INFORMED VOLUNTARY CONSENT
on the types of medical interventions included in the List of certain types of medical interventions for which citizens give informed voluntary consent when choosing a doctor and a medical organization for receiving primary health care
I, a capable person who has reached the age of fifteen, hereby, for the purpose of fulfilling the terms of the Agreement for the provision of paid medical services with JSC "Clinic for active aging" Institute of Beauty on Arbat "(OGRN 1027700056207, TIN 7704199040, location address: 119002, Moscow, small nikolopeskovskiy per., 8) on the terms of the Offer posted at qapsula.com, to which this Consent is attached, I give informed voluntary consent to the types of medical interventions included in the List of certain types of medical interventions to which citizens give informed voluntary consent when choosing a doctor and a medical organization for receiving primary health care, approved by order of the Ministry of Health and Social Development of the Russian Federation dated April 23, 2012 N 390n (registered by the Ministry of Justice of the Russian Federation on May 5, 2012 N 24082) (hereinafter - the List) , for receipt by me and / or a person legally represented The author of which I am (the Patient), primary health care in accordance with the terms of this Agreement in the selected Medical Organization.
P / p No.
Type of medical intervention
1. Interview, including identification of complaints, collection of anamnesis
2. Examination, including palpation, percussion, auscultation, rhinoscopy, pharyngoscopy, indirect laryngoscopy, vaginal examination (for women), rectal examination.
3. Anthropometric studies (height, weight, head circumference, etc.).
4. Thermometry (measurement of body temperature).
5. Tonometry (pressure measurement).
6. Non-invasive examinations of the organ of vision and visual functions.
7. Non-invasive examinations of the organ of hearing and auditory functions
8. Investigation of the functions of the nervous system (sensory and motor spheres).
9. Laboratory methods of examination, including clinical, biochemical, bacteriological, virological, immunological, cytological, histological, etc., including sampling of blood, urine, feces, saliva, sweat and other biological fluids and tissues
10. Functional examination methods, including electrocardiography, 24-hour blood pressure monitoring, daily electrocardiogram monitoring, spirography, pneumotachometry, peakfluometry, reoencephalography, electroencephalography, cardiotocography (for pregnant women), ultrasound with vaginal and rectal sensors, etc.
11. X-ray examination methods, including fluorography (for people over 15 years old) and radiography, ultrasound examinations, Doppler studies, computed tomography (CT), X-ray and ultrasound, densitometry, Magnetic resonance imaging (MRI) and other radiation methods of research
12. The introduction of drugs as prescribed by a doctor, including intramuscularly, intravenously, subcutaneously, intradermally, into the joints, by electrophoresis, etc.
13. Medical massage and acupuncture.
It has been explained to me that I have the right to refuse one or more types of medical interventions included in the List, or to demand its (their) termination, except for the cases provided for by part 9 of Article 20 of the Federal Law of November 21, 2011 N 323-FZ " On the basics of protecting the health of citizens in the Russian Federation. "
This consent was provided to JSC "Clinic for active longevity" Institute of Beauty on Arbat "by me on the terms of the Offer to conclude an agreement for the provision of paid medical services, by putting a mark I agree (" tick ") on the website qapsula.com using a simple electronic signature, and is equivalent paper document signed with a handwritten signature.