Form 063/у in Kazakhstan is a patient record completed by a social worker or psychologist. It is part of medical records and is used to record information about the patient, the reason for seeking assistance, social status and the results of the specialist’s work.
The form is stipulated by Order of the Acting Minister of Healthcare of the Republic of Kazakhstan dated 30 October 2020 No. ҚР ДСМ-175/2020 “On Approval of Forms of Healthcare Records and Instructions for Their Completion”.
According to the list of medical records, Form 063/у may be maintained electronically or on paper. The established retention period is 3 years. The procedure for its use should be considered in the context of the medical organisation’s activities and the applicable requirements for maintaining medical records.
What Form 063/у Is Used For
Form 063/у is intended to document the work of a social worker or psychologist with a patient. It makes it possible to record basic information about the person, the reason for seeking assistance, the referral source and information required for the specialist’s further work.
In particular, the form provides for information on:
the patient’s surname, first name and patronymic;
date of birth and sex;
individual identification number (IIN);
place of residence;
registration with a medical organisation;
population category;
reason for seeking assistance;
the person or organisation that referred the patient;
source of information about the request.
The form is intended not for calculating taxes or substantiating expenses, but for medical and social-psychological records. Therefore, an accountant, HR specialist or other employee of an organisation should first determine whether this particular medical form is actually being requested.
What Information Is Specified in the Form
When completing Form 063/у, information corresponding to the patient’s details and the circumstances of the request must be used. The information must be entered in the designated fields without arbitrarily changing the structure of the document.
The main information includes:
- Personal data. The patient’s surname, first name, patronymic, if any, date of birth and sex are specified.
- Identification details. The form provides a field for the IIN.
- Place of residence. Details of the place of residence are specified, together with the form’s designated indication of whether the patient is an urban or rural resident.
- Registration with a medical organisation. It is indicated whether the patient belongs to the registered population.
- Population category. The form provides the following options: school student, university student, employed, unemployed or other.
- Reason for seeking assistance. Depending on the situation, consultation, illness, social problem, psychological problem, participation in training sessions or another reason is specified.
- Who referred the patient. The appropriate option is specified: self-referral, medical organisation, state organisation or institution, non-governmental organisation, or another referral source.
The confidentiality of personal data must be maintained when completing the form. The information should be used only for purposes related to maintaining records and providing the relevant assistance.
How to Complete Form 063/у
The completion procedure depends on the organisation and the document format used. If the form is maintained in an electronic system, the information is entered in the designated fields. If a paper version is used, the prescribed template applies.
Before completing the form, verify:
That Form 063/у is being used and not another document with a similar number.
That the patient’s personal data are specified correctly.
That the IIN matches the patient’s details.
That the reason for seeking assistance and the population category are recorded correctly.
That the referral source is specified in accordance with the actual circumstances.
That the required fields have been completed.
That the document has been completed and is stored in accordance with the procedure adopted by the medical organisation.
The official structure of the form should not be changed independently, nor should a random template from the internet be used without checking it against the current version of the regulatory legal act.
In What Format the Form Is Maintained and How Long It Is Retained
Electronic and paper formats are provided for Form 063/у. The list of medical records establishes a retention period of 3 years.
When arranging storage, the medical organisation’s requirements concerning personal data protection, access to medical records and document security should be taken into account. Electronic and paper copies must be accessible to authorised employees within the scope of their official duties.
If an organisation uses its own information system, the procedure for maintaining the form must be checked against the system’s functionality and the applicable requirements for medical records. The mere availability of an electronic template does not eliminate the need to comply with the completion and retention rules.
Do Not Confuse Form 063/у with an Immunisation Record
When searching for medical documents by form number, it is important to bear in mind that similar numerical designations may refer to different documents.
Form 063/у is a patient record completed by a social worker or psychologist. It is not a preventive immunisation record.
For recording preventive immunisations, the list of medical records provides for Form 065/у. Under the current regulations, it is called an immunisation passport. Therefore, if the document is required for a school, kindergarten or confirmation of immunisation status, its exact name must be clarified with the medical organisation.
Frequently Asked Questions
What is Form 063/у? — It is a patient record completed by a social worker or psychologist and provided for by Kazakhstan’s medical records system.
Who completes Form 063/у? — A social worker or psychologist as part of their work with the patient and maintenance of the relevant records.
What information does the form contain? — The patient’s personal and identification details, place of residence, population category, reason for seeking assistance and information about who referred the patient.
In what format is Form 063/у completed? — Electronic and paper formats are provided.
What is the retention period for Form 063/у? — The list of medical records specifies a retention period of 3 years.
Is Form 063/у an immunisation record? — No. Form 063/у is intended for the work of a social worker or psychologist. A separate document, Form 065/у, is provided for recording preventive immunisations.
Sources
Order of the Acting Minister of Healthcare of the Republic of Kazakhstan dated 30 October 2020 No. ҚР ДСМ-175/2020 — forms of healthcare records
Amendments to Order No. ҚР ДСМ-175/2020 dated 25 July 2025 No. 39