Arranges mandatory examinations, referrals and lists; for periodic examinations, establishes an internal attendance schedule and completion monitoring.
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No. dated · Medical organization, license and contract: . Under Article 220 of the Labor Code of the Russian Federation (ТК РФ) and the Procedure approved by Order of the Ministry of Health of Russia of 28.01.2021 No. 29n (29н), I hereby order: Arrange periodic medical examinations for employees on the named list at , . Ground: the calendar plan developed by the medical organization, agreed with the employer and approved by the medical organization's head: . Approve an internal attendance schedule consistent with that calendar plan:
| No. | Employee / group | Unit | Attendance date / time | Location / room | Note |
The schedule is introduced for the first time. Coordinator: , . Check referrals, named lists and consistency of dates. Ensure the approved named list is sent to the medical organization at least two months before the agreed examination start date; use a different period only on a ground provided by paragraph 24 of Procedure No. 29n. Send a copy of this order to the medical organization to arrange attendance. Familiarize employees with the calendar plan at least 10 working days before the agreed start of periodic examinations; communicate any changes in good time. Unit heads shall ensure attendance and release employees from work for mandatory examinations. The employer bears examination costs; statutory guarantees shall be maintained. Monitor receipt of medical examination conclusions and completion of examinations. In the event of non-completion or contraindications, decide on authorization to work under the prescribed procedure; do not include diagnoses in the schedule. This order establishes the employer's attendance arrangements and does not replace approval of the calendar plan by the medical organization's head. I retain oversight.
__________ / /
Persons acquainted with the order (personal signatures and dates):
Obtain the final report under the prescribed procedure and determine the necessary measures without including diagnoses in generally accessible documents. Specific arrangements: .
| Measure | Basis without diagnosis | Person responsible | Deadline | Evidence of implementation |
| No. | Occupation / position | Department | Factor / type of work | Item in the applicable list | Frequency / examination type |
Grounds are checked against the current lists, working condition assessment results and work performed; diagnoses are not included in the list.
| Full name / date of birth | Occupation / position | Department | Factors / types of work | Length of service in this work | Additional details under the procedure |
The list is approved and sent to the medical organization separately; access is restricted. This form supplements the details of the appendix .
This is a draft template. Before signing, check that it is completed correctly, that its terms apply and that it meets current legislative requirements; consult an appropriate specialist where necessary.
10 of 23 fields are taken from the company, employee or counterparty record, the questionnaire can be dictated to the AI, and the finished document comes with a number, a PDF and an acknowledgement record.