííÿ ì³í³ñòåðñòâà, ³íøîãî îðãàíó âèêîíàâ÷î¿ âëàäè, ï³äïðèºìñòâà, óñòàíîâè, îðãàí³çàö³¿, äî ñôåðè óïðàâë³ííÿ ÿêîãî (ÿêî¿) íàëåæèòü çàêëàä îõîðîíè çäîðîâ'ÿ (çà íàÿâíîñò³) ______________________________________
__________________________________________________

ÌÅÄÈ×ÍÀ ÄÎÊÓÌÅÍÒÀÖ²ß

Íàéìåíóâàííÿ, ì³ñöåçíàõîäæåííÿ (ïîøòîâà àäðåñà) çàêëàäó îõîðîíè çäîðîâ'ÿ àáî ïð³çâèùå, âëàñíå ³ì'ÿ, ïî áàòüêîâ³ (çà íàÿâíîñò³) ô³çè÷íî¿ îñîáè - ï³äïðèºìöÿ, àäðåñà ¿¿ çàðåºñòðîâàíîãî / çàäåêëàðîâàíîãî ì³ñöÿ ïðîæèâàííÿ (ïåðåáóâàííÿ) ÔÎÏ _________
__________________________________________________

Ôîðìà ïåðâèííî¿ îáë³êîâî¿
äîêóìåíòàö³¿
N 058-2/î
ÇÀÒÂÅÐÄÆÅÍÎ
Íàêàç ÌÎÇ
â³ä 25 âåðåñíÿ 2026 ðîêó N 1427

Êîä çà ªÄÐÏÎÓ þðèäè÷íî¿ îñîáè àáî ðåºñòðàö³éíèé íîìåð îáë³êîâî¿ êàðòêè ïëàòíèêà ïîäàòê³â ô³çè÷íî¿ îñîáè - ï³äïðèºìöÿ (ñåð³þ (çà íàÿâíîñò³) òà íîìåð ïàñïîðòà çàçíà÷àþòü ô³çè÷í³ îñîáè - ï³äïðèºìö³, ÿê³ ÷åðåç ñâî¿ ðåë³ã³éí³ ïåðåêîíàííÿ â³äìîâëÿþòüñÿ â³ä ïðèéíÿòòÿ ðåºñòðàö³éíîãî íîìåðà îáë³êîâî¿ êàðòêè ïëàòíèêà ïîäàòê³â òà îô³ö³éíî ïîâ³äîìèëè ïðî öå â³äïîâ³äíèé êîíòðîëþþ÷èé îðãàí ³ ìàþòü â³äì³òêó ó ïàñïîðò³) ____________________________


Åêñòðåíå ïîâ³äîìëåííÿ
ïðî ï³äîçðó íà ñêàç ó ëþäèíè N _____

"___" ____________ 20__ ðîêó
(äàòà çàïîâíåííÿ ïîâ³äîìëåííÿ)

Ðîçä³ë I. Åï³äåì³îëîã³÷í³ äàí³

1. Ïîâ³äîìëåííÿ íàïðàâëåíî äî: _________________________________________________________
                                                                                                                      (íàéìåíóâàííÿ ÖÊÏÕ)

2. Ïð³çâèùå ________________ âëàñíå ³ì'ÿ __________ ïî áàòüêîâ³ (çà íàÿâíîñò³) ________________, êîíòàêòíèé òåëåôîí +38 (0__) ___ __ __

3. Àäðåñà çàðåºñòðîâàíîãî / çàäåêëàðîâàíîãî ì³ñöÿ ïðîæèâàííÿ (ïåðåáóâàííÿ) íà äàòó âèíèêíåííÿ ïî䳿 __________________________

4. Äàòà íàðîäæåííÿ ___/___/____
                                           (÷èñëî/ ì³ñÿöü/ ð³ê)

5. Ãåíäåðíà ³äåíòè÷í³ñòü:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ÷îëîâ³÷à  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif æ³íî÷à  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íåâèçíà÷åíà

6. Êîíòàêòíà îñîáà (çà ïîòðåáè): âëàñíå ³ì'ÿ ______________, òåëåôîí +38 (0__) ___ __ __

7. Äàòà òà ÷àñ ïåðâèííîãî çâåðíåííÿ çà ìåäè÷íîþ äîïîìîãîþ __/___/___/___:___
                                                                                                                                            (÷èñëî / ì³ñÿöü / ð³ê / ãîä / õâ)

8. Êîä â³äïîâ³äíî äî íàö³îíàëüíîãî êëàñèô³êàòîðà ÍÊ 25:2021 "Êëàñèô³êàòîð õâîðîá òà ñïîð³äíåíèõ ïðîáëåì îõîðîíè çäîðîâ'ÿ", çàòâåðäæåíîãî íàêàçîì ̳í³ñòåðñòâà åêîíîì³êè Óêðà¿íè â³ä 04 ñåðïíÿ 2021 ðîêó N 360:

  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif Z20.3 - Êîíòàêò ç õâîðèì àáî ìîæëèâ³ñòü çàðàæåííÿ ñêàçîì;

  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif W54 - Óêóñ àáî óäàð, çàâäàíèé ñîáàêîþ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif W54.0 - Óêóñ ñîáàêè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif W54.8 - ²íøèé êîíòàêò ç ñîáàêîþ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif W55 - Óêóñ àáî óäàð, çàâäàíèé ³íøèìè ññàâöÿìè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif W55.1 - Óêóñ àáî óäàð, çàâäàíèé êîòîì  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif W55.8 - Óêóñ àáî óäàð, çàâäàíèé ³íøèìè óòî÷íåíèìè ññàâöÿìè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif W55.9 - Óêóñ àáî óäàð, çàâäàíèé íåóòî÷íåíèìè ññàâöÿìè

9. Êàòåãîð³ÿ êîíòàêòó / óøêîäæåííÿ:
  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif êàòåãîð³ÿ I  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif êàòåãîð³ÿ II  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif êàòåãîð³ÿ III

10. ×è îòðèìóâàëà îñîáà ðàí³øå ïðîô³ëàêòè÷íó àáî ïîñòêîíòàêòíó âàêöèíàö³þ ïðîòè ñêàçó:
  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íåâ³äîìî

10.1. ßêùî òàê, çàçíà÷èòè äàòó ââåäåííÿ îñòàííüî¿ äîçè âàêöèíè ___/___/____/
                                                                                                                                               (÷èñëî / ì³ñÿöü / ð³ê)
òà ê³ëüê³ñòü ââåäåíèõ äîç âàêöèíè _________

11. Äàòà òà ÷àñ ïî䳿 ___/___/____/___:___
                                              (÷èñëî / ì³ñÿöü / ð³ê / ãîä / õâ)

12. ̳ñöå ïî䳿 (êàòåãîð³ÿ íàñåëåíîãî ïóíêòó):   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ì³ñòî  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ñåëî  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ñåëèùå  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif çà ìåæàìè íàñåëåíîãî ïóíêòó

13. Âèä êîíòàêòó:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif óêóñ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ïîäðÿïèíè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif îñëèíåííÿ ïîøêîäæåíî¿ øê³ðè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif îñëèíåííÿ íå ïîøêîäæåíî¿ øê³ðè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif êîíòàêò ³ç ñëèçîâèìè îáîëîíêàìè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ³íøå

14. Ëîêàë³çàö³ÿ óøêîäæåííÿ:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ãîëîâà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif øèÿ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òóëóá  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ê³íö³âêà íèæíÿ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ê³íö³âêà âåðõíÿ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ³íøå ___

15. Îïèñ îáñòàâèí ïî䳿: _____________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

16. ²íôîðìàö³ÿ ïðî òâàðèíó, ùî ñïðè÷èíèëà êîíòàêò / óøêîäæåííÿ:

16.1. Âèä òâàðèíè:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ñîáàêà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ê³ò  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ëèñèöÿ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif êàæàí  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ³íøå: ______________

16.2. Ñòàòóñ òâàðèíè:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif äîìàøíÿ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif áåçïðèòóëüíà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif äèêà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íåâ³äîìî

16.3. Äîñòóïí³ñòü òâàðèíè:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ï³ä íàãëÿäîì  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif äîñòóïíà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íåäîñòóïíà

17. Íàäàííÿ ìåäè÷íî¿ äîïîìîãè ë³êàðåì ïðè ïåðâèííîìó çâåðíåíí³:
  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif îáðîáêà ðàíè
  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif çóïèíêà êðîâîòå÷³
  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íàêëàäàííÿ ïîâ'ÿçêè
  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ³íøå ____________________________________

18. Íàäàííÿ ñïåö³àë³çîâàíî¿ ìåäè÷íî¿ äîïîìîãè:
  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íàêëàäàííÿ øâ³â
  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif õ³ðóðã³÷íà îáðîáêà ðàíè

19. Ïîñòêîíòàêòíà ïðîô³ëàêòèêà:

19.1. Ïðèçíà÷åíî àíòèðàá³÷íó âàêöèíó:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³

19.2. Ïðèçíà÷åíî àíòèðàá³÷íèé ³ìóíîãëîáóë³í:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³

20. ˳êàð, ÿêèé çàïîâíþº öþ ôîðìó: ïð³çâèùå ________________ âëàñíå ³ì'ÿ _________________ êîíòàêòíèé òåëåôîí _______________ ï³äïèñ ________________

Ðîçä³ë II. Åï³äåì³îëîã³÷í³ äàí³ ÖÊÏÕ

1. Äàòà òà ÷àñ îòðèìàííÿ ïîâ³äîìëåííÿ ___/___/____/___:___
                                                                                           (÷èñëî / ì³ñÿöü / ð³ê / ãîä / õâ)

2. Ïðàö³âíèê ÖÊÏÕ, ùî îòðèìàâ ïîâ³äîìëåííÿ ïðî âèïàäîê: ïîñàäà ________________
ïð³çâèùå _________________ âëàñíå ³ì'ÿ ___________________ ï³äïèñ _________________

3. Ïîâíîòà íàäàíèõ äàíèõ äëÿ åï³äåì³îëîã³÷íîãî íàãëÿäó:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ïîâí³  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íåïîâí³ (ïîòðåáóþòü óòî÷íåííÿ)

3.1. Ó ðàç³ íåïîâíîòè äàíèõ, ùî ñàìå ïîòðåáóº óòî÷íåííÿ:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif äàí³ ïðî ïàö³ºíòà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif îáñòàâèíè êîíòàêòó   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif äàí³ ïðî òâàðèíó  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif êàòåãîð³ÿ åêñïîçèö³¿  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íàäàííÿ äîìåäè÷íî¿ äîïîìîãè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ³íøå ______

4. Äîäàòêîâà ³íôîðìàö³ÿ ïðî òâàðèíó, ùî ñïðè÷èíèëà êîíòàêò / óøêîäæåííÿ:

4.1. Ïîâåä³íêà òâàðèíè íà ìîìåíò íàïàäó:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif çâè÷àéíà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif àãðåñèâíà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íåòèïîâà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íåâ³äîìà

4.2. ³äîìîñò³ ïðî âëàñíèêà àáî ì³ñöå ïåðåáóâàííÿ (äëÿ äîìàøí³õ òâàðèí):
_______________________________________________________________________________________

4.3. Ñòàòóñ âàêöèíàö³¿ òâàðèíè â³ä ñêàçó:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif âàêöèíîâàíà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íå âàêöèíîâàíà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íåâ³äîìî

4.4. Ïîäàëüøå ïîâîäæåííÿ ç òâàðèíîþ:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ï³ä íàãëÿäîì âåòåðèíàðíî¿ ñëóæáè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif äîñòóïíà äëÿ ñïîñòåðåæåííÿ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif çàãèíóëà / áóëà çíèùåíà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ³íøå _____________________________

5. Ïîâ³äîìëåíî òåðèòîð³àëüíèé îðãàí Äåðæïðîäñïîæèâñëóæáè:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³

5.1. ßêùî òàê, òî äàòà ³ ÷àñ ïîâ³äîìëåííÿ: ___/___/____/___:___
                                                                                                (÷èñëî / ì³ñÿöü / ð³ê / ÷àñ)

6. ×è º ³íø³ ïîñòðàæäàë³ âíàñë³äîê öüîãî âèïàäêó êîíòàêòó / óøêîäæåííÿ?   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³

6.1. ßêùî òàê, ³íôîðìàö³ÿ ïðî ³íøèõ ïîñòðàæäàëèõ:

ïð³çâèùå, âëàñíå ³ì'ÿ, ïî áàòüêîâ³ (çà íàÿâíîñò³) ___________________________________________,
òåëåôîí ____________, çâåðíåííÿ çà ìåäè÷íîþ äîïîìîãîþ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³, ÿêùî òàê - äàòà åêñòðåíîãî ïîâ³äîìëåííÿ /___/___/____

ïð³çâèùå, âëàñíå ³ì'ÿ, ïî áàòüêîâ³ (çà íàÿâíîñò³) ___________________________________________,
òåëåôîí ____________, çâåðíåííÿ çà ìåäè÷íîþ äîïîìîãîþ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³, ÿêùî òàê - äàòà åêñòðåíîãî ïîâ³äîìëåííÿ /___/___/____

ïð³çâèùå, âëàñíå ³ì'ÿ, ïî áàòüêîâ³ (çà íàÿâíîñò³) ___________________________________________,
òåëåôîí ____________, çâåðíåííÿ çà ìåäè÷íîþ äîïîìîãîþ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³, ÿêùî òàê - äàòà åêñòðåíîãî ïîâ³äîìëåííÿ /___/___/____

ïð³çâèùå, âëàñíå ³ì'ÿ, ïî áàòüêîâ³ (çà íàÿâíîñò³) ___________________________________________,
òåëåôîí ____________, çâåðíåííÿ çà ìåäè÷íîþ äîïîìîãîþ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³, ÿêùî òàê - äàòà åêñòðåíîãî ïîâ³äîìëåííÿ /___/___/____

ïð³çâèùå, âëàñíå ³ì'ÿ, ïî áàòüêîâ³ (çà íàÿâíîñò³) ___________________________________________,
òåëåôîí ____________, çâåðíåííÿ çà ìåäè÷íîþ äîïîìîãîþ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³, ÿêùî òàê - äàòà åêñòðåíîãî ïîâ³äîìëåííÿ /___/___/____

7. Íàÿâí³ñòü ï³äñòàâ äëÿ ì³æòåðèòîð³àëüíîãî ³íôîðìóâàííÿ:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³

7.1. Ó ðàç³, ÿêùî åêñïîçèö³ÿ â³äáóëàñÿ â ³íø³é àäì³í³ñòðàòèâíî-òåðèòîð³àëüí³é îäèíèö³, íàïðàâëåííÿ ³íôîðìàö³¿ äî â³äïîâ³äíîãî ÖÊÏÕ çà ì³ñöåì âèíèêíåííÿ ïî䳿:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif çä³éñíåíî  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íå çä³éñíåíî
Äàòà íàïðàâëåííÿ ³íôîðìàö³¿: ___/___/____

ÖÊÏÕ, äî ÿêîãî íàïðàâëåíî ³íôîðìàö³þ: _____________________________

Íàéìåíóâàííÿ ì³í³ñòåðñòâà, ³íøîãî îðãàíó âèêîíàâ÷î¿ âëàäè, ï³äïðèºìñòâà, óñòàíîâè, îðãàí³çàö³¿, äî ñôåðè óïðàâë³ííÿ ÿêîãî (ÿêî¿) íàëåæèòü çàêëàä îõîðîíè çäîðîâ'ÿ (çà íàÿâíîñò³) ______________________________________
__________________________________________________

ÌÅÄÈ×ÍÀ ÄÎÊÓÌÅÍÒÀÖ²ß

Íàéìåíóâàííÿ, ì³ñöåçíàõîäæåííÿ (ïîâíà ïîøòîâà àäðåñà) çàêëàäó îõîðîíè çäîðîâ'ÿ àáî ïð³çâèùå, âëàñíå ³ì'ÿ, ïî áàòüêîâ³ (çà íàÿâíîñò³) ô³çè÷íî¿ îñîáè-ï³äïðèºìöÿ (ÔÎÏ), ì³ñöåçíàõîäæåííÿ (ïîâíà ïîøòîâà àäðåñà) ÔÎÏ _________
_________________________________________________

Ôîðìà ïåðâèííî¿ îáë³êîâî¿
äîêóìåíòàö³¿
N 058-2/î
ÇÀÒÂÅÐÄÆÅÍÎ
Íàêàç ÌÎÇ
____________ N _____

Êîä çà ªÄÐÏÎÓ / Ðåºñòðàö³éíèé íîìåð îáë³êîâî¿ êàðòêè ïëàòíèêà ïîäàòê³â ÔÎÏ _____________________________


 

 

Ðîçä³ë III. Íàäàííÿ ìåäè÷íî¿ äîïîìîãè

Äàòà ___/___/____/
         (÷èñëî / ì³ñÿöü / ð³ê)

1. Ïð³çâèùå ______________ âëàñíå ³ì'ÿ _____________ ïî áàòüêîâ³ (çà íàÿâíîñò³) _______________, êîíòàêòíèé òåëåôîí +38 (0__)___ __ __

2. Äàòà íàðîäæåííÿ ___/___/____
                                           (÷èñëî / ì³ñÿöü / ð³ê)

3. Õàðàêòåð çâåðíåííÿ:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ïåðâèííå  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ïåðåíàïðàâëåíèé ç ____________________________________

4. Äàòà òà ÷àñ ïåðâèííîãî çâåðíåííÿ çà ìåäè÷íîþ äîïîìîãîþ ___/___/____/______
                                                                                                                                                (÷èñëî / ì³ñÿöü / ð³ê / ÷àñ)

5. Íàäàííÿ ìåäè÷íî¿ äîïîìîãè ïðè ïåðâèííîìó çâåðíåíí³:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ïðîâåäåíà  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íå ïðîâîäèëàñü

6. ßêùî ïðîâîäèëàñÿ ïåðâèííà îáðîáêà ðàíè çàçíà÷èòè õàðàêòåð îáðîáêè:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ïðîìèâàííÿ âîäîþ ç ìèëîì  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif îáðîáêà àíòèñåïòèêîì  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif çóïèíêà êðîâîòå÷³  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íàêëàäàííÿ ïîâ'ÿçêè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ³íøå

7. Õ³ðóðã³÷íà òàêòèêà âåäåííÿ ðàíè:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íå ïîòðåáóº õ³ðóðã³÷íîãî âòðó÷àííÿ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ïåðâèííà õ³ðóðã³÷íà îáðîáêà ðàíè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íàêëàäàííÿ øâ³â  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif äðåíóâàííÿ ðàíè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif íàïðàâëåííÿ/ïåðåâåäåííÿ äî ³íøîãî çàêëàäó îõîðîíè çäîðîâ'ÿ äëÿ ñïåö³àë³çîâàíî¿ äîïîìîãè  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ³íøå ______________________________________

8. Íàïðàâëåííÿ íà îòðèìàííÿ ñïåö³àë³çîâàíî¿ ìåäè÷íî¿ äîïîìîãè N _______________________

9. Ïîñòêîíòàêòíà ïðîô³ëàêòèêà:

9.1. Ïðèçíà÷åíî àíòèðàá³÷íó âàêöèíó:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³

9.2. Ïðèçíà÷åíî àíòèðàá³÷íèé ³ìóíîãëîáóë³í:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³

10. Íàïðàâëåííÿ äëÿ ïðîâåäåííÿ ïîñòêîíòàêòíî¿ ïðîô³ëàêòèêè äî ³íøîãî çàêëàäó îõîðîíè çäîðîâ'ÿ:  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³.

˳êàð, ÿêèé íàäàâàâ ìåäè÷íó äîïîìîãó: ïð³çâèùå ____________________ âëàñíå ³ì'ÿ ____________ òåëåôîí ____________ ï³äïèñ ___________________

11. Ââåäåííÿ àíòèðàá³÷íèõ ïðåïàðàò³â:

11.1. Ñõåìà ïîñòêîíòàêòíî¿ âàêöèíàö³¿:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif - ïðîòîêîë 1:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif - ïðîòîêîë 2:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ïðîòîêîë äëÿ ðàí³øå âàêöèíîâàíî¿ îñîáè:

11.2. ââåäåííÿ àíòèðàá³÷íîãî ³ìóíîãëîáóë³íó:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif òàê  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif í³

12. ÊÀÐÒÀ ÏÐÎÂÅÄÅÍÍß ÏÎÑÒÊÎÍÒÀÊÒÍί ÏÐÎÔ²ËÀÊÒÈÊÈ ÑÊÀÇÓ

Äîçà

Òîðãîâåëüíà íàçâà ë³êàðñüêîãî çàñîáó (âàêöèíà, ³ìóíîãëîáóë³í)

Íàéìåíóâàííÿ âèðîáíèêà

Äàòà ââåäåííÿ ë³êàðñüêîãî çàñîáó

Ñåð³ÿ, íîìåð

Ñïîñ³á ââåäåííÿ

̳ñöå ââåäåííÿ

Ïð³çâèùå, âëàñíå ³ì'ÿ ìåäè÷íîãî ïðàö³âíèêà, ÿêèé ââ³â ë³êàðñüêèé çàñ³á

N 1
âàêöèíè

 

 

 

 

 

 

 

N 2

 

 

 

 

 

 

 

N 3

 

 

 

 

 

 

 

N 4

 

 

 

 

 

 

 

²ìóíîãëîáóë³í

 

 

 

 

 

 

 

 

13. Êóðñ ïîñòêîíòàêòíî¿ ïðîô³ëàêòèêè:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif çàâåðøåíèé  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ïåðåðâàíèé  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif îñîáà âèáóëà ç-ï³ä íàãëÿäó  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ïîìåð(ëà).

13.1. ßêùî êóðñ ïåðåðâàíî, çàçíà÷èòè ïðè÷èíó:   https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif â³äì³íåíî, òâàðèíà âèÿâèëàñü êë³í³÷íî çäîðîâîþ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif â³äìîâà â³ä ïîäàëüøî¿ âàêöèíàö³¿  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ïîðóøåííÿ ãðàô³êà / íåÿâêà íà ÷åðãîâå ââåäåííÿ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ìåäè÷í³ ïðîòèïîêàçàííÿ / íåáàæàíà ðåàêö³ÿ  https://ips.ligazakon.net/l_flib1.nsf/LookupFiles/Re46771_img_001.gif/$file/Re46771_img_001.gif ³íøå: ______________________________

14. ˳êàð (ïð³çâèùå, âëàñíå ³ì'ÿ): __________________ ï³äïèñ ____________________________

 

Äèðåêòîð Äåïàðòàìåíòó
ìåäè÷íèõ ïîñëóã

Âàëåð³ÿ ÑÎÐÓ×ÀÍ

 

ÇÀÒÂÅÐÄÆÅÍÎ
Íàêàç ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè
25 âåðåñíÿ 2026 ðîêó N 1427

²íñòðóêö³ÿ
ùîäî çàïîâíåííÿ ôîðìè ïåðâèííî¿ îáë³êîâî¿ äîêóìåíòàö³¿ N 058-2/î "Åêñòðåíå ïîâ³äîìëåííÿ ïðî ï³äîçðó íà ñêàç ó ëþäèíè N _____"

1. Öÿ ²íñòðóêö³ÿ âèçíà÷ຠïîðÿäîê çàïîâíåííÿ ôîðìè ïåðâèííî¿ îáë³êîâî¿ äîêóìåíòàö³¿ N 058-2/î "Åêñòðåíå ïîâ³äîìëåííÿ ïðî ï³äîçðó íà ñêàç ó ëþäèíè N _____", çàòâåðäæåíî¿ íàêàçîì ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè â³ä 25 âåðåñíÿ 2026 ðîêó N 1427 (äàë³ - Ôîðìà N 058-2/î).

2. Ôîðìà N 058-2/î º îñíîâíèì ìåäè÷íèì äîêóìåíòîì, ïðèçíà÷åíèì äëÿ îáë³êó òà åêñòðåíîãî ³íôîðìóâàííÿ ïðî âñ³ âèïàäêè óêóñó, îñëèíåííÿ àáî ³íøîãî êîíòàêòó ëþäèíè ç òâàðèíîþ, ùî ñòàíîâèòü ðèçèê ³íô³êóâàííÿ ñêàçîì. Ôîðìà N 058-2/î çàñòîñîâóºòüñÿ ç ìåòîþ çä³éñíåííÿ åï³äåì³îëîã³÷íîãî íàãëÿäó çà ñêàçîì, ñâîº÷àñíîãî ïðèçíà÷åííÿ ïîñòêîíòàêòíî¿ (àíòèðàá³÷íî¿) ïðîô³ëàêòèêè (äàë³ - ÏÊÏ), âçàºìî䳿 ³ç âåòåðèíàðíîþ ñëóæáîþ òà ôîðìóâàííÿ äåðæàâíî¿ ñòàòèñòè÷íî¿ ³íôîðìàö³¿.

3. Ôîðìó N 058-2/î çàïîâíþþòü:

1) çàêëàäè îõîðîíè çäîðîâ'ÿ òà ô³çè÷í³ îñîáè - ï³äïðèºìö³, ÿê³ îòðèìàëè ë³öåíç³þ íà ïðîâàäæåííÿ ãîñïîäàðñüêî¿ ä³ÿëüíîñò³ ç ìåäè÷íî¿ ïðàêòèêè, ³ º íàäàâà÷àìè ïåðâèííî¿ àáî ñïåö³àë³çîâàíî¿ ìåäè÷íî¿ äîïîìîãè (äàë³ - ÇÎÇ, ÔÎÏ) - ðîçä³ë I;

2) öåíòðè êîíòðîëþ ïðîô³ëàêòèêè õâîðîá ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè (äàë³ - ÖÊÏÕ), äî ÿêèõ ïîäàºòüñÿ çàïîâíåíèé ÇÎÇ ÷è ÔÎÏ ðîçä³ë I Ôîðìè N 058-2/î - ðîçä³ë II;

3) ÇÎÇ òà ÔÎÏ, ÿê³ íàäàþòü àíòèðàá³÷íó äîïîìîãó òà çàáåçïå÷óþòü çä³éñíåííÿ ïîñòêîíòàêòíî¿ ïðîô³ëàêòèêè (äàë³ - ÏÊÏ) - ðîçä³ë III.

4. Ðîçä³ë I Ôîðìè N 058-2/î çàïîâíþºòüñÿ íåâ³äêëàäíî ï³ñëÿ ïåðâèííîãî çâåðíåííÿ ïàö³ºíòà çà ìåäè÷íîþ äîïîìîãîþ äî ÇÎÇ, ÔÎÏ ç ïðèâîäó óêóñó, îñëèíåííÿ àáî ³íøîãî íåáåçïå÷íîãî êîíòàêòó ç òâàðèíîþ. Çàïîâíåíèé ðîçä³ë I Ôîðìè N 058-2/î ïîäàºòüñÿ ÇÎÇ, ÔÎÏ äî ÖÊÏÕ ó ñòðîê íå ï³çí³øå 24 ãîäèí ç ÷àñó ïåðâèííîãî çâåðíåííÿ ïàö³ºíòà çà ìåäè÷íîþ äîïîìîãîþ, ðîçä³ë II Ôîðìè N 058-2/î çàïîâíþºòüñÿ ÖÊÏÕ ïðîòÿãîì 48 ãîäèí ï³ñëÿ ¿¿ îòðèìàííÿ.

Ðîçä³ë III Ôîðìè N 058-2/î çàïîâíþºòüñÿ ÇÎÇ, ÔÎÏ, ÿê³ çàáåçïå÷óþòü çä³éñíåííÿ ÏÊÏ, òà ïîäàºòüñÿ äî ÖÊÏÕ ó ñòðîê íå ï³çí³øå 24 ãîäèí ç ÷àñó çàâåðøåííÿ àáî ïåðåðèâàííÿ ç áóäü-ÿêèõ ïðè÷èí êóðñó ÏÊÏ.

Ôîðìà N 058-2/î çàïîâíþºòüñÿ ó äâîõ ïðèì³ðíèõ, îäèí ç ÿêèõ çàëèøàºòüñÿ â ÇÎÇ, ÔÎÏ, ÿêèé ¿¿ çàïîâíèâ, à äðóãèé ïðèì³ðíèê ïîäàºòüñÿ äî ÖÊÏÕ. Ôîðìà N 058-2/î ïîäàºòüñÿ äî ÖÊÏÕ íàðî÷íî ó ïàïåðîâ³é ôîðì³ àáî â åëåêòðîíí³é ôîðì³ íà àäðåñó åëåêòðîííî¿ ïîøòè, ³íøèìè òåõí³÷íèìè çàñîáàìè åëåêòðîííèõ êîìóí³êàö³é.

5. Óñ³ çàïèñè ó Ôîðì³ N 058-2/î çä³éñíþþòüñÿ ÷³òêî, ðîçá³ðëèâî, óêðà¿íñüêîþ ìîâîþ, áåç ñêîðî÷åíü (êð³ì çàãàëüíîïðèéíÿòèõ ìåäè÷íèõ) òà ïðè ¿¿ çàïîâíåíí³ ó â³äïîâ³äíèõ ïóíêòàõ ðîáèòüñÿ â³äì³òêà "+".

Ó ðàç³ âåäåííÿ Ôîðìè N 058-2/î â åëåêòðîíí³é ôîðì³ âîíà ïîâèííà âêëþ÷àòè â ñåáå âñ³ äàí³, ÿê³ ì³ñòÿòüñÿ ó çàïîâíåí³é ïàïåðîâ³é ôîðì³ òà çáåð³ãàþòüñÿ â ìåäè÷í³é ³íôîðìàö³éí³é ñèñòåì³ çàêëàäó îõîðîíè çäîðîâ'ÿ, ÿê³ ïåðåäáà÷åí³ ö³ºþ ²íñòðóêö³ºþ òà â³äïîâ³äàòè âèìîãàì Çàêîíó Óêðà¿íè "Ïðî åëåêòðîíí³ äîêóìåíòè òà åëåêòðîííèé äîêóìåíòîîá³ã".

6. Ó âåðõíüîìó ë³âîìó êóò³ Ôîðìè N 058-2/î âêàçóºòüñÿ íàéìåíóâàííÿ ì³í³ñòåðñòâà, ³íøîãî öåíòðàëüíîãî îðãàíó âèêîíàâ÷î¿ âëàäè, îðãàíó ì³ñöåâîãî ñàìîâðÿäóâàííÿ, ó ñôåð³ óïðàâë³ííÿ ÿêîãî ïåðåáóâຠÇÎÇ (çà íàÿâíîñò³), íàéìåíóâàííÿ, ì³ñöåçíàõîäæåííÿ (ïîøòîâà àäðåñà), êîä çà ªÄÐÏÎÓ ÇÎÇ þðèäè÷íî¿ îñîáè àáî ïð³çâèùå, ³ì'ÿ, ïî áàòüêîâ³ (çà íàÿâíîñò³), àäðåñà çàðåºñòðîâàíîãî / çàäåêëàðîâàíîãî ì³ñöÿ ïðîæèâàííÿ (ïåðåáóâàííÿ), ðåºñòðàö³éíèé íîìåð îáë³êîâî¿ êàðòêè ïëàòíèêà ïîäàòê³â ÔÎÏ (ñåð³þ (çà íàÿâíîñò³) òà íîìåð ïàñïîðòà çàçíà÷àþòü ÔÎÏ, ÿê³ ÷åðåç ñâî¿ ðåë³ã³éí³ ïåðåêîíàííÿ â³äìîâëÿþòüñÿ â³ä ïðèéíÿòòÿ ðåºñòðàö³éíîãî íîìåðà îáë³êîâî¿ êàðòêè ïëàòíèêà ïîäàòê³â òà îô³ö³éíî ïîâ³äîìèëè ïðî öå â³äïîâ³äíèé êîíòðîëþþ÷èé îðãàí ³ ìàþòü â³äì³òêó ó ïàñïîðò³).

7. Ïðè çàïîâíåíí³ ðîçä³ë³â I, II, III Ôîðìè N 058-2/î îáîâ'ÿçêîâî âêàçóþòüñÿ äàòà òà ÷àñ çàïîâíåííÿ êîæíîãî ðîçä³ëó.

8. Ïðè çàïîâíåíí³ ðîçä³ëó I Ôîðìè N 058-2/î ó ïóíêò³ 1 çàçíà÷àºòüñÿ íàéìåíóâàííÿ ÖÊÏÕ â³äïîâ³äíî¿ àäì³í³ñòðàòèâíî-òåðèòîð³àëüíî¿ îäèíèö³, äî ÿêîãî íàïðàâëÿºòüñÿ Ôîðìà N 058-2/î.

9. Ó ðîçä³ë³ I Ôîðìè N 058-2/î:

1) ó ïóíêò³ 2 çàçíà÷àþòüñÿ ïð³çâèùå, âëàñíå ³ì'ÿ, ïî áàòüêîâ³ (çà íàÿâíîñò³) ïàö³ºíòà, ÿêèé çâåðíóâñÿ çà ìåäè÷íîþ äîïîìîãîþ ó çâ'ÿçêó ç óêóñîì, îñëèíåííÿì àáî ³íøèì êîíòàêòîì ïàö³ºíòà ç òâàðèíîþ, ùî ñòàíîâèòü ðèçèê ³íô³êóâàííÿ ïàö³ºíòà ñêàçîì, à òàêîæ éîãî êîíòàêòíèé òåëåôîí;

2) ó ïóíêò³ 3 çàçíà÷àºòüñÿ àäðåñà çàðåºñòðîâàíîãî / çàäåêëàðîâàíîãî ì³ñöÿ ïðîæèâàííÿ (ïåðåáóâàííÿ) íà äàòó âèíèêíåííÿ ïî䳿 ïàö³ºíòà, ÿêèé çâåðíóâñÿ çà ìåäè÷íîþ äîïîìîãîþ;

3) ó ïóíêò³ 4 çàçíà÷àþòüñÿ ÷èñëî, ì³ñÿöü òà ð³ê íàðîäæåííÿ ïàö³ºíòà;

4) ó ïóíêò³ 5 çàçíà÷àºòüñÿ ãåíäåðíà ³äåíòè÷í³ñòü ïàö³ºíòà;

5) ó ïóíêò³ 6 çàçíà÷àºòüñÿ çà ïîòðåáè êîíòàêòíà îñîáà, âêàçóºòüñÿ ¿¿ âëàñíå ³ì'ÿ òà íîìåð òåëåôîíó;

6) ó ïóíêò³ 7 çàçíà÷àþòü äàòà (÷èñëî, ì³ñÿöü ð³ê) òà ÷àñ (ãîäèíè ³ õâèëèíè) ïåðâèííîãî çâåðíåííÿ çà ìåäè÷íîþ äîïîìîãîþ;

7) ó ïóíêò³ 8 çàçíà÷àºòüñÿ ³íôîðìàö³ÿ ïðî êîä â³äïîâ³äíî äî íàö³îíàëüíîãî êëàñèô³êàòîðà ÍÊ 025:2021 "Êëàñèô³êàòîð õâîðîá òà ñïîð³äíåíèõ ïðîáëåì îõîðîíè çäîðîâ'ÿ", çàòâåðäæåíîãî íàêàçîì ̳í³ñòåðñòâà åêîíîì³êè Óêðà¿íè â³ä 04 ñåðïíÿ 2021 ðîêó N 360.

Ó ðàç³ êîíòàêòó ïàö³ºíòà ç îñîáîþ, ÿêà çàõâîð³ëà íà ñêàç, êîäóâàííÿ çä³éñíþºòüñÿ çà êîäîì Z20.3 "Êîíòàêò ç õâîðèì àáî ìîæëèâ³ñòü çàðàæåííÿ ñêàçîì". Ó ðàç³ íàïàäó ñîáàêè êîäóâàííÿ çä³éñíþºòüñÿ çà êîäîì W54 "Óêóñ àáî óäàð, çàâäàíèé ñîáàêîþ", ó ðàç³ óêóñó ñîáàêè âêàçóºòüñÿ êîä W54.0 "Óêóñ ñîáàêè", ó ðàç³ îñëèíåííÿ àáî ³íøîãî êîíòàêòó ïàö³ºíòà ç ñîáàêîþ âêàçóºòüñÿ êîä W54.8 "²íøèé êîíòàêò ç ñîáàêîþ".

Ó ðàç³ êîíòàêò³â ç ³íøèìè òâàðèíàìè êîäóâàííÿ ìîæå áóòè çä³éñíåíî çà êîäàìè W55 "Óêóñ àáî óäàð, çàâäàíèé ³íøèìè ññàâöÿìè", W55.1 "Óêóñ àáî óäàð, çàâäàíèé êîòîì", W55.8 "Óêóñ àáî óäàð, çàâäàíèé ³íøèìè óòî÷íåíèìè ññàâöÿìè", W55.9 "Óêóñ àáî óäàð, çàâäàíèé íåóòî÷íåíèìè ññàâöÿìè";

8) ïóíêò³ 9 çàçíà÷àºòüñÿ êàòåãîð³ÿ êîíòàêòó / óøêîäæåííÿ, à ñàìå: êàòåãîð³ÿ I, êàòåãîð³ÿ II, ÷è Êàòåãîð³ÿ III.

êàòåãîð³ÿ I - áåç óøêîäæåíü øê³ðè;

êàòåãîð³ÿ II - ïîâåðõíåâ³ ïîäðÿïèíè, ñàäíà áåç âèä³ëåííÿ êðîâ³;

êàòåãîð³ÿ III - òðàíñäåðìàëüí³ óêóñè àáî ïîäðÿïèíè, îñëèíåííÿ ïîøêîäæåíî¿ øê³ðè, îñëèíåííÿ òà áóäü-ÿêèé êîíòàêò ³ç êàæàíàìè;

9) ó ïóíêò³ 10 çàçíà÷àºòüñÿ, ÷è îòðèìóâàëà îñîáà ðàí³øå ïðîô³ëàêòè÷íó àáî ïîñòêîíòàêòíó âàêöèíàö³þ ïðîòè ñêàçó. Ó ðàç³ îòðèìàííÿ, ó ï³äïóíêò³ 10.1 äåòàë³çóºòüñÿ ³íôîðìàö³ÿ, ùîäî äàòè ââåäåííÿ îñòàííüî¿ äîçè âàêöèíè òà ê³ëüêîñò³ ââåäåíèõ ïàö³ºíòó äîç âàêöèíè;

10) ó ïóíêò³ 11 âêàçóºòüñÿ äàòà (÷èñëî, ì³ñÿöü, ð³ê) òà îð³ºíòîâàíèé ÷àñ (ãîäèíè, õâèëèíè) ïî䳿 êîíòàêòó ç òâàðèíîþ;

11) ó ïóíêò³ 12 âêàçóºòüñÿ ì³ñöå ïî䳿, äå â³äáóâñÿ êîíòàêò ïàö³ºíòà ç òâàðèíîþ: ì³ñòî, ñåëî, ñåëèùå â³äïîâ³äíî äî òèïó òåðèòîð³àëüíî¿ ãðîìàäè;

12) ó ïóíêò³ 13 âêàçóºòüñÿ ³íôîðìàö³ÿ ùîäî âèäó êîíòàêòó ç òâàðèíîþ: óêóñ, ïîäðÿïèíè, îñëèíåííÿ ïîøêîäæåíî¿ øê³ðè, îñëèíåííÿ ïîøêîäæåíî¿ øê³ðè, îñëèíåííÿ íå ïîøêîäæåíî¿ øê³ðè, êîíòàêò ³ç ñëèçîâèìè îáîëîíêàìè, ³íø³ âèäè êîíòàêòó;

13) ó ïóíêò³ 14 â³äì³÷àºòüñÿ ëîêàë³çàö³ÿ óøêîäæåííÿ (çà íàÿâíîñò³ óøêîäæåííÿ), à ñàìå: ãîëîâà, øèÿ, òóëóá, ê³íö³âêà íèæíÿ, ê³íö³âêà âåðõíÿ, ³íøå;

14) ó ïóíêò³ 15 âêàçóºòüñÿ îïèñ îáñòàâèí ïî䳿, äå âêàçóºòüñÿ îïèñ õàðàêòåðó óøêîäæåíü, à ñàìå: ãëèáèíà óøêîäæåíü, ê³ëüê³ñòü ðàí, íàÿâí³ñòü êðîâîòå÷³, çàáðóäíåííÿ òîùî. ²íôîðìàö³ÿ âêàçóºòüñÿ ë³êàðåì ó äîâ³ëüí³é ôîðì³;

15) ó ïóíêò³ 16 çàçíà÷àºòüñÿ ³íôîðìàö³ÿ ïðî òâàðèíó ç ÿêîþ â³äáóâñÿ êîíòàêò àáî ÿêà ñïðè÷èíèëà óøêîäæåííÿ:

ó ï³äïóíêò³ 16.1 â³äì³÷àºòüñÿ âèä òâàðèíè. Çà íåîáõ³äíîñò³ âíîñèòüñÿ äîäàòêîâà ³íôîðìàö³ÿ ùîäî âèäó òâàðèíè â ïîë³ "³íøå";

ó ï³äïóíêò³ 16.2 â³äì³÷àºòüñÿ ñòàòóñ òâàðèíè: äîìàøíÿ, áåçïðèòóëüíà, äèêà;

ó ï³äïóíêò³ 16.3 â³äì³÷àºòüñÿ äàí³ ïðî äîñòóïí³ñòü òâàðèíè: ï³ä íàãëÿäîì, äîñòóïíà, íåäîñòóïíà;

16) ïóíêò 17 çàïîâíþºòüñÿ ë³êàðåì, ÿêèé íàäàâàâ ìåäè÷íó äîïîìîãó ïðè ïåðâèííîìó çâåðíåíí³ òà âêàçóºòüñÿ âèä ìåäè÷íî¿ ïîñëóãè, ÿêà íàäàâàëàñü ïàö³ºíòó ë³êàðåì: îáðîáêà ðàíè, çóïèíêà êðîâîòå÷³, íàêëàäàííÿ ïîâ'ÿçêè. Ó ïîë³ "³íøå" çàçíà÷àºòüñÿ â äîâ³ëüí³é ôîðì³, ÿêà ìåäè÷íà äîïîìîãà íàäàâàëàñü. Òàêîæ â ïîë³ "³íøå" çàçíà÷àºòüñÿ, ÿêùî ìåäè÷íà äîïîìîãà ë³êàðåì íå íàäàâàëàñÿ;

17) ïóíêò 18 çàïîâíþºòüñÿ ë³êàðåì, ÿêèé çàáåçïå÷óº íàäàííÿ ñïåö³àë³çîâàíî¿ ìåäè÷íî¿ äîïîìîãè, ïîçíà÷àºòüñÿ âèä ñïåö³àë³çîâàíî¿ ìåäè÷íî¿ äîïîìîãè, ÿêà íàäàâàëàñü íèì: íàêëàäàííÿ øâ³â ÷è õ³ðóðã³÷íà îáðîáêà ðàíè;

18) ó ïóíêò³ 19 çàçíà÷àºòüñÿ ³íôîðìàö³ÿ ùîäî ÏÊÏ ïàö³ºíòà. Ó ï³äïóíêòàõ 19.1 òà 19.2 öüîãî ïóíêòó ïîçíà÷àºòüñÿ ³íôîðìàö³ÿ ïðî ïðèçíà÷åííÿ ïàö³ºíòó àíòèðàá³÷íî¿ âàêöèíè àáî àíòèðàá³÷íîãî ³ìóíîãëîáóë³íó. Ó ðàç³ ââåäåííÿ âàêöèíè àáî ³ìóíîãëîáóë³íó çàïîâíþºòüñÿ ³íôîðìàö³ÿ ïðî ïåðøó äîçó ë³êàðñüêîãî çàñîáó, ÿêèé áóëî ââåäåíî;

19) ó ïóíêò³ 20 çàçíà÷àºòüñÿ ³íôîðìàö³ÿ ïðî ë³êàðÿ, ÿêèé çàïîâíèâ öåé ðîçä³ë, âêàçóºòüñÿ éîãî ïîñàäà, ïð³çâèùå, âëàñíå ³ì'ÿ, êîíòàêòíèé òåëåôîí òà ïðîñòàâëÿºòüñÿ éîãî ï³äïèñ.

10. ϳñëÿ çàïîâíåííÿ ðîçä³ëó I Ôîðìà N 058-2/î íàïðàâëÿºòüñÿ (ïåðåäàºòüñÿ) íå ï³çí³øå 24 ãîäèí ç ÷àñó çâåðíåííÿ ïàö³ºíòà äî ÖÊÏÕ â³äïîâ³äíî¿ àäì³í³ñòðàòèâíî-òåðèòîð³àëüíî¿ îäèíèö³.

11. Ðîçä³ë II Ôîðìè N 058-2/î çàïîâíþº ïðàö³âíèê ÖÊÏÕ, ÿêèé îòðèìàâ ïîâ³äîìëåííÿ, íå ï³çí³øå 48 ãîäèí ï³ñëÿ éîãî îòðèìàííÿ.

12. Ó ðîçä³ë³ II Ôîðìè N 058-2/î:

1) ó ïóíêòàõ 1 òà 2 ïðàö³âíèê ÖÊÏÕ âêàçóº äàòó òà ÷àñ îòðèìàííÿ ïîâ³äîìëåííÿ, à òàêîæ ïîñàäó, ïð³çâèùå, âëàñíå ³ì'ÿ òà ïðîñòàâëÿº ñâ³é ï³äïèñ;

2) ó ïóíêò³ 3 âêàçóºòüñÿ, ÷è äîñòàòíüî íàäàíèõ äàíèõ äëÿ åï³äåì³îëîã³÷íîãî íàãëÿäó, ïîçíà÷àºòüñÿ, ÷è äàí³ ïîâí³, ÷è íåïîâí³ ³ ïîòðåáóþòü óòî÷íåííÿ. Ó ðàç³ íåïîâíîòè äàíèõ, ïîçíà÷àºòüñÿ, ùî ñàìå ïîòðåáóº óòî÷íåííÿ: äàí³ ïðî ïàö³ºíòà, îáñòàâèíè êîíòàêòó, äàí³ ïðî òâàðèíó, êàòåãîð³ÿ åêñïîçèö³¿, íàäàííÿ äîìåäè÷íî¿ äîïîìîãè, ³íøå. Ó ïîë³ "³íøå" îïèñóºòüñÿ â äîâ³ëüí³é ôîðì³ ³íôîðìàö³ÿ, ÿêî¿ íå âèñòà÷àº;

3) ó ïóíêò³ 4 çàçíà÷àºòüñÿ äîäàòêîâà ³íôîðìàö³ÿ ïðî òâàðèíó, ùî ñïðè÷èíèëà êîíòàêò / óøêîäæåííÿ. Ó ï³äïóíêò³ 4.1 öüîãî ïóíêòó ïîçíà÷àºòüñÿ ïîâåä³íêà òâàðèíè íà ìîìåíò íàïàäó: çâè÷àéíà, àãðåñèâíà, íåòèïîâà, íåâ³äîìà. Ó ï³äïóíêò³ 4.2 öüîãî ïóíêòó âêàçóþòüñÿ â³äîìîñò³ ïðî âëàñíèêà òâàðèíè àáî ì³ñöå ïåðåáóâàííÿ òâàðèíè (äëÿ äîìàøí³õ òâàðèí). Ó ï³äïóíêò³ 4.3 öüîãî ïóíêòó ïîçíà÷àºòüñÿ ñòàòóñ âàêöèíàö³¿ òâàðèíè â³ä ñêàçó, à â ï³äïóíêò³ 4.4 öüîãî ïóíêòó - âêàçóºòüñÿ ³íôîðìàö³ÿ ïðî ïîäàëüøå ïîâîäæåííÿ ç òâàðèíîþ;

4) ó ïóíêò³ 5 ïîçíà÷àºòüñÿ, ÷è ïîâ³äîìëåíî òåðèòîð³àëüíèé îðãàí Äåðæïðîäñïîæèâñëóæáè. ßêùî òàê, òî â ï³äïóíêò³ 5.1 öüîãî ïóíêòó äåòàë³çóºòüñÿ ³íôîðìàö³ÿ ïðî äàòó (÷èñëî, ì³ñÿöü ð³ê) òà ÷àñ (ãîäèíè ³ õâèëèíè);

5) ó ïóíêò³ 6 âêàçóºòüñÿ, ÷è º ³íø³ ïîñòðàæäàë³ âíàñë³äîê öüîãî âèïàäêó êîíòàêòó / óøêîäæåííÿ, ïðîñòàâëÿºòüñÿ "òàê" àáî "í³". ßêùî ïðîñòàâëÿºòüñÿ "òàê", ó ï³äïóíêò³ 6.1 öüîãî ïóíêòó äåòàë³çóºòüñÿ ³íôîðìàö³ÿ ïðî ³íøèõ ïîñòðàæäàëèõ ³ç çàçíà÷åííÿì ïð³çâèùà, âëàñíîãî ³ìåí³, ïî áàòüêîâ³ (çà íàÿâíîñò³), êîíòàêòíîãî òåëåôîíó êîæíîãî ïîñòðàæäàëîãî, à òàêîæ, ÷è áóëî çâåðíåííÿ çà ìåäè÷íîþ äîïîìîãîþ. ßêùî îñîáà çâåðòàëàñü çà ìåäè÷íîþ äîïîìîãîþ âêàçóºòüñÿ äàòà åêñòðåíîãî ïîâ³äîìëåííÿ ÇÎÇ ÷è ÔÎÏ, äî ÿêîãî çâåðíóëàñü îñîáà çà ìåäè÷íîþ äîïîìîãîþ, ïîäàíîãî äî ÖÊÏÕ;

6) ó ïóíêò³ 7 âêàçóºòüñÿ ïðî íàÿâí³ñòü ï³äñòàâ äëÿ ì³æòåðèòîð³àëüíîãî ³íôîðìóâàííÿ. Ó ï³äïóíêò³ 7.1 öüîãî ïóíêòó äåòàë³çóºòüñÿ ó ðàç³, ÿêùî åêñïîçèö³ÿ â³äáóëàñÿ â ³íø³é àäì³í³ñòðàòèâíî-òåðèòîð³àëüí³é îäèíèö³, íàïðàâëåííÿ ³íôîðìàö³¿ äî â³äïîâ³äíîãî ÖÊÏÕ çà ì³ñöåì âèíèêíåííÿ ïî䳿 çàçíà÷àºòüñÿ, çä³éñíåíî ÷è íå çä³éñíåíî. ßêùî ³íôîðìóâàííÿ çä³éñíåíî, òî äåòàë³çóþòüñÿ äàí³ ùîäî äàòè íàïðàâëåííÿ ³íôîðìàö³¿ òà ÖÊÏÕ, äî ÿêîãî íàïðàâëåíî ³íôîðìàö³þ.

13. Ðîçä³ë III Ôîðìè N 058-2/î çàïîâíþþòü ë³êàð³ ÇÎÇ àáî ÔÎÏ, ÿê³ îòðèìàëè ë³öåíç³þ íà ïðîâàäæåííÿ ãîñïîäàðñüêî¿ ä³ÿëüíîñò³ ç ìåäè÷íî¿ ïðàêòèêè, íàäàþòü ñïåö³àë³çîâàíó ìåäè÷íó äîïîìîãó òà ïðîâîäÿòü ÏÊÏ ñêàçó.

14. Ó ðîçä³ë³ III Ôîðìè N 058-2/î:

1) ó âåðõíüîìó ë³âîìó êóò³ âêàçóºòüñÿ ³íôîðìàö³ÿ, ïåðåäáà÷åíà ïóíêòîì 6 ö³º¿ ²íñòðóêö³¿;

2) ó ïóíêò³ 1 çàçíà÷àþòüñÿ ïð³çâèùå, âëàñíå ³ì'ÿ, ïî áàòüêîâ³ (çà íàÿâíîñò³) ïàö³ºíòà, ÿêèé çâåðíóâñÿ çà ìåäè÷íîþ äîïîìîãîþ, à òàêîæ éîãî êîíòàêòíèé òåëåôîí;

3) ó ïóíêò³ 2 çàçíà÷àºòüñÿ äàòà íàðîäæåííÿ ïàö³ºíòà;

4) ïóíêò³ 3 çàçíà÷àºòüñÿ õàðàêòåð çâåðíåííÿ òà ïîçíà÷àºòüñÿ ïåðâèííå çâåðíåííÿ ÷è ïåðåíàïðàâëåíèé ç ³íøîãî ÇÎÇ ÷è ÔÎÏ (âêàçóºòüñÿ ÿêîãî);

5) ó ïóíêò³ 4 âêàçóºòüñÿ ³íôîðìàö³ÿ ïðî äàòó (÷èñëî, ì³ñÿöü ð³ê) òà ÷àñ (ãîäèíè ³ õâèëèíè) ïåðâèííîãî çâåðíåííÿ çà ìåäè÷íîþ äîïîìîãîþ;

6) ó ïóíêò³ 5 âêàçóºòüñÿ, ÷è áóëî íàäàíî ìåäè÷íó äîïîìîãó ïðè ïåðâèííîìó çâåðíåíí³ çà ìåäè÷íîþ äîïîìîãîþ;

7) ó ïóíêò³ 6 âêàçóºòüñÿ, ÷è ïðîâîäèëàñü ïåðâèííà îáðîáêà ðàíè ³ çàçíà÷àºòüñÿ õàðàêòåð îáðîáêè;

8) ó ïóíêò³ 7 çàçíà÷àºòüñÿ õ³ðóðã³÷íà òàêòèêà âåäåííÿ ðàíè: íå ïîòðåáóº õ³ðóðã³÷íîãî âòðó÷àííÿ, ïåðâèííà õ³ðóðã³÷íà îáðîáêà ðàíè, íàêëàäàííÿ øâ³â, äðåíóâàííÿ ðàíè, íàïðàâëåííÿ/ïåðåâåäåííÿ äî ³íøîãî ÇÎÇ äëÿ ñïåö³àë³çîâàíî¿ äîïîìîãè, ³íøå. Ó ïîë³ "³íøå" äåòàë³çóºòüñÿ, ùî ñàìå;

9) ó ïóíêò³ 8 ðîçä³ëó âêàçóºòüñÿ ³íôîðìàö³ÿ ïðî íàïðàâëåííÿ íà îòðèìàííÿ ñïåö³àë³çîâàíî¿ ìåäè÷íî¿ äîïîìîãè ó ðàç³, ÿêùî ó ïóíêò³ 3 öüîãî ðîçä³ëó áóëî çàçíà÷åíî ïðî ïåðåíàïðàâëåííÿ ç ³íøîãî ÇÎÇ ÷è ÔÎÏ äëÿ ñïåö³àë³çîâàíî¿ äîïîìîãè;

10) ó ïóíêò³ 9 âêàçóºòüñÿ ³íôîðìàö³ÿ ïðî ÏÊÏ, à ñàìå: ó ï³äïóíêòàõ 9.1 òà 9.2 öüîãî ïóíêòó äåòàë³çóºòüñÿ, ÷è áóëî ïðèçíà÷åíî àíòèðàá³÷íó âàêöèíó àáî àíòèðàá³÷íèé ³ìóíîãëîáóë³í;

11) ó ðàç³ ïðèçíà÷åííÿ ÏÊÏ ó ïóíêò³ 10 âêàçóºòüñÿ, ÷è áóëî íàïðàâëåííÿ äëÿ ïðîâåäåííÿ ïîñòêîíòàêòíî¿ ïðîô³ëàêòèêè äî ³íøîãî ÇÎÇ, ÿêùî òàê, òî çàçíà÷àºòüñÿ éîãî íîìåð;

12) ï³ñëÿ ïóíêòó 10 âêàçóþòüñÿ äàí³ ïðî ë³êàðÿ, ÿêèé íàäàâàâ ìåäè÷íó äîïîìîãó, à ñàìå: çàçíà÷àºòüñÿ ïð³çâèùå, âëàñíå ³ì'ÿ, òåëåôîí òà ïðîñòàâëÿºòüñÿ éîãî ï³äïèñ;

13) ó ïóíêò³ 11 âêàçóºòüñÿ ³íôîðìàö³ÿ ïðî ââåäåííÿ àíòèðàá³÷íèõ ïðåïàðàò³â. Ó ï³äïóíêòàõ 11.1 òà 11.2 äåòàë³çóºòüñÿ ³íôîðìàö³ÿ ùîäî ñõåìè ÏÊÏ àáî ïðî ââåäåííÿ àíòèðàá³÷íîãî ³ìóíîãëîáóë³íó;

14) ïóíêò 12 ì³ñòèòü ³íôîðìàö³þ ùîäî ïðîâåäåííÿ ÏÊÏ, äå âêàçóþòüñÿ: äîçà ë³êàðñüêîãî çàñîáó, òîðãîâåëüíà íàçâà ë³êàðñüêîãî çàñîáó (âàêöèíà, ³ìóíîãëîáóë³í), íàéìåíóâàííÿ âèðîáíèêà, äàòà ââåäåííÿ ë³êàðñüêîãî çàñîáó, ñåð³ÿ, íîìåð, ñïîñ³á ââåäåííÿ, ì³ñöå ââåäåííÿ, ïð³çâèùå òà âëàñíå ³ì'ÿ ìåäè÷íîãî ïðàö³âíèêà, ÿêèé ââ³â ë³êàðñüêèé çàñ³á.

Äàí³ ùîäî ïðîâåäåííÿ ÏÊÏ âíîñÿòüñÿ äî ÅÑÎÇ;

15) ó ïóíêò 13 âíîñÿòüñÿ â³äîìîñò³ ùîäî êóðñó ÊÏÊ, ïðîñòàâëÿºòüñÿ ³íôîðìàö³ÿ ùîäî éîãî ïðîâåäåííÿ, à ñàìå: ïîâí³ñòþ çàâåðøåíèé, ïåðåðâàíèé, îñîáà âèáóëà ç-ï³ä íàãëÿäó, ïîìåð(ëà). ßêùî êóðñ áóëî ïåðåðâàíî, çàïîâíþºòüñÿ ï³äïóíêò 13.1 öüîãî ïóíêòó, äå âêàçóºòüñÿ ïðè÷èíà: â³äì³íåíî, òâàðèíà âèÿâèëàñü êë³í³÷íî çäîðîâîþ, â³äìîâà â³ä ïîäàëüøî¿ âàêöèíàö³¿, ïîðóøåííÿ ãðàô³êà / íåÿâêà íà ÷åðãîâå ââåäåííÿ, ìåäè÷í³ ïðîòèïîêàçàííÿ / íåáàæàíà ðåàêö³ÿ, ³íøå. Ïîëå "³íøå" äîäàòêîâî çàïîâíþºòüñÿ â äîâ³ëüí³é ôîðì³;

16) ó ïóíêò³ 14 çàçíà÷àþòüñÿ ïð³çâèùå òà âëàñíå ³ì'ÿ ë³êàðÿ òà ïðîñòàâëÿºòüñÿ éîãî ï³äïèñ.

15. Ñòðîê çáåð³ãàííÿ Ôîðìè N 058-2/î â ÇÎÇ, ÔÎÏ, ÿê³ ¿¿ çàïîâíèëè, òà â ÖÊÏÕ - 1 ð³ê.

 

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