Outpatient clinic. Outpatient treatment of patients with gynecological diseases Outpatient treatment

The date: 19.07.2019

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Tuberculosis is an insidious and serious disease. Long time a person can be a carrier of Koch's bacillus, but the pathology does not manifest itself in any way, no dangerous symptoms not visible. But any negative factors can translate the disease into active form, then long-term treatment is indispensable. The therapy is usually carried out in specialized medical institutions. But sometimes outpatient treatment of tuberculosis is possible, what it is and in what situations is it allowed.

What it is?

If tuberculosis therapy is carried out in a hospital, then the patient is under the supervision of doctors around the clock throughout the course. Outpatient treatment includes the following:

The patient must come to the outpatient department every day and take medications under the supervision of medical personnel.
Undergo planned examinations in the department, take tests.

Home therapy has significant advantages over inpatient treatment. The risk of infection with chemo-resistant mycobacteria, which may be in inpatient departments, is eliminated. In addition, being at home has positive influence on the psychological attitude of a person.

Another important plus, rather for the state, this type of therapy significantly reduces the cost of anti-tuberculosis treatment and saves money for those patients who need hospitalization.

Indications and contraindications

Can TB be treated on an outpatient basis? Yes, but only if he eats his testimony for this:

The patient has tuberculosis in initial stage.
The person is not dangerous to others.
Nothing threatens the patient's health and life.
There is no high risk of serious complications.
The patient is in a mentally adequate state.
Age and health conditions allow to come to the outpatient department every day.

If a decision is made to conduct therapy on an outpatient basis, then the phthisiatrician must constantly monitor the course of treatment.

Contraindications to this type of therapy are:

The disease is in an active phase.
A person can infect others.
It is not possible to visit the outpatient department every day.
The patient has mental illness.
The life and health of the patient is at risk due to the severity of the stage of the disease.
There are chronic pathologies that complicate the course of the disease.

Whether outpatient treatment is possible or not, only the doctor decides in each case.

Stages and treatment regimen

Almost all TB facilities have outpatient departments. The essence of therapy in them is as follows:

When treating tuberculosis, regardless of location, whether it is a hospital or an outpatient department, it is important to observe the following principles:

Timely initiation of therapy.
Compliance hygiene regime in terms of nutrition, daily routine.
Conducting etiotropic therapy aimed at taking antibiotics and chemotherapy drugs that can fight mycobacteria.
An integrated approach involving a combination of several drugs and treatment methods at the same time.
Pathogenetic therapy. This principle implies the use of methods that will stimulate the immune response, increase the body's resistance to infection.
Treatment is symptomatic. For example, taking medications for fever or sleeping pills for sleep disorders.
Collapse therapy methods. With their help in pleural cavity gas is injected in order to cause the abnormal tissue site in the lungs to collapse.

During therapy, it is also important to maintain continuity, you cannot take breaks in taking medications, otherwise mycobacteria develop resistance to active substances medicines.

Any therapy also involves following certain stages:

Intensive therapy, which is most often recommended in a hospital setting.
In the second stage after removal acute symptoms disease treatment can be continued on an outpatient basis.

Treatment of tuberculosis in outpatient implies taking antibacterial agents, which have a detrimental effect on Koch's sticks. These include: "Isoniazid", "Ethambutol", "Rifampicin", "Streptomycin". If there is an increased resistance of mycobacteria to such drugs, then fluoroquinolones and "Pyrazinamide" are used.

Before prescribing a medicine, it is mandatory bacteriological examination on the sensitivity of mycobacteria to antibiotics.

The discovery of resistant strains forces doctors to prescribe several antibacterial agents to patients at the same time. In the treatment of tuberculosis, specialists resort to the use of three treatment regimens:

At the same time, she is taking Isoniazid, Streptomycin and Aminosalicylic acid.
When more resistant strains are found, a four-component scheme is used. To the first two components from the first scheme "Rifampicin" and "Pyrazinamide".
The five-component scheme, in addition to the previous one, involves taking "Ciprofloxacin".

The duration of therapy depends on the severity of the disease. Initial stage tuberculosis will require medication for 3-4 months, and if a five-component regimen is prescribed, then therapy will most likely last at least a year.

In addition to the listed drugs, the administration of immunomodulators, for example, drugs based on interferon, is added to the therapy regimen. Physiotherapy procedures provide essential assistance in therapy. Breathing exercises are recommended for all patients. The outpatient department has an exercise therapy room, where a set of exercises is performed under the guidance of a specialist.

Don't forget about proper nutrition during tuberculosis therapy. The diet should be rich in vitamins, minerals and all useful substances for the body.

Where is treated on an outpatient basis in the Russian Federation?

Almost every TB dispensary has an outpatient department. If we talk about Moscow, then such medical care can be obtained in the following institutions:

Tuberculosis dispensary on the street. Dokunin, 18.
Branch of the Moscow Scientific and Practical Center for Combating Tuberculosis DZM in the South-Western Administrative District No. 4.
Tuberculosis Clinical Dispensary No. 21 on Metallurgov Street.
Moscow regional dispensary on pl. Struggle, 11 and others.

In our northern capital, St. Petersburg, there are also no problems with this, you can undergo effective tuberculosis treatment at the following addresses:

Tuberculosis dispensary number 2 on the street. Children's, 14.
Tuberculosis dispensary on the street. Serdobolskaya.
Leningrad Regional TB Dispensary at the address: per. Nogin, 5.

When dealing with outpatient treatment, it is important to remember that even after undergoing procedures and taking medications in the department, all medical advice at home. Pay attention to the mode of work and rest, take the recommended multivitamin preparations, engage in breathing exercises... If the disease is at an early stage of development, then this type of treatment will help to recover and cope with the pathology.

What is inpatient treatment? You will find the answer to this question in the materials of this article. In addition, we will tell you what grounds are necessary for such treatment, how it is carried out, etc.

general information

Inpatient treatment is various forms therapies used in various clinical cases... These may include rehabilitation, detoxification, a combination of both, and an approach in which one of the presented methods is accompanied by the other.

Where is it carried out?

Inpatient treatment is treatment that takes place in a regular or psychiatric clinic. In addition, such therapy is often carried out in a specialized department of a hospital (for example, a drug addiction clinic).

Treatment features

Inpatient care is a special form of therapy that is provided 24 hours a day. Most often, patients remain in medical institutions for several days, weeks, or even months, years.

The most important difference between inpatient treatment and outpatient treatment is the amount of medical care that the patient receives. Indeed, with such therapy, the patient is under constant supervision.

Why is inpatient treatment necessary?

This therapy has several advantages over low-intensity programs. Thus, thanks to the hospital environment, the highest level of medical supervision is possible, as well as safety for clients who desperately need regular somatic or psychiatric treatment.

Inpatient treatment is indicated for those patients who, from the point of view official medicine, are situated in dangerous condition or pose a danger to others and themselves. In addition, it is also useful for those patients who, for whatever reason, do not react in any way to the advice and recommendations of doctors. For example, hospitalization is indicated for those patients who are in a life-threatening condition, but do not want to undergo

It should also be noted that referral to a hospital is quite often written out for people who have narcotic or strong alcohol addiction... In this case, the patients are in a protected environment and cannot "break down" again.

When should patients be hospitalized?

Now you know what it is hospital treatment... It should be noted that therapy in such conditions is much more effective than in outpatient settings. However, the existing list of indications makes it possible to stay in the hospital only for those who have sufficient serious problems with health.

IN currently highlighted six points that are necessary in order to assess and decide whether the patient needs full or partial hospitalization, or he can be prescribed outpatient treatment.

acute intoxication or withdrawal syndrome;
complications serious illnesses and biomedical status;
behavioral and emotional state;
potential for relapse;
resistance to or acceptance of treatment;
environment in the process of recovery.

After the assessment is completed, the specialist makes a decision on the patient's hospitalization. In this case, the doctor must take into account two serious points:

the patient's danger to others and himself;
the likelihood that the patient will achieve success in treatment using less intensive programs.

Refusal of hospital treatment

According to article Federal law"On the rights of patients", absolutely any citizen has the full right to provide medical care in inpatient or outpatient settings. The patient has the right to refuse hospitalization, but this is only if his state of health does not pose a threat to the people around him and does not threaten his life.

In such situations, the doctor who examined the patient and offered him hospital treatment is obliged to take a written refusal from the patient. It is this paper that will be a confirmation that only he himself bears all responsibility for the health and life of a citizen.

in day hospital

Inpatient treatment, in particular daytime, provides mainly for the patient's bedtime regimen. So, each patient is allocated a separate bed with a standard set of bed linen.

It is intended for carrying out rehabilitation and preventive measures that do not require round-the-clock supervision.

A referral for inpatient treatment of a patient should be issued only by a local therapist or any narrow specialist (neurologist, endocrinologist, surgeon, gastroenterologist, pulmonologist, rheumatologist).

Hospitalization is carried out in a planned manner. To shorten the examination time of patients and to quickly prescribe treatment, all patients should be admitted to the day hospital already with the results of general clinical examinations ( general analysis urine, blood, ECG, biochemical blood test, examination by a gynecologist, fluorography, EGDS), as well as after consultation with narrow specialists.

How is the treatment going?

Inpatient treatment (including daytime) is carried out using a set of measures that include drug therapy and physiotherapy (acupuncture, hydrotherapy, exercise therapy, massage, etc.).

It should also be noted that patients are treated free of charge in accordance with the available medical standards specially designed for hospitals.

Reasons for referral to day hospital

Patients can be referred for treatment in a day hospital for the following indications:

01.03.2017

Outpatient and inpatient treatment are equally in demand on the territory of Moscow and the Moscow region, but not everyone knows what the differences are between them. Our drug treatment clinic "Ugodie" specializes in returning to normal life people with alcohol addiction.

The staff of the clinic is staffed with doctors high level with extensive work experience, skills in the psychology of communication with addicted patients. We provide both inpatient and outpatient treatment. The pros and cons of each type are discussed below. On the recommendation of a doctor, the patient can choose the way of interacting with doctors, the price of services depends on this.

Outpatient and inpatient care: the difference

Outpatient treatment is applicable when the patient is strong-willed, disciplined and, for whatever reason, cannot spend all the time in the clinic. He will have to attend procedures and regular consultations with the attending physician without being placed in a hospital ward. The patient is treated anonymously, without registration, and no data is transferred to third parties. This method has a lot of advantages:

The patient can live in a normal rhythm, not limited in the daily routine. The only condition is to be on time for an appointment with a doctor and go through all necessary procedures appointed by the doctor.
The patient remains in his usual environment, where close people will quickly help him adapt to a life without alcohol. The support of friends and family often plays a critical role in treatment.
A former alcoholic has the opportunity to get a job and do things that have long been postponed due to an addiction to alcohol. This helps to feel the importance of your place in society and opens a person's eyes to a new life.

Inpatient treatment will the best option for those patients who are not able to independently go to the clinic, as well as independently refrain from drinking alcohol. Unwillingness to fight alcoholism on outpatient treatment leads to the fact that a person quickly breaks down, in every possible way avoids repeated visits to the doctor, tests and procedures. The hospital implies the isolation of the addict (but only with his consent) on the territory of the clinic with the possibility of walking, leisure and visiting family and friends.

Significant advantages here include:

Constant doctor's control over the patient's condition.
Being in the environment of the same patients, which helps to transfer the period of adaptation.
Complete absence of alcohol and alcohol-containing compounds in the clinic.

Inpatient and outpatient treatment equally help addicts. The main thing is to awaken in a person the desire to stop drinking. Doctors of the clinic "Ugodie"

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Treatment of drug addiction or alcoholism and subsequent rehabilitation is a rather long process. As a rule, it takes at least six months, and often more. There are times when it is impossible to put a person in the clinic for such a long time. If this is your case, outpatient drug addiction treatment is also possible in all First Step centers.

It is no secret that the most significant expense item during treatment and rehabilitation is the patient's accommodation and meals in the center. In the case of outpatient drug addiction treatment, this cost item is losing its relevance, and although the cost of the therapy itself turns out to be somewhat more expensive, sometimes you can save a lot on the total amount. At the same time, it is important to understand that outpatient drug addiction treatment has both its advantages and disadvantages. However, let's not get ahead of ourselves.

In exceptional cases, it is possible to carry out outpatient treatment of drug addiction and alcoholism. Outpatient treatment is such treatment in which the patient is not admitted to the hospital. As a rule, with such an organization of treatment, the patient or doctors come to the patient's home, or the patient is delivered to medical institution for examination and for procedures.

Isolation is believed to be one of the main therapeutic effects in the treatment of drug and alcohol addiction. In fact, the task of limiting the freedom of movement of the patient is to protect him from the harmful influence of society and the ability to get alcohol or drugs. If it is possible to limit the social circle and access to prohibited substances without hospitalization, outpatient treatment is also possible.

In exceptional cases, outpatient drug and alcohol addiction treatment is impossible or not recommended for medical indications... For example, in cases where treatment can cause complications of chronic diseases. If the patient is at risk, any treatment is safer to carry out in medical hospital, under the constant supervision of doctors. In addition, outpatient drug and alcohol addiction treatment implies constant monitoring of the patient's condition. If relatives are not ready to constantly be with him, it is more correct to place a person in a hospital.

Why is the outpatient treatment of drug addiction and alcoholism bad?

In part, we have already touched on this issue above, but this is not a reason to consider the disadvantages of outpatient drug addiction treatment in more detail.

Lack of constant medical monitoring of the course of treatment. Observing the patient only from time to time, the narcologist cannot record changes in the course of the disease as objectively and promptly as during observation in a hospital. If a person has chronic diseases, as well as if drug addiction or alcoholism is in a state of neglect, outpatient treatment is not recommended, and sometimes it is expressly prohibited.
The need to carry out constant monitoring of the patient by the forces of relatives or a visiting nurse, as a result - unnecessary costs, often commensurate with the cost of hospital stay.
The impossibility, if necessary, to promptly provide urgent medical care. In emergencies, it is likely that you will have to go to the state ambulance, because of which the addicted person may be “registered”.
It is much more difficult to restrict an addict's access to drugs if he is outside the clinic. In this case, a single breakdown can jeopardize all the treatment already taken.
To regularly (quite often) take a patient to a rehabilitation center (usually a suburban one), you will need to allocate a lot of time and money.
Conflicts and roughness in relations with relatives are inevitable, which happen in the life of anyone. addicted person... They can seriously complicate the rehabilitation process, lead to breakdowns and repeated drug use. After each of these cases, you will, in fact, have to start treatment from scratch.

Each family decides for itself which option to prefer - to choose the placement of a relative in a medical hospital (drug treatment clinic or rehabilitation center) or drug addiction treatment on an outpatient basis. Specialists hotline"The first step" will always help you make your choice, weigh all the pros and cons that are relevant specifically for your family, in your specific case.

Why is outpatient addiction treatment good?

Don't be intimidated by the previous part. There are also certain advantages that outpatient drug addiction treatment provides. Let's fix them, also, in the form of a convenient list:

One of the most tangible advantages is the cost savings for hospital accommodation. Housing is the most expensive component of the estimate for the treatment and rehabilitation of drug addicts and alcoholics.
The entire period of rehabilitation, with rare exceptions, the patient spends at home, with his family. For many people, this is significantly more comfortable in a psychological sense.
During treatment and rehabilitation, the patient has the opportunity to remain a full member of society. This is especially true for those whose addiction has not yet gone too far, and there is little point in isolating a person from the outside world. The patient can go to work, and take the course of treatment in free time... So, by the way, those who independently made the decision to fight addiction are often treated - as they say, on the job.
When a person is absent from the field of vision of his environment for a long time, various rumors are often born (this is especially pronounced in small settlements) - he was sitting, being treated, something else. Outpatient drug addiction treatment can help avoid these unnecessary rumors and misinterpretations.

Each family determines for itself which option to prefer - to place a relative in a hospital or to treat drug addiction on an outpatient basis. The First Step hotline specialists will always help you make your choice, weigh all the pros and cons that are relevant specifically for your family, in your specific case.

Outpatient drug addiction treatment in First Step clinics

In general, those who undergo outpatient drug addiction treatment at First Step clinics have access to all the same opportunities and services that we provide to inpatients. The only difference is that the patient lives and eats at home, in a familiar environment.

You only come to a narcologist - for droppers, injections and examinations. In addition, it is necessary to visit the clinic to communicate with a psychologist - for personal consultations and group therapy sessions. The addict can also stay in the center during major events for addicts - holidays, joint sports and other activities. Communication with “colleagues” is an important part of both therapy and subsequent socialization of drug addicts. We recommend not to deprive the person of the possibility of such interaction.

You can also consider an intermediate option for passing the course. You can leave the patient in the rehabilitation center for the whole week and take him home for the weekend, or do the opposite, depending on how much time you can devote to the relative yourself. On weekdays, the treatment and rehabilitation program is combined with educational and sports activities, on weekends - with outdoor activities and games. In addition, the guys regularly organize holidays, grill kebabs together, and engage in amateur performances.

Rehabilitation Center "First Step" - near you

The First Step rehabilitation centers are located in different regions of Russia - you can always choose the one that is convenient for you from a geographic point of view. Most centers operate in large cities, regional and district centers.

Rehabilitation centers in the Moscow region operate in most satellite cities and in all administrative centers of districts of the Moscow region. We try to open our new complexes in those places where the problem of the spread of drug addiction is especially acute, we interact a lot with the authorities so that our sites effectively help fight addiction.

Implementing its strategy in the field of combating drug addiction in Russia, First Step holds a significant number of publicly available regional and city events, open days, open lectures and seminars. In addition, we conduct active educational activities, develop several large information projects at once in the field of combating drug addiction and alcoholism, combating drug trafficking.

How is drug addiction treatment

Drug addiction treatment in First Step rehabilitation centers takes place in three main stages. Let's take a closer look at each of them.

Drug addiction treatment

The first stage is drug addiction treatment. It begins with detoxification, during which all harmful substances accumulated during drug use. Further, the treatment itself begins. The task of the narcologist at this stage is to restore the natural functions of the patient's body.

Narcotic drugs (surfactants) replace substances and hubbubs produced in the body healthy person... The body of the addict quickly gets used to receiving them ready-made, in significant doses. Speaking simple language, the body begins to be "lazy" and gradually "forgets" how to produce substances on its own.

With the help of droppers and vaccinations, as well as accompanying therapeutic procedures, the doctor restores the body's ability to produce everything it needs on its own. Chemical dependence on drugs is gradually disappearing, the human body itself ceases to require the next dose of psychoactive substances.

Rehabilitation of drug addicts

After completing the course drug treatment and finally getting rid of chemical addiction, there is still a psychological one - even more complex. It remains to cope with it. At this stage, work is carried out with the patient's consciousness, his inner world, with a system of values and moral principles.

The first task of a psychologist is to find hidden reasons that prompted a person to try drugs, find out exactly what he was trying to escape into the world of altered consciousness. Next, the doctor will step by step build new life priorities for a recovering drug addict, help to sort out relationships with friends and relatives, find their place in society, in life in general.

Rehabilitation is the longest stage associated with big amount work with a psychologist. Personal consultations and confidential conversations alternate with group therapy sessions, psychological trainings and games. During joint classes, recovering drug addicts learn to interact with each other, restore the basic social skills necessary for normal, a fulfilling life after being discharged from the clinic or after completing an outpatient drug addiction treatment course.

It is very important that those who live under the same roof with a recovering drug addict undergo at least a small consultation with a psychologist. Often old domestic grievances are the root cause of addiction. In Russia, unfortunately, it is not customary to regularly consult with a home (family) psychologist - as a result, many grievances and misunderstandings drag on for decades.

Socialization of drug addicts

One of the important parts of a successful drug addiction fight is effective program socialization of drug addicts. Unfortunately, in the overwhelming majority of Russian drug treatment clinics(both public and private) is not given due attention to this, and often - and no one is given at all. After discharge, most patients are left to their own devices, which is why they very quickly return to the ranks of drug addicts, and then either to the clinic or under investigation.

Unfortunately, Russian society is not yet ready to have any tolerance towards recovering drug addicts, even those who have undergone a course of treatment and long-term rehabilitation in a specialized center. At the same time, most of the graduates of clinics are completely ready for a normal life, they are not dangerous to society. In these conditions, it is very important that the family, labor collective and the immediate environment were appropriately prepared for the return of the person after treatment and rehabilitation.

Socialization problems are less relevant for the majority of those undergoing outpatient drug addiction treatment. As a rule, such patients do not fall out of the existing environment - they remain socialized throughout the course of treatment and rehabilitation. However, if the psychologist sees such a need, our convalescent re-socialization program is, of course, also available to outpatients.

Anti-drug hotline

If you are in doubt as to whether and to a loved one outpatient drug addiction treatment, call us at the hotline of the First Step rehabilitation centers network. Experienced specialists will help you weigh the pros and cons that are relevant specifically for your family. This will help you make the right decision and heal a stumbled relative faster, cheaper and safer for his own health.

A person who has started taking drugs can no longer help himself on his own. He seems to have stepped off a cliff and is flying into the abyss. The only thing he can do is shout and call for help. It is very important that his call is heard. First of all - his family and friends, friends and caring colleagues. The sooner the treatment begins, the faster and more efficiently it will pass.

First Step aid centers will provide comfortable living, truly effective treatment and rehabilitation. You can get rid of drug addiction. The main thing is to promptly apply for a professional medical help... If the patient does not agree to undergo treatment, we will help you to accurately and competently explain to him the reasons why a person should really agree to go to a clinic or undergo outpatient drug addiction treatment.

A significant number of patients with gynecological diseases should be treated on an outpatient basis. The leading role in the implementation of this task of improving the health of the female population belongs to antenatal clinics, medical and sanitary units at work and feldsher-obstetric centers in the countryside.

The structure of outpatient clinics is determined by a number of ethnographic factors, the conditions of production in which women work, and therefore the number service personnel may vary depending on them. The general and main condition of all outpatient gynecological institutions is their prophylactic orientation, and, consequently, early detection gynecological diseases, the desire to accurate diagnosis, development and implementation of targeted therapy in the category of patients who can be treated outside the hospital.

A gynecologist working on an outpatient basis must be highly qualified, since he is responsible for correctness primary diagnosis and developing the most effective treatment... That is why doctors of antenatal clinics should know the mechanisms of development of one or another pathology of the female genital organs, have a good command of modern methods diagnosis and treatment.

In the process of examining patients, along with well-known and long-rooted methods in the practice of gynecologists, it is necessary to widely introduce such methods as bacteriological, cytological, hormonal (the degree of estrogenicity, a symptom of crystallization of mucus from the cervical canal, pupil, biological reactions to chorionic gonadotropin, etc.), widely conduct biochemical research in liquid media... Naturally, the appropriate examination of patients should be reasonable, taking into account the indications.

In some cases, it becomes necessary to consult related specialists: endocrinologist, urologist, therapist, neuropathologist, etc.

Large specific gravity among the patients is a group of women with menstrual dysfunction.

The vast majority of them should be treated on an outpatient basis. These patients require particularly careful and careful examination, without which the development of targeted treatment is impossible. They have within 1-2 menstrual cycles it is necessary to study the estrogen level, basal temperature, other indicators and only after that start treatment, individual in each case.

Concerning the treatment of patients with chronic inflammatory processes genitals, it must be remembered that it must be carried out with the registration and under the strict control of bacterioscopic and bacteriological data. Treatment should be comprehensive and include components aimed at various links of the pathological process (disinfectants, protein irritants, vitamins, desensitizing agents, physical methods, and, if necessary, hormones, etc.).

A special group is occupied by patients suffering from infertility. It is highly desirable, especially in large antenatal clinics, to entrust their treatment to one doctor, and allocate separate hours for the appointment. After a thorough examination, including a study of semen from a sexual partner, hormonal, bacterioscopic and bacteriological data, determination of patency fallopian tubes, the doctor starts treatment. Infertility therapy should be built depending on the etiological factor.

In the complex method of treatment of these nosological forms of gynecological diseases, an important place belongs to physical methods, which in some cases are irreplaceable in their effect.

IN last years great importance acquire new hormonal drugs... This is very important, as new opportunities for effective treatment of these patients appear. However, it must be remembered that the appointment of hormones should not be routine and should always be carried out taking into account the hormonal profile of each patient. Otherwise, their appointment can cause great harm.

Working in the gynecological office at the medical and sanitary units, the obstetrician-gynecologist, along with his usual work, must study the working conditions and their influence on the condition of the genital organs in women, and, if necessary, carry out the appropriate correction to reduce and eliminate them.

A large role in the improvement of the female population belongs to the clinical examination, which should be done on a daily basis. medical workers at all levels of outpatient gynecological institutions. In their work, these institutions should be constantly connected with the anti-tuberculosis, venereal and oncological dispensaries, as well as with the district polyclinic.

The documentation in them is carried out according to a single principle, taking into account all the data on the work carried out, and should be extremely clear, specific and at the same time concise.

In the center of attention of doctors of antenatal clinics is sanitary and educational work, in the process of which the preventive principle of Soviet medicine should be reflected.