1. ADMISSION PROCEDURES
1.1.UAB “Draugystės sanatorija” (hereinafter referred to as the “Sanatorium”) is a personal health care institution of the Lithuanian National Health System providing medical rehabilitation (rehabilitation II, rehabilitation II repeated course, maintenance rehabilitation, outpatient rehabilitation, initial rehabilitation and anti-recidivism sanatorium) treatment services for patients in accordance with the valid orders of the Minister of Health of the Republic of Lithuania and their supplements.
1.2.The Sanatorium shall provide scheduled inpatient and outpatient medical rehabilitation services financed from the budget of the Compulsory Health Insurance Fund (hereinafter – the “PHCF”) and other sources of financing.
1.3 In the event of a declared epidemic/pandemic or other emergency, the Rules may be supplemented by a separate document, which shall be made known to the patient by signature.
1.4.Medical documents are evaluated in the ESPBI IS software at the reception desk: an extract from an inpatient treatment facility or an outpatient treatment form E027.
1.5 The patient must arrive at the Sanatorium no later than 2 months after signing the form E027 “Referral for consultation, examination, treatment” (hereinafter – the form E027) for rehabilitation services. If the patient is indicated for rehabilitation services at a later date, the specific date of arrival is determined by the FMR doctor.
1.6 The patient must arrive at the Sanatorium within the time specified by the FMR doctor. If the patient is unable to arrive on time for objective reasons, the patient shall arrange the next arrival time independently, but not later than 2 months after the referral for rehabilitation services has been issued.
1.7 The duration of treatment for patients who have presented with a certificate from the ICU is set out in the current order of the Minister of Health of the Republic of Lithuania.
1.8 The receptionist, after the e-health record has been created, sends the patient to the nurses, who coordinate the patient’s appointment with the doctor.
1.9 Following the admission and appointments, the procedure registrars will draw up a schedule of procedures, which will include re-admissions.
1.10 After admissions, medical records are forwarded to the nurse on duty’s office for review and follow-up of appointments. The medical records shall be kept in each doctor’s binder.
1.11.The nomenclature of the services provided by the Sanatorium is specified in the licence. The current version of the licence shall be published on the website of the State Service for Accreditation of Health Care Activities.
1.12. Services provided at the Sanatorium:
– group of inpatient medical rehabilitation services: adult rehabilitation II for diseases of the nervous system, musculoskeletal disorders, diseases of the circulatory system, diseases of the respiratory system, diseases of the gastrointestinal system; adult repeatedrehabilitation II for diseases of the nervous system, musculoskeletal disorders and maintenance rehabilitation II for diseases of the nervous system, musculoskeletal disorders.
-outpatientmedical rehabilitation services: adult outpatient rehabilitation, diseases of the nervous system, musculoskeletal disorders, diseases of the circulatory system, diseases of the respiratory system, diseases of the digestive system, exposure to ionising radiation.
1.13. Consultancy services – outpatient and/or inpatient personal health care
services (hereinafter – Services) are provided to the patients of the Sanatorium in accordance with the service provision agreement concluded between the Sanatorium and another healthcare institution in order to ensure the availability and continuity of the services required by patients. The doctor treating the patient shall be responsible for the organisation of the consultancy services.
1.14. Patients must use the aids prescribed by the doctor (canes, elbow crutches, axillary crutches, walkers, splints, etc.) during their treatment at the Sanatorium. Patients using assistive devices are strictly forbidden to climb stairs without the supervision of medical staff.
2. NOMENCLATURE, RANGE AND PROCEDURE OF FREE SERVICES FOR REHABILITATION II, OUTPATIENT REHABILITATION, SUPPORTIVE REHABILITATION AND REPEATED REHABILITATION PAID FOR FROM THE PSDF BUDGET
2.1 General: for Rehabilitation II, Outpatient Rehabilitation, Maintenance and Repeatable Rehabilitation Treatment, the premium for the number of services and the number of services provided for in the current Order of the Minister of Health of the Republic of Lithuania shall not apply in the Sanatorium.
2.2. Accommodation arrangements:
2.2.1 The patient shall be allocated a bed in a standard double or triple room with shower and toilet.
2.2.2 If necessary, the patient may be transferred to another room during his/her stay at the Sanatorium.
2.2.3 In case of special needs, patients with disabilities are accommodated in adapted rooms.
2.2.4 If necessary, the patient shall be isolated in a single room with shower and toilet.
2.2.5.The patient shall pay extra for comfort conditions (e.g. single room) in accordance with the prices in force in the Sanatorium at the time, approved by the Director’s Order.
Note: For inpatient treatment, the first and last day are counted as one bed-day and services are allocated on a bed-day basis; for outpatient treatment, visits are counted. On the day of arrival, the patient is entitled to lunch and dinner, and on the day of departure only to breakfast.
Patients must return their keys to reception by 12 noon on the day of departure, and by 2 pm for weekend arrivals. If relatives do not arrive on time, the patient shall be left waiting in the room, but shall not object to the staff tidying up his/her bed and wardrobe and bringing in the new arrival’s belongings.
2.3 Scope and procedure formedical rehabilitation services :
Medical rehabilitation services are provided in accordance with the current Order of the Minister of Health of the Republic of Lithuania No.V-1828 of 7 December 2022 and Order of the Ministry of Health of the Republic of Lithuania No.V-889 of 24 July 2015. Each patient’s treatment booklet contains information on the scope of medical rehabilitation services for the period of treatment, according to the patient’s type and profile of treatment. The Sanatorium follows this rehabilitation treatment plan:
2.3.1. assessment of the patient’s physical capacity, risk group testing,assessmentofbiopsychosocialfunctions, determination of physical activity and treatment regimen.
2.3.2. diet therapy, determining the daily number of nutrients and dietary calories, according to the patient’s weight, height, age, lifetime physical activity quotient and type of disease, and prescribing an individual dietary programme. If necessary, a dietician’s consultation is given to determine the individual dietary intake. Meals shall be organised in a way that ensures compliance with infection control requirements.
2.3.3 Patients are fed in the canteen on a buffet basis.
2.3.4 Assessment and correction of the patient’s lifestyle and risk factors.
2.3.5 Physiotherapy. The patient’s physical activity status is assessed and the appropriate form of physiotherapy is prescribed (respiratory gymnastics, active or passive, individual or group physiotherapy in halls, aquatic physiotherapy, applied physiotherapy, spinal stretching, muscle strengthening with treadmills, cycling, Motomed trainer, balance platform, metered walking, Nordic walking with Nordic poles).
2.3.6. Functional diagnostic samples. ECG, 6-minute test, veloergometry, spirometry, etc.
2.3.7 Occupational therapy.
2.3.8. Classical massage and underwater massage. Underwater massage and classical massage shall not be given on the same day.
2.3.9 Physiotherapy (therapeutic baths, therapeutic mud applications, electrotherapy, magnetotherapy, phototherapy, ultrasound, inhalation, halotherapy, etc.) is administered to patients according to the indications and contraindications.
2.3.10. Psychotherapy (individual, group, audio-visual relaxation, audio-visual relaxation with Alpha-stim, lectures on stress reduction).
2.3.11. Clinical speech and language therapy sessions. For patients with speech and/or swallowing disorders.
2.3.12. Teaching the patient and their relatives. Organised for patients according to disease profiles and lecture schedule.
2.3.13. Specialist consultations and laboratory tests are free of charge for patients coming for medical rehabilitation with reimbursement from the National Health Insurance Fund.
2.3.14. Medicinal products. For patients arriving with ICU certificates, the attending or on-call physician assesses the patients’ condition within 2 hours and prescribes medical treatment for the condition for which the patient has been referred for medical rehabilitation. Other reimbursable medicines must be brought by the patient and taken as prescribed by the attending physician. During the rehabilitation, when the medication for other conditions has expired, the attending physician will prescribe it in the ESPBI IS.
Remark. The number of services per patient can be increased or decreased. If the number of services is reduced, this must be justified and recorded in the medical records.
2.4List oftreatment and diagnosticservices:
| I. Medical rehabilitation services: | |
| 1. | BALNEOTHERAPY (15-20 min.): |
| 1.1. | High mineralisation bath “Cheese” |
| 1.2. | Sulphur pearl bath |
| 1.3. | Herbal bath |
| 1.4. | Herbal pearl bath |
| 1.5. | Turpentine fragrance |
| 1.6. | Turpentine pearl bath |
| 1.6. | Carbonic acid bath |
| 2. | PELOIDOTHERAPY (15-20 min.): |
| 2.1. | Healing mud applications – 2-4 fields |
| 2.2. | Paraffin bath for hands |
| 2.3. | Fangoparaffin 2-4 fields |
| 3. | Kinesitherapy and Ergotherapy (30 min.): |
| 3.1 | Individual physiotherapy |
| 3.2. | Small-group physiotherapy |
| 3.3. | Respiratory physiotherapy |
| 3.4. | Exercise with exercise bikes and other physiotherapy equipment |
| 3.5. | Intensive group exercise |
| 3.6. | Cycling training |
| 3.7. | Active-passive training with Motomed |
| 3.8. | Balance training with the POSTUROMED platform |
| 3.9. | Dosed walking with Nordic walking sticks |
| 3.10. | Swimming in a pool of mineralised water |
| 3.11. | Vertical bath |
| 3.12. | Aqua aerobics |
| 3.13. | Therapeutic gymnastics in water (for patients with nervous system disorders, musculoskeletal disorders) |
| 3.14. | Occupational therapy individual |
| 3.15 | Occupational therapy small-group |
| 4. | MASSAGE (15-20-30 minutes): |
| 4.1. | Classical massage |
| 4.2. | Underwater massage |
| 4.3. | Compression therapy for feet |
| 4.4. | Dry hydromassage bed |
| 5. | PHYSIOTHERAPY (5-30-45 min.) |
| 5.1. | Pulsed electrotherapy (transcranial, electrostimulation, TENS, dyadic currents, amplipulsive currents, interferential currents, darsonvalisation) |
| 5.2. | Pulsed magnet therapy |
| 5.3. | Ultrasound therapy |
| 5.4. | Ultrasonophoresis |
| 5.5. | Microwave therapy |
| 5.6. | Deep oscillation |
| 5.7. | Inhalations |
| 5.8. | Salt room |
| 5.13. | Treatment with INCO 2 carbon dioxide gas |
| – | face |
| – | cleavage |
| – | painful body points |
| 6. | PSYCHOTHERAPY TREATMENTS (30-45 min.): |
| 6.1. | Psychophysical training |
| 6.2. | Group psychotherapy “Anti-stress life lesson” |
| 6.3. | Audiovisual relaxation with Alpha-stim |
| II. Diagnostic procedures and specialist advice | |
| 1. | Spirometry |
| 2. | Electrocardiogram in 12 derivations with computer and doctor’s report |
| 3. | Cardiac echocardiography |
| 4. | Consultation with a cardiologist |
| 5. | Consultation with a cardiologist for echocardiography and/or veloergometry |
| 6. | Consultation with an internal medicine doctor |
| 7. | Consultation with a doctor of physical medicine and rehabilitation |
| 8. | Consultation with a dietician |
| 9. | Consultation with a medical psychologist |
| 10. | Speech and language therapy consultation |
| 11. | Consultation with a neurologist |
| III. Diagnostic tests | |
| 1. | Automated venous blood test (norm) |
| 2. | Automated venous blood test (pathology) |
| 3. | Determination of total protein concentration |
| 4. | Blood test for ENG (in venous blood) |
| 5. | Automated urine testing |
| 6. | Determination of serum (plasma) glucose concentration |
| 7. | Determining uric acid concentration |
| 8. | Determining creatinine concentration |
| 9. | Determining urine concentration |
| 10. | Determining total cholesterol levels |
| 11. | Determination of high-density lipoprotein cholesterol levels |
| 12. | Calculation of low-density lipoprotein cholesterol using the Friedewald formula |
| 13. | Determination of triacylglycerol concentration |
| 14. | Determination of total bilirubin concentration |
| 15. | Determination of direct bilirubin concentration |
| 16. | Determination of K, Ca, Cl concentrations |
| 17. | Determination of magnesium concentration |
| 18. | Determination of Aspartate aminotransferase (ASAT/GOT) activity |
| 19. | Determination of alanine aminotransferase (ALAT/GPT) activity |
| 20. | Determination of alpha-amylase activity |
| 21. | Prothrombin complex assay by the prothrombin-proconvertin method (SPA) |
| 22. | Activated partial thromboplastin time (ADTL) |
| 23. | Quantification of C-reactive protein |
| 24. | Qualitative determination of rheumatoid factor |
| 25. | Infusions for the treatment of non-profile conditions |
| 26. | Determination of Troponin T levels |
3. RULES OF GUEST BEHAVIOUR AND INTERNAL ORDER
3.1 Guests are admitted to the Sanatorium on presentation of an identity document.
3.2 Each guest staying at the Sanatorium shall be registered in the Sanatorium’s accounting and charging register software.
3.3 New arrivals are welcomed and accommodated in a tidy room 24 hours a day.
3.4 Upon departure, guests are obliged to hand in their bed linen and room equipment to the maid and/or reception for signature.
3.5 The door is locked with a card when leaving the room. The card is suitable for unlocking the entrance door to the housing.
3.6 Inform your doctor if you are expecting.
3.7 It is recommended to go for the treatment 40 minutes after eating.
3.8 It is recommended to drink more fluids while attending treatments.
3.9 It is recommended that the guest arrives 5 minutes before the start of the treatment. If you are unable to attend the scheduled procedure, you must inform the doctor and the procedure registrar of your absence.
3.10 Inform the worker of his/her health problems before the procedure.
3.11. Attend the procedures wearing appropriate clothing and footwear.
3.12. Guests are not allowed to bring electronic devices (mobile phones, tablets, laptops, etc.) to the procedures.
3.13. Do not make noise during the procedure.
3.14. Meal times: breakfast 8.00 – 10.00, lunch 13.00 – 15.00, dinner 18.00 –
7.30 pm On the day of departure, the canteen-restaurant invites you to breakfast. Lunch on the day of departure is not included.
3.15. Guests of the sanatorium are only allowed to enter the canteen-restaurant wearing wristbands. It is forbidden to take food from the canteen-restaurant to the rooms.
3.16. On the day of departure, receptionists will remove the wristbands by 12.00.
3.17. The location of the classrooms is shown on the information board at the entrance to the Sanatorium.
3.18. Specialist consultations in the sanatorium can be carried out by contact and at a distance.
3.19. We invite you to actively listen to medical lectures and take part in cultural events organised by the Sanatorium.
3.20. To get the maid to tidy your room, you need to hang a card on the door handle that says “Please tidy my room”.
3.21. Morning visiting of rehabilitation patients from 9.00 to 10.00 a.m. and/or evening visiting of rehabilitation patients from 9.00 to 9.30 p.m., if necessary.
3.22. Medical staff have the right to enter the room at any time of the day.
3.23. We are not responsible for valuables left in the rooms.
3.24. For more information about the Sanatorium’s guests’ agenda, rights and obligations, and treatment services, please contact the reception desk at the Sanatorium’s Central Hall.
3.25. Guests returning to the premises after 22.00 are required to show their wristband and/or room key to the staff on duty.
3.26. Thank you for signing the questionnaire “Patient’s declaration of intent regarding health care services” and for completing the questionnaires provided to you by the Sanatorium about the quality of our work.
4. PROCEDURES FOR THE PROVISION OF PAID PERSONAL HEALTHCARE SERVICES
4.1 Paid personal health care services are provided, except in the case of an emergency, when the patient:
4.1.1 is not covered by compulsory health insurance and he/she applies to the Sanatorium for healthcare services;
4.1.2 is covered by compulsory health insurance, but goes to an institution on his/her own initiative without a referral from a family doctor or specialist;
4.1.3 is covered by compulsory health insurance, but wants additional services and additional services not contracted with the territorial health insurance fund;
4.1.4 is covered by compulsory health insurance and applies with a referral from a general practitioner or a specialist doctor for a consultation with a physiotherapist for physical medicine and rehabilitation in order to receive more than the number of approved physical medicine and rehabilitation procedures;
4.1.5 the institution has exhausted the funds (limit of funds) for the services of a physical medicine and rehabilitation doctor provided for in the contract with the territorial sickness fund and the director of the institution has announced in a prominent place that he/she is temporarily not able to provide planned services due to the lack of funds;
4.2 Payment for fee-for-service personal health care services:
4.2.1 medical staff informs the patient about the range of treatments available for payment, their availability and prices;
4.2.2 The FMR physician shall record the paid procedures prescribed for the indications in the personal health record, with a list of paid services on the cover sheet, which shall include:
– Signed consent for the provision of the paid services by the patient;
– the name of the paid service provided and the basis for its provision;
– the number and date of the document evidencing payment for the service.
4.3 Procedures and premiums for improved living conditions are paid for patients who arrive with a certificate from the IPC. If patients wish to receive more therapeutic services than those provided for in the orders of the Ministry of Health of the Republic of Lithuania and their supplements, and Article 10(5) of the Law on Health Insurance of the Republic of Lithuania, patients may accept them with the approval of the attending physician. The patient signs that he/she agrees to pay or pay extra for the procedures. He/she shall pay for them at the cash desk of the Sanatorium and present a receipt for payment. Prices for all services are available at the reception, in the spa and on the website www.draugyste.lt. The prices and regulations for the award of paid treatments and the bonuses for improved living conditions are laid down in the Director’s orders.
4.4.Patients coming for outpatient rehabilitation shall pay for board and lodging at the Sanatorium cash desk the amount determined by the Director’s valid order (the difference between the price of an outpatient rehabilitation visit paid by the ICS and the commercial bed-day rate approved at that time).
4.5 For commercial patients coming for SELF-ADMITTED rehabilitation treatment, the following procedure volumes are available:
4.5.1 Purchasers of the Standard Treatment Package will receive 5 treatments, which will be selected from a basket of treatments based on medical indications and contraindications. The basket of treatments is regulated by an order of the Director. Dry massage: 1,5 units.
4.5.2.Those who purchase the “All-inclusive Treatment” package are entitled to 7 treatments, which are selected according to medical indications and contraindications from the basket of treatments. The basket of treatments is regulated by a Director’s order. 1,5 units of dry massage.
4.5.3. physicians shall complete an outpatient personal health record form 025/a and ESPBI IS form E025 for commercial patients.
4.5.4 For commercial patients, additional procedures are available upon payment at the cash desk.
4.5.5. Relaxing spa packages and massages are additional services at extra cost if they are not included in the “Standard Treatment” and “All-inclusive Treatment” packages.
4.6 Specialist consultations and blood tests for commercial patients are chargeable.
5. PATIENT RIGHTS
5.1 The right to quality healthcare.
5.1.1 Every patient must receive quality healthcare. Patients’ rights shall not be restricted on the basis of their sex, age, race, nationality, nationality, language, origin, social status, religion, beliefs, opinions, sexual orientation, genetic characteristics, disability or any other circumstances not justified by law.
5.1.2 Every patient has the right to be treated with dignity and respect and to be treated with dignity and respect by the staff of the health care facility in the provision of services to the patient. Any intervention in a patient’s health, including examinations, must be carried out in accordance with appropriate professional duties and standards.
5.1.3 If the patient’s continued stay in the healthcare facility is not medically justified, the rationale for this decision must be fully explained to the patient before discharge from the healthcare facility to home or referral to another healthcare facility. The patient shall acknowledge receipt of such information by signing.
5.1.4 Patients must be provided with scientifically valid pain relief,
to prevent them from suffering from their medical conditions, and to continue the recommended treatment with other medicinal products.
5.2 The right to access to health care.
5.2.1 Patients must have access to healthcare. The conditions for the exercise of this right shall be laid down by the laws and regulations of the Republic of Lithuania.
5.2.2 Emergency medical care must be provided to the patient without delay. First medical aid must be given immediately by healthcare professionals and other persons closest to the patient in need of emergency medical care. If the patient cannot receive appropriate emergency medical care in a timely manner at the Sanatorium, or if the Sanatorium is not able to provide emergency medical care to the patient within its competence, it shall inform the patient and ensure that the patient is transferred to another health care facility as soon as possible. The scope and procedure for the provision of emergency medical care shall be determined by the Ministry of Health.
5.3 Right to choose a doctor or nursing specialist.
5.3.1 The patient has the right to choose the doctor and the nursing specialist.
5.3.2 This right may be restricted only on the grounds and in accordance with the procedure established by the laws of the Republic of Lithuania. 5.4 Right to Information.
5.4.1 The patient has the right to receive information about the services provided by the Sanatorium and the possibilities to use them.
5.4.2 The patient must be provided with the name, title and qualification details of the treating doctor and nursing professional.
5.4.3 The patient shall be made aware of the patient’s rights and obligations as set out in the Internal Rules of the healthcare facility. The patient has the right to receive a description of the diagnosis, treatment and care.
5.4.4 The patient has the right to information about his/her state of health, the diagnosis of his/her illness, the results of medical examinations, the methods of treatment and the prognosis of treatment. When informing the patient about the treatment, the doctor shall explain to the patient the course of the treatment, the possible results of the treatment, the possible alternative methods of treatment and other circumstances which may influence the patient’s decision to accept or refuse the proposed treatment, as well as the consequences of refusing the proposed treatment. The information shall be provided to the patient in a form that is understandable to him/her, taking into account his/her age and state of health, and explaining special medical terms.
5.4.5 The Sanatorium may withhold the information provided for in Clause 4.4.4 from a patient, including minors aged 16 to 18, only if the communication would be a clear presumption of serious harm to the patient (harm to the patient’s health or endanger his/her life). In such cases, any information provided for in this Article shall be given to the representative designated by the patient and shall be equivalent to the provision of information to the patient. The information provided to the representative shall be provided as soon as the risk that its communication to the patient may lead to the harm in question no longer exists. The healthcare institution shall not communicate the information provided for in this Article to the patient even if the patient refuses the information.
5.4.6 The patient has the right to know the opinion of another professional about his/her condition and the proposed treatment and diagnosis.
5.5 Patient participation in teaching and biomedical research
5.5.1 The patient must not be involved in training or biomedical research without his/her written consent. Consent may be sought only after the patient has been made aware of the purpose, nature, consequences and risks of the process and research in question.
5.5.2 Where the consent/permission referred to in 4.5.1 is in place, the patient may only be involved in the training process and biomedical research in accordance with the procedures laid down in the Law on Ethics in Biomedical Research and in other legislation.
5.5.3 Patient involvement in training and scientific medical trials/biomedical research must be guided by the notion that the patient’s interests and well-being take precedence over the interests of science.
5.6 The right to choose diagnostic and therapeutic methods and to refuse treatment.
5.6.1 Patients may only be treated or receive any other health care with their consent.
5.6.2 Where diagnostic and therapeutic options are available in accordance with the standards of care, the patient must be informed of the characteristics of these options and given the choice. The choice of patients, including minors aged 16 to 18 years, shall be documented in writing.
5.6.3 Before the consent referred to in paragraph 2 of this Article is sought, the purpose, nature, consequences and risks of the intervention on the patient’s health shall be explained to the patient (his representative). The personal healthcare provider shall record all personal healthcare services in the patient’s medical records. Consent for services not covered by a healthcare contract shall be confirmed by the signature of the patient (his/her representative) in the patient’s medical records.
5.6.4 The patient may withdraw his/her consent to treatment at any time in writing. Where the patient is in such a state of health that he/she is unable to express his/her will concerning the consent to treatment and the choice of diagnostic and therapeutic techniques, his/her previously expressed will in writing shall be taken into account as far as possible without prejudice to the patient’s best interests. In the absence of the patient’s (patient’s representative’s) expressed will in accordance with the established procedures, care, diagnosis and treatment may be provided only on the grounds and in accordance with the procedures laid down by law, where there is a real threat to the health or life of the patient or of the persons around him. The consent of the patient’s representative is required for the provision of emergency (first or urgent) medical care to a patient who, because of his age or state of health, is not able to express his will properly. The patient shall, as far as possible, be involved in the decision on consent to treatment. Assistance may be given without the consent of the representative if the representative is not available or if consent cannot be obtained in time and it is in the best interests of the patient to provide medical assistance. This shall be noted in the patient’s medical record.
5.7. Privacy
5.7.1 Patients’ private lives are inviolable. Information about the facts of patients’ lives may be collected with the consent of the patients and only if it is necessary for the diagnosis, treatment or care of the disease.
5.7.2. data on the patient’s stay in the Sanatorium, his/her health condition, diagnostic, treatment and nursing measures applied to him/her shall be entered into the medical documents of patients of the form and types prescribed by the Ministry of Health. The protection of the patient’s privacy and confidentiality shall be ensured when determining the form, content and procedure for the use of these documents.
5.7.3 All information about the patient’s stay at the Sanatorium, treatment, medical condition, diagnosis, prognosis and treatment, as well as all other information of a personal nature about the patient shall be kept confidential even after the patient’s death. The procedure for keeping such confidential information confidential shall be laid down by the laws of the Republic of Lithuania and by legal acts approved by the Minister of Health. Confidential information may be disclosed to other persons only with the written consent of the patient. Persons directly involved in the treatment or care of the patient or in the medical examination of the patient may, without the patient’s consent, be provided with confidential information in the cases and to the extent necessary to protect the patient’s interests. Confidential information may be provided, without the patient’s consent, in accordance with the procedure laid down by the legislation, to public authorities which are entitled by the laws of the Republic of Lithuania to receive confidential information about the patient against the patient’s will. Where the patient is unconscious and without his/her consent, confidential information may be provided to the patient’s representative, spouse (partner), parents (adoptive parents) or adult children only in the cases and to the extent necessary to protect the patient’s interests.
5.7.4 The patient’s right to privacy must be guided by the principle that the patient’s interests and well-being take precedence over the public interest. The unlawful collection and use of confidential patient information shall be subject to liability in accordance with the procedures laid down by law. In addition to pecuniary damage, the patient shall also be compensated for non-pecuniary damage.
5.8. Right to complain.
5.8.1.If the patient (or his/her representative) considers that his/her rights as a patient have been violated, he/she shall write to the Director. The Director or his/her nominee must examine the complaint within the shortest possible time, but not more than 5 days, and inform the patient (his/her representative) of the outcome of the examination.
5.8.2. dissatisfied with the hearing and its outcome, the patient (his/her representative) may appeal to the court or to the state authorities that control the healthcare provider in accordance with the Healthcare Institutions Act. If the patient (his/her representative) appeals to the Ministry of Health, which shall examine the appeal itself or, according to the nature of the matter under examination, shall refer it to other state authorities which control the healthcare provider. The patient (his/her representative) also has the right to appeal against the decisions and actions (inaction) of these institutions and officials of the Ministry of Health to the court.
5.9. Right to compensation.
5.9.1 The patient has the right to compensation for damage caused by the violation of his/her rights in the provision of healthcare services. The conditions and procedure for compensation of damages shall be determined by Chapter III of the Law on Amendments to the Law on Patients’ Rights and Compensation of Damages to Healthcare of the Republic of Lithuania, as well as by the Civil Code, the Law on Insurance, and other legal acts.
6. PATIENT RESPONSIBILITIES
6.1. passport or other proof of identity upon arrival.
6.2. to observe the general order of the Sanatorium (not to disturb the staff working in the rooms, not to make noise, not to disturb other patients, not to consume alcoholic beverages, not to smoke in the premises of the Sanatorium).
6.3 Provide the doctor with full information about your medical condition (past and present illnesses), allergic reactions, medications used and treatment you have received or are receiving.
6.4 In the event of ill health or other illness, inform the nurse, attending physician or doctor on duty immediately.
6.5 Strictly follow the instructions and prescriptions of the attending physician or nursing staff.
6.6. protect the material assets of the Sanatorium. If the Patient has damaged the Sanatorium’s material valuables, he/she shall be obliged to compensate the Sanatorium for the material damage.
6.7 A patient leaving the Sanatorium (for very important reasons) for more than 24 hours shall write a request to the Head of the Department, stating the reason for leaving, the duration of the stay and how he/she can be contacted.
6.8. to abide by the Sanatorium’s Internal Rules and Regulations, which have been made known to him/her by signature. 6.9. the Patient shall leave the Procedure Card at the reception of the Sanatorium upon leaving the Sanatorium. 6.10. A patient who has been issued with a sick leave certificate shall not violate the established rules of conduct during the period of sick leave.
7. TRANSFERRING PATIENTS TO OTHER HEALTHCARE FACILITIES FOR TREATMENT. VISITING PATIENTS, DISCHARGING THEM AT THE END OF THEIR TREATMENT AT THE SANATORIUM
7.1 Patients may be discharged early if:
7.1.1. grossly violates the Sanatorium’s Internal Rules of Procedure (does not follow the doctor’s instructions, drinks, does not attend procedures, interferes with other patients’ treatment at the Sanatorium).
7.1.2. the Patient and/or his/her relatives request to be discharged from the Sanatorium without completing the treatment. When the treatment is not completed and the patient is discharged, the physician shall indicate in the Inpatient Treatment Record (Form 003/a) the reason for which the patient and/or his/her relatives discontinued treatment.
7.1.3. when the patient’s medical condition requires further treatment in another medical institution.
7.2 Before the patient is discharged from the Sanatorium or sent to another health care institution, the doctor shall explain to the patient in detail the reasons for the decision.
7.3.In case of an exacerbation of the patient’s illness or other illness, he/she shall be sent by the attending physician to VšĮ “Druskininkai Hospital” or, depending on the illness, to another hospital. On non-working days, the doctor on duty decides on the patient’s hospitalisation and, if necessary, consults by telephone with the Deputy Medical Director or the Head of Department. If the patient is hospitalised, information is given to the patient’s representative indicated in the ‘Patient’s declaration of intent for healthcare services at Draugystės sanatorium UAB’ (name, surname, date of authorisation). Patients are transported to other medical institutions by the Sanatorium’s transport or the doctor/nurse contacts the ambulance station. The referring physician uploads the epicrisis of the hospitalised disease or the response to the referral form E003, E027 in ESPBI IS. The receptionists check out the departing patients from the SVEIDRA subsystem. If the patient is hospitalised, the attending physician or the on-call physician, if necessary, issues an electronic sick leave certificate and discharges the patient from the Sanatorium. The doctor who has hospitalised the patient shall inform the reception and canteen staff, and shall inform the administrative managers during the morning meetings.
7.4 The procedure for visiting patients in the Sanatorium is set out in the Director’s Order No. 57 of 6 November 2020.
7.5 When discharging patients, the sickness certificate shall be completed in accordance with the current sickness certificate regulations. The patient shall also be provided with an inpatient medical epicrisis or a referral reply (form E003, E027), which shall include the medical history, objective condition, treatment administered and recommendations for further treatment. These forms are uploaded to the ESPBI IS.
8. PROCEDURES FOR RESOLVING DISPUTES AND CONFLICTS BETWEEN THE INSTITUTION AND PATIENTS
8.1 The patient or his/her representative shall have the right to lodge a complaint, orally or in writing, in accordance with the procedure provided for by law, regarding the quality of personal healthcare services provided, the violation of the patient’s rights, the damage caused to his/her health, or the improper execution or non-execution of the contract.
8.2 In the event of failure to resolve the dispute and/or in the event that the patient believes that his/her rights provided for in Clause 8.1 have been violated, he/she shall have the right to lodge a complaint in writing with the Administration of the Sanatorium, in accordance with the requirements of the content and form of the procedure of handling complaints of patients set out in the Law.
8.3 The patient must provide proof of identity with the complaint. Where such a complaint is sent by post or courier, it must be accompanied by a copy of the applicant’s identity document certified by a notary public or a lawyer representing the patient. The patient’s representative shall provide proof of identity and representation when requesting such information.
8.4 The sanatorium shall examine the patient’s complaint and inform the patient or, if the complaint has been submitted by the patient’s representative, the patient’s representative in writing of the results of the examination not later than within 20 working days from the date of receipt of the complaint in the establishment.
8.5 If the documents to be submitted with the complaint are incomplete, improperly executed, and/or contain incomplete and/or inaccurate information, the Sanatorium shall, not later than within 3 working days from the date of receipt of the complaint, point out to the complainant the deficiencies identified and inform him/her that if the complaint is not corrected within 30 days from the date of informing him/her about the deficiencies, it shall not be considered, and that in such a case, the patient shall have the right to submit a complaint to the Sanatorium anew.
8.6 The patient has the right to lodge a complaint no later than one year after becoming aware that his/her rights have been violated, but no later than three years from the date of the violation of rights.
8.7 Patients have the right to appeal to the state authorities dealing with patients’ complaints only if they are dissatisfied with the Sanatorium’s handling of their complaints.
8.8 If the patient does not wish to resolve disputes with the attending physician or the administration, he/she may submit complaints in writing in accordance with the procedure established by the Director of the Sanatorium. The persons in charge shall inform the administration about the complaints received. If the patient so requests, the representatives of the administration of the Sanatorium shall reply in writing to the written complaints.
8.9 The administration shall endeavour to deal with disputes and conflicts objectively and, where possible, to resolve them in the patient’s favour.
8.10. at the reception of the Sanatorium there are questionnaires and feedback books where the patient can express his/her opinion.
8.11. Complaints to the Administration shall be submitted in writing to the address V. Krėvės g. 7, 66126 Druskininkai, or by e-mail to sanatorija@draugyste.lt.
8.12. Disputes regarding improper performance or non-performance of the Contract shall be settled out of court in accordance with the procedure established by the Law on Consumer Rights Protection of the Republic of Lithuania, at the State Consumer Rights Protection Service, A. Goštauto st. 12, 188770044, Vilnius, e-mail: tarnyba@vvtat.lt, telephone: 2626760, website: www.vvtat.lt. You can submit your application electronically via the EGS platform http://ec.europa.eu/odr/.
9. PROCEDURES FOR PROVIDING INFORMATION TO THE PATIENT AND HIS/HER RELATIVES ABOUT HIS/HER STATE OF HEALTH
9.1 The patient’s (patient’s representative’s) right to information is set out in clause 5.4. All information about the patient’s condition, diagnosis, treatment, care may only be disclosed to others with the written consent of the patient (his/her representative). Information is not provided by telephone.
9.2 The patient (his/her representative) shall be informed of the Internal Rules of Procedure in a signed statement.
9.3 The doctor, after drawing up the treatment and, if necessary, the examination plan, shall inform the patient (his/her representative) of the plan and shall note in the medical record that the patient (his/her representative) has been informed of and agrees to the treatment and examination plan.
9.4 If the patient (or his/her representative) refuses the prescribed treatment or examination, or refuses to go to other medical institutions for consultations and specialist advice, the doctor shall record this in the patient’s medical history/personal health record. The patient shall confirm the refusal by signing the medical/personal health record, which shall be presented to the patient for signature by the doctor.
9.5 The attending physician shall inform the patient (his/her representative) of any changes to the treatment and test plan. The physician shall note in the patient’s medical record/personal health record that the patient (his/her representative) has been informed of and accepts the changes.
9.6 The doctor shall inform the patient of the diagnosis, the results of examinations and treatment, the conclusions of the consultation, and further recommendations for treatment.
9.7 All information about a patient may be disclosed without the written consent of the patient or his/her representative for official purposes where the information is required to be disclosed by law:
9.7.1. healthcare facilities where the patient is being treated, cared for or undergoes a medical assessment;
9.7.2. the authorities controlling healthcare services;
9.7.3. to the court, prosecutor’s office, pre-trial investigation bodies and other institutions which are entitled to do so by the laws of the Republic of Lithuania.
9.8 The information shall be provided in accordance with the Orders in force of the Minister of Health and their amendments.
10. PROCEDURE FOR MAKING COPIES OF MEDICAL RECORDS, PERSONAL HEALTH RECORDS AND OTHER DOCUMENTS, AND FOR ISSUING THEM TO THE PATIENT OR OTHER NATURAL AND LEGAL PERSONS
10.1 Persons entitled to receive written information about the patient (copies of medical documents) on the grounds and in accordance with the procedure laid down by the legislation, shall submit a written request and the patient’s corresponding written consent to the Sanatorium. The request shall specify the nature of the information sought and the purpose of its use.
10.2 The Sanatorium shall make available, within 1 working day of the patient’s oral or written request, the patient’s original medical records at a location designated by the Company.
10.3 The patient may access his/her medical records at any time, free of charge, by logging into the Electronic Health Services and Collaborative Infrastructure Information System (hereinafter referred to as ESPBI IS).
10.4 Copies of the patient’s medical records must be made available on request. The time limit for the production of copies is 1 working day from the time of the request. Copies shall be issued for the first time only at the expense of the Sanatorium.
10.5.Originals, copies, transcripts of medical records/personal health records and other medical documents, as well as certificates of treatment at the Sanatorium may be given to the court, prosecutor’s office, pre-trial investigation bodies, authorities controlling health care services, and to health care institutions where the patient is being treated, cared for, or is undergoing a medical examination. Documents shall be issued to those institutions on the basis of a written request signed by the head of that institution or his/her authorised representative, or on the basis of a mandate or other document required in such cases under the legislation governing the work of those institutions or bodies, with the authorisation of the Director-General or the Medical Director.
10.6 The original of the treatment card must remain at the Sanatorium upon the patient’s departure and must be pasted into the medical record.
10.7 The Sanatorium shall provide the requested written information to the patient or his/her representative not later than within 20 working days from the date of receipt of the request by the Sanatorium.
10.8 Personal health care institutions wishing to obtain information about a patient shall submit a letter to the Sanatorium, signed by the head of the institution, which shall specify the nature of the information to be obtained and the purpose of its use.
11. OPENING HOURS OF THE ADMINISTRATION AND OTHER SERVICES
11.1 The sanatorium has a mixed working time system: for administrative and economic staff, five working days with two days off; for medical staff, five to six working days with one or two days off; for other services, a total working time system. In all cases, working time may not exceed the limits laid down by applicable law.
11.2 The start of the working day, lunch break and end of the working day shall be determined by the Heads of Departments in the work schedules approved by the Director.
11.3 During working hours, it is prohibited to distract staff from their direct work or to hold meetings of public organisations.
11.4 Annual leave shall be granted to staff members according to a schedule, taking into account that the normal work of the Sanatorium shall not be disrupted. In all cases, annual leave shall be granted in accordance with the requirements of the Labour Code.
12. PROVISIONS OF LAWS, REGULATIONS AND OTHER LEGAL ACTS AND NORMATIVE DOCUMENTS GOVERNING WORK SAFETY
12.1 The Sanatorium shall be guided in matters of occupational safety and health by the Law on Occupational Safety and Health of the Republic of Lithuania, the Labour Code adopted on 14 September 2016 and its supplements, and the orders of the Director of the institution.
12.2 At the workplace, it is obligatory to observe the requirements of occupational safety, fire safety and electrical safety, to comply with the provisions of the Law of the Republic of Lithuania on Occupational Safety and Health and other legal acts related to occupational safety, the requirements of the instructions for the duties and the rules of procedures, and any other orders issued by the Director.
12.3 A member of the staff of the Sanatorium may commence work only if the equipment and working facilities are in good working order and comply with safety requirements, and the workplace is properly arranged.
12.4.It is forbidden for the staff of the Sanatorium to be drunk or under the influence of alcohol, narcotic or psychotropic substances.
12.5 The Sanatorium’s electronic communications, software, office equipment, telephone communications, and office and other facilities may be used by staff members only for work-related purposes.
12.6 Sanatorium staff who have direct contact with patients must work in clean and tidy medical clothing.
12.7 The staff of the Sanatorium is obliged to ensure the security of the personal data of patients in accordance with the procedure established by the legislation.
12.8 Persons staying in the territory of the Sanatorium must comply with the requirements of information, prohibition and other signs.
12.9 Persons on the territory and premises of the Sanatorium may use the Sanatorium’s Wi-Fi network only for legal purposes.
12.10 Patients and visitors must follow the instructions of healthcare professionals regarding safe behaviour, environmental and fire safety.
12.11.Patients who notice abnormal operation of the equipment in the room (increased noise, vibration, temperature rise, specific smell, etc.) and any other causes that pose a risk to their health or life, shall immediately report it to the staff of the Sanatorium.
12.12 Patients are not allowed to troubleshoot any equipment on their own. Patients must inform the Sanatorium staff of any faults observed in the room.
12.13. The patient must not touch at the same time parts of the body to earthed parts (central heating radiators, pipes, etc.) and electrical equipment, or open electrical panels or power cabinets.
12.14. The patient shall not be allowed to arbitrarily change the position of equipment and furniture in the room, narrow the gaps between the bed and the walls and between the beds, etc. without the permission of the Sanatorium staff.
12.15. The patient must take all precautions when moving on surfaces that have been recently wet cleaned, or that have spillages or splashes on them, and when showering or bathing. Footwear worn by the patient shall be low-heeled and non-slip.
12.16. When moving around at night in the room or in the common areas of the Sanatorium, the patient must beware of obstacles. If necessary, health professionals must be called upon.
13. PROCEDURES FOR RECORDING AND STORING PRECIOUS METAL ARTICLES, PRECIOUS PROSTHESES AND MONEY HELD BY THE PATIENT
13.1 Patients’ valuables, belongings, documents and money shall be accepted for storage in individual safes in the sanatorium during the period of treatment in accordance with a contract concluded with the reception.
13.2 A safe deposit box rental or storage of valuables and documents agreement shall be concluded with the patient in two copies of equal legal force, one for each party.
13.3 Upon departure, stored items and money shall be returned to the patient in accordance with the signed agreement and procedure.
14. PROVISION OF PERSONAL HEALTHCARE SERVICES FOR HEARING IMPAIRED PATIENTS
14.1 The procedure for the provision of personal health care services to hearing impaired patients shall apply in all departments of the Sanatorium where there is direct contact with the patients;
14.2 The Sanatorium shall ensure the availability of Lithuanian sign language interpretation services for patients with hearing impairment:
14.2.1. enable the patient to call a Lithuanian sign language interpreter;
14.2.2. if the person does not speak Lithuanian, but has a hearing impairment, opportunities to communicate with the patient in writing are provided.
14.3 A patient with a hearing impairment shall acquire his/her rights, assume his/her obligations and exercise them himself/herself or through his/her representative(s).
14.4 The rights of patients of the Sanatorium shall not be restricted on the basis of their sex, age, race, nationality, language, origin, social status, faith, beliefs and opinions. People with disabilities have the same rights as the rest of society.
14.5 Sign language interpreting services are provided in 5 Sign Language Interpreter Centres (Vilnius, Kaunas, Klaipėda, Šiauliai, Panevėžys). The services are provided by sign language interpreters working in the centres, who must be able to translate Lithuanian oral language into sign language and vice versa – sign language into Lithuanian oral language.
14.5.1.If the patient expresses his/her wish to use Lithuanian sign language translation services, the Sanatorium Administrator shall organise the order of Lithuanian sign language translation services on the website www.vertimaisgestais.lt (el.paštu:uzsakymas.vilnius@vertimaigestais.lt; by phone or SMS +370 682 23304) using the ordering methods and the patient’s preferred method of translation (contact or remote).
14.5.2 Sign language interpretation services shall be booked for the next available time specified by the interpreters or for a later time requested by the patient. The time shall also be suitable and agreed with the attending physician or other employee of the Sanatorium, who will provide the patient with the information that the patient is entitled to receive under the Law on Patients’ Rights and Compensation for Damage to Health of the Republic of Lithuania.
14.6 Upon arrival at the Sanatorium, a patient with hearing impairment shall be assigned a general nurse or a nurse’s assistant, who will guide the patient’s way in the Sanatorium and will be responsible for the smooth communication process between the Sanatorium’s specialists and the patient with hearing impairment.
14.7 The organisation of the translation service in the Sanatorium is the responsibility of the IT specialists/social workers. The ward matrons shall contact the IT specialists for the delivery of the equipment to the ward.
14.8 Technological solutions for the provision of ASDP to patients with hearing impairment include: sign language interpretation services via the internet and telecommunication (Skype, telephone (video calls to the on-call interpreter), including video messaging, sign language interpretation via SMS, etc.).
14.9 After office hours, patients can contact the LGKVC’s Remote Interpreting Unit, which provides services 24/7. “Skype address: 24/7LGC Translation.
15. REGULATION ON THE ORGANISATION OF MEDICAL REHABILITATION SERVICES
15.1.The health care professionals of UAB “Draugystės Sanatorija”, providing licensed health care – medical rehabilitation services, shall be guided by the listed and other legal acts related to the activities of the sanatorium:
15.1.1.Order of the Minister of Health of the Republic of Lithuania of 7 December 2022 No.V-1828 “On the approval of the descriptions of the general and special requirements for the provision of medical rehabilitation and anti-rejection sanatorium treatment services”.
15.1.2. the Order of the Minister of Health of the Republic of Lithuania of 24 July 2015 No.V- 889 “On the Approval of the Description of the Special Requirements for the Activities of Medical Rehabilitation Institutions (Units)” and its new wording of 1 January 2023 in its new version No.V-697 and its consolidated version of 21 February 2023.
15.1.3. the Order of the Minister of Health of the Republic of Lithuania of 23 November 2022 No.V-1738 “On the Approval of the Description of the Procedure for Prescribing and Provision of Medical Rehabilitation and Anti-Rejection Sanatorium Treatment” and the consolidated version from 12-09-2023 until 31-12-2024.
15.1.4. the Order of the Minister of Health of the Republic of Lithuania No V-935 of 14 December 2004 “On the implementation of the Lithuanian Medical Standard MN 123:2020 “Physical Medicine and Rehabilitation Physician. Approval of the “Medical and physical rehabilitation and rehabilitation therapy and physiotherapy” Regulations.
15.1.5. the Order of the Minister of Health of the Republic of Lithuania of 5 February 2016 No V- 184 “On the Lithuanian Medical Standard MN 124:2023 “Physiotherapist. Approval of the “Physiotherapy Physiotherapist’s Regulation No.
15.1.6. the Order of the Minister of Health of the Republic of Lithuania No V-936 of 28 April 2016 “On the implementation of the Lithuanian medical standard MN 125:2022 “Occupational therapist. The Regulation of the European Parliament and of the Council on Occupational Therapy Services for Occupational Therapists.
15.1.7. the Order of the Minister of Health of the Republic of Lithuania of 23 February 2022 No V- 591 “On the implementation of the Lithuanian medical standard MN 28:2019 “General practice nurse. Rights, duties, competences and responsibilities”.
15.1.8. the Order of the Minister of Health of the Republic of Lithuania of 23 February 2022 No V- 388 “On the Approval of the Description of the Requirements for the Activities of a Clinical Speech and Language Therapist”.
15.1.9. the Order of the Minister of Health of the Republic of Lithuania of 8 October 2019 No V- 1148 “On the Approval of the Lithuanian Medical Standard MN 165:2021 “Therapeutic Massage Specialist””
Prepared by: Arvydas Balčius Arvydas.Balcius@draugyste.lt