APPROVED

by Order No V1-232

by the Director of the Public Institution

Clinical Hospital of Vilnius City

Of 31 July 2019

INTERNAL RULES OF PROCEDURE OF THE POLYCLINIC OF

PUBLIC INSTITUTION VILNIUS CITY CLINICAL HOSPITAL

I. GENERAL PART

1. The Polyclinic (hereinafter referred to as the Polyclinic) of the Public Institution Vilnius City Clinical Hospital (hereinafter referred to as the Hospital) is a structural unit of the Hospital, with its operational address at Antakalnio St. 124, Vilnius.

2. The Polyclinic shall operate in accordance with the Constitution of the Republic of Lithuania, the Civil Code of the Republic of Lithuania, the Law on Health System of the Republic of Lithuania, the Law on Health Care Institutions of the Republic of Lithuania, the Law on Health Insurance of the Republic of Lithuania, the Law on Public Institutions of the Republic of Lithuania, the Law on the Compensation of Rights of Patients and Damage to Health of the Republic of Lithuania, the Law on the Rights of Patients and Damage to Health of the Republic of Lithuania, the resolutions of the Government of the Republic of Lithuania, the orders of the Minister of Health of the Republic of Lithuania, as well as other legislative acts and regulatory documents regulating the operation of healthcare institutions, the Articles of Association of the Institution, the internal rules of procedure of the Institution, and the other documents internal to the Hospital.

3. The Polyclinic shall carry out the activities specified in the Articles of Association of the Hospital and in the licence of the Vilnius City Clinical Hospital.

4. The Internal Rules of Procedure of the Polyclinic (hereinafter - the Rules) have been prepared in accordance with the laws and sub-legislative legal acts of the Republic of Lithuania and regulate the procedure of applying to the Polyclinic, the rights and obligations of patients, the procedure of resolving disputes and conflicts between the Polyclinic and patients, the procedure of providing information to the patient and his/her relatives about his/her health condition, the procedure of providing copies of medical documents (outpatient personal health records, etc.), issuing them to patients and other natural and legal persons, the working hours of the Polyclinic, and the provisions of the laws, other legal acts and normative documents regulating the safety and health of employees.

5. The requirements of the Rules are binding on all employees of the structural units of the Polyclinic, patients and their representatives.

6. The Rules are published on the website www.vmkl.lt of the Hospital and on the information boards of the Polyclinic.

7. The Hospital has a quality management system installed, which complies with the requirements of the LST EN ISO 9001 standard, and therefore the Polyclinic follows the quality management system documents to improve its business processes.

8. The outpatient personal health care services provided at the Polyclinic of the Hospital are specified in the Personal Health Care Licence of the Institution No. 3421 (hereinafter referred to as the “Licence”) issued by the State Accreditation Service for Health Care Activities (hereinafter referred to as the VASPVT) under the Ministry of Health of the Republic of Lithuania on 6 January 2012. The current version of the Licence is available on the website of the VASPVT at:

https://www.vaspvt.gov.lt/vaspvt/m/m_files/Lic/L3421.pdf (see pages 7-11)

II. PROCEDURE FOR REFERRAL AND REGISTRATION OF PATIENTS AT THE POLYCLINIC

9. The enrolment of the residents to primary personal health care is carried out in accordance with the Order of the Minister of Health of the Republic of Lithuania No 583 of 9 November 2001 “On the Procedure for Enrolment of the Residents to Primary Personal Health Care Institutions”.

Everyone is free to choose the closest primary health care institution (hereinafter – the PHCI) to his or her place of residence or one that is more accessible to him or her. A person may change to a new PHCI provider no earlier than six months after enrolment. The restriction does not apply to persons who have entered an in-patient educational establishment or who have returned to their place of residence after completing their studies.

10. Persons wishing to subscribe to the Polyclinic, during the opening hours of the institution, must apply to the Reception and Information Department (hereinafter referred to as the Reception) and present a document confirming their identity (passport, identity card, permanent/temporary residence permit, birth certificate of the child or other documents).

11. When enrolling to the Polyclinic, the person must fill in the “Application for treatment at the chosen primary health care institution” (Form No 025-025-1/a). When filling in the application form, it is possible to choose a specific doctor working in the Polyclinic. If a specific doctor is not selected, the receptionist will appoint him/her. If the residents served by the doctor selected by the patient exceeds the maximum number of the people served, the Receptionist shall select another doctor.

12. A patient who wishes to be treated by another doctor in the same institution shall fill in the “Request for treatment by another doctor of the chosen health care institution” (form No 025-025-2/a).

13. If the patient chooses another healthcare institution, his/her Outpatient Personal Health Record shall be transferred to the institution of the patient’s choice upon submission of the “Request for transfer of outpatient record, developmental health records of children” (form No 025-025-3/a). The transfer of the outpatient record shall take place within three working days of receipt of the request.

14. When subscribing to the Polyclinic, the person pays a fixed fee, the amount of which depends on the frequency of changing the PHCI. The registration fee shall be EUR 0.29 at the PHCI and EUR 0.29 at the Primary Mental Health Service (hereinafter referred to as the PMHS). If changing occurs for more than once every six months, the registration fee is EUR 2,90 at the PHCI and EUR 2,90 at the PMHS.

15. By completing the “Application for treatment at the chosen primary health care institution”, the person confirms that he/she understands and agrees that the Polyclinic will process his/her personal data (name, surname, personal identification number, date of birth, place of residence, telephone number, e-mail address, social security number and information on insurance, as well as special data on health). The data will be processed for the purpose of providing the service.

16. A patient who voluntarily comes to the Polyclinic or calls primary health care professionals to his/her home is informed and agrees to be examined, to have his/her health condition assessed, to be prescribed and to undergo the necessary examinations, treatments and nursing procedures.

17. Registration with primary health care professionals. Registration for a visit (consultation) with a doctor shall be made by the patient by contacting the Reception, by phone, online at: www.sergu.lt. or on the VMKL website https://www.vmkl.lt/ Register at sergu.lt Poliklinika. When registering with specialist doctors, a medical document extract/referral, form 027/a (hereinafter referred to as a referral) from the primary care doctor or specialist doctor is required, except for a dermatovenerologist.

18. Patients can see specialists on their own initiative (without a referral) and receive a service of a specialist by paying for a specialist’s consultation. The patient must confirm his/her agreement to pay by signing the Outpatient Personal Health Record.

19. Emergency medical care is provided to the patient on an urgent basis (urgent, out-of-turn, without referral).

20. When registering for an appointment with a doctor, the patient must inform the reception staff and the doctor to whom he/she is applying that he/she is not undergoing treatment at an inpatient personal health care institution (hospital) at the time of his/her visit to the Polyclinic.

21. Patients are admitted to the doctor only at the appropriate time registered for that appointment. If a patient is late for an appointment, his/her admission is not guaranteed.

22. If, due to important circumstances, the doctor services a patient for a longer period of time than the time allocated for that patient, other patients shall be admitted at a later time than the time specified in the registration, but not later than 30 minutes.

23. If the patient is unable to attend the appointment at the scheduled time:

23.1. he/she must notify the Reception of Polyclinic by telephone or any other acceptable way;

23.2. cancel their online registration and may choose another available appointment time if they registered online.

24. In the event of a change in the doctor’s working hours due to illness or other important reasons, and if it is not possible to service patients who have previously registered with the doctor, the latter shall be informed by telephone or other means of communication, and at the same time the patient shall be offered to make an appointment with the required doctor at the nearest available time.

25. The patient’s Outpatient Personal Health Record and/or other medical documents prepared at the reception desk shall be delivered to the doctor’s room only by the Polyclinic staff. After the end of the doctor’s admission time, medical documents shall be returned to the Reception on the same working day by medical staff.

III. PROCEDURES FOR THE PROVISION OF REMOTE PRIMARY OUTPATIENT PERSONAL HEALTHCARE SERVICES

26. In accordance with the Regulations of the Order of the Minister of Health of the Republic of Lithuania No V-826 of 19 July 2018, patients and their relatives may apply to a doctor for the provision of a remote healthcare service (hereinafter referred to as NHS) if they wish to do so by filling in a consent form.

27. The NHS is provided only to patients registered at the outpatient clinic of Vilnius City Clinical Hospital, 124 Antakalnio Street, Vilnius.

28. A patient or his/her representative under the law or under a power of attorney (hereinafter referred to as the representative), who wishes to receive the NHS service, shall apply to the Polyclinic Receptionist responsible for the NHS service.

29. The patient signs the “The consent of the Patient to Receive a Remote Primary Outpatient Healthcare Service” (hereinafter referred to as the “Consent”) and is included in the list of patients eligible for the NSP service and is given a 4-digit PIN code, which will identify the patient for the further provision of these services.

30. A patient wishing to receive the NHS service shall be registered in the Information Patient Registration System of Polyclinic (hereinafter referred to as IPRS) to the nearest vacant place in the schedule of appointments for the provision of the NHS service, if the patient meets the eligibility criteria for the NSP service, in the manner prescribed by the legislation.

31. After registering the patient, the receptionist of the polyclinic responsible for the NHS service informs the patient when he/she will be contacted by a doctor.

32. The patient can also be registered for the NHS service at the time of the last visit to the Polyclinic. In this case, before the first provision of the NHS service, the patient shall also sign the “The consent of the Patient to Receive a Remote Primary Outpatient Personal Healthcare Service”.

33. At the scheduled time of provision of the NHS service, the physician shall call the patient or his/her representative on the telephone number provided in the IPRS, identify the patient, who must provide the patient’s name and a 4-digit PIN code.

IV. CLINIC OPENING HOURS

34. The clinic is open Monday to Friday 7.00 - 20.00.

35. House calls are registered on weekdays from 7.00 - 12.00.

36. During the closure of the Polyclinic, primary personal health care services for the residents who are registered with the Polyclinic are provided in the Admission-Emergency Department 2 of the Hospital.

37. Opening hours are subject to change during an epidemic of influenza (or other diseases).

38. The cloakrooms are open from 07:00 to 19:00 and closed during the summer period (1 June to 1 September).

39. The opening hours of the polyclinic are indicated on the information boards of the institution.

V. RIGHTS OF THE PATIENTS

40. Every patient has the right to receive quality and qualified health care services provided by the Polyclinic. The rights of a patient may not be restricted on the basis of his/her sex, age, race, nationality, language, origin, social status, religion, beliefs or opinions, sexual orientation, disability or any other circumstances not justified by law.

41. The patient has the right to be treated with respect for his or her honour and dignity and to be treated with respect by healthcare professionals. The patient shall receive services in accordance with the Code of Medical Ethics and the principles of mutual respect. The patient shall be provided with science-based painkillers so that he/she does not suffer from his/her own health problems.

42. The patient shall have the right to receive information about free and paid services provided by the Polyclinic, the prices of paid services and the possibility to use them.

43. The patient has the right, if indicated, to receive a referral for consultation from a family doctor and other specialists at the primary level of care to specialists and for inpatient treatment.

44. The patient has the right to choose (for children under 16 years of age and for disabled persons, the choice is made by the parents or guardians) the healthcare professional who will provide the services to him/her, provided that the healthcare professional is available to see the patient at the time and that this does not violate other patients’ rights or the working procedures of the hospital and the rights of the employee.

45. The patient has the right to be informed of the name, position and qualifications of the doctor or nursing staff treating them.

46. The patient shall have the right to information about his/her state of health, the diagnosis of the disease, the data of medical examinations, the methods of treatment or examination, the possible risks, complications, side effects, and prognosis of the disease and the treatment, and any other circumstances which may influence the patient’s decision to accept or refuse the proposed treatment, as well as about the consequences of refusing the proposed treatment. The doctor shall provide this information to the patient in a form that is understandable to him, taking into account his age and state of health, and explaining special medical terms.

47. The information referred to in point 5.7 may be withheld from the patient only in cases where it would be detrimental to the patient’s health or endanger his/her life or where the patient refuses the information in accordance with the procedure laid down in this Law. The decision not to provide a patient with information which may harm the patient’s health or endanger his/her life shall be taken by the attending physician, unless the law provides for a different procedure for such a decision. The decision not to provide information and the reasons for it shall be recorded in the patient’s medical records (outpatient personal health record, F 025/a). In cases where the notice would be likely to cause damage to the patient’s health, all the information provided for in this Article shall be given to the patient’s representative, which shall be equivalent to giving information to the patient. The information shall be provided to the patient when the risk of harm to health is no longer present. The specifics of the right of a patient with mental and behavioural disorders to receive information shall be determined by the Law on Mental Health Care of the Republic of Lithuania.

48. Patient have the right to refuse information about their health. This shall be noted in the patient’s Outpatient Personal Health Record and confirmed by the patient’s signature.

49. A patient may not be treated or receive any other health care or nursing care against his or her will, unless otherwise provided by the laws of the Republic of Lithuania. The patient shall confirm his/her consent or refusal of the services to be provided to him/her by signing his/her Outpatient Personal Health Record. In the event of refusal of services, the attending physician must explain the health risks to the patient or his/her representative and warn him/her of the possible complications.

50. Healthcare services shall be provided to a patient aged 16 years or over only with his or her consent, except in the case of emergency healthcare services where the patient is unable to express his or her own will.

51. Patients aged at least 16 years who are suffering from a list of diseases established by the Government or an authority authorised by the Government shall have the right to receive health care services without revealing their identity. The patient shall pay for healthcare services without disclosing the identity of the person, except for the exceptions provided for by the legislation.

52. The specifics of the treatment of a mentally ill patient who is unable to correctly assess his/her state of health are determined by the Law on Mental Health Care of the Republic of Lithuania.

53. Doctors and nursing staff must respect patients’ personal privacy: a patient has the right to confidentiality of information about his or her health (except in cases provided for by the legislation of the Republic of Lithuania).

54. The patient’s private life is inviolable. Information about the facts of the patient’s life may be collected only with the patient’s consent.

55. The patient has the right to address the administration of the Hospital or Polyclinic on any disputable issues concerning the provision of healthcare services.

56. A patient has the right to compensation for damage caused by a breach of his or her rights in the provision of healthcare. The damage, the conditions and the procedure for its compensation shall be determined by the Law on the Rights of Patients and Compensation for Damage to Health, the Civil Code, and other legal acts in force in the Republic of Lithuania.

57. All necessary information is provided to the patient during his/her visit to the Polyclinic. The information shall be published on the information boards of the Polyclinic, on the website of the Hospital, at the Reception.

VI. RESPONSIBILITIES OF PATIENTS

58. The patient must take care of his/her health, not abuse his/her rights, and cooperate with healthcare professionals and other staff.

59. Patients must provide proof of identity in order to receive healthcare services, except in the case of emergency healthcare.

60. The patient must comply with the established procedure of registration and admission to doctors or other health care specialists, must know the Rules of the Polyclinic and fulfil the obligations specified therein.

61. The patient should immediately inform the receptionists of the polyclinic about any change of address or other contact details.

62. The patient must provide healthcare professionals with information about his or her health, illnesses, operations, medications taken and being taken, allergic reactions, intolerance of treatment methods, genetic inheritance, and any other data known to the patient that are necessary for the proper provision of healthcare services.

63. A patient who has received information about the healthcare services to be provided to him or her shall confirm in writing his or her consent or refusal to the provision of those healthcare services.

64. The patient is obliged to comply with the prescriptions and recommendations of healthcare professionals or to refuse the healthcare services prescribed by law. The patient must inform the healthcare professionals of any deviations from the prescriptions or regimen for which he or she has given consent.

65. The patient shall be obliged to treat all employees of the Polyclinic and other patients with respect and in appropriate manner, and not to violate their honour and dignity.

66. The patient shall be obliged to pay on time for paid services (examinations, consultations, treatment, etc.) in accordance with the rates in force at the time, in accordance with the procedure established by the orders of the Minister of Health of the Republic of Lithuania and the Hospital Director.

67. Patients shall observe public order in the Polyclinic, shall not make noise, shall not throw litter, shall respect the property of the institution, shall not smoke, shall not consume alcohol, narcotic, psychotropic or other psychoactive substances, shall observe personal hygiene, and shall not smoke in the premises and territory of the Polyclinic. It is forbidden to possess cold or firearms, to bring animals on the territory of the Polyclinic.

68. Patients and visitors are prohibited to visit the service premises of the Polyclinic in an unauthorised manner.

69. The patient shall be liable for any damage caused by his/her actions to the Polyclinic or its employees in accordance with the procedure established by the laws of the Republic of Lithuania.

70. A patient who breaches his or her duties, thereby endangering his or her own and other patients’ health and life, or interferes with their access to quality health care, may have his or her health care terminated, unless life of the patient would be endangered.

VII. PROCEDURE FOR PROVIDING INFORMATION TO THE PATIENT AND/OR HIS/HER REPRESENTATIVES ABOUT HIS/HER STATE OF HEALTH

71. All information about health status of the patient, prognosis and treatment, and information of a personal nature is confidential, even after death of the patient. The right to receive information after death of the patient shall have their heirs by will and by operation of law, and spouse/partner, parents, children.

72. If the request of the patient is justified, inaccurate, incomplete, ambiguous data in the medical records, or data that are not related to the diagnosis, treatment or care, shall be corrected, supplemented, completed, deleted and/or replaced by the attending physician within 15 working days. A dispute between a doctor and a patient concerning the correction, addition, completion, cancellation and/or amendment of entries in his/her medical records shall be settled by the Director of the Hospital.

73. Information on the state of health of a patient who cannot be considered to have the capacity to make a reasonable assessment of his/her own interests shall be provided to the patient’s spouse, cohabitant (partner), parents (adoptive parents) and adult children at their request. If the persons indicated are not available or cannot be contacted as soon as necessary, information on the state of health of a patient who cannot be considered to have the capacity to make a reasonable assessment of his/her own best interests shall be provided to one of the patient’s adult brothers (sisters) or one of the patient’s adult grandchildren, or one of the patient’s elderly grandparents, upon request. Without prejudice to the rights conferred on other persons, these persons shall, with the consent of the doctor(s) responsible for the patient.

74. The medical records of a minor patient under the age of 16 years and of a minor patient over the age of 16 years who cannot be considered to be capable of exercising a reasonable judgement in his/her own interests shall be accessible to his/her legal representatives: a parent (adoptive parent), guardians, custodians, who shall provide a document certifying their representation.

75. Patient information is not provided over the phone.

76. Confidential information may be disclosed to other persons only with the written consent of the patient, stating the basis for the disclosure and the purposes for which it is to be used, unless the patient has indicated in the medical records, by signature, the specific person entitled to receive the information, as well as the scope and timing of the disclosure of such information. The patient shall have the right to specify the persons to whom confidential information may not be provided. Confidential information may be provided to persons directly involved in the treatment or care of the patient, without consent of the patient, where and to the extent necessary to protect interests of the patient. Where the patient is considered to be incapable of making a reasonable assessment of his/her own interests and his/her consent is lacking, confidential information may be provided to the representative of the patient, spouse, cohabitant/partner, parent(s)/adoptive parent(s), or adult child (children) at his/her request, in so far as it is necessary to protect the patient’s interests. If the persons indicated are not available or cannot be contacted as quickly as necessary, confidential information may be provided to one of the patient’s adult brothers/sisters or one of the patient’s adult grandchildren or one of the patient’s grandparents, at their request, to the extent necessary to protect the patient’s interests.

77. Before a radiological examination, interventional and/or invasive procedure, or surgery to be performed, the physician shall inform the patient (or his/her representative) of the nature, purpose and course of the procedure/surgery, and of possible complications. Having familiarised himself/herself with the information provided, the patient (his/her representative) confirms his/her consent or disagreement with the procedure/operation by signing the internal forms used in the Polyclinic, which are part of the medical records.

78. The patient (his/her representative) shall also be informed that the Hospital has concluded agreements with higher education institutions (universities, colleges) training health care professionals for the training of students, resident-physicians, and that he/she (the patient (his/her representative) may be involved in the training process with his/her consent.

79. The patient (his/her representative) confirms that the above information has been provided and understood, as well as gives his/her consent/non-consent, by signing the internal use form “Declaration of Will of the Outpatient for the Provision of Health Care Services”, which is a part of the medical documents filled in at the Polyclinic. If the patient (his/her representative) does not agree to participate in the training process or to the use of information about him/her for scientific and educational purposes, he/she shall confirm his/her refusal by signing. In this case, the patient may not be included in the training process and the information contained in the medical records of the patient may not be used for scientific and educational purposes.

80. Information about the patient may be disclosed to other persons only with the written consent of the patient or if provided for by the laws of the Republic of Lithuania. The consent of the patient shall specify the basis for the provision of such information and the purposes for which it is to be used, except where the patient has indicated in the medical records in a signed statement which specific person is entitled to receive such information and the extent and timing of the provision of such information. The patient shall have the right to specify the persons to whom confidential information may not be provided.

81. The staff of the Polyclinic shall provide information to the patient (his/her representative) orally within the limits of their competence. Written information shall be provided on information boards and in the consulting rooms. The provision of information shall in all cases comply with the principles of reasonableness, fairness and protection of the patient’s rights and interests.

VIII. PROCEDURE FOR MAKING COPIES OF OUTPATIENT PERSONAL HEALTH RECORDS AND OTHER DOCUMENTS, FOR ISSUING THEM TO THE PATIENT (REPRESENTATIVE), TO PUBLIC AUTHORITIES AND OTHER BODIES OR TO OTHER NATURAL AND LEGAL PERSONS

82. The personal health record (Outpatient Personal Health Record, F 025/a) is a document of the institution and is kept at its reception or archives. Neither the patient nor other persons have the right to keep (store) or remove this document from the Polyclinic.

83. The information contained in the personal health record (Outpatient Personal Health Record, F 025/a) is confidential and may only be consulted by authorised persons.

84. Upon presentation of identity documents, copies of the medical documents of the patient, certified by the Polyclinic, as well as descriptions of the diagnosis and treatment shall be made and issued at the patient’s expense upon his/her request. This right of the patient may be restricted only in accordance with the procedure established by the laws of the Republic of Lithuania. The price of this service shall be determined by order of the head of the institution, in agreement with the founder.

85. The patient shall have the right to receive copies of his/her medical records, made at his/her own expense, not later than within one working day from the date of the written request of the patient to the Polyclinic.

86. In the event that the Polyclinic does not have the requested written information (does not have medical documents about the patient and the services provided to him/her), it shall inform the applicant in writing no later than within 5 working days from the date of receipt of the request for information and shall refund the payment for the service.

87.State institutions, which are entitled by the laws of the Republic of Lithuania to receive copies and transcripts of medical documents without the consent of the patient, shall be copied by the Chief Specialist of the Polyclinic at the expense of the Hospital and shall submit them together with the accompanying letter, signed by the Director of the Hospital (or his/her authorised person), in accordance with the requirements of the laws of the Republic of Lithuania and other normative acts.

88. Copies (or transcripts) of medical documents required for the purpose of sending a patient for examination, consultation or treatment to another medical institution shall be made at the expense of the Hospital.

89. When a patient is transferred to another medical institution, his/her Outpatient Personal Health Record shall be sent to that medical institution in accordance with the written request of the latter.

90. Except for the cases provided for in the legislation, the Request shall be accompanied by the written consent of the patient to provide information about him/her to the institution requesting information about the patient (the original of the patient’s consent or a copy of it certified by a notary public or another person in accordance with the procedure established by the legislation of the Republic of Lithuania) that complies with the following requirements:

90.1. expressed in written form (either as a separate paper document printed (written) and signed by the patient, or as an electronic document created by the patient and signed with a qualified electronic signature);

90.2. the name and surname of the patient, personal identification number (if the patient does not have a personal identification number, the date of birth) of the patient;

90.3. specify for what purpose and what specific information about the patient would be provided, with the consent of the patient, to the authority requesting the patient information;

90.4. the period of validity of the consent of the patient and the right of the patient to withdraw consent at any time.

91. Patient information may be provided without the consent of the patient:

91.1. to healthcare facilities where the patient is or has been treated, cared for, undergoes a health assessment or registers for healthcare services;

91.2. to the authorities controlling the provision of healthcare services;

91.3. to the incapacity review commissions to carry out their functions;

91.4. to the court, office of the prosecutor, pre-trial investigation bodies, the State Child Rights Protection and Adoption Service under the Ministry of Social Security and Labour, and other institutions, which are entitled to act so in accordance with the laws of the Republic of Lithuania.

IX. PROCEDURES FOR RESOLVING DISPUTES AND CONFLICTS BETWEEN THE INSTITUTION AND PATIENTS

92. A patient who believes that his/her rights have been violated shall have the right to lodge a complaint in accordance with the requirements of the content and form of the procedure for handling complaints of the patients, as laid down in the Law on the Republic of Lithuania on the Rights of Patients and Compensation for Damage to Health.

93. A complaint can be lodged by the patient or their representative. A complaint shall be considered if it is written in the official (Lithuanian) language, signed by the patient, containing the name and surname of the patient, actual place of residence and contact details, and stating the substance of the complaint. If the complaint is lodged by a representative of the patient, the name and surname of the representative, his/her place of residence, the document certifying the representation and the patient on whose behalf he/she is making the complaint shall be indicated. Complaints that are illegible and do not meet the requirements specified shall be returned to the patient, with the reason for the return.

94. The patient must provide proof of identity in the complaint. Where such a complaint is sent by post or courier, it shall be accompanied by a copy of the identity document of the applicant certified by a notary public or a lawyer representing the patient. The representative of the patient shall provide proof of identity and representation when requesting such information.

95. A complaint submitted by a patient (his/her representative) electronically and signed with an electronic signature shall be treated as a complaint submitted in writing. A patient (his/her representative) may submit a complaint electronically to the e-mail address (info@vmkl.lt) of the Hospital.

A complaint submitted electronically must be submitted in such a way that the Hospital, upon receipt of the complaint, can:

95.1. recognise the format of an electronic document;

95.2. to open and process it by means of the electronic document management system or other information technology tools used by the Hospital;

95.3. recognise the content of the request;

95.4. identify the electronic signature and the person making the request.

96. A complaint submitted by electronic means, where the format of the electronic document cannot be recognised, where it cannot be opened and processed by the electronic document management system or by any other means of information technology used by the institution, or where the content of the request cannot be recognised, shall be returned to the complainant by electronic means (e-mail), indicating the reason for the return, not later than the next working day. A complaint submitted electronically where the electronic signature and the person submitting the request cannot be identified shall not be examined, unless the Director of the hospital decides otherwise.

97. The Director of the hospital shall appoint a responsible person to investigate the complaint, set up a committee or instruct an audit team to carry out an unscheduled internal medical audit.

98. Upon receipt of a duly lodged complaint from a patient (his/her representative), the hospital must investigate the complaint and notify the patient (his/her representative) in writing of the outcome of the investigation within 20 working days at the latest.

99. The Hospital Outpatient Clinic shall only address complaints of the patients (their representatives), the handling of which is within the competence of the Outpatient Clinic. If the examination of the information provided in the complaint is not within the competence of the Polyclinic, the complaint shall be returned to the applicant not later than within 3 working days from its receipt, indicating the reason for not examining the complaint.

100. A complaint with which the same person repeatedly applies to the Hospital or Polyclinic on the same issue (for the same reason) shall not be examined unless new circumstances are stated which form the basis of the complaint or additional arguments are presented which rise doubt on the validity of the previous reply to the applicant. Where a repeated complaint is not investigated, the Hospital shall inform the complainant within 5 working days of receipt of the complaint why his/her complaint is not investigated.

101. If a patient (his/her representative) is not satisfied with the handling of his/her complaint at the Hospital or Polyclinic, he/she has the right to apply to the state institutions dealing with complaints of the patients (his/her representative), i.e. the complaint of the patient must first be addressed in the Hospital, and then the patient (his/her representative) is entitled to apply to the other institutions to have his/her complaint handled.

102. Complaints (requests) of the patients may be submitted to the administration of the Polyclinic orally. Oral complaints/requests shall be accepted only in cases when they can be addressed immediately, without prejudice to the interests of the applicant and the institution. An applicant who disagrees with the outcome of the oral complaint (request) may submit his/her complaint (request) in writing.

103. The patient has the right to lodge a complaint no later than one year after becoming aware that his or her rights have been infringed, but no later than three years after the date of the infringement.

104. Anonymous complaints are not addressed.

X. PROCEDURE FOR REFERRING A PATIENT TO AN INPATIENT TREATMENT FACILITY

105. The appropriateness of a treatment of the patient in an inpatient facility is determined by the attending physician.

106. In the event of a need to treat a patient in an inpatient treatment facility, the doctor, in accordance with the procedure laid down by the Minister of Health of the Republic of Lithuania, shall fill in a referral form (Extract of Medical Documents/Referral, F 027/a) and give it to the patient or the representative of the patient. The referral may be completed electronically. The patient goes with this referral to the medical institution of his choice.

107. A patient with a referral may go to a recommended inpatient healthcare facility or freely choose any other healthcare facility of the appropriate level.

108. If the patient refuses to go to an inpatient treatment facility, the doctor shall record this in the personal health record of the patient (Outpatient Personal Health Record, F 025/a). The patient or his representative shall certify this by his signature.

109. In case of deterioration of the patient’s condition, when inpatient care is necessary, the staff of the Polyclinic shall transport the patient in a wheelchair or on a stretcher (according to the indications or as prescribed by the doctor) to the Admission-Emergency Department 2 of the Hospital, and in case it is necessary to urgently hospitalise the patient to another institution, the Ambulance (GMP) shall be called to transport the patient.

XI. GENERAL PROVISIONS GOVERNING THE INTERNAL PROCEDURES AND OCCUPATIONAL SAFETY OF THE POLYCLINIC

110. The territory and premises of the polyclinic must be clean, tidy and regularly cleaned.

111. Smoking, the use of tobacco products and electronic cigarettes is prohibited on the premises of the polyclinic and its territory.

112. The working environment and workplaces in the Polyclinic shall comply with the requirements of the Law on Occupational Safety and Health of the Republic of Lithuania, the Labour Code of the Republic of Lithuania, and other occupational safety and health legislation.

113. Employees of the Polyclinic are forbidden to be drunk or under the influence of alcohol, narcotic or toxic substances in the Polyclinic.

114. The use of mechanical and electric scooters is prohibited on the premises of the Hospital Polyclinic.

115. The employees of the polyclinic must use their working tools, transport, electricity and other material resources rationally and economically.

116. The electronic communications, software, office equipment, telephone connections and stationery and other tools of the Polyclinic may be used by staff only for work-related purposes.

117. Personal health care professionals and receptionists must work in clean and tidy medical working clothes.

118. Employees of the polyclinic are obliged to observe work discipline, to come and go from work on time, and to interact with employees, visitors and patients in a respectful and business-like manner.

119. Clinic staff must ensure that unauthorised persons are present in their workplace only when the staff member is present.

120. Clinic staff can only start work when the equipment is in good working order and the workplace is properly organised. The last employee to finish work in the room shall tidy the work area, switch off electrical appliances, close windows and lock the premises.

121. During working hours, employees of the Polyclinic must wear valid work certificates issued in accordance with the procedure established by the Director of the Hospital.

122. The employees of the Polyclinic are obliged to ensure the security of personal data of the patients in accordance with the legal acts.

123. Employees of the polyclinic are obliged to immediately inform their line managers of any conflicts or misunderstandings with patients and/or their representatives or other employees.

124. The administration of the institution is not responsible for items left in places other than those designated for that purpose (corridors, waiting rooms, cloakrooms, etc.).

125. Advertising (posters, announcements, verbal advertising, samples) is prohibited in the premises and on the territory of the polyclinic without the express permission of the employer.

126. Persons wishing to film or take photographs in the Polyclinic or its departments must coordinate their activities with the administration of the Polyclinic or Hospital. Representatives of mass media may communicate with a patient and/or film or photograph him/her in the Polyclinic or on its territory only after coordination with the administration of the Polyclinic or the Hospital and after obtaining the consent of that patient.

127. The safety and health of workers at the hospital shall be the responsibility of the person representing the employer, the Director of the Hospital, who shall ensure that the working conditions of workers are safe and healthy in all aspects of their work.

128. The Occupational Safety and Health Department is established in the Hospital, and in carrying out its functions, it is guided by the Occupational Safety and Health Law of the Republic of Lithuania, other legal acts regulating occupational safety and health, the occupational safety of the Hospital and health normative documents, and the Regulations of the Occupational Safety and Health Department of the PI Vilnius City Clinical Hospital.

129. The heads of the departments who implement occupational safety and health requirements shall be appointed as persons authorised by the employer for occupational safety and health in the structural units of the Hospital by order of the Director.

130. The hospital provides briefings on occupational safety and health issues in accordance with established procedures.

131. The hospital organises compulsory health checks for staff and provides facilities for health checks during working hours. Refusal to do so shall result in suspension from work and non-payment of wages for the period of time during which the health check is required. On the basis of the findings of the health check, workers may be reassigned to another job with their agreement. Pregnant women, women who have recently given birth or women who are breastfeeding are provided with a safe working environment.

132. Mild accidents at work are investigated by a bilateral commission, approved by order of the hospital director, consisting of a representative of the employer - a specialist from the Occupational Safety and Health Department - and a representative for the safety and health of workers. The injured worker may be present during the investigation of a workplace accident or an accident on the way to/from work. Any accident at work, on the way to or from work, or incident occurring at work, must be reported immediately to the Head of Unit by the injured worker or by a person who witnessed the accident or its consequences, and to the Occupational Health and Safety Section by the Head of Unit.

133. The hospital organises occupational risk assessments to determine the occupational safety and health status of its units and individual workplaces. If the situation is found not to comply with the requirements laid down in regulatory legislation, the implementation of the necessary measures to eliminate and/or reduce the risks shall be organised.

134. All staff of the Hospital are provided with safe working equipment. The mandatory safety requirements and conformity assessment procedures for work equipment shall be laid down in the relevant technical regulations (medical standards for medical devices). Particular attention shall be paid to the protection of employees against exposure to hazardous chemicals and preparations and biological agents.

135. According to the procedure for the determination of drunkenness or intoxication of employees, approved by the Director of the Hospital, if an employee is found to be drunk or intoxicated at work, he/she shall be immediately suspended from work, shall not be allowed to continue working, and shall not be paid any wages for the day on which he/she was found to be drunk or under the influence of narcotic drugs or toxic substances.

136. Any worker who violates the mandatory requirements of occupational safety and health legislation to which he or she has been made aware shall be liable to the penalties laid down by law.

XII. FINAL PROVISIONS

137. The Internal Rules of Procedure of the Polyclinic shall come into force from the date of their approval for all employees, patients, visitors of the Polyclinic.

138. The Rules are published on the bulletin boards of the Polyclinic and on the website www.vmkl.lt.

139. The Rules may be amended and/or supplemented in the event of changes in the organisation of the work of the Polyclinic or in the legal acts related to these Rules.

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Prepared by

Mečislovas Barkus, Medical Auditor

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