Rights and responsibilities of citizens in the field of health care

Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”

Chapter 4. RIGHTS AND RESPONSIBILITIES OF CITIZENS IN THE FIELD OF HEALTH PROTECTION

Article 18. Right to health

1. Everyone has the right to health care.

2. The right to health protection is ensured by environmental protection, the creation of safe working conditions, favorable working conditions, living conditions, recreation, education and training of citizens, the production and sale of food products of appropriate quality, high-quality, safe and affordable medicines, as well as the provision of accessible and high-quality medical care.

Article 19. Right to medical care

1. Everyone has the right to medical care.

2. Everyone has the right to medical care in a guaranteed volume, provided without charging a fee in accordance with the program of state guarantees of free medical care to citizens, as well as to receive paid medical services and other services, including in accordance with a voluntary health insurance agreement.

3. The right to medical care of foreign citizens living and staying on the territory of the Russian Federation is established by the legislation of the Russian Federation and the relevant international treaties of the Russian Federation. Stateless persons permanently residing in the Russian Federation enjoy the right to medical care on an equal basis with citizens of the Russian Federation, unless otherwise provided by international treaties of the Russian Federation.

4. The procedure for providing medical care to foreign citizens is determined by the Government of the Russian Federation.

5. The patient has the right to:

1) choice of a doctor and choice of a medical organization in accordance with this Federal Law;

2) prevention, diagnosis, treatment, medical rehabilitation in medical organizations in conditions that meet sanitary and hygienic requirements; 3) receiving consultations from medical specialists;

4) relief of pain associated with a disease, condition and (or) medical intervention, methods and medications, including narcotic drugs and psychotropic drugs; 5) obtaining information about one’s rights and obligations, the state of one’s health, choosing persons to whom, in the interests of the patient, information about the state of his health can be transferred, including after his death;

6) receiving therapeutic nutrition if the patient is undergoing treatment in a hospital setting;

7) protection of information constituting medical confidentiality;

8) refusal of medical intervention;

9) compensation for harm caused to health during the provision of medical care; 10) access to him by a lawyer or legal representative to protect his rights; 11) admission to a clergyman, and if the patient is undergoing treatment in an inpatient setting - to provide conditions for the performance of religious rites, which can be carried out in an inpatient setting, including the provision of a separate room, if this does not violate the internal regulations of the medical organization.

Article 20. Informed voluntary consent to medical intervention and refusal of medical intervention

1. A necessary precondition for medical intervention is the giving of informed voluntary consent by a citizen or his legal representative to medical intervention on the basis of complete information provided by a medical professional in an accessible form about the goals, methods of providing medical care, the risks associated with them, possible options for medical intervention, its consequences, as well as the expected results of medical care.

2. Informed voluntary consent to medical intervention is given by one of the parents or other legal representative in relation to:

1) a person who has not reached the age established by Part 5 of Article 47 and Part 2 of Article 54 of this Federal Law, or a person recognized as legally incompetent, if such person, due to his condition, is not capable of giving consent to medical intervention;

2) a minor with drug addiction when providing him with drug treatment or during a medical examination of a minor in order to establish the state of narcotic or other toxic intoxication (except for cases established by the legislation of the Russian Federation for minors acquiring full legal capacity before they reach the age of eighteen).

3. A citizen, one of the parents or other legal representative of the person specified in part 2 of this article has the right to refuse medical intervention or demand its termination, except for the cases provided for in part 9 of this article. The legal representative of a person recognized as incompetent in accordance with the procedure established by law exercises this right if such person, due to his condition, is unable to refuse medical intervention.

4. If a citizen, one of the parents or other legal representative of the person specified in Part 2 of this article refuses medical intervention, the possible consequences of such refusal must be explained in a form accessible to him.

5. If one of the parents or other legal representative of the person specified in part 2 of this article, or the legal representative of a person recognized as legally incompetent, refuses medical intervention necessary to save his life, the medical organization has the right to go to court to protect the interests of such person. The legal representative of a person recognized as legally incompetent shall notify the guardianship and trusteeship authority at the place of residence of the ward of the refusal of medical intervention necessary to save the life of the ward no later than the day following the day of this refusal.

6. Persons specified in parts 1 and 2 of this article, in order to receive primary health care when choosing a doctor and medical organization for the period of their choice, give informed voluntary consent to certain types of medical intervention, which are included in the list established by the authorized federal executive body.

7. Informed voluntary consent to medical intervention or refusal of medical intervention is contained in the citizen’s medical documentation and is drawn up in the form of a paper document signed by a citizen, one of the parents or another legal representative, a medical professional, or is formed in the form of an electronic document signed by a citizen, one of the parents or other legal representative using an enhanced qualified electronic signature or a simple electronic signature through the use of a unified identification and authentication system, as well as medical employee using an enhanced qualified electronic signature. Informed voluntary consent to medical intervention or refusal of medical intervention by one of the parents or other legal representative of the person specified in Part 2 of this article can be generated in the form of an electronic document if there is information about his legal representative in the patient’s medical documentation. When registering informed voluntary consent for medical intervention, a citizen or his legal representative has the right to identify persons to whom, in the interests of the patient, information about the state of his health can be transferred, including after his death. The effect of these requirements regarding the method of signing informed voluntary consent to medical intervention or refusing medical intervention in the form of an electronic document can be changed in relation to participants in the experimental legal regime in the field of digital innovation in accordance with the program of the experimental legal regime in the field of digital innovation, approved in accordance with the Federal Law of July 31, 2020 No. 258-FZ “On experimental legal regimes in the field of digital innovation in the Russian Federation.”

8. The procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention, including in relation to certain types of medical intervention, the form of informed voluntary consent to medical intervention and the form of refusal of medical intervention are approved by the authorized federal executive body.

9. Medical intervention without the consent of a citizen, one of the parents or other legal representative is permitted:

1) if medical intervention is necessary for emergency reasons to eliminate a threat to a person’s life and if his condition does not allow him to express his will or there are no legal representatives (in relation to the persons specified in part 2 of this article);

2) in relation to persons suffering from diseases that pose a danger to others;

3) in relation to persons suffering from severe mental disorders; 4) in relation to persons who have committed socially dangerous acts (crimes); 5) during a forensic medical examination and (or) forensic psychiatric examination;

6) when providing palliative medical care, if the citizen’s condition does not allow him to express his will and there is no legal representative.

10. The decision on medical intervention without the consent of a citizen, one of the parents or other legal representative is made:

1) in the cases specified in paragraphs 1 and 2 of part 9 of this article - by a council of doctors, and if it is impossible to assemble a council, - directly by the attending (duty) doctor with such a decision entered into the patient’s medical documentation and subsequent notification of officials of the medical organization (the head of the medical organization or the head of the department of the medical organization), the citizen in respect of whom the medical intervention was performed, one of the parents or other legal representative of the person who specified in part 2 of this article and in respect of which medical intervention was carried out, or by a court in cases and in the manner established by the legislation of the Russian Federation; 2) in relation to the persons specified in paragraphs 3 and 4 of part 9 of this article - by the court in cases and in the manner established by the legislation of the Russian Federation; 3) in the case specified in paragraph 6 of part 9 of this article - by a medical commission or, if it is impossible to assemble a medical commission, - by a council of doctors or by the attending (duty) doctor directly, with such a decision entered into the patient’s medical documentation and subsequent notification of officials of the medical organization (the head of the medical organization or the head of the department of the medical organization), the citizen in respect of whom the medical intervention was performed, one of the parents or other legal representative of the person specified in part 2 of this article and in respect of which medical intervention has been carried out.

11. Compulsory medical measures may be applied to persons who have committed crimes on the grounds and in the manner established by federal law.

12. In the case of providing medical care to a minor, the attending physician is obliged to inform the minor who has reached the age established by Part 2 of Article 54 of this Federal Law, one of the parents or other legal representative of the minor who has not reached this age, about the medicinal product used, including those used in accordance with the indicators (characteristics) of the medicinal product not specified in the instructions for its use, about its safety, expected effectiveness, degree of risk for the patient, as well as the patient’s actions in the event of unforeseen effects of the drug on the patient’s health.

Article 21. Choice of doctor and medical organization

1. When providing medical care to a citizen within the framework of the program of state guarantees of free medical care to citizens, he has the right to choose a medical organization in the manner approved by the authorized federal executive body, and to choose a doctor, taking into account the doctor’s consent. The specifics of choosing a medical organization by citizens living in closed administrative-territorial entities, in territories with physical, chemical and biological factors hazardous to human health included in the relevant list, as well as by employees of organizations included in the list of organizations of certain industries with particularly hazardous working conditions, are established by the Government of the Russian Federation.

2. To receive primary health care, a citizen chooses a medical organization, including on a territorial-precinct basis, no more than once a year (except for cases of a change in the citizen’s place of residence or place of stay). In the selected medical organization, a citizen chooses no more than once a year (except for cases of replacement of the medical organization) of a general practitioner, local physician, pediatrician, local pediatrician, general practitioner (family doctor) or paramedic by submitting an application personally or through his representative addressed to the head of the medical organization.

3. The provision of primary specialized health care is carried out: 1) by referral from a local physician, local pediatrician, general practitioner (family doctor), paramedic, medical specialist;

2) in the event of a citizen’s independent appeal to a medical organization, including the organization chosen by him in accordance with Part 2 of this article, taking into account the procedures for providing medical care.

4. To receive specialized medical care in a planned form, the choice of a medical organization is carried out on the direction of the attending physician. If several medical organizations providing medical care in the relevant profile take part in the implementation of the territorial program of state guarantees of free medical care to citizens, the attending physician is obliged to inform the citizen about the possibility of choosing a medical organization, taking into account the fulfillment of the conditions for the provision of medical care established by the territorial program of state guarantees of free provision of medical care to citizens.

5. Emergency or emergency medical care is provided to citizens, taking into account compliance with established requirements for the timing of its provision.

6. When providing medical care to a citizen within the framework of the program of state guarantees of free medical care to citizens, the choice of a medical organization (except for cases of emergency medical care) outside the territory of the constituent entity of the Russian Federation in which the citizen lives is carried out in the manner established by the authorized federal executive body.

7. When choosing a doctor and a medical organization, a citizen has the right to receive information in a form accessible to him, including information posted on the Internet information and telecommunications network (hereinafter referred to as the Internet), about the medical organization, about the medical activities it carries out and about doctors, about the level of their education and qualifications.

8. The choice of a doctor and a medical organization by military personnel and persons equivalent in medical support to military personnel, citizens undergoing alternative civilian service, citizens subject to conscription for military service or sent to alternative civilian service, and citizens entering military service under a contract or service equivalent to it, is carried out taking into account the specifics of the provision of medical care established by Article 25 of this Federal Law, as well as taking into account the specifics established by the Federal Law of March 28, 1998 No. 53-FZ “On Military Duty and Military Service”.

8.1. The choice of a doctor and a medical organization by detainees, prisoners serving a sentence of restriction of freedom, arrest, imprisonment or administrative arrest is carried out taking into account the specifics of providing medical care established by Article 26 of this Federal Law.

9. When providing medical care to citizens as part of the practical training of students in professional educational programs of medical education, the patient must be informed about the participation of students in the provision of medical care to him and the right to refuse the participation of students in the provision of medical care to him. In this case, the medical organization is obliged to provide medical care to such a patient without the participation of students.

Article 22. Health Information

1. Everyone has the right to receive, in a form accessible to him, information available in a medical organization about the state of his health, including information about the results of a medical examination, the presence of a disease, the established diagnosis and prognosis of the development of the disease, methods of providing medical care, the risks associated with them, possible types of medical intervention, its consequences and the results of medical care.

2. Information about health status is provided to the patient personally by the attending physician or other medical professionals directly involved in medical examination and treatment. In relation to persons who have not reached the age established in Part 2 of Article 54 of this Federal Law, and citizens recognized as incompetent in accordance with the procedure established by law, information about their state of health is provided to their legal representatives. In relation to persons who have reached the age established by Part 2 of Article 54 of this Federal Law, but have not acquired full legal capacity, information about their health status is provided to these persons, as well as to their legal representatives until these persons reach the age of majority.

3. Health information cannot be provided to a patient against his or her will. In the event of an unfavorable prognosis for the development of the disease, information should be communicated in a sensitive form to the citizen or his spouse, one of the close relatives (children, parents, adopted children, adoptive parents, siblings, grandchildren, grandparents), unless the patient has prohibited telling them about this and (or) has not identified another person to whom such information should be transferred.

4. The patient or his legal representative has the right to directly familiarize himself with medical documentation reflecting the state of his health, and to receive advice from other specialists on the basis of such documentation. The spouse, close relatives (children, parents, adopted children, adoptive parents, siblings, grandchildren, grandparents) or other persons indicated by the patient or his legal representative in written consent to the disclosure of information constituting medical confidentiality, or informed voluntary consent to medical intervention, have the right to directly familiarize themselves with the patient’s medical documentation, including after his death, unless the patient or his legal representative prohibits disclosure of information constituting medical confidentiality. The procedure for reviewing a patient’s medical documentation is established by the authorized federal executive body.

5. The patient or his legal representative has the right, upon request, including in electronic form, to receive medical documents (copies thereof) reflecting the patient’s health status and extracts from them, including in the form of electronic documents. The spouse, close relatives (children, parents, adopted children, adoptive parents, siblings, grandchildren, grandparents) or other persons indicated by the patient or his legal representative in written consent to the disclosure of information constituting medical confidentiality, or informed voluntary consent to medical intervention, have the right to receive medical documents (copies thereof) and extracts from them, including after his death, if the patient or his the legal representative did not prohibit the disclosure of information constituting medical confidentiality. The procedure and timing for the provision of medical documents (copies thereof) and extracts from them are established by the authorized federal executive body.

Article 23. Information about factors affecting health Citizens have the right to receive reliable and timely information about factors that contribute to the preservation of health or have a harmful effect on it, including information about the sanitary and epidemiological well-being of the area of residence, the state of the environment, rational nutrition standards, the quality and safety of industrial products, food products, goods for personal and household needs, potential dangers to human health performed works and services provided. Such information is provided by state authorities and local governments in accordance with their powers, as well as by organizations in the manner prescribed by the legislation of the Russian Federation.

Article 24. Rights of workers engaged in certain types of work to health protection

1. In order to protect health and preserve the ability to work, prevent and timely detect occupational diseases, workers engaged in work with harmful and (or) dangerous production factors, as well as in cases provided for by the legislation of the Russian Federation, workers engaged in certain types of work undergo mandatory medical examinations.

2. The list of harmful and (or) dangerous production factors and work, during the performance of which mandatory preliminary medical examinations upon entry to work and periodic medical examinations are carried out, is approved by the authorized federal executive body.

3. If, during mandatory medical examinations, medical contraindications to the performance of certain types of work are identified, the list of which is established by the authorized federal executive body, the employee may be recognized by the medical commission of the medical organization, based on the results of the examination of professional suitability, as temporarily or permanently unfit for health reasons to perform certain types of work.

4. For health protection purposes, employers have the right to employ medical workers and create units (doctor's office, health center, medical office, medical unit and other units) that provide medical care to the organization's employees. The procedure for organizing the activities of such units and medical workers is established by the authorized federal executive body.

5. Employers are required to provide conditions for employees to undergo medical examinations and medical examinations, as well as to freely release employees to undergo them.

Article 25. Rights of military personnel and persons equivalent in medical care to military personnel, as well as citizens undergoing alternative civil service, citizens subject to conscription for military service (directed to alternative civil service), and citizens entering military service or equivalent contract service, to health protection

1. Military personnel and persons equivalent in medical care to military personnel (hereinafter referred to as military personnel and persons equivalent to them), as well as citizens undergoing alternative civilian service, have the right to undergo a military medical examination to determine suitability for military service or equivalent service and for early dismissal from military service or equivalent service based on the conclusion of a military medical commission.

2. Citizens subject to conscription for military service or sent to alternative civilian service, and citizens entering military service or equivalent service under a contract, undergo a medical examination in the manner prescribed by Article 61 of this Federal Law, and have the right to receive complete information about medical contraindications for military service or equivalent service and indications for deferment or exemption from conscription due to health reasons.

3. Military personnel and persons equivalent to them have the right to receive medical care in departmental medical organizations, and in their absence or in the absence of departments of the relevant profile, specialists or special medical equipment in departmental medical organizations - to receive medical care in the manner established by the Government of the Russian Federation, at the expense of budgetary allocations of the federal budget provided for these purposes to federal executive authorities and federal state bodies in which federal law provides for military service or equivalent service.

4. The procedure for organizing medical care for military personnel and persons equivalent to them is established by the Government of the Russian Federation, the specifics of organizing the provision of medical care to military personnel and persons equivalent to them, including the procedure for their release from military service (official duties) due to illness and other reasons, are established by federal executive authorities and federal government bodies in which federal law provides for military service or service equivalent to it.

5. Citizens when registering for military service, conscription or entering military service under a contract or equivalent service, entering military professional educational organizations or military educational organizations of higher education, concluding with the Ministry of Defense of the Russian Federation an agreement on training in a military training center at a federal state educational organization of higher education under a military training program or in a military educational organization of higher education under a military training program for sergeants, reserve sergeants or a military training program soldiers, reserve sailors, conscription for military training, as well as citizens sent to alternative civilian service, have the right to receive medical care in medical organizations within the framework of the state guarantee program for the provision of free medical care to citizens, with the exception of a medical examination to determine suitability for military service or equivalent service.

6. Features of health protection for military personnel and persons equivalent to them, as well as certain categories of citizens undergoing military service or service equivalent to it in federal executive authorities and federal government bodies in which federal law provides for military service or service equivalent to it, are determined by the legislation of the Russian Federation regulating the activities of these bodies.

Article 26. The rights of persons detained, taken into custody, serving a sentence of restriction of freedom, arrest, imprisonment or administrative arrest to receive medical care

1. Persons detained, taken into custody, serving a sentence in the form of restriction of freedom, arrest, imprisonment or administrative arrest have the right to medical care, including, if necessary, in medical organizations of the state health care system and the municipal health care system, in accordance with the legislation of the Russian Federation.

2. Pregnant women, women during childbirth and in the postpartum period from among the persons specified in part 1 of this article have the right to medical care, including in medical organizations for the protection of motherhood and childhood.

3. If it is impossible to provide medical care in institutions of the penal system, persons in custody or serving a sentence of imprisonment have the right to provide medical care in medical organizations of the state health care system and municipal health care system, as well as to invite specialist doctors from these medical organizations for consultations in the manner established by the Government of the Russian Federation, at the expense of federal budget allocations provided for these purposes to the federal body executive power, which carries out law enforcement functions, control and supervision functions in the field of execution of criminal penalties in relation to convicted persons.

4. When providing medical care in medical organizations of the state health care system and municipal health care system, employees of bodies and institutions of the penal system provide protection for the persons specified in part 3 of this article, and, if necessary, round-the-clock surveillance in order to ensure the safety of these persons, medical workers, as well as other persons located in medical organizations of the state and municipal health care systems, in the manner established by the federal executive body exercising the functions of developing and implementing state policy and legal regulation in the field of execution of criminal penalties, together with the authorized federal executive body.

5. Clinical testing, testing of medicinal products, specialized medical nutrition products, medical devices and disinfectants involving persons specified in part 1 of this article as an object for these purposes is not allowed.

6. For persons serving sentences in institutions of the penitentiary system, the contract on voluntary health insurance is terminated.

7. The procedure for organizing the provision of medical care, including in medical organizations of the state and municipal health care systems, to persons specified in part 1 of this article, is established by the legislation of the Russian Federation, including regulatory legal acts of the authorized federal executive body, which carries out the functions of developing and implementing state policy and legal regulation in the field of execution of criminal penalties, in agreement with the authorized federal executive body.

Article 27. Responsibilities of citizens in the field of health protection

1. Citizens are obliged to take care of maintaining their health.

2. Citizens, in cases provided for by the legislation of the Russian Federation, are required to undergo medical examinations, and citizens suffering from diseases that pose a danger to others, in cases provided for by the legislation of the Russian Federation, are required to undergo medical examination and treatment, as well as engage in the prevention of these diseases.

3. Citizens undergoing treatment are required to comply with the treatment regimen, including those determined for the period of their temporary disability, and the rules of patient behavior in medical organizations.

Article 28. Public associations for the protection of citizens' rights in the field of health care

1. Citizens have the right to create public associations to protect the rights of citizens in the field of health care, formed on a voluntary basis.

2. Public associations for the protection of citizens' rights in the field of health protection may, in accordance with the procedure established by the legislation of the Russian Federation, take part in the development of norms and rules in the field of health protection and resolving issues related to violations of such norms and rules.

3. Public associations for the protection of citizens' rights in the field of health protection do not have the right to advertise specific trade names of medicines, dietary supplements, medical devices, specialized medical nutrition products and breast milk substitutes.