APPROVED BY
Order No V-124
of the Director at Public Institution Naujoji Vilnia Polyclinic
of 25/10/2021
RULES OF PROCEDURE OF PUBLIC INSTITUTION NAUJOJI VILNIA POLYCLINIC
1. GENERAL PROVISIONS
1.1. The Rules of Procedure of Public Institution Naujoji Vilnia Polyclinic (hereinafter the Rules) shall govern the internal working arrangements at Public Institution Naujoji Vilnia Polyclinic (hereinafter the Polyclinic), as well as the rights, duties and behaviour of its staff, patients, their representatives and visitors.
1.2. The Polyclinic shall operate in accordance with the applicable laws of the Republic of Lithuania, resolutions of the Government of the Republic of Lithuania, orders of the Minister of Health, national, European and international medical standards (medical and hygiene standards), as well as the founder’s legislation governing the activities of the Polyclinic.
1.3. To regulate and improve business processes, the Polyclinic shall follow the Quality Management System (hereinafter the QMS) and operate in accordance with the approved QMS procedures.
1.4. The job functions and duties of the Polyclinic’s staff shall be outlined in the Labour Code of the Republic of Lithuania, staff employment contracts, health & safety manuals, rules of procedure, job descriptions (instructions), rules of procedure of individual departments, QMS procedures, Director’s orders and instructions, internal documents and the present Rules.
1.5. A patient, who is registered with a family doctor, a doctor of internal medicine or a paediatrician working in the Polyclinic or who has made an appointment for any services with the Polyclinic’s doctors, shall be made familiar with these Rules, and it shall be considered that, where they have given their written consent to receiving the services at the Polyclinic, they automatically agree to abide by these Rules.
1.6. Any member of staff of the Polyclinic, who is in an employment contract therewith, shall be made familiar with these Rules against their signature.
1.7. Terms and definitions used in these Rules:
1.7.1. ‘processing of personal data’ shall mean any action performed with personal data: collection, recording, gathering, storage, classification, grouping, combination, alteration (supplementation or correction), provision, publication, use, logical and/or arithmetic operations, search, dissemination or destruction, or any other action or a set of actions;
1.7.2. ‘ID document’ shall mean a passport, an ID card or a Lithuanian temporary (permanent) residence permit;
1.7.3. ‘Polyclinic’ shall mean Public Institution Naujoji Vilnia Polyclinic owned by of Vilnius City Municipality and located at the following address: V. Sirokomlės g. 8, LT-11200 Vilnius, data collected and stored in the Register of Legal Entities, entity number: 124246043;
Primary and secondary health care services are also offered at the following address: Dariaus ir Girėno g. 18, LT-02169 Vilnius;
Primary health care services are available at the following address: P. Žvirkos g. 14, LT-09310 Vilnius;
1.7.4. ‘patient’ shall mean a person, who uses the services provided by the Polyclinic, regardless of whether they are healthy or ill, and has statutory rights and obligations when receiving such services;
1.7.5. ‘minor patient’ shall mean a patient under the age of 18, except for persons aged 16 to 18 with full active legal capacity recognised by a court of law (emancipated);
1.7.6. ‘patient’s representative’ shall mean a representative by law (parents, adoptive parents, guardians or carers) or a representative by power of attorney. A representative by power of attorney may be chosen by a patient 16 years or older if this is confirmed with their signature. The powers of a representative by power of attorney shall be formalised in accordance with the procedure established by the laws of the Republic of Lithuania;
1.7.7. ‘free services’ shall mean the services that are covered from the budget of the Compulsory Health Insurance Fund or a state or municipal budget in accordance with the procedure established by the legislation of the Republic of Lithuania and for which the Polyclinic has an agreement with a territorial health insurance fund or a municipality;
1.7.8. ‘paid services’ shall mean the services, which are provided by a health care institution and which are to be covered by the patients themselves or may also be covered by other natural or legal persons and independent insurance institutions in accordance with the legislation or orders of the Director of the Polyclinic.
1.7.9. ‘member of staff of the Polyclinic’ shall mean a person who in an employment contract with the Polyclinic.
1.7.10. ‘referral’ shall mean a doctor’s referral to another doctor in order to seek a consultation on the patient’s condition, diagnosis or clarification thereof, treatment tactics (whether to start, extend, modify or discontinue the started treatment) or fitness for work, providing information about the patient’s diagnosis made prior to the referral, any tests carried out and the findings of the consulting specialist doctors as well as the treatment offered, and completed in a document whose template has been established in the Order No V-636 of the Minister of Health of the Republic of Lithuania of 28 June 2008 Approving the Schedule of Procedures for Formalising and Issuing Referrals for Specialised Primary Outpatient Health Care Services to be Received and Expensive Tests to be Performed and for Providing Responses thereto.
2. OPENING HOURS OF THE POLYCLINIC
2.1. The Polyclinic’s opening hours are between 7.00 and 20.00 hours Monday to Friday, and between 8.00 and 12.00 hours on Saturdays. The Polyclinic is closed on public holidays and Sundays. The opening hours at Salinikai Outpatient Department are between 7.00 and 17.00 hours Monday to Friday. The Outpatient Department is closed on Saturdays, Sundays and public holidays.
2.2. Out-of-hours access to the Polyclinic’s premises shall only be permitted subject to an authorisation by the Director of the Polyclinic.
2.3. Staff shall work shifts based on work schedules pre-approved by an order of the Director of the Polyclinic. The hours for seeing patients shall be announced on the doors of the rooms, on the Polyclinic’s website and on information boards.
2.4. The working hours as well as the start and end of work at the Polyclinic shall be determined by the founder.
2.5. The opening hours of the Polyclinic shall be announced at the entrances to the Polyclinic’s premises and on the Polyclinic’s website.
2.6. During the Polyclinic’s out of hours, any services to individuals registered with it shall be provided at other health care institutions. Directions as to where the services are provided during the Polyclinic’s out of hours shall be published at the reception of the Polyclinic, on the website and at the entrance to the Polyclinic. Should the relevant contract change, the directions shall be updated.
3. ADDING PATIENTS TO PATIENT LISTS OF PAEDIATRICIANS, DOCTORS OF INTERNAL MEDICINE, FAMILY DOCTORS AND MENTAL HEALTH PATIENTS AT THE POLYCLINIC AND CHOOSING AND CHANGING A FAMILY DOCTOR
3.1. Every resident of the Republic of Lithuania or a foreigner shall have the right to contact the Polyclinic for primary and secondary health care services to be received. If an individual has compulsory health insurance cover, they may register with the Polyclinic and receive health care services covered by the compulsory health insurance fund (free). Free health care services (except for the necessary medical care services) shall be provided only after it has been verified that the person is covered by compulsory health insurance. Persons not covered by compulsory health insurance shall pay for their appointments with doctors in accordance with the fees approved by an order of the Director of the Polyclinic.
3.2. Procedure for registering with the Polyclinic:
3.2.1. completing an application in the prescribed form (Form No 025-025-1/a);
3.2.2. at the time of completing the application, a particular family doctor working in the Polyclinic may be chosen. In addition, the patient shall state in their application which Mental Health Centre (that owned by the Polyclinic or another health care institution) they have chosen. If they do not chose a particular doctor, the applicant shall confirm their consent to having appointments with the family doctor (doctor of internal medicine and/or paediatrician) assigned to them;
3.2.3. if the number of individuals registered with the family doctor (doctor of internal medicine and/or paediatrician) of the patient’s choice exceeds the maximum number of individuals to be registered as set forth in Order No V-943 of the Minister of Health of the Republic of Lithuania of 5 December 2005 Approving the Schedule of Procedures for Primary Outpatient Health Care Service Arrangements and Payment Procedure and the Base Prices of Primary Outpatient Health Care Services (as last amended on 03/07/2020), the Senior Medical Receptionist shall offer the patient a different doctor;
3.2.4. when a minor patient turns 18, their services shall be provided by a family doctor or a doctor of internal medicine. The patient may chose a family doctor or a doctor of internal medicine themselves by completing Form No 025-025-2/a at least 3 working days before they turn 18. Otherwise, the doctor shall be chosen for them by the Senior Medical Receptionist;
3.2.5. by completing the Application for Treatment at the Chosen Primary Health Care Institution (Form No 025-025-1/a), the individual confirms that they understand and accept that the Polyclinic shall process their personal data (forename, surname, personal number, date of birth, place of residence, telephone number, email address, social insurance number and information about their insurance cover, as well as sensitive data about their health). Data shall be processed for the purpose of service provision;
3.2.6. paying a fee of EUR 0.29 for the administration of registration documents. If the application is made within 6 months of registering with another polyclinic, the fee to be paid shall be EUR 2.90. The fee of EUR 0.29 shall also be payable when a person comes to study at a full-time learning institution or returns to their permanent residence after graduation and chooses another primary health care institution (hereinafter the PHCI);
3.2.7. presenting an ID document and other necessary information to the receptionist at the reception.
3.3. The administration of the Polyclinic may consider the matter of adding the patient to the lists of individuals registered with the Polyclinic and has the right to reject the provision of health care services outside its catchment area.
3.4. For a first-time patient, the receptionist shall start a medical record in the prescribed form (Form No 025/a), which shall record information about all services provided to this patient in the Polyclinic, and shall register their application in the Log of Individuals Registered with the Primary Health Care Institution and of Incoming Outpatient Cards and Children’s Health Development Records.
3.5. If the patient has changed their PHCI, the Polyclinic shall receive, in accordance with the procedure established by the Minister of Health of the Republic of Lithuania (hereinafter the MH), the patient’s medical record and register it in the Log of Individuals Registered with the Primary Health Care Institution and of Incoming Outpatient Cards and Children’s Health Development Records (e-Form No 025-025-9/a).
3.6. The data shall be entered into the database of the “SVEIDRA” Information System owned by the National Health Insurance Fund.
3.7. Cases for changing a family doctor (doctor or internal medicine and/or paediatrician) and/or a psychiatrist registered with:
3.7.1. at the patient’s initiative. The patient must complete an application (Form 025-025-2/a) to be treated by a different doctor, which is available at the reception;
3.7.2. if the doctor terminates their employment contract with the Polyclinic;
3.7.3. following the doctor’s death;
3.7.4. if the administration recognises the doctor’s refusal to serve the patient due to mal-performance of the patient’s duties as reasonable;
3.7.5. if the doctor forfeits their licence;
3.8. The patient intending to change their doctor shall contact the reception and complete an Application to be Treated by a Different Doctor at the Chosen Primary Health Care Institution (Form No 025-025-2/a). The receptionist shall record the application in the log (Form No 025-025-9/a) and enter the data thereof into the database of the “SVEIDRA” Information System owned by the National Health Insurance Fund.
4. BOOKING PATIENT APPOINTMENTS FOR POLYCLINIC’S SERVICES TO BE RECEIVED
4.1. Procedure for being seen by a doctor:
4.1.1. coming to the Polyclinic: the patient (guardian) shall contact the reception and present an ID document;
4.1.2. telephoning:
4.1.2.1. reception: (+370 5) 260 68 60 (general enquiries for V. Sirokomlės g. 8 and Dariaus ir Girėno g. 18) and (+370 5) 2358180 (for P. Žvirkos g. 2);
reception at the Mental Health Centre: (+370 5) 205 5440 (V. Sirokomlės g. 8) and (+370 5)233 0232 (Dariaus ir Girėno g. 18).
4.1.3. When telephoning, the patient shall provide the staff at the reception with either their forename, surname and date of birth along with the last 4 digits of their personal number, or their personal number and their medical record number (preferably). The patient must remember or take a note of the date and time of their doctor’s appointment given by the receptionist and the doctor’s room number.
4.1.4. using the appointment booking system for the Polyclinic’s patients at the following address www.nvpoliklinika.lt.
4.1.5. When making an appointment online, the patients shall follow the steps provided on the online booking program and remember or print the information about the chosen appointment (date, time, room number and doctor’s surname).
4.1.6. The patients who wish to be seen by a doctor of the Polyclinic must make their appointment in advance by telephone, at the reception or online. After examining the patient, the doctor shall assesses their health condition and, if necessary, prescribe the necessary treatment/tests or refer them to a different specialist doctor for a consultation.
4.1.7. If the patients are treated in inpatient health care institutions and make an appointment with their family doctor, doctor of internal medicine, surgeon, paediatrician, obstetrician-gynaecologist, dentist, psychiatrist or specialist doctor, they must inform the staff at the Polyclinic’s reception and their doctor thereof at the time of booking the appointment.
4.1.8. When a child is born, the reception staff shall be notified thereof and a doctor shall be chosen. The newborn shall be visited and examined by a doctor or a nurse within three working days of notification about the child’s birth. The next examination of the baby shall be carried out in accordance with the procedure established by the MH of the Republic of Lithuania.
4.1.9. In case of indications of the necessary medical care needed, patients shall be seen as a matter of urgency.
4.1.10. Patients shall be seen by the doctor and other specialists only at the time of their appointment booked in advance, except for cases of the necessary medical care detailed in Order No V-208 of the MH of the Republic of Lithuania of 08/04/2004 Approving the Procedure and Scope of Necessary Medical Care and Necessary Medical Care Services to be Provided. The patient must come to the Polyclinic 10 minutes before the time of their dedicated appointment. If the patient is late for an appointment with the doctor or other specialists, they shall not be seen and must make another appointment. In the latter case, the patient shall be offered the next available appointment to be seen by this particular doctor or another specialist.
4.1.11. Individuals registered with a district doctor shall be notified of any changes to their doctor upon their arrival at the Polyclinic.
4.1.12. In cases where an appointment has been booked in advance, the patient’s outpatient medical record (and, if necessary, the person’s outpatient treatment record card) must be presented to the doctor’s office for the duration of the dedicated time. The patient’s medical documents prepared at the reception shall be taken to the doctor’s office by the reception staff and/or general practice nurses. Where this is necessary, the patient’s medical documents may be forwarded from one doctor’s office to another one only by the staff of the Polyclinic. At the end of the appointment with the doctor, the staff of the Polyclinic shall return the outpatient medical records to the reception without delay.
4.1.13. Any appointments for a doctor’s home visit shall be made and any services shall be provided at home following the procedure approved by the Director of the Polyclinic:
4.1.13.1. for children with full disability;
4.1.13.2. for children under one year of age, when their temperature is in excess of 38.6°C and in the presence of at least any of the following symptoms: multiple episodes of vomiting, diarrhoea (more than 5 times a day), high-pitched screaming and a new rash;
4.1.13.3. for adults with full disability;
4.1.13.4. for adults when their temperature is in excess of 39.6° C; for individuals with sudden impairment of movement function/coordination (the patient is unable to move independently) within the past 24 hours or perception (where causes of disorder are of non-traumatic origin).
5. PROVISION OF SERVICES
5.1. In order to receive health care services, the patients must provide ID documents, except in cases of necessary medical care.
5.2. The Polyclinic shall provide primary and secondary level outpatient services with the list and range thereof to be detailed in the institution’s health care licence issued to the Polyclinic.
5.3. In addition, the Polyclinic provides other, non-health care services.
5.4. Free primary level services, which are subject to an agreement with a territorial health insurance fund for the fees thereof to be covered from the budget of the Compulsory Health Insurance Fund, shall be provided in accordance with the procedure established by the internal legislation of the Polyclinic to all patients, who have registered with the Polyclinic and who have cover from the Compulsory Health Insurance Fund.
5.5. Free secondary level services, which are subject to an agreement with a territorial health insurance fund for the fees thereof to be covered from the budget of the Compulsory Health Insurance Fund, shall be provided in accordance with the procedure established by the internal legislation of the Polyclinic to patients, who have a doctor’s e-referral or an F027/A completed in accordance with the provisions of Order No V-636 of the MH of the Republic of Lithuania of 28/06/2008 (as last amended on 01/01/2019).
5.6. The Polyclinic shall provide paid services, the provision of which is governed by the legislation of the Republic of Lithuania and the internal regulations of the Polyclinic.
5.7. Necessary medical care shall be provided free of charge to every person contacting the Polyclinic, regardless of the fact of whether they are registered with the Polyclinic or the status of having cover from the Compulsory Health Insurance Fund. (Necessary medical care services shall be provided to patients on the day of their contact)
5.8. Patients, including minors between the ages of 16 and 18, shall be treated or provided with another health care service subject to their consent. For minor patients under 16 years of age, health care and nursing shall be provided subject to the consent of their representatives, except in cases where the request for such consent would be contrary to the interests of the minor patient or in life-threatening conditions.
5.9. Patients with routine appointments shall be seen by a specialist doctor only at the time booked for their appointment (no later than within 30 minutes). Patients must arrive at the reception 10 minutes before the stated time of consultation with the specialist. If the health care professional’s appointment with the patient goes beyond their appointment slot, other patients shall be seen consecutively at a later time than the dedicated time of their appointment.
5.10. The nurse, who works with the doctor seeing the patients, shall be responsible for regulating the queue of patients to be seen and explaining the reasons for emergency appointments (jumping the queue) or any delays to other patients in the queue.
5.11. Persons under the influence of alcohol/narcotic or psychotropic substances shall not be offered routine services, except for the necessary medical care. If it is suspected that a patient or the patient’s representative or a visitor may be under the influence of alcohol/ narcotic or psychotropic substances, the member of staff providing the service shall offer the patient or the patient’s representative or the visitor to have a test to determine whether they are under the influence of alcohol and/or narcotic or psychotropic substances. A refusal by the patient or the patient’s representative to have a test shall be considered acceptance of the fact of being under the influence of alcohol and/or respective substances and shall be recorded in the medical documentation or in the official report by the member of staff of the Polyclinic.
5.12. The patients without pre-booked appointments shall only be offered necessary medical care services free of charge in accordance with the Order No V-208 of the Minister of Health of the Republic of Lithuania of 08/04/2004 Approving the Procedure and Scope of Necessary Medical Care and Necessary Medical Care Services to be Provided (as last amended on 07/03/2020) and the Polyclinic’s documents governing internal arrangements.
5.13. If the insured is entitled to reimbursement of the cost of medicines and medical aids to be purchased, they must provide a document proving the benefit. When prescribing medicines on the positive list, the outpatient medical record (Form 025/a) or the child’s health development record (Form 025-112/a) shall state the name and number of the document proving the benefit. For patients treated in inpatient health care institutions, the doctors of the Polyclinic shall not prescribe any medicines on the positive list following the legislation.
5.14. If other patients in the queue have queries when a patient is seen as an emergency (jumping the queue), the nurse working with the doctor shall inform about the reasons for seeing the patient as an emergency (jumping the queue) and the further procedure for seeing patients.
5.15. If the patient in unable to attend their appointment at the set time:
5.15.1. they must notify this by telephoning or texting the reception on +370-615-40706 no later than 24 hours before the appointment;
5.15.2. cancel their online appointment booking and choose a different available appointment time.
5.16. If the doctor gets ill and is unable to see their patients with pre-booked appointments, the latter shall be notified thereof by a telephone call or a text message where they have provided a personal contact telephone number. The patient shall be held liable for giving false or outdated contact information.
5.17. Information about the paid and free outpatient services provided shall be published at the Polyclinic’s reception, on information stands and on the website.
5.18. The Polyclinic shall provide the following free services:
5.18.1. Primary level outpatient health care services;
5.18.2. Secondary level outpatient health services for patients with referrals;
5.18.3. Preventive and counselling services provided by doctors and nurses offering primary outpatient health care.
5.19. An outpatient medical record is a document owned by the Polyclinic that is stored at its reception or in the archive. The outpatient medical record shall not be given to the patient in person. If the patient registers with a different health care institution, their medical record shall be forwarded to the institution upon its written request (Form 025-025-3/a).
5.20. If a doctor refers the patient to a different doctor for a consultation in the Polyclinic, they shall make the referral in the outpatient medical record. The nurse working with the doctor shall agree with the patient the date and time of their appointment with the other doctor and book the patient’s appointment in the patient appointment booking system.
5.21. If a doctor refers the patient to a secondary or tertiary level doctor for a consultation to a different health care institution, they shall issue an e-referral to them following the requirements of Order No V-636 of the Minister of Health of the Republic of Lithuania of 28 June 2008 Approving the Schedule of Procedures for Formalising and Issuing Referrals for Specialised Primary Outpatient Health Care Services to be Received and Expensive Tests to be Performed and for Providing Responses thereto (as last amended on 01/01/2019).
5.22. The doctor who prescribes medicines that are on a positive list shall have the date of their next appointment agreed with the patient. The nurse working with the doctor shall arrange for the time of the next appointment for the patient and book the patient’s appointment in patient appointment booking system, unless there is no doctor’s work schedule in place for the planned date of the next appointment yet.
5.23. If the doctor is planning for the need of a repeat appointment of the patient, they shall agree with the patient the date of their next appoint, while the nurse working with the doctor shall book the patient’s appointment of the patient appointment booking system.
5.24. At the Polyclinic, patients shall be offered remote health care services without the need for them to come to the Polyclinic, i.e. the patient has an option of contacting their family doctor and receiving a remote health care service (hereinafter the RHC service). RHC services shall be as follows: to prescribe repeat tests to the patient, to renew the prescription or administration of prescribed medicines or medical aids (including those whose acquisition costs are covered from the budget of the Compulsory Health Insurance Fund (hereinafter medicines and MAs).
5.25. RHC services may be provided by members of the family doctor’s team and/or consultant doctors. If the patient is willing to receive a RHC service, they must book an appointment with the family doctor, a doctor of internal medicine or a paediatrician during the Polyclinic’s opening hours between 7.00 and 20.00 hours.
5.26. A member of the family doctor’s team shall:
• before commencing the provision of a RHC service, identify the patient by calling the telephone number provided for that purpose and asking at least 3 questions related to the patient’s personal data (forename, surname, date of birth or health care record number); in case of any doubt about the patient’s identity, they may ask the patient additional questions;
• following the identification of the patient, find out the subjective condition of the patient’s health (based on the data provided by the patient or their representative) and the reason for the patient’s appointment and make a decision on further provision of the service.
5.27. If the person making the call does not correctly state all the data required for the respective authentication or does not have the authority, no RHC services shall be provided to such a person by telephone.
5.28. A RHC service shall only be provided to those representatives of the Polyclinic’s patients whose data are recorded in the patient’s medical record.
5.29. The member of the family doctor’s team must ask the patient if they are not currently undergoing treatment in an inpatient health care institution. If a positive response is received, a RHC service shall not be provided.
5.30. The patient or their representative shall bear responsibility for the accuracy of the data on the patient’s health condition provided via information or electronic communication technology.
5.31. If the member of the family doctor’s team rejects a RHC service (it is impossible to verify the veracity of the health data provided by the patient or their representative, the requested service is not a RHC service as it is a new case of treatment, the family doctor cannot assess the patient’s health condition without examination, a prescription for medicines of MAs has been requested where they had not taken them before, etc.), the patient shall have an appointment booked for a consultation following the standard procedure.
5.32. When providing the RHC service, the member of the family doctor’s team may:
5.32.1. renew the prescription of previously prescribed medicines or MAs for an adult patient by issuing a prescription in accordance with the procedure established in Order No 112 of the Minister of Health of the Republic of Lithuania of 8 March 2002 Approving the Regulations for Issuing Prescriptions and for Issuing (Selling) Medicinal Products, Medical Devices (Medical Instruments) and Medical Aids on the Positive List at Pharmacies to Individuals and for Storage of Paper Prescriptions Following the Issuance (Sale) of Medicinal Products, Medical Devices (Medical Instruments) and Medical Aids of the Positive List in a Pharmacy; for children, a prescription may be issued for a period not exceeding 1 month;
5.32.2. if the patient’s condition is stable, prescribe repeat tests and clarify the results of the tests carried out to the patient or their representative as well as adjust treatment and the use of medicines or MAs on the basis thereof.
5.33. Via a RHC service, the member of the family doctor’s team may renew the prescription of previously prescribed medicines or MA’s for the patient, prescribe repeat tests and clarify the results of tests performed to the patient or their representative as well as adjust treatment on the basis thereof no more than once. When the RHC service has been provided, the patient shall be under the obligation to present themselves to the Polyclinic the next time for the same reason.
5.34. Medical documentation on the RHS services provided shall be completed in accordance with the applicable legislation of the Republic of Lithuania.
6. RIGHTS AND OBLIGATIONS OF PATIENTS, THEIR REPRESENTATIVES AND VISITORS
6.28. Patient rights and obligations shall be outlined by the Law on the Rights of Patients and Compensation of the Damage to their Health of the Republic of Lithuania, these Rules and other legislation of the Republic of Lithuania, as well as the legislation of Public Institution Naujoji Vilnia Polyclinic.
6.29. Patient rights must not be restricted because of patient gender, age, race, nationality, language, origin, social status, faith, beliefs or convictions or any other circumstances not justified by law.
6.30. Patients shall have the right to receive affordable, qualified and free health care services with the costs thereof covered by the budget of the Compulsory Health Insurance Fund or state or municipal budgets, as provided for by the laws and other legislation of the Republic of Lithuania.
6.31. Before signing an application for health care services to be provided at the Polyclinic, the patient shall be made familiar with these Rules. Therefore, once the application is signed, it shall be considered that the patient has duly familiarised with the Rules of Procedure of the Polyclinic and the rights and obligations of the patient, unless proved otherwise.
6.32. Patients shall have the right to receive information about the services provided at the Polyclinic and access thereto. Patients may access the list of all services provided, the price list of paid services and other information in relation to the provision of services on the information stands available at the reception of the Polyclinic and on the website.
6.33. Patients shall be have the right to be free to choose (for children under 16 years of age and for people without legal capacity they shall be chosen by the parents or guardians) one PHCI closest to their residence or with more convenient access thereto, as well as their doctor, as provided for in the legislation.
6.34. The patient must be informed of the forename, surname and position of the treating doctor and of the nursing staff and, at the patient’s request, of the doctor’s qualifications.
6.35. The patient shall have the right to information about their health condition, diagnosis of the disease, results of medical tests, treatment methods and treatment prognosis. At the patient’s request, the doctor must explain the meaning of the records in their medical record to them.
6.36. At the patient’s request, they must be familiarised, in a form comprehensible to them, with special medical terms and definitions explained, with the records in their medical documents, except in cases where this may harm the patient’s health or even endanger their life (this is to be decided by the treating doctor or a case conference held by doctors). In such instances, the treating doctor shall make a note of any restrictions on provision of information in the outpatient medical record.
6.37. The specific details concerning a mental health patient’s right of access to the patient’s medical documents shall be determined by a psychiatrist doctor.
6.38. The patient has the right to request copies of their medical documents to be made at their expense. This patient’s right may be limited only in accordance with the procedure established by the legislation of the Republic of Lithuania.
6.39. Any information intended for a minor patient, their parents or guardians must be provided in a form comprehensible to them. Should there be any disagreements between the minor patient and their parents or guardians, any diagnostic and treatment methods shall be chosen by a case conference held by doctors, taking account of the minor patient’s interests.
6.40. A minor patient (between 16 and 18 years of age), who is, in the doctor’s opinion, capable of accurately evaluating their health condition, shall have the right to be seen independently and make decisions as to the treatment offered to them. At the request of the minor’s parents or guardians, the treating doctor must inform the minor’s representatives by law about the treatment; however, at the minor’s request, such information may be withheld if it could considerably harm the interests of the minor patient, unless other legislation provides otherwise. If a minor is hospitalised, their parents or guardians must be advised thereof.
6.41. The patient shall have the right not to know. The Polyclinic’s staff shall not have the right to provide information to the patient about their health condition, diagnosis of the disease, results of medical tests, treatment methods and treatment prognosis against their will. The patient’s will must be confirmed by the patient’s signature in the patient’s medical documents. The right not to know shall not apply where the patient’s unwillingness (refusal) to receive information may lead to detrimental consequences for the patient or other persons.
6.42. The patient must not be treated or be provided with health care services against their will, unless otherwise provided for by the laws of the Republic of Lithuania. The patient’s refusal shall be formalised in accordance with the procedure established by the legislation.
6.43. If the patient is dissatisfied with health care services, they shall have the right to contact the Polyclinic’s administration following the provisions set out in Chapter 9 of these Rules.
6.44. The patient, patient’s representative or visitor must:
6.44.1. take care of their health and the health of their minor children (adopted or cared for children);
6.44.2. exercise their rights in good faith, not abuse them, cooperate with the professionals or staff at the health care institution;
6.44.3. not violate the rights of other persons and patients, respect the Polyclinic’s staff and other patients, as well as present themselves to be seen by the doctor sober as well as clean and tidy;
6.44.4. take care of your health insurance and contact the Polyclinic only after making sure that they have insurance cover in place (except in cases of necessary medical care), otherwise, they must pay for the services at own expense;
6.44.5. hold documents proving their identity on them;
6.44.6. in case of representing a patient, hold documents confirming their identity and representation on them;
6.44.7. follow the established procedure for making appointments with and being seen by doctors;
6.44.8. inform the Polyclinic about any changes to their address or other contact details;
6.44.9. not interfere with medical staff performing their duties;
6.44.10. present, as much as possible, the treating doctor and nurse, or other staff at the Polyclinic who are required to assess the patient’s health, with correct and complete information that is reasonably necessary to diagnose the disease, condition or medical conditions and treat the patient (e.g. about current and past medical conditions, previous diseases, injuries or interventions (operations), genetic heredity and other data known to them, previous and current medicines, narcotic substances, observed allergic reactions to medicines or vitamins);
6.44.11. inform the treating doctor and nurse of any changes to their health condition during the provision of health care services;
6.44.12. follow the instructions and guidelines of the treating doctor and nurse, not only as regards their treatment, but for prevention and nursing purposes too;
6.44.13. in their medical documents, accept by affixing their signature all actions for which the patient’s informed consent is given, as provided for in the legislation of the Republic of Lithuania and/or the Polyclinic’s documents of internal procedure;
6.44.14. following any financial documents presented, pay for health care services that are not covered by the budget of the Compulsory Health Insurance Fund or state or municipal budgets;
6.44.15. respect the Polyclinic’s property and be held liable for any damage or destruction thereof in accordance with the procedure established by the legislation of the Republic of Lithuania;
6.44.16. observe public order;
6.44.17. a patient attending the Polyclinic may be accompanied by only one accompanying person.
6.45. The patient must confirm their rejection of the health care services prescribed to them against their signature affixed in the outpatient medical record. If the patient rejects health care services, the treating doctor must explain the health risks to the patient and warn about potential complications.
6.46. If the patient fails to comply with their duties, thereby endangering their or other patients’ health and life, or prevents other patients from receiving quality health care services, the professionals at the Polyclinic shall have the right to refuse to provide services, making a note of this fact in the patient’s medical documents, unless the patient’s life was at risk.
6.47. When being temporarily unfit for work, the patient must follow the doctor’s instructions and not violate the rules of conduct which they had been made familiar with at the issuance of their fit note.
6.48. Violations of rules of conduct when being unfit for work shall include the following cases where a person declared temporarily unfit for work:
6.48.1. fails to attend the doctor’s appointment or a meeting of Consultative Commission of Doctors at the set time;
6.48.2. fails to comply with the treatment and/or nursing arrangements prescribed by the doctor;
6.48.3. fails have the prescribed treatment, diagnostic and/or nursing procedures;
6.48.4. presents themselves to the doctor whilst being under the influence of alcohol;
6.48.5. works (has worked), studies (has studied) or travels (has travelled);
6.48.6. has used alcohol, narcotic, toxic or psychotropic substances;
6.48.7. has acted in such a way that their actions are like to have prolonged the duration of their temporary unfitness for work;
6.48.8. where a person, who had been issued a fit note to care for a sick family member, fails to care for them.
6.49. The patient, patient’s representative or visitor shall be prohibited from:
6.49.1. making loud noises, smoking, consuming alcoholic beverages, narcotic or psychotropic substances inside the premises and/or in vicinity of the Polyclinic, except for the use of these substances for treatment purposes in the presence of a health care professional;
6.49.2. bringing a cold weapon and/or a firearm to the Polyclinic or the vicinity thereof;
6.49.3. taking (bringing) animals to the Polyclinic;
6.49.4. arbitrarily visiting the prohibited areas in the Polyclinic;
6.49.5. using a mobile phone during medical examinations (consultations) by doctors and other diagnostic or treatment procedures;
6.49.6. without a written permission of the administration, taking photographs, filming and making audio recordings inside the premises of the Polyclinic;
6.49.7. bringing prams, strollers and pushchairs to the premises of the children’s department at the Polyclinic and taking them around the Polyclinic. Prams, strollers and pushchairs must be left outside or in the lobby on the first floor of the main building of the Polyclinic.
7. REFERRING A PATIENT FOR INPATIENT SERVICES TO BE RECEIVED
7.28. Indications for treating a patient in an inpatient facility shall be determined by their treating doctor.
7.29. If it is necessary to have the patient treated in an inpatient setting, the treating doctor shall complete, in accordance with the procedure established by the Minister of Health, an electronic referral/extract from medical documents (Form No 027/a). With the referral in place, the patient may go to the recommended inpatient medical institution.
7.30. If the patient refuses to go to an inpatient medical institution, the doctor shall make a note thereof in their outpatient medical record, while the patient shall confirm this with their signature.
8. PROCEDURE FOR PROVIDING INFORMATION ABOUT THE PATIENT’S HEALTH CONDITION
8.28. The patient or their authorised representative, who has provided ID documents, shall have the right to receive information about the health condition, diagnosis of the disease, other methods of treatment or examination used in the health care institution or known to the doctor, potential risks, side effects, treatment prognosis and other circumstances that may affect the patient’s decision to accept or reject the proposed treatment, as well as the consequences of rejecting the proposed treatment.
8.29. All information about the patient’s health condition, diagnosis, prognosis and treatment, and information of a personal nature shall be confidential even after the patient’s death. The procedure for storing confidential information shall be established by the legislation of the Republic of Lithuania. Confidential information may be provided to other persons only with the patient’s written notarised consent or in cases provided for by the laws of the Republic of Lithuania.
8.30. Media representatives may communicate with the patient and/or film them/take photographs of them inside the Polyclinic or in the vicinity thereof only with the patient’s consent.
8.31. Media representatives may communicate with staff and/or film them/take photographs of them inside the Polyclinic or in the vicinity thereof only with the consent of the Polyclinic’s administration.
8.32. Information about the patient’s health condition shall be provided to the patient verbally and in writing:
8.32.1. the family doctor, the doctor of internal medicine or the paediatrician that has provided health care services, or another health care professional, who has been contacted for information in person (by presenting oneself to the Polyclinic and subject to an ID document being provided), may provide information verbally;
8.32.2. an application for the information to be provided in writing (extracts from medical documents/copies of medical records) shall be made in writing at the office and accompanied by an ID document. If the patient wishes to receive information by email, they must provide, in their written application, the email address for such information to be sent to. Where such an application is posted, it must be accompanied by a copy of the applicant’s ID document certified by a notary public or an advocate representing the patient. When making an application for written information, the patient’s representative shall present their ID document and documents proving representation.
8.33. Patient’s information shall not be provided by telephone.
8.34. Patient’s information shall only be provided to a single authorised person at a time. In this case, the person authorised by the patient must present a document proving their identity and documents proving representation (an entry in the outpatient medical record or a notarised power of attorney).
8.35. If the patient wishes to receive a response, test results or other information by email, they must inform the doctor of their wish and have the patient’s contact email address included in their medical record.
8.36. The information about their health condition, diagnosis of the disease, results of medical tests, treatment methods and treatment prognosis shall be presented to the patient in a comprehensible form with special medical terms and definitions explained. When informing about the treatment, the doctor must explain the course of treatment, possible treatment outcomes, available alternative treatment methods and other circumstances, which may affect the patient’s decision to accept or refuse the proposed treatment, as well as implications of refusing the proposed treatment, to the patient. Information must not be given to the patient against their will, but such will must be clearly stated, while the patient’s medical record shall have a note of any such will.
8.37. Any information intended for a minor patient, their parents or guardians must be provided in a form comprehensible to them. Should there be any disagreements between the minor and their parents or guardians, the treating doctor must follow the interests of the minor patient when providing information. If the minor is referred to be hospitalised, their parents or guardians must be informed thereof.
8.38. Information shall not be provided to the patient if:
8.38.1. the patient has exercised the right not to know information about their health condition, diagnosis of the disease, alternative treatment methods used, potential risks, complications, side effects and treatment prognosis;
8.38.2. there is a note in the patient’s medical record that the patient must not have all the information disclosed. In this case, the decision as to the extent to which information shall be provided to the patient shall be made by the family doctor (doctor of internal medicine or paediatrician) chosen by the patient or the professional who provided the health care service.
8.39. Before providing information about the patient to their relatives (heirs, spouse (partner), parents or children after the patient’s death) or other persons, the person providing this information must make sure that those persons are entitled to receive information about the patient. When requesting information about the patient, any such persons shall present:
8.39.1. the patient’s written consent (the consent must be notarised), except in cases where the patient has detailed in their medical documents, against their signature, which specific person has the right to receive such information;
8.39.2. a request, which must state the purpose of use of the information, the legal basis for receiving it (specific law, the article thereof and the paragraph of the article) and the scope of the data requested. If the request does not meet the above requirements, the Polyclinic shall refuse, within 5 working days, to provide information about the patient stating the reason for the refusal.
8.40. If the patient wishes to detail which specific person has the right to receive information about their health condition, they shall complete the patient’s consent for provision of information about their health condition to other persons and provide the forename, surname, date of birth/personal number of those persons and the relationship with such persons. Such patient’s consent shall be inserted using adhesives into the outpatient medical record and shall be valid until withdrawal thereof.
8.41. The patient shall have the right to identify persons to whom confidential information must not be provided.
9. PROCEDURE FOR RESOLVING DISPUTES AND CONFLICTS BETWEEN THE POLYCLINIC AND THE PATIENTS
9.28. The patient shall have the right to lodge a complaint with the health care institution where, in their view, their rights have been violated, not later than within one year from the day on which they have learned of the violation of their rights, but not later than within 3 years from the date of violation of the rights, except in cases where the violation of their rights has causes damage, in which case, not later than within 3 years from the date on which they became or should have become aware of the damage.
9.29. Complaints may be submitted in person (by presenting oneself to the health care institution) or remotely (by recorded delivery post, via a courier, sent by email or other electronic means of communication ensuring a possibility to verify the identity of the person submitting the complaint). The complaint must detail the patient’s rights, which have been violated, in their view, by the health care institution, the circumstances justifying this and the patient’s claims to have the violation of their rights rectified. The complaint must be accompanied by documents (if the patient has any) supporting the circumstances stated in the complaint and justifying the claims provided in the complaint. If the complaint is lodged by a patient’s representative, it shall also be accompanied by a document proving representation. Detailed requirements for the complaint and documents accompanying the complaint shall be determined by the Minister of Health.
9.30. Examination shall be availed to such complaints that have been signed by the patient and contain their forename and surname, actual residence and contact details along with the nature of complaint outlined. If the complaint is lodged by the patient’s representative, it must contain the forename and surname as well as residence of the representative, the document proving representation and the patient on whose behalf the complaint is made. Illegible complaints that do not meet the requirements set out in this paragraph shall be returned to the patient with the reason for return stated.
9.31. The complaint must detail the patient’s rights, which have been violated, in their view, by the health care institution, the circumstances justifying this and the patient’s claims to have the violation of their rights rectified. The complaint must be accompanied by documents (if the patient has any) supporting the circumstances stated in the complaint and justifying the claims provided in the complaint. If the complaint is lodged by a patient’s representative, it shall also be accompanied by a document proving representation. Detailed requirements for the complaint and documents accompanying the complaint shall be determined by the Minister of Health.
9.32. Complaints shall not be examined, but shall be returned to the person who submitted them, stating the reasons for return, in the following cases:
9.5.1. the complaint is not accompanied by all or is accompanied by incorrectly formalised documents which are required to be submitted with the complaint, and/or the complaint contains incomplete and/or inaccurate information and the complainant has not fulfilled the request to have the defects rectified within the time limit referred to in paragraph 3 of this Article;
9.5.2. the complaint has been written in an illegible manner.
9.6. Patients shall have the right to appeal against decisions of the Polyclinic and other public bodies dealing with complaints in accordance with the procedure established by law.
10. PROCEDURE FOR MAKING AND ISSUING COPIES OF DOCUMENTS TO THE PATIENT OR OTHER NATURAL AND LEGAL PERSONS
10.28. The Patient shall have access to the records in their medical documents within 1 working day after the patient’s request to the Polyclinic being made verbally or in writing.
10.29. The patient shall have the right to request copies of their medical records or other medical documents relating to their disease to be made at their expense. This patient’s right may be limited only in accordance with the procedure established by the laws of the Republic of Lithuania.
10.30. To receive copies of medical documents (extracts), the patient or their representative shall make a written application to the reception. Copies of the patient’s medical documents (extracts) shall be made, at the patient’s expense, and issued no later than within 10 working days from when the payment is made for the service. If the patient wishes to receive copies as a matter of urgency, they shall be made and issued to the patient within 3 working days after payment. Making copies as a matter of urgency shall attract a surcharge of 50% to be paid by the patient.
10.31. Information about the patient, the patient’s medical documents and copies thereof may be provided only for official purposes, without a written consent of the patient or their representative, in the following cases:
10.31.1. to health care institutions where the patient is being treated or cared for or where they are having their health examination;
10.31.2. to institutions controlling health care services;
10.31.3. to a court of law, prosecutor’s office, pre-trial investigation bodies, municipal child rights protection services and other bodies which are entitled thereto under the laws of the Republic of Lithuania.
10.32. Persons, who have the right to receive written information on the grounds and in accordance with the procedure established by the legislation and who wish to receive this information, shall submit a written request signed by the head of the institution or body wishing to receive information about the patient. The request must state the nature of the information to be obtained and the purpose of its use and must also be accompanied by the instruction, decision or other document from the head of the institution or body, which is required to be submitted in such cases under the legislation governing the business of those institutions or bodies.
10.33. The time limit for written information to be provided shall be 10 working days from the date the request was received.
11. GENERAL PROVISIONS OF THE RULES OF PROCEDURE AND OCCUPATIONAL SAFETY
11.28. The vicinity and premises of the Polyclinic must be clean, tidy and regularly cleaned.
11.29. Smoking shall be prohibited inside the premises and in the vicinity of the Polyclinic.
11.30. The Polyclinic’s staff shall be prohibited from being under the influence of alcohol/ narcotic or toxic substances whilst in the Polyclinic.
11.31. The Polyclinic’s staff must use work tools, transport, electricity and other material resources reasonably and sparingly.
11.32. Compliance with the occupational, fire and electrical safety requirements shall be mandatory at the workplace, in accordance with the Law on Safety and Health at Work of the Republic of Lithuania and the provisions of other regulatory and local legislation concerning occupational safety. Before starting a job, all staff of the Polyclinic shall be trained and instructed on occupational safety issues.
11.33. The Polyclinic’s staff must not violate hygiene standards in their activities and must observe the procedure for decontamination of waste.
11.34. Health care professionals and staff at the reception must work dressed in clean and tidy clothing.
11.35. The Polyclinic’s staff must abide by labour discipline, come to and leave work on time, deal with staff, patients and visitors in a respectful and businesslike manner, as well as follow the instructions of the Director, their deputies, line managers and other staff of the administration.
11.36. The Polyclinic’s staff must notify their line managers without delay of any conflicts with patients and their representatives, visitors or staff.
11.37. During work, the Polyclinic’s staff must wear valid employee IDs that have been issued in accordance with the procedure established by local legislation.
11.38. The Polyclinic’s staff must change their clothes, store their workwear and non-work clothes along with personal belongings, and eat in designated rooms.
11.39. The Polyclinic’s staff must ensure that patients and/or their representatives are present at their workplace only in the presence of a member of staff.
11.40. A member of staff of the Polyclinic that is the last in the room to finish work must tidy up the workplace, turn off electrical appliances, close windows and lock the premises.
11.41. The Polyclinic’s staff must ensure the safety of patients’ personal data in accordance with the procedure established by the legislation.
11.42. For the safety and security of the Polyclinic’s property, staff, patients and visitors, the common premises at the Polyclinic shall be CCTV monitored.
12. PROCEDURE FOR REGISTERING AND STORING ARTICLES MADE OF PRECIOUS METALS, EXPENSIVE PROSTHESES AND MONEY IN THE POSSESSION OF THE PATIENT
12.28. No articles made of precious metals, prostheses and money in possession of patients shall be stored in the Polyclinic.
13. FINAL PROVISIONS
13.28. The Rules shall enter into force from the date of approval thereof.
13.29. All staff must be made familiar with these Rules against their signature.
13.30. The approved Rules shall be mandatory for all staff, patients, their representatives and visitors of the Polyclinic. The staff, patients, their representatives and/or visitors of the Polyclinic shall be held liable for non-compliance or mal-performance of the provisions of these Rules in accordance with the procedure established by the legislation of the Republic of Lithuania.
13.31. By an order of the Director, the Rules may be amended and/or supplemented should the working arrangements at the Polyclinic or relevant legislation change.
13.32. The Rules shall be published on the Polyclinic’s notice board and on the Polyclinic’s website.
