Internal rules of procedure of the Šeškinė Polyclinic

INTERNAL RULES OF PROCEDURE OF THE

 PUBLIC INSTITUTION ŠEŠKINĖ POLYCLINIC 

(Summary) 

WORKING HOURS OF THE POLYCLINIC 

1. Personal health care services at the Polyclinic are provided from 7.00 a.m. to 8.00 p.m. on Mondays to Fridays. The reception is open from 6.45 a.m. to 8.00 p.m. Patient registration for the same working day closes at 19.40. On weekdays, telephone registration is available from 07.00 to 20.00. The laboratory serves patients on weekdays from 7.00 a.m. to 7.00 p.m.
2. Working hours on Saturdays are from 8.00 a.m. to 4.00 p.m. A family or internal medicine doctor, a paediatrician and a dentist are on duty at the Polyclinic to provide emergency care for acutely ill patients.
3. Medical staff do not serve patients or their representatives during the lunch break. 
4. During the Polyclinic's non-working hours, the services of a general practitioner are provided to insured patients (children and adults) registered at the Polyclinic at the Vilnius City Clinical Hospital. For more information, visit the Polyclinic's website (www.poliklinika.lt). 

THE PROCEDURE FOR REFERRING PATIENTS TO ŠEŠKINĖ POLYCLINIC

1. A patient may seek personal healthcare services without a referral from family, internal medicine, paediatricians and other members of the primary level team, i.e. surgeon, dentist, obstetrician-gynaecologist, psychiatrist, and secondary level specialists, i.e. dermatovenerologist, nurse.
2. A referral is required when registering for a consultation with a specialist.
3. Urgent admission of patients requiring emergency medical care.
4. Personal healthcare services (other than emergency services) that are free of charge to the patient, subject to verification that the person is covered by Compulsory Health Insurance.
5. A patient is registered for one healthcare service of the same type. In the case of a treatment programme, the patient may be registered for all the health services included in the programme.
6. Patients who arrive at the Polyclinic shall apply to the Reception Desk and present a document confirming their identity.
7. Patients can pre-register with primary level doctors (family medicine, internal medicine, paediatricians, surgeons, gynaecologists, obstetricians, dentists, dermatovenerologists) by coming to the Polyclinic's reception desk, by calling by phone or by using the online registration system (e.poliklinika.lt).
8. Patients can pre-register with specialists by coming to the Polyclinic's reception or by calling or using the online registration systems (e.poliklinika.lt or https://ipr.esveikata.lt). In such cases, the patient must have the appropriate referral for the consultation and/or examination (paper, F 027 or electronic, F E027).
9. When registering by telephone for an appointment with a doctor, patients must give either their name and date of birth or their personal identification number to the receptionist.
10. If the patient is unable to attend the appointment at the scheduled time:

• they must inform the reception by telephoning the reception, and may at the same time arrange another appointment time;
• must cancel their online registration and can choose the next available appointment if the registration has been made online.

1. If the patient is not insured by the Compulsory Health Insurance (except in cases of medical emergency) or does not have a referral, they must pay for the doctor's consultation at their own expense at the Polyclinic's Cashier's Office, at the payment terminals or via the Internet according to the current service rates.

ASSIGNMENT OF THE FAMILY PHYSICIAN AT THE POLYCLINIC.

CHANGING  THE FAMILY PHYSICIAN

1. A person wishing to subscribe to the Polyclinic shall apply to the Reception Desk during working hours and, upon presenting their identity document, declare their wish to subscribe to the Polyclinic to receive services of a family physician (primary personal health care). It is also possible to fill in an online application form for these services. The application form is available on the website (www.poliklinika.lt).  
2. If a minor wishes to join the Polyclinic, their birth certificate and the identity document of their representative must be submitted. Applications for minors shall be signed by a parent or, in the absence of a parent, by a guardian.
3. For a minor patient under the age of 18, services are provided by a family or internal medicine doctor. The patient may choose the family physician or the doctor of internal medicine by filling in the Application for treatment in the primary health care institution of choice (form No 025-025-1/a), otherwise the patient shall be assigned a family physician.

PROCEDURE FOR PROVIDING OUTPATIENT SERVICES

1. Šeškinė Polyclinic provides free services, the nomenclature of which is available on the Polyclinic's website (www.poliklinika.lt).
2. The Polyclinic shall provide paid outpatient personal health care services, the provision and payment for which shall be regulated by legal acts and/or orders of the Director of the Polyclinic. Information on paid services is available at the Polyclinic reception desk and on the website (www.poliklinika.lt).
3. Emergency medical assistance is provided to every person coming to the Polyclinic, regardless of their place of residence and health insurance status.
4. The Polyclinic has acquired the status of a Vilnius University Residency Base and conducts a certain amount of residency studies there. Patients of the Polyclinic may be included in the training process in accordance with the procedure provided for by law, by informing them about it.
5. When providing personal healthcare services to patients under 16 years of age, their statutory representative must be present. Such minor patients must not interfere with the staff and, if requested, must be actively involved in the provision of care to them.
6. A minor patient under 16 years of age shall receive healthcare only with the consent of their representatives, except in the case of emergency medical services.
7. 25.  Patients are admitted to personal health care professionals on a scheduled basis at the time specified in the pre-registration. Patients are advised to arrive at the Polyclinic 10 minutes prior to the appointment with the health care professional. The aim is to see the patient no later than within 15 minutes from time specified in the registration.
8. Patients are seen at the appropriate registered time. If a patient is late for an appointment, the appointment shall be curtailed or not guaranteed if it would impair the quality of service to other patients.
9. If, due to important and objective circumstances, the doctor attends to a patient for a longer period of time than the time allocated to that patient, other patients shall be admitted in turn at a later time than the time indicated in the registration. Patients who are waiting shall be informed of the reason for the delay.
10. Only the patient, his/her representative, and the personal healthcare professionals providing the service may be present at the place of service provision (room). Representatives shall not interfere with the professionals providing the service.
11. A third party (family members, guardians, interpreters, persons involved in the training process, etc.) may be present during the patient's visit and participation in intimate examinations (genital, breast, anus, etc.) only with the patient's written consent.
12. Planned services shall not be provided to persons who are drunk or possibly under the influence of narcotic drugs or psychotropic substances (except for emergency medical assistance).
13. In case of suspicion of the patient's sobriety or intoxication by narcotic drugs or psychotropic substances, the staff member providing the service shall offer the patient to be tested for sobriety and/or intoxication by narcotic drugs or psychotropic substances. The patient's refusal to be tested shall be considered as an acknowledgement of the fact of drunkenness and/or corresponding intoxication and shall be recorded in the medical documentation.
14. Personal health record is an electronic document of the Polyclinic, stored in the information system used by the Polyclinic, which is submitted to the Electronic Health Services and Collaborative Infrastructure Information System (hereinafter referred to as ESPBI IS).
15. Paper Outpatient Personal Health Records (F 025/a) are kept at the Polyclinic. Neither the patient nor their representatives shall have the right to keep (store), carry or remove the paper document from the Outpatient Clinic.
16. When referring a patient for consultation with another doctor at the Polyclinic, the doctor writes the visit record/referral (F E025) in the information system of the Polyclinic and submits the data to the ESPBI IS. The nurse working with the doctor agrees with the patient the date and time of their visit to another doctor in the Polyclinic, registers the patient in the Polyclinic information system in the pre-registration section.
17. Before the provision of a remote outpatient personal healthcare service, the patient shall be identified (verified) by asking at least 3 questions related to their personal data. If this is not sufficient or if the patient's identity is in doubt, the healthcare professional shall ask additional questions.
18. If the employee of the Polyclinic cannot reliably identify the patient, they may refuse to provide remote personal healthcare services. In such cases, it is recommended that the person should come to the Polyclinic, after registering for an appointment.
19. If the patient does not consent to the use of personal data for their identification, the remote outpatient personal healthcare service shall not be provided. The patient shall have the right to refuse remote healthcare services.

RIGHTS AND OBLIGATIONS OF PATIENTS (THEIR REPRESENTATIVES)

1. Patients have the rights set out in the Law on Patients' Rights and Compensation for Damage to Health:

• the right to quality healthcare;
• the right to choose your healthcare provider and health professional. In exercising the right to choose a healthcare institution, a patient's right to free healthcare may be restricted in accordance with the procedure laid down by law;
• the right to information about their health and healthcare;
• the right not to know;
• the right to have access to your medical records;
• the right to respect for private life. All information about a patient's stay in a healthcare institution, treatment, health status, diagnosis, prognosis and treatment, as well as any other information of a personal nature about the patient, must be kept confidential after the patient's death. The right to receive information after the patient's death shall be available to heirs by will and by operation of law, spouse/partner, parents, children.;
• he right to anonymous healthcare;
• the right to choose to participate/not participate in biomedical research and training;
• right to redress;
• right to complain;
• the right to choose diagnostic and therapeutic methods and to participate in health care decisions;
• right to refuse treatment;
• the right to be treated with dignity and respect by health professionals.

1. The patient's private life is inviolable. Information about the facts of a patient's life may be collected only with the patient's consent and if it is necessary for the diagnosis, treatment or care of the disease.
2. Data on the patient's state of health and the diagnostic, therapeutic and nursing measures applied to the patient shall be recorded in the patient's electronic medical records in the prescribed format. The patient may access the records of the Polyclinic's healthcare professionals in the information system esveikata. At the patient's request, the doctor shall print the healthcare records in the prescribed form during the consultation (diagnostic or therapeutic procedure).
3. All information about the patient's stay in a healthcare institution, treatment, medical condition, diagnosis, prognosis and treatment, as well as all other information of a personal nature about the patient, shall be kept confidential after the patient's death. The right to receive information after the patient's death shall be available to heirs by will and statutory heirs: spouse/partner, parents, children.
4. Confidential information may be disclosed to other persons only with the written consent of the patient, stating the basis for disclosure and the purposes for which the information is to be used, unless the patient has indicated in the medical records in writing which specific person is entitled to receive such information. 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.
5. The patient, by signing these Rules, agrees to be included in the training process.
6. In the Polyclinic, patients must:

• respect the employees of the Polyclinic, other patients and visitors, treat them with respect and dignity, and not violate their rights and legitimate interests;
• to familiarise themselves with the Polyclinic's internal rules of procedure, other documents established by the health care institution by signing them and to fulfil the duties specified therein;
• take care of their health, exercise their rights conscientiously and without abuse, cooperate with health care professionals and staff, and treat all health care staff and other patients with respect and dignity;
• provide healthcare professionals with information about their health, illnesses, operations, medications taken and being taken, allergic reactions, genetic inheritance and any other information known to the patient that is necessary for the proper provision of healthcare services;
• comply with the prescriptions and recommendations of healthcare professionals, or refuse the healthcare services prescribed in accordance with this Law. The patient must inform the healthcare professionals of any deviations from the prescriptions or regimen for which they have given consent;
• must provide proof of identity to receive healthcare services, except in the case of emergency healthcare;
• in cases where the patient has registered for a scheduled healthcare services, but is unable to attend at the scheduled time, the patient must inform the personal healthcare institution at least twenty-four hours before the scheduled time of the service;
• not disturb other patients;
• maintain order and cleanliness;
• take care of the security of their belongings;
• to preserve, protect and return in due time the property of the Polyclinic received by them and to indemnify the Polyclinic for any material damage caused by their fault;
• use the cloakroom during opening hours, and use the cloakroom when coming for personal healthcare appointments. Patients and/or their representatives who have not left their outer clothing (coats, jackets, etc.) in the cloakroom will not be treated;

1. The patient must not:

• film or take photos of another person without their express consent; make an audio recording if this could violate another person's privacy;
• use mobile phones or other electronic devices during consultations with healthcare professionals, diagnostic or therapeutic procedures, if this interferes with the provision of quality and safe healthcare by medical staff and the access of patients to healthcare services;
• arbitrarily enter and visit service premises, and enter patient reception rooms when services are provided to other patients;
• bring cold weapons and/or firearms into the Polyclinic or its premises;
• smoke, consume alcoholic beverages on the premises and/or territory of the Polyclinic;
• use narcotic and/or psychotropic substances, except for therapeutic use in the presence of a personal health care professional;
• bring pets to the Polyclinic.

1. A patient who breaches their duties, thereby endangering their own health and life and the health and life of other patients, or interferes with their access to quality health care, may have their health care terminated, unless this would endanger the life of the patient.

PROCEDURE FOR RESOLUTION OF DISPUTES AND CONFLICTS BETWEEN PATIENTS (THEIR REPRESENTATIVES)

Oral complaints from applicants (patients) and their handling:

1. The applicant (patient) may apply orally (by telephone or directly to the Polyclinic) during the working hours of the Polyclinic.
2. Applicants may contact any member of staff who will deal with the matter(s) within their competence or refer the applicant to the member of staff responsible.
3. The responsible staff member is determined by the nature of the referral (the issue(s) raised). The head of unit or the member of staff responsible for the organisation of the unit's work shall deal with the referral.
4. If the responsible person is not available at the time of the application, the employee shall inform the applicant of the responsible person's title, name, office number, working hours and telephone number.
5. The request must be dealt with immediately or within the shortest possible time, no later than within 2 (two) working days. The member of staff responsible shall, after taking note of the situation and having analysed the issue(s) raised, inform the applicant of the decision.

Handling written complaints from applicants (patients):

1. The patient shall have the right to lodge a complaint with the Polyclinic no later than within one year from the date on which they become aware that their rights have been violated, but no later than within 3 years from the date of the violation of rights.
2. Complaints may be submitted directly, upon arrival at the Polyclinic or remotely (by registered mail, by email, by other electronic means of communication ensuring the possibility to identify the person submitting the complaint).
3. The complaint must specify the patient's rights that they believe have been violated and/or inadequate diagnosis and treatment, and other circumstances that have adversely affected the quality of care.
4. If the complaint is submitted by a patient's representative, it shall be accompanied by a document certifying the representation and a document proving the identity of the person.
5. If the complaint is not accompanied by all the documents required to be submitted with the complaint, which are not properly executed, the complainant shall be instructed to remedy the deficiencies within 3 working days of receipt of the complaint at the latest. If the deficiencies are not remedied within 30 days of the date of notification of the deficiencies, the complaint shall be investigated.
6. The complaint is investigated. A written reply shall be given to the patient or, if the complaint is made by the patient's representative, to the patient's representative, within 20 working days of receipt of the complaint, unless additional time is required to remedy deficiencies in the complaint documentation.

PROCEDURE FOR THE PROVISION OF INFORMATION REGARDING THE STATE OF HEALTH TO THE PATIENTS AND THEIR RELATIVES

1. Privacy and confidentiality of patient's health information shall be protected in the Polyclinic in accordance with the procedure established by legislation.
2. The patient (their representative) shall have the right to information on their (the person’s they represent) state of health, the diagnosis of the disease, the data of the medical examination, the methods of treatment and the prognosis of the treatment, on presentation of a document proving identity.
3. When informing the patient about the treatment/examinations, the doctor shall explain the course of treatment, the possible results of the treatment, the alternative methods of treatment/examinations available at the institution or known to the doctor, the possible risks, complications, side effects and other circumstances that may affect the patient's decision to accept or refuse the proposed treatment/examinations. Also the consequences of refusing the proposed treatment/examinations.
4. Confidential information about the patient's treatment, health condition, diagnosis, and other information of a personal nature, which will be learned in the course of the diagnosis of the disease, treatment and nursing, in the process of training, in the course of conducting biomedical research, in the course of statistical and archival medical documentation, shall not be disclosed to the public without the patient's written consent, with the exception of the specific cases provided for by the legislation.
5. If the patient consents to information about their health condition, diagnoses, treatment and medical test data, prognosis and other information of a personal nature being provided to other persons, including family members, they shall complete and sign the relevant section of the Patient's declaration of intent for the provision of personal healthcare services, indicating the name(s) of the person(s) concerned.
6. Confidential information about the patient's health may be provided to persons directly involved in the treatment or care of the patient, or in the examination of the patient's health, without the patient's consent, in the cases and to the extent necessary to realise the patient's interests. 

PROCEDURES FOR MAKING COPIES OF OUTPATIENT PERSONAL RECORDS AND OTHER DOCUMENTS AND FOR ISSUING THEM TO THE PATIENT OR OTHER NATURAL/LEGAL PERSONS 

1. Written information services and information/documents about the patient shall be provided when the patient or their representative submits a request for the information service or other information/documents (copies of extracts from the personal health history or other medical documents, certificates, etc.), having paid a specified amount for the service (provision of data, transcripts, copying of documents, etc.) in accordance with the procedure established by the Director of the Polyclinic. 

GENERAL PROVISIONS FOR WORKING PROCEDURES AND OCCUPATIONAL SAFETY 

1. Smoking is prohibited in the premises and on the territory of the Polyclinic.
2. To ensure the security of the Polyclinic, the territory of the Polyclinic is monitored by video cameras and a security guard is on duty.