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Regulation Of The General Law Of Health In The Field Of Provision Of Services Of Health Care

Original Language Title: Reglamento de la Ley General de Salud en Materia de Prestación de Servicios de Atención Médica

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Regulation of the General Health Law on the provision of health care services

GENERAL HEALTH LAW REGULATION ON HEALTH CARE DELIVERY SERVICES

Published in the DOF on May 14, 1986

Last reform published in the DOF on March 24, 2014

On the sidelines a seal with the National Shield, which reads: United Mexican States.-Presidency of the Republic.

MIGUEL DE LA MADRID H., Constitutional President of the United Mexican States, in exercise of the power conferred on the Federal Executive by Fraction I of the Article 89 of the Political Constitution of the United Mexican States, and based on Articles 1o., 2o., 3o., Fraction I, 27 Fraction III, 32, 33, 45, 47,100, 313 to 350 and other relative of the General Health Law and

CONSIDERING

That on February 3, 1983, the addition to Article 4 of the Constitution was published in the Official Journal of the Federation. to the protection of health. The Law shall define the bases and modalities for access to health services and shall establish the concurrency of the federation and the federative entities in the field of general health, in accordance with the provisions of Article 73 of the Constitution ";

That the aforementioned constitutional addition represents in addition to raising the mentioned social law to the highest hierarchy, the basis according to which the government programs will be carried out in the field of health, as well as the foundation of Mexican health legislation;

That on December 26, 1983, the Congress of the Union approved the General Health Law, the regulation of the third paragraph of Article 4. Constitutional, which was published in the Official Journal of the Federation on February 7, 1984 and in force on the 1st. of July of the same year;

The bases and modalities for access to health services, as well as the integration, objectives and functions of the National Health System and the distribution of competencies, among the Federation and the Federative Entities, have been defined in compliance with the Constitutional mandate;

That the National Health System is the link between the public, social, and private sectors in achieving the right to health protection through mechanisms of coordination and concertation of actions;

That health services are the set of actions carried out for the benefit of the individual in society, which aims to protect the promotion and restore of health;

That the General Health Law classifies health services into three types: medical care, public health care, and social assistance; the health care set is understood by health care as a whole. services to be provided to the individual in order to protect, promote and restore their health;

That health care services represent a means for the conservation and protection of people's health, involving prevention, healing and rehabilitation;

The Health Secretariat is responsible for the control of the provision of health care services, as a matter of general health, and this dependency must be legal and regulatory instruments to specifically perform their privileges, and

That in exercise of the faculty that the Federal Executive confers the Political Constitution of the United Mexican States to provide, in the administrative sphere, to the exact observance of the Law, I have had to issue the following

THE GENERAL HEALTH LAW REGULATION ON THE PROVISION OF HEALTH CARE SERVICES.

CHAPTER I

General Provisions

ARTICLE 1o.- This Regulation is applicable throughout the national territory and its provisions are of public order and social interest and aims to provide, in the sphere In the case of medical care services, the health care provider is required to comply with the General Health Law.

ARTICLE 2o.- When in this Regulation reference is made to "The Law", or to "The Secretariat", it will be understood that it is the General Law of Health and the Secretariat of Health, respectively.

ARTICLE 3o.- The application of this Regulation is the responsibility of the Secretariat and the governments of the Federative Entities, in the terms of the General Health Law and the coordination that you subscribe to with that dependency.

ARTICLE 4.- It is up to the Secretariat to issue the Mexican official rules to the provision of services throughout the national territory. health in the field of health care, which shall be published in the Official Journal of the Federation for due observance.

ARTICLE 5o.- It is for the Secretariat to carry out the assessment of the provision of the services referred to in this Regulation.

ARTICLE 6o.- The Secretariat will encourage, encourage and develop study and research programs related to the provision of health care services.

ARTICLE 7o.- For the purposes of this Regulation it is understood by:

I.- MEDICAL CARE.-The set of services provided to the user in order to protect, promote and restore their health, as well as provide palliative care to the user. patient in terminal situation;

II.- PLAINTIFF.-All that person who for himself or for another, requests the provision of health care services;

III.- ESTABLISHMENT FOR HEALTH CARE.-Everyone, public, social or private, fixed or mobile whatever their denomination, that provides health care services, is outpatient or for the detention of patients, except for offices;

IV.- OUTPATIENT CLINIC. -All health care services user who does not need hospitalization;

V.- HEALTH CARE SERVICE.-The set of resources that are systematically involved in the prevention, cure and palliative care of diseases affecting the users, as well as the rehabilitation of them, and

VI.- USER.-All that person who requires and obtains the provision of health care services.

ARTICLE 8o.- Health care activities are:

I.- The following: What include general promotion and specific protection;

II.- CURAICAS: They are intended to make early diagnosis of clinical problems and to establish appropriate treatment for resolution of the clinical problems; and

III.- REHABILITATION: These include actions to limit damage and correct physical or mental disability, and

IV.- PALIAOVIs: That include comprehensive care to preserve the quality of life of the user, through the prevention, treatment and control of pain, and other physical symptoms and emotional, by a multidisciplinary team.

ARTICLE 9o.- Medical care must be carried out in accordance with the scientific and ethical principles that guide medical practice.

ARTICLE 10.- They will be considered establishments for medical care:

I.- Those in which preventive, curative, rehabilitation and palliative care activities are developed aimed at maintaining and reintegrating the health status of the people, as well as alleviating the symptoms of the condition;

II.- Those where dental care is provided;

III.- Those that pay attention to people's mental health;

IV.- Those in which auxiliary diagnostic and treatment services are provided;

V.- Mobile units, whether air, sea or land, intended for the same purposes and classified as:

A).- Intensive care ambulance;

B).- Emergency Ambulance;

C).- Transport Ambulance, and

D).- Others who provide services in accordance with what is established by the Secretariat.

Mobile units shall be subject to the applicable Mexican official standards, without prejudice to compliance with other applicable provisions, and

VI.- The other analogues to the foregoing that hereinafter referred to as such the applicable general provisions or those that, if applicable, determine the Secretariat.

ARTICLE 11.- In all prisons and social rehabilitation centers, there must be a medical-surgical care service, which will enable the problems to be solved. present.

In the event that an inmate is to be transferred to a medical unit with greater resolution power, the custody will be in charge of the competent authority.

ARTICLE 12.- In amusement parks, fairs, circuses, sports stadiums, taurine squares, and in general, in any type of event, there must be a fixed or mobile unit of medical services to deal with the emergency situations, without prejudice to their subsequent reference to other establishments in order to continue their care.

The Secretariat will dictate the Mexican official rules to which these services will be subject.

ARTICLE 13.- For the organization and operation of health care services, the Secretariat takes into account, where appropriate, the opinion of service providers public, social or private, will establish the criteria for the distribution of the universe of users, the regionalization and the staggering of the services, as well as the universalization of coverage.

ARTICLE 14.- The criteria for the distribution of the universe of users and coverage should consider, among other factors, the open population, the population that enjoys social security, the installed capacity of the health sector, as well as the Mexican official standards issued by the Secretariat.

ARTICLE 15.- Regarding the regionalization of medical services, the diagnosis of health, geographic accessibility, other medical units installed and the acceptance of the users, considering the technical opinions of the corresponding organs of the Secretariat, in order to install units that tend to regional self-sufficiency, as well as the development of the municipality.

ARTICLE 16.- Medical care shall be granted in accordance with a staggering of the services according to the classification of the model to be determined by the Secretariat.

ARTICLE 17.- Private establishments, in the terms of Article 44 of the Law, shall provide the following services:

I.- Collaborating on the provision of basic health services referred to in Article 27 of the Law, with special emphasis on health education, prevention and control Communicable diseases of priority care, family planning and availability of health inputs;

II.- Providing emergency services in the terms of the Act and this Regulation;

III.- Make appropriate notifications of communicable diseases to the health authority, in the terms outlined by the Law;

IV.- Providing medical care to the population in disaster situations;

V.- Collaborate on the training and development of human resources for health, and

VI.- Develop research activities, in accordance with the requirements outlined by the Law and within the framework of professional ethics.

The proportion and terms for the provision of these services may be set out in the instruments of concertation which the Secretariat and the Secretariat have for the establishments, taking into account the degree of complexity and the ability to resolve each of them. In any case, the participation of private establishments, in the terms of this article, will be based on the Mexican official rules that the Secretariat will issue.

ARTICLE 18.- The establishments in which health care services are provided must have a responsible person, who must have a diploma, certificate or diploma, as the case may be, state the relevant knowledge in the area concerned.

The documents referred to in the preceding paragraph must be registered by the competent educational authorities.

ARTICLE 19.- Corresponds to those responsible for the above article, to perform the following functions:

I.- Establish and monitor the development of procedures to ensure the timely and efficient delivery of the services offered by the establishment, as well as for the fit compliance with the Law and other applicable provisions;

II.- To monitor that the safety and hygiene measures for the protection of the health of the staff exposed by their occupation are applied within them;

III.- To directly address complaints that are made by irregularities in the provision of services, whether those arising from establishment staff or by independent professionals, technicians or auxiliaries, who provide their services, without prejudice to the professional responsibility for which they are incurred;

IV.- Inform, in the terms determined by the Secretariat, the competent health authorities, the notifiable diseases, as well as adopt the measures necessary for epidemiological surveillance, taking into account the provisions of the Law, and

V.- Notify the Public Ministry and, where appropriate, the other competent authorities, cases where health care services are required for persons with injuries or other signs that are presumably linked to the commission of unlawful acts.

ARTICLE 20.- The person responsible must make known to the public, through a sign on the site where he provides his services, the schedule of his assistance, as well as the schedule of operation of the establishment.

ARTICLE 21.- In establishments where health care services are provided, it must be counted, according to Mexican official rules relevant, with sufficient and appropriate staff.

ARTICLE 22.- You will not be able to be hired by health care establishments, or by professionals who independently provide their services, staff of the Health disciplines which are not duly authorised by the competent educational authorities.

ARTICLE 23.- Those who engage in professional, technical and auxiliary activities of the health disciplines independently, must put their title in the public eye professional, certificates, diplomas and in general, the relevant documents, which prove it as such.

ARTICLE 24.- Those responsible for establishments where health care services are provided are required to keep an updated file containing the documentation of the professionals, technicians and auxiliaries of the health disciplines who provide their services in a subordinate manner, which shall be displayed to the health authorities upon request.

ARTICLE 25.- Staff who provide their services to health care establishments on the terms that are established by the Secretariat may carry visible place, identification mark, in which the name of the establishment, its name, photograph, as well as the position it plays and the time in which it attends, the document must be signed by the person responsible for the establishment.

ARTICLE 26.- The establishments that provide health care services will have the physical, technological and human resources available to them. Regulations and Mexican official rules that the Secretariat will issue to the effect.

ARTICLE 27.- It shall be punishable under the law applicable to those who have no professional title, legally issued and registered in the terms of Law, to call or announce by adding to their own name, the word doctor, surgeon, or any other word, sign or set of terms that they assume are dedicated as professionals to the exercise of the disciplines for health.

ARTICLE 28.- The Secretariat shall issue the Mexican official rules to be subject to the activity of the non-professional personnel authorized by the competent agencies, in connection with the provision of health care services, for which the provisions of this Regulation shall be observed.

ARTICLE 29.- Every health professional shall be obliged to provide the user and, where appropriate, his or her family, guardian or legal representative, complete information about the diagnosis, prognosis and appropriate treatment.

ARTICLE 30.- The person responsible for the establishment shall be obliged to provide the user, family member, guardian or legal representative, upon request, with the clinical summary on the diagnosis, evolution, treatment and prognosis of the condition that has affected interment.

ARTICLE 30 Bis.- In case of medical urgency and where it is not possible to obtain authorization for the incapacity of the user and in the absence of the parents, guardians or who exercise the right of custody, the persons responsible for their custody or custody and, in the absence of such custody, the person of their trust, the oldest or the competent judge, in accordance with the applicable provisions, the decision to provide the information to persons who request it after the entry of the user, shall be taken by the authorised doctors of the hospital concerned, after checking the relationship of parentage or corresponding representation.

ARTICLE 31.- The professionals, technicians and auxiliaries of the health disciplines, must participate in the development and promotion of health education programs.

ARTICLE 32.- The establishments for the internment of patients, will be obliged to keep the clinical records of the users, for a minimum period of five years.

ARTICLE 33.- In all health care establishments, with the exception of laboratories and cabinets, the vaccines ordered by the Law and the which, where appropriate, indicate the regulations, the official Mexican rules and those determined by the Secretariat.

If necessary, the patient must be transferred to an official institution for application.

In no case can you be charged for the vaccines and inputs that are provided for your application, free of charge.

ARTICLE 34.- All those professionals, technical or auxiliary of the health disciplines that vaccinate a user, must make the corresponding annotations in the Cartilla Vaccination National and forward the coupon to whom it corresponds.

ARTICLE 35.- When in an establishment for medical care, a service plaintiff is present with a contagious infectious disease. Mandatory notification shall immediately refer to the relevant service in order to ensure that the person has the minimum contact with the users.

ARTICLE 36.- Staff who provide services in any health care setting, in no case may be able to perform their duties if they suffer from any of the diseases infectious-infectious, mandatory notification reason.

ARTICLE 37.- In all the stationery and documentation of the establishments referred to in this order, it must be stated:

I.- The type of establishment in question;

II.- The name of the establishment and if any, the name of the institution to which it belongs;

III.- Where appropriate, the reason or social name;

IV.- Where applicable, the health license number, and

V.- Other data that you point to applicable Mexican official rules.

ARTICLE 38.- The public sector agencies and agencies that provide health care services will be in accordance with the Basic Tables of Health Sector Informs, prepared by the Council of Health in General.

The Secretariat will promote the adoption of the Basic Inform Tables between the social and private sectors.

ARTICLE 39.- The Secretariat of the Economy, hearing the opinion of the Secretariat, will ensure adequate distribution and marketing, and will fix the maximum prices of sale to the public of the medicines and inputs.

ARTICLE 40.- The determination of the recovery fees for public health services to the general population must comply with the criteria and procedures provided for in the effect by law.

ARTICLE 41.- The Secretariat of the Economy, taking into account the opinion of the Secretariat, will establish the rates to which the attention services will be subject medical and social health, with the exception of the independent personal service, which shall be in accordance with the degree of complexity and the power to resolve them.

ARTICLE 42.- Both the recovery quotas to be determined, and the rates authorized by the Secretariat of Economy, must be fixed in a visible place to the public within the establishments.

ARTICLE 43.- Those responsible for health care establishments will monitor the development of health statistics indicated by the Secretariat; they will also have the the obligation to provide such a dependency and the relevant health authorities with the information of any type that it requires, in the forms or questionnaires and with the periodicity that it determines.

ARTICLE 44.- In the establishments referred to in this order it is strictly prohibited:

I.- To those responsible for the drogueries, pharmacies, boticas and in general of the establishments destined to the drug process, the provision of services of care medical, when they do not have the documentation that accredits them as medical professionals;

II.- To staff who provide services in establishments for the process of prostheses, orthotics and functional aids, to provide health care services, and

III.- To the establishment staff, to conclude contracts with the user, except those relating to the economic obligations of the establishment, with respect to the institution.

ARTICLE 45.- The visits to the establishments shall be governed by internal provisions which shall indicate limitations related to any type of health risk and avoid interference with the drive activities.

CHAPTER II

Of The Rights and Obligations Of Users and Community Participation

ARTICLE 46.- The competent health authorities and the health institutions themselves shall establish procedures for guidance and advice to the plaintiffs and users on the use of the services they require.

ARTICLE 47.- Health sector agencies and agencies, and the governments of federal entities, will promote and support the formation of groups, associations and other institutions that aim to participate in the programs for the improvement of individual and collective health, as well as in the prevention of diseases, accidents, rehabilitation and palliative care.

ARTICLE 48.- Users will have the right to obtain timely and quality health benefits and to receive professional and ethically responsible care, as well as treatment. respectful and worthy of the professionals, technicians and auxiliaries.

ARTICLE 49.- The user shall be subject to the provisions of the institution providing health care services in relation to the use and preservation of furniture, equipment doctors and materials to be made available to you.

ARTICLE 50.- Every person may request the health authority concerned, the detention of patients when they are prevented from requesting assistance in case of same.

ARTICLE 51.- The competent health authorities and the health institutions themselves, will point out the procedures for the users of the health care services, file their complaints, complaints and suggestions regarding the provision of the same and in relation to the lack of probity, if any, of the public or private servants.

ARTICLE 52.- In the face of any irregularity in the provision of health care services, in accordance with the provisions of the Law and this Regulation, any person may be entitled to communicate it to the Secretariat or other competent health authorities.

ARTICLE 53.- In order to be able to take the action referred to in the previous article, it will be necessary to indicate the irregularity, name and address of the establishment in which the commission, or the professional, technical or auxiliary to whom it is charged, is presumed, as well as the name and address of the complainant.

ARTICLE 54.- The health authorities concerned shall carry out the necessary measures to verify the information contained in the complaint, taking care that it is due to this fact, the complainant shall not be liable to harm.

ARTICLE 55.- The infringement, the Secretariat, or, where appropriate, the other competent health authorities, will dictate the measures necessary to remedy the deficiencies. found in the provision of medical services, irrespective of any sanctions that may be imposed by the same facts.

CHAPTER III

Provisions for the Consulting Services Provision

ARTICLE 56.- For the purposes of this regulation, any public, social or private establishment, independent or linked to a hospital service, is understood by office, to provide medical care to outpatients.

ARTICLE 57.- The establishments in which services are provided for the control and weight reduction to outpatients, whatever their denomination or regimen legal, will be considered for the purposes of this Regulation as offices.

ARTICLE 58.- The activities of the offices will be restricted to the development of health care procedures, which do not require the hospitalization of the user.

ARTICLE 59.- The offices should have the following areas:

I.- Reception or waiting room, where there are no objects or facilities that endanger the lives or health of users;

II.- The one for the patient interview;

III.- The one for the physical exploration of the patient;

IV.- Administrative control area;

V.- Appropriate health facilities, and

VI.- The others that set the official Mexican standards.

ARTICLE 60.- The offices must have the equipment and instruments indicated in the Mexican official rules issued by the Secretariat, both for medical As for the various medical specialties, the person responsible for the application must also indicate the activities that will be carried out in the office.

ARTICLE 61.- The offices within a hospital, which are used for the service of the hospital, will not require an individual health license and will be covered by the license of that establishment.

ARTICLE 62.- In the offices, a daily register of patients must be carried out in the form that the Mexican official rules indicate to the effect.

ARTICLE 63.- The offices must have an emergency kit with the inputs that establish the official Mexican norms that the Secretariat issues.

ARTICLE 64.- Medical prescriptions issued to users must have the name of the physician, the name of the institution that has issued the professional title, the number of the professional cedula issued by the competent educational authorities, the address of the establishment and the date of issue.

ARTICLE 65.- Recipes issued by medical specialists, in addition to the above mentioned in the previous article, must contain the number of specialty records, issued by the competent authority.

ARTICLE 66.- For the operation of any specialized office it will be required in each case, at least, a health professional with specialty in the area that treat.

ARTICLE 67.- In optometry offices, only tests can be performed to measure the refraction of the eye and adaptations of prostheses, lenses, and functional aids.

ARTICLE 68.- The offices, including dentists, which use radiation sources, must comply with the provisions of Chapter IX of this Regulation. Regulations and Mexican official rules that will be issued to the effect.

CHAPTER IV

Hospitals Service Delivery Provisions

ARTICLE 69.- For the purposes of this Regulation, it is understood by hospital, any public, social or private establishment, whatever its name and that has the purpose of the attention of users who are hospitalized for diagnosis, treatment, or rehabilitation.

You can also treat outpatients and conduct training and development activities for health and research personnel.

ARTICLE 70.- Hospitals will be classified according to their degree of complexity and resolution power in:

I.- GENERAL HOSPITAL: It is the second or third level setting for patient care, in the four basic specialties of medicine: General Surgery, Gineco-Obstetrics, Internal Medicine, Paediatrics and other complementary and supportive specialties derived from them, which provide emergency services, external consultation and hospitalization.

The hospitalization area will count in general hospitals with beds of General Surgery, Gineco-Obstetrics, Internal Medicine and Pediatrics, where the attention of the different branch specialties.

In addition, it will have to do, in favor of users, activities of prevention, healing, rehabilitation and palliative care, as well as training and development of health personnel and scientific research;

II.- SPECIALTY HOSPITAL: It is the second and third level setting for patient care, one or several medical, surgical or Medical-surgical services that provide emergency services, external consultation, hospitalization and to be carried out, in favor of the users, activities of prevention, healing, rehabilitation and palliative care, as well as of training and development of personal health, and scientific research, and

III.- INSTITUTE: It is the third-level establishment, mainly aimed at scientific research, training and development of health personnel. It may provide emergency services, external consultation, hospitalization and palliative care, to persons who have a specific disease, condition of a system or diseases affecting an age group.

ARTICLE 71.- Public, social and private establishments that provide health care services for the internment of patients are obliged to pay attention immediate to any user, in case of urgency that occurs in the vicinity of the same.

ARTICLE 72.- It is understood by urgency, any acute medical-surgical problem, that endangers life, an organ or a function and requires immediate attention.

ARTICLE 73.- The head of the emergency department of the establishment is obliged to take the necessary measures to ensure the medical assessment of the user and the full treatment of the urgency or the stabilization of their general conditions so that it can be transferred.

ARTICLE 74.- When the resources of the establishment do not permit the final resolution of the problem, the user must be transferred to another institution of the sector, which will ensure their treatment and that you will be obliged to receive it.

ARTICLE 75.- The shipment will be carried out with the own resources of the unit that makes the shipment, under the responsibility of its manager and according to the respective rules.

If the appropriate means of transport are not to be counted, those of the receiving institution will be used.

ARTICLE 76.- The entry of users to hospitals will be voluntary, when this is requested in writing by the user himself and there is a prior indication in this regard by the treating physician. In this respect, the provisions of Article 80 of this Regulation for the granting of informed consent shall apply.

ARTICLE 77.- It will be involuntary to enter hospitals, when the user is prevented from requesting it by himself, for temporary incapacity or permanent, be requested by a family member, guardian, legal representative or other person who in case of urgency requests the service and whenever there is a prior indication of the case by the treating physician. In this respect, the provisions of Article 81 of this Regulation for the granting of informed consent shall apply.

ARTICLE 78.- It is considered mandatory to be admitted to hospitals, when ordered by the health authority to avoid risks and damage to the health of the community.

ARTICLE 79.- In case of voluntary discharge, even against the medical recommendation, the user, if any, a relative, the guardian or his legal representative, must sign a document in which the reasons for the discharge are clearly expressed, as it must also be subscribed by at least two suitable witnesses, of which one shall be designated by the hospital and another by the user or the person who in representation issues the document.

In any case, the document referred to in the preceding paragraph shall relieve the liability of the establishment and shall be issued in duplicate, with one copy remaining in the same and other will be provided to the user.

ARTICLE 80.- In any hospital and whenever the user's condition permits, his/her written authorization must be obtained on his/her entry to practice, with therapeutic diagnostic purposes, the medical-surgical procedures necessary to arrive at a diagnosis or to take care of the condition in question, and must clearly inform you of the type of document presented to you for signature.

Once the user has a diagnosis, the type of condition in question and its possible treatments, risks and risks will be clearly and accurately expressed. sequels.

This initial authorization does not exclude the need to collect after each procedure that poses a high risk to the patient.

ARTICLE 81.- In case of urgency or when the patient is in a state of temporary or permanent incapacity, the document referred to in the previous article shall be signed by the closest family member to accompany you, or if appropriate, by your guardian or legal representative, after you have been informed of the nature of the authorisation.

When it is not possible to obtain the authorization for the patient's incapacity and the absence of the persons referred to in the preceding paragraph, the authorized doctors of the hospital in the case, after assessment of the case and with the agreement of at least two of them, they shall carry out the therapeutic procedure which the case requires, in writing, in the clinical file.

ARTICLE 82.- The document stating the authorization referred to in Articles 80 and 81 of this Regulation shall contain:

I.- The name of the institution to which the hospital belongs;

II.- The name, reason, or social name of the hospital;

III.- Document Title;

IV.- Place and date;

V.- The name and signature of the person granting the authorization;

VI.- Name and signature of witnesses, and

VII.- Procedure or treatment to apply and explain it.

The document must be printed, written in clear form, without abbreviations, amendments or attachments.

ARTICLE 83.- In case any amputation, mutilation or organ removal is to be performed that produces permanent physical modification in the patient or in the condition The document referred to in the previous Article shall also be subscribed by two appropriate witnesses appointed by the person concerned or by the person who subscribes to it.

These authorizations will conform to the models that point to Mexican official standards.

ARTICLE 84.- Any diagnostic, preventive, therapeutic, rehabilitatory or palliative measure that has an experimental character shall be subject to the Articles 100, 101, 102 and 103 of the Act and other applicable provisions.

ARTICLE 85.- The establishment that retains or intends to retain any user or corpse to ensure payment of the medical care provided, or any other obligation, is shall comply with the penalties provided for in this Regulation and other applicable provisions, without prejudice to the penalties for creditors in accordance with the provisions of criminal law.

ARTICLE 86.- In hospitals where they are admitted sick as detainees, the hospital will only be responsible for medical care, and the authority will be in charge of the medical care. corresponding to the responsibility of their custody.

ARTICLE 87.- The emergency services of any hospital must have adequate and adequate resources according to the official Mexican norms that The Secretariat shall also be issued by the Secretariat 24 hours a day throughout the year, and shall be provided on a permanent basis with a doctor responsible for the service.

ARTICLE 88.- In every hospital, according to its degree of complexity and power of resolution, the commissions and committees indicated by the Law will be integrated. Regulations and Mexican official regulations issued by the Secretariat.

The directors or holders of the establishments for the provision of health care services in which they comply with the general provisions issued A Hospital Committee of Bioethics must be established by the Secretariat, and must register the Committee with the National Bioethics Committee, in terms of the applicable legal provisions.

ARTICLE 89.- In any hospital, a person responsible for the management of narcotic drugs and psychotropic substances for clinical use should be counted, and he/she will be in charge of monitoring the statutory and regulatory provisions for such inputs are complied with.

The activities of those responsible will be in accordance with the procedures outlined in the Mexican official rules.

ARTICLE 90.- It is the responsibility of the Hospital, to have an up-to-date record of identification of the doctors who provide their services, must be carried out in accordance with what is stated in the Mexican official rules.

ARTICLE 90 Bis 1.- The birth certificate shall be issued for the only time to all born alive on national territory, once the fact has been checked, in form free and mandatory.

The birth certificate may be issued by a doctor with professional cedula or by the person authorized to do so by the governments of the entities federative.

The Secretariat, through publication in the Official Journal of the Federation, will make known the models that will be used as formats for the expedition of birth certificates.

ARTICLE 90 Bis 2.- For the issue of the birth certificate it is essential to corroborate, in terms of the applicable legal provisions, the mother-child bond, and the identity of the mother.

The Secretariat, in accordance with the official Mexican law that for this purpose will issue, will determine the form by which, according to the circumstances accompanying the birth, corroborate by the person issuing the birth certificate the mother-child link and the identity of the mother.

ARTICLE 90 Bis 3.- The Secretariat for the purpose of establishing the mechanisms to ensure the issuance of the birth certificate shall be coordinated with the agencies and entities of the Federal Public Administration that correspond, as well as with the competent authorities of the federal entities.

ARTICLE 90 Bis 4.- The technical regulation that complements the provisions of this Chapter to fix the characteristics and technical specifications of the Certificates of birth, death and fetal death, as well as the criteria and procedures for their issuance, shall be established in the official Mexican standard issued by the Secretariat.

ARTICLE 91.- Fetal death and death certificates shall be issued, once the death has been ascertained and their causes determined, by:

I.- The legally-issued physician, who has attended the death, attended the last disease, or has carried out prenatal care;

II.- In the absence of this, by any other legally-issued medical practitioner, who has known the case and provided that the death is not suspected of being linked to the commission of unlawful acts, and

III.- Other persons authorized by the competent health authority.

The certificates referred to in this article will be extended in the models approved by the Secretariat and in accordance with the Mexican official rules issue.

ARTICLE 92.- In the case of a violent death or allegedly linked to the commission of unlawful acts, notice must be given to the Public Ministry and the provisions will be observed. relevant laws and regulations.

ARTICLE 93.- Only necropsies may be performed in duly authorized establishments, in accordance with the provisions of the applicable legislation, their regulations and the official Mexican rules to be issued.

ARTICLE 94.- The Secretariat will issue the Mexican official rules to be subject to activities that develop in short-surgery units. stay.

ARTICLE 95.- Hospitals must have a range of medicines for their operation, twenty-four hours a day throughout the year.

CHAPTER IV BIS

Provisions for the Cosmetic or Cosmetic Surgery Services Provision.

ARTICLE 95 Bis 1. For the purposes of this Regulation, it is understood by cosmetic or cosmetic surgery, the surgical procedure performed to change or correct the contour or shape of different areas or regions of the face and body, with the purpose of modifying the physical appearance of people for aesthetic purposes.

ARTICLE 95 Bis 2. Any cosmetic or cosmetic surgery must be carried out in establishments or medical units that have a health license in force in terms of the provisions of Article 198, fraction V of the Law.

ARTICLE 95 Bis 3. Health care establishments performing cosmetic or cosmetic surgeries must have the resources, areas and equipment to indicate the Mexican official norms that the Secretariat issues in this regard.

ARTICLE 95 Bis 4. Only cosmetic or cosmetic surgery procedures, professional medical practitioners and specialty cedula may be performed. by a competent authority, in a surgical branch of medicine, in terms of Articles 78 and 81 of the Law. Trainee doctors will be able to perform such procedures, accompanied and supervised by a specialist in the field.

CHAPTER V

Provisions for the Maternal Care Services Delivery

ARTICLE 96.- For the purposes of this regulation it is understood by:

I.- GINECO-OBSTETRIC HOSPITAL: Every specialized medical establishment that has as an end the attention of the diseases of the female genital apparatus, of the pregnancy, the delivery and the puerperium, and

II.- PEDIATRIC HOSPITAL: Every specialized medical facility that has the primary purpose of medical care for children under 18 years of age.

ARTICLE 97.- They may only be responsible for a gyneco-obstetric hospital, doctors specialized in gynec-obstetrics, with a minimum of 5 years in the exercise of the craft.

ARTICLE 98.- The staff responsible for the crib services and the like of a gyneco-obstetric hospital will be obliged to encourage breastfeeding. They shall only be entitled to indicate artificial formulae for the feeding of newborns, the doctors tending to them during their stay in the hospital.

ARTICLE 99.- Those responsible for a gyneco-obstetrical hospital will have the obligation to take the necessary measures to reduce the maternal morbidity and mortality of children, recommendations for the effect of the respective national committees.

ARTICLE 100.- Women's prisons must have the necessary facilities for pregnancy, delivery and puerperium care, as well as for new born and establish protective measures for both the mother and her child, in accordance with the official Mexican rules that will be issued.

ARTICLE 101.- Orphanages and crib houses must have the facilities and specialized staff necessary for the medical care of the hospitalized children.

ARTICLE 102.- For the purposes of this Regulation, non-professional personnel authorized to provide health care services are considered to be persons receiving medical care. the relevant training and the authorisation issued by the Secretariat which enables them to exercise as such, which shall be endorsed every two years.

In any case, for the issue of the authorization referred to in the preceding paragraph, account shall be taken of the needs of the community and the assistance required.

ARTICLE 103.- Non-professional staff authorized for the provision of health care services referred to in the previous article may provide obstetrics services and family planning, in addition to others that the Secretariat deems appropriate to authorize and which are useful to the population.

ARTICLE 104.- The activities of health auxiliaries in obstetrics will be subject to the provisions of the Law, this Regulation and the official rules The Mexican government will be exercising control and oversight of the Federal Executive's own dependency.

ARTICLE 105.- To enroll in training courses for technicians and auxiliaries, the following requirements must be met.

I.- Being older;

II.- Know how to read and write;

III.- Having recognition of their activities on the subject matter, and

IV.- The others that the Secretariat points to.

ARTICLE 106.- The verification of the requirement indicated in section III of the previous Article shall be done by means of the investigation that practices the Secretariat or by the evidence that The interested party.

ARTICLE 107.- Non-professional staff authorized to provide health services in obstetrics, to enroll in the knowledge update courses in the (a) the authorisation referred to in Article 102 of this Regulation shall be subject to the authorisation.

ARTICLE 108.- The plans and programmes of the training and updating courses, referred to in Article 105 of this Regulation, shall be position of the Secretariat and shall be imparted by the Federal Executive's own dependency or by the institutions authorized by it for that purpose.

ARTICLE 109.- The Secretariat shall periodically carry out the supervision of the services they provide and the activities carried out by the personnel referred to in the Article 102 of this Regulation.

ARTICLE 110.- Non-professional personnel authorized to provide services in the field of obstetrics may:

I.- Understand the normal pregnancies, deliveries, and puerperios that occur in your community, giving notice to the Secretariat;

II.- Prescribe the medications that are required in such cases according to the Mexican official standards that the Secretariat issues for that purpose, and

III.- Perform other activities as determined by the Secretariat.

ARTICLE 111.- You may not, under any circumstances, be authorized to the provision of obstetrics services:

I.- Understanding pathological pregnancies, deliveries, or puerperios, except where the lack of immediate attention or the transfer of the patient to the medical care unit close, endanger the life of the mother or the product. In this case they must give notice to the Secretariat;

II.- Perform surgical interventions;

III.- Prescribing different medications from those expressly authorized;

IV.- Cause abortions, and

V.- Other activities to be determined by the Secretariat.

ARTICLE 112.- Non-professional personnel referred to in Article 102 shall have the following obligations:

I.- Send to the nearest health care facility, cases of pathological pregnancies or in which the possibility of pathological deliveries or puerperios is presumed;

II.- Communicate immediately to the Secretariat the cases of deliveries or pathological puerperios, requesting the provision of services by medical professionals with legally authorised exercise;

III.- Give the information requested by the Secretariat and facilities in the monitoring of the activities they perform;

IV.- Attend the information meetings to which they are summoned by the Secretariat;

V.- Accuse to the knowledge update courses provided by the Secretariat or the institutions authorized by the Secretariat for that purpose;

VI.- Pay the Secretariat quarterly information about the activities and their results;

VII.- Give notice to the Secretariat of the cases of any communicable disease of which it has knowledge or founded suspicion;

VIII.- Give notice to the Secretariat of your residency changes;

IX.- The other obligations set forth in the Act, this Regulation and other applicable provisions.

ARTICLE 113.- The Secretariat, in the federal entities, will carry a state registration of the permits and endorsement that will issue to the non-professional personnel authorized for the benefit of health care services in obstetrics.

ARTICLE 114.- The authorized non-professional health personnel in obstetrics who incur the following violations shall be punished:

I.- Skip the authorization endorsement;

II.- Do not go to the knowledge upgrade course in the subject;

III.- Skip the aid to be obligated, and

IV.- In general for acts or omissions involving non-compliance with obligations arising from the Act and its regulatory provisions.

ARTICLE 115.- Only physicians specializing in pediatrics with a minimum of five years in the exercise of the specialty will be responsible for a pediatric hospital. the obligation to take the necessary measures to reduce the perinatal, child, preschool and school morbidity and mortality, by complying with the recommendations for the effect of the respective national committees.

CHAPTER VI

Provisions For Family Planning Services Provision

ARTICLE 116.- It is up to the Secretariat to dictate the Mexican official rules for the provision of basic health services in the field of planning family.

ARTICLE 117.- The Secretariat will provide advice and technical support that is required in the public and social institutions, as well as in the institutions. private, for the proper provision of basic health services in the field of family planning.

ARTICLE 118.- It will be the obligation of the institutions of the public, social and private sectors to provide free of charge within their facilities, services including information, guidance and motivation regarding family planning, in accordance with the Mexican official rules issued by the Secretariat.

ARTICLE 119.- For the realization of salpingoclasias and vasectomies, it will be essential to obtain the express and written authorization of the applicants, after informing the on the nature of the intervention and its consequences.

ARTICLE 120.- Such interventions shall be carried out in accordance with the applicable Mexican official standards.

CHAPTER VII

Provisions For Mental Health Services Provision

ARTICLE 121.- For the purposes of this Regulation, it is understood by the provision of mental health services, any action aimed at the prevention of mental illness, as well as the treatment and rehabilitation of persons suffering from them.

ARTICLE 122.- The prevention of mental illness will be borne by the Secretariat and the governments of the federal entities, in coordination with the competent authorities in each matter.

ARTICLE 123.- For the promotion of mental health, the Secretariat, the health institutions and the governments of the federal entities, in coordination with the competent authorities in each subject, shall encourage and support:

I.- The development of educational, socio-cultural and recreational activities that contribute to mental health;

II.- The implementation of programs for the prevention of the use of psychotropic substances, narcotic drugs, inhalants and others that may cause mental disorders or dependence, and

III.- Other actions that directly or indirectly contribute to the promotion of the mental health of the population.

ARTICLE 124.- The actions mentioned in the above articles will be addressed to the general population with special emphasis on children and youth.

ARTICLE 125.- For the provision of outpatient care, mental health professionals shall comply with the applicable Articles of Chapter III of this Regulation.

ARTICLE 126.- The establishment that shelters patients with mental illness must have the necessary physical and human resources for the adequate protection, security and attention of users, in line with the Mexican official standards issued by the Secretariat.

ARTICLE 127.- The psychiatric units that are located in prisons or social rehabilitation centers, in addition to the internal regulations, adjust to the official Mexican standard of provision of mental health services issued by the Secretariat.

ARTICLE 128.- In psychiatric hospitals, the person responsible must be a surgeon, with a specialty in psychiatry, with a minimum of 5 years of experience in the craft.

Also, the heads of emergency department, foreign consultation and hospitalization should be medical surgeons, with specialty in psychiatry, duly registered with the authorities. competent education.

ARTICLE 129.- All staff who provide their services in any mental health facility must be able to provide them adequately in the terms of the appropriate legal and regulatory provisions.

ARTICLE 130.- The person responsible for any establishment of this nature, will be obliged to develop refresher courses for the staff of the unit, in accordance with what is stated in the Mexican official rules issued by the Secretariat.

ARTICLE 131.- During interment, the user will receive stimuli through recreational and socio-cultural activities.

ARTICLE 132.- The Secretariat will advise public, social and private institutions to devote themselves to the care and rehabilitation of the mentally ill.

ARTICLE 133.- Personal information that the mentally ill provides to the psychiatrist or mental health personnel during his/her treatment will be handled with discretion, confidentiality and shall be used solely for scientific or therapeutic purposes. It may be released only to third parties, by order of the judicial or health authority.

ARTICLE 134.- Clinical records will only be handled by authorized personnel.

CHAPTER VIII

Provisions for Rehabilitation Services Provision

ARTICLE 135.- For the purposes of this Regulation, it is understood by:

I.- INVALIDITY: The limitation on a person's ability to perform, by itself, activities necessary for his physical, mental, social, occupational and economic performance, as a result of somatic, psychological or social insufficiency;

II.- REHABILITATION: The set of measures aimed at improving a person's ability to perform for themselves, activities necessary for his physical, mental, and physical performance. social, occupational and economic, by means of orthotics, prostheses, functional aids, reconstructive surgery or any other procedure that will enable it to integrate with society;

III.- INSTITUTE OF REHABILITATION: The medical establishment that performs mainly functions, scientific research and teaching in the field of rehabilitation invalid;

IV.- REHABILITATION CENTER: The medical facility providing diagnostic, treatment, and occupational training services to invalids;

V.- REHABILITATION UNIT: The unit that is part or not of a hospital, provides diagnostic and treatment services to invalid, as well as recovery of deficiencies and disabilities;

VI.- REHABILITATION OFFICE: The establishment that primarily provides diagnostic services and provides treatments that do not require equipment, personnel, and special facilities in accordance with the provisions of this Regulation;

VII.- OCCUPATIONAL REHABILITATION CENTER: The establishment that primarily provides training for work or employment to disabled people in the process of rehabilitation or rehabilitated, and

VIII. Repealed.

ARTICLE 136.- The provisions provided for in this Regulation shall apply to any institution for the rehabilitation of persons with disabilities, even if is called, ostentatious or otherwise constituted, and must be subject to the official Mexican rules issued by the Secretariat.

ARTICLE 137.- In nurseries, kindergartens, schools, institutes and in general, in those establishments, whatever their denomination or regime In the case of special education or rehabilitation activities for persons with disabilities, the official Mexican rules issued by the Secretariat will be included.

ARTICLE 138.- Nurseries, kindergartens and basic education schools, will promote disability screening activities and suspected cases, will make them aware of of parents or guardians for proper care.

CHAPTER VIII BIS

Provisions for Palliative Care Services Provision

ARTICLE 138 Bis.- This Chapter aims to establish general procedures for the provision of adequate palliative care to users of any age that a disease is in terminal status.

ARTICLE 138 Bis 1.- The objectives of palliative care are:

I.- Providing well-being and a dignified quality of life until the time of death;

II.- Preventing possible actions and behaviors that result in the abandonment or therapeutic obstinacy, as well as the application of extraordinary means, respecting at all times the dignity of the person;

III.- Providing pain relief and other severe symptoms associated with terminal conditions;

IV.- Establish the treatment protocols to be provided to the terminally ill patients through palliative care, so that they do not interfere with the natural process of death;

V.- Provide the terminally ill with the necessary physical, psychological, social and spiritual supports to provide the best possible quality of life, and

VI.- Give support to the family or the person of their trust to help them cope with the disease of the patient and, where appropriate, grieving.

ARTICLE 138 Bis 2.- For the purposes of this Chapter, in addition to the definitions provided for in Article 166 Bis 1 of the Act, it is understood by:

I.- ADVANCE GUIDELINES: The document referred to in article 166 Bis 4 of the Act;

II.- PAIN: It is the sensory experience of physical and emotional suffering, of varying intensity, that can be presented accompanied by real or potential harm tissue of the patient;

III.- MULTIDISCIPLINARY TEAM: Professional, technical and auxiliary staff of various disciplines in the area of health, who are involved in medical care integral of the terminally ill patient;

IV.- MEDICAL TREATMENT: The health professional responsible for care and follow-up to the palliative care plan;

V.- CURATIAL TREATMENT: All measures supported by scientific evidence and ethical principles aimed at offering healing possibilities of a disease, and

VI.- PALLIATIVE CARE PLAN: The set of actions indicated, programmed and organized by the treating physician, complemented and supervised by the team multidisciplinary, which must be provided according to the specific condition of the patient, giving in a complete and permanent manner the possibility of the control of the symptoms associated with his condition. It may include the participation of family members and volunteer staff.

ARTICLE 138 Bis 3.- The Secretariat will issue the official Mexican standard that provides, among other aspects, the criteria for the care of patients in situations terminal through palliative care that must be met by the health care institutions and institutions of the National Health System that provide these services.

ARTICLE 138 Bis 4.- The Secretariat will provide the technical advice and support that is required in the institutions and health care facilities of the public, social and private sectors for the provision of palliative care services.

ARTICLE 138 Bis 5.- Healthcare providers in the public, social, and private sectors that provide palliative care should provide free of charge within the establishment, information, guidance and motivation on palliative care, in accordance with applicable regulations.

FIRST SECTION

Of The Rights of the Sick in Terminal Situation

ARTICLE 138 Bis 6.- The patient has the right to be informed in a timely, understandable and sufficient manner that curative treatment is no longer offering positive results for both your prognosis and quality of life, informing you and, if you so authorize, the guardian, legal representative, family or person of your trust, the diagnosis of a disease in the state terminal, as well as the available palliative care options. In case of doubt, the patient may request additional information and explanations, which should be provided in the form described above. You can also request a second opinion.

ARTICLE 138 Bis 7.- In addition to the rights set out in Article 166 Bis 3 of the Law, patients who are terminally ill have the following:

I.- Receiving outpatient and hospital care;

II.- To be provided with guidance and counseling services to him, his family or person of his/her trust, as well as follow up on his/her status of health;

III.- To respect their will expressed in the advance guidelines document, and

IV.- The others that point to the applicable provisions.

ARTICLE 138 Bis 8.- Advance guidelines may be revoked at any time only by the person who subscribed them.

When the advancement of the medicine emerged, new or experimental curative treatments that could be applied to the patient in a terminal situation, report on that fact, in order to be able to ratify in writing its willingness not to receive palliative care or to revoke it in writing in order to undergo such treatments.

If the health status of the terminally ill person prevents you from being aware or in full use of your mental faculties, the decision referred to in the paragraph may be taken by your family member, guardian, legal representative or person of your trust.

ARTICLE 138 Bis 9.- Without prejudice to article 166 Bis 8 of the Law, minors shall be provided with complete and truthful information that because of their age, maturity and special circumstances, they require their disease in terminal condition and the corresponding palliative care.

ARTICLE 138 Bis 10.- From the fact that the terminal situation of the disease is diagnosed with certainty by the treating physician, the care will be provided palliative, based on the palliative care plan established by the physician. Such care cannot be provided if the plan is not available.

ARTICLE 138 Bis 11.- The provision of outpatient care services in the field of palliative care will, in general, be adjusted to the provisions of the Chapter III of this Regulation, as well as the provisions of this Chapter.

SECTION SECOND

Of the Faculties and Obligations of Health Institutions

ARTICLE 138 Bis 12.- The institutions of the National Health System will promote the training and updating of professionals, technicians and auxiliary workers the health of palliative care is carried out at least once a year.

For the purpose of promoting the creation of specialized areas provided by the Law in the fifth section of article 166 Bis 13, the institutions of the National Health System, according to the degree of complexity, resolutive capacity, availability of financial resources, organization and operation, will have the infrastructure, suitable personnel and material and technological resources suitable for the medical care of palliative care, in accordance with the official Mexican standard for this effect to be issued by the Secretariat.

Medical care institutions and institutions that provide palliative care must have sufficient supplies of drugs and inputs for management of the pain of the terminally ill patient.

ARTICLE 138 Bis 13.- Palliative care physicians in the second and third level institutions and establishments and sector equivalents social and private, will have the following obligations:

I.- Providing information to the terminally ill patient, about the results expected and possible consequences of the disease or treatment, respecting at all times their dignity;

II.- Prescribing the palliative care plan, taking into account the characteristics and specific needs of each terminally ill patient;

III.- Comply with advance guidelines;

IV.- Abduction in accordance with the provisions of the Law, this Regulation and other applicable provisions;

V.- Participate in the elaboration and implementation of treatment plans and protocols palliative care, as well as in the assessment of the effectiveness of the palliative care;

VI.- Provide psychological support to family members or the person of their trust to coping with the disease of the patient and, where appropriate, coping with grief;

VII.- Capacity, auxiliary and monitor the patient to encourage self-care health, as well as their family or responsible for their care, preserving the dignity of the sick person and favoring their self-esteem and autonomy;

VIII.- Prescribing drugs that require the condition of the terminally ill patient subject to the palliative care treatment plan and protocol, and

IX.- The others that point to the applicable provisions.

ARTICLE 138 Bis 14.- It is the responsibility of the treating physician and the multidisciplinary team to identify, assess and respond in a timely manner, pain and symptoms associates that the user refers, regardless of the different locations or degrees of intensity of the same, to indicate the appropriate treatment to each symptom according to the best medical evidence, with attachment to the scientific and ethical principles that guide the medical practice, without incurring any time in actions or behaviors considered as therapeutic obstinacy or intended to end the life of the patient.

ARTICLE 138 Bis 15.- The palliative care plan must consider those actions to be carried out at the home of the patient terminal, on the part of family members, carers or voluntary staff, taking into account the following criteria:

I.- Must be indicated by the treating physician, according to the specific characteristics and condition of the user. This fact must be recorded in the clinical case of the terminally ill patient;

II.- The multidisciplinary team of the institution or health care establishment that provides palliative care should be involved;

III.- The multidisciplinary team will provide the appropriate training in the various fields of professional competence, family, caregivers or volunteer staff, who will be responsible for the care and basic care of the terminally ill patient;

IV.- The multidisciplinary team will supervise the compliance of the basic care actions and actions indicated by the treating physician, within the plan of palliative care. The findings should be reported to the treating physician and recorded in the clinical case of the terminally ill patient, and

V.- Other than determine applicable provisions.

ARTICLE 138 Bis 16.- For the case that palliative care is carried out at the home of the patient in a terminal situation and assistance is required The Secretariat shall:

I.- Be expeditious, attentive, respectful and sufficient to meet the information needs of the caller;

II.- Documenting and annexing the report of the call to the clinical case of the terminally ill patient, and

III.- Meet the other requirements that are set.

ARTICLE 138 Bis 17.- Everyone who provides palliative care services to terminally ill patients must have the resources physical, human and material necessary for the protection, safety and quality of care of users, in accordance with the Mexican official standards issued by the Secretariat.

ARTICLE 138 Bis 18.- For the purposes of obtaining the authorization referred to in Articles 80 and 81 of this Regulation, and other legal provisions The patient should be explained to the user why the curative treatment is stopped and the application of palliative care is suggested.

ARTICLE 138 Bis 19.- The multidisciplinary team shall be integrated, at least, by:

I.- Medical treating physician;

II.- Nurse;

III.- Physiotherapist;

IV.- Social Worker or its equivalent;

V.- Psychologist;

VI.- Algologo or Anesthesiologist;

VII.- Nutriologist, and

VIII.- Other professionals, technicians and auxiliaries who require each case in particular.

ARTICLE 138 Bis 20.- Personal information provided to the treating physician or the multidisciplinary team in palliative care by the patient in terminal situation, shall be used with confidentiality and used only for scientific or therapeutic purposes in terms of the official Mexican standard that the Secretariat and other applicable provisions have to the effect.

ARTICLE 138 Bis 21.- The bioethics committees of health institutions, dealing with palliative care, should:

I.- Avaling the palliative care plan, at the request of the treating physician, in cases that are difficult or complicated by the nature of the terminal disease or the circumstances in which it is developed, taking care to ensure that during the analysis of the plan the necessary medicines are provided to mitigate the pain, unless they put their life at risk;

II.- Propose policies and protocols for the smooth functioning of the multidisciplinary treatment team in palliative care, and

III.- What the other applicable legal provisions set out for you.

SECTION THIRD

Of Advance Guidelines

ARTICLE 138 Bis 22.- The institutions of the National Health System will have to observe the will expressed in the advance guidelines. When the will expressed in the advance guidelines is not executed accurately, the penalties will be imposed to establish the applicable laws.

Except as provided for in the previous paragraph, those provisions that are contrary to the Mexican legal order, particularly as regards the penal type equivalent to euthanasia and assisted suicide. The execution of these provisions by the medical, technical and auxiliary health personnel does not exempt them from the responsibilities of any type they may contract.

ARTICLE 138 Bis 23.- Advance guidelines may be subscribed by any older person in full use of their mental faculties, regardless of when you are diagnosed as terminally ill.

ARTICLE 138 Bis 24.- The advance guidelines document must have the following formalities and requirements:

I.- Realize in writing, with the name, signature, or fingerprint of the subscriber and two witnesses;

II.- Constar that the will has manifested itself in a personal, free and unequivocal manner;

III.- The manifestation, whether expressed or not, regarding the disposition of organs susceptible to being donated;

IV.- The indication of receiving or not receiving any treatment, in the event of a terminal illness, and

V.- Where appropriate, the appointment of one or more representatives to corroborate the execution of the will of the terminally ill patient.

The acceptance of the representation referred to in the preceding paragraph shall be carried out in the same act as the advance guidelines and must be entered in the same document.

ARTICLE 138 Bis 25.- They will be null and void the advance guidelines that will establish the order to assist or intentionally cause death, in particular, by What it does to euthanasia and assisted suicide. The guidelines shall also be considered to be null and void where they contravene the provisions of the Act, this Regulation and other applicable legal provisions.

ARTICLE 138 Bis 26.- They are obligations of the representatives, as referred to in Article 138 Bis 24 of this Regulation:

I.- Corrobar the execution of the will of the sick in terminal situation, in the terms established by this in the advance guidelines;

II.- Review changes and modifications made to advance guidelines after rendering acceptance, and

III.- The others that point to the applicable legal provisions.

ARTICLE 138 Bis 27.- In case the terminally ill person decides to revoke or modify the advance guidelines, he/she must comply with the same formalities and requirements that were required for your subscription.

CHAPTER IX

Provisions for the provision of diagnostic and diagnostic auxiliary services

FIRST SECTION

ARTICLE 139.- For the purposes of this Regulation, auxiliary diagnostic and treatment services are considered, to any public, social or private establishment, independent or linked. to any health care service, which is intended to assist in the study, resolution and treatment of clinical problems.

ARTICLE 140.- The auxiliary diagnostic and treatment services will be:

I.- Labs of:

a) Clinical pathology, and

b) Pathological anatomy, histopathology and exfoliative cytology.

II.- Cabinets of:

a) Radiology and Computed Axial Tomography;

b) Nuclear medicine;

c) ultrasonography, and,

d) Radiation Therapy.

ARTICLE 141.- The requirements for the organization, operation and health engineering of the auxiliary diagnostic and treatment services shall be determined by the Mexican official rules issued by the Secretariat.

ARTICLE 142.- The auxiliary diagnostic and treatment services will carry a record of their activities according to the official Mexican standard respective.

ARTICLE 143.- The establishments providing services of diagnostic and treatment aids must have a responsible person in the terms indicated by the present Regulation, being able to assume, if necessary, up to two responsives.

ARTICLE 144.- The obligations of those responsible referred to in the previous article, in addition to those mentioned in the General Provisions chapter of this Regulation will be:

I.- Notify the Secretariat of communicable disease cases in writing, with a certain or probable diagnosis, in addition to any suspected agent poisoning. chemical, physical or bacteriological;

II.- Carry out both internal and external control systems as determined by the Secretariat;

III.- To monitor that the results of the studies are signed by the authorized personnel and autograph;

IV.- To monitor that samples of the contaminated or potentially contaminated biological products, material and equipment are sterilized and decontaminated before being discarded or reused, according to the Mexican official rules that the Secretariat points out in this regard;

V.- Vigil and maintain the proper functioning of the reception and sampling that the laboratory or cabinet has established outside the premises;

VI.- Keep up to date the documentation of the staff of the laboratory or cabinet referred to in Article 24 of this Regulation;

VII.- Communicate in writing to the Secretariat the examinations to be carried out by other laboratories or cabinets, annexing the corresponding letters convention, as well as informing when they are no longer valid;

VIII.- Communicate to the Secretariat the schedule of its assistance to the establishment, which may not be less than three hours a day, as well as any changes thereto;

IX.- Monitor compliance with the conventions regarding the execution of the studies that your lab or cabinet performs, and

X.- Communicate in writing to the Secretariat the date of cessation of its functions as responsible, either on a temporary basis exceeding 15 days or with a definitive nature; the latter case, return the authorisation of the person responsible to the health authorities, within a period of not more than 15 days, for cancellation.

ARTICLE 145.- The auxiliary diagnostic and treatment services must have the corresponding health license, which must be kept in good condition and instead visible within the establishment.

ARTICLE 146.- The establishments must be designated with the name expressed in their health license, in addition, they will have in the public view a sign of at least 20 by 30 centimetres, including the name of the person responsible, the institution which issued the title, diploma or constancy, the registration numbers of the person and the timetable in which he/she attends.

ARTICLE 147.- The staff working in the establishments referred to in this Chapter shall bear identification cards, including the name of the establishment, name, address and photograph of the employee, as well as the position he/she plays and the time he/she attends.

SECOND SECTION

From Laboratories

ARTICLE 148.- They shall be considered laboratories, the establishments providing services of:

I.- Clinical Pathology, and

II.- Pathological anatomy, histopathology and exfoliative cytology.

ARTICLE 149.- Clinical pathology laboratories shall have the following areas:

I.- Waiting room;

II.- Receiving and sampling;

III.- Lab;

IV.- Administration, and

V.- Health facilities.

ARTICLE 150.- Clinical pathology laboratories must be able, according to their resolution power, to carry out the tests that the standard Mexican officer to issue the Secretariat.

ARTICLE 151.- For tests that are sent to other laboratories for processing, agreements signed by those responsible for the laboratories involved must be concluded. which must be authorized by the Secretariat and shall be valid for 2 years.

ARTICLE 152.- Services for the reception and sampling of samples shall not be able to operate independently, therefore, the responsible and the health of these services, they shall be the same as the owner laboratory and must be counted for its operation, with the personnel authorized by the Secretariat in accordance with the official Mexican standard that the same issue.

ARTICLE 153.- It is understood by receipt and sampling of the service that performs this function only, and then transferred to an authorized laboratory.

ARTICLE 154.- The services referred to in the previous article shall have the necessary means for the taking, preservation and transport of the samples.

ARTICLE 155.- Samples for laboratory studies must be processed within the time that ensures the accuracy of the results.

ARTICLE 156.- The prenuptial examinations may only be performed by clinical pathology laboratories authorized by the Secretariat for this purpose and the results shall be be signed exclusively by the person responsible.

ARTICLE 157.- Clinical pathology laboratories may include the other auxiliary diagnostic and treatment services, which, in each case, must be comply with the Mexican official rules of the Secretariat.

ARTICLE 158.- Laboratories must use the highest quality reagents and culture media, in accordance with the official Mexican standard that the Secretariat.

ARTICLE 159.- Clinical pathology laboratories that handle radioactive isotopes will be required to observe the safety and security measures determined by the Secretariat, which will also monitor compliance with existing provisions.

ARTICLE 160.- Laboratories that handle radioactive isotopes must obtain prior authorization from the Secretariat and the National Nuclear Safety Commission and Safeguards for the storage, transportation and handling of radioactive substances.

ARTICLE 161.- Diagnostic tests that require radioactive material must be carried out by personnel specialized in Nuclear Medicine or by trained technical personnel. acting under the responsibility of the same.

ARTICLE 162.- Medical treatments with radioactive isotopes performed in the laboratory will be performed exclusively by medical specialists, under his own responsibility. When radioisotopes are required for treatment in the course of surgical interventions, the safety measures that the Secretariat points out must be taken through the respective official Mexican standard.

ARTICLE 163.- They may be responsible for a clinical pathology laboratory:

I.- Drug-biologists, chemical bacteriologists, parasitologists, or biologists, with a degree issued and registered by the competent educational authority;

II.- Medical surgeons who have specialty certificates in any of the clinical laboratory areas, issued by the relevant council, or present a degree of university degree or doctorate in clinical pathology laboratory areas, issued by a competent educational institution, and

III.- Other as determined by the Secretariat.

ARTICLE 164.- The auxiliary diagnostic and treatment services attached to a clinical pathology laboratory, may operate with a single health license, comprising: the various activities, as long as they belong to the same owner.

ARTICLE 165.- Clinical pathology laboratories or services for the reception and taking of samples attached to medical offices, even if they only serve the patients of These offices must be provided with a health license, both for the laboratory or service for the reception and sampling, and for the office.

ARTICLE 166.- Laboratories must have the necessary means to preserve and store the samples, reagents and culture media under the conditions The best to mark the respective Mexican official standards.

ARTICLE 167.- The laboratories that have an annex blood bank, transfusion services or nuclear medicine laboratories, must comply with the specifications of this Regulation and the official Mexican rules issued by the Secretariat.

ARTICLE 168.- The laboratories of pathological anatomy, histopathology and exfoliative cytology must have the following areas:

I.- Sample Take;

II.- Necropsy Room in Hospital Units;

III.- Study and description;

IV.- Photography and Microphotography;

V.- Lab;

VI.- Conservation and storage of organs, tissues, and corpses in hospital units only;

VII.- Protocol file and laminillas;

VIII.- Administration, and

IX.- Health facilities.

ARTICLE 169.- The laboratories of pathological anatomy, histopathology and exfoliative cytology shall be in accordance with their resolution power, being in the possibility of practice studies that point to the official Mexican standard.

ARTICLE 170.- They may be responsible for a laboratory of pathological anatomy, histopathology and cytology and exfoliative:

I.- Medical surgeons with certificates issued and registered by the competent educational authority, or present a degree of evidence of an institution recognized by the Secretariat;

II.- In cases of exfoliative cytology laboratories, medical surgeons who have a certificate of the specialty issued by the relevant council or by a competent educational institution, and

III.- Other as determined by the Secretariat.

ARTICLE 171.- Establishments providing pathological anatomy, histopathology and exfoliative cytology services may be part of a hospital unit or function in Independent form.

ARTICLE 172.- The organization and operation of the laboratories of pathological anatomy, histopathology and exfoliative cytology, will be determined by the standard Mexican official, issued by the Secretariat.

SECCLON THIRD

Of Gones

ARTICLE 173.- They will be considered Gvientos, the establishments that provide services of:

I.- Radiology and Computed Axial Tomography;

II.- Nuclear Medicine;

III.- Ultrasonography; and

IV.- Radiation Therapy;

ARTICLE 174.- Radio-diagnostic Cabinet is understood to use equipment and apparatus of X-Ray for diagnostic purposes.

ARTICLE 175.- For the purposes of this regulation you will understand:

I.- RADIOLOGICAL SECURITY: The set of preventive measures aimed at maintaining the doses of radiation produced by diagnostic X-ray devices, at the highest levels low points to the respective Mexican official standards;

II.- RESPONSIBLE FOR RADIATION SAFETY: The professional in charge of monitoring and supervising that diagnostic type X-ray equipment works according to official standards (i) their respective Mexican counterparts, as well as advising the Radiologist Technician on the appropriate employment of the same;

III.- RADIOLOGIST DOCTOR: To the professional who directly uses the diagnostic X-ray equipment and who will be responsible for ensuring the minimum doses to the patient and the occupational personnel exposed, according to the respective Mexican official standards;

IV.- RADIOLOGIST TECHNICIAN: The person who under the supervision of the radiation safety officer, or the Radiologist Doctor, operates the type X-ray equipment and equipment. diagnosis;

V.- OCCUPATIONAL PERSONNEL EXPOSED: The person who works in the X-ray facility diagnostic type;

VI.- PATIENT: The person exposed to radiation produced by a team of X-Ray for diagnostic purposes;

VII.- PUBLIC: Every person who may be exposed to radiations of diagnostic X-ray equipment, to be found in the vicinity of a facility at the moment to operate such equipment;

VIII.- MAXIMUM ALLOWABLE DOSE: It is the largest amount of radiation, which is allowed, to be received by a person according to the official Mexican standards, and

IX.- REM: The radiation measurement unit received. For X-ray effects it is equivalent to 1 rad or 1 roentgen.

ARTICLE 176.- Both in establishments, such as mobile units using radiation sources for diagnostic and treatment purposes, must have a responsible and subject to the Mexican official rules issued by the Secretariat and, where appropriate, the National Nuclear Safety and Safeguards Commission.

ARTICLE 177.- To be responsible for Radiological Safety the following requirements must be met:

I.- Being a medical surgeon with a legally issued and registered title to the competent educational authorities;

II.- Have a certificate of the craft;

III.- Contar with Secretariat authority, and

IV.- Other as determined by the Secretariat.

ARTICLE 178.- They are responsible for radiation safety:

I.- Advise the staff working on the establishment in the application of the official Mexican security and radiological standards;

II.- To monitor compliance with the Mexican official standards issued by the Secretariat and the National Nuclear Safety and Safeguards Commission;

III.- Train staff in the radiological security methods and inform you about the risks involved in your work;

IV.- Take the record of the different levels of radiation to which the staff working with the diagnostic type X-ray equipment, as well as the radiation levels in neighboring areas;

V.- Investigate cases of excessive or abnormal exposure and immediately take necessary steps to prevent their repetition, as well as give notice to the Secretariat;

VI.- Inform the occupational staff exposed about the dose they have received in performing their duties, and

VII.- Other analogous to be determined by the Secretariat.

ARTICLE 179.- The maximum allowable doses will be in accordance with the respective Mexican official standards.

ARTICLE 180.- The occupational personnel exposed will be obliged to report to the radiation safety officer, the radiation doses received in the the performance of similar activities in other establishments; in this case, the person responsible must submit it to a continuous individual dose control and to the examinations that indicate the respective Mexican official standards.

ARTICLE 181.- The occupational staff exposed must undergo medical examinations before being employed and periodically during the time they are employed. his services, according to the Mexican official rules issued by the Secretariat.

ARTICLE 182.- In no establishment where radiodiagnostic services are provided, persons under 18 years of age may be employed.

ARTICLE 183.- Only under medical prescription will a human being exposed to radiation produced by a diagnostic X-ray apparatus.

ARTICLE 184.- Only public health surveys involving the use of X-Ray will be applied when there is no other less aggressive diagnostic method that fully guarantees the use of Detection of diseases.

ARTICLE 185.- Fluoroscopes can only be operated by radiologists.

ARTICLE 186.- The use of portable fluoroscopy equipment and so-called hand and head fluorosscopes is strictly prohibited.

ARTICLE 187.- During radiation, they will only remain in the X-ray room, the patient and the staff needed for the execution of the study in question.

ARTICLE 188.- Access to the X-Ray rooms must be kept closed during radiation.

ARTICLE 189.- In establishments where radiodiagnostic services are provided, it must be counted with visible announcements to the public indicating the presence of radiation.

ARTICLE 190.- The X-ray room must have the shield that will point to the Mexican official rules issued by the Secretariat and, where appropriate, the Commission National Nuclear Safety and Safeguards.

ARTICLE 191.- It is understood as nuclear medicine cabinets, those establishments that use open radiation sources for both in vivo and in vitro use, for purposes of diagnosis and treatment.

ARTICLE 192.- The nuclear medicine establishments must be subject to the provisions of the Law, this Regulation and the official Mexican norms that the Secretary, and the National Nuclear Safety and Safeguards Commission.

ARTICLE 193.- To be responsible for a nuclear medicine cabinet the following requirements must be met:

I.- Be a legally-issued and registered medical surgeon before the competent educational authorities;

II.- Having a craft certificate;

III.- Contar with authorization from the Secretariat and the National Nuclear Safety and Safeguards Commission, and

IV.- Other as determined by the Secretariat.

ARTICLE 194.- Nuclear medicine cabinets shall have a radiation safety officer whose obligations shall be those set out in Article 178 of this Regulation. Regulation.

ARTICLE 195.- The technical personnel operating the nuclear medicine equipment and apparatus must demonstrate their capacity to the Secretariat.

ARTICLE 196.- Nuclear medicine establishments, as well as the personnel who work in them, must comply with the provisions of Radiological Safety, mentioned in this Regulation and other applicable provisions.

ARTICLE 197.- Nuclear medicine establishments must observe the official Mexican rules issued by the Secretariat and the National Commission of Nuclear Safety and Safeguards in the field of pollution, waste disposal and control of radioactive materials.

ARTICLE 198.- Nuclear Medicine establishments should preferably be within a Hospital Unit and will have the following areas:

I.- Waiting room;

II.- Consultants;

III.- Lab;

IV.- Therapy room;

V.- Administration, and

VI.-Health facilities.

ARTICLE 199.- Nuclear medicine cabinets will store their materials and reagents in the form specified in the corresponding instructions.

ARTICLE 200.- The diagnostic tests shall be performed by medical surgeons specializing in nuclear medicine or trained technical personnel acting under the responsibility of a physician specializing in nuclear medicine.

ARTICLE 201.- Medical treatments with radioactive material will be performed under the responsibility of the medical specialist in nuclear medicine; when radioisotopes are Required by treatment in the course of surgical interventions, safety measures should be taken by the Secretariat in this regard.

ARTICLE 202.- It is understood by ultrasonography cabinet the establishment that uses ultrasound equipment and equipment for diagnostic purposes.

ARTICLE 203.- The application of the ultrasonography procedures shall be subject to the official Mexican rules issued by the Secretariat.

ARTICLE 204.- The person responsible for an ultrasound cabinet must meet the following requirements:

I.- Be a surgeon with registered title to the competent educational authorities;

II.- Have a certificate of the craft;

III.- Contar with Secretariat authority, and

IV.- Other as determined by the Secretariat.

ARTICLE 205.- The ultrasonography room must be isolated and protected from any other service, particularly from those employing radiation sources.

ARTICLE 206.- Technical personnel who operate the ultrasound equipment and apparatus shall develop their activities under the supervision of the controller.

ARTICLE 207.- It is understood by radiotherapy cabinet, the establishment that uses ionizing radiation sources for therapeutic purposes.

ARTICLE 208.- It is understood by ionising radiation to be emitted by cobalt, cesium, linear accelerators, betatron and X-ray tubes.

ARTICLE 209.- The radiation therapy establishments must be subject to the provisions of the Law, this Regulation and the official Mexican norms that the Secretariat, and where appropriate, the National Nuclear Safety and Safeguards Commission.

ARTICLE 210.- The radiation therapy cabinets must have a radiation safety officer whose obligations are those set out in Article 176 of the Regulation.

ARTICLE 211.- The controller of a radiation therapy cabinet must meet the following requirements:

I.- Be a surgeon with registered title to the competent educational authorities;

II.- Have a certificate of the craft;

III.- Contar with authorization from the Secretariat and the National Nuclear Safety and Safeguards Commission, and

IV.- Other as determined by the Secretariat.

ARTICLE 212.- The technical personnel who operate the equipment and the radiation therapy devices must demonstrate their capacity to the Secretariat.

ARTICLE 213.- The radiation therapy establishments, as well as the personnel who work in them, must comply with the provisions of Radiological Safety, which the effect of Secretariat and the National Nuclear Safety and Safeguards Commission.

ARTICLE 214.- The radiation therapy establishments will have to observe the official Mexican norms issued by the Secretariat and the National Security Commission. Nuclear and Safeguards in the field of pollution, waste disposal and control of radioactive materials.

ARTICLE 215.- The radiation therapy establishments should preferably be within a hospital unit and will have the following areas:

I.- Waiting room;

II.- Consultants;

III.- Therapy room;

IV.- Administration, and

V.- Sanitary Facilities.

CHAPTER IX BIS

From Medical Care to Victims

ARTICLE 215 Bis 1. This Chapter is intended to regulate the provision of health care services, including the care of medical, dental, surgical and hospital emergencies, in accordance with the provisions of the Law, the General Law of Victims and other applicable provisions.

ARTICLE 215 Bis 2. For the purposes of this Chapter, in addition to the definitions contained in the other Articles of this Regulation, the following definitions shall apply:

I.      Emergency Medical: To medical urgency, in terms of the provisions of Article 72 of this Regulation, which is presented by a person, as a consequence of the commission of a crime or of violation of his human rights, and

II.     Victim: The natural person who is in the cases of the first and second paragraphs of Article 4 of the General Victims Act.

ARTICLE 215 Bis 3. Victims who have suffered injuries, diseases and emotional trauma from the commission of a crime or of violation of their human rights have the right to be restored to their physical and mental health. To this end, the Public Sector Health Care Facilities are obliged to provide them with Health Care services, including the attention of Medical Emergencies, in terms of the Law, the General Law of Victims, the This Regulation shall provide for the provisions of each public institution providing for medical care and other applicable legal instruments.

ARTICLE 215 Bis 4. The Public Health Care Facilities that provide Medical Care services to Victims, including Medical, Dental, Surgical and Hospital Emergency Care, must, in accordance with the model of care comprehensive health as referred to in Article 32 of the General Law of Victims, establish the mechanisms that correspond to ensure the attention to those Victims who are not entitled to them or beneficiaries of the institution to which they belong The Establishment for Medical Care in which it provides Medical Care, thus as for the reference to other Health Care Facilities, when the specialized services required by the Victim cannot be provided by the Establishment in which the services are provided.

The Medical Care provided in terms of the preceding paragraph, must take into account the main effects and consequences of the victimizing event, respecting always the general principles for the protection of victims established in the applicable provisions and, in particular, the differential approach for women, children, adolescents, persons with disabilities, older adults and the population indigenous.

ARTICLE 215 Bis 5. The person responsible for the Medical Care Establishment who provides services to a Victim must supervise the assessment of his or her general health, in order to determine the injuries and other conditions caused by the commission of the crime or the violation of their human rights.

Treatment of Medical Emergency, the head of the emergency department of the Medical Care Establishment is obliged to take the necessary measures that ensure, once the medical assessment of the Victim is performed, the full treatment of the Medical Emergency or, the stabilization of its general physical conditions so that it can be referred to another Establishment for Medical Care, when this is the case.

ARTICLE 215 Bis 6. In the event of a Medical Emergency, the Public Sector Health Care Facilities will be required to provide the Victim with the services referred to in Article 30 of the General Victims Law, regardless of their socio-economic capacity or nationality and without them being able to make their provision conditional upon the lodging of the complaint or complaint, as appropriate, without prejudice to the fact that such a character is subsequently recognised in terms of the provisions applicable.

ARTICLE 215 Bis 7. For Medical Care and the follow-up to the health status of the Victim, the Chief Medical Officer and the treating physician, should consider the following:

I.      Make the reference to a higher resolution hospital, in which the specialty services required by the Victim can be provided until the end of their treatment.

The shipment will be carried out with own resources of the Establishment that makes the shipment. If the appropriate means of transport are not to be counted, those of the establishment for the receiving medical care shall be used.

For the purposes of the first paragraph of this fraction, the end of treatment shall be determined by the treating physician through the medical discharge, the which must be based on a set of assessments of the health status of the User and, where appropriate, supported by the laboratory and cabinet studies, including those of image, which correspond;

II.     The medical appointment requested by the Victim must be granted in a period no longer than eight days. For the case of a Medical Emergency, the Victim must be immediately addressed;

III.    Make the Victim the laboratory and cabinet studies, including imaging, that are required to establish a proper diagnosis and to give timely follow-up to the evolution of their health status, and

IV.    For the case of reconstructive dental services, the Victim must receive all the services it requires for the damages caused as a result of the crime or the violation of its human rights.

CHAPTER X

Of Mismas Authorizations and Revocation

ARTICLE 216.- Health authorization is the administrative act by which the competent authority allows a person or public, social or private entity to carry out activities related to human health in cases and with the requirements and modalities to be determined by this Regulation and the provisions of this Regulation.

Health authorities will have the character of licenses, permissions, records, or health control cards.

ARTICLE 217.- Health authorizations shall be granted by the Secretariat and by the governments of the federal entities, in the field of their respective powers, in the terms of this Regulation and other applicable provisions.

ARTICLE 218.- The competent health authorities shall issue the respective authorisations, where the applicant has satisfied the requirements which he or she the applicable Mexican official rules and, where appropriate, covered by the rights established by the tax legislation, in accordance with the provisions of Article 371 of the Law.

ARTICLE 219.- Health authorizations may be extended in accordance with the terms set out in this Regulation.

The application must be submitted to the health authorities with 30 calendar days prior to the expiration of the authorization.

The extension will only proceed when the requirements set out in the Law, this Regulation and other applicable provisions and prior payment of the corresponding rights are still met.

In the case of health licenses, the revalidation application must be submitted within 30 days prior to expiration.

ARTICLE 220.- Health license requirements:

I.- The establishments referred to in this Regulation, with the exceptions set out therein;

II.- The mobile units referred to in this order, and

III.- The others that point to this Regulation.

When the establishments referred to in the I fraction change location, they will require new health license.

ARTICLE 221.- Such licenses shall be valid for two years from the date of their issue and shall be displayed in a visible place of the establishment or vehicle.

ARTICLE 222.- To obtain the health license, it must be submitted to the Secretariat, written request and in triplicate, in which it must be indicated:

I.- The name and address of the establishment in question and where appropriate, name and address of the owner;

II.- The name of the legally constituted representative in case of being a moral person;

III.- The name and address of the responsible professional and the number of Professional Cedula;

IV.- Internal Organization;

V.- Human, material, and financial resources you count on;

VI.- Activities you intend to develop;

VII.- The internal regulation of the establishment, except for the case of offices, and

VIII.- The other data indicated by the Secretariat, according to the respective Mexican official standard.

The application must be accompanied by the documentation of the information provided, as well as the plan and the descriptive memory of the local that occupies and of each of the sections which integrate it, with specifications regarding size, lighting, facilities and health services.

ARTICLE 223.- To obtain the health license of the mobile units referred to in this Regulation, a written application must be submitted in the form and terms to which it is refers to the previous article, in which it must be stated:

I.- Vehicle data;

II.- The establishment to which the service will be provided, and

III.- The others to be set by the Secretariat according to the respective Mexican official standard.

The application must be accompanied by the documentation of the information provided.

ARTICLE 224.- Requires permission;

I.- The construction, expansion, remodeling, rehabilitation, conditioning and equipping of the establishments dedicated to the provision of health care services, in any of its modes;

II.- Those responsible for the establishments referred to in this Regulation;

III.- Those responsible for the operation and operation of X-ray equipment and their technical auxiliaries;

IV.- The possession, transport and use of radiation and radioactive materials, as well as the disposal, dismantling and disposal of radioactive materials. wastes;

V.- Those responsible for the control of narcotic drugs and psychotropic substances of the establishments referred to in this Regulation;

VI.- The subrogation of health care services by social and private establishments, and

VII.- The other activities that are set in this order.

The permits referred to in this article may only be issued by the Secretariat, with the exception of the case provided for in part III, which will be subject to the provisions of the Article 125 of the Law.

The permits referred to in fractions II and V of this article and valid for two years in other cases shall be granted for indeterminate time.

ARTICLE 225.- To obtain the permits referred to in the previous article, in addition to complying with the obligations established by the Law and the present Regulation, will be due to the corresponding Mexican official norms.

ARTICLE 226.- Those responsible for the establishments which are the subject of this Regulation, in which it is intended to change the conditions which have been required for the granting of the health licence shall be issued to the health authority within a period of at least 30 days prior to the date on which the change is intended.

ARTICLE 227.- When by decision of its own, the establishment is to suspend temporarily or definitively the provision of its services, the holder of the authorization, give notice of this to the Secretariat at least 30 days in advance; if the suspension is final, the health authority shall revoke the respective authorization. In the case of a temporary suspension, the resumption of work shall be immediately notified.

ARTICLE 228.- Staff who provide services in any establishment for medical care, whose activities may spread some of the Communicable diseases referred to in Article 134 of the Law, shall have a health control card issued by the competent health authority, in accordance with the official Mexican rules that the Secretariat has in effect.

ARTICLE 229.- The authorizations referred to in this Regulation may be reviewed by the competent health authority, where appropriate.

ARTICLE 230.- The rights referred to in this Regulation shall be governed by the provisions of the tax legislation and the coordination agreements concluded in the matter, the Federal Executive and the governments of the federative entities.

ARTICLE 231.- The revocation of the authorizations referred to in this chapter shall be in accordance with the provisions of the Law.

ARTICLE 232.- The Secretariat shall have a period of sixty working days to resolve the application for authorizations, counted from the date of the filing of the request, or from the date on which the additional clarifications or information expressly required of the applicant are provided. If the decision is not made within the time limit, the licence or permit requested shall be deemed to be denied.

CHAPTER XI

Medical Care Services Delivery Surveillance

ARTICLE 233.- It is for the Secretariat and the governments of the federal entities, in the field of their respective competences, to monitor the compliance with this Regulation and other provisions issued on the basis thereof, in accordance with the provisions of Title Tenth of the Law.

The municipal authorities shall participate in such surveillance to the extent that they are determined by the agreements they conclude with the governments of their respective federative entity and by the local orders are available.

ARTICLE 234.- Other public agencies and agencies will contribute to the monitoring of compliance with Mexican official health and health standards. when they find irregularities which in their judgment constitute violations thereof, they shall do so with the knowledge of the competent health authorities.

ARTICLE 235.- The act or omission contrary to the provisions of this Regulation and to the provisions of this Regulation may be the subject of the guidance and education of the offenders. irrespective of whether the security measures and the related sanctions are applied, where appropriate.

CHAPTER XII

Security and Sanctions Measures

ARTICLE 236.- Security measures are considered, those provisions of immediate execution that the competent health authority dictates, in accordance with the provisions of this Regulation and other applicable provisions to protect the health of the population. The security measures shall be applied without prejudice to the penalties provided for in this case.

ARTICLE 237.- They are competent to order or execute security measures, the Secretariat and the governments of the federal entities, in the field of their respective competencies.

The participation of the municipalities will be determined by the agreements that they will hold with the governments of the respective federal entities and so that the local.

ARTICLE 238.- The health authority may, for the purposes of applying this Regulation, order the following health safety measures:

I.- Isolation;

II.- Quarantine;

III.- Personal observation;

IV.- Vaccination of people and animals;

V.- The destruction or control of insects or other transmissive and noxious fauna;

VI.- The suspension of jobs or services;

VII.- The securing and destruction of objects, products, or substances;

VIII.- The vacancy or eviction of houses, buildings, establishments, and in general, any property;

IX.- The prohibition of use acts, and,

X.- Other health measures to be determined by the competent authorities that may prevent them from being caused, or continue to cause risks or damage to health.

ARTICLE 239.- For the implementation of the security measures, the provisions of the Law and this Regulation must be in accordance with the provisions of the Law and this Regulation. people.

ARTICLE 240.- The competent health authorities may impose the following administrative penalties:

I.- Multa;

II.- Temporary or definitive closure, partial or total, and

III.- Arrest for up to 36 hours.

ARTICLE 241.- The competent health authorities, when applying the penalties provided for in this Regulation, shall observe the rules referred to in Articles 416 and 418 of the Law.

ARTICLE 242.- An equivalent fine of up to twenty times the general daily minimum wage, in force in the area concerned, shall be punished with a fine of up to twenty times provisions contained in Articles 12, 18, 19, fraction IV, 23, 24, 25, 29, 30, 30 Bis, 32, 36, 45, 63, 90, 91 and 92 of this Regulation.

ARTICLE 242 Bis.- A fine of three hundred times the daily minimum daily wage in the economic zone in question shall be punished with a fine of three hundred times, the violation of the provisions contained in Chapter VIII BIS of this Regulation, where such violation does not correspond to another sanction in accordance with the Law.

ARTICLE 243.- An equivalent fine of ten to one hundred times the daily minimum daily wage, in force in the economic zone concerned, shall be punished with a fine of ten to 100 times. provisions contained in Articles 114, 126, 129, 220 and 224 of this Regulation.

ARTICLE 244.- A fine of one hundred to five hundred times the daily minimum wage, in force in the economic zone in question, shall be fined to the person responsible for any the establishment in which health care services are provided, where it is intended to retain or retain the user or body, in order to ensure the payment of services received at that establishment, such a penalty may be doubled in the case of recidivism.

ARTICLE 245.- A fine of five hundred times the daily minimum daily wage, in force in the economic zone concerned, shall be punished with a fine of five hundred times. the establishment providing health care services, in which adequate and appropriate staff or appropriate equipment, material or premises are provided according to the services they provide.

In case of recidivism or failure to correct the deficiencies, the temporary closure will be carried out, which will be final if the service continues the violation.

ARTICLE 246.- A fine of up to five hundred times the general daily minimum wage, in force in the economic zone in question, shall be punished. any establishment in which diagnostic or treatment studies are carried out by means of X-ray equipment, dental X-rays, computed axial tomography, magnetic resonance imaging, positron emissions, laser beam and any other type of ionising radiation that does not conform to official Mexican standards to dictate to the Secretariat and in its case the National Nuclear Safety and Safeguards Commission, both for the public and for its staff.

In case of recidivism, the final closure of the establishment shall be carried out.

ARTICLE 247.- The person responsible for any establishment that provides health care services, in which the user's family or representative is not authorized in writing. legal, surgical interventions that endanger the life or physical integrity of the user, will be punished with a fine of 200 times the daily minimum daily wage in force in the economic zone in question, unless the imperative need to be practiced to avoid Further injury.

ARTICLE 248.- A fine of one hundred to five hundred times the daily minimum daily wage, in force in the economic zone in question, to the doctor psychiatrist or any Member of staff specialized in mental health who provides for various purposes to the scientists or therapeutics and without any written order of the judicial or health authority, the information contained in the clinical record of any patient.

ARTICLE 249.- The definitive closure of any health care establishment, in which it is used as a therapeutic measure, shall be carried out any proscribed procedure. for health legislation that is against the physical integrity of the patient.

ARTICLE 250.- The infringements of this Regulation not provided for in this Chapter shall be punished with a fine of up to five hundred times the daily minimum wage, in force in the economic zone in question, taking into account the qualification rules laid down in Article 418 of the Law.

ARTICLE 251.- In case of recidivism, the amount of the corresponding fine will be doubled. For the purposes of this Chapter, it is understood by recidivism that the infringer commits the same violation to the provisions of this Regulation, two or more times within the period of one year, counted from the date on which it was notified to it. the immediate sanction above.

ARTICLE 252.- The application of the fines will be without prejudice to the health authority dictating the security measures until the irregularities are remedied.

ARTICLE 253.- The temporary or permanent closure, partial or total, according to the seriousness of the infringement and the characteristics of the activity or establishment, in the Following cases:

I.- When establishments lack the corresponding health license;

II.- When the danger to the health of the persons is caused by the repeated violation of the precepts of this Regulation and the provisions that of the emanen, constituting rebelling to comply with the requirements and provisions of the health authority;

III.- When after the reopening of an establishment, for the purpose of suspension of work or activities, or temporary closure, the activities carried out in it shall continue constituting a health hazard;

IV.- When because of the dangerousness of the activities that are carried out or by the nature of the establishment in question, it is necessary to protect the health of the population;

V.- When in the establishment they are sold or supplied with narcotic drugs or psychotropic substances without complying with the requirements of the Law and its regulatory provisions, and

VI.- When it is verified that activities performed in an establishment violate health care provisions, constituting a health hazard.

ARTICLE 254.- In the case of definitive closure, the authorizations that have been granted to the establishment concerned shall be without effect.

ARTICLE 255.- They will be definitively closed, the establishments in which the provision of a medical service is denied in case of notorious urgency, endangering the the life or physical integrity of a person.

ARTICLE 256.- When the closure of an establishment for the internment of the sick is ordered, whether temporary or permanent, partial or total, it may be ordered, in addition to security measures:

I.- The non-admission of new users;

II.- The immediate transfer of non-serious users, to other similar or equivalent health institutions in their services and medical equipment, in the judgment of the authority health, after the opinion of the user or the family member responsible, and

III.- The continuation of the attention of users who by severity of their condition cannot be immediately referred, until they can be transferred to another setting, for treatment to continue.

Users ' transfer costs shall be borne by the owner of the establishment in which the infringement was committed.

ARTICLE 257.- You will be punished with arrest for up to thirty-six hours:

I.- To the person who interferes or objects to the exercise of the health authority's functions; and,

II.- The person who in absentia refuses to comply with the requirements and provisions of the health authority.

This sanction will only proceed, if any other of the sanctions referred to in this chapter were previously issued.

Tax the arrest, the resolution will be communicated to the appropriate authority to execute it.

ARTICLE 258.- For the implementation of security measures and sanctions, the provisions of Chapter III of Title Tenth of the Law shall be observed.

ARTICLE 259.- Against acts and resolutions of the health authorities, which, in order to implement this Regulation, terminate an instance or resolve a file, Interested parties may bring an action of non-conformity, which shall be dealt with in accordance with the provisions of Chapter IV of Title Tenth of the Law.

TRANSIENT

ARTICLE FIRST.- This Regulation shall enter into force on the day following its publication in the Official Journal of the Federation.

ARTICLE SECOND.- The administrative acts and procedures related to the matter of this Regulation that would have been initiated under the terms of the Regulations mentioned above. In the Third Transitional Article, they shall be processed and resolved in accordance with the provisions thereof.

ARTICLE THIRD.- The following legal provisions are opened: Regulations for Hospitals, Maternities and Maternal and Child Centers in the District and Public Zones published in the Official Journal of the Federation on the seventeenth of November of a thousand nine hundred and fifty one; Regulation for General Hospitals Dependent of the Secretariat of Health and Assistance published in the Official Journal of the Federation on the fourteenth December of a thousand nine hundred and fifty-four; Regulation of Clinical Analysis Laboratories published in the Official Journal of the Federation on the twentieth of March of a thousand nine hundred and sixty-four; Regulation of the Provision of Services for Medical Care, the application of which corresponds to the Secretariat of Health and Assistance published in the Official Journal of the Federation on the twelve of November of one thousand nine hundred and seventy-four; Regulation of the Prevention of Invalidity and Rehabilitation of Invalides published in the Official Journal of the Federation on February 6, one thousand nine hundred and seventy-six; Regulation of Empowered Parterers, published in the Official Journal of the Federation on October 25, one thousand nine hundred and seventy-six; Security Regulations Radiological for the use of X-ray equipment Diagnostic Type, published in the Official Journal of the Federation on the twenty-fifth of April of one thousand nine hundred and seventy-eight; Regulation for the issuance and use of the Sanitary Control Card, published in the Official Journal of the Federation on the first of February of a thousand nine hundred and eighty.

Given at the Federal Executive Branch in Mexico City, Federal District at the twenty-nine days of the month of April of a thousand nine hundred and eighty-six.- Miguel de la Madrid H..-Heading.-The Health Secretary, Guillermo Soberon Acevedo.-Heading.-The Head of the Federal District Department, Ramón Aguirre Velázquez.-Heading.