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Ministry of Justice of Ukraine

October 6, 2016

No. 1325/29455

ORDER OF THE MINISTRY OF HEALTH OF UKRAINE

of September 15, 2016 No. 970

About approval of forms of primary accounting documentation and instructions for their filling

According to Articles 11, of 12, 13 Laws of Ukraine "About mental health services", the paragraph of the subitem 8 of item 4 of the Regulations on the Ministry of Health of Ukraine approved by the resolution of the Cabinet of Ministers of Ukraine of March 25, 2015 No. 267, order the ninety fourth:

1. Approve:

1) form of primary accounting documentation No. 003-7/o "Informed consent of person on carrying out psychiatric survey" and the instruction for its filling which are applied;

2) form of primary accounting documentation No. 003-8/o "Informed consent of person on out-patient mental health services" and the instruction for its filling which are applied;

3) form of primary accounting documentation No. 003-9/o "Informed consent of person on hospitalization in mental health facility" and the instruction for its filling which are applied;

4) form of primary accounting documentation No. 003-10/o "Informed consent of person on treatment in psychiatric institution" and the instruction for its filling which are applied;

5) form of primary accounting documentation No. 003-11/o "Informed consent of parents or other legal representative on carrying out psychiatric survey of person aged up to 14 years (juvenile)" and the instruction for its filling which are applied;

6) form of primary accounting documentation No. 003-12/o "Informed consent of parents or other legal representative on out-patient mental health services to person aged up to 14 years (juvenile person)" and the instruction for its filling which are applied;

7) form of primary accounting documentation No. 003-13/o "Informed consent of parents or other legal representative on hospitalization in mental health facility of person aged up to 14 years (juvenile)" and the instruction for its filling which are applied;

8) form of primary accounting documentation No. 003-14/o "Informed consent of parents or other legal representative on treatment in psychiatric institution of person aged up to 14 years (juvenile)" and the instruction for its filling which are applied.

2. To provide to the Minister of Health of the Autonomous Republic of Crimea, heads of structural divisions concerning health care of the regional, Kiev and Sevastopol city public administrations accomplishment of this order.

3. To provide to the director of Medical department (Kravchenko V. V.) submission of this order on state registration in the Ministry of Justice of Ukraine in accordance with the established procedure.

4. I reserve control over the implementation of the order.

5. This order becomes effective from the date of its official publication.

Acting minister

V. Suprun

Approved by the Order of the Ministry of Health of Ukraine of September 15, 2016 No. 970

Informed consent of person on carrying out psychiatric survey

1 See. Informed consent of person on carrying out psychiatric survey (13Kb In original language)

Acting as Direktora Medical department

A. Gavrilyuk

Approved by the Order of the Ministry of Health of Ukraine of September 15, 2016 No. 970

Instruction for filling of form of primary accounting documentation No. 003-7/o "Informed consent of person on carrying out psychiatric survey"

1. This Instruction determines procedure for filling of form of primary accounting documentation No. 003-7/o "Informed consent of person on carrying out psychiatric survey" (further - form No. 003-7/o).

2. The form No. 003-7/o is filled with person who addressed to healthcare institution and agrees to carrying out to it psychiatric survey. It occurs in the presence of the doctor of this healthcare institution.

3. Person with own hand enters the surname, name, middle name; the doctor leads up information on the plan of diagnostics, provides information on the rights of the patient and obligation of the doctor in available form.

4. The consent of person to psychiatric survey makes sure signatures of the doctor and person with indication of date (number, month, year).

5. The form No. 003-7/o is filled in duplicate, first of which (form No. 025/about) or the medical record of the inpatient (form No. 003/about), by the approved order of the Ministry of Health of Ukraine of February 14, 2012 No. 110, registered in the Ministry of Justice of Ukraine on April 28, 2012 on No. 661/20974 is applied to the medical record of the outpatient (in edition of the order of the Ministry of Health of Ukraine of January 21, 2016 No. 29), and the second is stored at person.

6. The form No. 003-7/o has storage duration which corresponds to storage duration of the accounting forms specified in Item 5 of this Instruction.

Acting as Direktora Medical department

A. Gavrilyuk

Approved by the Order of the Ministry of Health of Ukraine of September 15, 2016 No. 970

Realized the consent of person to out-patient mental health services

2 See. Realized the consent of person to out-patient mental health services

Acting as director of Medical department

A. Gavrilyuk

Approved by the Order of the Ministry of Health of Ukraine of September 15, 2016 No. 970

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