UAB TELESANTE TELEHEALTH SERVICE RULES

1. All patients and employees of UAB Telesante are obliged to familiarize themselves with the UAB Telesante Telehealth Service Rules (hereinafter referred to as the Rules).

By using UAB Telesante’s telehealth services, you accept and agree to be bound by these rules. If you do not agree with the rules, you should not use the services provided by UAB Telesante.

2. Terms

UAB “Telesante” is a legal person, company code 305917454, registered office address Didžioji Riešė, Mėtų g.2, LT-14261 Vilniaus raj. (“Telesante”).

“Telesante website” means the URL https://telesante.lt  and related pages.

“Doctor” or “doctors” refers to the doctor or doctors working at Telesante.

Services – personal healthcare services.

Patient means a person who wishes to receive Telesante services, whether healthy or sick.

Telehealth service / teleconsultation is a personal healthcare service that provides outpatient personal healthcare to a patient by means of telecommunication when the doctor and the patient are in different places at the same time. The doctor can provide this service from the premises of Telesante  or from his/her remote workplace.

‘means of remote communication’ means video and/or audio means of communication  and/or other electronic communications technologies which are capable of identifying a person and which
can be used in the context of a healthcare service where the provider and the recipient are in different places at the same time or at different times.

ESPBI IS is an electronic information system for health services and collaborative infrastructure.

3. Service delivery procedures.
   • The purpose of the remote consultation is to assess the patient’s condition, prescribe and/or continue medication and medical aids, provide counselling to the patient, issue and/or renew electronic sick leave certificates as provided for in the legislation on sick leave, pregnancy and maternity leave, and prescribe necessary and/or repeated tests. The telehealth service provider chooses which means of telehealth communication are used to provide telehealth services. Secure means of data transmission are used.
   • Telesante provides only the services specified in Telesante’s personal health care licence. A Patient shall not be registered or admitted if Telesante is unable to provide the necessary services to the Patient.
   • Services for patients aged 16 and over are provided only with the patient’s consent, except for exceptions provided for by law.
   • For a minor patient under the age of 16, Services are provided only with the consent of his/her representatives. A minor patient under the age of 16 years who, in the reasonable opinion of the doctor expressed in the medical records, is capable of making a correct assessment of his/her own state of health, has the right to independently apply for and decide on the provision of the Services he/she needs, except in cases provided for by law.
   • Patient registration.
     • To receive the Telesante service, patients must register on the telesante.lt website
     • The patient registers for a teleconsultation according to the teleconsultation schedule of the doctor concerned.
     • Before the start of the consultation, the patient pays the Remote Consultation Fee set by Telesante and signs the “Consent for the Provision of Healthcare Services” and the “Consent for the Processing of Personal Data”.
     • Patient registration is confirmed when the patient signs 3.5.3. the consents referred to in Clause 4.1 and pay the Remote Consultation Fee.
     • The patient must inform Telesante as soon as possible by telephone or e-mail of the cancellation of the Distance Consultation if he/she is unable to receive, or does not wish to receive, the Distance Consultation at the time confirmed at the time of registration. A patient who cannot receive a Remote Consultation at the time confirmed during the registration must re-register if he/she wishes to receive services at another time. If the patient does not wish to receive a Remote Consultation, the fee for the Remote Consultation is refunded.
     • If the Patient does not cancel the pre-registration less than 24 hours prior to the start of the Remote Consultation, Telesante shall be entitled to apply to the Patient a penalty of fifty (50) per cent of the value of the Services due to the failure of the Remote Consultation. This  fine can be deducted from the amount to be refunded to the patient for the missed consultation.
     • If the Remote Consultation does not take place due to a temporary malfunction of the Remote Communication Facilities or for other objective reasons beyond the patient’s control, Telesante shall, at the patient’s request, offer the patient an alternative time for the Remote Consultation.
   • Remote consultation.
     • At the time of registration, at an agreed time and by agreed means of telecommunication, the doctor contacts the patient or the patient’s representative and identifies the patient by asking the patient’s name, surname, date of birth and/or asking to see his/her identity document.
     • Providing a remote consultation to a patient by means of a teleconference
       Only the doctor providing the remote consultation and the patient can be online together. It is forbidden for other persons to be present at the doctor’s workplace and/or to be connected together by means of remote communication during the provision of this service.
     • A remote consultation for a patient includes:
   • history taking, assessment of the patient’s health status;
   • Patient counselling, drawing up conclusions and recommendations;
   • Completion of mandatory medical documents and submission to ESPBI IS in accordance with the procedures laid down by legislation;
   • other necessary steps to be taken to provide remote medical advice to the patient;
   • As required:
   • prescribing diagnostic and/or therapeutic services, tests and procedures;
   • evaluation and discussion of the results of diagnostic and/or therapeutic services and procedures;
   • Prescribing and/or renewing prescriptions for medicinal products;
   • issuing and renewing electronic sickness, pregnancy and maternity leave certificates, if provided for in the legislation on sickness, pregnancy and maternity leave certificates;
   • Issuing referral(s) for medical advice;
   • arranging a contact consultation, if necessary, and arranging for the patient to be registered for a consultation.
     • During, before, during or after a teleconsultation, the patient may, at the doctor’s request, with his/her consent, provide the doctor, via electronic information channels, with the patient’s evaluation of his/her medical records, consultation notes, results of instrumental or laboratory examinations, photographs of various parts of the body, or any other documentary or photographic material that would help the doctor to diagnose the disease more accurately and/or to carry out a differential diagnostic procedure. The patient is responsible for any information provided, incompletely provided, misrepresented or not provided at all during the teleconsultation that is relevant to the decision taken during the teleconsultation.
     • A typical remote consultation lasts up to 30 minutes, including 10 minutes for documentation.
     • After a Remote Consultation, the record of the consultation is uploaded to the ESPBI IS.
     • Patients’ personal data and their medical data are automatically deleted from the system after the consultation or if no consultation has taken place and are not stored in the system. All data provided is used only for the consultation and is deleted immediately afterwards.

4. Medical emergencies.
   • If, during a teleconsultation, it is determined that the patient requires emergency medical assistance, the teleconsultation is immediately terminated and the patient is informed, provided with the necessary information and assistance, and if the patient consents, an ambulance is called, or if the patient is unable to give consent, assistance is called without his/her consent. If necessary, the doctor keeps in contact with the patient until the ambulance arrives and gives advice as appropriate.
5. Processing of personal data.
   • Telesante processes the following personal data in the provision of its services: name, surname, telephone number, personal identification number, date of birth, e-mail address, social security number, health data, etc.
   • Information about the processing of personal data is provided in the Telesante Privacy Policy.
   • No video and/or audio recording is allowed during remote consultations.
6. Patient rights and responsibilities.
   • The patient shall have the rights and obligations provided for in these Rules and in the legislation of the Republic of Lithuania.
   • Patients must exercise their rights in good faith, without abuse, and respect the rights and legitimate interests of others. Patients’ rights may be limited to the extent provided for by law and these rules.
   • The patient is obliged to comply with the obligations laid down in the rules and the legislation of the Republic of Lithuania. Telesante may refuse to provide services to a Patient who breaches his/her duties, thereby endangering his/her own health and life and the health and life of other Patients, or interferes with their access to the quality of the Services.
7. Procedures for resolving disputes and conflicts.

The patient shall be given the opportunity to express his/her opinion in writing or orally about the quality of the services provided, the competence of the staff, the organisation of activities, etc. If a patient feels that his/her rights have been violated or is not satisfied with the quality of the services provided, he/she can contact the Director of Telesante. The therapist always seeks to resolve the conflict with the patient by mutual agreement. If a patient feels that his/her rights are being violated at Telesant, he/she has the right to file a complaint:

The patient or his/her representative can lodge a complaint. Complaints that are signed by the patient, with the patient’s name, actual place of residence and contact details, and the substance of the complaint are considered. If the complaint is submitted by a patient’s representative, the name and surname of the representative, his/her place of residence, the document certifying the representation and the patient on whose behalf he/she is making the complaint shall be indicated. Complaints that are illegible and do not meet the requirements set out in this paragraph shall not be examined and shall be returned to the patient with reasons for the return.

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.

After receiving a patient’s complaint, the Telesante must investigate it and inform the patient in writing (by email or registered mail) of the outcome of the investigation no later than 20 working days

If the patient (his/her representative) is dissatisfied with the outcome of his/her complaint, he/she may appeal to the public authorities dealing with patients’ complaints or to a court in accordance with the procedure laid down by law. Telesante shall respond to any other written requests no later than 20 working days from the date of receipt of the requests, but this time limit shall not include the time allowed by law for the resolution of deficiencies in complaints (where applicable). The patient has the right to appeal to the State Service for Accreditation of Health Care Activities under the Ministry of Health for the protection of his/her violated rights related to accessibility and quality of services, to the State Patient Fund under the Ministry of Health for the protection of his/her violated rights related to issues of compulsory health insurance, to the State Patients’ Insurance Fund under the Ministry of Health, and to the Bioethics Committee of the Republic of Lithuania for the protection of his/her violated rights related to the compliance of the services with bioethical requirements. The patient shall have the right to apply to the institutions referred to in this paragraph only if he/she disagrees with the decision taken by the Telesante following the examination of his/her complaint, or if his/her complaint is not examined within the time limit laid down by the law, as well as in any other cases provided for by the law. In the cases referred to in this paragraph, the patient shall also have the right to apply directly to the courts and to challenge before the courts the actions or omissions of the authorities referred to in this paragraph in the course of the examination of his or her complaint. The Patient shall apply for compensation of damages to the Commission for the Determination of Damages to Patients’ Health, operating under the Ministry of Health, in accordance with the procedure for the compensation of material and non-material damages caused by the damage to the patient’s health, as approved by the Government of the Republic of Lithuania.

8. Procedures for making and issuing copies of medical documents.

The extract is issued in Lithuanian by the doctor who provided the services to the patient. This extract is hosted on the ESPBI IS, where it is always available to the patient.

9. Procedures for providing information to the patient and his/her relatives about his/her state of health.

When informing about the treatment, the doctor shall explain the course of the treatment, the possible results of the treatment, the possible alternative methods of treatment, the possible risks, complications, side effects, prognosis of the treatment and other circumstances that may influence the patient’s decision to accept or refuse the proposed treatment, as well as the consequences of refusing the proposed treatment. The doctor must provide this information to the patient, taking into account his or her age and state of health, by explaining special medical terms in a way that the patient can understand. Health information is withheld from the patient only in cases where the patient does not consent to receive the information (patient’s declaration of intent is required) and where the communication would be a clear presumption of serious harm to the patient (harm to the patient’s health or endanger the patient’s life). In such cases, all the information provided for in this Article shall be provided to the patient’s representative and shall be treated as information to the patient. The doctor explains to the patient the meaning of the entries in their medical records. If the patient’s request is justified, the inaccurate, incomplete, ambiguous data, or data not related to diagnosis, treatment or care, must be corrected, supplemented, completed, cancelled and/or replaced by the physician within 15 working days. Information on the state of health of a patient who cannot be considered capable of exercising a reasonable judgement in his/her own interests shall be provided to the patient’s spouse, cohabitant/partner, parents/guardians and the patient’s adult children at their request.
If the persons indicated are not available or cannot be contacted as quickly as necessary, information on the state of health of a patient who cannot be considered to be capable of exercising a reasonable judgement in his or her own interests shall be given to one of the patient’s adults
brothers/sisters, or one of the patient’s adult grandchildren, or one of the patient’s grandparents at their request.

Information about the patient’s attendance at the institution, his/her state of health, the diagnosis of the disease, the details of the medical examination or treatment, etc. is not made available to persons not authorised by the patient, except for exceptions provided for by law.

10. Procedures for providing patient information to public authorities and other bodies.

All information about the patient is confidential and may be provided only with the written consent of the patient, except in cases where the information must be provided in accordance with the procedure established by law: to the authorities controlling personal healthcare services, the court, the public prosecutor’s office, the quota bodies and other institutions to which such right is granted by the law of the Republic of Lithuania.