Order 330 Ministry of Head of 24.11. Regulatory legal documents. Contraindications for the use of enteral nutrition

A white-baked cabbage is excluded from the sparing diet and its content is somewhat reduced in other standard diets. In addition, rye bread is excluded from a gentle diet, which is contraindicated under a number of inflammatory diseases gastrointestinal tractAt the same time, the amount of wheat bread, starch, pasta and potatoes was increased.

According to new regulations in therapeutic nutrition, the amount of cereals for cooking soups, porridge, side dishes. More became vegetables - cucumbers and tomatoes, as well as fermented dairy products, coffee and cocoa.

The components for the preparation of diet food dishes also include protein composite dry mixtures.

Approaches to the creation of mixtures of protein composite dry and their formulations were developed as early as the 70s of the last century by Academician A.A. Pokrovsky. These products are produced on the basis of milk whey proteins with the inclusion of lecithin, polyunsaturated fatty acids, dietary fibers, vitamins and minerals, maltodextrin (carbohydrate sources).
Mixtures protein composite dry include well-balanced and easily disabled protein, the source of which is not soy, but milk whey proteins. At the same time, they do not contain animal fat, the excess consumption of which leads to the development of atherosclerosis and overweight.
The effectiveness of their inclusion in dietary dishes with many cardiovascular diseases, diabetes mellitus, liver diseases, metabolic disorders and other diseases is confirmed by the results of clinical trials, which for two years have been conducted in the FSBI "NII" RAMS, FSBI "Central Research and Research Institute of Tuberculosis »RAMS, etc.
Mixtures protein composite dry are produced in accordance with GOST R 53861-2010 "Dietary (therapeutic and prophylactic) food products. Mixtures protein composite dry. General specifications. "
The mixtures are made by B. State Register and used as a component for the preparation of dishes of therapeutic and preventive nutrition of children from 3 years and adults, and workers engaged in work with harmful and especially harmful working conditions.
In therapeutic and sanatorium food, protein composite mixes were introduced in accordance with the previous standards for six standard diets, which were approved by the Order of the Ministry of Health of Russia in 2003 (Order of the Ministry of Health of Russia of August 5, 2003 N 330 "On measures to improve therapeutic nutrition in Medical and preventive institutions Russian Federation") With amendments to April 26, 2006, made by the orders of the Ministry of Health and Social Development of Russia No. 2 of January 10, 2006. and № 316 of 26.04.2006

The norms approved by the Order are developed by the FSBI specialists, RAMS with the involvement of practical nutritionists, medical specialists.

When developing the average daily sets of foodstuffs of standard diets, the characteristics of their chemical composition and energy value are taken as the basis, the nature of the disease is taken into account. Development is based on innovative technologies in the field of medical nutrition. All this, including the introduction of easily digestible components into the diet of the diet nutrition, allows for the body with the necessary foodstuffs.

The draft of the order passed a public discussion on a single portal of disclosure of preparation information federal bodies executive of projects of regulatory legal acts and the results of their public discussion. Notes and proposals for the project of the order did not receive.

www.rosminzdrav.ru.

330 Order of the Ministry of Health

Medicine and law

Here can be

Rules for storage, accounting and vacation of narcotic drugs and special recipe forms on pharmacy warehouses (bases)

1. Narcotic drugs, regardless of the dosage form, should be kept in warehouses (bases) with the resolution of the Permanent Committee for Drug Control (PCN) to work with them. Premises for storing narcotic drugs must meet the current standard requirements for technical reinforcement (Appendix 1).

Administration Note: Change Paragraph 1.

2. The storage room for narcotic drugs at the end of work should be shoved and sealing or segged, and keys, printing and seal should be in a material and responsible person responsible for storing drugs.

Z. Responsibility for organizing the right storage, the safety of narcotic drugs and special recipe forms is assigned to the head of the pharmacy warehouse (base).

4. Access to the room where narcotic drugs and special recipe forms are stored, only persons directly working with them are allowed, which is issued by order of the warehouse leader (bases) and a special admission from the ATC bodies.

5. When drug acquisitions, the head of the warehouse (base) or his deputy must personally check the correspondence of the accompanying documents obtained.

6. Narcotic drugs are released from the warehouse (bases) only in a sealed form, and the etiquette is pasted on each package with the sender, the name of the contents and number of the analysis.

7. Vacation of narcotic drugs should be made according to the requirements signed by the head of the institution or its deputy and certified seal of the institution.

All demands and accounts for narcotic drugs should be written separately from the requirements and accounts for other drugs, indicating the quantities in them.

Administration Note: Changes of clause 7.

8. The issuance of narcotic drugs is made at a separate power of attorney, decorated in the prescribed manner, indicating the name of the obtained funds and the number of their words. Duration of power of attorney 15 days.

9. Before the release of narcotic drugs, a materially responsible person must personally check the foundation of the vacation day, the compliance of the vacuized drug drug with the accompanying document, the correctness of the packaging and sign in the copy of the invoice remaining in the warehouse (database).

Administration Note: Changes in paragraph 9.

10. Narcotic drugs are released from pharmacy warehouses (bases) only for medical purposes with preventive and pharmaceutical (pharmacy) organizations, as well as research institutions and medical educational institutions with hospital beds.

Administration Note: Changes in paragraph 10.

11. Narcotic drugs, regardless of the dosage form, are taken into account in warehouses (bases) in the numbered and missing book (according to the attached form), bonded by seal and signed by the head of the management body pharmaceutical organizations Subject of the Russian Federation.

Administration Note: New edition of paragraph 11.

12. All documents on the arrival and consumption of drug drugs in the warehouse (base) should be stored in a closed and sealing safe by the person responsible for their storage, in accordance with the established storage periods.

Administration Note: Changes in paragraph 12.

13. Storage on pharmacy warehouses (databases) of narcotic drugs, not allowed to use in medical practice in the Russian Federation, is prohibited.

14. Transportation of narcotic drugs is carried out in accordance with the existing special rules.

Head of the Office of the Organization

Providing medication I.

drug Control Committee

Name of the pharmacy warehouse (base)

accounting for narcotic drugs on pharmacy warehouses (bases)

Administration Note: An accounting book of narcotic drugs on pharmacy warehouses (bases) is excluded.

Name of funds __________________________________________

Unit of measurement __________________________________________________

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Free consultation

Federal legislation

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Healthcare, N 3, 1998

Order of the Ministry of Health of the Russian Federation of 12.11.97 N 330 "On measures to improve the accounting, storage, discharge and use of narcotic drugs"

In order to streamline the accounting, storage, discharge and use of narcotic drugs, I order:

1. Enter:

- Model requirements for technical strengthening and equipping by means of security - fire alarm systems with storage of narcotic drugs (Appendix 1).

- the form of a special recipe form for a narcotic drug (Appendix 2).

- Estimated standards for the needs of narcotic drugs for outpatient and stationary patients (Appendix 3).

- Rules for the storage and accounting of narcotic drugs in pharmacies (Appendix 4).

- Rules for the storage and accounting of narcotic drugs and special recipe forms in therapeutic - preventive institutions (Appendix 5).

- Regulations on the write-off and destruction of narcotic drugs and special recipes not used oncological patients (Appendix 6).

- Rules for storage, accounting and vacation of narcotic drugs and special recipe forms for narcotic drugs in pharmacy warehouses (bases) (Appendix 7).

- Rules for storing and accounting for narcotic drugs in control-analytic laboratories (Appendix 8).

- Rules for the storage and accounting of narcotic drugs in scientific and survey institutes, laboratories and educational institutions (Appendix 9).

- Act on the destruction of used ampoules from under narcotic drugs (Appendix 10).

- The form of an extraordinary report submitted by the Ministry of Health of the Russian Federation on the embezzlement and theft of drugs from pharmacy and medical and preventive institutions (Appendix 11).

2.2. Head of Health Authorities and Pharmaceutical Organizations in the Subjects of the Russian Federation:

2.1. To entrust the heads of therapeutic - preventive institutions personal responsibility for accounting, preservation, vacation, appointment and use of narcotic drugs and special recipe forms, in accordance with Annexes 1 to 11, entered by this order.

2.2. Provide therapeutic - preventive institutions with special recipe forms for narcotic drugs obtained from pharmacy warehouses (bases). The supply of special recipe forms for narcotic drugs in health care and medical and preventive institutions should not exceed a monthly need.

2.3. To oblige the heads of therapeutic - preventive institutions (or their deputies) to ensure the storage of special recipe forms for narcotic drugs only in the safe, the key of which should be in these managers; and systematically control over the purpose of narcotic drugs and the established procedure for their discharge (Appendix 2). To categorically prohibit doctors to issue, as well as write recipes for narcotic drugs with patients suffering from addicts.

2.4. To oblige the appointment and use of narcotic drugs to issue entries in the history of the disease, indicating the names of the drug form of the drug, its quantities and dosage.

2.5. Obliged attending or duty doctors used ampoules from under narcotic drugs to take on the same day, with the exception of the weekend and festive days, Deputy Head of the Medical Part, and in institutions, where it is absent - the head of the medical institution. The destruction of used ampoules produced by the Commission chaired by the head with the design of the appropriate act on the established form (Appendix 7).

3. The Permanent Committee for Drug Control, Heads of Medical - Preventive Institutions, Heads of Research Institutions When determining the need for narcotic drugs, be guided by drugs for drugs for drugs (Appendix 9).

4. Heads of health authorities and pharmaceutical organizations in the constituent entities of the Russian Federation systematically organize verification of the correctness of the appointment and design of persons admitted (including temporarily) to work on obtaining, storage, accounting and vacation of narcotic drugs in pharmacy and medical and preventive institutions . In case of identifying the facts of violation of the procedure for appointing and tolerance of persons to work with narcotic drugs of those responsible to involve in strict responsibility in accordance with the legislation of the Russian Federation.

5. Heads of health authorities and pharmaceutical organizations in the constituent entities of the Russian Federation to bring this order to the attention of medical and pharmaceutical workers, to carry out permanent control over its execution.

6. Consider the Order of the USSR Ministry of Health in the Russian Federation from 30.12.82 N 1311 "On measures to eliminate serious shortcomings and further strengthening the fight against drug addiction, an improvement in accounting, storage, prescribing and use of narcotic drugs" (Appendix 2 "Form Special recipe form for a narcotic drug ", Annex 3" Narcotic drug flow rates ", Annex 4" The form of an extraordinary report submitted by the USSR Ministry of Health, about the embezzlement and theft of drugs from pharmacy and medical and preventive institutions ", Annex 5" Storage Rules And accounting for narcotic drugs in household pharmacies ", Annex 6" Rules for storing and accounting for narcotic drugs and special recipe forms in medical and preventive institutions ", Annex 7" Rules for storage, accounting and vacation of narcotic drugs and special spences Pattural forms for narcotic drugs in pharmacy warehouses », Annex 8" Rules for storing and accounting for narcotic drugs in control and analytical laboratories of pharmacy offices ", Annex 9" Rules for storing and accounting for narcotic drugs in scientific and survey institutes, laboratories and educational institutions of health care systems " , Annex 10 "Regulations on the write-off and destruction of narcotic drugs and special recipes not used oncological patients", Annex 11 "Act to the destruction of used ampoules from under narcotic drugs in health facilities").

7. Control over the implementation of this order to shall be entrusted to the Deputy Minister of Health Vilken A.E.

Appendix 1
Approved
Order of the Ministry
health
Russian Federation
dated November 12, 1997 N 330
AGREED
Deputy Minister
internal affairs
Russian Federation
A.N. Kulikov
March 5, 1993
AGREED
Chairman
Permanent Committee
according to drug control
E.A. Babayan.
March 4, 1993

1.1. These requirements provide for technical strengthening measures and determine the basic principles for creating multiserized security systems for fire alarm systems to protect premises (special storage) with narcotic drugs entered in the lists issued by the Permanent Committee on Drug Control.

Requirements apply to designed, newly built and reconstructed drug storage facilities. The technical strength of the premises with drugs, whose protection contract has already been concluded, should be in line with the requirements of this document in terms established in the acts of commission surveys.

Requirements apply to premises for storing potent and poisonous substances.

1.2. Commission examinations of drug warehouses are held as part of representatives of health authorities, security departments, domain and other interested organizations. The Commission on the basis of existing regulatory acts and the available documentation determines the concentration of narcotic drugs, chooses the optimal embodiment of the object using the alarm tools, taking into account its telephony and power supply. During the survey, vulnerable places in building structures (windows, doors, non-vacant walls, ceilings, floors, ventilation holes, etc.) are detected, the number of security and fire cables, devices, detectors, sensors needed to protect drug storage sites are determined.

According to the results of the survey of the vaulting of narcotic drugs, the act of the provided form is drawn up, the performers and deadlines for the performance of work are determined.

1.3. Preparation and performance of work on the equipment with drugs with the means of OPS must be carried out in accordance:

- with technological cards and installation instructions for systems and security alarm systems;

- from VN 25-09.68-85 "Rules of production and acceptance of work. Installation of security, fire and security - fire alarm ";

- with technical documentation for products;

- with the requirements of PUE, SNIP 2.04.09-84 and SNiP 3.05.06-85.

2.1. Drug facilities should have walls equivalent to brick walls, a thickness of at least 510 mm, floors and overlaps, equivalent to the strength of the reinforced concrete plate with a thickness of at least 100 mm.

2.2. Walls, ceiling floors, floors that do not meet the specified requirements, from the inside throughout the area must be strengthened with steel lattices with a rod diameter of at least 10 mm and cell sizes no more than 150 x 150 mm. The lattices are welded to the wall or slabs released from the masonry or plates of the anchors with a diameter of at least 12 mm in 500 x 500 mm increments.

If it is impossible to build anchors allowed to reinforced concrete and concrete surfaces with four dowels to target mortgage parts from a steel strip of 100 x 50 x 6 mm.

2.3. Input doors of narcotic storage facilities must comply with the requirements of GOST 6629-88, GOST 24698-81, GOST 24584-81, GOST 14624-84, be good, well-fitted under the door frame, full, thickness of at least 40 mm, have at least two mortise Uncomplicated locks. The doors are outside of two sides by leaf iron with a thickness of at least 0.6 mm with a bend of the edges of the sheet on the inner surface of the door or to the end of the web blade. The doorway from the inside is additionally protected by lattice metal doors manufactured from a steel bar with a diameter of at least 16 mm, cells of no more than 150 x 150 mm, which are welded in each intersection. The design of the doorway (door frame) is performed from the steel profile. In the existing storage facilities, wooden boxes are allowed, reinforced with steel corners with a size of 30 x 40, a thickness of at least 5 mm, fixed in the wall with pins from reinforcement steel with a diameter of 10 - 12 mm and a length of 120-150 mm.

2.4. The window openings of drugs with drugs from the inside or between the frames are equipped with metal lattices, which are made of steel rods with a diameter of at least 16 mm and the distance between the rods vertically and horizontally not more than 150 mm. The ends of the bars are climbing into the wall to a depth of at least 80 mm and poured with concrete.

It is allowed to use decorative lattices or blinds, which, according to strength, should not be given to the above lattices.

2.5. Narcotic funds should be stored in safes. In technically fortified premises, drugs are allowed in metal cabinets. Safes (metal cabinets) must be in a closed state. After the end of the working day, they must be sealing or segged. Keys from safes, printing and sealing must keep materially responsible persons who are authorized by orders for organs or healthcare facilities.

3.1. Drug warehouses must be equipped with multiserous security alarm systems with the connection of each turn on the individual numbers of the centralized observation consoles.

3.2. The first border of the alarm is protected by building designs of perimeters of rooms - window and door openings, ventilation channels, thermal inputs and other elements of the room available for penetration from the outside. Doors are blocked on "opening" and "break". The windows are protected by alarm on "opening" and "destruction" of glass. Necipital walls, ceilings, communication sites - on the "break". Capital walls, ventilation boxes - on "destruction" and "shock impact".

The blocking of building structures on the "opening" (windows, doors) is recommended to carry out the detectors of the QMS type, foil, "window-1" detectors or similar to them are applied to the "destruction" of the glass. The non-vacant walls (partitions) are protected on a "break" with PAL wire. To block the capital walls and the ceiling of the room, it is recommended to use the "Edge-1" type detector, which allows you to detect the destruction of building structures from a brick of at least 150 mm and concrete with a thickness of at least 120 mm. The vulnerable areas of the perimeters of the premises can be protected by optical - electronic detectors of the "Photon-2" type, "photon-5", which form the detection zone in the form of a vertical barrier.

3.3. Additional borders of the alarm are protected by internal areas and areas of premises, safes (metal cabinets) used for storing narcotic drugs. For additional bubbles, the choice of detectors is determined depending on the nature of the premises and location of material values \u200b\u200bin them. As instruments and detectors for these purposes, ultrasound, optical - electronic, radio wave, capacitive detectors "Echo-2,3", "Photon-1M, 4", "Kvant-3", "Wave-2, M", " Von-1 "," Reef-M "," Peak ", etc.

To increase the reliability of the security alarm, the use of detectors of various principles of operation is recommended.

3.4. In multi protection systems, it is necessary to use control devices that control the signaling loops in the disappearance of the power supply. The use of receiving control devices and detectors having autonomous nutrition or power transition blocks from the centralized monitoring panel by telephone lines in conjunction with the object devices of the seal equipment in which the backup power is impossible.

3.5. In addition to self-lines, protection is recommended to equip sensors - traps directly safely safes (metal cabinets), which are included in the plume of the additional turn of alarm.

3.6. When the power failure is disconnected, the performance of the PCP, sensors and detectors of one of the lines of signaling should be provided. In the absence of telephone lines in the storage facilities, it is necessary to use the RF sealing of free distribution network lines, line of telephones of organizations, apartments of citizens located near the repository, or taxophone lines.

3.7. On large objects (bases, warehouses) with the storage of narcotic drugs, it is allowed to use the "low centralization" principle with the installation of low-capacity concentrates in control - group members With connecting them to the consoles of centralized observation.

3.8. The workplaces of personnel producing drug transactions, as well as storage facilities, are equipped with alarming alarm, which is intended to transmit anxiety signals to duty parts of the internal affairs bodies and take measures in case of robbery during working hours.

3.9. The fire alarm system should provide round-the-clock operation. Fire detectors are included in general or independent locking loops connected to common or independent devices with an alarm output to the consoles of centralized observation or local audio and light alarms.

3.10. At the facilities (indoors) with the storage of narcotic drugs, the use of safety alarm equipment is not included in the list technical means Security, security - fire and fire alarm recommended for use.

4. The implementation of the provisions of these Model Requirements is mandatory in obtaining the permission of the Permanent Committee for Drug Control on the Storage of Narcotic Drugs.

Appendix 2.
Approved
Order of the Ministry
health
Russian Federation
dated November 12, 1997 N 330

Appendix 3.
Approved
Order of the Ministry
health
Russian Federation
dated November 12, 1997 N 330

Estimated standards for narcotic drugs
Per 1000 people of the population per year (in grams)

Order of the Ministry of Health of Russia of 05.08.2003 N 330 (ed. Dated November 24, 2016) "On measures to improve therapeutic nutrition in medical institutions of the Russian Federation" (together with the "Regulations on the organization of a nutrient doctor", "Regulations on the organization of activities Medical sister dietary "," Regulations on the Council for therapeutic nutrition of medical and preventive institutions "," Instructions for the organization of medical nutrition in medical institutions ") (registered in the Ministry of Justice of Russia 09/12/2003 N 5073)

Ministry of Health of the Russian Federation

About improvement measures

Medical nutrition in therapeutic and prophylactic

Institutions of the Russian Federation

In order to implement the concept of state policy in the field of healthy eating of the population of the Russian Federation for the period up to 2005, approved by the Decree of the Government of the Russian Federation of 10.08.1998 N 917 "*", improving the organization of therapeutic nutrition and an increase in the effectiveness of its use in the complex treatment of patients I order:

"*" Meeting of the legislation of the Russian Federation, 24.08.1998, N 8, Art. 4083.

1.1. Regulation on the organization of the activities of a dietetologist (Appendix N 1);

1.2. Regulation on the organization of the activities of the Dietary Medical Sister (Appendix N 2);

1.3. Regulations on the forced nutrition council in medical and preventive institutions (Appendix N 3);

1.4. Instructions for the organization of medical nutrition in medical preventive institutions (Appendix N 4);

1.5. Instructions for the organization of enteral nutrition in medical and preventive institutions (Appendix N 5).

2. Control over the implementation of this order shall be entrusted to the Deputy Minister R.A. Halphine.

On the organization of the activity of a dietologist

1. A specialist training person who has a nutrition training and a certificate with a specialty "diet" is appointed for the position of a nutrient doctor.

2. A nutritionist is responsible for organizing therapeutic nutrition and adequate use of it in all branches of health institutions.

3. A nutritionist manages dietary medical sisters, carries out control of the work of the german.

4. A nutritionist is obliged:

a) advise the doctors of departments on the organization of medical nutrition;

b) advise patients on therapeutic and rational nutrition;

c) conduct a selective inspection of the diseases of the disease in accordance with the appropriate diets and the stages of diet and therapy;

d) conduct analysis of the effectiveness of therapeutic nutrition;

e) check the quality of products when they arrive at the warehouse and sophobors; control the correctness of the storage of food supply;

e) carry out control over the correctness of the product bookmark when preparing dishes;

g) to prepare documentation on the organization of medical nutrition:

- seven-day summary menu - summer and winter option;

h) control the correctness of the documentation of the dietary sister diet (layout menu, a requirement menu, etc.);

and) monitor the quality of finished food before issuing it to the department by removing the sample to each meal;

k) together with the heads of departments to determine the list and the number of food domestic gears in the patient who is treated in a medical and prophylactic institution;

l) control the timeliness of preventive medical examinations of food professionals and buffet workers and prevent persons who did not pass preventive medical examinations, and patients with minerals, intestinal diseases, angina;

m) systematically organize an increase in the level of qualification of food professionals on therapeutic nutrition;

n) conduct active sanitary and educational work on rational and healing nutrition for all employees of therapeutic and preventive institution and patients;

o) increase the level of professional qualifications on the cycles of improvement on nutrition at least 1 time in 5 years.

About the organization of medical activities

1. A specialist with secondary medical education is appointed to the post of a dietary medical sister, which has special training on therapeutic nutrition and a certificate with a degree in dietology.

2. The dietary sister dietary works under the leadership of a dietegologist.

3. The dietary sister dietary is monitored by the work of the metering and compliance with the sanitary and hygienic rules of the foodborne workers.

4. Medical sister dietary required:

a) check the quality of products when they arrive at the warehouse and sophobors; control the correctness of the storage of food supply;

b) cook daily under the control of a nutrient doctor and with the participation of the heading of the layout menu (or the requirement menu) in accordance with the dishes and summaryapproved by the Medical Power Council;

c) carry out control over the correctness of bookmarking products when cooking dishes and defects finished products, to remove the sample of finished food;

d) monitor the correctness of the release of dishes from the metero in the department in accordance with the "handouts";

e) monitor: for sanitary state premises of the food, handouts, buffet, inventory, dishes, as well as for the execution of user-friendly personal hygiene rules;

(e) Organize and personally participate in conducting activities with secondary medical personnel and health care workers on therapeutic nutrition;

g) to keep medical records;

h) to carry out the timely conducting preventive medical examinations of food workers, handouts and buffets and prevent persons who have not passed prophylactic medical checkup, and patients with minecut, intestinal diseases, angina;

and) raise the level professional training at least 1 time in 5 years.

from 05.08.2003 N 330

About the Council on Medical Power

1. The Council for therapeutic nutrition is a deliberative body and is created in a medical and prophylactic institution with the number of bakers from 100 and higher.

2. The number of members of the Medical Council Council and its personalized composition is approved by the order of the Chief Doctor of the Institution.

3. The Council for Medical Power Supplies includes: Chief Doctor (or his deputy for therapeutic work) - Chairman; A nutritionist doctor - responsible secretary, heads of departments - doctors, doctors anesthesiologist-resuscitator, gastroenterologist, therapist, transfusiologist, surgeon (members of the brigade of nutritional support), Deputy Chief Doctor for the Economic Part, Dietary Sitters, Head of Production (or Chef) . Other medical and preventive institutions can be involved in the work of the Council if necessary.

4. Tasks for the Council for therapeutic Power:

a) improving the organization of medical nutrition in a medical and prophylactic institution;

b) the introduction of new technologies for prophylactic, dietary and enteral nutrition;

d) approval of the nomenclature of diets, mixtures for enteral nutrition, mixtures of protein composite dry for therapeutic nutrition, biologically active additives subject to introduction in this health care institution;

e) approval of seven-day menus, dishes and mixing cards for enteral nutrition;

g) improving the system of orders of dietary sets and mixtures for enteric power;

h) development of forms and plans to improve the qualifications of medication officers;

and) control over the organization of therapeutic nutrition and analysis of the effectiveness of diet and therapy in various diseases.

5. The healing council holds meetings as necessary, but at least once every three months.

On the organization of medical nutrition

In medical and preventive institutions

The organization of therapeutic nutrition in a medical and prophylactic institution is an integral part of the medical process and is among the main medical events.

In order to optimize therapeutic nutrition, improving the organization and improving its quality management in medical and preventive institutions is introduced new Nomenclature diet (system of standard diets) differing in the content of basic foodstuffs and energy value, cooking technology and the average daily set of products.

Previously used license system diets (diet N N 1 - 15) are combined or included in the standard diet system, which are prescribed under various diseases, depending on the stage, the severity of the disease or complications from various organs and systems (Table 1).

Along with the main standard diet and its variants in a medical and prophylactic institution, according to their profile uses:

- surgical diets (0-i; 0-II; 0-III; 0-IV; diet with ulcerative bleeding, diet with stomach stenosis), etc.;

- Specialized diets: a high-protected diet with active tuberculosis (hereinafter - a high-protein diet (T));

- unloading diets (tea, sugar, apple, rice-compotect, potato, cottage cheese, juice, meat, etc.);

- Special rations (diet Kaliya, magnesium, probe, diet with myocardial infarction, diets for unloading and dietary therapy, vegetarian diet, etc.).

The individualization of the chemical composition and calorie content of standard diets is carried out by selecting the medical nutrition in the card file, increase or decrease the number of bofoft products (bread, sugar, oil), the control of grocery grocery for patients who are treated in a medical and prophylactic institution, as well as Use in therapeutic and enteral nutrition of biologically active additives to food and ready-made specialized mixtures. To correct the food diet, 20-50% of the protein of finished specialized mixtures may be included (Table 1a).

The acquisition of mixtures of protein composite dry for therapeutic nutrition is carried out in accordance with the instructions on the procedure for applying the budget classification of the Russian Federation, approved by the Order of the Ministry of Finance of the Russian Federation of December 21, 2005 N 152N (in accordance with the letter of the Ministry of Justice of the Russian Federation of January 10, 2006 N 01/32-EZ Order in state registration It does not need it) under article 340 of the economic classification of the costs of budgets of the Russian Federation "Increasing the value of material reserves" with the assignment of ready-made specialized mixtures for therapeutic nutrition to the section "Food (food payment), including food solders to military personnel and persons equivalent to them."

The nomenclature of permanent diets in each medical and prophylactic institution is established in accordance with its profile and is approved on the healing council. In all therapeutic and preventive institutions, at least a four-time power regimen is set, according to readings in individual compartments or for some categories Patients (peptic ulcer disease of the 12-sick, the disease of the operated stomach, diabetes mellitus, etc.) more frequent power is used. The power mode is approved on the healing board.

Recommended average daily sets of products are the basis for the preparation of standard diets in a medical and prophylactic institution (Table 2). When forming standard diets for children and adults receiving sanatorium-resort treatment, use more expensive products of products, taking into account daily nutritional standards in sanatoriums and sanatoriums - profilatories (Tables 3, 4, 5). In the absence of a complete set of products on the sophistication provided for by a consolidated seven-day menu, one product is replaced by another when maintaining the chemical composition and energy value of the healing rations used (Tables 6, 7).

Control of the correctness of the conducted diet therapy should be carried out by checking the compliance of the diet obtained by patients (for a set of products and dishes, cooking technologies, chemical composition and energy value) recommended characteristics of standard diets and by checking the uniform use of allocations in quarters of the year.

The general guidance of a diet in a medical and prophylactic institution is carried out by the chief physician, and in its absence - the deputy on therapeutic part.

Responsible for the organization of therapeutic nutrition is a nutritionist. In cases where the position of a nutrient doctor in a medical and prophylactic institution is absent, responsible for this work is a medical sister dietary.

In submission of a nutrient doctor, dietary sisters are dietary and all-friendly food professionals that provide medical nutrition in a medical and prophylactic institution in accordance with this order.

On the sophistication of the treatment and prophylactic institution, control over compliance with the cooking technology and the release of ready-made dietary dishes is carried out by the workmanship (chef, art. Cook), quality control of ready-made dietary dishes - a dietary doctor, a medical sister dietary, duty officer, allowing the issuance of the finished Food in the department.

All issues related to the organization of therapeutic nutrition in a medical and prophylactic institution are systematically (at least 1 time per quarter) and are resolved at the meetings of the Medical Council.

to the organization's instructions

Chemical composition and energy

The value of standard diets used in the LPU

Ministry of Health of the Russian Federation

About improvement measures
medical nutrition in therapeutic and prophylactic
institutions of the Russian Federation

from 07.10.2005 №624, from 10.01.2006 №2, from 26.04.2006 №316,
Order of the Ministry of Health of Russia of 06/21/2013 №395n,
Pragina of the Ministry of Health of Russia of 24.11.2016 №901N)

In order to implement the concept of state policy in the field of healthy eating of the Russian Federation for the period up to 2005, approved by the Decree of the Government of the Russian Federation of 10.08.1998 N 917, improving the organization of therapeutic nutrition and increase the effectiveness of its use in the complex treatment of patients I order:

1. Approve:

1.1. Regulation on the organization of the activities of a dietetologist (Appendix N 1);

1.2. Regulation on the organization of the activities of the Dietary Medical Sister (Appendix N 2);

1.3. Regulations on the Treatment Council on therapeutic power (Appendix N 3);

1.4. Instructions for the organization of medical nutrition in medical preventive institutions (Appendix N 4);

1.5. Instructions for organizing enteric nutrition in medical and preventive institutions (Appendix N 5);

2. Control over the implementation of this order shall be entrusted to the Deputy Minister R.A. Halphine.

Minister
Yu.L.Shevchenko

Comment

For the use of this order, see the letter dated April 7, 2004 N 2510 / 2877-04-32 and a letter of social development of the Russian Federation of July 11, 2005 N 3237-Sun

Appendix N 1.

Approved
Order of the Ministry
Health
Russian Federation
from 05.08.2003 N 330

POSITION

On the organization of the activity of a dietologist

1. A specialist doctor is appointed to the position of a nutrient doctor who has preparations for therapeutic nutrition and a certificate with a degree in dietology.

2. A nutritionist is responsible for organizing therapeutic nutrition and adequate use of it in all branches of health institutions.

3. A nutritionist manages dietary medical sisters, carries out control of the work of the german.

4. A nutritionist is obliged:

a) advise the doctors of departments on the organization of medical nutrition;

b) advise patients on therapeutic and rational nutrition;

c) conduct a selective inspection of the diseases of the disease in accordance with the appropriate diets and the stages of diet and therapy;

d) conduct analysis of the effectiveness of therapeutic nutrition;

e) check the quality of products when they arrive at the warehouse and sophobors; control the correctness of the storage of food supply;

e) carry out control over the correctness of the product bookmark when preparing dishes;

g) to prepare documentation on the organization of medical nutrition:

Layout cards;

Seven-day menu;

Seven-day summary menu - summer and winter option;

h) control the correctness of the documentation of the dietary sister diet (layout menu, a requirement menu, etc.);

and) monitor the quality of finished food before issuing it to the department by removing the sample to each meal;

k) together with the heads of departments to determine the list and the number of food domestic gears in the patient who is treated in a medical and prophylactic institution;

m) systematically organize an increase in the level of qualification of food professionals on therapeutic nutrition;

n) conduct active sanitary and educational work on rational and healing nutrition for all employees of therapeutic and preventive institution and patients;

o) increase the level of professional qualifications on the cycles of improvement on nutrition at least 1 time in 5 years.

Appendix N 2.

Approved
Order of the Ministry
Health
Russian Federation
from 05.08.2003 N 330

POSITION

About the organization of medical activities

Dietary siblings

1. A specialist with secondary medical education is appointed to the position of a dietary sister's dietary specialist, which has special training on therapeutic nutrition and a certificate with a degree in dietology.

2. The dietary sister dietary works under the leadership of a dietegologist.

3. The dietary sister dietary is monitored by the work of the metering and compliance with the sanitary and hygienic rules of the foodborne workers.

4. Medical sister dietary required:

a) check the quality of products when they arrive at the warehouse and sophobors; control the correctness of the storage of food supply;

b) prepare daily under the control of a diets and with the participation of the head of the production menu-layout (or requirement menu) in accordance with the Card file and the consolidated menu, approved by the Medicine Council;

c) monitor the correctness of the product bookmark in the preparation of dishes and defects finished products, to remove the sample of finished food;

d) monitor the correctness of the release of dishes from the food furniture in the separation in accordance with the "handouts";

e) control: behind the sanitary condition of the premises of the food, handouts, buffet, inventory, dishes, as well as for the execution of user-friendly personal hygiene rules;

(e) Organize and personally participate in conducting activities with secondary medical personnel and health care workers on therapeutic nutrition;

g) to keep medical records;

h) carry out the timely conduct of preventive medical examinations of foodborne workers, handouts and buffets and prevent persons who have not passed prophylactic medical examination, and patients with minerals, intestinal diseases, angina;

and) raise professional training at least 1 time in 5 years.

Appendix N 3.

Approved
Order of the Ministry
Health
Russian Federation
from 05.08.2003 N 330

POSITION

About the Council on Medical Power

Medical and prophylactic institutions

1. The Council for therapeutic nutrition is a deliberative body and is created in a medical and prophylactic institution with the number of bakers from 100 and higher.

2. The number of members of the Medical Council Council and its personalized composition is approved by the order of the Chief Doctor of the Institution.

4. Tasks for the Council for therapeutic Power:

a) improving the organization of medical nutrition in a medical and prophylactic institution;

b) the introduction of new technologies for prophylactic, dietary and enteral nutrition;

(as amended by the order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

e) approval of seven-day menus, dishes and mixing cards for enteral nutrition;

g) improving the system of orders of dietary sets and mixtures for enteric power;

h) development of forms and plans to improve the qualifications of medication officers;

and) control over the organization of therapeutic nutrition and analysis of the effectiveness of diet and therapy in various diseases.

5. The healing council holds meetings as necessary, but at least once every three months.

Appendix N 4.

Approved
Order of the Ministry
Health
Russian Federation
from 05.08.2003 N 330

Instruction

On the organization of medical nutrition

In medical and preventive institutions

(as amended by the orders of the Ministry of Health and Social Development of Russia
from 07.10.2005 N 624, from 10.01.2006 N 2, from 26.04.2006 N 316,
Order of the Ministry of Health of Russia of 21.06.2013 N 395n)

The organization of therapeutic nutrition in a medical and prophylactic institution is an integral part of the medical process and is among the main medical events.

In order to optimize therapeutic nutrition, improving the organization and improving its quality management in medical and preventive institutions, a new range of diets is introduced (system of standard diets), differing in the content of basic nutrients and energy value, cooking technology and the average daily set of products.

Along with the main standard diet and its variants in a medical and prophylactic institution, according to their profile uses:

Surgical diets (0-i; 0-II; 0-III; 0-IV; diet with ulcerative bleeding, diet with stomach stenosis), etc.;

Specialized diets: a high-protein diet with active tuberculosis (hereinafter - a high-blooded diet (T));

Unloading diets (tea, sugar, apple, rice-compotect, potato, cottage cheese, juice, meat, etc.);

Special rations (diet Kaliya, magnesium, probe, diet with myocardial infarction, diet for unloading and dietary therapy, vegetarian diet, etc.).

(as amended by the order of the Ministry of Health and Social Development of Russia of January 10, 2006 N 2)

The acquisition of mixtures of protein composite dry for therapeutic nutrition is carried out in accordance with the instructions on the procedure for applying the budget classification of the Russian Federation, approved by the Order of the Ministry of Finance of the Russian Federation of December 21, 2005 N 152N (in accordance with the letter of the Ministry of Justice of the Russian Federation of January 10, 2006 N 01/32-EZ Order in state registration does not need) under article 340 of the economic classification of the costs of budgets of the Russian Federation "Increasing the value of material reserves" with the assignment of ready-made specialized mixtures for therapeutic nutrition to the section "Food products (food payment), including food solders to military personnel and those equivalent to them. "

(paragraph was commissioned by the Order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

The nomenclature of permanent diets in each medical and prophylactic institution is established in accordance with its profile and is approved on the healing council. In all therapeutic and preventive institutions, at least a four-time power regimen is established, according to the indications in separate compartments or for individual categories of patients (peppercase ulcerative disease, the disease of the operated stomach, diabetes mellitus, etc.) is used more frequent power. The power mode is approved on the healing board.

The general guidance of a diet in a medical and prophylactic institution is carried out by the chief physician, and in its absence - the deputy on therapeutic part.

Table 1

Characteristic,
Chemical Composition and Energy Value
Standard diets used in LPU
(in hospitals, etc.)

(as amended by the order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

Standard diets	Diet number system (diet N n 1-15)	Indications for use	Common Character Tick, Culinary Processing	Proteins, incl. Belly, g	Fats are common, incl. grow-vehicles	Carbohydrates are common, incl. Mono- and Disaccharides, g	ENERGY GET-CASH PRICE, KKAL
1	2	3	4	5	6	7	8
	1, 2, 3, 5, 6, 7, 9, 10, 13,14, 15	Chronic gastritis in the remission stage. Ulcery disease of the stomach and the 12-risos in the remission stage. Chronic bowel diseases with the predominance of irritable intestinal syndrome with advantageous constipation. Acute cholecystitis and acute hepatitis in the stage of recovery. Chronic hepatitis with non-timber expressed signs of liver functional failure. Chronic cholecystitis and bile-stone disease. GRAND, MOUNTAIN DIATEES, NEFROMOLYAZ, HIPERICEMIA, phosphatia. Type 2 diabetes mellitus without concomitant overweight body or obesity. Diseases of the cardiovascular system with a unwitting circulatory impairment, hypertensive disease, IBS, an atherosclerosis of the coronary arteries of the heart, brain, peripheral vessels. Acute infectious diseases. Forestands.	Diet with the physiological content of proteins, fats and carbohydrates, enriched with vitamins, minerals, vegetable tissue (vegetables, fruits). When prescribing a diet with diabetes mellitus, refined carbohydrates (sugar) are excluded. A nitrogenous extractive substances are limited, the salt (6-8 g / day), food rich in essential oils, are excluded sharp seasonings, spinach, sorrel, smoked. Dishes are cooked in boiled or pair, baked. Hot dishes tempera - no more than 60-65 ° C, cold dishes - not lower than 15 ° C. Free liquid - 1.5-2 liters. Food rhythm, 4-6 times a day.	85-90 40-45	70-80 25-30	300-330 30-40 (refined carbohydrates are excluded from diet patients with diabetes mellitus)	2170- 2400
	1B, 4B, 4V, 5P (I option)	The ulceal disease of the stomach and the 12-rosewood in the aggravation stage and the unstable remission. Acute gastritis. Chronic gastritis with preserved and high acidity in the stage of a unaware exacerbation. Gastroesophageal reflux disease. Breeding the function of the chewing apparatus. Acute pancreatitis, the stage of the fading exacerbation, a pronounced exacerbation of chronic pancreatitis. During the recovery period after acute infections; After operations (not in the internal organs).	A diet with the physiological content of proteins, fats and carbohydrates, enriched with vitamins, minerals, with a moderate restriction of chemical and mechanical stimuli of the mucous membrane and the receptor apparatus of the gastrointestinal tract. Sharp snacks, seasonings, spices are excluded; Salt salt is limited (6-8 g / day). Dishes are cooked in boiled or pair, rubbed and unzp. Food temperature - from 15 to 60-65 ° C. Free liquid -1.5-2 l. Food rhythm, 5-6 times a day.	85-90 40-45	70-80 25-30	300-350 50-60	2170- 2480
Option diet with increased amount of protein (high-protein diet)	4E, 4Ag, 5P (II option), 7B, 7G, 9B, 10B, 11, R - I, R-II	After resection of the stomach in 2-4 months about the peptic disease in the presence of dumping syndrome, cholecystitis, hepatitis. Chronic enteritis as the presence of a pronounced violation of the functional state of the digestive organs. Gluten enteropathy, celiac disease. Chronic pancreatitis in the remission. Chronic glomerulonephritis of nephrotic type in the stage of the decaying exacerbation without disorders of the nominality of the kidney function. Sugar diabetes mellitus 1 or 2 without concomitant obesity and disorders of the nominality of the kidney function. Rheumatism with a low degree of activity of the process with a protracted course of the disease without circulatory disorders; Rheumatism in the stage of the fading exacerbation. Pulmonary tuberculosis. Void processes. Malokrovia various etiology. Burn disease.	A diet with an increased protein content, a normal number of fats, complex carbohydrates and the limitation of easily durable carbohydrates. When appointing a diet with diabetes mellitus and after resection of the stomach with dumping syndrome, refined carbohydrates (sugar) are excluded. Salt salt (6-8 g / day), chemical and mechanical stimuli stimuli, biliary tracts are limited. The dishes are prepared in a boiled, stew, baked, rubbed and non-stuck, for a couple. Food temperature - from 15 to 60-65 ° C. Free liquid - 1.5-2 liters. Food rhythm, 4-6 times a day.	110-120 45-50	80-90 30	250-350 30-40	2080- 2690
Option diet with reduced amount of protein (low-facility diet)	7B, 7A.	Chronic glomerulonephritis with a sharp and moderately pronounced violation of the nominality of the kidney and severe and moderately pronounced azotemia.	Diet with a limit of protein to 0.8 g or 0.6 g or 0.3 g / kg of perfect body weight (up to 60, 40 or 20 g / day), with a sharp limitation of the table salt (1.5-3 g / day ) and liquid (0.8-1 l). Azotist extractive substances, alcohol, cocoa, chocolate, coffee, salt snacks are excluded. The diet introduces dishes from Sago, shyless bread, mashed potatoes, mousses from the swelling starch. Dishes are prepared without salt, in boiled form, for a pair, unzp. Food is preparing in boiled form for a pair, not crushed. The diet is enriched with vitamins, minerals. Free liquid - 0.8-1.0 liters. Food rhythm, 4-6 times a day.	20-60 15-30	80-90 20-30	350-400 50-100	2120- 2650
Low-calorie diet version (low-calorie diet)	8, 8A, 8O, 9A, 10C	Various degrees of alimentary obesity in the absence of pronounced complications by digestive organs, blood circulation, and other diseases that require special power modes. Sugar diabetes type II with obesity. Cardiovascular diseases in the presence of overweight.	A diet with a moderate restriction of energy value (up to 1300-1600 kcal / day) is advantageous, but at the expense of fats and carbohydrates. Simple sugars are excluded, animal fats, cooking salt (3-5 g / day) are limited. Vegetable fats, food fibers (raw vegetables, fruits, food bran) are included. Liquid is limited. Food is prepared in boiled or pair, without salt. Free liquid - 0.8-1.5 liters. Food rhythm, 4-6 times a day.	70-80 40	60-70 25	130-150 0	1340- 1550
Option Diet with an increased amount of protein (high-protein diet (T) (introduced by order of the Ministry of Health and Social Development of Russia from 26.04.2006 №316)	11	Respiratory tuberculosis: primary; infiltrative; encased pneumonia; Tuberculle B. decay phase; cavernous; cirrotic; Tuberculous pleurisy including empieme; bronchi; Silicotuberculosis. Empty tuberculosis: CNS; peripheral lymph nodes; abdominal organs; urogenital system; genital; musculoskeletal system; eye; Skin and mucous membranes. Tuberculosis in combination with another pathology: HIV; diabetes; chronic obstructive pulmonary disease; toxico-mania and acognism; hepatitis; Profilities. Tuberculosis in combination with multiple drug resistance.	A diet with an increased protein content, fat, physiological quantity of complex carbohydrates, restriction of easily sauhar sugars, cooking salts (up to 6 g / day). Diet with increased energy value. When prescribing a diet with diabetes mellitus, refined carbohydrates (sugar) are excluded. The dishes are prepared in a boiled, stewed, baked form, with mechanical or without mechanical gentry. Food temperature - from 15 to 60-65 degrees C. Free liquid - 1.5-2 liters of nutrition - fractional, 4-6 times a day. When prescribing a diet with diabetes mellitus, refined carbohydrates (sugar) are excluded.	130 – 140 (60 - 70)	110 – 120 (40)	400 – 500 (50) (Refined carbohydrates are excluded from a diet of patients with diabetes and patients after stomach resection with dumping syndrome)	3100 - 3600

Table 1A.

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Natural food ratio
and specialized food
In the daily diet of the patient

(introduced by the Order of the Ministry of Health and Social Development of Russia of January 10, 2006 N 2,
as amended Order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

Diet	Proteins, incl. Animals, G.	Fats are common, incl. vegetable, g	Carbohydrates are common, incl. Mono-Disacharii, g	Energy value, kcal
Basic version of the standard diet
	85-90 (40-45)	70-80 (25-30)	300-330 (30-40)	2170-2400
Natural food	69-72	62-71	288-316	1990-2190
Specialized products nutrition (protein composite dry mix)	16-18	8-9	12-14	180-210
Option diet with mechanical and chemical gene
Chemical Composition and Energy Value Diet	85-90 (40-45)	70-80 (25-30)	300- 350 (50-60)	2170-2480
Natural food	69-72	62-71	288-336	1990-2270
	16-18	8-9	12-14	180-210
Option diet with increased protein
Chemical Composition and Energy Value Diet	110-120 (45- 50)	80-90 (30)	250-350 (30-40)	2080-2690
Natural food	88-96	69-78	232-330	1825-2410
Specialized food (protein composite dry mix)	22-24	11-12	18-20	255-280
Option diet with reduced amount of protein
Chemical Composition and Energy Value Diet	20-60 (15-30)	80-90 (20-30)	350-400 (50-100)	2120-2650
Natural food	2-38	71-79	336- 380	1910-2395
Specialized food (protein composite dry mix)	18-22	9-11	14-20	210-255
Low calorie diet version
Chemical Composition and Energy Value Diet	70-80 (40)	60-70 (25)	130-150 (0)	1340-1550
Natural food	54-64	52-62	118-138	1116-1420
Specialized food (protein composite dry mix)	16	8	12	180
A variant of diet with an increased amount of protein (T) (introduced by the Order of the Ministry of Health and Social Development of Russia dated 26.04.2006 N 316)
Chemical composition and energy value of a diet (introduced by the Order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)	130-140 (60-70)	110-120 (40)	400-500 (50)	3100-3600
Natural foods (introduced by the Order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)	91-98	77-84	280-350	2170-2450
Specialized foods (a mixture of protein composite dry) (introduced by the Order of the Ministry of Health of Russia from 26.04.2006 No. 316)	39-42	33-36	120-150	930-1150

table 2

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

in medical and preventive institutions

It has lost strength. - Order of the Ministry of Health of Russia of 21.06.2013 N 395n.

Table 2A.

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

The average daily set of products per patient
in anti-tuberculosis medical and preventive institutions

(introduced by order of the Ministry of Health and Social Development of Russia from 26.04.2006 No. 316)

Product name
Product name	gross	net
1	2	3
Rye bread (bran)	150	150
Wheat bread	200	200
Wheat flour	50	50
Potato starch	5	5
Makarona, Vermichel	25	25
	75	75
Potatoes:
from September 1 to October 31	400	300
from November 1 to December 31	428	300
from January 1 to February 28-29	461	300
from March 1	500	300
Other vegetables	505	500
of them:
white cabbage	275	220
carrot
until January 1	120	100
from January 1	125	100
beet
until January 1	94	75
from January 1	100	75
bulb onions	24	20
green onion	18,8	15
parsley dill	20	15
cucumbers, Tomatoes Fresh greenhouse	30,6	30
	38	25
Fruits fresh	250	250
Dried fruits (compote, raisins, prunes, kuraga)	26	20
Rosehip dried	15,0	15,0
Fruit juices, vegetable	200	200
Beef (cut)	176,5	150
Chickens I Category	28,6	20
Sausage boiled (diabetic, dietary, (doctoral), ham, sausages, sausages	15,6	15
Fresh fish, fresh frozen (fillet)	93,8	90
Seafood: Sea Cabbage, Fish Caviar	15,2	15
Cottage cheese	81,5	80
Sour cream, cream	25	25
Cheese	16	15
Chicken egg	1 PC.	1 PC.
Kefir, Yogurt, Ryazhka, Prostokvash, Acidoofilin, Kumys **	207	200
Milk	300	300
Butter	40	40
Vegetable oil	25	25
Sugar*	50	50
Jam, jam, honey bee, waffles, cookies, confectionery	10	10
Tea	2	2
Coffee, cocoa	1	1
Gelatin	0,5	0,5
Juveniles pressed	1	1
Salt	6,0	6,0
Tomato Pasta, Tomato Puree	5	5

** Kums, as a rule, is used in the regions where Kumys are traditionally used in the nutrition and its production is developed.

Notes:

1. The average daily set of products is necessary to complement specialized food products (a mixture of protein composite dry) in accordance with Tables 1A, 7 to the instructions for the organization of therapeutic nutrition in medical and preventive institutions.

2. The average daily set of products may differ from the set of products provided for in this table, depending on the season (winter, spring, summer, autumn).

Table 3.

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Average daily set of products
For adults on sanatorium treatment

(as amended by the order of the Ministry of Health and Social Development of Russia of 07.10.2005 N 624)

Product name	The number of products in grams
	gross	net
1	2	3
Rye bread (bran)	150	150
Wheat bread	200	200
Wheat flour	50	50
Potato starch	10	10
Makarona, Vermichel	20	20
Cereals (buckwheat, oat, semolina, millet, pearl, wheat, rice), legumes (peas, beans, lentils, etc.)	95	95
Potatoes: from September 1 to October 31 From November 1 to December 31 from January 1 to February 28-29 from March 1	275 294 317 343	206 206 206 206
Other vegetables: of them: White cabbage	175	140
carrot: until January 1 from January 1	115 122	92 92
beet: until January 1 from January 1	55 59	44 44
bulb onions	20	16,8
onions green, greens and root parsley, celery	20	16
parsley, dill, celery	16	12
cucumbers, tomatoes (pumpkin, zucchini, radishes, salad green, etc.)	150	147
sauerkraut, salty cucumbers, salty tomatoes, canned food vegetables, salted mushrooms	30	21
canned green polka dot, canned corn	30	19,5
Fruits fresh, berries	250	250
Dried fruits (compote, raisins, prunes, kuraga), nuts	26	20
Rosehip dried	20	20
Fruit, vegetable juices, canned compotes	250	250
Beef (cut), offal (liver, kidneys, tongue)	150	127,5
Chickens (turkey)	57	40
Sausage boiled (diabetic, dietary, doctoral), ham, sausages, sausages	10	7,5
Fresh fish fresh frozen	140	70
Herring Fish Red, Sevryuga (Ostr) Chang grainy	15 7,8 6,2	7,5 5 6
Seafood: Sea cabbage, fish caviar squid, shrimp, trepanga, mussels, crabs	15,2 33	15 30
Cottage cheese	81,5	80
Sour cream, cream	30	30
Cheese, Brynza	10	9,2
Chicken egg	1 PC.	1 PC.
Kefir, yogurt, ryazhka, prokobvash, acidophilus	103,5	100
Milk	317	300
Butter	50	50
Vegetable oil	30	30
Mayonnaise	5	5
Sugar*	50	50
Jam, jam, honey bee, waffles, cookies, grazing, marshmallows, candy	20	20
Tea	2	2
Coffee, cocoa	1	1
Drinking water	200	200
Gelatin	1	1
Juveniles pressed	2	2
Salt	10	10
Tomato Pasta, Tomato Puree	5	5
Spices, soda, citric acid	0,5	0,5

______________________________

* Refined carbohydrates (sugar and confectionery with sucrose) are excluded from diet with diabetes mellitus. The equivalent replacement is made on specialized dietary products that do not contain sucrose.

Notes:

1. The average daily set of products may differ from the set of products provided for in this table, depending on the season (winter, spring, summer, autumn).

2. The average daily set of products is complemented by specialized products for dietary (therapeutic and prophylactic) nutrition.

Table 4.

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Products (g, ml gross)
Products (g, ml gross)	1-3 of the year	4-6 years	7-10 years	11-17 years
1	2	3	4	5
Wheat bread	60	100	150	200
Rye bread	40	50	100	150
Wheat flour	20	50	50	55
Potato flour	1	1	2	2
Cereals, bean, pasta	35	50	65	80
Potatoes	150	250	300	350
Vegetables are different and greens	200	300	350	400
Fruits fresh	100	200	200	250
Fruit dry	10	15	20	20
Fruit juice	150	200	200	200
Sugar	50	60	70	75
Confectionery	10	15	20	25
Butter	30	35	40	50
Vegetable oil	5	10	15	20
Egg, pcs.	1/2	1	1	1
Cottage cheese 9%	40	50	55	60
Milk, kefir and other Other Products	550	550	550	550
Sour cream	10	12	15	15
Cheese	5	10	10	10
Meat 1 cat. (incl. Sub-products)	100	130	150	180
Sausages	-	15	20	25
Bird 1 cat. P / P.	15	25	35	45
Seafood	-	15	15	20
Fish (fillet)	30	40	50	60
Herring, caviar	-	6	6	10
Coffee grasses, cocoa powder	2	2	3	4
Tea	0,5	0,5	1	1
Yeast	0,5	1	1	2
Salt, spices	4	5	8	10

Table 5.

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Average daily sets of products for children,
affected by radiation impact
being treated in sanatorium resort
Institutions of various profiles (except tuberculosis)

Products (g, ml gross)	Number per day per child aged
Products (g, ml gross)	4-6 years	7-10 years	11-17 years
1	2	3	4
Wheat bread	100	100	150
Rye bread	50	150	200
Wheat flour	35	35	40
Potato flour	2	5	5
Cereals, Pasta, Bean	50	60	65
Potatoes	250	300	350
Vegetables are different and greens	320	445	490
Fruits fresh	250	300	300
Fruit dry	15	20	20
Fruit juice	200	200	200
Sugar	60	60	60
Confectionery	15	20	25
Butter	30	40	40
Vegetable oil	10	15	20
Egg, pcs.	1	1	1
Cottage cheese	55	55	60
Milk, kefir	550	550	550
Sour cream	10	12	15
Cheese	10	10	15
Meat, incl. Sub-products and sausages	125	140	175
Bird	35	40	50
Fish (fillet)	50	60	70
Seafood	30	40	40
Ikra, herring	6	6	10
Coffee drink	2	3	4
Tea	0,5	1	1
Cocoa	0,5	1	1,5
Yeast	0,5	0,5	1
Salt, spices	6	8	10
Bran	-	10	15
Walnuts	5	5	5
Rosehip fruits dried	5	5	5
Dry vitamined drinks	15	20	30

Table 6.

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Interchangeability of products in the preparation of dietary dishes

(as amended by the order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

Name of replaceable products	Mass product-com, gross, kg	Name of replacement products	Equiva-tape mass product-com, gross, kg	Culinary use
1	2	3	4	5
Eggs without shell	1,00	Egg melange ice cream	1,00	In dishes from eggs, casseroles, flour products
Also	1,00	Dry egg ohlette mixture	0,35	Also
Also	1,00	Egg powder	0,28	Also
Oil cow's unsalted, "Vologda"	1,00	Peasant oil	1,13	In culinary products and dishes (except refueling dishes when vacation)
Also	1,00	Oil cow amateur	1,06	Also
Also	1,00	Salted cow oil (with a decrease in the salt laying in the recipe by 0.02 kg) * (2)	1,00	In stuffing, pancakes, Oladiah
Also	1,00	Oil cow foiled	0,84	In stuffing, pancakes, pancakes and for refueling culinary products
Sunflower oil	1,00	Oil peanut, corn, soy, cotton, olive	1,00	In cold dishes, flour, marinades, dishes from fish, etc.
Sunflower oil refined	1,00	Unrefined sunflower oil	1,00	In marinades, some sauces, cold, vegetable, fish dishes, flour products
	1,00	Cow's milk pasteurized non-fat (with an increase in bookmark in the receptor of the oil of a cow's unsalted by 0.04 kg)	1,00
Cow's milk pasteurized, whole	1,00	Milk cow whole dry	0,12	In soups, sauces, eggs from eggs, flour, vegetable, sweet dishes, beverages, etc.
Cow's milk pasteurized, whole	1,00	Milk cow skimmed dry (with an increase in bookmark in a cow's caustary oil recipe for 0.04 kg)	0,09	In soups, sauces, dishes from eggs, sweet dishes, flour, porridge
Also	1,00	Cream dry (with a decrease in the bookmark in the cow's caustary oil recipe for 0.042 kg)	0,16	In dairy porridge
Also	1,00	Milk solid condensed with sugar (with a decrease in bookmark in sugar recipe by 0.17 kg)	0,38	In sweet dishes, drinks
Also	1,00	Condensed milk sterilized in banks	0,46	In soups, sauces of sweet dishes, flour products and drinks
Also	1,00	Cream condensed with sugar (with a decrease in the laying in the cow's oil intake formulation by 0.07 kg and sugar by 0.18 kg)	0,48	In dairy cushas, \u200b\u200bflour products
Sugar sand * (3)	1,00	Natural honey	1,25	In drinks, kissels, mousse, jelly
Also	1,00	Rafine powder	1,00	In sweet dishes, casseroles, puddings
Jumped, jam	1,00	Marmalade fruit-berry (carved)	0,84	In sweet dishes
Also	1,00	Jam without bones	1,00	Also
Starch potato dry (20% humidity)	1,00	Starch potato (raw 50% humidity)	1,60	In kissels, sweet soups
Potato starch	1,00	Corn starch	1,50	In dairy kissels, jelly
Yeast bakery extruded	1,00	Yeast bakery dry	0,25	For cooking drinks, flour products
Tea Black Baichova not packaged	1,00	Tea tiled black	1,00	For cooking drinks
Natural, fried coffee	1,00	Natural soluble coffee	0,35	Also
Vanillin	1,00	Vanilla sugar	20,0	In sweet dishes
Also	1,00	Vanilla Essence	12,7	Also
Gelatin	1,00	Agaraid.	0,70	In sweet gemaled dishes
Green peas (canned)	1,00	Peas of vegetable (blade) Fresh	0,82	In cold dishes, soups, vegetable dishes, side dishes
Also	1,00	Vegetable bean (blade) Fresh	0,82	Also
Also	1,00	Fresh red-frozen polka dot	0,71	Also
Greens of dill, parsley, celery fresh	1,00	Greens of dill, parsley, celery sprigs salted (with a decrease in salt laying in a recipe by 0.29 kg)	1,00	To aromatize broths, soups, sauces
Also	1,00	Greens of dill, parsley, celery, crushed salty (with a decrease in salt laying in a recipe by 0.22 kg)	0,76	Also
Also	1,00	Dill, parsley, celery, branches, quick-frozen	0,76	Also
Pasternak, parsley, celery, root fresh	1,00	White roots parsley, celery and parsnips, dried	0,15	In soups, sauces, when extinguishing meat, fish, vegetables
Sorrel fresh	1,00	Puree from sorrel (canned food)	0,40	In soups using sorrel
Spinach fresh	1,00	Spinach puree (canned food)	0,40	In soups using spinach, in vegetable dishes
Tomatoes (Tomatoes) Fresh	1,00		0,46	In soups, sauces and with vegetable extinguishing
Also	1,00		0,37	Also
Also	1,00	Tomato Natural Juice * (4)	1,22	Also
Tomatoes (Tomatoes) Fresh	1,00	Canned food. Natural whole tomatoes (rounded fruits)	1,70	In cold dishes and garnings
Also	1,00	Canned food. Natural whole tomatoes (drain fruits)	1,42	Also
Fresh leek	1,00	Onion green fresh	0,95	In soups, cold dishes, side dishes, dishes from vegetables
Tomato puree with dry substances 12%	1,00	Tomato natural juice	2,66	In soups, sauces and when carrying meat, fish, vegetables, etc.
Also	1,00	Tomato puree with dry substances 15%	0,80	Also
Also	1,00	Tomato paste with dry substances content 25-30%	0,40	Also
Tomato puree with dry substances 12%	1,00	Tomato paste with dry substances content 35-40%	0,30	Also
Also	1,00	Tomato Paste Salted with a content of dry substances 37% (with a decrease in the salt laying in a recipe by 0.03 kg)	0,30	Also
Apples fresh	1,00	Apples whole, halves, quartens (blanched in sugar syrup) quick-frozen	0,8/0,73*(5)	In sweet dishes
Lingonberry fresh	1,00	Cranberry fresh	1,00	In salads from cabbage and sweet dishes
Dried apricots	1,00	Kuraga, Kaisa	0,75	In puddings, sweet sauces, dishes
Dried grapes (raisins, sabza)	1,00	Cooks, Kais, Kuraga	1,00	Also
Nut core, almond sweet	1,00	Core of walnuts, hazelnuts, peanuts	1,00	In sweet dishes, puddings
Chicken lemon food	1,00	Wine Food Acid	1,00	In dishes, where citric acid is used
Also	1,00	Lemon juice	8,00	Also

Notes:

* (1) When using a creamy oil for refueling when dishes, the number of other species replaceable and replacing other types of oil is the same.

* (3) Despite the fact that sorbitals are two times less sweet than sucrose, the norm of its interchangeability is 1: 1.

* (4) Calculation of the change rate is manufactured in accordance with GOST.

* (5) The numerator is a mass of apples when defrosting the semi-finished product in air, the denominator is a mass of apples when defrosting a semi-finished product in sugar syrup.

Table 7.

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Replacing products for proteins and carbohydrates

(as amended by the order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

Product name	Number of products in net, g	Chemical composition			Add to the daily diet (+) or exclude from it (-)
Product name	Number of products in net, g	proteins, G.	fats, G.	carbohyded, g	Add to the daily diet (+) or exclude from it (-)
1	2	3	4	5	6
Bread replacement (protein and carbohydrate)
Wheat bread from flour I s.	100	7,5	2,9	51,4
Rye Bread Simple Mold	125	7,62	1,5	49,87
Wheat flour I s.	70	7,42	0,91	48,3
Makarona, Vermicelle I s.	70	7,7	0,91	49,35
Semolina	75	7,72	0,9	52,95
Replacing potatoes (for carbohydrates)
Potatoes	100	2,0	0,4	16,3
Beet	190	2,85	0,19	16,72
Carrot	240	3,12	0,24	16,56
Cabbage b / k	370	6,66	0,37	17,39
Makarona, Vermicelle I s.	25	2,75	0,32	17,62
Semolina	25	2,57	0,25	17,65
Wheat bread from flour I s.	35	2,62	1,01	17,99
Rye Bread Simple Mold	45	2,74	0,54	17,95
Replacing fresh apples (for carbohydrates)
Apples fresh	100	0,4	0,4	9,8
Dried apples	15	0,33	0,01	8,85
Kuraga (without seeds)	18	0,94	0,05	9,18
Prunes	15	0,34	0,1	8,63
Replacing milk in protein
Milk	100	2,9	3,2	4,7
Cottage cheese bold	16	2,88	1,44	0,48
Cottage cheese	20	3,0	3,6	0,56
Cheese	13	3,02	3,83	-
Beef i k.	15	2,79	2,4	-
Beef II k.	15	3,0	1,47	-
Beef tenderloin	15	3,03	0,42	-
Cod fish)	20	3,2	0,12	-
Specialized food (protein composite dry mix)	7	2,8	1,4	2,1
Meat Replacement (protein)
Beef i k.	100	18,6	16,0	-
Beef II k.	90	18,0	8,82	-	oil + 7 g
Beef tenderloin	90	18,18	2,52	-	oil + 13 g
Cottage cheese bold	100	18,0	9,0	3,0	oil + 5 g
Cottage cheese	120	18,0	21,6	3,7	oil - 5 g
Cod fish)	115	18,4	0,69	-	oil + 5 g
Chicken egg	145	18,4	16,67	1,01
Specialized food (protein composite dry mix)	45	18,0	9,0	13,68
Fish replacement (protein)
Cod fish)	100	16,0	0,6	-
Beef i k.	85	15,81	13,6	-	oil - 13 g
Beef II k.	80	16,0	7,84	-	oil - 7 g
Beef tenderloin	80	16,6	2,24	-
Cottage cheese bold	90	16,2	8,1	2,7	oil - 7 g
Cottage cheese	110	16,5	19,8	3,08	oil - 19 g
Chicken egg	125	15,87	14,37	0,87	oil - 13 g
Specialized food (protein composite dry mix)	40	16,0	8,0	12,2
Replacing cottage cheese (protein)
Cottage cheese bold	100	18,0	9,0	3,0
Beef i k.	100	18,6	16,0	-	oil - 7 g
Beef II k.	90	18,0	8,82	-
Beef tenderloin	90	18,18	2,52	-	oil + 6 g
Cod fish)	110	17,6	0,66	-	oil + 8 g
Chicken egg	140	17,78	16,1	0,98	oil - 7 g
Specialized food (protein composite dry mix)	45	18,0	9,0	13,68
Replacement eggs (protein)
Chicken egg	40	5,08	4,6	0,28
Cottage cheese bold	30	5,4	2,7	1,2
Cottage cheese	35	5,25	6,3	0,98
Cheese	22	5,1	6,49	-
Beef i k.	30	5,58	4,8	-
Beef II k.	25	5,0	2,45	-
Beef tenderloin	25	5,05	0,7	-
Cod fish)	35	5,6	0,73	-
Specialized food (protein composite dry mix)	12,7	5,08	2,5	3,8

Power statement order

for patients in medical and preventive institutions

1. Power outlet is carried out by a dietary sister under the guidance of a dietegologist.

In medical and preventive institutions, where the position of a nutrient doctor is absent, the statement of food is produced by a medical sister on nutrition under the control of the doctor responsible for therapeutic nutrition.

2. When the patient's admission to the medical and prophylactic institution, therapeutic nutrition is prescribed by a duty doctor. The designated diet is introduced into the history of the disease and at the same time as a consolidated order on all the patients received, which is sent on the sophisticated at the set time.

3. Accounting Diet is maintained by store medical sisters, the number of patients and their distribution of diet daily by the senior medical sister of separation. Based on these information, the senior medical sister of the department is in the form of N 1-84 "Pulp on the nutrition of patients", which is signed by it, the head of the department and is transmitted to the dietary sisters of the dietary sister.

4. Medical sister dietary food, on the basis of information received from all offices, is "summary information on the presence of patients on nutrition" in a medical and prophylactic institution, which are checked with the receiving branch data and are signed by it (form N 22-MW).

5. Based on the "summary" medical sister dietary, with the participation of the head. Production (chef) and an accountant is under the guidance of a diet-nutrition doctor of the layout menu in form N 44-MW for the nutrition of patients the next day.

The layout menu is compiled according to a consolidated seven-day menu, taking into account the average daily set of food, is approved daily by the chief physician of the institution and is signed by a dietary doctor, accountant, head. Production (chef). In the layout menu, the dietary sister in the numerator stifles the amount of food for the preparation of one portion of each dish, in the denominator accountant (calculator) indicates the number of products needed to prepare all portions of this dish.

6. Based on the final data of the form N 44-MW, "the requirement for issuing food products from a warehouse (pantry)" in form N 45-MW in two copies.

7. Booking food to the boiler is made in the presence of a nutrient doctor (dietary sibling). Pre-food products are weighed regardless of the fact that they were obtained by weight from the warehouse (pantry).

8. The issuance of diet branches is made in the form of N 23-MH ("Vedency to leave the branches of feeding diet for patients"), which is filled with a dietary sister dietary in one instance. When issuing breakfasts, dinners and dinners, employees of branches are described in their receipt. The statement is signed by a medical sister dietary and head. Production (chef).

Bofoft products (oil, bread, tea, salt, etc.) are issued to buffets directly from the warehouse (pantry) at the request of the form N 45-MW.

9. Additional extract and / or product refund is made on the invoice (requirement) to the warehouse (pantry) in form N 434. Food facilities laid in the boiler are not refundable.

10. Additional food appointed in the dietary unit is drawn up in two copies, signed by the attending physician, the head of the department and is approved by the head physician of the medical and prophylactic institution. The first is transmitted on the sophisticated, the other persists in the history of the disease.

11. For each dish, cooked in a medical and preventive institution, is drawn up in form N 1-85 layout card in two copies: one copy is preserved at the accountant, the second is a dietary sibling (on the back of the card, a dish technology is described).

The procedure for controlling the quality of finished foodin the medical and preventive institution

1. The control of ready-made food before issuing it to the department is made by a duty doctor and 1 time per month - the head physician (or his deputy on therapeutic work) of the medical and prophylactic institution, and is also carried out by a nutrient physician, a dietary sister, head. Production (or chef), regardless of the sample produced by the duty doctor.

2. Check ready-made food on the sophon before it is issued in the department in the following order:

a) directly from the boiler, in accordance with the list of dishes specified in the layout menu.
The volume of the first courses is installed on the basis of a pot of pan or boiler and the number of ordered servings and the volume of one portion. The weight of the second dishes (porridge, puddings, etc.) is determined by weighing the total amount in the overall dishes with a deduction of the weight of the packaging and the consideration of the number of portions. Breeding dishes (cutlets, bokings, meat, bird, etc.) weigh in the amount of 10 servings and the average weight of one portion is set. Weight deviations from the norm should not exceed 3%;

b) by selecting the sample of the dishes of one of the devices used.

3. The results of the food sample are recorded by a duty doctor in the journal of finished food (form N 6-LP).

4. Selection ready dishes For laboratory analysis (determining the chemical composition and energy value, taking into account losses during cold and heat treatment) is carried out by the institutions of the State Sanitary Education of the Ministry of Health of the Russian Federation in a planned manner in the presence of a nutritionist or a medical sister on nutrition.

Technological equipment Doodlebrush is divided into mechanical, thermal and refrigeration.

1. Mechanical equipment It is used for primary processing of products, it includes:

a) machines for processing croup, potatoes and vegetables (cheerry bag, potato, vegetable cutters, liner machines, cleaning machines, juicers);

b) Meat and fish processing machines (meat grinders, minced meat, special devices for cleaning fish from scales, cutlet machine, saws for sawing meat carcins);

c) test machines (sifters, dough mixers, mechanism for layout and dough division);

d) dishwashing machines (or baths for handwearing dining room dishes and bath for washing kitchenware);

e) cutting machines, eggs;

e) whipping machine for liquid mixtures.

2. Thermal equipment is used for thermal processing of products (cooking, frying, baking, pair preparation, combined processing).

a) the cooking equipment includes cooking boilers, sauce boilers, pairing cabinets, egg cooking devices, sausages;

b) The frying equipment includes power plants, electricity, electric stoves, microwave ovens. Hot wardrobes (with t - 150 - 200 hail.); Cabinets for drying (T - 100 - 150 degrees.), Baking cabinets (T - up to 300 degrees.).

3. Non-commercial equipment:

a) cutting tables, cutting boards, racks, trolleys, scales, storage cabinets for kitchenware and appliances, lari, discharge decks;

b) pans, buckets, bars, pans, sieves, funny, kettles;

c) inventory: knives, forks, blades, mortar, molds, cediffs, noise, etc.

4. Refrigeration equipment is represented by refrigerator and refrigerated cabinets.

5. Premises of buffets in the departments of therapeutic and preventive institutions must be provided:

a) cold and hot running water, regardless of the availability of a hot water supply; Bofoft must be equipped with electrical boilers of continuous action;

b) two-section washing baths that are connected to sewage; tank for soaking (disinfection) or boiling dishes;

c) washing disinfectants;

d) grids for drying dishes, devices and storage products (bread, salt, sugar);

e) storage cabinet economic inventory;

g) a maritating or electric stove for heating of food;

h) a hygienic coating table for distribution of food;

and) table for dirty dishes;

k) a set of dishes at the calculation per patient: one deep, small and dessert plates, fork, spoons (dining and tea); Mug, and in children's departments with a margin, according to the table of equipment;

l) cleaning equipment (buckets, rags, brushes, etc.) with labeling "for buffet".

Responsibility for the proper equipment of the metering and bofeting departments of the medical doctor under the administrative and economic part and a nutritionist.

Transportation of finished food

(a) In the absence of centralized ring food delivery for their transport, special transport (indoor) is distinguished, which at least once a year is subjected to passporting in institutions of state-poidnadzor. It is strictly forbidden to use this transport for other purposes (transportation of linen, equipment, patients, etc.).

b) For the transportation of finished food into the hospital boftites, thermoses, thermos trucks, marmate carts or tightly closing dishes are used.

Sanitary and hygienic mode of food and buffet

1. In the food blocks of medical and preventive institutions should be strictly observed:

Requirements for the device for food, sanitary content and cooking technology provided for by existing sanitary regulations for enterprises catering;

Sanitary rules on the conditions and timing of the storage and implementation of specially perishable products;

Requirements on mandatory preventive and medical examinations of food workers, handout and buffet (forms 1-LP and 2-LP).

It is strictly forbidden to carry out dining room dishes from the departments of the medical and prophylactic institution. Washing dishes are carried out only in the washing buffets of offices with compliance with the disinfecting regime of the dishes.

The distribution of finished food produces no later than 2 hours after it is prepared, including the time of food delivery to the office.

Distribution of food Patients produce buffets and duty medical sisters of the department. Distribution of food should be carried out only in a bathrobe with labeling "for distribution of food."

Technical staff busy cleaning the chambers and other premises of the department, not allowed to distribute. Nutrition of all patients, except for seriously ill, are carried out in a specially dedicated room - dining room. Personal foods of patients (transmission from home) are stored in a closet, bedside table (dry products) and in a special refrigeration cabinet (perishable products).

The transfer of patients is accepted only within the range of the assortment allowed by the doctor and the amount of products.

After each distribution, food produces a thorough cleaning of the premises of the buffet and dining room using solutions of disinfectants.

The harvesting material after washing is poured with a 0.5% clarified solution of chlorine lime or 1% chlorine solution for 60 minutes, then rinsed in running water and dried (the inventory is used strictly by purpose).

Personnel of food and bofuity is obliged to follow the rules of personal hygiene. Before visiting the toilet, the staff is obliged to remove the bathrobe, after visiting - handle hands with a brush using disinfectants or economic soap.

Responsible for compliance with the sanitary requirements in the preparation and leave of finished food in the sophistine is the head. Production (chef), medical sister dietary, nutritionist, and in the department - buffets and senior medical sisters.

Letter of the Ministry of Health of Russia dated 07.04.2004 No. 2510 / 2877-04-32 it was reported that the duration of the storage of daily samples of finished food is 48 hours instead of the following paragraph "within 24 hours".

Daily samples of finished food are left daily in the amount of one portion or 100 - 150 g of each dish, placed in pure boiled for 15 minutes. A labeled dishes with a lid, which are stored in a separate refrigerator during the day.

List of food documentation for the extraction of food and monitoring the quality of finished food in medical and preventive institutions

Form N 1-84

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

PORTENANT

for the nutrition of patients "__" __________ 20__

Head Department (signature)

Art. honey. Sister branch (signature)

Honey. Sister dietary branch (signature)

Form N 22-MW

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Name of the institution ______________________________________________

Consolidated information on the presence of patients on nutrition

on ___ hours "__" ________ 20__

(Reverse side)

Individual and Additional Food
(as well as the nutrition of mothers in the medical and preventive institution with breasts)

Form N 23-MW

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Redemption statement

On vacation branches of diet

(Meals: breakfast, lunch, dinner, etc.)

20__

Medical sister dietary ______ head produce (chef) _____

Form N 1-85

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Name of therapeutic institution ________________________________________

I argue: ____________

Head of the institution

Laying card n

Name of dishes ___________________________________________________

Indication for application ___________________________________________________

Product name	Gross	Net	Chemical composition				Cost
Product name	Gross	Net	Proteins, G.	Fats, G.	Carbohydrates, G.	Calorieness kkal	Cost






Weight of a finished dish:

Nutritionist (medical sister dietary)

Head producing (chef)

Accountant

Card turnover

Cooking technology: ________________________________________________

Form N 44-MW

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

"I argue"

Chief Doctor (Signature)

Name of the institution _____________________________________________

Menu-layout for cooking on ________________________

patients on "__" ___________ 20__

Day of the week

Name

Ko-Li Chesian dishes

N dishes by car-trees

Product name, in grams

Goto dishes

M.
I
with
about

I
J.
C.
and

T.
at
about
R
about
G.

M.
about
L.
about
to
about

WITH
and
H.
and
R

Juice fruit

Sour cream

Butter

Vegetable oil

TO
and
R
T.
about
F.
E.
L.
b

TO
and
P
W.
with
T.
and

M.
W.
to
and

H.
L.
E.
B.

Green pea

I
B.
L.
about
to
and

Trembled press-co-bath

L.
and
M.
about
N.

Stan-dartny diets

Entrance of food and dishes in it

B.
W.
F.
E.
T.

TO
W.
H.
N.
I

B.
W.
F.
E.
T.

TO
W.
H.
N.
I

B.
W.
F.
E.
T.

TO
W.
H.
N.
I

TOTAL:

Nutritionist (signature)

Medical sister dietary (signature)

Head produce (chef) (signature)

Accountant (signature)

Form 1-LP

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

I. Information about the owner of the medical record.

II. Mark on the transition to work in other institutions.

III. The results of a medical examination.

IV. The results of the study on tuberculosis.

V. RESULTS OF RESEARCH ON BACILLERS.

Vi. Results of research on silfone carrier.

VII. Marks about transferring infectious and intestinal diseases.

VIII. Putting the exam on sanitary minimum.

IX. Mark about preventive vaccinations.

X. Special marks of Sannezor about this employee (violation of the rules

personal hygiene, sanitary supervision requirements, etc.).

Form 2-LP

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Journal "Health"

Form 3-LP

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Magazine C-Vitaminization Dishes

Form 6-LP

to the instructions for the organization of therapeutic nutrition
in medical and preventive institutions

Journal of Control Quality of Finished Food (Praelectory)

* - When replacing individual dishes in breakfast, lunch or dinner to make the appropriate entry

Appendix 5.

Approved by order of the ministry
Health of the Russian Federation
from 05.08.2003 N 330

Instructions for organizing enteral nutrition

In medical and preventive institutions

(as amended by the order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

Enteral nutrition is a type of nutritional therapy, in which nutrients are introduced through a gastric (intravenous) probe with the impossibility of adequate to ensure the energy and plastic needs of the body naturally under a number of diseases.

In therapeutic and preventive institutions, the organization of enteral nutrition is carried out by doctors anesthesiologists-resuscitation, gastroenterologists, therapists, surgeons, phthisiators, combined in the brigade of nutritional support, which have passed special training at enteral nutrition.

(as amended by the order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

The acquisition of nutrient mixtures for enteral nutrition is carried out in accordance with the instructions on the application of the budget classification of the Russian Federation, approved by the order of the Ministry of Finance of the Russian Federation of December 21, 2005 N 152N (in accordance with the letter of the Ministry of Justice of the Russian Federation of January 10, 2006 N 01 / 32-Ж Order in state registration does not need) under article 340 of the economic classification of the costs of the budgets of the Russian Federation "Increasing the value of material reserves" with the attribution of nutritional mixtures for enteric power to the section "Medicines and dressings.
(as amended by the order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

Members of the Nutrival Support Brigade: conduct entertainment activities with medical and prophylactic physicians; Consultative assistance to the doctors of other specialties and the analysis of the clinical and economic efficiency of enteric patients.

Indications for the use of enteric power

Belkovo-energy failure if it is impossible to ensure adequate receipt of nutrients:

Neoplasms, especially localized in the field of head, neck and stomach;

Disorders of the central nervous system: comatose states, cerebrovascular strokes or Parkinson's disease, as a result of which breeding disorders are developing;

Radiation and chemotherapy in cancer;

Diseases of the gastrointestinal tract: Crohn's disease, Mal Absorption Syndrome, short intestine syndrome, chronic pancreatitis, ulcerative colitis, liver disease and biliary tract;

Power supply in pre- and postoperative periods;

Injury, burns, acute poisoning;

Complications of the postoperative period (the fistula of the gastrointestinal tract, sepsis, the failure of the seams of anastomoses);

Infectious diseases;

Mental disorders: neuropsychic anorexia, severe depression;

Acute and chronic radiation lesions;

Common and generalized forms of tuberculosis with a disintegration and disintegration, with a significant weight deficit, tuberculosis in combination with HIV in III b and further stages; pre-and postoperative periods; Local forms of tuberculosis in children early age and in the adolescence.

Contraindications for the use of enteral nutrition

Intestinal obstruction;

Acute pancreatitis;

Heavy forms of Malabsorption.

Evaluation of power failures

When appointing enteral nutrition, as well as when choosing a nutrient mixture and determining the dosage, control over the degree of food status disorders. At the first stage, with the help of the collection of anamnesis and clinical examination, patients reveal risk groups for malnutrition. In patients related to the risk group, a more detailed assessment of the state of the power supply is carried out and appropriate treatment is prescribed if necessary.

Evaluation of the state of food is made in terms of indicators whose combination characterizes the nutritional status of the patient and its need for nutrients:

a) Anthropometric data:

Growth
- body mass
- body mass index (BMI)
- Circle of shoulder
- measurement of the sensor-fat folds of the triceps (CZHST)

b) biochemical indicators:

Common protein
- Albumin
- Transfirin

c) Immunological indicators:

The total number of lymphocyte

(as amended by the order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

Map of observation
patient receiving enteral nutrition

(Liner in a hospital patient's medical card, account form N 003 / y)

Name of therapeutic and preventive institution ________________________

N disease history ___________________________________________________

FULL NAME. __________________________ Paul _____ Age _____________________

Growth ______________________ body weight when admission _____________ (kg),

when discharge ______________ (kg).

Dynamics of body mass over the past 6 months ______________________________

Clinical diagnosis:_____________________________________________________

_________________________________________________________________________

N.	Indicators	Initial data	After treatment	Standards	Non-food failure
	Indicators	Initial data	After treatment	Standards	easy	average	heavy
	Point			3	2	1	0
1	BMI kg / m2			25-19	19-17	17-15	<15
2	Shoulder circle, cm
	men			29-26	26-23	23-20	<20
	women			28-25	25-22,5	22,5-19,5	<19,5
3	KZHST, MM.
	men			10,5-9,5	9,5-8,4	8,4-7,4	<7,4
	women			14,5-13	13-11,6	11,6-10,1	< 10,1
4	Circle muscles shoulder, see
	men			25,7-23	23-20,5	20,5-18	<18
	women			23,5-21	21-18,8	18,8-16,5	<16,5
5	Common protein, g / l			265	65-55	55-45	<45
6	Albumin, g / l			>35	35-30	30-25	<25
7	Transfirin, g / l			82,0	2,0-1,8	1,8-1,6	<1,6
8	Lymphocytes, thousands			>1,8	1,8-1,5	1,5-0,9	<0,9

	The amount of points			24	24-16	16-8	8

BMI - body mass index: weight / height m2

KZHST is a triceps leather fold.

For enteral nutrition, it is necessary to determine the energy needs of the body. It is necessary to determine the energy consumption with the help of methods direct or indirect calorimetry. If it is impossible to carry out these research methods, energy needs assessment can be calculated using the respective equations:

according to the Harris-Benedict equation:

DRE \u003d OEO X FT FT X TF X DMT,

where DRE is valid energy costs (kcal / day);

OEO - the main energy exchange;

F - activity factor; FT - injury factor;

{!LANG-c602699bea2337c124b7c95bedbabd2d!}

{!LANG-1121f696001ee99bcb1a6740d1b7a709!}

{!LANG-d219ae5ba4e8c7fdaa42f2ea395e09ab!}

{!LANG-731217d084dec756bc6bccc1cb425531!}

{!LANG-2788d80ff2d261399ee38863a0e246df!}

{!LANG-75e35d1ec9ecf86c36009eb5b2d787aa!}

{!LANG-c89dd25fb721c37b5f4e0decdd71aea9!}

{!LANG-dcf2bcd8eb0c76d59c5d58387cc9f299!}

{!LANG-658cacab7a86d537ef5157d6cd4dc8b8!}

{!LANG-bccbdb6091b1cb81123eb0aa5b98d608!}

{!LANG-cb8c4f291ec7f7f44a0e366b709dd7d4!}

{!LANG-d03d17140bd32def1ec9d8663123e401!}

{!LANG-1e4c4972d80bd07ca359b1986679e71e!}

{!LANG-8dd6f655a43c0b9db72b53127311214f!}
(as amended by the order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

{!LANG-5dbe9cb995d34811f7c1788ab51d40a4!}

{!LANG-019f605c31bb061e5e99b813a19add72!}

{!LANG-c6709fabb84362bd04a88c039786644d!}

{!LANG-3cb365a6fc4ab25ce48e845410634f4e!}

{!LANG-f7f8210158707d8183b9bad885b7ab37!}

{!LANG-3bec43ba980234ea940f2f118aa5d180!}

{!LANG-8be333aa74a5ba6579b4d9a7010ad78d!}

{!LANG-61ae516f8195ae829f1924170ab35ff6!}

{!LANG-458d6ae9c21b82dd27128a3129da2d20!}

{!LANG-fe68377d2c47cd8856c06ff4802cf3c4!}
(as amended by the order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

{!LANG-8eee782fe7d7be3dcc139e038d6bc4df!}

{!LANG-f989fb14a860517a0c4132b47b4eef06!}
{!LANG-bb9e0ac9574ea33b8e33162c25761c56!}

{!LANG-6cfb143253ad3b1173955bd064529eb5!}

{!LANG-10a627ee18d4a5e0596ca8e64a5e3b5a!}
in medical and preventive institutions

{!LANG-964081d77264e13d4dcac1aac51a3691!}
{!LANG-ae28c06de9f1ca07445bc9228139befe!}

(as amended by the order of the Ministry of Health and Social Development of Russia of 26.04.2006 No. 316)

{!LANG-6c8d6b810745c01bca2b0b806c1cd19c!}

{!LANG-b229caaed37c9368b8474acb16c56475!}
in medical and preventive institutions

{!LANG-7ccfbbc2933c275a2760388078a03104!}

{!LANG-b017019db034c48991ae65eec16cf7fd!}

{!LANG-3df6424fdfbfd4f990c9064cb808bc9b!}

{!LANG-c7757ddb4a9d4b7c8b8738a526ee9bb4!}

{!LANG-ac09845738db882f8ec96d0ae8aad2ca!}

{!LANG-d3736a183dd6b85330b9bbbcc70185cf!}

{!LANG-110bc0c966ad89d24b40429a10ca4707!}

{!LANG-ca557054b684298d1eda798d9d781712!}
Indicators	{!LANG-e27dc682a3913c1ae7eb1fcec3470039!}
{!LANG-eeaaf04e431ce5a2686088f5e1cfaed0!}
{!LANG-e3c29a1937bc4ef80295d6a4e40d5826!}
{!LANG-b238bc9f5c020a4dd3e507639a60b72a!}
{!LANG-d3c758b22dfc89737e7aa2d7aa8bce8e!}
{!LANG-8884a31c5be1fc24216dcb45fc3999e2!}
{!LANG-7b96fe0f6be11ff8b0beb6fd947023bc!}
{!LANG-d468d7412e73ae8bdf3877202f833bbc!} {!LANG-a9d7e22487cfd3f605c3506b1cf5408d!} {!LANG-277b6c419f5689cc2671985ddefd034d!} {!LANG-6d727802c26863f933ca8a3de8b36e2c!}
{!LANG-5c5942edb324b10ebea0fb7a52398705!}
{!LANG-bfe786857977b7263ccb504a43b1b67d!}
BMI kg / m2
Shoulder circle, cm
{!LANG-563d5e08e62747bccd5a255fba8d1f08!}
Circle muscles shoulder, see

Indicators	{!LANG-565c22c61d24e24030353e0170554a1d!}

{!LANG-f815d2e96cd710178df989c51bb2c6ae!}
{!LANG-ad0d247b3af9743c58524a86158763a9!}
{!LANG-a511329466b0045a02e22fce15f567c4!}
{!LANG-850a837a74267a83f1c57df2e513fbb9!}
{!LANG-a9d8e723c538bad7c1c1ea3ff3cf2b51!}
{!LANG-5d91ffd44148269b129c5b2ac1e6b9f8!}
{!LANG-a6b37e7663acc2200a68ee8c8c52d421!}
{!LANG-a9e592fbe309669df72baa2e2ef778c5!}
{!LANG-2a682b9af198e87725fca31a52c1503e!}
{!LANG-69df6ae499495446a754ac71bb776f20!}
{!LANG-3db763aedb2e78c05acdfe0c1118140a!}
{!LANG-8da6ab133497bdb7fe6d041b9ce050e0!}
{!LANG-92d9d792537302bcea7e92c171569803!}
{!LANG-81480d5732b3f8440b9d14512dc29831!}
{!LANG-05d533753d63833e1b9a56c8761ca3c3!}
{!LANG-f5f0dbf5fa3da170865581ef324fa9e8!}
{!LANG-9956264af31890c15873b81165f4f439!}
{!LANG-6a59d34913a9667a0559a0182120194e!}
{!LANG-16970408009fb2dcb3a76b77e376cd60!}
{!LANG-c438dcfd451f40ad32f2e3f839e27d27!}
{!LANG-2ad663b4f03582b9a49d36d20d2cb435!}
{!LANG-36194df735241240e873a25e0bbc65c9!}
{!LANG-c669f1acdff51513b6d905dad00e83dd!}
{!LANG-7cb154e86e2a5377048cad832e473457!}
{!LANG-3db763aedb2e78c05acdfe0c1118140a!}
{!LANG-8da6ab133497bdb7fe6d041b9ce050e0!}

{!LANG-8696706ef217634b3008a0357d8a0a98!}
{!LANG-a062b9983b8fc49c3ca74f689a2be372!}

{!LANG-647ba78f3c9a1e7862a4116db9e6e37b!}

{!LANG-a05e049383d3e64119c584d33ffbf2ce!}

1. .

{!LANG-812b400c0db3ea8630b851398f056e6e!}

{!LANG-e37418478207b311a3f79e76189769b6!}
{!LANG-13d7c8d939c7cf02111f485021d2c39a!}
{!LANG-da09c9a627ea96ccebf7c2340093683d!}
{!LANG-e2000b14f11a61d4959176fc4fe3b147!}
{!LANG-cc76ccf4ae99d708629b4c1317c5685d!}
{!LANG-2cb976200d98144e8789373da5741350!}
{!LANG-20a07095c23b3322c52acd749c1a635b!}
{!LANG-8d3b20cc8339fc95f0c67a78842bcd1e!}
{!LANG-f59afb5e5b5fa60909b8eb15b10d82e0!}
{!LANG-7beab4b92614248368152d62eefe47ea!}
{!LANG-16a6b621af7fac43b2fa9b597addd850!}

{!LANG-a95ca9a9ec77a0f3f06e5b0daaa7a587!} {!LANG-531be18f78bd267848a834499c935497!}

{!LANG-8a743b5cc0404803b101bc6dd5b75384!}

{!LANG-b75934551c7bff9a2a7f7c2f4351dc0a!}

{!LANG-e81d7b64bb06a0125ec432a0dde83aea!} {!LANG-531be18f78bd267848a834499c935497!}

{!LANG-ece43d601fec1cf30c9677c4d9b44b22!} {!LANG-531be18f78bd267848a834499c935497!}

{!LANG-eb49101652a992fb7374c5e99ef88acb!} {!LANG-531be18f78bd267848a834499c935497!}

{!LANG-0629a315ddce5142e6d3d28d998b51f0!} {!LANG-531be18f78bd267848a834499c935497!}

{!LANG-b1b75648d50e56ef25b635dffb9f2ebe!} {!LANG-531be18f78bd267848a834499c935497!}

{!LANG-34d17bc1322adfb82f2802c73f14b5e8!} {!LANG-531be18f78bd267848a834499c935497!}

{!LANG-08f8cfcfe43ac5aab0f48449b7cc8b0a!} {!LANG-531be18f78bd267848a834499c935497!}

{!LANG-ac0db8208056a9c40e2970f411ec6514!}

{!LANG-8a72ce816b11e0a44b612fafce09d191!} {!LANG-531be18f78bd267848a834499c935497!}

{!LANG-9e316d101640b2f512a71422fd959460!}

{!LANG-2a0f23f0d2ef1116b2fb6dad29c97755!}
{!LANG-18f8540d702bc4aeef59da2dced0a0b4!}

AGREED
Deputy Minister
internal affairs
Russian Federation
A.N. Kulikov
March 5, 1993

AGREED
Chairman
Permanent Committee
according to drug control
E.A. Babayan.
March 4, 1993

{!LANG-8d10bb9e0ec57b8dbf0a01f7917c3dde!} {!LANG-1f9c3e1b9c73c95d1da796c9e4380bcd!}

Appendix 2.
Approved
Order of the Ministry
health
Russian Federation
dated November 12, 1997 N 330

{!LANG-628ba5dd0c640bbb2eeca1b437ad5f58!} {!LANG-f3694af10966d1b708a7235b24fc8e5a!}

Appendix 3.
Approved
Order of the Ministry
health
Russian Federation
dated November 12, 1997 N 330

{!LANG-c338e5665933c98d7e709537822c3d69!}

Table 1

{!LANG-9bd82418aafe42084f4a85d00fc9d7f9!}

{!LANG-8986fd074a8de0412405c3ae7f72e1e2!}

{!LANG-52556dd9df2d39a7b61709742a61a588!}	{!LANG-3a46ec1211a10b7ee693fc83ba5f0089!}	{!LANG-9ae46b2d8f57685ced3a2476089ad2c1!}
1.	{!LANG-d9000acfd93a4482d440569aa414292d!}	0,3
2.	{!LANG-a3d7e5f43e9e7bd2a76f15b5b55cc2c9!}	5,0
3.	{!LANG-4ec8ba948e3364f2b1e321a0556d8b77!}	0,3
4.	{!LANG-0922eba9a054abef899c68935d18459c!}	0,02
5.	{!LANG-30a6dda95c2c5473917581cd95fb3a9d!}	0,1
6.	{!LANG-671ddf37d0b89151c50930b1f2e782af!}	0,3
7.	{!LANG-a5eda4e965df4442a2b51a39ff3207f1!}	70,3
8.	{!LANG-5379de44d62572ec7144776b5b84c976!}	833,3
9.	{!LANG-23f18537055c0b0579e94648fde77bfd!}	0,006

{!LANG-e7a5226a46a42a6bb051734cdfa54c80!}

Chairman
Permanent Committee
according to drug control
E.A. Babayan.

table 2

{!LANG-da2b2ed51c10eac8651dd7b8f03fd73c!}

{!LANG-8986fd074a8de0412405c3ae7f72e1e2!}

{!LANG-52556dd9df2d39a7b61709742a61a588!}	{!LANG-2dc6034c7d0a7fa18bb67b4df944189e!}	{!LANG-2f4a213ea1768cd6c59959423e3f6ac9!}<**>
{!LANG-52556dd9df2d39a7b61709742a61a588!}	{!LANG-2dc6034c7d0a7fa18bb67b4df944189e!}	{!LANG-c420ccbda4e3494459453cfabf81c5f9!}	{!LANG-2fec4d2c63ff94152c1b90018d8ca874!}	{!LANG-86dba46483010ddd8baa0b4f4de2c271!}	{!LANG-3289f76f57c77930e94956760534f4db!}	{!LANG-2cd015c9c92bdd9ee38c08c245ae92b9!}	{!LANG-4f1a76813e2612339e45bcffa1b49302!}	{!LANG-29d8e333f4cedf20d700ac47be49e1ea!}<*>{!LANG-a7f4b6cebf0aa40cee8597dddf3ae7ad!}	{!LANG-ba756c9edee0bb3980648db0585ff10c!}	{!LANG-af1c4f9826f2ad62b8bcbcdbde7f443a!}	{!LANG-cfbe726cfc7163a4308a9ddd57144e7b!}	{!LANG-961cd0595a2d615fd02f67c3c8f11698!}	{!LANG-eed3beb5e84bba78999dc4de088060b7!}	{!LANG-65bae75d3aca9c3e5ce8f63563b758c1!}	{!LANG-10421a5bc9aebde018a2242ca475126c!}
1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16
1	{!LANG-d361ad444cb1d612133a7305956a60b2!}	3,0	0,5	2,0	0,5	5,0	11,0	0,4	0,25	1,5	0,6	0,5	0,2	5,0
2	{!LANG-2c248272077325da620ad8415ff71ec8!}	3,0		0,5	0,5	5,5	9,5	1,0		0,5				2
3	{!LANG-888981b7f0c4493137b993df3abb81ea!}	1,0	0,5	1,5	0,5	5,5	9,0	1,5		1,0		2,0		1,0
4	{!LANG-92a4b00d05b308f8e3bb757661c83956!}	1,0	1,0	2,0	1,0	6,0	11,0	0,5				0,06	0,2	4,0
5	{!LANG-9f244cde5b710c64b76cf0989235f201!}					1,0	1,0							1,0
6	{!LANG-36ca387f70334236994dbe4aa9b27e35!}			0,6		1,0	1,6	3,0				0,01		0,1
7	{!LANG-b32fa89b970558f805d061ff01e3175d!}	3,0		0,5	0,5	5,5	9,5	1,0		0,5				1,5
8	{!LANG-7d5723efa275dada3bb0a8556097117e!}	2,5	2,0	12,0	4,0	36,0	56,5	5,0		0,5		0,3		1,5
9	{!LANG-a67b92bc313ae17eb1e62c6ed869c7ea!}	1,0	1,0	2,0	0,5	6,0	10,0					0,06	0,2	3,0
10	{!LANG-9f8c7b18be7a901e1e872eae5217298f!}	6,0	1,5	8,5	7,0	58,0	81,0	6,0	0,4	1,0	0,2	0,4	0,3	6,0	0,04
11	{!LANG-1b25d4224a40c80328e7e51d9863713f!}	3,0	1,0	5,0	3,0	21,0	33,0	2,0		0,5		0,5		3,0	0,03
12	{!LANG-7ea7c1b6b0354efbc043965e4bb50428!}			0,2	1,0	4,0	5,2
13	{!LANG-5b6b5ce258614e8e4a360f3653e9bf97!}	5,0	0,5	5,0	4,0	31,0	45,0	7,0	0,3			0,07	0,2	3,0
14	{!LANG-cf66ee8c56e044391874be2f55c1f4f7!}	2,0		5,0	20,0	150,5	177,0	5,0			0,2			5,0
15	{!LANG-92786a957743c81aa74b6f36d46c21a8!}	9,5	3,0	13,0	15,0	115,0	155,5	11,0	0,6	4,0	0,2	0,3	0,5	5,0	0,5
16	{!LANG-a719b0b784427e6bfc5a801647032804!}	9,0	1,0	10,0	20,0	145,0	185,0	100,0
17	{!LANG-c0136dad9906276c57c26fa81259a892!}	2,0	3,0	2,0	31,0	5,0	43,0	0,2		1,0		0,3		7,5
18	{!LANG-6875815ba187f799c88fc9d3ac0f737d!}	4,0	0,5	1,0	6,0	4,0	15,5	1,0		1,0		0,25		1,0
19	{!LANG-58894e864228fc4d2c24209209516753!}					0,5	0,5							0,1
20	{!LANG-d88d8ba409ada0065e709f2669c9aa0e!}	3,0	2,5	9,0	2,5	14,0	31,0	4,0		7,0	0,9	0,05		1,5
21	{!LANG-f95c03f25ae8886ed4bef9afaae01b3c!}	0,5		0,5	2,0	1,0	4,0	0,6	0,3			0,45	0,6	1,5	0,03
22	{!LANG-6a9d4fa463111e374917e679941a47b8!}	0,2				0,2	0,4					0,15	0,4	0,1
23	{!LANG-d9a40ded6a9576e4a1db5981b7ab45fb!}	0,3	0,5	0,5	0,5	4,0	5,8	1,0	0,3		0,2	0,7		1,5	0,2
24	{!LANG-96204f68de6d30381dc2625f123f0781!}	2,0		6,0	0,5	3,5	12,0	0,6	0,3			1,3		2,5	3,0
25	{!LANG-db7637ee40b0524b20e694c76ee8eb18!}					0,1	0,1					0,1		4,0
26	{!LANG-396ec3915f218225461bc6d92c63adb8!}	2,0		1,5	1,0	2,0	6,5		0,1	1,2	0,2	0,35		4,0	0,01
27	{!LANG-b9d517ec8879eb7abd7a9cc65f6e4a45!}													0,1
28	{!LANG-8d5c8dbba0731bba27a556264c6c68c9!}	0,2	0,1		0,3		0,3			1,2		0,05	1,0	1,0
29	{!LANG-703d576a76af88f271df8c32de45599c!}	2,5		15,5	2,0	60,0	80,0	10,0		0,5		0,4		1,7
30	{!LANG-fe06ce2f362c7ee037f9a031d677b92e!}	0,5	2,5	12,0	3,0	7,0	26,0	1,0		0,1
31	{!LANG-a40afe42174ebd147a0315c92bf278e9!}			0,1		0,25	0,38							0,45
32	{!LANG-b2115374bef734cd3b5a1d6a2a7d5254!}	10,0	1,0	6,0	2,0	7,0	26,0	20,0	0,2	0,2		0,2	0,5	6,0	0,1
33	{!LANG-fc1bb96e5f45c77b5ba6cc92b6bcbfbe!}	2,0	0,7	0,3	1,0	2,0	6,0			0,5		0,2		2,0	0,04
34	{!LANG-4353de2f5d1e0da9e02f78829d205d71!}		0,2	0,3	0,3/ 0,3	- / 0,5	0,35/ 0,85	- / 1,0							0,2
35	{!LANG-ff8c082eb1ecb987d944d6aa00f9a885!}	140			55,0	80,0	275,0
36	{!LANG-d618a6c4bc1232eefe32efef80630735!}			1,0	0,5	1,0	3,0							3,5
37	{!LANG-d2a978cfebd1b9efb837e0e73c01dff4!}	14,0		7,0		39,0	60,0	2,5		1,5

<*>{!LANG-ea051f2a2afdf334df666601c5581738!}

<**>{!LANG-c08ec9c4549faa622ec4a0c64e5e228a!}

Notes:

{!LANG-e99b2cb8cc561c48cd1bf3890a401fc5!} {!LANG-ada9dc221b36a342221bdb92cbc6e16b!}

{!LANG-86ff4ee4f5eb742bbca6ea688db847ab!} {!LANG-2fa107ec897ba29cf4d3b20bc082fd7c!}

{!LANG-0e69571a26f9c1ee0aa904e01e68d268!} {!LANG-2fa107ec897ba29cf4d3b20bc082fd7c!}

Chairman
Permanent Committee
according to drug control
E.A. Babayan.

Table 3.

{!LANG-c5ae55ac4e5a22c6d1b0640cb8c996f7!}
{!LANG-5751543088ec62ffcfea1378314615ca!}

{!LANG-0aa6847d6befc76494e2d8c1b2e67438!}

{!LANG-52556dd9df2d39a7b61709742a61a588!}	{!LANG-5aafec4924ea8bdf318641fb6f97d233!}	{!LANG-fba8b2f0b3476a8e55f63e482ff363dd!}	{!LANG-543ee4326ab03fa46625b751eed45996!}
1	2	3	4
1.	{!LANG-f4d60d44a641bc4dba351fd6088ad793!}	{!LANG-5acf020a68172032a87389f72cb00bc5!}	{!LANG-7e636fb128eda7ea883ce4340a3565d4!}
		{!LANG-97b29cf3ee76eaf24b0a1c2f0f993477!}
		{!LANG-e33817ea50052f061bae85f4a5539bb2!}	{!LANG-ee67e5dddcdcadb15ff4bc6bf2b50414!}
		{!LANG-265ee3353b4e180e7c4ef0495752e9e9!}	{!LANG-bf81b61a4ba6b6df5c88a400ba6b892d!}<*>{!LANG-6e61f284a27f911a12f969f34a114675!}
2.	{!LANG-708c2a0dc2e3598849b5108057b79fe6!}	{!LANG-0b1d48b37229a91d7e67ea40a9ed6613!}
		{!LANG-97586d8271aaee0a72706927c9f1ab4f!}	{!LANG-7ddd2de5d0eb540c35c717837f33533c!}
		{!LANG-e58cd3b6f0bb90d9476ce3a1cae53dca!}	{!LANG-927fb9aed2618a5d4cf73b82dbfe699b!}
		{!LANG-c7a29e54f557f10060decfbb052e9b76!}	{!LANG-2042c34a5f951d3758bfe36eac952209!}<*>{!LANG-7cc566db1bec37c162824f9ae4976b82!}
3.	{!LANG-8e94006e8e24ac3f4ef394a2b7a2cc7d!}	{!LANG-53b4ebc2ecb04c0d17292d6fbc953551!}	{!LANG-d8f7bc62dee866a794d50fec3e0e2281!}
4.	{!LANG-f290a96b4e3c15e4cfcb972e3483bf93!}	{!LANG-fe0989016504e244403b6a0145d36106!}
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<*>{!LANG-3838aafe427c36bc61269a852f3765e7!}

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Chairman
Permanent Committee
according to drug control
E.A. Babayan.

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Approved
Order of the Ministry
health
Russian Federation
dated November 12, 1997 N 330

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Approved
Order of the Ministry
health
Russian Federation
dated November 12, 1997 N 330

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1.1. Regulation on the organization of the activities of a dietetologist (Appendix N 1);

1.2. Regulation on the organization of the activities of the Dietary Medical Sister (Appendix N 2);

1.3. Regulations on the forced nutrition council in medical and preventive institutions (Appendix N 3);

1.4. Instructions for the organization of medical nutrition in medical preventive institutions (Appendix N 4);

1.5. Instructions for organizing enteric nutrition in medical and preventive institutions (Appendix N 5);

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———————————
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2. Control over the implementation of this order shall be entrusted to the Deputy Minister R.A. Halphine.

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{!LANG-13c418104018bed6c58cf20a622eabfd!}
On the organization of the activity of a dietologist

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- seven-day summary menu - summer and winter option;

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from 05.08.2003 N 330

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The organization of therapeutic nutrition in a medical and prophylactic institution is an integral part of the medical process and is among the main medical events.

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Along with the main standard diet and its variants in a medical and prophylactic institution, according to their profile uses:

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The nomenclature of permanent diets in each medical and prophylactic institution is established in accordance with its profile and is approved on the healing council. In all therapeutic and preventive institutions, at least a four-time power regimen is established, according to the indications in separate compartments or for individual categories of patients (peppercase ulcerative disease, the disease of the operated stomach, diabetes mellitus, etc.) is used more frequent power. The power mode is approved on the healing board.

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The general guidance of a diet in a medical and prophylactic institution is carried out by the chief physician, and in its absence - the deputy on therapeutic part.

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The components for the preparation of diet food dishes also include protein composite dry mixtures.

The norms approved by the Order are developed by the FSBI specialists, RAMS with the involvement of practical nutritionists, medical specialists.

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www.rosminzdrav.ru.

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Standard diets{!LANG-d22e3a8adddd5dabf85515fbc4b8c31c!}

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Order 330 Ministry of Head of 24.11. Regulatory legal documents. Contraindications for the use of enteral nutrition

330 Order of the Ministry of Health

Legislative base of the Russian Federation

Free consultation

Federal legislation

The procedure for controlling the quality of finished foodin the medical and preventive institution

Transportation of finished food

Sanitary and hygienic mode of food and buffet

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