Since the 1990s In the Russian Federation, healthcare reform began and continues to this day. Over the years, various regulatory legal acts (both laws and by-laws) regulating relations in the field of protecting the health of citizens, including defining a number of organizational issues related to the provision of medical care to patients, have been repealed and adopted. However, almost all regulatory legal acts prescribe the procedure and rules of behavior - both for patients and medical workers - in ordinary, so-called. work situations that determine the daily activities of a medical organization. Therefore, the sudden occurrence of unusual, emergency circumstances that dictate the need to make decisions that are not prescribed in regulatory documents often provokes a conflict not only between the doctor and the patient, but also between medical workers. This is especially true in cases where additional work is required that is not provided for in the job description of a medical worker.
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Planned discharge of the patient from the hospital
The question of the possibility of discharging a patient on weekends and holidays echoes the question of the length of patients’ stay in the hospital and the grounds for transfer to another stage of treatment (for example, outpatient care).
There are no federal-level regulations defining the procedure for discharging patients specifically on weekends and holidays. And this is quite understandable and logical. The length of a patient's stay in a hospital is determined, first of all, by his condition and the effectiveness of the treatment provided, and secondly, by the standards of medical care for the corresponding nosology, approved in the prescribed manner (if the standard provides for inpatient treatment). Therefore, in normal cases, the attending physician plans the patient's discharge in advance and prepares all the necessary documents. Considering that, as a rule, hospitals operate on a five-day work week, only duty services operate on weekends and holidays. Attending physicians perform their functional responsibilities, including maintaining medical records and preparing the necessary documents (extracts from the medical history), on weekdays. Scheduled discharge is also carried out on these same days.
It should also be taken into account that, as a rule, sick leave certificates are not issued by duty services. In accordance with clause 19 of the order of the Ministry of Health and Social Development of Russia dated June 29, 2011 No. 624n “On approval of the procedure for issuing certificates of incapacity for work” (as amended and additionally): “... When a citizen is discharged after inpatient treatment, a certificate of incapacity for work is issued on the day of discharge from the hospital for the entire period of inpatient treatment. If temporary incapacity for work continues, the certificate of incapacity for work can be extended up to 10 calendar days. ..." This circumstance is also an additional argument that determines the need to plan the discharge of patients and timely preparation of all necessary documents on weekdays. This work is the function of the attending physician and should be reflected in his job description.
Extract at the request of the patient
In some cases, circumstances may arise that require the immediate discharge of patients and are beyond the control of the attending physician (for example, discharge from a hospital at the request of the patient or his legal representative). Such situations can arise not only on working days, but also on weekends and holidays.
In Art. 20 “Informed voluntary consent to medical intervention and refusal of medical intervention” of the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens of the Russian Federation” (hereinafter referred to as Law No. 323-FZ) states the right of citizens to refuse medical interventions.
We quote the document
3. A citizen, one of the parents or other legal representative of the person specified in part 2 of this article has the right to refuse medical intervention or demand its termination, except for the cases provided for in part 9 of this article.
4. If a citizen, one of the parents or other legal representative of the person specified in Part 2 of this article refuses medical intervention, the possible consequences of such refusal must be explained in a form accessible to him.<…>
7. ...refusal from medical intervention is made in writing, signed by a citizen, one of the parents or other legal representative, a medical professional and is contained in the patient’s medical documentation.
Federal law dated21.11.2011 No. 323-FZ
“On the basics of protecting the health of citizens of the Russian Federation”
In such cases, the doctor on duty must not only discharge the patient, but also draw up the necessary documents, including the form of refusal of medical intervention established by the relevant regulatory legal act.
Registration of discharge summary on weekends and holidays
Let's consider the need to prepare an discharge summary on weekends and holidays by the doctor on duty and the possibility of delayed or advance registration of the discharge summary by the attending physician.
Let's start with the conceptual apparatus. Epicrisis - translated from Latin means “judgment about a disease with conclusions.” A more detailed definition of the concept of epicrisis is given in the dictionary of foreign words, according to which “an epicrisis, or decision, is the final part of the medical history, containing the rationale for the final diagnosis and treatment, as well as a medical prognosis and treatment and preventive recommendations.”
Thus, the discharge summary is a special form of recording the doctors’ opinion about the patient’s diagnosis (main and concomitant), his state of health, the course of the disease and the results of the examination and treatment. A discharge summary is a medical document that is a mandatory component of medical records, issued by patients who were treated in inpatient medical organizations. Based on the characteristics of the course of the disease and the results of treatment, it may include the attending physician’s assumptions about the patient’s further prognosis, treatment, preventive and rehabilitation measures, work recommendations and recommendations for further monitoring of the course of the disease.
The discharge summary is drawn up by the attending physician on the basis of the inpatient medical record (medical history) of the established form No. 003/u at the end of the course of treatment upon discharge of the patient from the hospital. In addition to the attending physician, the discharge summary is signed by the head of the structural unit. Therefore, the preparation of this document should be carried out as planned, and the discharge summary should be completed by the day of the expected discharge.
The doctor on duty should not draw up a discharge summary while performing the work of the attending physician. Essentially, the discharge summary represents information about the patient’s health status in accordance with Art. 22 “Information about the state of health” of Law No. 323-FZ, according to which “...Information about the state of health is provided to the patient personally by the attending physician or other medical professionals directly involved in medical examination and treatment...”. The doctor on duty does not take part in the examination and treatment of patients who are not his patients or who are not left under his supervision. He has no information about the health status of other patients in “his” department or other departments in which he is the doctor on duty. If such an “unknown” patient suddenly insists on being discharged on a weekend or holiday, it will be impossible for the doctor on duty to analyze his medical history and give full recommendations in accordance with the requirements of the current legislation, even after examining the patient, especially since he must perform his basic functions duties of the duty doctor. In addition, the doctor on duty does not belong to the category of persons who have the right to provide information about the patient’s health status, as stated above. Therefore, the doctor on duty, when discharging the patient and issuing a refusal of treatment, must remember to warn the patient in writing that the discharge summary will be prepared by the attending physician and that he will need to come additionally for this document.
The issue of the possibility of performing work on weekends and holidays, in particular, preparing a discharge summary when a patient is unplannedly discharged not by the on-duty doctor, but by the attending physician on his day off (holiday), is regulated by the Labor Code of the Russian Federation (hereinafter referred to as the Labor Code of the Russian Federation).
We quote the document
Article 113. Prohibition of work on weekends and non-working holidays. Exceptional cases of attracting employees to work on weekends and non-working holidays
Work on weekends and non-working holidays is prohibited, except as provided for by this Code.
Involvement of employees to work on weekends and non-working holidays is carried out with their written consent if it is necessary to perform unforeseen work, on the urgent implementation of which the normal work of the organization as a whole or its individual structural divisions or an individual entrepreneur depends in the future.
Involving employees to work on weekends and non-working holidays without their consent is permitted in the following cases:
- to prevent a catastrophe, industrial accident or eliminate the consequences of a catastrophe, industrial accident or natural disaster;
- to prevent accidents, destruction or damage to the employer’s property, state or municipal property;
- to perform work the need for which is due to the introduction of a state of emergency or martial law, as well as urgent work in emergency circumstances, that is, in the event of a disaster or threat of disaster (fires, floods, famine, earthquakes, epidemics or epizootics) and in other cases posing danger threat to the life or normal living conditions of the entire population or part of it.
<…>In other cases, involvement in work on weekends and non-working holidays is permitted with the written consent of the employee and taking into account the opinion of the elected body of the primary trade union organization.
<…>Employees are recruited to work on weekends and non-working holidays by written order of the employer.
Labor Code of the Russian Federation
Consequently, on his day off and non-working holiday, the attending physician has every right to rest legally. Involvement of the attending physician to work on weekends and non-working holidays without his consent may be due to the circumstances provided for in Art. 113 of the Labor Code of the Russian Federation, in other cases a written order from the employer and the written consent of the employee are required.
Thus, difficult situations that arise in everyday practice related to the performance of certain duties by doctors are often caused by insufficient knowledge of regulatory documents or the inability to interpret them. A number of controversial situations would not have arisen if the job descriptions of the attending and duty doctors had detailed functional responsibilities, including those related to the discharge of patients and the preparation of medical documentation.
None of us are immune from trouble. This also applies to health. The disease can strike at any time, both on a weekday and on weekends and holidays.
If a person becomes seriously ill on a day off, the question arises of who and where to open a sick leave certificate, an important document confirming temporary incapacity for work. After all, as you know, local clinics do not work on weekends and holidays.
So, if you get sick on Sunday or Saturday, what should you do? How to get sick leave during non-working hours? Let’s talk on this page “Popular about health” today about this important topic:
What to do if you get sick? Who to contact for help?
Doctor on duty at the clinic
First of all, call your clinic and ask if there is a doctor on duty? Doctors are usually on duty on weekends and can be seen during the day. He has the authority to prescribe treatment and issue sick leave.
If there is no doctor on duty at the local clinic, or his duty time has ended, or you need medical assistance at night, you will have to contact emergency services:
Ambulance
Emergency doctors will provide emergency care at home and, if necessary, hospitalize you. An ambulance leaves in life-threatening cases, in particular, if the patient is unconscious, with breathing problems, in case of an accident, injury, childbirth, etc.
In case of flu, colds, vomiting and similar manifestations, the ambulance will most likely not arrive, since these conditions do not threaten the patient’s life.
Ambulance
If a chronic disease has worsened, an acute condition has arisen, accompanied by severe pain, sudden weakness, dizziness, if the body temperature has risen to 39C, but there are no obvious signs of a threat to life, call an ambulance. By the way, if the ambulance does not have urgent calls, the team can also be sent along the ambulance route.
Paid ambulance
In the event that a team of regular ambulance doctors cannot come to your call, for example, due to a lack of free cars, a large number of urgent calls, or it is simply impossible to reach them by phone, call. They will come guaranteed.
Where can I get sick leave??
Option 1: As you know, sick leave is paid by the employer in calendar days. If an employee falls ill on Saturday or Sunday, the sick leave will be issued by the doctor on duty at the clinic.
Option 2: If you called an ambulance, an ambulance or a paid ambulance, the doctor who responded to the call issues a signal card (signal sheet), which remains with you. It indicates the reasons for the call, as well as the date and time of visiting the patient. With this coupon you need to contact your local physician at your clinic on Monday.
A sick leave certificate is issued on the day of visiting a doctor. However, if there is a notice sheet or other document confirming the fact that the person fell ill on a day when the clinic was not open, a temporary disability certificate will be issued retroactively.
Option 3: If, for any reason, you were not given a signal card and there is no confirmation or emergency assistance, on Monday, with your passport, contact the head physician of the emergency facility.
You will be given a certified copy of the card upon your call. You, as a patient, have the right to receive it. With this document, go to the clinic to apply for sick leave. In any case, this document will be proof that you were absent from work for a good reason.
Option 4: If you got sick on a day off, but there was no police officer on duty at the clinic, and you didn’t call an ambulance, go to the hospital emergency department. There, the doctor on duty will issue you a certificate of appointment, fill out a card and record your appointment. With a doctor's certificate, go to your clinic on Monday morning to apply for sick leave.
Visiting a private clinic
If all the proposed options, for some reason, do not suit you or something does not work out, and treatment is necessary, the only remaining option is to contact a paid clinic or a licensed private doctor. They usually work seven days a week. Most of these clinics have a special license to issue temporary disability certificates, and the employer is obliged to pay for it.
How to get your money back?
If you have an insurance policy, but for certain reasons paid for the medical services provided yourself, be sure to collect all the documents confirming this: prescriptions, checks, receipts for payment for doctor’s services, purchase of medicines, medical devices, payment for transport, etc.
You have the right to then submit all the collected documentation to the insurance company, where you will write a statement about the insured event, asking for a refund of the funds you spent.
Take care of yourself, don’t get sick either on weekdays or on holidays. Take preventative measures and strengthen your immune system. Well, if you feel that you are getting sick, consult a doctor promptly.
What should I do if I get sick on a day off? Is it possible to open it? How will such days be paid, will they be included in the number of paid sick days? These questions concern many workers.
What should you do if you are sick - try to get better quickly over the weekend and go to work, or file for incapacity for work and calmly receive treatment, being sure of payment?
The rights of employees in case of illness are protected by the legislation of the Russian Federation. Sick leave entitles an employed person to a period of illness maintain not only your position, but also your average salary.
Important! The law does not limit citizens in their rights open sick leave any day.
If the employee works on a shift schedule, and his days off are not calendar Saturdays and Sundays, but those established by the schedule, then it is recommended to honestly inform the pediatrician on what date the sick leave should be opened - from a working day, and not from a scheduled day off.
Example with a shift schedule
The employee works 2/2, the child fell ill on Monday, which is a non-working day according to the schedule.
The next working day for this employee is Wednesday.
It is necessary to open the sheet from Wednesday, since on Monday and Tuesday the employee does not work and can care for the sick person without interrupting work.
If, after all, the sick leave is opened on Monday, then problems with it are possible in the future. The Fund may refuse compensation for scheduled days off.
It is possible that the certificate of incapacity for work will be opened on Monday, but in order to receive compensation from the Social Insurance Fund, the employer needs to make payment only for the period starting from the working day according to the employee’s schedule.
If a relative gets sick
There are also cases when opening a certificate of incapacity for work on a day off is necessary for an employee to care for an adult sick relative.
Important! In this case, there is full right to take sick leave on a day off and get paid for it.
The rules that apply to a child do not apply to caring for relatives.
If the sick leave ends on a day off, the employer must also pay for it. In this case, the benefit must be calculated for all calendar days, not working days, missed from work.
How is the slip paid?
Weekends that fall within the period of temporary loss of working capacity, payable in the same manner, like all other days.
The main responsibility of the employer and personnel employee is to know how to pay sick leave to their employee.
It is also in the employee’s interests to be aware of the issue of payment in order to prevent violation of his legal rights.
Benefits are accrued to the employee at the time the sheet is completely closed.
Designations in the time sheet
Article 91 of the Labor Code of the Russian Federation establishes the procedure for registering working time sheets during sick leave.
Weekends included in the list are indicated by the same codes in the report card as other days.
The following are distinguished: types of designation of periods of incapacity for work in the accounting sheet:
- B or 19. Fill out if the employer is aware of the fact that his employee is on sick leave.
- T or 20. Mandatory to fill out if caring for sick adult relatives of an employee.
- NN or 30. To be completed when the reason for the employee’s absence from the workplace is unclear. Next, you need to correct the information in this form.
A temporary disability certificate is filled out at a district clinic or inpatient facility.
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The doctor enters into the form the necessary information about the patient’s illness or indicates another reason for the disability.
The requirements for the form of a certificate of incapacity for work are indicated in the Order of the Ministry of Health and Social Development.
Closing sick leave
The doctor closes the sick leave taking into account the patient’s health condition. Document
If this time is not enough, then it is necessary to assemble a medical commission and extend the document for another 30 days. The total duration of sick leave cannot exceed 12 months.
The document is affixed with the triangular official seal of the institution, as well as the seal of the attending physician. Signatures of specialists are required.
An incorrectly completed document serves as grounds for refusal by the FSS.
Records of issued certificates of incapacity for work are kept in the register of such forms.
At your own request
The employee at any time has the right to demand the closure of the sick leave at his own request and refuse further treatment.
Exceptions exist only if the employee suffers from infections and poses a danger to others. Leaving the hospital is formalized by a corresponding refusal.
In other situations as well as in other circumstances of disability.
In violation of the regime
This may result in a reduction in the benefit amount. The circumstances of the violation are established by the employer. On the sick leave, the doctor makes a note of the violation.
Those days are not subject to payment on which, namely when the patient:
- left the hospital without the doctor’s permission;
- refused to comply with the hospital regime and was discharged from the hospital ahead of schedule.
A reduction in benefit payments can be challenged in court.
Early
Early closure of sick leave is possible if the circumstances of incapacity for work have passed. It is carried out solely at the request of the employee.
Upon discharge from the hospital, the sick leave may not be closed if it is necessary for the treatment to be continued on an outpatient basis, under the supervision of the attending physician.
On a day off
It is possible to close a sick leave certificate on a day off if the attending physician has an appointment on that day.
The document is drawn up by a therapist or a specialist doctor.
If there is no appointment on weekends, the certificate of incapacity for work is closed on the last weekday before the new work week.
In case of no-show
If an employee refuses to appear for a medical and social examination for examination and determination of the disability group, or does not come for a scheduled examination by a doctor, then a note about this can be made on the sick leave.
If there is a good reason for failure to appear, the amount of the benefit is retained.
If the circumstances were considered unjustifiable, then the employer and the Social Insurance Fund reduce the amount of benefits for the day when the absence was recorded. Such facts must be thoroughly established.
The employer also has the right to demand that the employee attach an explanatory note to the sick leave.
In hindsight
It is prohibited, except in cases where an employee is caring for a disabled child or a child with oncology, tuberculosis, or HIV.
In other cases, issuing a certificate of incapacity for work retroactively can lead to non-payment of benefits, administrative and even criminal liability.
In another city
The sick leave may be closed in another city if the patient was transported for treatment to another inpatient facility or he was forced to move for valid reasons.
The sheet should be closed at the last place of treatment, regardless of what region and locality it is located.
Registration procedure
The sick leave certificate opens on the day the employee seeks medical care.
To apply you will need:
- employee passport;
- TIN and insurance certificate;
- medical card/
Information about the attending physician and the circumstances of the establishment of incapacity for work is indicated by the employee of the medical institution. He also writes down the necessary information about the patient, including his personal data, on the sheet.
The sick leave certificate contains two seals of the institution and one of the attending physician. The form should be taken to the employer and await payment of benefits - usually along with your next salary.
What does it look like?
The sick leave sheet is blue, with light cells and protective watermarks. The document is considered a strict reporting form. It contains a security code and watermarks.
The procedure for filling out the sheet is indicated on the back of the form.
Due dates
Sick leave must be submitted immediately after returning to work. If this is not possible, then the employee has six months to complete the document properly.
Otherwise, benefits will not be accrued, and days missed from work may be counted as absenteeism and result in disciplinary action.
Notifying the employer about going back to work
It is not necessary, but desirable, since a temporarily disabled employee will usually be replaced by another specialist. Notification can be made in person or by telephone.
It is advisable to come to work with a sick leave certificate already issued, in which all signatures and seals have been affixed.
Consequences of an unclosed document
The main consequence is non-payment of benefits.
If the sick leave is not closed for a good reason, then the employee can complete the paperwork after he begins his work duties.
N.A. Martynyuk, tax expert
Sick leave is open on weekends: when they need to be paid and when not
Did your employee bring you sick leave, open on a weekend or a holiday? Let's figure out in what cases the first non-working days of sick leave need to be paid. After all, it is one thing when an employee himself was sick, another thing when he was caring for a sick child or another family member. In addition, a special situation may arise if a sick child was cared for by an employee working from home.
SITUATION 1. The employee himself was sick
Benefits for sick leave issued due to the illness of the employee himself are payable for all days indicated on it, including the weekend on which the onset of incapacity occurred. This is expressly stated in the law e Part 1 Art. 6, part 8 art. 6 of the Federal Law of December 29, 2006 No. 255-FZ (hereinafter referred to as Law No. 255-FZ); pp. 15, 20 Procedure for issuing certificates of incapacity for work for diseases... approved. By Order of the Ministry of Health and Social Development of Russia dated August 1, 2007 No. 514 (hereinafter referred to as the Procedure).
The first 3 days of such sick leave are paid at the expense of your company, the rest - at the expense of the Federal Fund WITH clause 1 part 2 art. 3 of Law No. 255-FZ.
SITUATION 2. An employee was caring for a sick child.
In this case, the issue of paying for weekends or holidays on which the onset of the illness occurred is resolved differently.
You can find the limits on the number of days of “children’s” sick leave paid from the Social Insurance Fund: section 14.1.3 “Personal Income Tax Benefits” in the ConsultantPlus system (section “Financial and personnel consultations”, information bank “Tax Guide”)
According to the rules, if a child falls ill during a period when the mother (another caring relative) did not need to be released from work, a sick leave certificate for care is issued to her from the day on which she was supposed to start work e clause 42 of the Order.
But in practice, the sheet can also be opened on days that, according to the mother’s work schedule, are days off, that is, they can be written out without taking into account the rule discussed. Purely formally, the FSS has the right to consider such a sick leave issued in violation and on this basis refuse to reimburse the costs of paying benefits for it at clause 4, part 1, art. 4.2 of Law No. 255-FZ.
To avoid this, it is often enough to accrue benefits starting from the correct date, that is, from the date from which sick leave should have been opened in accordance with the rules. And the inspectors from the FSS will not have any questions.
From authoritative sources
Head of the Department of Legal Support of Insurance in Case of Temporary Disability and in Connection with Maternity of the Legal Department of the Federal Social Insurance Fund of the Russian Federation
“ The doctor should ask the mother of a sick child from what day she needs sick leave in accordance with her work schedule. However, even on a sheet opened on a day off, the Social Insurance Fund will reimburse or offset the costs of paying benefits - but only if it is accrued correctly, that is, from the first working day falling during the period of caring for a sick child.”
On the back of the sheet, in the line “Didn’t work from ___ to ___,” you need to enter the date that falls on the first working day (according to the mother’s schedule) of the child care period. The number of calendar days of incapacity to be paid, indicated on the back of the sheet, must also be calculated starting from this date.
We warn the employee
If your child gets sick on the weekend, you should ask the doctor to open sick leave from the first working day following them.
The benefit for all days of sick leave to care for a child, including the first 3, is reimbursed by the FS WITH Part 3 Art. 3 of Law No. 255-FZ. True, there is a limitation here. The maximum number of days in a calendar year paid from the Fund depends on the child’s age and illness. I Part 5 Art. 6 of Law No. 255-FZ.
If at the onset of the illness the limit on the number of days had not yet been exhausted, but taking into account all the days of sick leave, this norm turns out to be exceeded, then at the expense of the Social Insurance Fund you can pay only for those days that “fit” into the limit.
SITUATION 3. An employee was caring for a sick adult family member
During the period when release from work is not required, it is prohibited to open sick leave only for child care. This restriction does not apply to care certificates for other members of the seven And clause 42 of the Order.
Therefore, if sick leave to care for an adult family member is open on a weekend or holiday, then this day must also be paid b part 8 art. 6 of Law No. 255-FZ. The benefit in full, including for the first 3 days of sick leave, will be reimbursed by the FS WITH Part 3 Art. 3 of Law No. 255-FZ. True, the maximum number of payable days is also limited here: no more than 7 days for one disease and a maximum of 30 days per calendar year for all such sick leave in total And clause 6, part 5, art. 6 of Law No. 255-FZ.
SITUATION 4. A home worker was caring for a sick child
Those who work from home are entitled to sick leave in the same way as those working in the workplace e Articles 183, 310 of the Labor Code of the Russian Federation. The problem is that working hours are usually not set for homeworkers. They plan their own work and rest time and are not subject to the organization’s work schedule. An employment contract with a homeworker usually only specifies the number of hours he must work per week, for example: “the employee works 20 hours a week.”
![](https://i0.wp.com/glavkniga.ru/images/digit/_elver/images/preview_360_X/09169.jpg)
This does not in any way affect the payment of leaves for temporary disability of the employee himself or for caring for an adult family member, but it may cause difficulties in calculating child care benefits. How can one understand on which days of the week he needed time off from work and on which days he did not, in order to correctly determine the date from which benefits should be accrued? Will the inspectors from the Fund say that on the first day or in the first few days of sick leave the home worker did not need to be excused from work?
The Labor Code of the Russian Federation prescribes that the working time and rest time regime be fixed in the contract only if for a given employee it differs from that established in the organization And Art. 57 Labor Code of the Russian Federation. Therefore, since the regime in your contract with the homeworker is not fixed, it means that for him it is equal to that accepted in the organization, and the employee has freedom in determining the time of work and rest only within the working day. And based on the organizational regime, it should be determined which day is a working day for a homeworker and which is a day off.
To avoid possible disputes, it is better to indicate in the employment contract with a homeworker the same work schedule as the entire organization or employees engaged in similar work in the workplace. But leave the time of work during the working day at the discretion of the homeworker. Then it will be easy for both you and the inspectors from the Fund to determine whether the day on which the employee is on sick leave is a day off or a working day.
As you can see, the first weekend is not subject to payment at the expense of the Social Insurance Fund in the only case - when sick leave for child care is open on a non-working day. For all other weekends “within” the period for which such a slip was issued, benefits must be paid.
But what if weekends or non-working holidays fall on the last days of sick leave to care for a child - do they need to be paid for? Yes, despite the fact that on these days release from work is also not required. After all, the procedure for issuing sick leave only prohibits opening a child care certificate on a day off, but otherwise the general rule applies: calendar days are subject to payment, and not just missed work days. e part 8 art. 6 of Law No. 255-FZ.