Disability certificate: sample form and design rules

The correct execution of the certificate of incapacity for work (according to the model) is the key to paying for the time that a person was on sick leave. If the sheet is not filled out correctly, this can cause a variety of consequences. In some cases, the employer pays the employee an allowance, according to a sheet of temporary disability, a sample of which can be found in the article, and then collects this money from the Social Insurance Fund. In other cases, the employee does not receive benefits for incorrectly filled sick leave sheets, and therefore sues the employer.

General information

Since 2011, a unified sample of temporary disability certificate has been adopted on Russian territory. This sheet has several degrees of special protection against copying or counterfeiting. Since two thousand and eleven, this form has not changed.

Clean sick leave

A certificate of incapacity for work is filled out on the model of the employer and the medical organization that issued it.

Since two thousand of the seventeenth year, medical institutions began to issue sick leave in two forms: in paper and electronic. The sample of the disability certificate is the same in both cases.

The color of the form in paper form is blue. A sample of a maternity and sickness certificate includes a column to fill out with pale yellow cells for each letter and number. Protection against fakes are watermarks.

A sample disability certificate includes the reverse side reserved for explanatory information, on which the rules for filling out the form and the procedure for entering information into the document are defined.

A sample of a maternity and sickness certificate has a large logo of the Federal Social Service of the Russian Federation as a protective watermark. The increased degree of protection against fakes - assignment to sheets of arbitrary numbers. According to the sample form of the certificate of incapacity for work, the number of the sick leave is located in the upper right corner and consists of twelve digits and a bar code.

Rules for filling in sick leave

A sample of how to fill out a disability certificate by an employer and a medical organization located above includes filling in each of the sides of their fields for entering the necessary information. The employee to whom the sick leave is issued does not record any data in it.

According to the model of a certificate of incapacity for work by pregnancy or illness, the employee puts only a signature on the sick-list, and then transfers the document to the employer. For their part, accounting and personnel enter the necessary information into the columns. Then the employer sends the sheet to the Federal Social Service.

Having received the completed sick leave, the Social Insurance Fund transfers the amount of temporary disability benefits calculated by the accounting department to the current account indicated by the employer organization, which transfers it to the employee.

Woman with sick leave

Each moment of visiting a medical institution with an increase in the period of the period of loss of working capacity is recorded in the certificate of disability. A sample of such records is in every organization. A note on the extension of sick leave is a mandatory requirement. If all the columns are filled out, and the sick-list is not finished yet, the doctor must give the patient an additional sick-list. After the sick leave, the employee receives the last sheet in which the doctor puts down all the key dates - from the opening date to the sick leave date.

Basic information recorded in the sick-list is entered into the sheet using codes. According to the sample, how to fill out a certificate of incapacity for work by the employer and the medical organization, the front part of the hospital includes three parts: for the attending physician, for the employer and the detachable part of the form for internal reporting of the medical organization.

Due to the fact that the input data is read by a special program automatically. Therefore, if you allow corrections in the certificate of incapacity for work when filling out the form with a medical institution or employer, these typos will not allow the electronic device to process the sheet.

If mistakes are made in filling out one of the parties in the sheet, such a form shall be recognized by the FSS as invalid. The Fund, in turn, refuses the employee to pay benefits, but the employer is obliged to compensate the employee for it, since violations were committed on his part. If errors were made by the medical organization, she is obliged to assume the costs of payment.

The procedure for registration of a hospital medical organization

All sick leave certificates after their issuance are recorded in the journal. There is no single sample of the journal of sick leave certificates. The main requirement is to indicate his number, name of patient with signature and date of issue. But the design of the sick leave has certain requirements.

The first points on the sick leave are filled in by the medical organization that issued it. Filling features include nine points:

  1. One of two concepts is indicated: “primary sick leave” or “duplicate”. This inscription should be located at the top of the disability sheet (near the number and barcode). If this sheet is a duplicate of the lost one, the number of the lost sick leave is put down after the word "duplicate". If several sick leave were issued during a long illness, each subsequent one contains the number of the previous sheet. If both the “primary sick leave” and the “duplicate” are indicated on the sick leave, such a sheet will be considered invalid.
  2. The address and full name of the medical organization are recorded. Words should be separated with numbers in one empty cell. In the event that the name is long and does not fit completely in the allotted lines, some words can be shortened.
  3. The date of issue of the hospital form and the main registration state number of the medical organization (PSRN) are indicated. Indication of the registration number is necessary so that in the event of a reduction in the name of the institution, its full name can be found out. Legal entities have a thirteen-digit number, individual entrepreneurs - a fifteen-digit number.
  4. If the sick leave was issued to care for a sick family member, care information is filled out. It also indicates the age and degree of relationship of the sick relative and caregiver. When indicating the age, the total number of years is entered in the first two cells, and the total number of months in the second two. For children up to a year, only two second cells are filled, respectively.
  5. If the sick leave was issued due to the illness of the patient himself, information about this person (last name, first name, middle name, date of birth, gender) is filled out. Checking the correctness of the indication of this data is necessary. In some cases, instead of the date of birth, the opening date of the sick leave is indicated.

Then, SNILS and an individual tax number are indicated for the correct identification of the sick person. It also indicates the cause of the incapacity for work, according to the codes, the meaning of which is indicated on the back of the sick-list.

After this, it is necessary to indicate the type of workplace (basic or part-time work). This information is reported by the patient himself. This data is not subject to verification. If the patient indicates that he is working part-time, the number of the main disability sheet should be indicated there.

Filling sick leave

The name of the organization of the employer is indicated there (according to the name, which is fixed by the FSS and is indicated in the Charter documents). If the patient is not sure that he knows the correct name of his place of work, the medical institution does not indicate it (the personnel department of the organization puts the name instead). In most cases, doctors do not specifically fill out this field to avoid alteration of the sick leave in the event of an error.

  1. The next item is the period of dismissal from work. The corresponding table indicates the day of the beginning and end of the period of the disease. The name of the doctor is recorded on the same line, and then he puts the signature. If the doctor’s specialization includes long words, it, like the name of the institution, can be reduced.
  2. After filling out the table, the doctor indicates the date from which the patient can begin to work. When extending the sick-list, the “other” column is filled in, where the corresponding code and number of the next sick-list issued to the patient are affixed.
  3. After filling out all the necessary information at the bottom of the sheet, the doctor puts his signature and seal on the medical institution. The seal can be round, triangular or with the purpose “for disability sheets”. The main thing is that the name of the medical institution should be clearly visible on the press. In some cases, the use of seals or stamps on which the profile of the organization is not indicated is allowed. Such stamps are used by narcological or psychiatric organizations, as well as AIDS prevention and control centers, and other similar institutions (in order to preserve medical secrets).
  4. The last item is filling out the root of the sick leave. It is filled out by a doctor for internal reporting by a medical organization. The spine indicates the minimum amount of data from the above sections. The new information there will be the serial number of the medical history, the date of manufacture of the sick-list and the signature of the patient himself.

All information in the form of a certificate of incapacity for work or a duplicate of a sample is entered using a computer or in block letters. When filling out the form, only a fountain pen, gel pen or capillary pen of exclusively black color may be used. It is strictly forbidden to use a ballpoint pen to fill out a sick leave. It is also forbidden to make corrections, blots or errors.

Important information

According to the law, not all organizations providing medical care can draw up sick leave. This right is reserved exclusively to persons who have a license to engage in medical activities. This list includes the following groups of persons:

  • attending and dentists, as well as paramedics of medical institutions;
  • attending doctors of various clinics related to research institutes (this also includes the Research Institute of Prosthetics and Prosthetics).

The list of persons entitled to apply for sick leave does not include:

  • emergency rooms and blood transfusion stations;
  • emergency rooms of hospital medical institutions, mud clinics or medical organizations of a balneological type;
  • medical institutions with a special purpose (for example, a center for medical preventive work, catastrophic medicine, a forensic examination bureau, etc.);
  • healthcare organizations in the field of consumer rights protection.
FSS of the Russian Federation

An important feature of filling a sick leave is that the diagnosis is not completely prescribed in any part of the disability sheet. The doctor involved in the treatment puts down only the disease code, according to the diagnosis that was established in the patient.

Based on the affixed code, the accounting department of the employer enterprise establishes the amount of the temporary disability allowance provided to the employee.

The physician performing the treatment is required to enter the necessary information in each appropriate box on the form. Some cells may be unfilled if there is a reason for this (for example, if the patient was treated on an outpatient basis, your cells related to inpatient treatment are not filled. The same applies to cases where the patient was not referred for medical and social examination )

According to the rules, blank lines must be filled with dashes, but their absence is not considered an error. This is attributed to technical shortcomings, which does not affect the payment of sick leave.

Features of filling out an employer disability sheet

As in the case of a medical organization, there is no model for registering disability certificates for employers. Otherwise, the requirements for registration of their part by the employer are the same high.

Corrections in the sick leave

Since the employer is responsible for the payment of hospital benefits, he is entitled to make adjustments and corrections on his part of the form. According to the above sample, corrections in the certificate of incapacity for work by the employer are common. But the employer is not entitled to correct the data entered by the medical institution.

If, upon delivery of the sick leave to the organization, errors made by medical workers were found, this document is returned to the medical organization for replacement. If you do not require a replacement, an incorrectly completed document will not be accepted by the FSS, and therefore the employee will not receive the benefit.

It is important for the employer to verify that the time spent on sick leave meets the standards established by law.

Regulatory framework for leadership

The regulatory documents governing the execution of sick leave include the following documents:

Work with documents
  1. Letter from the FSS of the Russian Federation No. 14-03-11 / 15-8605 relating to the design of sick leave forms. Here is a sample registry of disability certificates.
  2. Letter from the FSS of the Russian Federation No. 14-03-18 / 15-12956 explaining certain provisions of the Procedure for issuing sick leave.
  3. Letter from the FSS of the Russian Federation No. 14-03-11 / 15-16055 explaining the issues that arise when filling out sick leave.

The procedure for filling in sick leave by the employer

Filling includes nine stages:

  • information about the organization (full name, acronym or abbreviation);
  • type of work (main or part-time);
  • the main registration state number of the organization indicated in the FSS, as well as the code of subordination;
  • individual tax number and SNILS of the employee;
  • calculation of seniority;
  • filling in column H-1 (if the sick-list was opened due to an industrial injury received by an employee);
  • first working day after sick leave;
  • information about the salary of the employee (calculation of average and average daily earnings). The first three days are paid by the employer, another FSS;
  • signature of the head and seal of the organization.

Along with the sick leave, the accounting department sends to the FSS an accounting statement with the calculation of the accrued benefits. The work experience of the employee, his average monthly and average daily earnings, the amount of salary, allowances, and a report card are also indicated there.

If the parties cooperate under a fixed-term contract for a period of up to six months, code 46 is indicated, which means that the payment of benefits will be made no more than seventy-five days of the contract.

If, when checking a sick leave accountant found a mistake made in his calculations, he can fix it. More than two corrections in the document are not allowed.

Important requirements for the employer

Filling the sick leave by the employer is allowed, as with a medical organization, not with a black ballpoint pen or using a computer. These options in one document can be combined if the medical institution has a program for filling sick leave, but the organization does not.

The employer must fill out a disability sheet no later than ten business days after receipt from the employee. The employer can pay employee benefits. Then send a document to the FSS is not necessary.

Sick leave calculation

In the event that the employer wanted to receive compensation from the Social Insurance Fund for payment, he is obliged to send a sick leave there.

Filling tips

Since the FSS does not pay for incorrectly completed documents, both parties must correctly enter all the data.

If one of the parties has questions about how to fill out any cell (column), you need to see the explanations in the regulatory legal acts.

The law also allows you to seek help or advice from FSS employees. Recommendations can be obtained verbally or in writing.

Frequently made errors on the disability sheet

The most common mistakes are only five. These include:

  1. Printing touches the information indicated in the cells, which complicates the reading of data by the computer and slows down the process of paying benefits.
  2. The document is folded in half or wrinkled.
  3. Exceeding the fifteen-day period of incapacity for work is carried out by the doctor himself, although in this case only the medical commission can extend the sick-list.
  4. Only the doctor’s data are indicated, although it is necessary to specify the details with the signature of the head of the medical institution.
  5. No signature or stamp of one of the persons.

Examples of registration of a disability certificate and rules can be found in the article. Therefore, to prevent the occurrence of errors, it is best to study them, since the correct filling of the disability sheet is the key to quickly receiving accrued benefits.

Source: https://habr.com/ru/post/E821/


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