LEARNING GUIDE FOR THE DEVELOPMENT OF TRAINING

GUIDE IDENTIFICATION
TRAINING PROGRAM Nursing assistant
LEARNING UNIT User Admission
GUARANTEED TEACHER José Misael Ortega Daza
LEARNING OUTCOMES

Use technical language in nursing notes according to current regulations.

Identify those responsible for paying for the provision of health services.
Adequately manage administrative supports for care in accordance with institutional processes.
Record user information in accordance with the processes and procedures manual.
Identify the needs and expectations of users in accordance with institutional policy.
Identify the types of assurance to provide truthful and efficient information to the user.
Describe the benefit plans allowing the user to understand the benefits, duties and rights it provides them.
Recognize health standards regarding the Billing system, RIPS and criminal, civil and ethical liability since you must
carry out actions pertinent to your profession.
Identify the institutional procedures for the priority survey in this way to provide efficient information to the user.
Recognize and explain to users the health regulations regarding SISBEN, co-payments, moderator fee, senior citizen
program, Displaced Persons Law so that they understand the benefits, duties and rights in health.

ASSOCIATED KNOWLEDGE

Session 1: INTRODUCTION TO USER ADMISSION, TECHNICAL LANGUAGE

USER ADMISSION ("Admissions")

It is the integrated set of procedures through which the institution welcomes the user to offer them the services they require.
It is usually carried out by the ADMISSIONS service or office in hospitals. At this stage the user is identified and their
affiliation to an insurer or EPS or to the subsidized Regime is verified. That is why it is a shared responsibility between
nursing, administrative staff and the admissions office.

The functions of the nursing staff in this process are:

1. Greet the user cordially and introduce yourself
2. Receive the patient's medical history (if you already have it) and the hospitalization order. If the patient does not
 have a medical history, it is opened by the admissions office, assigning a number and folder. Nursing is responsible
for filling out all the administrative data on the sheets (admission sheet, etc.) recording: names and surnames, age,
address, telephone number, etc.
3. Make the patient comfortable
Provide information to the patient and family about: Healthcare services offered by the institution, professionals who
provide services, hours of operation, requirements for care, costs, rights and duties of users, instructions and special
care for procedures.
4. Be kind to the user, clarify all their doubts, giving them confidence to encourage their adaptation and count on their
collaboration.

IF THE ADMISSION IS TO HOSPITALIZE THE PATIENT OR LEAVE THE PATIENT UNDER OBSERVATION IN
THE EMERGENCY SERVICE:
 In addition to the previous activities, you must also:
1. Assign a unit to the patient
2. Explain the hospital regulations to the user and family: visiting hours, telephone use, food, prohibitions, etc.
3. Prepare an inventory of the unit's elements together with the user and family
4. In some cases, giving the patient a gown if warranted or if it is the norm of the institution.
5. Inform the doctor about the
admission
6. Take vital signs, assess the
patient's general conditions
7. Record the above data on the
corresponding sheets of the
medical history: vital signs
sheet, NURSING NOTES. Also
mark the heading of the rest of
the pages of the story with:
names and surnames, service,
bed.

TYPES OF INCOME OR ADMISSION:

1. EXTERNAL: external admission or

admission occurs when the user
arrives at the institution from an
external consultation (general,
specialized medical consultation)
or is referred from another
institution
2. EMERGENCIES: When the user
enters the emergency service in search of immediate medical attention necessary to avoid death or disability.
3. TRANSFER: occurs when within the same institution the patient is sent to another service to remain there according
to medical orders. In this case, the patient enters the new service with medical orders and clinical records (medical
history) generated in the service from which he or she comes. Before carrying out this transfer, it is the nursing
function to previously verify the availability of a bed and other resources necessary to care for the patient.
 DISCHARGE OF THE PATIENT OR DISCHARGE OF THE PATIENT

Procedure by which the patient is prepared and helped with everything necessary for leaving the hospital or transferring
him to another service.

HIGH TYPES:

1. BY IMPROVEMENT: it is carried out when according to medical concept it is considered that the patient's state of
health has been restored
2. VOLUNTARY: Occurs when, by the patient's own decision, departure is authorized even against medical advice. In
these cases, the patient or their family members are required to sign their free and express wish to leave on a sheet
printed by the hospital, releasing the doctor, health personnel and hospital from responsibility for harmful
consequences that occur to the patient.
3. TRANSFER: when the patient is transferred to another service within the same institution. In this case, the
admissions or billing office must be informed so that the collection account for all procedures, hospitalization time,
supplies, etc. can be made. consumed in this service.

When transferring the patient to another service, the following must be done:

1. Previously notify the other service to prepare your arrival and have all the necessary resources available.
2. Explain to the patient and family the reason for the transfer
3. Verify that the signed medical order exists
4. Prepare all the patient's belongings as well as medical history, X-rays, medication cards, medications that are
being administered
5. Take the patient to their new service and unit. Hand over the patient (as a shift handover) to the head of the
service and other nursing staff
 4. REFERRAL: Occurs when the patient is sent to another institution that may have a higher or lower level of care
depending on the medical concept. In this case, nursing must ensure that there is a signed medical referral order
and the hospital discharge form.
Prior to the referral, the person in charge of the institution (head nurse or user service) will establish contact with the
other institution to guarantee normality in the process and that they have all the resources to care for the user.
The patient will be sent with a medical referral order, a summary of the medical history prepared by the doctor, X-
ray results and other documents that are warranted.

5. LEAKAGE : Discharge of the patient without approval or written order authorized by health personnel

PROCESS THE DEPARTURE OF THE PATIENT .

Guarantee that the user does not leave the Hospital Institution without having complied with all administrative obligations.
For the above to be fulfilled:
1. The cashier issues a peace of mind when it has been guaranteed that the user complies with all the administrative
requirements of the case.
2. The Head Nurse of the Service or the Assistant must prevent the patient from leaving without authorization. To do
this, sign the respective peace and safe agreement.
3. The institution's doorman also intervenes in the control: he verifies that the user has a valid peace of mind and
signed by the Head Nurse or the Assistant.
4. The doorman collects the notes to compare them with the number of expenses and the amount of invoices. Thus,
keep track of leaks

CLINICAL RECORDS TO BE MADE ON THE ADMISSION AND DISCHARGE OF THE PATIENT BY NURSING

Nursing must keep a record of some documents at the time of admission and discharge of patients, namely:
1. Heading of all sheets of the medical history corresponding to: identification data such as: name and surname,
service, bed, Medical History No.
2. Heading of the identification data on the entry or admission sheet
3. Patient registration in the service's income book (each service has one)
4. You must record vital signs on the appropriate sheet, make nursing notes , record medications if placed, and your
medication cards.
5. Start recording in the fluid and neurological control sheet if the patient warrants it.
6. Upon discharge of the patient, the nurse must verify that all the medical history sheets are completely filled out in
their headings, make exit nursing notes and fill out the patient discharge book from the service. In addition, the other
 records that the institution requires

NURSING ACTIVITIES TO PERFORM WHEN THE PATIENT IS DISCHARGED OR REFERRED

1. The discharge order and/or the referral form duly completed by the doctor must be corroborated
2. Inform the social work and admissions office about the patient's transfer or discharge
3. Notify the patient and family of the discharge or the reason and place of referral if this is the case
4. Coordinate with the institution to which the patient is referred (in case of referral)
5. Take vital signs and final review of the patient
6. Make detailed nursing notes
7. Guide the family on the steps to follow for discharge or referral as the case may be.

REGIME OF REFERENCE AND COUNTER REFERENCE. LEGAL FRAMEWORK

DECREE NUMBER 2759 OF 1991

(December 11)

Article 2. OF THE DEFINITION. The Reference and Counter-Reference Regime is the Set of Technical and Administrative
Standards that allow the health service to be adequately provided to the user, according to the level of care and degree of
complexity of the health organizations with due timeliness and effectiveness.
OF THE PURPOSE. The purpose of the Reference and Counter-Reference Regime is to facilitate timely and
comprehensive care for the user, universal access of the population to the level of technology required, and to promote
rational use of institutional resources.

REFERENCE, the sending of users or elements of diagnostic aid (laboratories, pathology samples, etc.) by the units
providing health services (IPS) and State Social Enterprises (ESE), to other health institutions for care or diagnostic
complementation, which according to the degree of complexity responds to health needs
COUNTER REFERENCE, the response that the health service providing units receiving the reference give to the
organization that referred them.

The response may be: the user's counter referral with information about the care received by the user in the receiving
institution, the diagnosis issued, the result of the requests for diagnostic help, medical and pharmacological
recommendations that must continue to be provided to the patient, the result of requests for diagnostic help.

OF REFERRAL IN CASE OF EMERGENCIES. Public or private entities in the health sector, which have provided initial
emergency care, must guarantee the appropriate referral of these users to the institution of the required degree of
complexity, which is responsible for their care.

Paragraph. The entities of the official subsector that

have provided the initial emergency care will refer
the user covered by social security to the
corresponding health institution.

Article 6. OF THE RESPONSIBILITY OF

THE REFERENT INSTITUTION. The
referring institution will be responsible for the care of
the user or the item being sent, until it enters the
receiving institution.
REFERRAL TO ANOTHER IPS
What is a patient referral? It is the process by which a patient is sent for care, from one level to another, from one
Institution to another with greater resources for diagnosis and treatment, or is returned from this to its level of origin, with a
clear indication of the definitive diagnosis, treatment performed and course of action to follow. For the referral, records from
the “Request and Response Referral” Form will be used. The responsibility of the Coordination in the patient referral
functions includes the management of the documents related to the referral. For the total settlement of the services, the
doctor should have completed the discharge form and the referral order to another IPS.

Bill and Collect for Services Provided.

Once the previous procedures have been carried out, the settlement and collection of the services is carried out in
accordance with the procedures manual and
Rates established in the contractual relationship and current legislation.

Process the patient's departure .

The purpose is to guarantee that the user does not leave the Hospital Institution if he or she has complied with all
administrative obligations. For the above to be fulfilled, a peace of mind is issued by the cashier when it has been
guaranteed that the user complies with all the administrative requirements of the case.
 TECHNICAL LANGUAGE

It is also called technicalism or technical words that are used in scientific and technological language, some of which are in
general use but the majority are for private use. In each branch of science, to know the meaning of technical words, it is
necessary to consult the specialized dictionaries in each branch

TECHNICAL LANGUAGE OF THE HEALTH AREA

 Symptom: These are the discomforts or subjective sensations of the disease (example: pain, nausea, vertigo).
 Sign: they are understood as the objective or physical manifestations of the disease (example: observation of
jaundice.)
 Syndrome: it is a group of symptoms and signs, which can have different causes. For example: febrile syndrome,
anemic syndrome, meningeal syndrome.
 Eupnea: Normal respiratory rate.
 Bradypnea: Respiratory rate below normal.
 Tachypnea: Respiratory rate higher than normal.
 Orthopnea: Dyspnea that manifests itself only in a horizontal position (lying down).
 Trepopnea : Dyspnea that manifests itself in lateral decubitus.
 Apnea : absence of breathing.
 Chills: It manifests itself as generalized clonic contractions (tremor), accompanied by a sensation of cold on the
 skin, and precedes a febrile crisis.
 Sweating: Massive elimination of sweat towards the skin, usually following a febrile crisis.
 Edema: It is the abnormal accumulation of fluid in the interstitial space.
 Jaundice: It is the yellowish discoloration of the sclera, skin and mucous membranes as a result of the increase in
bilirubin in the blood. (hyperbilirubinemia). Jaundice can be prehepatic, hepatic and posthepatic.
 Anemia: It is a disorder in which circulating red blood cells are deficient in number and/or total hemoglobin content.
 Facies: It is the modification of the appearance and configuration of the face for pathological reasons and in some
cases it has special characteristics that allow certain pathologies to be identified.
 Decubitus: These are the positions that the patient takes in bed:
- Ventral ulna: Face down.
- Dorsal ulna: Face up.
- Left or right lateral ulna: From the side.
- Genitourinary position: Kneeling with the trunk leaning forward.
- Fowler position: sitting in bed at an angle of 35º to 45º degrees.
- Tredelemburg: lying with the legs higher than the rest of the body.
- Walking: It is a learned activity, which is carried out in most cases automatically, it occurs due to the stimulation of
tactile nerve endings, ligaments, joints and muscles. The most common gait alteration is lameness, this can be:

 Anphalgic: Slow gait, with a short stride and is associated with painful facies.
 Movement: It is the state of a body whose position varies in relation to a fixed point, involuntary movements are:
- Chills: Tremors with a sensation of cold and heat.
- Seizures: Involuntary and violent contractions of the muscles.
- Faciculations: Involuntary muscle contractions of a small muscle group innervated by a single nerve fiber.
- Myoclonus: Contractions of a muscle or muscle group.
- Tremors: Involuntary movements due to alternating contractions and relaxations of muscle groups.
- Cramps: Almost always painful contractions of one or more muscles.

 Paleness: It is the loss of skin color due to different causes such as increased skin thickness, peripheral
vasoconstriction, among others.
 Rubicundez: It is the intense red color of the skin due to thin and transparent skin, peripheral vasodilation due to
marked exertion, fever, etc.
 Cyanosis: Bluish discoloration of the skin and mucous membranes.
 Hyperpigmentation: It is the brown or blackish color of the skin. It is normal in areas very rich in melanin such as
the nipples, genital areas, around natural orifices, abdominal midline. It is pathological in cases of moles,
chloasmas, melanomas, tattoos, varicose lesions.
 Hypopigmentation : It is the absence of pigments in the skin. It is circumscribed in cases of vitiligo, leukoplakias,
pinto, scars, cloths and is generalized in cases of albinism.
 Macules: They are well-defined formations or spots on the skin, not palpable and without relief, they can be vascular
like erythema: it is a redness due to vasodilation, it disappears with digital pressure; the rash: which is a generalized
and fleeting erythema; red dermographism: Which is an erythema caused by curling the skin with the nail; the
exanthema: which is a generalized outbreak at the skin level, disappears with digital pressure; purple: which are
blood extravasations and appear as sometimes punctate red or violet spots on the skin and mucous membranes,
which do not disappear with digital pressure, and may be represented by petechiae, which are points; ecchymosis:
which are spots; and hematomas: which are edema plus ecchymosis.
 Warts: They are solid pedunculated elevations, when they appear on the genitals they are called condylomas.
 Fissures: They are linear lesions like small isolated cuts.
 Excoriations: They are like depressed scars.
 Ulcer: They are loss of tissue that compromises the epidermis and the deeper layers, when they heal they leave
scars.
 Scar: Formation of fibrous tissue in the area where there was tissue loss.
 Keloids: Hard, thick, sometimes painful scars due to the formation of excess granulation tissue and increased
collagen formation.
 Keratodermas (calluses): Circumscribed thickening of the corneal layer, they are conical with the tip facing inward.
 Hypertrichosis: Abnormal abundance of hair.
 Baldness : Abnormal sparseness of hair.
 Alopecia: Absence of hair.
 Trichotillomania: abnormal hair pulling due to emotional disorders.
 Dysphonia (hoarseness): It is the decrease in the intensity, frequency and tonality of sounds, which makes
phonation unclear.
 Aphasia: It is the alteration of the use and understanding of words, due to disturbances of the central nervous
system.
 Dysarthria: It is characterized by difficulty or inability to speak, due to paresis, paralysis of the muscles that
participate in articulate language.
 Myopia : Decreased distance vision (nuclear cataracts, untreated diabetes).
 Hyperopia: Decreased near vision.
 Amblyopia: It is the decrease in visual acuity, without visible injury to the eye, (hysteria, injury to the ocular
muscles).
 Amaurosis: It is absolute blindness without obvious eye lesions (it occurs in the same cases as amblyopia but in
advanced stages).
 Diplopia: It is the double vision of the same object (strabismus, in the initial phase of cataracts).
 Polyopia : It is the multiple vision of a single image (abnormalities of the cornea, vitreous humor).
 Phosphenes : Visualization of “little stars” or “flares” (retinal detachment, head trauma, tumors, HBP, etc.
 Nyctalopia or Hemeralopia : It is night blindness (retinitis pigmentosa, marked jaundice, etc.)
 Photophobia : Intolerance to light (conjunctivitis, uveitis).
 Epiphora : Increased tear secretion.
 Xerophthalmia : Decreased tear secretion.
 Anisocoria: Inequality in the size of both pupils (iritis, uveitis, glaucoma, unilateral myopia, etc.), it is not constant.
 Miosis: Decrease in the size of the pupils less than 2mm, (trauma and hemorrhage of the cervicodorsal spinal cord,
intense pain, anesthesia, etc.).
 Mydriasis: Abnormal increase in the size of the pupils more than 5mm, (epileptic seizures, eclampsia, intoxication,
fear, as a diagnostic sign of death).
 Hyposmia : Reduction in olfactory capacity (atrophy of the nasal mucosa, local abscesses, cocaine use, etc.).
 Anosmia : Absence of the ability to smell (for the same reasons as hyposmia).
 Heperosmia : Increased olfactory capacity (pregnant women, lactating women, ovulating women and neuropaths).
 Cacosmia : Continuous perception of unpleasant odors (sinusitis, rhinitis, etc.).
 Parosmia: Misperception of odors (neuropaths).
 Rhinitis : Watery, mucous, mucopurulent, yellowish-green secretions, eliminated through the nasal passages.
 Epistaxis : Bloody discharge or blood from the nose.
 Nasal flaring : These are movements of the cartilage that are synchronous with breathing.
 Cheilitis: Inflammation of the mucosa of the lips.
 Canker sores: Small ulcers with a white background on the oral mucosa.
 Glossodynia: Pain in the tongue.
 Toothache: Dental pain.
 Asialia : Decreased saliva secretion.
 Sialorrhea : Saliva coming out of the mouth.
 Sialophagia: Increased ingestion of saliva.
 Anodontia : Partial or total absence of teeth.
 Bruxism: It is the sound friction of the teeth (clicking) that is produced by rapid and involuntary contractions of the
muscles involved in chewing.
 Macrocheilia: Large lips.
 Microcheilia: Small lips.
 Proquelia: When the upper lip extends beyond the lower lip more than normal.
 Retrochelia : The lower lip surpasses the upper lip.
 Stomatitis : Inflammation of the oral mucosa.
 Gingivitis: It is inflammation of the gums.
 Macroglossia: Tongue larger than normal, it may be congenital (Down syndrome) or acquired as in acromegaly.
 Microglossia: Small, congenital tongue.
 Ankyloglossia : It is the tongue with a very short frenulum, congenital.
 Glossitis : It is the inflammation of the tongue; It appears in deficiencies of B complex vitamins, iron deficiency
anemia, trauma, burns, allergies, etc.
 Prognathism : It is the anterior projection of the chin, leaving the incisors in front of the upper ones (hereditary).
 Retrognathia: It is the projection of the lower jaw backwards.
 Macrognathia : Very large lower jaw (congenital or in acromegaly).
 Micrognathia: Very small lower jaw (juvenile rheumatoid arthritis).
 Odynophagia : Pain in the pharynx, it can occur spontaneously or caused by swallowing, the patient describes it as
a sensation of itching, burning, dryness of the throat (rhinopharyngitis, common cold, tonsillar abscess,
posttonsillectomy, etc.).
 Dysphagia: It is difficulty swallowing, it occurs in the same cases as Odynophagia.
 Dysphonia or hoarseness: Difficulty speaking.
 Aphonia : Total absence of voice.
 Hearing loss: Decrease in hearing capacity (conditions of the external ear, optic wax plugs, foreign bodies, stenosis
of the external auditory canal, etc.).
 Hyperacusis : Increased hearing capacity (hyperactivity of the auditory nerve).
 Paracusia : Distorted perception of sounds.
 Diploacusis : Perception of a sound in tones (S. de Meniere).
 Autophony: Resonance of one's own voice.
 Otalgia: Pain in the ears.
 Otorrhea: When the fluid eliminated is serous, mucous or purulent (mastoiditis).
 Otorrhagia: When the liquid eliminated is blood (trauma, wounds in the ear canal).
 Otoliquia : when the fluid removed is cerebrospinal fluid (skull base fractures).
 Tinnitus : These are non-true auditory perceptions (tinnitus) that appear in earwax plugs, hypertension, pre-
eclampsia, etc.
 Vertigo: Sensations of the patient rotating around things, or that they are spinning around the patient, may be
accompanied by loss of balance, nausea and vomiting.
 Macrotia : Ear larger than normal.
 Microtia : Ear that is smaller than normal.
 Poliotia : Existence of several ears or when only one has several accessory or rudimental pavilions.
 Anotia : Absence of ears.
 Cough: It is the sudden, violent and loud expulsion of air from the lungs preceded by a deep inspiration. It is
basically a reflex act, but it can be voluntary and serves as a defense mechanism to eliminate secretions and
irritating agents from the lungs, bronchi and trachea.
 Expectoration: It is the elimination of sputum (matter produced by the secretion of the serous and mucus glands of
the respiratory epithelium) from the respiratory tract to the outside, through coughing.
 Vomicing: It is the sudden expulsion of fluid (generally pus) from the respiratory tract. It generally appears after
coughing spells and as a consequence of a rupture in a bronchus of a cavity with liquid content.
 Palpitations: These are sensitive and uncomfortable heartbeats for the patient, that is, every time the patient
consciously perceives the heartbeat, which is not felt under normal conditions.
 Dysphagia : It is difficulty swallowing, the patient describes it as a particular sensation of substernal pressure or
discomfort or the sensation of the food balloon stopping.
 Regurgitation: It is the return of food from the esophagus to the oral cavity without nausea and without contractions
of the abdominal muscles. Unlike esophageal regurgitation, gastric regurgitation has a sour or bitter taste and
appears in cases of ulcer, spasms or pyloric stenosis.
 Belching: It is the evacuation or expulsion of gas from the stomach through the mouth.
 Heartburn: It is a burning sensation located retrosternally and epigastrically (regurgitation, esophagitis, esophageal,
gastric ulcer, etc.).
 Emesis or vomiting: It is the sudden and forceful expulsion of gastrointestinal contents through the mouth.
Vomiting frequently preceded by nausea and hypersalivation is a reflex act. In the vomit analysis we must take into
account the frequency, quantity, smell, content and time of appearance.
 Hematemesis: It is the elimination of blood through vomiting, it is light red when the bleeding is recent, and dark or
black when it has remained in the stomach for a long time (gastric ulcer, etc.).
 Tenesmus : It manifests itself as a painful sensation, burning or foreign body in the rectum that produces a need to
defecate that is never completely satisfied.
 Meteorism: Increase in the gas content of the intestine.
 Flatulence : it is the repeated elimination of an increased amount of gases through the anus (meteorism).
 Diuresis : It is the amount of urine eliminated in a certain time (24 hours). Normally there are 3 to 4 urinations
during the day of 150-300cc each. Under normal conditions the amount of urine eliminated in 24 hours in men is
1500 to 2000cc and in women it is 1200 to 1500cc.
 Polyuria: It is the increase in the amount of urine eliminated in 24 hours to more than 2000cc (increase in fluid
consumption).
 Oliguria: It is the decrease in the amount of urine eliminated in 24 hours below 800cc.
 Anuria : It is the disappearance or decrease in urine excretion below 50cc in 24 hours.
 Frequency: Frequent emission of urine in small quantities (cystitis, neoplasms).
 Bladder tenesmus : Sensation of need to urinate with pain that appears at the end of urination in the form of
tenesmus.
 Dysuria : It is difficulty urinating or difficult emission of urine.
 Nocturia: is the appearance of an increased desire to urinate during sleep.
 Priapism: It is an involuntary and long-lasting erection, it is not accompanied by sexual arousal, it is accompanied
by pain. It is due to thrombosis of the veins of the spermatic plexus, crisis of the internal pudendal nerve, leukemias,
sickle cell anemias; Payronie's disease is a plastic induration of the penis due to sclerosis.
 Henospermia: It is the elimination of blood with semen; It occurs in cases of Ca of the prostate or seminal vesicles,
prostatitis, urethritis, etc.
 Spermatorrhea: It is the involuntary release of semen without erection, without intercourse and without orgasm. It
frequently occurs in patients with emotional disorders, anxiety or psychogenic impotence.
 Andropause: It is the climacteric syndrome of men, caused by a decrease in testicular function, with minimal
production of androgens. Clinically it manifests itself with impotence, hot flashes, tachycardia, paresthesias, vertigo,
chills, physical decline, loss of memory and concentration.
 Microphallus or small penis.
 Macrophallus or large penis: Which may be of racial origin in black Africans; constitutional, by administration of
androgens.
 Phimosis: It is the presence of a narrow foreskin that does not allow it to retract over the glans.
 Balanitis : It is inflammation of the glans.
 Balanosposthitis : It is the inflammation of the glans and foreskin.
  Paraphimosis: It is the difficulty of the foreskin returning to its normal position.
 Varicocele: These are varicose veins or dilated veins in the scrotum.
 Hydrocele: It is the presence of serous fluid in the scrotum.
 Hematocele: It is the presence of blood inside the scrotum.
 Metrorrhagia: Blood loss that is not related to the menstrual cycle.
 Premature menarche : When the first menstruation appears before 9 years of age.
 Late menarche: When the first menstruation appears after reaching 16 years of age.
 Amenorrhea : It is the absence of menstrual bleeding.
 Hypermenorrhea : It is the presence of excessive menstrual bleeding that lasts longer than normal.
 Hypomenorrhea: It is a scarce and short-lasting menstruation.

Session 2: REGULATIONS FOR THE MANAGEMENT OF CLINICAL HISTORY

RESOLUTION NUMBER 1995 OF 1999

(JULY 8)

by which standards are established for the management of Clinical History

CHAPTER I
DEFINITIONS AND GENERAL PROVISIONS
ARTICLE 1.- DEFINITIONS.

a) The Clinical History is a private, mandatory and confidential document, in which the patient's health conditions, medical
acts and other procedures carried out by the health team involved in their care are chronologically recorded. This document
can only be known by third parties with prior authorization from the patient or in the cases provided for by law.

b) Health status: The patient's health status is recorded in data and reports about the somatic, psychological, social,
cultural, economic and environmental condition that may affect the user's health.
c) Health Team. They are the Professionals, Technicians and Auxiliaries in the health area who provide direct clinical care
to the User and the Medical Auditors of Insurers and Providers responsible for evaluating the quality of the service
provided.

d) Clinical History for archival purposes: It is understood as the file made up of the set of documents in which the
mandatory registration of the state of health, medical acts and other procedures carried out by the health team involved in
the care of patients is carried out. a patient, who also has the character of reserved.
e) Management File: This is where the Clinical Records of active Users and those who have not used the service during the
five years following the last care are stored.

f) Central File: It is the one where the Clinical Records of Users who did not use the provider's health care services again
are stored, after 5 years since the last care.

e) Historical Archive. It is the one to which the Clinical Records are transferred that, due to their scientific, historical or
cultural value, must be permanently preserved.

ARTICLE 2.- SCOPE OF APPLICATION.

The provisions of this resolution will be mandatory for all health service providers and other natural or legal persons related
to health care.

ARTICLE 3.- CHARACTERISTICS OF THE CLINICAL HISTORY.

The basic features are:

Comprehensiveness: A user's medical history must gather information on the scientific, technical and administrative
aspects related to health care in the phases of promotion, health promotion, specific prevention, diagnosis, treatment and
rehabilitation of the disease, addressing it. as a whole in its biological, psychological and social aspects, and interrelated
with its personal, family and community dimensions.

Sequentiality: Records of the provision of health services must be recorded in the chronological sequence in which the
care occurred. From the archival point of view, the medical history is a file that must chronologically accumulate documents
related to the provision of health services provided to the user.

Scientific rationality: For the purposes of this resolution, it is the application of scientific criteria in the completion and
registration of health actions provided to a user, so that it shows in a logical, clear and complete manner, the procedure that
was carried out in investigation of the patient's health conditions, diagnosis and management plan.

Availability : It is the possibility of using the medical history at the time it is needed, with the limitations imposed by the
Law.

Opportunity: It is the completion of the care records of the clinical history, simultaneously or immediately after the
provision of the service occurs.

ARTICLE 4.- MANDATORY OF REGISTRATION.

Professionals, technicians and assistants who are directly involved in the care of a user have the obligation to record their
observations, concepts, decisions and results of the health actions developed, in accordance with the characteristics
indicated in this resolution.

CHAPTER II
DILIGENCE
ARTICLE 5.- GENERALITIES .

The Medical History must be completed in a clear, legible manner, without erasures, amendments, intercalations, without
leaving blank spaces and without using acronyms. Each annotation must bear the date and time in which it was made, with
the full name and signature of its author.

ARTICLE 6.- OPENING AND IDENTIFICATION OF THE CLINICAL HISTORY.

Every health service provider who cares for a user for the first time must carry out the process of opening a medical history.
As of January 1, 2000, the identification of the medical history will be done with the citizenship card number for those of
legal age; the identity card number for minors over seven years of age, and the civil registry number for minors under seven
years of age. For foreigners with the passport number or immigration card. In the event that there is no identity document
for minors, the number of the mother's citizenship card will be used, or that of the father in her absence, followed by a
consecutive number according to the order number of the minor. minor in the family group.

FIRST PARAGRAPH. While the aforementioned deadline is met, health service providers must begin the adaptation
process corresponding to what is ordered in this article.

SECOND PARAGRAPH. Every health service provider must use a single institutional history, which must be located in the
respective file according to retention times, and organize a system that allows them to know at all times where in the
institution they are located. the medical history, and to whom and on what date it has been delivered.

ARTICLE 7.- CONSECUTIVE NUMBERING OF THE CLINICAL HISTORY

All the pages that make up the medical history must be numbered consecutively, by type of record, by the person
responsible for completing it.

ARTICLE 8.- COMPONENTS.

They are components of the medical history, user identification, specific records and annexes.

ARTICLE 9.- USER IDENTIFICATION.

The minimum contents of this component are: personal identification data of the user, surnames and full names, marital
status, identity document, date of birth, age, sex, occupation, address and telephone number of home and place of
residence, name and telephone number of the companion; name, telephone number and relationship of the person
responsible for the user, as applicable; insurer and type of connection.

ARTICLE 10.- SPECIFIC RECORDS.

Specific record is the document in which the data and reports of a specific type of care are recorded. The health service
provider must select to record the information on the health care provided to the user, the specific records that correspond
to the nature of the service provided. The minimum contents of information on the care provided to the user, which the
specific record must contain, are the same as contemplated in the
Resolution 2546 of July 2, 1998 and the regulations that modify or add it and those generally accepted in the practice of
disciplines in the health area.

FIRST PARAGRAPH. Each institution may define additional data in the clinical history that is necessary for adequate
patient care.
SECOND PARAGRAPH. Every health service provider must adopt, through the respective act, specific records, in
accordance with the
 CHAPTER III
ORGANIZATION AND MANAGEMENT OF THE FILE OF CLINICAL HISTORIES
ARTICLE 12.- MANDATORY OF THE FILE.
All health service providers must have a single file of medical records in the management, central and historical file stages,
which will be organized and provide the relevant services, keeping the general principles established in Agreement 07 of
1994, referring to the General Archives Regulations, issued by the General Archive of the Nation and other regulations that
modify or add to it.

ARTICLE 13.- CUSTODY OF CLINICAL HISTORY.

The custody of the clinical history will be the responsibility of the health services provider who generated it in the course of
care, complying with the archiving procedures indicated in this resolution, without prejudice to those indicated in other
current legal regulations. The provider may deliver a copy of the medical history to the user or their legal representative
when they request it, for the purposes provided for in current legal provisions.

FIRST PARAGRAPH. The transfer between health service providers of a user's medical history must be recorded in the
minutes of delivery or return, signed by the officials responsible for the entities in charge of its custody.

SECOND PARAGRAPH. In cases where there are multiple medical records, the provider who requires information
contained in them may request a copy from the provider in charge of them, with prior authorization from the user or their
legal representative.

THIRD PARAGRAPH. In the event of liquidation of a Health Services Providing Institution, the medical history must be
delivered to the user or their legal representative. If it is impossible to deliver it to the user or their legal representative, the
liquidator of the company will designate who will be in charge of the custody of the medical history, up to the legally
stipulated retention period. This fact will be communicated in writing to the competent Sectional, District or Local Health
Directorate, which must keep a file of these communications in order to inform the user or the competent authority, under
whose custody the medical record is located.

ARTICLE 14.- ACCESS TO CLINICAL HISTORY.

They may access the information contained in the medical history, in the terms provided in the Law:
1) The user.
2) The Health Team.
3) The judicial and Health authorities in the cases provided for in the Law.
4) Other persons determined by law.

PARAGRAPH. Access to medical history is understood in all cases, solely and exclusively for the purposes that are
appropriate in accordance with the law, and in all cases, legal confidentiality must be maintained.

ARTICLE 15.- RETENTION AND CONSERVATION TIME.

The medical history must be kept for a minimum period of 20 years from the date of the last care. Minimum five (5) years in
the management file of the health services provider, and minimum fifteen (15) years in the central file. Once the
conservation period has elapsed, the medical record may be destroyed.

ARTICLE 16.- SECURITY OF THE FILE OF CLINICAL RECORDS.

The health service provider must archive the medical record in a restricted area, with limited access to authorized health
personnel, preserving the medical records in conditions that guarantee physical and technical integrity, without adulteration
or alteration of the information. The institutions providing health services and, in general, the providers in charge of the
custody of the medical history, must ensure its conservation and be responsible for its adequate care.

ARTICLE 17.- PHYSICAL CONDITIONS OF CONSERVATION OF THE

CLINIC HISTORY.
The medical records files must be kept in location, procedural, environmental and material conditions, appropriate for this
purpose, in accordance with the parameters established by the General Archive of the Nation in agreements 07 of 1994, 11
of 1996 and 05 of 1997, or the regulations that repeal, modify or add them.

ARTICLE 18.- TECHNICAL MEANS OF REGISTRATION AND

PRESERVATION OF THE CLINICAL HISTORY.
Health Service Providers may use physical or technical means such as computers and magneto-optical means, when they
consider it appropriate, in accordance with the provisions of circular 2 of 1997 issued by the General Archive of the Nation,
or the regulations that modify it. or add. The automated programs that are designed and used for the management of
Medical Records, as well as their equipment and documentary supports, must be provided with security mechanisms that
make it impossible to incorporate modifications to the Medical Record once the data are recorded and saved. .

In any case, the confidentiality of the medical history must be protected by means of mechanisms that prevent access by
unauthorized personnel to know it and adopt measures to avoid the accidental or provoked destruction of the records.

Health service providers must allow the identification of the personnel responsible for the data recorded, through codes,
indicators or other means that replace the signature and seal of the records on physical media, so that it is established
exactly who made the records. the time and date of registration.

CHAPTER IV
CLINICAL HISTORY COMMITTEE
ARTICLE 19.- DEFINITION.
The medical records committee is defined as the group of people who, within a Health Services Providing Institution, are
responsible for ensuring compliance with the standards established for the correct completion and adequate management
of the medical history. Said committee must be established formally as a collegiate body or by assigning functions to one of
the existing committees in the Institution.

PARAGRAPH. The committee must be made up of health team personnel. Minutes will be taken of the meetings with a
copy to the management of the Institution.

ARTICLE 20.- FUNCTIONS OF THE CLINICAL HISTORY COMMITTEE.

a) Promote in the Institution the adoption of national standards on clinical history and ensure that these are complied with.

b) Prepare, suggest and monitor compliance with the manual of standards and procedures of the Provider's clinical records,
including the clinical history.

c) Submit to the Management and the Technical-Scientific Committee recommendations on the formats of the specific
records and annexes that the clinical history must contain, as well as the mechanisms to improve the records contained
therein.

d) Ensure that the necessary resources are provided for the administration and operation of the Clinical Records archive.

ARTICLE 21. - SANCTIONS.

Health Service Providers who fail to comply with the provisions of this resolution will incur the applicable sanctions in
accordance with current legal provisions.

Session 3: HEALTH SERVICES NETWORK

The health services network is an organized set of health institutions of different levels of complexity to provide health
services, in a humanized and comprehensive manner with characteristics of opportunity, accessibility and sufficiency, thus
responding to their health needs. The Pan American Health Organization (PAHO), in 2010, defined integrated health
service networks as “the management and delivery of services.” health services so that people receive a continuum of
preventive and curative services, according to their needs over time and through the different levels of the health system.

Health service networks, in general, involve people, processes and infrastructure , which must be interrelated. ned and
coordinated to be able to guarantee adequate and quality care to the user, also taking into account the efficiency of the
organization and the needs of the population.

Objectives of health service networks

The objective is the search for information Integration of health services as a strategy to achieve collaboration between
institutions and services that can complement each other, optimizing resources and providing better conditions to users,
taking into account the development of shared strategies. Another objective is the promotion of alliances between the
institutions that make up the networks and even between them.

The health services network is characterized by the following elements:

- Infrastructure.
- Staff.
 - Resources.
- Facilities.
For better care there must be coordination between:
- The correspondence.
- Reciprocity in institutions in their planning stages.
- Assistance levels.
- Management and delivery of health services.
- Cooperation between professionals and caregivers.
Network size is defined as the number of different types of services offered to network users through a continuum of care in
the network.
Law 100 of 1993 creates the SGSSS, which in its article 159 guarantees emergency care to members throughout the
national territory and the choice of Service Provider Institutions and professionals among the options that each Health
Promotion Entity offers within of its service network.

UNITS OF ANALYSIS AND REFERENCE AND COUNTERREFERENCE

They are those instances before which all the Health Provider institutions that are part of the public and complementary
Network of the department come together with the objective of Providing the user with comprehensive health care at the
level of technology appropriate to their need and Facilitating the population universal, timely and functional access to
comprehensive health care, through the integration of the different actors in the system.

The Health Services Network is made up of:

- The insurers.
- The providers.

Insurers : They are public or private entities that insure the population, act as intermediaries and administrators of the
resources provided by the state in the form of an annual premium called Capitation Payment Unit -UPC-. They are the
health promoting entities (EPS) and the occupational risk administrators (ARL).

The providers: they are the health-providing institutions (IPS), they are the hospitals, clinics, laboratories, etc. that directly
provide the service to users and provide all the necessary resources for the recovery of health and the prevention of
disease.
 Session 4: TYPES OF INSURANCE

Insurance is the main strategy of the General Social Security Health System (SGSSS) to achieve access and quality in the
provision of services and their coordination, and the protection of families against the financial risk involved in care. of
health events. The insurance of the population is carried out through two regimes: contributory and subsidized.

The contributory regime is a set of rules that govern the connection of individuals and families to the General Social
Security Health System, when such connection is made through the payment of an individual and family contribution, or a
previously financed financial contribution. directly by the member or in conjunction between him and his employer. Thus,
people who have the ability to pay join, these are those people linked through an employment contract, public servants,
pensioners and retirees and independent workers with the ability to pay.

The contribution or financial contribution is equivalent to 12.5% of the base salary, and this percentage is paid between the
employer 8.5% and the worker 4%, in case the person has a work relationship; Otherwise, the worker contributes 100% of
the contribution. 1.5 points of the contribution are allocated for the subsidized regime. Affiliates have the right to a
mandatory health plan, defined by the National Social Health Security Council (CNSSS).

The subsidized regime is a set of rules that govern

the connection of individuals to the General Social
Security Health System, when such connection is made
through the payment of a subsidized contribution, totally or
partially, with fiscal or solidarity resources. Solidarity
resources come from the contribution made by people
affiliated with the contributory regime, corresponding to
1.5 points. Affiliates of the subsidized regime are people
without the ability to pay; they are those who have the
resources to cover the total amount of the contribution in
the contributory regime; That is, they are the poorest
and most vulnerable people.
  TAX REGIME
The contributory regime covers people who join the general social health security system by paying a contribution or prior
financial contribution.
The contributory regime must be affiliated as a contributor, in accordance with current regulations,
 nationals or foreigners, residents in Colombia, bound by an employment contract that is governed by Colombian
regulations, including those people who provide their services in diplomatic headquarters and international
organizations accredited in the country.
 public servants.
 pensioners due to retirement, old age, disability, survivors or substitutes.
 independent workers.
 the rentiers.
 the owners of the companies.
and in general all natural persons residing in the country with the capacity to pay

Exempt from this regime are members of the Military Forces and the National Police, unpaid members of Public
Corporations, the National Fund for Social Benefits of the Teachers and public servants and pensioners of the Colombian
Petroleum Company. Membership automatically grants the right to contributors to include the basic family nucleus, which is
made up of the spouse or permanent partner of the affiliate; children under 18 years of age of either spouse, who are part
of the family unit and who are financially dependent on it; children over 18 years of age with permanent disability or those
who are under 25 years of age, are full-time students and are financially dependent on the member. In the absence of a
spouse, permanent partner, or eligible children, family coverage may be extended to the member's parents, not pensioners,
who are financially dependent on the member.

Currently the POS includes the following contents

 Medical and/or paramedical consultation.
 Consult with a specialist doctor.
 Urgent Care.
 Surgical services.
 Services with hospitalization, stays, professional services, room rights, materials, supplies and equipment.
 Supply of prostheses, orthoses, devices and orthopedic accessories in accordance with the definitions of the
Manual.
 Treatments of high-cost diseases, including: Treatment with radiotherapy and chemotherapy for cancer, dialysis for
chronic kidney failure, kidney, heart, bone marrow and cornea transplant, treatment for AIDS and its complications,
surgical treatment for diseases of the heart and central nervous system, surgical treatment for diseases of genetic or
congenital origin, medical surgical treatment for major trauma, intensive care unit therapy and joint replacements.
Essential medications in their generic presentation.
Financial coverage : In addition to basic health services, contributors have the right to receive financial benefits in case of
disability due to general illness and maternity and/or paternity leave.

Disability due to general illness . When the disability is longer than three days, the EPS recognizes the contributing
member an economic benefit that is equivalent to a portion of the worker's monthly income for up to one hundred and
eighty (180) days, as follows: two-thirds (2/3) of the salary during the first ninety (90) days and half the salary for the
remaining time. Payment for the first three days of disability is assumed by the employer.

Maternity licence . It is granted to all contributing workers who are pregnant and consists of a 12-week paid rest period
during childbirth. During this period, a benefit equivalent to 100% of the worker's income for said time is recognized. The
Social Security System assumes it as long as the woman has contributed uninterruptedly throughout the entire pregnancy
period. When there has been a delay, the EPS will recognize the economic benefit in accordance with current regulations,
as long as it has been fulfilled during the gestation period with the payment of all the contributions owed, with the respective
default interest. . If the contributor is an independent worker, maternity leave will be recognized, as long as the delay is for
a maximum of one contribution period and the late contribution has been paid with the respective interest, before its
recognition.
Maternity leave for independent contributing women with income equal to or less than a current legal monthly minimum
wage will be settled by the EPS proportionally to the days contributed that correspond to the actual gestation period of each
contributing worker, taking into account that the maximum to recognize is 84 days. When the days quoted are less than the
days of the actual gestation period, the number of days to be recognized will be the percentage that results from dividing
the number of days quoted by the number of actual days of gestation.
In the event that the actual management period is less than 270 days and as long as this period corresponds to the days
contributed, the EPS will recognize the maximum license, or proportionally when the contribution time is less than the
gestation time. ; with the exception of non-viable births that will be subject to the recognition of the license, as defined in the
current regulations on the matter contained in Law 100 of 1993.

Paternity leave . The contributing father has the right during the time of childbirth to 8 working days of paid leave
equivalent to 100% of the worker's income corresponding to said period as long as they have paid contributions during the
entire gestation period.

 SUBSIDIZED REGIME
The subsidized regime allows affiliation to the general health social security system for people who do not have the ability
to pay. This connection is made through the granting of a total or partial subsidy.

 Affiliates: All people who do not have an employment relationship or the ability to pay to belong to the contributory
regime and who have been identified through the application of a survey as potential beneficiaries of social subsidies
(SISBEN ) can join the subsidized regime. of Social Programs . Currently, levels 1 and 2 of SISBEN are prioritized.
Membership automatically grants the right to contributors to include the basic family nucleus, which is made up of
the spouse or permanent partner of the affiliate; children under 18 years of age of either spouse, who are part of the
family unit and who depend financially on it; children over 18 years of age with permanent disabilities or those who
are under 25 years of age, are full-time students and are financially dependent on the member. In the absence of a
spouse, permanent partner, or eligible children, family coverage may be extended to the non-pensioned parents of
the member who are financially dependent on the member.

 Health Promotion Entities of the EPSS subsidized regime : They are in charge of carrying out the insurance of
the population that joins the subsidized regime. In this sense, the EPSS must be responsible for the affiliation of
contributors and their family groups, assuming the duty of managing their health risk and providing the health
services included in the Mandatory Health Plan of the subsidized regime -POSS- directly ( through their IPS) or
 indirectly (through contracting with third parties).

 Health coverage: People affiliated with the subsidized regime have the right to receive a set of health benefits
explicitly defined in POSS. Its contents are defined by the Health Regulation Commission (CRES) and the POSS
includes actions of education, information and promotion of health and the prevention, diagnosis, treatment and
rehabilitation of the disease, at different levels of complexity as well as the supply of essential medicines in their
generic name. Currently, the benefit plan for boys and girls under 12 years of age is the same in the contributory
regime and in the subsidized regime. When the member requires health services not covered in the POSS, they
must go to the territorial entity to guarantee their care through the public network.

 Financial coverage : In the subsidized regime there is no coverage of financial benefits for disability due to general
illness, nor for maternity and paternity leave.

 Exceptions to the POS: In addition to what is expressly covered, the following are expressly excluded from the
POSS:

 Cosmetic surgery for beautification purposes.

 Nutritional treatments for aesthetic purposes.
 Treatments for infertility.
 Treatments not recognized by medical-scientific associations worldwide or those of an experimental nature.
 Rest or sleep treatments or cures.
 Elastic support stockings, corsets, girdles, insoles, orthopedic shoes, wheelchairs, contact lenses. Glasses (without
frames) will be supplied once every five years for adults and once a year for children, always by medical prescription
and for defects that reduce visual acuity.
 Medications or substances that are not expressly authorized in the Manual of Medications and Therapeutics.
 Treatment with experimental drugs or substances for any type of disease.
 Organ transplant. Those such as kidney, bone marrow, corneal and heart transplants are not excluded, with strict
subjection to the eligibility conditions and other requirements established in the respective Comprehensive Care
Guides.
 Treatment with individual psychotherapy, psychoanalysis or prolonged psychotherapy. Supportive individual
psychotherapy is not excluded in the critical phase of the disease, and only during the initial phase; Group therapies
are not excluded either. The critical or initial phase is understood to be one that can last up to thirty days of
evolution.
 Treatment for varicose veins for aesthetic purposes.
 Activities, procedures and interventions for chronic, degenerative, carcinonamatosis, traumatic or any kind of
diseases in their terminal phase, or when there are no possibilities of recovery for them. Psychological support,
palliative therapy for pain, discomfort and dysfunction, or maintenance therapy may be provided. All activities,
interventions and procedures must be contemplated in the respective Comprehensive Care Guides.
 Activities, procedures and interventions of an educational or training nature that are carried out during the
rehabilitation process, other than those strictly necessary for the medical management of the disease and its
consequences.
 Prosthetics, orthodontics and periodontal treatment in dental care.
 Activities, interventions and procedures not expressly considered in the Manual.

 LINKED POPULATION

The linked population is those who are not yet part of or belong to the
subsidized regime. People who do not have the ability to pay and who,
while they manage to be beneficiaries of the Subsidized Regime, have
the right to health care services in public and private IPS contracted by
the Local Health Secretariat.

This group includes:

 Identified population NOT affiliated with an EPS-S.
 Members of EPS-S for events not included in the Mandatory
Subsidized Health Plan.
 Special population NOT affiliated with the Subsidized Regime:
indigenous people, indigents, minors in protection, demobilized
and/or reincorporated, non-attributable, displaced population and
Roma people (gypsies). This population includes these social
groups that, due to their diverse cultural, legal and economic
conditions, enter the SGSSS through census listing as a special
population.
Under this condition, the special population becomes a linked special
population. If at the time of requesting the health service that does not
appear in the databases of the Subsidized Regime, you may be
provisionally served with the HEALTH LETTER format, issued by the
corresponding entity, in accordance with your condition.

What are the rights of linked participants?

• Actions to promote health and prevent disease.

• Diagnosis, treatment and rehabilitation of the disease at its different levels of complexity.
• Supply of medicines.
• Initial care in the emergency department, anywhere in the country.
• Care for high-cost diseases

 MANUAL OF ADMINISTRATIVE PROCEDURES OF THE INSTITUTION

It is a work instrument that contains the set of standards and tasks that each official develops in their daily activities and will
be technically prepared based on the respective procedures, systems and standards that summarize the establishment of
guides and guidelines to carry out daily routines and tasks. .

Those in charge of using the procedures manual are:

 All officials of the entity.
 The heads of the different departments
 Control bodies both internally and externally.

Elements that make up a manual.

 Front page.
 Index.
 Introduction.
 Objective of the manual.
 Legal framework.
 Name of the procedure.
 Purpose.
 Scope.
 Operation policies.
 Standards and guidelines.
 Procedure description.
  Flowchart.

 Session 5: HEALTH BENEFIT PLANS, TYPES AND CONCEPTS

 What is the Mandatory Health Plan (POS)?

It is a set of health care services that every member of the SGSSS is entitled to.

 How is the SGSSS integrated?

The SGSSS is made up of the state through the ministry of health and social protection, which acts as a coordination,
direction and control body; the health promotion entities (EPS) responsible for membership and collection of contributions
and for guaranteeing the provision of POS to members; and the Health Providing Institutions (IPS), which are hospitals,
clinics and laboratories, among others, in charge of providing care to users. Territorial entities and the national health
superintendency are also part of the SGSSS.

 What is the purpose of the benefit plan –POS?

The benefit plan seeks the comprehensive protection of families from maternity and general illness, in the phases of
promotion and promotion of health and prevention, diagnosis, treatment and rehabilitation for all pathologies.

 How can I know what I am entitled to in the POS?

The benefits plan is contained in resolution 5521 of 2013 of the Ministry of Health and Social Protection, with its two
annexes that are an integral part of it, and resolution 5926 of 2014 (list of medications, list of category of procedures and
list of clinical laboratories of the benefit plan.

 Who receives the benefits of the pos?

All members of the SGSSS, whether beneficiaries or contributors.

 Who are contributors and who are beneficiaries?

Contributors are workers with an employment contract, contractors and independent workers obliged to contribute, as well
as those who contribute voluntarily. Beneficiaries in accordance with the provisions of decree 806 of 1998 and decree
1164 of 2014 are:
 In the contributory regime, in addition to the contributor, relatives in the first degree of consanguinity may be
registered as beneficiaries of the POS: the spouse and children under 18 years of age, or students under 25 years of
age with exclusive dedication to this activity (with the exception of who have an employment relationship or contract
for the provision of services). In some special cases (financially dependent on the contributor) children, parents and
even third-degree relatives may be included.
 Subsidized regime, all members with their family group are beneficiaries of the Pos.

 RESOLUTION 5521 OF 2013 OF THE MINISTRY OF HEALTH AND SOCIAL PROTECTION

The Mandatory Health Plan is the set of health technologies described in this administrative act, which determines what
everyone affiliated with the General Social Security Health System -SGSSS- is entitled to, if needed. It is an instrument for
the Health Promotion Entities -EPS- to guarantee access to health technologies under the conditions provided for in this
administrative act.

The POS is articulated with other Benefit Plans of the General Social Security Health System - SGSSS-; as well as with the
programs, plans and actions of other sectors, which must guarantee the other aspects that affect health and well-being.

 CONDITIONS OF ACCESS TO HEALTH SERVICES:

 GUARANTEE OF ACCESS TO HEALTH SERVICES. The Health Promoting Entities must guarantee SGSSS
members effective access to the health technologies included in this administrative act, through their network of
health service providers. In the case of initial emergency care, the Promoting Entities of Health must also guarantee
it outside their network, in accordance with the provisions of article 25 of this administrative act.
 ENTRANCE GATE TO THE SYSTEM. Primary access to POS services will be done directly through emergencies
or non-specialized medical and dental consultations. Children under 18 years of age or pregnant women may
directly access specialized pediatric, obstetric or dental consultations. for family medicine without requiring a referral
from the general practitioner and when the available supply allows it.
 ASSIGNMENT TO AN IPS. After joining an EPS, every person must enroll, according to their choice, for outpatient
care in one of the Health Services Providing Institutions -IPS- of the network of providers formed by the EPS, so that
in this way they can benefit. of all disease promotion, risk prevention and health recovery activities, without prejudice
 to the provisions of the regulations that regulate National Portability. The member may request a change of affiliation
to the IPS when required and the Health Promotion Entity must process and address the request within its network
of providers.
 ACCESS TO SPECIALIZED HEALTH SERVICES. The POS covers care for all medical-surgical specialties
approved for provision in the country, including family medicine. To access specialized health services, referral
through general medicine, general dentistry or any of the specialties defined as a gateway to the system in article 10
of this resolution is essential, in accordance with current regulations on reference and counter-reference, without that
this constitutes a pretext to limit access to care by a general practitioner, when the specialized resource is not
accessible due to geographical conditions or lack of offer in the municipality of residence.
If the case warrants consultation with a specialist, the user must continue to be treated by the general professional,
unless the specialist recommends otherwise in his or her response. When the person has been diagnosed and
periodically requires specialized services, they can directly access said specialized consultation without the need for
a referral from the general doctor or dentist. When the patient's municipality of residence does not have the required
service, they will be referred to the closest municipality that has it.
 TELEMEDICINE. In order to facilitate timely access to the benefits defined in this administrative act and in
accordance with the quality standards in force in the country, the POS includes the telemedicine modality when it is
available, allowing the purpose of the provision of the service. service or guarantee greater opportunity, in the event
that in-person care is limited by geographic access barriers or low availability of supply.
 GUARANTEE OF SERVICES IN THE MUNICIPALITY OF RESIDENCE . To allow effective access to the health
benefits included in the POS, the EPS must ensure that their members have access in their municipality of residence
to, at least, the services indicated as the gateway to the system in article 10 of this document. administrative act, as
well as the procedures that can be executed in low complexity
services by non-specialized personnel, in accordance with the
available offer, current quality standards and those related to
vertical integration.

 MANDATORY HEALTH PLAN COVERAGE

 Promotion and prevention coverage

 Specific protection and early detection.
 male condom
 Application of vaccines.
 Prevention of vertical transmission of HIV/AIDS
 Actions for health recovery.
 Urgent Care.
 Initial emergency care
 Ambulatory care.
 Care with hospitalization.
 Home care
 Comprehensive care of the pregnancy, childbirth and puerperium process
 Alternative and complementary medicine and therapies
 Analgesia, anesthesia and sedation
 Transplants
 Grafts
 Supply of whole blood or blood products
 Oral health care
 Dentures.
 Reconstructive treatments
 Reinterventions.
 Medication coverage.
 Medical devices.
 External lenses.
 Glucometry kit
 Ostomy kit
 Coronary stent coverage.
 Emergency mental health care.
 Outpatient psychotherapy for the general population.
 Outpatient psychotherapy for women victims of violence.
 Inpatient mental health care for the general population.
 Palliative care.
 Care for people from the prenatal stage to children under 6 years of age
 Attention to people from 6 years old to children under 14 years old.
 Care for people from 14 years old to those under 18 years old
 Transportation or transfers of patients.
 High-cost events and services

 Session 6: RIPS AND SUPPORTING DOCUMENTS, BILLING SYSTEM AND INVOICE

  Individual record of health service provision RIPS
The Health Benefits Information System is "the set of minimum and basic data that the General Health Social Security
System requires for the management, regulation and control processes, and to support the sale of services, whose name,
structure and characteristics has been unified and standardized for all the entities referred to in the second article of the
Resolution in question.
The RIPS provides the minimum and basic data required to monitor the Health Benefits System in the SGSSS, in relation
to the mandatory package of services (POS and POSS). Likewise, the objective of the Registry is to facilitate commercial
relations between the administrative entities (payers) and independent institutions and professionals (providers) by
presenting the details of the invoice for the sale of services in magnetic media, with a structure that, being standard, ,
facilitates communication and the data transfer and
account review processes, regardless of the IT solutions
that each provider uses.
The data in this record refer to the identification of the
health service provider, the user who receives it, the
provision of the service itself and the reason for its
provision: diagnosis and external cause.
Information must always generate new knowledge, but
what is needed for decision making is the organization of
the information and the knowledge of the data that
comprise it, so that its very organization allows us to open
options to understand and act. .
Successful information occurs when a user obtains the
right information, at the right time, in the right place, at the
right level, and to the right extent.
Within the health care provision process, it became
necessary to unify the language that identifies the
provision itself and that once registered allows it to guarantee not only the continuity of the care process, but also the
course of the processes linked to the care. contract and the administrative management of the different actors in the
system.
This unification seeks to optimize the registration of each participant in the care process, to save time, save money, and
guarantee both quality of information and knowledge.

 What is RIPS?
Resolution 3374 of 2000 defines an individual record of health service provision, it is the set of minimum and basic data
that the general health social security system requires for the management, regulation and control processes, to support
the sale of the service. .
These minimum data identify one by one the health activities carried out by the IPS or independent health professionals to
people, thus becoming one of the main sources of the comprehensive SGSSS information system, for the construction of
the epidemiological profile of the country. , in addition to being the support for the sales invoice for health services.
 What is the RIPS registry?

 A record is made for each person served.

 A record is made for each service provided to the user.
 It defines what types of data make up the record.
 A field is defined for each data in each record.
 The type of data, values, units, lengths, order, and the form of computer storage are normalized.

 RIPS Objectives

 Formulation of health policies.

 Adjust the capitation payment unit.
 Adjust the contents of health benefit plans.
 Carry out planning, monitoring and evaluation of health actions.
 Know the health status of the population.
 Automation of the medical and administrative audit system.
Supersalud : (National Health Superintendency) is responsible for carrying out inspection, surveillance and quality control
in the provision of health services.
Use of RIPS information for the provider:
 Report health activities provided – management indicators.
 Support the amount charged to paying entities – billing.
 Know the causes that generate the demand for health services – morbidity addressed.
Who should report RIPS? Institutional IPS providers, independent professionals and associated practice groups, who
provide care for: early detection, specific protection, general prevention, diagnosis of pathologies or health states, treatment
or rehabilitation, which are in the benefit plans of the SGSSS, outside of these or in a particular way.
Who registers? All members of the health team who participate not only in the administrative process linked to care but
also in the care itself.
Why the care record? The recording of the patient's conditions and care is vital to identify, detect, prevent or treat
diseases, in addition to being an activity inherent to health care.
Why the care record? All providers are responsible before the SGSSS for building knowledge about the characteristics of
their target population, the health profile and the health services they receive, due to a contractual relationship and/or
ethical and social responsibility.

MINISTRY OF HEALTH
RESOLUTION NUMBER 3374 OF 2000
(December 27)

By which the basic data that health care providers must report are regulated.
health services and the entities administering benefit plans on the
health services provided

THE MINISTER OF HEALTH,

in use of its legal powers, especially those conferred by numerals 3 and 7 of the
article 173 of Law 100 of 1993, and

CONSIDERING
 That it is up to the Ministry of Health to regulate the collection, transfer and dissemination of the
information in the subsystem to which all members of the System must attend
General of Social Health Security.

That it is necessary to regulate, standardize and rationalize the institutional effort in the
generation of data and information on the health services provided.

That it is the responsibility of the Ministry of Health to establish the basic data that must be generated by the
Health Service Providers, on the individual health services provided and
billed to the Benefit Plan Administrative Entities, the definition,
structure, flow and storage thereof, the administration and disposition of the
information and responsibilities that correspond to the different participants of the
SGSSS obligated to report to the Comprehensive Health Information System.

RESOLVES:
CHAPTER I
GENERALITIES

ARTICLE ONE.- Definitions: For the purposes of this Resolution, it will be understood as:

1. Individual provision of health services: All health services, whether promotion, prevention, diagnosis, treatment or
rehabilitation, that are provided as part of a SGSSS benefit plan, or outside of it.

2. Entities administering benefit plans: These are the entities responsible for the provision of health services to a
specific population, based on an insurance plan or by order of the SGSSS, such as: Health Promotion Entities -EPS- and
those that are assimilated to them, for the Mandatory Health Plan of the Contributory Regime; the Administrators of the
Subsidized Regime -ARS-, for the Mandatory Health Plan of the Subsidized Regime; departmental, district and local health
directorates for health services covered with supply resources; Insurance Companies for traffic accidents, hospitalization
and surgery policies or any other health protection; the Solidarity and Health Guarantee Fund -FOSYGA- for traffic
accidents and catastrophic events and the administrators of benefit plans in special regimes
of social security.

3. Individual Record of Provision of Health Services – RIPS -: It is the set of minimum and basic data that the General
Health Social Security System requires for the management, regulation and control processes, and as support for the sale
of service. , whose name, structure and characteristics have been unified and standardized for all the entities referred to in
the second article of this Resolution. The data in this record refer to the identification of the health service provider, the user
who receives it, the provision of the service itself and the reason for its provision: diagnosis and external cause.

The Individual Registry for the Provision of Health Services -RIPS- is made up of three types of data:
· Identification
· From the health service itself
· Of the reason that originated its provision

The identification data are those of the administrative entity of the benefit plan, those of the service provider and those of
the transaction, reported in a service sales invoice.

The data from the Individual Health Services Provision Registry - RIPS - are those related to consultations, procedures,
emergency services, hospitalization and medications, the characteristics of said data and the values for each of them.

The consultation data is applicable to all types of consultations, scheduled or emergency, general and specialized medical,
general and specialized dental, and those carried out by other health professionals.

The procedure data is applicable to all of them, whether they are diagnostic or therapeutic procedures, early detection or
specific protection.

Hospitalization data are those generated when it occurs, whatever the reason for it, and includes consultations, procedures
and stays. The transfer of said data will be done in separate files.

The data corresponding to the individual provision of emergency health services includes consultations, procedures and
stays under observation. The transfer of said data will be done in separate files.

Newborn data correspond individually to the conditions and characteristics at birth of one or more boys or girls.

Medication data is related to their name and pharmacological form.

4. Computer processes: The computer processes are as follows:

  Update: It consists of the primary registration of the data, the modification, the elimination and the entry of these to
magnetic or electronic media.
 Validation: Consists of the verification of the recorded data, in terms of correspondence with the definition, structure
and characteristics defined in this Resolution; correspondence with values and cross-reference between variables.
 Organization: It consists of the organization of data on individual health services generated by the institution in
accordance with the standardized structures managed by the Comprehensive Health Information System and
established in this resolution.
 Data administration: It consists of the conservation, purification and elimination of information in databases and the
establishment of data control and security levels.
 Data transfer: It consists of sending data, using a magnetic or electronic means of communication, which allows the
data to be updated between the different entities.
 Information provision: It consists of the offer of public domain information in mass media.

5. Epicrisis: It is the summary of the clinical history of the patient who has received emergency services with observation
or hospitalization, with the contents and characteristics defined in the technical annex of this Resolution.

SECOND ARTICLE.- Scope of Application: The provisions contained in this Resolution are mandatory for the institutions
providing health services (IPS), independent professionals, or professional practice groups, the managing entities of benefit
plans, defined in section 2. of the first article of this Resolution and the management, surveillance and control bodies of the
SGSSS.

CHAPTER II
BASIC DATA ABOUT INDIVIDUAL HEALTH SERVICES

ARTICLE THREE.- Source of data on individual provision of health services: The sources of these data are the
Invoices of Sale of Services and the Clinical Records of the patients.

ARTICLE FOUR.- Of the basic data that health service providers must include in the specific description: In
accordance with the provisions of articles 617 and 618 of the Tax Statute, in accordance with article 618-3 of the same
system, in In relation to the requirements that invoices must meet, the following data is established that must be recorded in
the specific description of the health services provided.
These basic data refer to the transaction, the service and the value invoiced for them:

1. Data related to the transaction:

  Identification code of the health service provider in the SGSSS, assigned by the Local, District, Departmental Health
Directorate, or by the Ministry of Health for the institutions under its jurisdiction:
 Name or company name when it is a legal entity or surname and name of the provider when it is an independent
professional
 Type of provider identification document
 Provider identification document number
 invoice number
 Invoice issue date
 Start date of the billing period sent
 End date of the billing period sent
 Code and name of the Benefit Plan Administrative Entity or who pays the bill
 Contract number, when required
 Benefits plan
 Compulsory Traffic Accident Insurance (SOAT) policy number
 Shared payment value (Copayment)
 Value of the commission to be recognized by the EPS, for the diagnostic studies carried out to confirm occupational
disease
 Discounts value
 Net value to be paid by the contracting entity

2. Data related to the health service and the invoiced values: The specific data corresponding to the provision of
individual health services to users must be reported in a unitary manner, in the Individual Registry of Provision of Health
Services – RIPS, with the following data:

 User identification data

When health services are provided to people who are affiliated with the SGSSS, whether in the contributory or subsidized
regime, the following information must be filled out:

- Type and user identification number

- Type of user
For all users of other benefit plans or special events, the following must be completed, in addition to the above:
- Surnames
- Names
- Age
- Unit of measurement of age
- Sex
- Department and municipality of habitual residence of the user
- Zone
 Consultation Data:
- Date of the consultation
- Authorization number, when required
Query code
- Purpose of the consultation
- External cause that originated the consultation
- Principal diagnostic
- Related diagnosis No. 1
- Related diagnosis No. 2
- Related diagnosis No. 3
- Type of main diagnosis
- Query value
- Value of the moderator fee
- Net amount to be paid by the administrative entity of the benefit plan

 Procedure data
- Procedure date
- Authorization number, when required
- Procedure code
- Scope of performance of the procedure
- Purpose of the procedure
- Assisting personnel, which applies exclusively when the procedure is related to childbirth
- Primary diagnosis, only for surgical procedures
- Diagnosis related, only for surgical procedures
- Complication (when it occurs within a procedure)
- Method of carrying out the surgical act
- Value of the procedure

 Data on the individual provision of emergency services with observation

- Date of admission to observation
- Time of admission to observation
- Authorization number, when required to continue with the emergency service
- External cause
- Main diagnosis on departure
- Related diagnosis No. 1, at the exit
- Related diagnosis No. 2, at the exit
- Related diagnosis No. 3, at the exit
- Destination of the user to the observation exit
- Status upon departure
- Basic cause of death (when it occurs)
- Observation departure date
- Observation departure time

 Hospitalization data
- Route of entry to the institution
- Date of admission
- Entry time
- Authorization number, when required
- External cause
- Main admission diagnosis
- Main discharge diagnosis
- Related diagnosis No. 1, egress (if required)
- Related diagnosis No. 2, egress (if required)
- Related diagnosis No. 3, egress (if required)
- Diagnosis of the complication (if it occurs)
- Status upon departure
- Diagnosis of the basic cause of death (when it occurs)
- Egress date
- Exit time

 Newborn data
- Birthdate
- Time of birth
- Gestational age
- Prenatal control
- Sex
- Weight
- Newborn diagnosis
- Diagnosis of the basic cause of death (when it occurs)
- Death date
- Time of death

 Medication data:
POS Medications
- Medication code
- Type of medication
- Number of units applied or administered of the medication
- Unit value
- Total value
Medications outside the POS
- Authorization number, when required
- Medication code
- Generic name of the active ingredient (medicine)
- Pharmaceutical form
- Concentration
- Unit of measurement
- Number of units administered or applied
- Unit value
- Total value

Data from other services

- Authorization number
- Type of service
- Service code
- Service name
- Amount
- Unit value of the material, input, transfer, fees or stays
- Total value of the material, supplies, transfer, fees or stays

ARTICLE FIFTH.- Of the basic data that the entities administering benefit plans must report to the Ministry of
Health, regarding the individual provision of health services: The basic data that the entities administering benefit
plans must report to the Ministry of Health, in the Individual Records of Provision of Health Services -RIPS-, are the
following:

 Identification data:
- Code of the benefit plan administrative entity
- User ID type
- User identification number
- Type of user
- Affiliate type
- Occupation
- Age
- Unit of measurement of age
- Sex
- Department and municipality of habitual residence of the user
- Area of habitual residence

 Query details:
- Health service provider code
- Invoice number
- Date of the consultation
- Query code
- Purpose of the consultation
- External cause that originated the consultation
- Principal diagnostic
- Related diagnosis No. 1
- Related diagnosis No. 2
- Related diagnosis No. 3
- Type of main diagnosis
- Query value
- Value of the moderator fee
- Net amount to be paid by the administrative entity of the benefit plan

 Procedures data:
- Health service provider code
- Invoice number
- Procedure date
- Procedure code
- Scope of performance of the procedure
- Purpose of the procedure
- Personnel who attend, exclusively when the procedure is related to childbirth
- Primary diagnosis, only for surgical procedures
- Diagnosis related, only for surgical procedures
- Diagnosis of the complication (when it occurs within a procedure)
- Value of the procedure

 Data from the emergency service when it includes observation:

- Health service provider code
- Invoice number
- Date of admission to observation
- External cause
- Main diagnosis on departure
- Related diagnosis No. 1, at the exit
- Related diagnosis No. 2, at the exit
- Related diagnosis No. 3, at the exit
- Destination of the user to the observation exit
- Status upon departure
- Diagnosis of the basic cause of death (when it occurs)
- Departure date

 Hospitalization data:
- Health service provider code
- Invoice number
- Route of entry to the institution
- Date of admission
- Entry time
- External cause
- Main admission diagnosis
- Main discharge diagnosis
- Related diagnosis No. 1, egress
- Related diagnosis No. 2, egress
- Related diagnosis No. 3, egress
- Complication (when it occurs)
- Status upon departure
- Basic cause of death (when it occurs)
- Egress date
- Exit time

When the hospitalization has been related to childbirth, the

following information about the newborn:
- Health service provider code
- Invoice number
- Type and identification number of the mother
- Birthdate
- Time of birth
- Gestational age
- Prenatal control
- Sex
- Weight
- Newborn diagnosis
- Basic cause of death (when it occurs)
- Death date
- Time of death

 Medication data:
POS Medications
- Health service provider code
- Invoice number
- Medication code
- Number of units applied or administered of the medication
- Unit value
- Total value
Medications outside the POS
- Medication code
- Generic name of the active ingredient (medicine)
- Pharmaceutical form
- Concentration
- Unit of measurement
- Number of units administered or applied
- Unit value
- Total value

CHAPTER III
OF THE STRUCTURE AND FLOW OF DATA

ARTICLE SIX.- Structure and transfer of data: The data of the specific description of the services provided, along with
the other requirements of the invoice, established by the Tax Statute, in articles 617 and 618 that service providers The
health documents sent to the Benefit Plan Administrative Entities must be contained in magnetic media, with the structure
and characteristics defined in this Resolution and specified in the Technical Annex, which is part of it.

Neither the departmental, district or municipal health directorates, nor the benefit plan administrative entities nor any other
administration, management, surveillance and control body, may modify, reduce or add the data referred to in this
Resolution, nor the structure. in which they must be presented in a magnetic medium, in terms of length of the fields, type
of data, values that the data can adopt and order thereof. The foregoing is without prejudice to the fact that in the health
service providers' own databases, they may have additional information for their own use.

ARTICLE SEVEN.- Of the supports on the individual provision of health services that must accompany the sales
invoices: The Individual Records of Provision of Health Services - RIPS - in magnetic medium, must be presented together
with the sales invoices and with the following supports:

1. Copy of the epicrisis signed by the treating physician or person responsible for providing the health service, for
emergencies with observation, for hospitalization, for high-cost health services, or that are subject to reinsurance.
2. In cases of claims for traffic accidents, catastrophic events, terrorist acts or work accidents, in addition to the epicrisis,
the specific claims established by the regulations in force at the time of billing must be submitted.

Paragraph.- The entity administering benefit plans may only request, by exception, a copy of all or part of the medical
history, when it involves high-cost health services or reinsured services.

ARTICLE EIGHTH.- Data flow: The data referred to in this Resolution will be sent by the health service providers to the
benefit plan administrative entities, as part of the sales invoice for the services provided, and these will be sent to the
Ministry of Health, for consolidation in the Comprehensive Health Information System.

The data for the provision of individual health services covered with supply resources must be sent by the service provider
to the respective local health directorate. Local health directorates must send them to the Ministry of Health.

In cases where capitation contracting has been carried out, health service providers are similarly obliged to register and
send monthly data on the services actually provided to the administrative entity of the health benefits plan, with the same
structure defined in this Resolution. The entity administering the benefit plan must send the data to the Ministry of Health.

Data on the individual provision of health services paid particularly by users must be sent by health service providers to
local health directorates, in accordance with the data standard defined in this Resolution. The local health directorates or
whoever takes their place must send them to the Ministry of Health.

Paragraph.- The departmental, district and municipal health directorates and the entities administering benefit plans may
not request from health service providers additional data to those defined in this Resolution, nor statistics or consolidated
reports that can be obtained from of these records.

CHAPTER IV
COMPUTER PROCESSES IN THE GENERATION OF BASIC DATA ABOUT THE
PROVISION OF HEALTH SERVICES

ARTICLE NINTH.- Computer processes in health service providers: Health service providers are responsible for the
following computer processes:
1. When updating data, they must: i) standardize manual or automated registration forms, which include the contents and
structure defined in this resolution; ii) record the data simultaneously with the provision of the health service, and iii)
guarantee the reliability and validity of the data.

2. When validating the data, prior to its transfer, the consistency of the data must be verified in terms of the values
assumed by the variables and their cross-reference.

3. In the transfer of data to the benefit plan administrative entities, they must send the data in the respective files, within the
same month or in the first twenty (20) days of the month following the billing of the health services.

ARTICLE TEN.- Computer processes in the entities that administer benefit plans: The entities that administer benefit
plans are obliged to guarantee the reliability, security and quality of data on the individual provision of health services; the
timely delivery to the Ministry of Health and the formation of its own database on the services provided, on an individualized
basis.

The departmental, district and local health directorates, which act as administrators for the provision of health services to
the linked population and to the beneficiaries of the subsidized regime covered with health services outside the POSS,
which are financed with supply resources, must carry out the same computer processes and form the database of the
services provided to the population, within its territorial scope.

These computer processes also apply to the management of data on the provision of individual health services due to
catastrophic events, traffic accidents and professional risks, without prejudice to the other special requirements established
by the Ministry of Health, for these cases.

For the above purposes, the health benefit plan administrators, and all the entities indicated in the second article of this
Resolution, are responsible for the following computer processes:

1. When updating data, they must receive the information sent by health service providers, verify its origin and the reported
period, and integrate the data received to form the database for the provision of health services to their user population.
When validating the data, they must verify that the structure of the files corresponds to the established one; that the data is
consistent and verify that the data fields are filled out correctly.

3. In the organization of the information to be sent to the Ministry of Health, they must generate, from their database for the
provision of individual health services, the organized data required by the Comprehensive Information System of the
SGSSS. This organizational process must include the data that they generate primarily and that complement that received
from health service providers.

4. In the transfer of data to the Ministry of Health, they must send the Individual Records of the Provision of Health Services
- RIPS -, on magnetic media, according to the annex of technical specifications, which is an integral part of this Resolution.

The entities administering benefit plans must transfer the Individual Health Service Provision Records – RIPS – within thirty
(30) days following their receipt, validation and acceptance. When providers have transferred Individual Records for the
Provision of Health Services - RIPS - corresponding to previous months, the benefit plan administering entities may include
them in the month's report, clarifying that said information corresponds to another period.

ARTICLE ELEVEN.- Computer processes of the Ministry of Health:

1. In updating data, the Ministry of Health, directly or through an external operator, will receive the information and update
its databases, periodically integrating the information received from the benefit plan administrative entities to form the
database. data on the provision of health services, with information from the entire country.

2. In data validation, the Ministry of Health, directly or through an external operator, prior to updating the databases, must
verify the origin and reported periods; request the benefit plan administering entities for information that has not been sent;
verify that the structure of the files corresponds to that established and that the data fields are filled out correctly.

3. Identified inconsistencies will be reported to the benefit plan administering entities for correction. The corrected Individual
Health Service Provision Records – RIPS – must be returned by the entities in the same structure during the following
month.
4. In the feedback of information to the territorial management bodies, the Ministry of Health will send quarterly to each
departmental health directorate, in flat files, the data on the health services provided to the population of its department,
discriminating the information by municipality (people's place of residence) and by entities administering benefit plans. The
departmental addresses must deliver the information to their respective municipalities, with a periodicity of no more than
four (4) months.

5. The information for each municipality will contain data on the individual provision of health services to the population
covered by the contributory regime in each EPS, those provided within the POS-S to the population covered by the
subsidized regime, those provided outside of the POS-S to the beneficiary population of the subsidized regime, those
corresponding to the linked population, financed with supply resources and those caused by catastrophic events.
6. The Ministry of Health will periodically generate consolidated and grouped information, at the national level, for common
use by all participants in the General Health Social Security System.

ARTICLE TWELFTH.- Validity: This Resolution is in force from the date of its publication, takes effect as of April 1, 2001,
and repeals Resolutions 2546 of 1998, 1958 of 1999 and 1832 of 1999.

Paragraph.- The date of entry into force of this Resolution for professionals who independently provide health services is
June 1, 2001, as established by Resolution No. 1077 of 2000.

BILLING AND INVOICE SYSTEM

It is the set of activities that allows the identification, registration, classification, settlement and quantification of the
provision of health services, which leads to the care of a user in an IPS based on the procedures manual. The invoice is a
document that is generated when purchasing and selling services.

The billing of health services is a responsibility of great relevance to guarantee the adequate financial performance of any
institution in the health sector, considering the structure of the health system, the contracting modalities specific to the
sector, the complexity of the billing process, the knowledge of the tariff manuals, requires highly qualified and trained
personnel to adequately and responsibly assume the important role.

Phases of the billing process:

1. Previous definitions.
2. Registration.
3. Compilation.
4. Processing.
5. Types of attention.
6. Analysis, interpretation and use of information.
8. Storage.
9. Filter.
10. Liquidation.
11. Preparation of collection account.
  Session 7: CIVIL, CRIMINAL AND ETHICS LIABILITY
 Historical background

Before starting to define the different types of Responsibility in which we can find ourselves immersed, let's remember a
little history. In fact, very little has been written about the history of nursing professional responsibility, since since ancient
times there has been talk of this responsibility applied to the healer, tacitly including nursing, but the figure of the nurse
does not appear explicitly as such until recent centuries. and appears in such a way that society does not hold her
responsible for her actions because they are all derived from medical orders. When the nursing profession acquires its own
identity, nurses acquire a series of responsibilities that are demanded of them by society and, in recent times and like the
doctor, in the courts. In this historical evolution it must be said that the concept of medical liability appears as early as 2392
BC, when the Code of Hamurabi dedicated a series of canons to faults and punishments for doctors. Thus it was said: “If a
doctor opens a large wound in someone with the bronze knife and kills him, his hands must be cut off.” Roman law
established the guilt of the doctor even when, having done well, the results were negative due to a certain abandonment,
which could be considered negligence. Alexander the Great established the penalty of crucifixion for the doctor who freely
and voluntarily abandoned a sick person, thus the Juzgo Court handed the doctor over to the relatives of the ill willfully
abandoned patient and thus the sentence was at the mercy of the relatives of the injured patient.
That is to say, at all times and in different civilizations there were doctors who, although with different methodologies or
beliefs, had to answer for their good work whether before the people, the judge or the chief of the tribe. In Spain, until the
seventies, jurisprudence in relation to medical liability was very scarce. Since then it has increased and it is in recent years
that the number of complaints has increased considerably. A multitude of factors have influenced the current increase in
conflict, but fundamentally those inherent to the complexity of the profession itself with the increase in invasive or bloody
diagnostic methods, or high-risk therapeutics, and also a series of social factors such as the greatest information of the
population regarding consumer rights or the legal protection of the person.
It must be said that the awareness of professional responsibility and the consequent emergence of health and
compensation law in this field is relatively recent.
It must also be said that the phenomenon has been unstoppable and that claims for compensation for damages through
judicial means, for damage to health, have grown alarmingly for professionals.

 CRIMINAL LIABILITY
The person who provides a medical service may engage in typical, unlawful and guilty conduct, punishable by a penalty,
such as those regulated by our penal code, when the actions that may be of action or omission are not carried out within
the parameters of ethics. , morality and legality, such as:

 Injuries to the fetus (art. 125 CP)

Penalties increased by article 14 of Law 890 of 2004, as
of the 1st. January 2005. The text with the increased
penalties is as follows: > Anyone who, by any means,
causes damage to the body or health of a fetus that
impairs its normal development, will incur a prison
sentence of thirty-two (32) to seventy-two (72). )
months.
If the conduct was carried out by a health professional,
disqualification from practicing the profession will also
be imposed for the same term.

 Induction or assistance to suicide (art. 107 CP)

Penalties increased by article 14 of Law 890 of 2004, as of the 1st. January 2005. The text with the increased
penalties is as follows: > Anyone who effectively induces another to commit suicide, or provides effective help to
commit suicide, will incur a prison sentence of thirty-two (32) to one hundred eight (108) months.

When the inducement or help is aimed at putting an end to intense suffering resulting from bodily injury or serious
and incurable illness, imprisonment of sixteen (16) to thirty-six (36) months will be incurred.

 Omission of relief (art. 131 CP)

Penalties increased by article 14 of Law 890 of 2004, as of the 1st. January 2005. The text with the increased
penalties is as follows: Anyone who omits, without just cause, to assist a person whose life or health is in serious
danger will be imprisoned for thirty-two (32) to seventy-two (72) months. .

 Culpable homicide (art. 109 CP)

Penalties increased by article 14 of Law 890 of 2004, as of the 1st. January 2005. The text with the increased
penalties is as follows: > Anyone who kills another through guilt will be liable to imprisonment of thirty-two (32) to one
hundred eight (108) months and a fine of twenty-six point sixty-six (26.66) to one hundred and fifty (150) current
legal monthly minimum wages.
 When the culpable conduct is committed using motorized means or a firearm, the deprivation of the right to drive
motor vehicles and motorcycles and the deprivation of the right to possess and carry a weapon, respectively, of
forty-eight (48) will also be imposed. to ninety (90) months.

 Culpable personal injuries (art. 120 CP)

Penalties increased by article 14 of Law 890 of 2004, as of the 1st. January 2005. The text with the increased
penalties is as follows: > Anyone who, through fault, causes any of the injuries referred to in the previous articles to
another, will incur the respective penalty reduced from four-fifths to three-quarters.

When the culpable conduct is committed using motorized means or a firearm, the penalty of deprivation of the right
to drive motor vehicles and motorcycles and deprivation of the right to possess and carry a weapon, respectively, of
sixteen (16) to fifty will also be imposed. and four (54) months.

 CIVIL LIABILITY

It is one by virtue of which the patient (victim or his heirs) can demand pecuniary compensation from the doctor for
damages caused during the exercise of the medical profession.
Talk about the responsibility of the doctor, whether civil, criminal, administrative, etc. It is inevitably referring to a modern
phenomenon, almost of our days since only the consumerist and demanding society that defends individual rights, and
some why not, of fundamental rights could manage to sit on the bench to request legal and material reparation from the
doctors who They cause harm to their relatives in the performance of their profession.
Medicine carries an enormous responsibility that arises from the characteristics that encompass its practice, therefore,
every procedure, whether therapeutic, surgical or diagnostic, has an associated risk for the patient, represented by the
actions of a doctor that cause damage or physical consequences. , psychic, have legal implications.
Currently, the most accepted element in relation to the obligation to make reparation due to third parties is the obligation of
security and guarantee, through which it is sought to be provided to the patient either within an obligation of means or an
obligation of result. a minimum of security in terms of professionals who are working in a public or private institution,
adequate and necessary elements, so that the intended goal, which is the preservation of health, can be achieved. This
legal figure does not intend, at a given moment and in the face of obvious harm caused to the patient, to demonstrate the
subjectivity of the action or omission of a medical professional, but rather, non-compliance with the principle of safety and
good faith.
The civil liability of doctors and, in general, that of health professionals, can manifest itself in two known ways:

 Contractual: It occurs when a contract for the provision of professional services has been concluded between the
doctor and the patient.
 Extracontractual: It occurs when there has been no agreement or contract and the professional must care for
the patient due to the special circumstances in which he or she is located, such as: in a state of unconsciousness, in
emergency cases because he or she is acting in the name and representation of the public or private institution to
which it is linked, such as the EAPB, IPS or some prepaid health institutions, cases in which the contract or
contractual relationship is understood to be concluded with the institution and not with the professional.
 Obligations of the Medical Professional:
 Have a professional degree that qualifies you to practice the profession and the specialty it offers.
 Have knowledge, preparation and experience that are necessary to face your patients' cases.
 Correctly prepare the medical history or document that must be
collected or document that must collect all the circumstances,
symptoms and treatments, and behavior of the patient.
 Maintain professional secrecy.
 Use the equipment, instruments, procedures appropriate to the
symptoms presented by the patient.
 Use when necessary the collaboration and help of other
colleagues who are authorized.
 The Medical Act:
These are those activities or procedures that must be carried out
by the medical professional to adequately resolve the case of
which he or she is aware. It is made up of several stages or
moments, which are concatenated until achieving final success.

 The diagnosis:
It is the initial moment of the medical act, in which the medical
professional searches for the causes or reasons that originate the
consultation. To do this, it uses clinical and technical means, where the patient must explain with truthfulness and
 certainty the symptoms or manifestations of the health disorder. When necessary, the professional can seek help
and collaboration with other colleagues.

 Information:
It consists of providing the patient with adequate and sufficient information about the health disorders that clearly
afflict them.

 Consent:
The above aims to obtain the patient's consent to carry out the treatments or procedures arranged by the
professional. This is known as the patient's informed consent, that is, an express, conscious authorization.
There will be exceptions for special cases, where the patient's consent cannot be required and others in which it
must be requested from relatives and close family members, since it cannot be obtained from the patient directly due
to their state of health or the possible consequences of knowing the truth. .

 Treatment:
If consent is obtained, it must provide the treatment for the patient, which can be given in two ways.
 Surgical, when there is no other way
 Therapeutic, when the health disorder can be faced with drugs.
 Posttreatment: Activities that must be completed after surgical or therapeutic treatment for a successful end to
the process, such as: controls. The medical act ends here.

 ETHICAL RESPONSIBILITY

This responsibility assumed by health professionals is established by Law 23 of 1981 and its regulatory decree of the same
year 3380. Of which, it is determined that the medical profession fulfills and has a social function that must prevail in all
their professional actions, both in private and public life they must adhere to strict moral standards and the way of carrying
out their duties is also established. relationships with patients.
The investigation of unethical conduct can be initiated by a complaint from an interested party or ex officio by order of a
medical ethics court, which is responsible for judging the conduct of medical professionals who are unaware of the rules of
 this order.
There is a national court that operates in the capital of the country and is the second instance of the determinations made
by the first instance, which correspond to the sections located in the capital of the departments, which will designate a
medical instructor to investigate. and instructs the process and sets terms for it, where at the end of its action it submits a
report in which it states whether or not there is a violation of ethical standards. The person under investigation must be
accompanied by a legal professional.
The ruling issued by the court does not become res judicata in the civil field nor in the criminal field, that is, if it involves
investigating and judging criminal or civil liability for the same fact that the ethics court investigated and judged. medical
ethics, judicial officials are not obliged to respect such determinations and may adopt different conclusions, even opposite
to those admitted by the medical ethics court.

 . Session 8: INSTITUTIONAL PROCEDURES FOR PRIORITY SURVEY (SISBEN)

It is an Information System that allows you to identify which people or families live
in conditions of poverty in the municipalities to select them and enjoy government
benefits, through social programs.
The SISBEN is the Identification System of Potential Beneficiaries of Social
Programs. This is an identification tool, which organizes individuals according to
their standard of living and allows the technical, objective, uniform and equitable
selection of beneficiaries of the social programs managed by the State, according
to their particular socioeconomic condition.

BENEFITS OF SISBEN

If a person has been identified as a potential

beneficiary of social programs, that is, the level is
between 1 and 3, they will be able to access the
subsidies granted by the State through different
programs such as:
 Health.
 Employment Subsidies.
 Older Adult.
 Housing.
 Conditional subsidies.
 Educational Credits.
 Children's Breakfasts.

GLOSSARY ACCORDING TO DECREE NUMBER 1192 OF 2010

 SISBEN Certified Base: It is the SISBEN database that is periodically sent by the National Planning Department, to
the territorial entities and to the social programs of the national or territorial order, as a result of applying to the
SISBEN Gross Base, all the processes of quality control and the information cross-checks necessary for its
purification.

 SISBEN Municipal Gross Base: It is the database generated by the municipality from the survey updating
processes. The SISBEN Municipal Gross Base is delivered on the information cut-off dates to the respective
department or the National Planning Department.

 SISBEN Gross District Base: It is the gross database generated by the districts from the survey updating
processes. The SISBEN Gross District Base is periodically delivered to the respective department or to the National
Planning Department.

 SISBEN Gross Base: It is the national SISBEN database made up of the union of the SISBEN Municipal and
District Gross Bases that were delivered to the National Planning Department on the established cut-off dates.

 Information outages: Corresponds to each of the periods of updating and sending information from the Municipal
and District Bases of SISBÉN, established by the National Planning Department to the territorial entities.

 FREE WAY DATABASE, DISPLACED, REINSERTED, PROTECTION OF HELPFUL CHILDREN

The design of the structure of the databases, the criteria for the entry, suspension and exclusion of people in the
databases, the quality control processes and the information crossings necessary for the purification that generate
the SISBEN Certified Base , are a constituent part of the process of identifying potential beneficiaries of social
programs and will be adopted by the National Planning Department through resolution, Targeting Instruments.
Decree 4816 of 2008 - December 23, 2008. The CONPES Social will define, every three years, the criteria and
 instruments for the determination, identification and selection of potential beneficiaries, as well as the criteria for the
application of social spending by the entities. territorial.

 Beginning
The targeting instruments will be guided by the principles of transparency, equality and publicity of information that
does not enjoy constitutional protection or legal reservation, as well as the other principles that govern the
administrative function. Consequently, natural persons have the right to be surveyed, to have their data processed in
a timely manner and to receive true and timely information through regular and public communication channels.

 Conditions for inclusion in databases

Any natural person can request inclusion in the databases. For this purpose, you must provide the information
required to complete the socioeconomic classification form in your municipality of habitual residence.

Records in the database can be of three types:

 Validated record: It is that record that remains with the corresponding score and level in the database after
passing all the purification and quality control processes.
 Suspended record: Corresponds to glossed records, that is, those that, due to the purification processes and
quality controls, remain in the database but must gather support to not be excluded.
 Excluded record: These are the records that do not remain in the database due to its purification processes and
quality controls.

 The National Planning Department - Directorate of Social Development

This entity is responsible for coordinating and supervising the organization, administration, implementation,
maintenance and updating of the databases that make up the instruments of the system for identifying potential
beneficiaries of social programs.

 . Session 9: CO-PAYMENTS AND MODERATION FEES

 Moderating Fee: Its objective is to regulate the use of the health service and encourage its proper use. They apply
only to the Contributory Regime.

 Co-payments: These are the monetary contributions made by users of health services and are intended to help
finance the system.
 AGREEMENT NUMBER 000260 OF 2004 (February 4)
by which the regime of shared payments and moderating fees is defined
within the General Health Social Security System.

The National Council of Social Security in Health, in exercise of the powers

legal conferred in numeral 7 of article 172 and article 187 of Law 100 of 1993,

AGREE:

Article 1. Moderating fees. The objective of the moderating fees is to regulate the use of the health service and encourage
its proper use, promoting enrollment among members in the comprehensive care programs developed by the EPS.

Article 2. Copays. Copayments are monetary contributions that correspond to a part of the value of the service requested
and are intended to help finance the system.

Article 3. Application of moderating fees and co-payments. Moderator fees will be applicable to contributing members and
their beneficiaries, while co-payments will apply solely and exclusively to beneficiary members.

Paragraph. In accordance with the third paragraph of article 160 of Law 100 of 1993, it is the duty of the contributing
member and the beneficiaries to pay the moderator fees and the corresponding co-payments.

Article 4. Base income for the application of moderator fees and co-payments. The moderating fees and co-payments will
be applied taking into account the base contribution income of the contributing member. If there is more than one
contributor per family unit, the lowest declared income will be considered as the basis for calculating the moderator fees
and co-payments.

Article 5. Principles for the application of moderating fees and co-payments. In the application of moderating fees and co-
payments, the following basic principles must be respected:

1. Equity.
2. User information.
3. General application.
 4. Not simultaneity.

Article 6. Services subject to the collection of moderator fees. Moderation fees will be applied to the following services, at
the frequencies autonomously defined by the EPS:

1. Accepted medical, dental, paramedical and alternative medicine outpatient consultation.

2. External consultation by a specialist doctor.
3. Formulation of medications for outpatient treatments. The moderator fee will be charged for the entire order issued in the
same query, regardless of the number of items included. The format for said formula must include at least three boxes.
4. Diagnostic tests by clinical laboratory, ordered on an outpatient basis and that do not require additional authorization
than that of the treating physician. The moderator fee will be charged for the entire order issued in the same query,
regardless of the number of items included in it. The format for said order must include at least four boxes.
5. Diagnostic imaging exams, ordered on an outpatient basis and that do not require additional authorization than that of
the treating physician. The moderator fee will be charged for the entire order issued in the same query, regardless of the
number of items included in it. The format for said order must include at least three boxes.
6. Care in the emergency department only and exclusively when the use of these services is not due, in the opinion of an
authorized health professional, to problems that compromise the life or functionality of the person or that require immediate
protection with emergency services. health.
Article 7. Services subject to the collection of co-payments. Copayments must be applied to all services contained in the
mandatory health plan, with the exception of:
1. Promotion and prevention services.
2. Control programs in maternal and child care.
3. Control programs in the care of communicable diseases.
4. Catastrophic or high-cost illnesses.
5. Initial emergency care.
6. The services stated in the preceding article.

Those mentioned are some articles that explain how co-payments and the moderating fee are handled in the country. The
apprentice is asked to carry out the research and read the agreement.

 Session 10: DISPLACED LAW, SENIOR PROGRAM

 DISPLACED LAW (LAW 387 OF 1997 - JULY 18)

By which measures are adopted to prevent forced displacement; the care, protection, consolidation and socioeconomic
stabilization of those internally displaced by violence in the Republic of Colombia.
A DISPLACED person is defined as any person who has been forced to migrate within the national territory, abandoning
their place of residence or usual economic activities, because their life, physical integrity, personal security or freedom have
been violated or are directly threatened, with occasion of any of the following situations: Internal armed conflict, internal
disturbances and tensions, generalized violence, massive violations of Human Rights, violations of International
Humanitarian Law or other circumstances emanating from the previous situations that may drastically alter or alter public
order.

PRINCIPLES OF THE DISPLACED LAW

1. Forced displaced persons have the right to request and
receive international aid and this generates a correlative right
of the international community to provide humanitarian aid.
2. The forcibly displaced person will enjoy the fundamental
civil rights recognized internationally.
3. The displaced person and/or forcibly displaced persons
have the right not to be discriminated against due to their
social status as displaced persons, race, religion, public
opinion, place of origin or physical disability.
4. The family of the forcibly displaced person must benefit from
the fundamental right of family reunification.
5. The forcibly displaced person has the right to access
definitive solutions to their situation.
6. The forcibly displaced person has the right to return to his or
her place of origin.
7. Colombians have the right not to be forcibly displaced.
8. The displaced person and/or forcibly displaced persons have the right to have their freedom of movement not subject to
more restrictions than those provided for by law.
9. It is the duty of the State to foster conditions that facilitate coexistence among Colombians, equity and social justice.

STATE RESPONSIBILITY
It is the responsibility of the Colombian State to formulate policies and adopt measures for the prevention of forced
displacement; the care, protection and consolidation and socioeconomic stabilization of those internally displaced by
violence.

The system will be made up of the set of public, private and community entities that carry out plans, programs, projects and
specific actions, aimed at comprehensive care for the displaced population and whose objectives will be the following:
1. Provide comprehensive care to the population displaced by violence so that, within the framework of voluntary return or
resettlement, they achieve their reintegration into Colombian society.
2. Neutralize and mitigate the effects of the processes and dynamics of violence that cause displacement, by strengthening
the comprehensive and sustainable development of the sending and receiving areas, and the promotion and protection of
Human Rights and International Humanitarian Law.
3. Integrate public and private efforts for adequate prevention and attention to situations of forced displacement due to
violence.
4. Guarantee timely and efficient management of all human, technical, administrative and economic resources that are
essential for the prevention and attention of situations that arise due to forced displacement due to violence.

NATIONAL PLAN FOR COMPREHENSIVE CARE TO THE POPULATION DISPLACED BY VIOLENCE

The National Government will design the National Plan for Comprehensive Care of the Population Displaced by Violence
which, once approved by the National Council, will be adopted by decree. To prepare this plan, there will be the
collaboration of the public, private and community entities that make up the National System of Comprehensive Care for
Populations Displaced by Violence.
The measures and actions adopted in the National Plan must address the special characteristics and conditions of the
"expulsion zones" and "reception zones." The objectives of the National Plan will be the following, among others:
1. Prepare diagnoses of the causes and agents that generate displacement due to violence.
2. Design and adopt social, economic, legal, political and security measures, aimed at preventing and overcoming the
causes that generate forced displacement.
3. Adopt emergency humanitarian care measures for the displaced population, in order to ensure their protection and the
necessary conditions for subsistence and adaptation to the new situation.
4. Create and apply mechanisms that provide legal and legal assistance to the displaced population to guarantee the
investigation of the facts, the restitution of violated rights and the defense of affected property.
5. Design and adopt measures that guarantee the displaced population access to comprehensive urban and rural
development plans, programs and projects.
6. Adopt the necessary measures to enable the voluntary return of the displaced population to their area of origin or their
relocation to new settlement areas.
7. Provide special attention to women and children, preferably widows, female heads of households and orphans.
8. Guarantee special attention to black and indigenous communities subjected to displacement in accordance with their
practices and customs, and promoting their return to their territories.

EMERGENCY HUMANITARIAN CARE

Once the displacement occurs, the National Government will initiate immediate actions aimed at guaranteeing emergency
humanitarian care with the purpose of helping, assisting and protecting the displaced population and meeting their needs
for food, personal hygiene, management of supplies, utensils. cooking, medical and psychological care, emergency
transportation and transitional accommodation in decent conditions.
The General Social Security Health System will implement expeditious mechanisms so that the population affected by
displacement can access comprehensive medical, surgical, dental, psychological, hospital and rehabilitation assistance
services, in accordance with the provisions of Law 100 of 1993. .
The Social Solidarity Network will give priority to the needs of displaced communities at the solidarity tables and will assist
the victims of this phenomenon, linking them to its programs.
The Colombian Institute of Family Welfare will give priority in its programs to the care of nursing children, minors, especially
orphans, and family groups, linking them to the family and community social assistance project in the settlement areas of
the displaced.

SENIOR PROGRAM (DECREE 731 OF 1995)

By which the Tripartite Concertation Commission for the Development of Programs for the Elderly is created, as an
advisory body of the National Government, attached to the Ministry of Labor and Social Security.

PURPOSE AND FUNCTIONS

The Commission's objective will be the development of policies and programs aimed at protecting and caring for people
who, due to their age, deserve help from society and their integration into the community in general.
The functions of the Commission will be aimed at:
1. Analyze the relevant articles of the Political Constitution related to the rights of the elderly.
2. Propose actions on the positive recognition of old age, aging and preparation for retirement.
3. Recommend the adoption of plans and programs for the development of a system of social services that address the
needs of health, housing, loneliness, leisure, culture and recreation.
4. Recommend the adoption of plans and programs for the reintegration of the elderly into productive activities in
cooperatives, microenterprises, family businesses and associative companies.
The Commission will be made up of representatives of the National Government, public or private universities and
pensioners. For the Government, the Ministry of Labor and Social Security, who will coordinate it, the Ministry of Health and
the Ministry for Social Policy, will be part of the Commission. For public or private universities that have programs for the
development of the elderly, three (3) representatives will be part of the Commission, who will be designated by the Ministry
for Social Policy, on topics presented by them. For the pensioners, two representatives of the Confederation of Pensioners
of Colombia and one of the other Confederations of Pensioners, designated by the Ministry of Labor and Social Security,
will be part of the Commission on topics presented by them.

ORAL HEALTH IN THE OLDER ADULT

The consequence of inadequate dentition is poor oral function. Despite the low demand for services in the elderly, the
primary objective of dentistry is to maintain natural, healthy and functional dentition throughout life, with all the social and
biological benefits (aesthetics, comfort, proper chewing, sense of taste (speaks) that this gives to patients, thus contributing
from the dental profession to what is considered successful aging.
When treating a partially edentulous older adult patient, the dentist should ask what is the minimum number of teeth
required to meet the functional and social demands of that patient. The answer to this question is not yet clearly
established, but it is necessary to say that it varies individually, depending on local and systematic factors (periodontal
conditions of the remaining teeth, occlusal activity, spatial relationship of the upper and lower remaining teeth, type of
feeding and chewing patterns, adaptive capacity and age) and that functional demands are dynamic and individual and
therefore the focus of dental treatment should be as well.

 Session 11: ICBF PROTECTION, REINSERTED PEOPLE, UNINSURED POOR POPULATION

ICBF PROTECTION

COLOMBIAN INSTITUTE OF FAMILY WELFARE (ICBF)

The ICBF, an entity attached to the Ministry of Social Protection, is one of the most representative institutions in the
country. It was created in 1968 in response to problems such as nutritional deficiency, family disintegration and instability,
loss of values and abandoned childhood.
The ICBF is present in each of the departmental capitals, through its regional and sectional offices.
Its mission is to be a Public Service institution committed to the comprehensive protection of the Family and especially
Children. They coordinate the National Family Welfare System and as such they propose and implement policies, provide
advice and technical and socio-legal assistance to communities and public and private organizations of the national and
territorial order.
REINSERTED
In Colombia there are more than 33 thousand reinserted people, that is to say; people are part of the reintegration process,
led by the High Council to seek the abandonment of weapons by thousands of combatants from guerrilla and paramilitary
organizations.

REGULATIONS OF OTHERS

AGREEMENT NUMBER 253 OF 2003

By which the expansion of coverage in the Subsidized Regime with contract settlement surpluses is approved and other
provisions are dictated.

PRIORITIZATION CRITERIA FOR SUBSIDY BENEFICIARIES

The mayors or governorates (in the case of departmental townships) will prepare the lists of potential affiliates of the
Subsidized Regime, classified in levels 1 and 2 of the SISBEN survey, in ascending order from lowest to highest score and
from oldest to oldest. most recent, with your family nucleus when applicable, as well as in the census lists and will be
prioritized taking into account the following criteria:
1. Newborns.
2. Minors separated from the armed conflict, under the protection of the Colombian Institute of Family Welfare.
3. The population of the rural area.
4. Indigenous population.
5. Population of the urban area.
In each of the population groups, described in paragraphs 3, 4 and 5 above, potential affiliates will be prioritized in the
following order:
1. Women who are pregnant or breastfeeding who enroll in prenatal and postnatal control programs.
2. Children under five years of age.
3. Population with disabilities identified through the SISBEN survey.
4. Women heads of household, according to the legal definition.
5. Elderly population.
6. Population in conditions of forced displacement.
7. Family nuclei of community mothers.
8. Demobilized.
 Paragraph 1
Newborns, children under 5 years of age and minors separated from the armed conflict under the protection of the ICBF,
who are priorities as established in this agreement, may join without their family group.

Paragraph 2
In any case, the prioritized list must be available between 150 and 120 calendar days before the contracting process and
cannot be modified during the following year. In this case, the Ministry of Social Protection will authorize the modification of
the databases.

Paragraph 3
The availability period does not apply to the prioritized list of minors separated from the armed conflict, under the protection
of the Colombian Institute of Family Welfare. The ICBF will be responsible for the information required by the Social Health
Security System to affiliate this population group, previously verifying that it is not currently affiliated with the contributory
and subsidized regimes.

Paragraph 4
As a general principle, the SISBEN survey cannot be applied by Health Service Providing Institutions.

SUBSIDIZED POS
It is the set of Health services to which a user is entitled, whose purpose is the Promotion of Health, the Prevention of
Disease, the cure of different pathologies, if they occur, and the rehabilitation of the same in accordance with the current
regulations.

HOW ARE THESE GROUPS IDENTIFIED?

Each municipality identifies the potential population through the application of the SISBÉN Survey (System for Selection of
Beneficiaries for Social Programs), through the census list of indigenous communities, through the certification of the
abandoned child population issued by the ICBF, or through the identification of the indigent population in the established
formats or in the instruments that take their place.

IDENTIFICATION INSTRUMENTS FOR SISBEN BENEFICIARIES

· Abandoned child population: The Colombian Institute of Family Welfare (ICBF) makes the census list.
· Indigent Population: The Mayor's Office prepares the census list.
· Population in conditions of forced displacement: Single Registration System of the Social Solidarity Network.
· Indigenous Communities: As provided in Article 5 of Law 691/01.
· Demobilized population: List prepared by the Special Secretariat for Reintegration of the Ministry of the Interior.
· Community Mothers Family Nuclei: List prepared by the Colombian Institute of Family Welfare.
· Elderly people in protection of shelter homes for men and women (elderly homes): List prepared by the territorial entity.
· Migratory Rural Population: List prepared by agricultural unions or user organizations.

WHO JOINS THE POS-S?

The family nucleus composed of:
· Spouse or permanent partner.
· Children under 18 years of age of either spouse or permanent partner.
· Children over 18 years of age with certified permanent disabilities.
· Children between 18 and 25 when they are full-time students and financially dependent on the head of the family unit.
· When there are other members other than those mentioned above, they will continue to be affiliated individually, as long as
they meet the prioritization criteria.
Identification documents required to join:
· Children under 7 years of age: Civil Registry with NUIP (Unique Personal Identification Number).
· Minors under 18 years of age: Identity Card.
· People over 18 years of age: Citizenship Card or Immigration Card in the case of foreign residents.
Minimum time spent in the Subsidized Regime:
Three (3) continuous years.

 Session 12: CONTROL MECHANISM FOR THE OUTPUT OF THE CLINICAL HISTORY,
ARCHIVE METHODS

 CONTROL MECHANISMS FOR THE OUTPUT OF THE CLINICAL HISTORY

For the daily record of entry and exit of the Clinical Records, the Clinic Administrator and the Clinic Administration
Assistants will keep a record in which the number of the History delivered to each doctor is filled out. This format will
contain, at a minimum, the following information:
  Medical History Number.
 Date of delivery.
 Return date.
 Signature of the person receiving the history for medical or control purposes and signature of the official who enters
and receives it.

This completion is mandatory and the forms are kept in a chronological folder with a file for the purposes of any
investigation. In the event of a request to loan medical records to other departments, professionals or students for
consultation, an authorization order signed by the Clinic Director must be obtained and as support ENTRY AND OUTPUT
RECORD. For the daily record of entry and exit of the Clinical Records, the Clinic Administrator and the Clinic
Administration Assistants will keep a record in which the number of the History given to each student is filled out. This
format will contain, at a minimum, the following information: Medical Record Number, date of delivery to the student; return
date, signature of the student in both cases and signature of the person who delivers and receives it. This completion is
mandatory and the forms are kept in a chronological folder with a file for the purposes of any investigation. In the event of a
request to loan medical records to other departments, professionals or students for consultation, an authorization order
signed by the Clinical Director must be provided as support.

REQUIREMENTS TO REQUEST A MEDICAL HISTORY

If the request is being made by the patient and is of legal age, they only need to present their identity document or
citizenship card. To request a medical history you must present:

 Identity document (Citizenship Card, civil registry, identity card or immigration card) of the patient and the claimant.
 If the claimant is the spouse, they must present the marriage certificate or the extra-trial declaration in the case of a
common-law union.
 If the patient died, the following must also be delivered: The death certificate and a right to petition based on the right
to the truth, family privacy, human dignity, tranquility and access to the administration of justice.
 In specific cases, a notarized power of attorney must be presented with the patient's authorization.

NOTE: The password is only valid in case of renewal of the citizenship card.

File methods
They are the ways of organizing medical records in the Archive.
Conventional method
It is a simple method, through which medical records are filed in strict ascending numerical order, following a consecutive
sequence according to the order of registration. It is useful in Clinical Files with a low volume of stories.
It is a fast, safe and accurate method of filing Medical Records based on a mathematical principle that ensures equal
distribution among 100 sections.

Simple Terminal Digit Method

It is a modality of the terminal digit file method. It has two variants:

10-section single terminal digit: in which the file is divided into 10 sections, starting from 0 to 9 and the stories are filed in
the section corresponding to the last digit of the number and in consecutive order.

100-section single digit terminal: in which the file is divided into 100 sections, starting from 00 to 99 and the stories are filed
in the section corresponding to the last two digits of the number and in consecutive order.

Composite Terminal Digit Method

It is a more complex method, but it allows stories to be archived more quickly, safely and accurately.
The Archive is initially divided into 100 sections
(00 – 99), each of which is in turn subdivided into 100 divisions.

To file a medical record, the last two numbers are taken as the first element, which constitute its section; Then the two
central numbers are taken and the division is placed within the corresponding section. The first two numbers serve to locate
the corresponding consecutive order within the respective division.
• Stories in the passive archive and special archive, if applicable, will be archived according to the same
method used in the active archive.
The medical records will be kept in the active file for a period of 5 years from the patient's last care, and must be transferred
to the passive file on a regular and permanent basis. When moving to the passive file, the Records will retain their original
number.
Medical records will be kept in the passive archive for up to fifteen years, as long as there are no judicial or other pending
proceedings.

These types of stories with pending processes should be transferred to the special file if they exist.
If during this period the user requests attention, their story will be removed from the passive file and reincorporated into the
active file. Stories that are removed from the passive archive for research, teaching or administrative purposes will be
returned to the passive archive.
Prior to the destruction of the Clinical History. A summary must be kept that contains minimum basic information, which
must be defined by the Medical Records Committee, and must preferably be recorded on magnetic media.
In the event that users request health care after the destruction of their history, the summary will be the document that
restarts their medical history, preserving the number originally assigned.
The location of the history in the patient index or index card should be recorded, if possible, whether in the active, passive
or special file – if applicable; which will be updated according to the movements of the medical history
No medical records may leave the health facility.

An authenticated copy of all or part of the history may only be delivered at the request of the user, at the request of the
judicial authority, police or Public Ministry, or to other health establishments to maintain the continuity of the user's medical
care.

ORGANIZATION OF TRAINING ACTIVITIES

SESSION ACTIVITY AIM METHODOLOGICAL STRATEGIES RESOURCES

Student: Participate in
brainstorming to create the
user admission concept.

Identify the process of Participation in the

Board, marker, learning
Introduction to user admission of users to the demonstration to recognize
guide, laboratory,
1 admission and technical health services network technical language.
language cardboard, colors, Video
and correctly use technical
beam, computer.
language in nursing notes. Teacher: Organize
brainstorming and motivate
student participation to
create the user admission
concept.

2 Regulations for the Manage medical history Student: Previous research Board, marker, learning
management of medical information and data in a on the topic Resolution 1995 guide, laboratory,
history confidential, legal and of 2000 and Participation in cardboard, colors, Video
 the round table to create the
discussion on the
management of Clinical
History and its
responsibilities.
ethical manner. Prepare an admissions
File the medical history certificate, in a group of 5
according to the apprentices. beam, computer.
institutional procedure
manual. Teacher: Organization of
the round table, Guide the
participation of students in
the management of
regulations.

3 Health services network Identify the processes of Student: Previous reading Board, marker, learning
user entry into the health and participation in a round guide, laboratory,
services network according table on the topic Health cardboard, colors, Video
to the entity responsible for services network. beam, computer.
payment.
Prepare an admissions
certificate, in a group of 5
apprentices.

Teacher: Organize the

students in a round table to
develop the service network
topic, direct the round table
and, through a simultaneous
dialogue, deepen the topic.

Organize the students into a

group of 2 members and
 guide them in completing
the admissions card.

Student: Previous reading

and participation in a round
table on the topic Types of
assurance, manual of
administrative procedures of
the institution

Prepare an admissions
certificate, in a group of 5
apprentices.
The student will be able to
Types of assurance, describe the list of Board, marker, learning
Teacher: Organize the
manual of administrative conditions, interventions guide, Video beam,
4
procedures of the
students in a round table to
and benefits of the computer. Cardboard and
institution develop the topic Types of
Essential Health Insurance colors
assurance, manual of
Plan at the national level.
administrative procedures of
the institution , direct the
round table and, through a
simultaneous dialogue,
deepen the topic.

Organize the students into a

group of 5 members and
guide them in completing
the admissions card .
5 Health benefit plans, The student will have the Student: Previous reading Board, marker, learning
types and concepts ability to define the explicit and participation in a round guide, Video beam,
guarantees of opportunity table on the topic of health computer.
and quality of the benefits benefit plans, types and
of the Benefits Plan. concepts.
 Prepare an admissions
certificate, in a group of 5
apprentices.
Teacher: Organize the
students in a round table to
develop the topic of health
benefit plans, types and
concepts, direct the round
table and, through a
simultaneous dialogue,
deepen the topic.

Organize the students into a

group of 5 members and
guide them in completing
the admissions card .
6 RIPS and supporting The student will be able to Student: Group Board, marker, learning
documents, billing and identify and analyze the presentation of 4 students guide,
invoice system different phases of the on the RIPS topic and Computer, billboards,
billing process for different supporting documents, Video Beam.
services. billing and invoice system,
using billboards and/or
video beam as help
material.
Prepare an admissions
certificate, in a group of 5
apprentices.

Teacher: Supervise
students' presentation of the
RIPS topic and supporting
documents, billing system
 and invoice.
Organize the students into a
group of 5 members and
guide them in completing
the admissions card .
Student: Group
presentation of 4 students
on the topic Civil, criminal
and ethical liability, using
billboards and/or video
beam as aid material.
Prepare an admissions
The student will be able to certificate, in a group of 5
Board, marker, learning
determine the ethical and apprentices.
Civil, criminal and ethical guide,
7
liability
moral values that regulate
Computer, billboards,
the conduct of the nursing Teacher: Supervise
Video Beam
professional. students' presentation of the
topic Civil, criminal and
ethical liability.

Organize the students into a

group of 5 members and
guide them in completing
the admissions card .
8 Institutional Know and apply the Student: Previous reading Board, marker, learning
procedures for priority SISBEN survey and participation in a round guide,
survey (SISBEN) procedures, guaranteeing table on the topic Computer, billboards,
the duties and rights of the Institutional procedures for Video Beam
population. priority survey (SISBEN)

Prepare an admissions
certificate, in a group of 5
apprentices.
 Teacher: Organize the
students in a round table to
develop the topic
Institutional procedures for
priority survey (SISBEN),
direct the round table and,
through a simultaneous
dialogue, deepen the topic.

Organize the students into a

group of 5 members and
guide them in completing
the admissions card .
9 Copayments and The student must identify Student: Previous reading Board, marker, learning
moderating fees the different values and and participation in a round guide,
fees that are generated by table on the topic Co- Computer, billboards,
the provision of health payments and moderating Video Beam .
services. fees.

Prepare an admissions
certificate, in a group of 5
apprentices.

Teacher: Organize the

students in a round table to
develop the topic Co-
payments and moderating
fees, direct the round table
and, through a simultaneous
dialogue, deepen the topic.

Organize the students into a

 group of 5 members and
guide them in completing
the admissions card .
The student will be able to Student: Group
learn about the different presentation of 4 students
programs and benefits to on the topic Displaced
which different population Persons Law, senior citizens
groups are entitled. program using aid material
such as billboards and/or
Video beam.

Prepare an admissions
certificate, in a group of 5 Board, marker, learning
Displaced Persons
apprentices. guide,
10 Law, Senior Citizens
Computer, billboards,
Program,
Teacher: Supervise Video Beam .
students' presentation of the
topic Displaced Persons
Law, senior citizens
program.

Organize the students into a

group of 5 members and
guide them in completing
the admissions card .
11 ICBF protection, Student: Group Board, marker, learning
reinserted people, presentation of 4 students guide,
uninsured poor on the topic ICBF Computer, billboards,
population Protection, reintegrated, Video Beam .
uninsured poor population
using aid material such as
billboards and/or Video
beam.
 Prepare an admissions
certificate, in a group of 5
apprentices.

Teacher: Supervise
students' presentation of the
topic ICBF Protection,
reinserted people, uninsured
poor population.

Organize the students into a

group of 5 members and
guide them in completing
the admissions card .
12 Control mechanisms Manage the entry and exit Student: Group Board, marker, learning
for the output of processes of hospital files presentation of 4 students guide,
medical records, (Clinical History) on the topic Control Computer, billboards,
archiving methods mechanisms for the output Video Beam .
of clinical history, archiving
methods using aid material
such as billboards and/or
Video beam.

Prepare an admissions
certificate, in a group of 5
apprentices.

Teacher: Supervise
presentation by students of
the topic Control
mechanisms for the output
of clinical history, archiving
 methods.

Organize the students into a

group of 5 members and
guide them in completing
the admissions card .
EVALUATION OF LEARNING
EVALUATION CRITERIA

The student will make nursing notes using technical language.

The student will identify those responsible for payment according to the origin of the care.
The student will identify the types of affiliation to the regime.
The student will interpret the regulations for the management of Clinical History.
The student will identify, describe and analyze the guarantees that the health standard provides to its members.
The student will identify erroneous processes in the billing system and analyze the billing of different services.
The student will know the procedures for the SISBEN survey in order to guarantee rights.
The student will participate in the socialization of the standards of the health programs provided by the state for these
population groups.
The student will manage and apply the processes for managing medical records.

REQUIRED EVIDENCE

FIRST ACADEMIC CUT (30%)

KNOWLEDGE PERFORMANCE PRODUCT
Answer to questions about user
admission to the health services No evidence of this type is required. No evidence of this type is required.
network, types of insurance and
technical language
IMPROVEMENT ACTIONS
Answer to written questions about
admission of the user to the health No evidence of this type is required. No evidence of this type is required.
services network, types of insurance.
 SECOND ACADEMIC COURT (30%)
KNOWLEDGE PERFORMANCE PRODUCT
Observation of sociodramas and
No evidence of this type is required. simulation associated with Types of No evidence of this type is required.
Insurance, Benefit Plans.
IMPROVEMENT ACTIONS
Observation of the Representations
No evidence of this type is required. associated with the Types of Insurance, No evidence of this type is required.
Benefit Plans.
THIRD ACADEMIC COURT (40%)
KNOWLEDGE PERFORMANCE PRODUCT
The student must be able to solve
questions where we will find the
subjects: Institutional Procedures for
Priority Survey (SISBEN), Co-payments
and Moderating Fees, Displaced
Persons Law, Senior Citizens Program,
This evidence is not required This evidence is not required
ICBF Protection, Reinserted People,
Uninsured Poor Population and
Mechanisms Control for the Output of
the Clinical History, Archiving Methods .
IMPROVEMENT ACTIONS
Response to direct questions about
Institutional Procedures for Priority
Survey (SISBEN), Co-payments and
Moderating Fees, Displaced Persons
Law, Senior Citizens Program, ICBF This evidence is not required This evidence is not required
Protection, Reintegrated, Uninsured
Poor Population and Control
Mechanisms for the Exit of the Medical
History, File Methods .