Internal regulations for service

INTERNAL REGULATIONS FOR SERVICE CONSUMERS OF

NORTHWAY MEDICAL CENTRES, UAB and
NORTHWAY SURGICAL CENTRE, UAB

1. GENERAL PROVISIONS

1.1. These Internal Rules (hereinafter – the Rules) of Northway, UAB, medical centres and Northway, UAB, Surgical Centre (hereinafter – the Centres) establish the procedure for patients seeking medical advice at the Centres, the procedure and conditions of service provision, the rights and obligations of the Centres’ patients, and the provision of information about patients. The Rules also regulate other matters related to the provision of services at the Centres.

1.2. The rights and obligations of the Centres’ staff are also established by staff employment contracts, job descriptions, corporate rules, the quality management documents related to the quality of the services rendered at the Centre, other legal acts, and standard and corporate documents.

1.2. The rights and obligations of patients are established by the legal acts of the Republic of Lithuania, the Contract for Healthcare Services, patient alert card and other standard and corporate documents from the Centre.

2. SERVICES PROVIDED AT THE CENTRE, THE LIST (NOMENCLATURE) AND RANGE OF FREE SERVICES AND THE PROCEDURE FOR THEIR PROVISION

2.1. In their business activities, the Centres provide healthcare services specified in the Centres’ licences and defined in the list of the healthcare services (hereinafter – the Services). Patients can access and become familiar with the list and the range of healthcare services.

2.2. Based on the procedure set out in the legislation, the Centres provide emergency medical care to their patients free of charge. The patient does not need to have a doctor’s referral or preliminary appointment booking in order to apply for emergency medical care at the Centre.

2.3. The patient must receive emergency medical care immediately. If the Centres are not able to provide the emergency medical care to the patient or if the Centres cannot provide the emergency medical care to the patient within their purview, they must notify the patient of this and make sure the patient is transported to another Health Care Institution as soon as possible. 

2.4. For patients who are registered with the Centres to receive regular healthcare services, the expenses for Services are fully or partially covered by the Territorial Health Insurance Fund from the State Social Insurance Fund based on the contract signed between the Territorial Health Insurance Fund and the Centres.

2.5. Patients who are not registered with the Centres to receive regular healthcare services, as well as patients whose expenses for Services are partially covered by the Territorial Health Insurance Fund from the State Social Insurance Fund, must pay the Service price or their respective part on the terms and conditions set out in the Contract for Healthcare Services signed between the patient and the Centre.

2.6. Centres have the right to refuse to provide the Services if the patient’s actions and/or behaviour violate their rights established by the Law on the Rights of Patients and Compensation of the Damage to their Health of the Republic of Lithuania, contradict the principles of medical ethics or risk causing real danger to the patient’s or doctor’s life, except for when emergency medical assistance is required. 

3. PROCEDURE FOR SEEKING MEDICAL ADVICE BY THE PATIENT

3.1. Based on the licences obtained, the Centres provide outpatient and hospital care services, emergency and elective care services financed by the State Social Insurance Fund Budget or any other financial bodies, as well as fee-based healthcare services.  

3.2. Any natural or legal person willing to receive information about the healthcare services, service prices and how to apply for them at the Centre can visit the webpage of the corresponding Centre, request the information required at the Appointment Desk of any Centre, or apply verbally or in writing to the administrative personnel and attending physicians.

3.3. The Centres are open for patients on Mondays-Fridays (on working days) from 7.30 a.m. to 8.30 p.m., and on Saturdays from 9.30 a.m. to 3 p.m.

3.4. A medical doctor (intensivist) is on duty 24/7 at the duty station of Northway, UAB, Surgical Centre. If necessary, we may call upon any other medical specialist.

3.5. A patient intending to see a healthcare professional at the Centres must book an appointment in advance by phone, by visiting one of the Centres, or via the Electronic Appointment System. A patient willing to apply for the services covered by the National Health Insurance Fund (NHIF) must register with these services by phone, by visiting one of the Centres, or via the Online Patient Booking System at https://ipr.esveikata.lt. 

At our Medical Centres, patients can book appointments during our opening hours. The opening hours of the Centres can be found on the announcement board and on the Centres’ website at https://nmc.lt/, in the section “Information for clients” select “Contacts and requisites”.

3.6. When the patient arrives at the Centre at the appointed time, they must provide a passport or any other ID document at the Appointment Desk. If the patient has insurance, they must also provide a document supporting their obligatory or voluntary insurance (for example, a certificate of insurance).

3.7. Patients who are being hospitalised must have a GP’s or medical specialist’s referral.

3.8. Patient consultations and hospitalisation are conducted in accordance with the procedure outlined in the Director General’s orders.

3.9. When booking an appointment:

3.9.1. the patient will receive information about the Centres’ healthcare specialists, their qualifications, work schedule, services they provide and prices;

3.9.1. the patient will sign a Contract for Healthcare Services under which the Centres provide medical services;

3.9.3. the patient will familiarise themselves with the Internal Rules of the Centre, patient alert card and other corporate documents required;

3.9.4. a new medical chart (medical documents) is made or corresponding entries are made in the existing medical documents about the scheduled appointment with a medical specialist at the Centre.

3.10. In exceptional cases when a certain Centre’s medical specialist is not able to see the patient at the specific time agreed with the patient due to unforeseen circumstances (for example, the medical specialist gets sick or the medical equipment required for the service fails), the patient will be immediately notified via phone and offered an alternative appointment time, another medical specialist or the chance to request another appointment time.  In any case, the Centres will make every possible effort to notify their patients about such circumstances as soon as possible.

4. PATIENT RIGHTS AND OBLIGATIONS AT THE CENTRE

4.1 At the Centre, patients can exercise all rights established in the Law on Patients’ Rights and Compensation of the Damage to their Health of the Republic of Lithuania, as well as the rights established in other legal acts. Patients’ rights cannot be restricted due to their gender, age, race, citizenship, nationality, language, origin, social status, faith, beliefs, views, sexual orientation, genetic peculiarities, disability or any other unreasonable circumstances under laws.

4.2. All patients have the right to be treated with respect by the Centres’ staff. Every intervention into patients’ health, including examinations and lab tests, must be conducted in accordance with the respective professional duties and standards.

4.3. Patients must be provided with information about the Centre doctor’s full name, position and qualification. The patient must familiarise themselves with the patients’ rights and obligations established in the Internal Rules and patient alert card.

4.4. Patients have the right to receive information about the services rendered by the Centres and how to apply for them. This kind of information is available on the Centres’ website or at the appointment desk and can also be provided by the patient’s attending physician.

4.5. Patients, including teenagers aged from 16 to 18 years may be treated or receive another type of healthcare service only after giving their consent. Teenagers aged under 16 years may receive healthcare services if their representatives give consent for this, except for in cases when request for such consent would contradict the underaged patient’s interests.

4.6. If it is possible to select diagnosis and treatment methods in compliance with healthcare standards, patients must familiarise themselves with the specific features of these methods and have the opportunity to make a choice. Patients’ choice, including for teenagers aged from 16 to 18, must be expressed in writing. Patients must confirm their choice by providing a signature. If patients are underage (under 16) or cannot give an objective evaluation of diagnosis and treatment methods due to their health status, their representatives will choose and sign for them. In the event of disagreements arising between the underage patient (under 16) and their representatives, diagnosis and treatment methods will be selected during a case conference between doctors, taking into consideration the underage patient’s interests.

4.7. Before requesting patient’s consent, the patient (their representative) will receive explanations about the objective, character, consequences and risks of the medical intervention. Consent for the provision of the Services which were not agreed in the Contract for Healthcare Services must be signed by the patient (their representative) in the patient’s chart. 

4.8. When exercising their rights at the Centre, the patient must:

4.8.1. fulfil the patients’ rights established in the Law on Patients’ Rights and Compensation of the Damage to their Health of the Republic of Lithuania, these Rules, patient alert card and other legal acts;

4.8.2. provide reasonable information and help the Centre’s staff to the extent which is necessary to provide healthcare Services of high quality and determine the causes of health disorders;

4.8.3. follow the Centre medical specialists’ instructions and behave in such a way that their or their related persons’ actions do not cause any complications, spread disease or worsen the patient’s condition in any other way;

4.8.4. arrive for an examination (consultation, check-up, etc.) at the Centre upon the Centre medical specialist’s request;

4.8.5. give their opinion, requests, disagreements and refusals in writing regarding the Services, diagnosis and treatment methods, referrals to other medical institutions, including any other matters related to their treatment process and submit the mentioned documents signed to the representatives of the Centres’ administration and approve on their behalf disagreement and (or) refusal by signing the patient chart;

4.8.6. refrain from any public comments, including but not limited to radio, television, teleconferences, press, internet and any other mass communication media on the Services provided by the Centres, including their healthcare specialists, their activity and actions without the Centres’ preliminary consent signed by the Director General and approved by corporate seal providing permission to publish such comments;

4.8.7. not violate the rights and human liberties of other patients, the Centres’ staff and other persons and not cause danger to the life and health of the people listed.

4.9. Centres have the right to refuse to provide new Services or suspend provision of current Services to the patient if the patient violates their obligations and thus causes danger to their and other patients’ life and health or impedes the provision of healthcare services to them, except for in cases when the patient’s life is under threat.

5. PROCEDURE FOR REFERRAL/TRANSFER TO OTHER HEALTHCARE INSTUTIONS

5.1. If the Centres do not have objective capabilities to provide the necessary Services to the patient in a timely manner, the Centres:

5.1.1. will refer the patient to another medical institution by issuing a medical referral and giving a detailed explanation of the reason standing behind such a decision; or

5.1.2. will make arrangements for the patient’s transfer (transportation) to another healthcare institution in which the patient will receive medical services, and give a detailed explanation of the reason for such a decision.

6. PROCEDURE FOR PROVISION OF INFORMATION TO THE PATIENT AND THEIR RELATIVES REGARDING THE PATIENT’S HEALTH STATUS, MEDICAL DOCUMENTS, MAKING COPIES OF DOCUMENTS, ISSUANCE TO THE PATIENT AND OTHER NATURAL AND LEGAL PERSONS

6.1. The patient has a right to receive information on their health status, diagnosis, data of the medical examination (lab tests), treatment methods and expected response to treatment. When the doctor informs the patient about the treatment, they must explain to the patient the course of the treatment, possible treatment outcome, possible alternative treatment methods and any other circumstances which could affect the patient’s decision to give consent for or refuse the suggested treatment, including the consequences of treatment refusal. Information must be provided to the patient with due regard of their age and health status, in an understandable way and with the explanation of specific medical terms. The patient must confirm that they have received and understood this information by signing the medical document or giving a separate consent (verification). 

6.2. Information about the patient’s health status will not be given over the phone. Information to the patient, their representatives or caregivers must be provided in clear terms; if there are any disagreements between them, the doctor will provide information with due regard for the underage patient’s interests. When the underage patient is being registered within a medical institution, it is necessary to indicate their representatives for the cases when the underage patient arrives at the institution without parents or a doctor is being called in. Furthermore, it is also necessary to indicate a person who will receive information about the underage person’s health status if it is not possible to provide it to their parents.

6.3. The patient has the right to request that the doctor correct, complete, remove and/or change inaccurate, incomplete and ambiguous data or information not related to the diagnosis, treatment or care recorded in the medical documents. If the attending physician disagrees on the mentioned patient’s request or the patient’s request is well-grounded, the patient has a right to address the said request in writing to the Centres’ administration. The final decision on the patient’s request will be made by a case conference between doctors.

6.4. The patient has the right to hear another medical opinion on their health status, suggested diagnosis and treatment. 

6.5. Information on health status, diagnosis, results of lab tests and examination, treatment method and expected response to treatment cannot be provided to the patient against their will. Patients’ will, including that of underage patients (aged between 16 and 18), must be explicitly expressed in the Contract for the provision of healthcare services or certified by the patient’s signature in their medical documents. This provision shall not apply when failure to provide information to the patient or other persons may cause harmful consequences and they cannot be avoided upon provision of information to the patient’s family members, representatives or other persons. Provision of information to the patient against their will must be recorded in the patient’s medical documents.

6.6. The Centres’ staff must handle and complete standard patient medical documents of different types (patient chart, other medical documents), fill them in and store them in the order established by legislation. The Centres may hire third parties to perform these actions or enter into contract for service provision with other medical institutions.

6.7. The Centres’ paperwork shall be maintained in Lithuanian. Medical documents (medical chart, patient chart, procedure orders, etc.) shall be filled out in Lithuanian. Diagnosis, drug prescriptions and drug orders may be written in Latin.

6.8. Information about patients’ attendance at the Centre, their health status, diagnosis, treatment and care methods and measures applied shall be recorded in the medical documents which types and forms approved by the Ministry of Health. All information regarding patients’ attendance at the Centre, their health status, diagnosis, treatment, expected response to treatment and any other personal information must be regarded as confidential.

6.9. Upon the patient’s request, the patient may obtain their medical documents, except in cases when it could harm the patient’s health or cause danger to their life. In these cases, the attending physician must record the restrictions on the provision of information in the patient’s medical chart.

6.10. The patient may address a written request to the Centres’ staff in order to obtain copies of their medical chat and/or other medical documents at their expense. This right may be restricted only in the order established by legislation of the Republic of Lithuania. The doctor must explain to the patient the essence of the records in their medical chart.

6.11. Confidential information may be provided to other persons only with the patient’s written consent. Confidential information may be provided to persons who directly participate in the patient’s treatment, provision of care or health evaluation without the patient’s consent only in those cases and to the extent necessary to protect the patient’s interests. Confidential information may be provided in the order established by legislation without patient consent to those state institutions which are entitled to obtain confidential information about the patient against their will under the laws of the Republic of Lithuania. When a patient is unconscious and there is no consent, confidential information may be provided to the patient’s representative, spouse (partner), parents (foster parents) or adult children only in those cases and to the extent necessary to protect the patient’s interests.

7. PROCEDURE FOR REGISTRATION AND STORAGE OF PATIENTS’ ITEMS MADE FROM PRECIOUS METALS, EXPENSIVE PROSTHETIC APPLIANCES AND MONEY

7.1. Upon the patient’s written request (a template is available), the Centres may offer a storage service on the Centre’s premises for patients’ items made from precious metals, expensive prosthetic appliances and money during the patient’s treatment at the Centre. The Centres offer security services free of charge but are not professional guardians. These security services are offered with a view to making patients feel comfortable.

7.2. When a patient wants to request the storage of items made from precious metals, expensive prosthetic appliances or money, they must fill out the request template and list the quantity, type and individual characteristics of items and the sum of money being transferred for storage. Patient requests for storage of items made from precious metals, expensive prosthetic appliances or money shall be registered in a logbook of due form. 

7.3. Patient requests must be submitted in two copies, one of which remains in the Centre, and the other signed by a Centre staff member is returned to the patient. The copy is put into a special envelope containing the listed items of value. The envelope is then glued, sealed and put into a lockable box (drawer). Once the procedure is completed, the patient will receive the envelope back and open it in the presence of the doctor, check the items against the list and certify the reception of items with the signature in their request. The request signed by the patient shall be attached to the patient’s medical documents and stored therein.

7.4. The templates for the request for item storage and the logbook shall be approved by the Director General of the Centres. The Director General of the Centres may approve the rules amplifying the procedure for registration and storage of items made from precious metals, expensive prosthetic appliances and money expressed therein.

8. PROCEDURE FOR DISPUTE RESOLUTION

8.1. If a patient believes that their rights have been violated, they can address a written request to the Centres’ administration. The Centres’ administration must review the patient’s request within a reasonably short term but not longer than 20 days and notify the patient of the review results in writing. If the patient is dissatisfied with the review and the results, they may address another state institution in the order established by laws.

8.2. A patient has a right to receive compensation for the damage done to their health during the provision of Services. The conditions and procedure for damage compensation is established by the Civil Code, the Law on the Rights of Patients and Compensation of the Damage to their Health, Law on Insurance and other legal acts of the Republic of Lithuania. 

8.3. The Centres’ liability for damage to patients’ health will be reduced given that it was made at the fault of the Centre and the patient: the latter failed to fulfil their obligations, comply with the provisions of the Rules and other documents which they familiarised themselves with and signed, and eventually, such failure or conscious actions facilitated the patient’s health impairment or even death. 

9. OCCUPATIONAL SAFETY

9.1. The Centres’ staff must follow the laws regulating occupational safety, provision of other legal acts and regulatory documents, including the requirements of respective hygiene and medical standards. The duty of each Centres’ staff members is to fulfil the requirements of corporate occupational and health safety documents and regulations which they have familiarised themselves with and been trained to comply with. The staff must also take special care of co-workers and their patients’ occupational safety and health based on their knowledge and following the instructions of the staff responsible for occupational health at the Centres.

9.2. Occupational safety and health instructions establish the specific duties for staff members who work with facilities and are responsible for protection of health and safety of staff members’ health and life. Job descriptions establish these duties for other Centres’ employees.

9.3. Patients must follow the general occupational safety regulations and immediately notify the Centres’ staff of any circumstances which may cause danger to other patients or the staff members.

10. WORK ETHIC

10.1. The Centres have an Ethics Committee which has been established to manage and monitor compliance with ethical requirements and resolve any issues arising between staff members and patients.

10.2. The Ethics Committee shall follow the Constitution, legislation of the Republic of Lithuania, orders issued by the Ministry of Health, recommendations issued by Lithuanian Bioethics Committee, other legal acts, ethical standards and these provisions.

10.3. The Committee’s work shall be arranged in the order approved by the Centres’ CEO.

10.4. The Committee’s tasks and functions are as follows:

10.4.1. to monitor compliance with ethical standards within the Centres and explain the essence and contents of these standards;

10.4.2. to approve and submit to the Centres’ administration recommendations regarding ethical matters, resolution of disputes, conflicts between medical specialists, patients and their relatives, between medical specialists, between medical specialists and other staff members, and in any other cases; 

10.4.3. to take part in the activities of Centre’s operation in relation to resolution of ethical issues;

10.4.4. to educate the staff of the healthcare institution, other staff members and patients on ethical matters;

10.4.4. to take part in developing corporate documents and evaluate them in terms of ethics;

10.4.6. to submit recommendations on good and fair selection of patients for provision of healthcare services when the institution’s capabilities are limited. 

11. OFFICE HOURS

10.1. The Centres’ office is open on weekdays, from 8 a.m. till 5 p.m., with a lunch break from 12 p.m. till 1 p.m.