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MINISTERUL SNTII

AL REPUBLICII MOLDOVA

ORDIN
mun. Chiinu
_05___februarie___2010

Nr. ____79_____

Cu privire la aprobarea
unor formulare statistice
n temeiul Legii nr. 10-XVI din 03 februarie 2009 privind supravegherea de stat
a sntii publice (Monitorul Oficial al Republicii Moldova, 2009, nr. 67, art. 183) i
n scopul sistematizrii, ntocmirii i utilizrii documentaiei de eviden medical i
controlului aplicrii sanciunilor administrative, n legtur cu intrarea n vigoare a
noului Cod Contravenional, precum i n temeiul p.8 al Regulamentului privind
organizarea i funcionarea Ministerului Sntii, aprobat prin Hotrrea Guvernului
nr.777 din 27 noiembrie 2009 (Monitorul Oficial al Republicii Moldova, 2009,
nr.173, art. 855),
ORDON :
1. Se aprob:
1) Formularul statistic: Hotrrea privind interzicerea/suspendarea, F nr.306/e
2) Formularul statistic: Proces-verbal cu privire la contravenie, F nr. 309/e;
3) Formularul statistic: Prescripie sanitar, F nr. 310/e;
2. Directorul general al Centrului Naional tiinifico-Practic de Medicin
Preventiv (O. Bene), medicii efi ai Centrelor de Medicin Preventiv municipale i
raionale:
1) vor pune n aplicare, ncepnd cu data de 01.03.2010, formularele statistice de
eviden medical, aprobate prin prezentul ordin;
2) vor interzice utilizarea, dup data de 01.03.2010 a formularelor statistice de
model vechi i a celor care nu sunt aprobate de Ministerul Sntii.
3. Se abrog Ordinul Ministerului Sntii nr. 508 din 08.12.2006 cu privire la
aprobarea unor formulare statistice de constrngere administrativ i formularul nr.
306/e Hotrrea privind interzicerea, suspendarea, aprobat prin Ordinul
Ministerului Sntii nr. 139 din 28.05.2002 cu privire la aprobarea formularelor de
eviden medical primar din instituiile medicale.
Controlul ndeplinirii ordinului se atribuie dlui Mihai Magdei, viceministru.
Ministru

Vladimir HOTINEANU

MINISTERUL SNTII
AL REPUBLICII MOLDOVA

ORDIN
mun. Chiinu
_________________2010

Nr. ___________



10-XVI 3 2009
(
, 2009, 67, . 183) ,

,
, .8

777 27 2009 (
M , 2009, 173, . 855),
:
1. :
1)
:

/
, F 306/e;
2) : , F 309/e;
3) : , F 310/e;
2. -
(. O. ),
:
1) , 01.03.2010,
, ;
2) , 01.03.2010
, ,
.
3. 508 08.12.2006

306/e ,
,
139 28.05.2002
.
.
, .

Ministerul Sntii al Republicii Moldova

DOCUMENTAIE MEDICAL
Formular
Nr. 306/e

Serviciul de Supraveghere de Stat a Sntii Publice



________________________________________

Aprobat de MS al RM

denumirea instituiei, adresa, telefon


, ,

HOTRRE Nr ______

PRIVIND INTERZICEREA / SUSPENDAREA


,

Din " _____" ________________________20 ___

Eu, medic-ef sanitar de stat al______________________________________________________________


,

___________________________________________________________________________________________
denumirea teritoriului administrat /

____________________________________________________________________________________________________
numele, prenumele, patronimicul / ..

examinnd documentele controlului sanitaro-igienic (investigaiilor) ____________________________


- ()

___________________________________________________________________________________________
denumirea obiectivului, adresa amplasrii / ,

___________________________________________________________________________________________
denumirea documentelor /

am stabilit _________________________________________________________________________________

_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
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_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
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_______________________________________________________________
_______________________________________________________________
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_______________________________________________________________

_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
n baza art.17, 67 din Legea privind supravegherea de stat a sntii publice nr.10-XVI din
03.02.2009, (Monitorul Oficial al Republicii Moldova, 2009, nr.67, art.183)
. 17, 67
03.02.2009 ( , 2009, 67, . 183)

10-XVI

HOTRSC:
:

A suspenda / a interzice _______________________________________________________________


,

din ____ __________________20______

pn la nlturarea nclcrilor constatate i conformarea unitii economice legislaiei sanitare n


vigoare

Concomitent, se suspend valabilitatea autorizaiei sanitare de funcionare nr. _____din _________


,

Rspunderea pentru ndeplinirea prezentei hotrri se atribuie _______________________________


____________________________________________________________________________________________
numele, prenumele, funcia / ..

Hotrrea de suspendare a activitii unitii economice poate fi atacat n instana de judecat,


potrivit legislaiei n vigoare

Medic-ef sanitar de Stat al _______________________________________________________________



L.
..

denumirea teritoriului administrat

________________________________________________________

_________________________________________________________
_________________________________________________________
semntura /

Hotrrea a primit-o ______________________________________________________________________


numele, prenumele, patronimicul, funcia / ..,

___________________________________________________________________________________________________

"_______" ______________________20___
Hotrrea a fost emis n _________ exemplare

1._______________________________________________

3.____________________________________________

2._______________________________________________

4.____________________________________________

REPUBLICA MOLDOVA
MINISTERUL SNTII
SERVICIUL DE SUPRAVEGHERE DE
STAT A SNTII PUBLICE

DOCUMENTAIE MEDICAL
Formular nr. 309/e
Aprobat de MS al RM
PROCES-VERBAL
cu privire la contravenie

________________________________________

din ____ ________ 20___

locul ncheierii /

Subsemnatul (a) ___________________________________________________________________________

numele, prenumele, patronimicul / ...

n calitate de _______________________________________ al ____________________________________


funcia /

denumirea autoritii pe care o reprezint /

n prezena:

Persoana fizic/persoana cu funcie de rspundere __________________________________, data naterii


/

numele, prenumele, patronimicul / ...

________________, locul naterii ___________________________________, buletin de identitate seria ___


nr. _________, eliberat de oficiul ________ la data de ___________, IDNP _________________, domiciliul

_________________________________________________________, locul de munc __________________


________________________ funcia __________________________________________________________

n conformitate cu cerinele art. 443 al Codului contravenional al Republicii Moldova, am ntocmit


prezentul proces-verbal
. 443

n timpul supravegherii de stat a sntii publice a _____________________________________________


denumirea, adresa juridic a obiectului verificat, IDNO/

_________________________________________________________________________________________
, ,

_________________________________________________________________________________________
Am constatat, la data de________________, ora ________:

_________________________________________________________________________________________
fapta contravenional, locul i timpul svririi, esena contraveniei / oe , , ,

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Semntura: ___________

gent constatator

___________

___________

ontravenient

victima (cnd exist)


( )

__________ __________
martor

martor

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
prin care se ncalc ________________________________________________________________________

actul normativ /

ce constituie contravenie, prevzut de art. ________ din Codul Contravenional al Republicii Moldova

Conform prevederilor Codului Contravenional al Republicii Moldova, nclcarea art. _____________ se


, .,

sancioneaz cu amend: de la ____ pn la _____ u.c. pentru persoana fizic,


:

..

de la ____ pn la _____ u.c. pentru persoana cu funcie de rspundere,

..

de la ____ pn la _____ u.c. pentru persoana juridic.


o

..

Drepturile i obligaiile prevzute de art. 34, 378, 384, 387 i 448 a Codului contravenional al Republicii
Moldova, precum i dreptul de a plti jumtate din amend, dac amenda este pltit n cel mult 72 de
ore de la stabilirea ei, i-au fost explicate contravenientului ________________________________________
semntura /

, . 34, 378, 384 387 448 ,


72
, .

Contravenientul nu este prezent sau refuz s semneze:_______________________________________


__________________________________________________________________________________
Martorii __________________________________________________________________________________

numele, prenumele, datele din buletinul de identitate/ ..,

_________________________________________________________________________________________
_________________________________________________________________________________________
Obieciile i probele contravenientului i ale victimei (dac exist)_______________________________
( )

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
La procesul-verbal se anexeaz: ______________________________________________________________

_________________________________________________________________________________________
Examinarea cazului va avea loc la____________________________________________________________

denumirea, adresa juridic a instituiei / ,

data _______________ ora ___________

Semntura ___________

___________

ontravenient

gent constatator

___________
victima (cnd exist)
( )

__________
martor

_________
martor

DECIZIE
innd seama de faptele svrite i apreciind existena de date suficiente pentru constatarea
contraveniei prevzute de art. ___________________ al Codului contravenional al Republicii Moldova,
, . ___________________________

Urmeaz a fi tras la rspundere persoana fizic/persoana juridic/persoana cu funcie de rspundere


//

__________________________________________________________________________________
numele, prenumele, patronimicul /denumirea, datele persoanei fizice care o reprezint / .. / ,

_________________________________________________________________________________________
n calitate de ______________________________________________________________________________

Data naterii_______________locul naterii ________________________cod fiscal____________________


Domiciliul/sediul(adresa juridic)____________________________________________________________
/

_________________________________________________________________________________________
Conform prevederilor Codului contravenional al Republicii Moldova, art. _________________
a , .

A aplica contravenientului amend n sum de_________________ MDL


Amenda se va achita la Banca _______________________________________________________________


n termen de 30 zile de la comunicare, urmnd ca n acelai termen s se prezinte bonul de plat la CMP
teritorial
30 ,

_________________________________________________________________________________________
localitatea, str., nr./ , ., .

Contestarea procesului-verbal cu privire la contravenie (inclusiv i a Deciziei) se face n instana de


judecat, n termen de 15 zile de la data comunicrii acestuia.
, 15- .

Medic-ef sanitar de stat al ______________________________________


_________________________

raionul/municipiul / /

L..
..

Am primit un exemplar ______________________

data ______________

semntura /

numele, prenumele/ ...

Ministerul Sntii al Republicii Moldova


Serviciul de Supraveghere de Stat a Sntii Publice



________________________________________
denumirea instituiei, adresa, telefon
, ,

DOCUMENTAIE MEDICAL

Formular

Nr. 310/e

Aprobat de MS al RM

PRESCRIPIE SANITAR

din _____ __________20____

Eu, medic ef sanitar de stat al______________________________________________________


, , teritoriul administrat, numele i prenumele / , ,

am verificat executarea prevederilor Legii nr.10-XVI din 03.02.2009 privind supravegherea de stat a
sntii publice i a actelor normative n vigoare ce prevd reglementri din domeniul sntii publice,
efectuat la,
10-XVI 03.02.2009
, ,

___________________________________________________________________________________
denumirea obiectivului, adresa amplasrii / ,
___________________________________________________________________________________

______________________________________________________________
Ca rezultat al controlului s-au constatat urmtoarele_____________________________________________

___________________________________________________________________________________

______________________________________________________________
se vor expune clar i n mod succesiv neajunsurile i nclcrile constatate

___________________________________________________________________________________

___________________________________________________________________________________

______________________________________________________________
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______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
n contextul celor constatate i n scopul remedierii deficienelor,____________________________
,

______________________________________________________________
se indic numele i prenumele persoanei responsabile, funcia / ,

___________________________________________________________________________________

SE PRESCRIE

n temeiul art. 17 alin.(2) p.7 ___________________________________________________________


.17 .(2) .7
se specific msurile pentru nlturarea neajunsurilor, nclcrilor depistate, conform prevederilor legale

______________________________________________________________
,

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Termenul de nlturare a neajunsurilor constatate ________________________________________

___________________________________________________________________________________
n cazul neexecutrii prescripiei n termenul stabilit se vor aplica msuri legale de
constrngere, potrivit legislaiei n vigoare.

, .

Prescripia este ntocmit n _____ exemplare i nmnat persoanelor responsabile, la data de


________________ 20____
____________ ,
_________________20____

Prescripia a fost primit_____________________________________________________________


numele persoanei responsabile, semntura / ,

Medic ef sanitar de stat al


__________________________________________
teritoriul administrat, semntura / ,