1. When residents in the jurisdiction receive services in community health service centers (stations), township hospitals and village health stations, medical personnel are responsible for establishing residents' health records for them, and filling in corresponding records according to their main health problems and service provision. At the same time, fill in and issue resident health record information cards for the clients.
2. Through on-site service (investigation), disease screening and health examination, community health service centers (stations), township hospitals and village health stations organize medical personnel to establish health records for residents, and fill in corresponding records according to their main health problems and health service needs.
3. The relevant record forms of health records established in the process of medical and health services shall be incorporated into the unified custody of residents' health records. In rural areas, it can be stored centrally in families. Conditional area input computer, the establishment of electronic health records.
Use of health records.
1. Residents who have filed files should hold the residents' health record information card when they go to the primary medical and health service institutions for follow-up. After obtaining their health records, the attending doctor will update and supplement the corresponding records in time according to the follow-up situation.
2. When carrying out home medical and health services, you should consult the health records of the clients in advance and carry the corresponding forms, and record and supplement the corresponding contents in the service process.
3. For clients who need referral and consultation, the attending doctor should fill in the referral and consultation records.
4. All service records shall be uniformly summarized and filed in time by the responsible medical personnel or file management personnel.
5. The establishment of rural residents' health records can be combined with the new rural cooperative medical system.