ORDER OF THE GOVERNMENT OF THE REPUBLIC OF MOLDOVA

of May 14, 2012 No. 295

About approval of the Regulations on procedure for application of forced temporary hospitalization in specialized TB medical institutions of persons sick with contagious form of tuberculosis who refuse treatment

For the purpose of execution of provisions of article 15 of the Law No. 153-XVI of July 4, 2008 on control and prevention of tuberculosis (The official monitor of the Republic of Moldova, 2008, No. 143-144, of the Art. 583) DECIDES: the Government

1. Approve Regulations on procedure for application of forced temporary hospitalization in specialized TB medical institutions of persons sick with contagious form of tuberculosis who refuse treatment it (is applied).

2. Provide to the Ministry of Health proper conditions for application of forced temporary hospitalization in specialized TB medical institutions of persons sick with contagious form of tuberculosis.

Approved by the Order of the Government of May 14, 2012 No. 295

REGULATIONS on procedure for application of forced temporary hospitalization in specialized TB medical institutions of persons sick with contagious form of tuberculosis who refuse treatment

Chapter I GENERAL PROVISIONS

1. This Provision establishes procedure for application of forced temporary hospitalization and medical observation of persons sick with contagious form of tuberculosis who refuse treatment and pose threat for health of people around because of spread of disease.

2. The faces sore with contagious form of tuberculosis which refuse treatment are subject to isolation by forced hospitalization, based on the judgment, in specialized TB medical institutions according to the regular scheme of the direction on treatment of patients with tuberculosis.

3. The this provision purpose - regulation of application of provisions of the current legislation for providing measures for non-proliferation of tuberculosis infection, safety of public health and observance of the rights of persons to which requirements of this provision are applied.

4. In any situation achievement of cooperation and the informed consent of the patient will be important priority for application of requirements of this provision as last resort after complete amount of all less tough opportunities.

Chapter II SCOPE. The MEASURES PRECEDING FORCED HOSPITALIZATION

5. Fall under action of this provision and persons who cumulatively correspond to the following conditions are subject to forced temporary hospitalization only:

1) the tuberculosis in contagious form confirmed with at least two positive results of research on acid resisting mikobakteriya (QOM) or one positive result of research of phlegm to QOM and the x-ray changes regarded by the specialist as corresponding to active tuberculosis of lungs is diagnosed;

2) consciously refuses cooperation and the voluntary specific treatment appointed by the specialist doctor;

3) there is expressed risk for health of the patient or the people surrounding it;

4) were accepted, but it is ineffectual, all feasible measures for cooperation and voluntary treatment of this person (at least all actions provided in Item 6 of this provision);

5) other less strict opportunities of treatment were applied and exhausted;

6) temporary isolation remains the last measure for providing the rights and interests of the patient and public health.

6. At least prior measures necessary for possible application of the mode of forced temporary hospitalization:

1) the doctor shall plan enough time for complete informing the patient on tuberculosis infection. Informing is carried out by the available language clear for the patient, with the description of etiology, transmissibility and method of transfer, outstanding performance of treatment in case of the consent of person, the current legislation, including the appropriate rights and obligations, explanation of feasible measures which should be undertaken to the patient for the prevention of infection of other persons. Information materials about tuberculosis shall be provided to the patient (reference books, brochures, leaflets, etc.). Actions for informing need to be reflected in the corresponding medical documentation of the patient with obligatory signatures of the doctor - the specialist and the patient;

2) in case of evasion signs from treatment or its non-compliance the reasons of this non-compliance without fail are considered and feasible measures on elimination are taken. Individual multi-profile medico-social assessment together with employees of primary medical network and workers of system of social protection, including the communitarian centers for support of treatment of TB patients in out-patient conditions shall be surely provided. It will be for this purpose undertaken:

a) the direction of patients with the map statement (form the 027th) the family doctor in coordination with the district police officer ftiziopulmonology in the Communitarian center for support of treatment of patients in out-patient conditions;

b) consultation of patients with tuberculosis specialists of multi-profile team as a part of the Communitarian center for support of treatment of patients in out-patient conditions and implementation of the individual plan of the help in coordination with the communitarian social assistant;

c) ensuring the integrated management of provision of services to the patient with tuberculosis by scoping of these services which can influence the consent of the patient to treatment, for each patient individually;

d) the maximum support of initiatives and proposals of the patient or relatives for possibility of overcoming situation and ensuring treatment. All these actions shall be surely documented in the medical record of observation of the patient.

3) in case of inefficiency of measures of belief, the patient it shall be informed in writing on possible consequences of its unwillingness to cooperate. In the letter 14-day term for confirmation, the description of enforcement powers, terms and the rights of person for representation of interests in degree of jurisdiction after which in case of not achievement of effect enforcement powers will be taken is specified. Information goes the registered mail or is handed under list to person subjected to enforcement powers. The copy of the letter is introduced in medical documentation of the patient.

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