RESOLUTION OF THE CABINET OF MINISTERS OF THE REPUBLIC OF UZBEKISTAN

of February 8, 2022 No. 62

About approval of Regulatory legal acts about organizational structure and the organization of activities of service of medico-social examination

(Extraction)

For the purpose of ensuring execution of presidential decrees of the Republic of Uzbekistan of March 25, 2021 No. UP-6195 "About social support aged and persons with disability, and also further development of system of houses boarding schools Sakhovat and Muruvvat and of January 28, 2022 No. UP-60 "About the Strategy of Development for New Uzbekistan for 2022-2026", resolutions of the President of the Republic of Uzbekistan of November 27, 2021 No. PP-22 "About measures for further enhancement of activities of service of medico-social examination and system of establishment of disability to children", and also phased transition on social model of establishment of disability the DECIDES: Cabinet of Ministers

1. Take into consideration that according to the Presidential decree of the Republic of Uzbekistan of February 3, 2021 No. UP-6155 "About the State program by strategy implementation of actions in five priority directions of development of the Republic of Uzbekistan in 2017-2021 in "Year of support of youth and strengthening of health of the population" determines task of implementation of practice of purpose of disability for the termless period to the citizen recognized as person with disability with the anatomic defects having strong indications of disability without carrying out additional survey for receipt of kliniko-functional data, and also forming of conceptual new model of medico-social service.

2. Approve:

Organizational structure of system of Service of medico-social examination of the Agency on development of medico-social services of the Republic of Uzbekistan according to appendix No. 1 *;

Structure of Republican inspection of medico-social examination of the Agency on development of medico-social services of the Republic of Uzbekistan according to appendix No. 2 *;

Standard structures of interdistrict, district (city), ad and pediatric medico-social commissions of experts of the main medico-social commissions of experts of the Republic of Karakalpakstan, areas and the city of Tashkent according to appendices No. 3*-5 *;

The list of the medico-social commissions of experts assigned to the public medical institutions equipped with the necessary equipment for carrying out free inspections according to appendix No. 6 *;

The regulations on Republican inspection of medico-social examination of the Agency on development of medico-social services of the Republic of Uzbekistan providing the main objectives, the rights and procedure for the organization of activities of Republican inspection of medico-social examination in the field of conducting medico-social examination of citizens and establishment of disability by it according to appendix No. 7 *;

The regulations on medico-social commissions of experts providing the main objectives, the rights and procedure for the organization and assessment of activities of medico-social commissions of experts in the field of conducting medico-social examination of citizens and establishment of disability by it according to appendix No. 8 *;

The regulations on procedure for carrying out survey of citizens in medico-social commissions of experts providing procedure for acceptance and carrying out survey of citizens in medico-social commissions of experts, the list of the main invalidiziruyushchy diseases and criteria of establishment of disability in case of these diseases, the list of diseases and complications with strong indications of disability, anatomic defects, and also with the adverse clinical forecast in case of which disability is established without specifying of term of re-examination, according to appendix No. 9 *;

Regulations on procedure for establishment of extent of loss of professional working capacity of persons who sustained the labor injuries or occupational disease providing the main criteria of conducting examination of extent of loss of professional working ability of the victim, the list of the occupational diseases connected with professional activity, extents of loss of professional working ability of the victim and procedure for their establishment according to appendix No. 10;

The regulations on the individual program of rehabilitation of person with disability providing terms and development stages of the individual program of rehabilitation of persons with disability, participation of persons with disability and specialists in its development, requirements to the organizations in case of accomplishment of the program and also procedure of monitoring and assessment of results of accomplishment of the actions determined in it, according to appendix No. 11*.

3. Take into consideration that to the organization of activities of pediatric medico-social commissions of experts in the period of the term of establishment by medical labor commissions of experts of group of disability to children aged from 16 up to 17 years and assignment of the status by it "disability since the childhood" is paid to them benefit and payments for group of disability according to the Law of the Republic of Uzbekistan "About the rights of persons with disability".

4. Make changes and additions to some decisions of the Government of the Republic of Uzbekistan according to appendix No. 12.

5. Recognize invalid some decisions of the Government of the Republic of Uzbekistan according to appendix No. 13.

6. To agency on development of medico-social services of the Republic of Uzbekistan together with the interested ministries and departments to bring the regulatory legal acts adopted by them into accord with this resolution in a month.

7. To impose control of execution of this resolution on the deputy prime minister of the Republic of Uzbekistan concerning social development and the director of the Agency on development of medico-social services of the Republic of Uzbekistan Inakov A. K.

Appendix No. 10

to the Resolution of the Cabinet of Ministers of the Republic of Uzbekistan of February 8, 2022 No. 62

Regulations on procedure for establishment of extent of loss of professional working capacity of persons who sustained labor injuries or occupational disease

Chapter 1. General provisions

1. This Provision determines procedure for establishment of extent of loss of professional working capacity of persons who sustained labor injuries or occupational disease, the Main, district, city, interdistrict, ad and pediatric medico-social commissions of experts (further - MSEK).

2. Extent of loss of professional working capacity is established as a percentage on date of survey of persons who sustained labor injuries or occupational disease proceeding from assessment of loss of capability to perform professional activity.

3. Occupational diseases are established based on the List of diseases according to appendix No. 1 to this Provision.

4. Extent of loss of professional working capacity in case of mutilation is established by MSEK according to appendix No. 2 * to this Provision.

Chapter 2. General rules of determination of extent of loss of professional working capacity

5. Extent of loss of professional working capacity is determined proceeding from consequences of damage of health owing to labor mutilation or occupational disease, taking into account the capabilities which are available for the victim, psychophysiological opportunities and qualities allowing to continue to carry out the professional activity preceding labor mutilation and/or occupational disease, the same content and in the same amount or taking into account decrease in qualification, reduction of amount of the performed work and weight of work in the regular, specially created working or other conditions and is established ranging from 5 to 100 percent

6. Extent of loss of professional working capacity in case of repeated labor mutilations or again arisen occupational diseases in general cannot exceed 100 percent and is determined:

at the time of survey on each of them separately irrespective of, they took place during work at one employee or at different employees;

depending on influence of their consequences on its capability to carry out the professional activity preceding repeated labor mutilation taking into account professional knowledge and abilities of the victim;

taking into account results of implementation of the individual program of rehabilitation of the victim on recovery of professional working capacity in the former profession preceding the previous labor mutilation.

When weighting group of disability in connection with again arisen disease which is not connected with labor mutilation or occupational disease, the reason of disability is established "general disease", and earlier established extent of loss of professional working capacity is reviewed based on the patient's condition on the date of survey.

If following the results of rehabilitation actions the group of disability established for the reason "labor mutilation" or "occupational disease" decreases (partial rehabilitation), the reason of disability does not change.

7. The basic methodological principle of examination of extent of loss of professional working ability of the victim is the analysis:

kliniko-functional criteria;

nature of professional activity (qualification, quality and amount of work, capability to its accomplishment);

categories and extents of restrictions of activity.

8. Kliniko-funktsionalnye criteria include:

nature and weight of labor mutilation and occupational disease;

features of course of the pathological process caused by labor mutilation or occupational disease;

nature (type) and the extent of violations of functions of organism (considerably expressed, expressed, moderately expressed insignificant);

clinical, rehabilitation and kliniko-labor forecast, and also psychophysiological opportunities.

9. In case of determination of extent of loss of professional working capacity expressiveness of violations of the functions of organism of the victim leading to restriction of capability to labor activity and other categories of restriction of activity is considered.

10. In case of determination of extent of loss of professional working capacity the capability of the emergence of labor mutilation or occupational disease which was injured later is considered to perform work in full on the former profession in the regular or specially created production or other working conditions.

11. Frequency rate of decrease in qualification is determined taking into account the established tariff and qualification categories, degrees, categories for this professional activity.

12. Extent of loss of professional working capacity is established depending on the level of decrease in qualification, taking into account reduction of coefficient of complexity of works.

13. In case of determination of extent of loss of professional working capacity degrees of working conditions on indicators of harm and danger of factors of the production circle, weight and intensity of labor process are considered.

Chapter 3. Determination of extent of loss of professional working capacity

14. If at the victim as a result of labor mutilation or occupational disease, in case of much the expressed violations of functions of organism, there came complete loss of capability to professional activity, including in specially created production or other working conditions, to it 100 percent of loss of professional working capacity are established.

15. Kliniko-funktsionalnymi criteria of establishment of 100 percent of loss of professional working capacity are the expressed violations of functions of organism following much:

a) lower paraplegia; much the expressed tetraparesis, triparez, paraparesis with increase in muscular tone on spastic type or hypotonia, hypotonia with the minimum amount (5,0-6,0 of degrees) of active movements in all joints of the lower extremities, considerable the expressed decrease in muscular force (to 1 point), with impossibility of independent movement; III type of electromyography (further - EMG) - frequent fluctuations of potential, misstatement of normal structure of the electromyogram "volleys of frequent oscillations" (obviously expressed paresis); The IV EMG type - complete bioelectric silence in case of functional loadings (paralysis of extremities);

b) much the expressed paresis of both upper extremities with the minimum amount of active movements in all joints (humeral - 5,5-10 of degrees, elbow - 4,3-7,7 of degrees, luchezapyastny - 5,5-8,5 of degrees); considerable restriction of opposition of thumb (the disteel phalanx of the last reaches the basis of the second finger), bendings of fingers in fist (disteel phalanxes of fingers do not reach palm at distance of 5-8 cm); decrease in muscular force of the upper extremities (to 1 point); violation of the main function of the upper extremity: it is impossible skhvat and deduction of large and small objects, only support function - maintenance and pressing of objects is kept;

c) vestibular and cerebellar violations: considerably the expressed static, dynamic ataxy; hyper reflection of vestibular excitability lasting post-rotary nistagm III degrees more than 120 seconds, caloric nistagm of III degree more than 130 seconds;

d) the amputating stumps of both lower extremities which are (not fitted a prosthesis) in combination with stump of the upper extremity, since lack of all fingers of brush;

e) respiratory insufficiency of III degree, violation of blood circulation of III stage (short wind at rest, the frequency of breath 30 and more one minute, increase of frequency of breath on 10-15 in minute after insignificant physical tension without recovery of initial level, the cyanosis much expressed, participation in rest of auxiliary respiratory muscles, the expressed tachycardia - 130 and more beats per minute, epigastralny pulsation, increase in liver, peripheral hypostases, decrease in vital reservoir of lungs to 50% of due, maximum ventilation of lungs - to 50 percent, increase in minute amount of breath up to 180 percent, decrease in index of Tiffno less than 40 percent and oxygen utilization rate to 20 percent, decrease in sokratitelny capability of myocardium of the right ventricle in combination with violation of pulmonary haemo dynamics);

e) much the expressed touch violations (the practical or absolute blindness of the only thing or is better than the seeing eye: visual acuity with correction - 0,03-0, the field of vision is equal - 0-10 degrees (peripheral borders on meridian from point of fixing and/or the central or paracentral drain scotomas); visual working capacity - the expressed decrease or absence, indicators of electrophysiological researches (further - EFI) - E-U thresholds more than 300 mk is considerable or are not determined, lability less than 20 Hz or is absent, CFMF (critical frequency of merge of flashings) less than 20 in second (it is normal of higher than 45 Hz) or is absent - in the presence of contraindications to accomplishment of any work;

g) much the expressed violations of functions of pelvic bodies (urine incontience, calla).

16. If the victim owing to the expressed violations of functions of organism can carry out professional work only in specially created working conditions, to it is established from 70 to 90 percent of loss of professional working capacity.

At the same time extent of loss of professional working capacity is established depending on the level of decrease in qualification in case of performance of work in specially created working conditions.

In cases, when:

a) the victim who was earlier performing skilled work in usual working conditions can carry out only unqualified types of work in specially created working conditions, 90 percent of loss of professional working capacity are established;

b) the victim can perform in specially created working conditions work of lower qualification taking into account professional knowledge and skills, 80 percent of loss of professional working capacity are established;

c) the victim can perform professional job in specially created working conditions, preceding labor mutilation or occupational disease, 70 percent of loss of professional working capacity are established.

17. Kliniko-funktsionalnymi criteria of establishment of 70-90 percent of loss of professional working capacity are the following expressed violations of functions of organism:

a) the expressed paresis of both lower extremities, tetraparesis, triparez, hemiparesis with the expressed increase in muscular tone on spastic type or hypotonia of muscles, with the expressed restriction of amplitude of active movements in all joints of the lower extremities - coxofemoral (to 20 degrees), knee (to 10 degrees), talocrural (to 6-7 degrees); with the expressed decrease in the muscular force (to 2 points) the lower extremities expressed by varusny, ekvino-varusny deformation of feet; spastic, paretic, peronealny gait with the expressed svisaniye of feet; movement with additional support (crutches);

b) the expressed violation of biomechanics of walking - increase in quantity of steps when walking on 100 meters to 204-226 (it is normal of 80-120 steps), increase in duration of double step to 2, seconds (it is normal of 1,0-1,3 of seconds), reduction of rate of walking till 29-46 steps in minute (it is normal of 80-100 steps), decrease in coefficient of rhythm of walking to 0,52-0,58 (it is normal of 0,94-1,00), reduction in the rate of movement to 1,0 of km/h (it is normal of 4-5 km/h); The II EMG type with the expressed violation of bioelectric activity of muscles - low-frequency potentials like "fastsikulyation" with accurate rhythm at rest and in case of functional loadings;

c) the expressed paresis of both upper extremities, contractures of joints of the upper extremities with amount of active movements within 10-20 degrees, with the expressed restriction of bending of fingers in fist (disteel phalanxes of fingers do not reach palm at distance of 3-4 cm), with violation of the main function of the upper extremity: it is impossible skhvat small objects, long and strong deduction of large objects, EMG - the II type;

d) the expressed vestibular and cerebellar violations (dizziness at rest, heavy and frequent - 4 and more times a month dizziness attacks), spontaneous nistagm II-III degrees, the expressed violations of statics and coordination of movements, movement by means of supportive applications (cane, crutches), hyper reflection of vestibular excitability lasting post-rotary nistagm II-III degrees of 85-120 seconds, caloric nistagm of II-III degree of 110-130 seconds;

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