Customer service: I-IV 8:00-20:00, V 8:00-18:00

+370 663 00 000

Internal rules of procedure

I. GENERAL PROVISIONS
1. “Gemma sveikatos centras” UAB (hereinafter – the Institution), company code 301240955, business address: Bistryčios g. 13, Vilnius, is an institution providing outpatient and inpatient health care services in accordance with the Constitution of the Republic of Lithuania, the Civil Code of the Republic of Lithuania, Government resolutions, Law on Health Care Institutions, Law on the Rights of Patients and Compensation for the Damage to their Health and other laws of the Republic of Lithuania, orders of the Minister of Health and other legislation, Institution’s Articles of Association and these Internal Rules of Procedure (hereinafter – the Rules).
2. The Rules were prepared in accordance with the requirements of Article 46 of the Law on Health Care Institutions of the Republic of Lithuania and they shall establish the general principles and norms of relations between the employees, patients and their representatives as well as their behaviour.
3. The Institution shall engage only in the activities specified in its Articles of Association and its license (Health Care Institution License No. 3254 of 15 July 2009).
4. The Institution provides health care services reimbursed from the funds of the Compulsory Health Insurance Fund (hereinafter – CHIF) (hereinafter – Free Services) as well as health care and other services which are not reimbursed from the funds of the CHIF (hereinafter – Paid Services).
5. The employees of the Institution have the right to deviate from these Rules, if in a specific case the compliance with the Rules would be contrary to the interests of the patient. Any deviation from these Rules must be noted in the medical records of the patient or other documentation.
6. All employees of the Institution, patients, their representatives and other persons on the territory or premises of the Institution must follow these Rules.
7. The Rules shall be published on the website of the Institution and on its premises. What is more, every patient shall have access to it.
8. During the provision of services and the communication process with the patients, the employees of the Institution must follow the provisions of the Code of Professional Ethics of Lithuanian Doctors, Code of Professional Ethics of Nurses as well as other national and international codes of conduct (hereinafter – the Codes of Conducts) and related internal documents of the Institution.
9. The territory of the Institution can be monitored by video surveillance cameras (only in places marked with special signs).
10. Key terms used in the Rules:
10.1. patient – a person who is a client of the Institution and uses the services provided by the Institution;
10.2. representative of the patient – a representative of the patient under the law (parents, adoptive parents, guardians, carers) or a representative under a power of attorney. In case an adult patient cannot be considered capable of intelligently assessing his/her own interests and neither the social care or guardianship has been established for him/her, all obligations of the Institution shall be fulfilled in respect of a person who was authorized in writing by the patient to act on his/her behalf. If there is no such authorized person or if the authorized person has not taken the necessary actions, the obligations must be fulfilled in respect of the patient’s spouse or cohabiting partner, unless they refuse. If there is no spouse or cohabiting partner, the obligations shall be fulfilled in respect of the patient’s parent or child, unless they refuse;
10.3. direct contact service – the method of providing health care services, when a doctor or other health care specialist and the patient are physically together in the same room of the Institution.
10.4. All other terms used in the Rules shall be understood as they are described in the legal acts of the Republic of Lithuania regulating the provision of health care services.

II. PROCEDURE OF PATIENT APPLICATION TO THE INSTITUTION
11. In order to receive information about health care services provided by the Institution, the procedure and scope of provision of Free Services, the prices and scope of Paid Services as well as the possibility to receive them independently, legal entities and natural persons can contact the employees of the customer service department of the Institution in writing (including email), directly or by calling 8 663 00000.
12. Health care specialists (as necessary) provide health care services to the patients according to their work schedules.
13. Patients can be registered for direct contact services by calling 8 663 00000 or upon their arrival at the Institution.
14. When a patient contacts the Institution by phone, the patient’s identity is determined by asking for the patient’s name, surname, date of birth, the last 4 digits of his/her personal number, contact details and in case the representative of the patient applies – the basis of representation. Telephone conversations with the patient or the representative of the patient are recorded and the patient or his/her representative shall be informed about this by an automatic message before the conversation begins. The patient or his/her representative may not give his/her consent for the recording of the conversation and in such event the patient must arrive at the Institution. Telephone conversations are recorded in order to ensure the appropriate quality of the provision of health care services.
15. In case the patient arrives at the Institution, he/she is asked to provide a personal identity document, if the patient is being registered by his/her representative, the representative is asked to specify patient’s name, surname, date of birth, the last 4 digits of the patient’s personal number, contact details, to provide a personal identity document of the representative and to specify the basis of representation.
16. Upon arrival, the patient must have (mandatory if the patient is applying for Free Services) an electronically issued Extract from Medical Case/Referral (Form E027, hereinafter – the Referral). The Referral is not mandatory in case the patient applies for the provision of Paid Services.
17. During the registration, the employees of the customer service department of the Institution provide the patient with the information about the health care specialists working at the Institution, their qualification, work schedule, type of services and prices. The patient shall rely on the recommendations of a health care specialist and his/her own decisions when choosing specific services.
18. Persons insured with state health insurance in other countries of the European Union, the European Economic Area and the Swiss Confederation shall present a European Health Insurance Card (hereinafter – the EHIC), a certificate replacing the EHIC or a structured electronic document (hereinafter – SED) S2 (or Form E112 or SED S010) which entitles them to receive the planned reimbursable services, medicines and medical aids specified in this document; document S3 (or SED S0008) which enables them to continue the treatment started in Lithuania, the costs of which are paid from the funds of CHIF.
19. The patient is reminded in advance about the planned visit to the wellness (rehabilitation) centre of the Institution. It shall be done by SMS, phone call or email (if the patient provided his contact details):
19.1. patients must arrive at the Institution 10 minutes before the scheduled visit time. If a patient is more than 15 minutes late, he/she may not be admitted;
19.2. if, due to important circumstances, the health care specialist consults the patient for a longer period of time than the time allotted for that patient, other patients shall be admitted at a later time than the time specified during the registration. We aim that the registered patient would be admitted no later than 15 minutes after the time specified during the registration. The customer service department or other employees shall inform the patient orally about the delay.
19.3. If a patient is registered for a specific time and the Institution wants to change it on its own initiative, the new appointment time shall be agreed on with the patient. The patient must be informed about the new time of his/her visit no later than 12 hours before the start of the planned visit. The before mentioned notice period may not be applied in cases where the health care professionals working in the Institution get sick, etc.;
19.4. if the patient cannot arrive to the Institution at the appointed time, he/she must inform the Institution in advance (no later than 24 hours before the start of the appointed visit) by calling or personally coming to the Institution and (if he/she wishes) agree on another visit time.
20. When the patient is being hospitalized at the nursing centre of the Institution, a treatment contract and its related documents (consents, etc.) shall be prepared while agreeing on all conditions of hospitalization in advance. Patients are hospitalized for supportive treatment and nursing or inpatient rehabilitation services:
20.1. when the final diagnosis is established and no further examination is required;
20.2. in case of at least one general indication for the provision of supportive treatment and nursing services and indication in respect of diagnosed illnesses and conditions.
21. General indications for the provision of supportive treatment and nursing services:
21.1. after the treatment and nursing at the patient’s home, when the outpatient care is ineffective;
21.2. after the inpatient treatment in an institution providing a higher level of health care services, when the supportive treatment and nursing is required:
21.3. in cases of prolonged illnesses and conditions when an active inpatient treatment is not required and medical rehabilitation is contraindicated;
21.4. after a brain surgery or other illnesses, when an early medical rehabilitation is not possible;
21.5. when radical treatment cannot be applied for objective reasons;
21.6. after medical rehabilitation, when there is no change in the degree of impairment of the patient’s biosocial functions, but there are indications for symptomatic treatment and nursing;
21.7. in case of negative effects of injuries, poisoning and other external causes, when medical rehabilitation is contraindicated.
22. Patients shall not be admitted to the nursing centre of the Institution without their or their representatives’ consent.
23. The consent of the patient or his/her representative is not necessary:
23.1. when there is a threat to a person’s life and the person himself/herself cannot give such consent;
23.2. when there is a threat to the life of a minor or an incapacitated person and his/her representatives cannot be found quickly;
23.3. in other cases provided for in the laws of the Republic of Lithuania.
24. After completing all registration procedures at the nursing centre of the Institution, a general practice nurse or an assistant of the general practice nurse takes all the documents of the patient being hospitalized and accompanies the patient to his/her room.

III. NOMENCLATURE, RANGE AND PROVISION RPOCEDURE OF FREE AND PAID SERVICES
25. Health care services that the Institution is licensed to provide are specified in the licence which can be found on the website of the State Health Care Accreditation Agency under the Ministry of Health of the Republic of Lithuania (hereinafter – the SHCAA).
26. Free services (except the necessary medical care) are provided in the Institution only after checking whether the person is covered by the compulsory health insurance.
27. Free Services include:
27.1. necessary medical care in accordance with the procedure established by the relevant legal acts of the Republic of Lithuania;
27.2. planned outpatient and inpatient health care services, specified in the agreement between the Institution and the territorial health insurance fund. The services are provided for Lithuanian residents covered by health insurance. Information about specific services (their range), provision procedure, queues, etc., is provided by the employees of the customer service department. What is more, in accordance with the procedure established by the relevant legal acts of the Republic of Lithuania, such information is published on the website of the Institution and the territorial health insurance fund with which the Institution has concluded an agreement.
28. Free Services are provided only in relation to the main illness (due to which the patient is referred for an outpatient consultation or is being hospitalized) in accordance with the agreement concluded with the territorial health insurance fund regarding the payment for services with the funds of the CHIF.
29. No additional fees are required to be paid by the patient for Free Services at the Institution and no additional conditions are imposed for the provision of such services that are not specified in the Rules and related legislation.
30. In case when the Institution exhausts the funds (funds limit) provided for in the agreement with the territorial health insurance fund, the employees of the customer service department shall inform the patients that they are temporarily unable to provide certain planned treatment services free of charge.
31. Paid Services:
31.1. all health care and other services listed in the price list of the Institution, except the Free Services;
31.2. all health care and other services listed in the price list of the Institution, when the patient is not covered by the compulsory health insurance or applies without having the Referral;
31.3. health care and other services requested by the patient at his/her own discretion (without the Referral);
31.4. health care and other services for citizens of foreign countries, except the cases specified in these Rules;
31.5. the patient requests to receive health care services without the order of priority and is informed under signature of his/her right and the possibility to receive such service free of charge in order of priority;
31.6. health care services which are provided without revealing the identity of the person, except in cases established by the legal acts of the Republic of Lithuania;
31.7. additional (for greater comfort, etc.) non-health care services in the nursing centre of the Institution.
32. In case when patients are covered by compulsory health insurance and when the base prices for health care services are reimbursed by funds from the CHIF, the difference between the prices of more expensive services, materials, procedures chosen on their own initiative (after familiarizing themselves and signing the forms of the relevant documents approved by the Institution) and the base prices of free services, materials and procedures shall be paid by the patient themselves.
33. Paid Services are provided in accordance with the procedure approved by Director-General, payments for them shall be accepted at the cash desk of the Institution (payments can also be made by bank transfer). In all cases, after paying for the services, the patient shall receive a receipt and, if necessary, an invoice.
34. If an advance payment is made for Paid Services, but the patient cancels the scheduled visit in accordance with the procedure established in Clause 19.4 of the Rules, the advance payment shall be refunded (after filling in an application) only in case of illness or other significant circumstances (after submitting the documents proving such circumstances).
35. If an advance payment is made for Paid Services, but such services cannot be provided due to the death of the patient, the Institution shall refund the remaining overpayment when the person entitled to collect the overpayment submits:
35.1. a completed application;
35.2. a personal identity document;
35.3. a receipt confirming the payment made;
35.4. a document confirming the certificate of inheritance (when the overpayment is not collected by the representative of the patient).
36. The price list of Paid Services shall be published on the website of the Institution and/or the information about the prices shall be provided by the employees of the customer service department of the Institution (by phone or upon arrival at the Institution).

IV. RIGHTS AND RESPONSIBILITIES OF PATIENTS AT THE INSTITUTION
37. Rights of patients:
37.1. the patient has the right to participate in making decisions about the health care services he/she needs and to receive professional health care services;
37.2. the patient has the right to be cared for in such conditions which would not degrade his/her honour and dignity, while the health care specialist should ensure respectful behaviour towards the patient;
37.3. the rights of the patient shall not be restricted because of his/her sex, age, race, nationality, language, origin, social status, religion, beliefs or opinions;
37.4. patients have the right to be treated with respect for their illness, treatment and care;
37.5. patients must get pain relievers so that they do not have to suffer from their medical conditions;
37.6. the patient must be informed about the name, surname, duties and qualification of a doctor, nurse or other health care specialist treating him/her;
37.7. the patient has the right to receive the information about the services being provided at the Institution, the prices of such services and possibilities to receive them;
37.8. the patient must be informed about the Rules and other procedures as far as it relates to his/her stay at the Institution;
37.9. health care services can only be provided to the patient after receiving his/her consent/expression of will;
37.10. the patient can be included in biomedical research only after receiving the patient’s consent/expression of will;
37.11. representatives of a third party (family members, guardians, translators, health care specialists participating in the educational process at the Institution, etc.) may participate in the provision of health care services;
37.12. the patient has the right to receive information about his/her health condition, diagnosis, medical examination data, treatment methods and the prognosis of the treatment;
37.13. the patient has the right to seek the opinion of another health care professional in respect of his/her health condition and proposed treatment;
37.14. the information must be presented to the patient in a form that he/she can understand and the specific medical terms shall be explained to him/her. When providing information about the treatment, the doctor must explain to the patient the course of treatment, possible results of treatment, possible alternative treatment methods and other circumstances that may affect the decision of the patient to accept or refuse the proposed treatment, as well as inform about the consequences of refusing the proposed treatment;
37.15. the patient has the right to refuse a specific treatment and/or procedure and seek a second clinical opinion, the Institution must respect the choice of the patient;
37.16. the information shall not be given to the patient against his will. The refusal to receive information about his/her health must be clearly expressed and confirmed by the signature of the patient;
37.17. all health care services shall be provided to the patient only after receiving his/her consent, except for the provision of necessary medical care, when the patient cannot express his/her will;
37.18. the patient cannot be treated or receive any other health care services or care against his/her will, unless otherwise established by the laws of the Republic of Lithuania;
37.19. when health care services are to be provided to a patient who cannot be considered capable of intelligently assessing his/her own interests, and the persons specified in the Law on the Rights of Patients and Compensation for the Damage to their Health are not available or have refused to be the representatives of the patient, or there is no way to contact them as quickly as possible or to obtain their consent in a timely manner, the decision on health care services provided to the patient, extent of such services and the choice of alternative methods shall be made by a doctor, and if necessary, by the consilium of doctors, while exclusively taking into account the interests of the patient. The doctor shall justify the decision for calling the consilium in the medical documents of the patient;
37.20. the patient recognized by the court as incapacitated in respect of health care shall be represented by a legal guardian;
37.21. doctors, nurses and other health care professionals must respect the personal privacy of the patient: the patient has the right to the confidentiality of information on his/her state of health (except in cases provided for in the legal acts of the Republic of Lithuania);
37.22. the private life of the patient shall be inviolable. Information concerning the facts of the patient’s personal life may be collected only with the consent of the patient and in case it shall be deemed necessary for diagnosing illness, treatment or nursing;
37.23. if the continued accommodation of the patient at the Institution is not medically justified, prior to discharge from the health care institution and sending a patient home or transferring him/her to another health care institution, the patient or his/her representative (in the cases established by the legislation) must be provided a thorough explanation of the grounds for such a decision and the continuity of further health care;
37.24. the patient has the right to apply to the Institution in writing, by email, by phone, as well as leave feedback on all issues that have arisen by sending an email to kokybe@gemma.lt;
37.25. the patient has the right to compensation for the damage caused by violating his/her rights while providing health care services;
37.26. all the necessary information is provided (available) to the patient during his/her stay at the Institution. The information is published on the website of the Institution, provided in the customer service department as well as in wellness (rehabilitation) and nursing centres;
37.27. the patient has the right to apply to the Institution with a request to provide information on whether the Institution processes his/her personal data and, if so, to get access to such data;
37.28. the patient has the right to apply to the Institution with a request to have his/her personal data rectified and/or to object to the processing of such personal data, except for storage, in the event it is determined that the personal data is incorrect, incomplete or inaccurate;
37.29. the patient has the right to apply to the Institution with a request to erase his/her personal data (or restrict the processing of personal data), which is processed only with the consent of the patient, provided that the patient withdraws such consent. This right cannot be exercised if the personal data that is requested to be erased is also being processed on another legal basis;
37.30. the patient has the right to receive the personal data provided by him/her, which is processed on the basis of his/her consent or for the purposes of fulfilling an agreement. The patient can receive such personal data in writing or in a commonly used electronic form, and if possible, such data can be transferred to another service provider (data portability);
37.31. the patient has the right not to give consent to the processing of his/her personal data if the basis for such processing is legitimate interests, including profiling for direct marketing purposes;
37.32. the patient has the right to withdraw his/her consent regarding the processing of personal data for the purposes of direct marketing at any time;
37.33. the patient has the right to address issues related to data protection directly to the Institution by submitting a written request in person, by mail, through a representative or by means of electronic communication (by email) as well as orally (by phone). The Institution examines the requests of the patients regarding the rights of data subjects free of charge. The request may be refused or an appropriate fee may be charged, if it is clearly unfounded or disproportionate as well as in other cases established by the legislation. More detailed information about the rights of patients as data subjects and the possibilities to exercise such rights at the Institution is provided in the Privacy Policy or Privacy Notice;
37.34. the patient has the right to apply to the State Data Protection Inspectorate in case it is not possible to resolve issues regarding data protection with the Institution.
38. Responsibilities of patients:
38.1. the patient may not claim any privileges on the basis of his/her sex, race, nationality, language, origin, social status, religion, beliefs or opinions;
38.2. the patient must familiarize himself/herself (under written or electronic signature) with the Rules and other documents provided by the Institution as well as fulfil the responsibilities specified in such documents;
38.3. the patient must take care of his/her health, exercise his/her rights honestly and without abusing them as well as cooperate with the employees of the Institution;
38.4. the patient must provide health care specialist with information about his/her health, illnesses, surgeries performed, medications, allergic reactions, genetic heredity and other data known to the patient which is necessary to properly provide health care services;
38.5. after the patient receives the information about the health care services which shall be provided to him/her, the patient must confirm (under written or electronic signature) his/her consent or refusal to the provision of such health care services in accordance with the laws of the Republic of Lithuania;
38.6. the patient must comply with the appointments and recommendations of a health care specialist or refuse the appointed health care services. The patient must inform the health care professional about any deviations from the appointed health care or prescribed regime, for which the patient gave his/her consent;
38.7. the patient must treat all the employees of the Institution and other patients with respect and appropriate behaviour;
38.8. the provision of health care services may be terminated in respect of the patient who violates his/her responsibilities and in this way endangers the health and life of his/her own as well as other patients, or prevents other patients from receiving high-quality health care services, except in cases when such termination of services would be a threat to the patient’s life;
38.9. to cooperate with the health care specialist who has appointed or provides health care services, to follow prescribed appointments and recommendations;
38.10. to pay for Paid Services on time and based on the rates valid at the Institution at that time;
38.11. to comply with personal hygiene requirements as far as the state of the patient’s health allows;
38.12. to properly use the equipment and inventory of the Institution, respect the property of the Institution;
38.13. patients are not allowed to film, photograph of otherwise violate the privacy of the employees, patients or the premises of the Institution without having the corresponding permission;
38.14. patients and visitors of the nursing centre of the Institution shall be held responsible for the damage caused to the Institution or its employees in accordance with the procedure established by the laws of the Republic of Lithuania.

V. PROCEDURES FOR VISITING, DISCHARGING AND TRANSFERRING PATIENTS TO ANOTHER HEALTH CARE INSTITUTION
39. Drunk or otherwise intoxicated as well as aggressive visitors shall not be allowed in the Institution.
40. Persons suffering from acute contagious infectious diseases are prohibited from visiting patients.
41. Patients of the nursing centre of the Institution can only be visited in accordance with the procedure or rules established by Director-General of the Institution. Due to the specifics of the activities of the Institution, visitation may be limited and a different visiting procedure may be established. What is more, visitors must comply with specific requirements regarding the footwear, clothing and the use of disinfectants. Visitors must follow reasonable instructions of the employees of the Institution.
42. The patient, who cannot be considered capable of intelligently assessing his/her own interests, can be visited by the spouse (cohabiting partner), parents (adoptive parents) and adult children at their request and with the consent of the doctor(s) responsible for the patient, without limiting the rights granted to other persons. The person who wants to visit the patient shall submit his/her personal identity document and indicate the relationship with the patient.
43. Visitors are not allowed in the room during the visits carried out by a health care specialist as well as during the procedures performed on the patient in the room, except in case where the assistance of the person caring for the patient is needed.
44. Visitors must remain calm and follow the procedures and instructions provided by the employees of the Institution as well as respect the rights and privacy of other patients.
45. Visitors are not allowed to bring alcoholic beverages, tobacco, narcotic, psychotropic and other psychoactive and prohibited substances, non-recommended foods and medications to the patients.
46. Food products brought to the patients must be fresh, properly packed, the employees of the Institution must be informed about perishable foods.
47. Visitors may be warned if they violate the procedure for visiting the patients, and in case the visitors do not obey, they shall be asked to leave the premises or territory of the Institution.
48. Patients are discharged from the Institution:
48.1. after completing the intended treatment, nursing or other health care plan;
48.2. in order to continue treatment on an outpatient basis;
48.3. in order to continue health-restoring or rehabilitation;
48.4. in order to transfer the patient to another health care institution;
48.5. for violating the Rules, after arbitrarily leaving the nursing centre, while taking into account the requirements of the relevant legal acts of the Republic of Lithuania;
48.6. at the request of the patient. Such request shall be recorded in the medical history of the patient and confirmed under his/her signature, the doctor treating the patient or the doctor on duty is responsible for providing the medical history to the patient;
48.7. in other cases established by legal acts of the Republic of Lithuania.
49. if the continued accommodation of the patient at the Institution is not medically justified, prior to discharge from the health care institution and sending a patient home or transferring him/her to another health care institution, the patient or his/her representative must be provided a thorough explanation of the grounds for such a decision and the continuity of further health care. The receipt of such information shall be confirmed by the signature of the patient or his/her representative. When a patient, who during his/her hospitalization cannot be considered capable of intelligently assessing his/her own interests, is being discharged from or transferred to another health care institution, the information specified in this part must be provided to the representative of the patient, if such person is indicated in the medical documents of the patient or if the representative submits to the Institution the document confirming representation, which shall meet the requirements of the legislation. The patient or the representative of the patient shall confirm the receipt of the information by signing the documents provided by the Institution.
50. The patient may be referred to another health care institution if the medical condition of the patient, in the opinion of the treating doctor, requires intensive additional treatment. The transfer of the patient must be coordinated with the institution to which the patient is referred to, the doctor shall issue a Referral and inform the patient.
51. If, in the opinion of the treating doctor, the health condition of the patient does not require intensive additional treatment, the treatment shall be continued at home or at a care institution in outpatient conditions, while following the coordinated treatment and care plan.
52. When the patient is being discharged, all medical documents required in a specific case shall be prepared and given to the patient. The documents can be given to the patient when the patient leaves for home or they can be sent by email provided that the patient gave his/her consent. The information regarding the security of personal data shall be encoded by technical means.
53. In the event of a patient’s death, the employees of the Institution inform the family members and legal representatives of the deceased no later than 2 hours after the patient’s death.
54. 2 hours after the patient’s death, the body of the deceased is transferred to the company providing funeral services which has been chosen by the relatives of the patient.
55. A medical death certificate shall be issued no later than on the new business day after the death of the patient in the nursing centre of the Institution.

VI. PROCEDURE FOR RESOLVING DISPUTES AND CONFLICTS BETWEEN THE INSTITUTION AND PATIENTS
56. The patient has the right to file a complaint with the Institution, if he/she believes that his/her rights have been violated. It shall be done no later than one year from the day when the patient becomes aware of the fact that his/her rights have been violated, but no later than 3 years from the day of the violation of rights, except in cases, when damage has been caused due to the violation of the patient’s rights. In order to receive compensation in accordance with the procedure established by the Law on the Rights of Patients and Compensation for the Damage to their Health of the Republic of Lithuania, the patient must apply to the Commission for Determining the Damage to the Health of Patients operating under the Ministry of Health of the Republic of Lithuania. It shall be done no later than within 3 years from the day when the patient becomes aware or should have become aware of the damage and in accordance with the Description of the Procedure for Compensating Material and Non-Material Damage Caused by Damage to the Patient’s Health, approved by the government.
57. Complaints can be submitted directly (upon arrival at the Institution) or at a distance (by registered mail, via couriers, sent by email, other means of electronic communication which ensure the possibility of determining the identity of the person making the complaint). The complaint must include the rights of the patient, which he/she believes the Institution has violated, the circumstances justifying this and the demands of the patient to eliminate the violation of his/her rights. The complaint must be submitted together with the accompanying documents (if the patient has such documents) confirming the circumstances stated in the complaint and justifying the requirements specified. If the complaint is being submitted by the representative of the patient, the document certifying the representation shall also be submitted.
58. If not all documents or improperly formalized documents, which shall be submitted together with the complaint, are submitted and/or such documents and/or the complaint contains incomplete and/or inaccurate information, the Institution, no later than within 3 business days from the date of receipt of the complaint at the Institution, shall indicate the identified lack of documents or information to the person who submitted the complaint and shall inform the person that the complaint will not be examined if the deficiencies are not eliminated within 30 days from the day of informing the person who submitted the complaint and that the patient has the right to submit a complaint to the Institution again.
59. Complaints shall not be examined and shall be returned to the person who submitted them while specifying the reasons for the return in the following cases:
59.1. when not all documents or improperly formalized documents, which shall be submitted together with the complaint, are submitted and/or such documents and/or the complaint contains incomplete and/or inaccurate and the person who submitted the complaint did not fulfil the requirement to correct the deficiencies within the specified deadline;
59.2. the complaint is illegible.
60. The patient having the complaint regarding the defence of his/her violated rights related to the availability and quality of health care services has the right to apply to the SHCAA; regarding the defence of patient’s violated rights related to compulsory health insurance issues – to the National Health Insurance Fund under the Ministry of Health of the Republic of Lithuania. Regarding the defence of patient’s violated rights related to the compliance of health care services with bioethics requirements – to the Lithuanian Bioethics Committee. The patient has the right to apply to the above-mentioned institutions only if he/she does not agree with the decision made by the Institution in which, in his/her opinion, the rights of the patient were violated, or in case the complaint of the patient was not accepted for examination at the health care institution.
61. After receiving the complaint of the patient, the Institution shall examine the complaint and notify the patient in writing about the results of such examination no later than within 20 business days.
62. The Institution periodically conducts patient surveys, the patient can also express his/her opinion by email kokybe@gemma.lt.
63. The Institution has approved the Procedure of Complaints Management elaborating the provisions of the Procedure for Resolving Disputes and Conflicts Between the Institution and Patients provided above.
64. Complaints, statements or other observations received without the personal data of the applicant shall be investigated depending on the significance of the stated facts. The decision to examine or not shall be made by Director-General of the Institution or the authorized employee. Responses to such complaints (depending on the circumstances) may not be provided.

VII. PROCEDURE FOR PROVIDING INFORMATION REGARDING THE STATE OF HEALTH OF THE PATIENT TO THE PATIENT AND HIS/HER RELATIVES
65. All information about the patient’s stay at the Institution, health condition, diagnosis, prognosis and treatment as well as other personal information is considered confidential.
66. After the patient submits documents confirming his/her identity, he/she has the right to the information about his/her health condition, diagnosis, other methods of treatment or examinations performed at the Institution or known to the doctor, possible risks, complications, side effects, treatment prognosis and other circumstances that may affect the decision of the patient to accept or refuse the proposed treatments. The patient shall also be informed about the consequences of refusing the proposed treatment, the information shall be provided in a form that is understandable to the patient, while taking into account his/her age and health status, and the specific medical terms shall be properly explained.
67. Information about the patient’s state of health, diagnosis, other methods of treatment or examinations performed at the Institution or known to the doctor, possible risks, complications, side effects, treatment prognosis cannot be provided to the patient against his/her will. The refusal to receive information shall be clearly expressed and confirmed under the patient’s signature.
68. Confidential information can be provided to other persons only after submitting the written consent of the patient, which shall indicate the basis for providing such information and the purposes of its use, except in cases when the patient has specified (under signature) in his/her medical documents the person who has the right to receive such information, the extent of providing such information and deadlines. The patient has the right to indicate persons to whom the confidential information cannot be provided.
69. Persons, who are directly involved in the treatment or care of the patient and examinations, can receive the confidential information without the consent of the patient in cases and to the extent which is necessary to protect the interests of the patient. When the patient is considered unable to intelligently assess his/her own interests and there is no consent submitted, the confidential information may be provided to the representative of the patient, spouse (partner), parents (adoptive parents) or adult children to the extent necessary to protect the interests of the patient.
70. Information about the health status of the patient who cannot be considered capable of intelligently assessing his/her own interests shall be provided to the patient’s spouse (partner), parents (adoptive parents) or adult children upon their request.
71. In accordance with the requirements of the legal acts of the Republic of Lithuania, the information about the patient cannot be provided over the phone.
72. Information about the patient’s health condition, diagnosis, examinations, possible treatment methods and results, treatment prognosis as well as the consequences of refusing the proposed treatment shall be provided to the patient and/or the persons specified in the statement in a clear and understandable form.
73. Information about the condition of patients who are undergoing treatment can be provided by the treating doctor and the doctor on duty.
74. After the patient’s death, the heirs according to the will and under the law (spouse (partner), parents, children) have the right to receive information about the patient’s stay at the Institution, treatment, health condition, diagnosis, prognosis and treatment as well as other personal information.

VIII. PROCEDURE FOR PREPARING AND ISSUING COPIES OF MEDICAL CASE HISTORIES, MEDICAL RECORDS AND OTHER DOCUMENTS TO PATIENTS OR OTHER NATURAL PERSONS AND LEGAL ENTITIES
75. Persons who have the right to receive written information about the patient (copies of medical documents) on the basis and procedure established by legislation, shall submit a written request (signed with a hand-written or an electronic signature) and the written consent of the patient (signed with a hand-written or an electronic signature) to the Institution. The request must specify the nature of the information to be received and the purpose of its use.
76. The patient, who is submitting a request to the Institution regarding the provision of written information (receiving copies), must submit a document confirming patient’s identity. When such request is sent by post or via courier, a copy of a personal identity document certified by a notary or a lawyer representing the patient shall also be submitted. When the patient’s representative is applying for written information, the representative shall provide a document confirming his/her identity and representation.
77. Medical documents are the documents of the Institution and shall be stored at the Institution or its archive.
78. At the request of the patient, he/she shall have the access to his/her medical documents (the documents shall be stored at the Institution). The access to medical documents may be restricted, if the information contained in such documents would harm the health of the patient or endanger his/her life. The decision not to provide medical documents to the patient is made by the treating doctor. The decision not to provide medical documents and the reasons for such decision shall be noted in the medical documents.
79. The patient can access his/her medical document at any time and free of charge by connecting to the Digital Health Services and Cooperation Infrastructure Information System (hereinafter – DHSCI IS).
80. At the request of the patient and upon submitting the personal identity document, the Institution shall prepare and issue copies of the patient’s medical documents approved by the Institution at the expense of the patient. The institution shall also issue descriptions of patient’s diagnosis and treatment. Copies of medical documents shall be issued within 3 business days after the request, while the descriptions of patient’s diagnosis and treatment shall be provided within 10 business days after the request.
81. In accordance with the procedure established by the legislation, the confidential information can be provided to the following institutions without the consent of the patient:
81.1. health care institutions, where the patient is or has been treated, cared for, where his/her health examination is being performed or where the patient registers for health care services;
81.2. institutions controlling the provision of health care services;
81.3. commissions for reviewing the status of incapacitated persons in order to be able to perform the functions of such commissions;
81.4. court, prosecutor’s office, pre-trial investigation institutions and other institutions which have the right to receive such information in accordance with the laws of the Republic of Lithuania;
81.5. confidential information can be provided only upon the written request, which shall indicate the basis for such request, the purposes of use and the extent of the required information. In all cases, the provision of confidential information must comply with the principles of reasonableness, fairness, protection of the rights of the patient and priority of interests. Such information shall be provided by the management of the Institution upon the written request.
82. Copies of medical documents, which are required in case of referring the patient for a consultation and on the basis of certain medical indications as well as transferring the patient to another health care institution or Disability and Working Capacity Assessment Office, shall be provided free of charge.
83. In the event that the Institution does not have the requested written information (it does not have medical documents about the patient and the services provided to him/her), it shall inform the applicant about this in writing no later than 5 business days from the date of receipt of the request for information and shall return the fee for the service to the applicant.

IX. WORKING HOURS OF THE INSTITUTION
84. The working hours of the Institution are published on the website of the Institution and on its premises in order for every patient of the Institution to get access to such information.
85. Working hours of the administration of the Institution:
85.1. Monday – Friday: 8 a.m. – 5 p.m.
85.2. Closed on weekends and public holidays.
86. Working hours of the customer service department of the Institution:
86.1. Monday – Thursday: 8 a.m. – 8 p.m.
86.2. Friday: 8 a.m. – 6 p.m.
86.3. Closed on weekends and public holidays.
87. Working hours of the wellness (rehabilitation) centre of the Institution:
87.1. Monday-Thursday: 8 a.m. – 8 p.m.
87.2. Friday: 8 a.m. – 6 p.m.
87.3. Closed on weekends and public holidays.
88. The nursing centre of the Institution is open every day, 24 hours per day.

X. PROVISIONS OF LAWS, OTHER LEGAL ACTS AND NORMATIVE DOCUMENTS REGULATING WORK SAFETY
89. It is mandatory to comply with work safety, fire and electrical safety requirements, to follow the Law on Safety and Health at Work of the Republic of Lithuania and the provisions of other legal acts related to work safety, the requirements of descriptions of positions and the rules for performing procedures as well as other orders of Director-General of the Institution.
90. Persons on the territory of the Institution must follow the requirements of informative, prohibitory and other signs.
91. Patients and visitors must:
91.1. follow the instructions of the employees of the Institution in respect of safe behaviour, environmental protection and fire protection;
91.2. upon noticing abnormal operation of the equipment in the room (increased noise, vibration, temperature rise, specific smell, etc.) or other factors that may cause risk to health or life, immediately notify the employees of the Institution;
91.3. avoid actions that may endanger his/her health or the life of others;
91.4. take all precautions when moving on surfaces that have recently been wet-cleaned or that have liquid or other materials spilled on them.
92. The following actions are prohibited on the premises and the territory of the Institution:
92.1. consuming alcoholic beverages and tobacco products (smoking);
92.2. carrying a firearm or cold weapon;
92.3. bringing pets;
92.4. filming, photographing the premises, employees and patients, recording conversations or otherwise violating the privacy of employees and patients without the permission of the Institution;
92.5. arbitrarily entering or visiting service spaces of the Institution;
92.6. disturbing public peace and order.
93. The occupational safety specialist or other natural person or legal entity appointed by Director-General of the Institution shall be responsible for ensuring work safety at the Institution.

XI. PROCEDURE FOR REGISTRATION AND STORAGE OF ARTICLES MADE OF PRECIOUS METALS, EXPENSIVE PROSTHESIS AND MONEY OWNED BY THE PATIENT
94. The Institution does not accept for storage and does not register the articles of precious metals, expensive prosthesis, money, mobile phones and/or other material assets owned by the patient.
95. The Institution shall not be held responsible for and shall not guarantee the protection of material assets belonging to the patients or other visiting persons at the premises of the Institution.

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