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Official Translation Official Translation REPUBLIC OF LITHUANIA LAW ON MEDICAL PRACTICE OF PHYSICIANS September 25, 1996 No I - 1555 Vilnius (Amended as of 19 May 1998) CHAPTER I GENERAL PROVISIONS ARTICLE 1. The Concepts Used in This Law 1. Physician is a person, possessing a university medical education and having the right, according to the procedure established by this law, to engage in individual health care, which includes the determination (expert medical examination) of a person’s state of health, prophylaxis of disease, diagnosis of disease, treatment and medical rehabilitation of patients. Within this Law the concept of physician shall include assisting physician, resident physician, research physician, medical physician and physician specialist concepts. 2. Assisting Physician is a person, possessing the diploma of a physician, who has not completed his post graduate medical studies in a speciality residency, or has completed the residency, but not in that speciality and does not have the right to engage in the independent practice of medicine. 3. Resident Physician is a person, possessing the diploma of a physician and continuing post graduate medical studies at the university level in general or specialised medical residency, not having the right to engage independently in the medical practice in that speciality. 4. Research Physician is a person possessing the diploma of a physician and a certificate attesting to his right to perform certain diagnostic (research) procedures of diseases, and having the right to engage in the independent practice of medicine, defined by the specialty norm of research physician. (amended 19 May 1998) 5. Medical Physician is a physician, having a valid license to engage in the general practice of medicine, in accordance with the procedure established by this Law, and able to engage in the general practice of medicine independently. 6. Specialist Physician is a physician who possesses a valid licence to engage in the specialised practice of medicine, in accordance with the procedure established by this Law, who may engage in the independent practice of the medical speciality indicated on the licence. 7. Medical Practice (general or specialised) denotes individual health care rendered by a physician having a license. 8. Licence in General Medical Practice (further- license) denotes a document which grants a person the right to engage in the general practice of medicine in the Republic of Lithuania. The Ministry of Health shall establish the procedure and scope of the general practice of medicine. 9. Licence in Specialised Medical Practice (further - license) denotes a document which provides a person with the right to engage in one of the types of specialised medicine, in the Republic of Lithuania. The Ministry of Health shall establish the types, scope and procedure of specialised medical practice. 10. Licence for the Temporary Practice of Medicine denotes a document which grants the right to foreign specialist physicians, temporarily visiting the Republic of Lithuania, to temporarily perform individual health care activities solely for the purposes of training (

  1. or)charity, in the Republic of Lithuania. 11. License Register denotes a list administered and kept by the Ministry of Health, which contains data on the issuance, re-registering, suspension of and revocation of licenses. 12. Certificate (permit) denotes a special document attesting to a person’s right to provide certain services of medical practice. ARTICLE 2. Issuance of Licenses for the Practice of Medicine to Physicians Who Have Begun Their Practice of Medicine Before July 1, 1998 1. Licenses for the practice of medicine for physicians engaging in the practice of medicine, before July 1, 1998 and having the specialist qualification category, shall be issued without applying Articles 5 and 6 of the Law on Medical Practice of Physicians, with the exception of the requirement to know the state language. 2. Licenses for the practice of medicine for physicians engaging in the practice of medicine before July 1, 1998 and not having the specialist qualification category, with the exception of the requirement to know the state language shall be issued without applying Articles 5 and 6, solely in cases in which they shall submit a document attesting to the completion of course of qualification ??? study according to a specialty. The Ministry of Health shall establish the scope, duration and procedure of this qualification course. 3. Licenses to engage in the practice of medicine shall be issued to the physicians indicated in parts 1and 2 of this Article, before December 31, 1999, shall be issued according to the Provisional Procedure of Issuance of Licenses to Engage in Medical Practice which shall be approved by the Ministry of Health. During this interval they shall not be applied the requirements of Articles 4 and 16 of the Law on the Medical Practice of Physicians. (amended 19 May 1998) CHAPTER II THE RIGHT TO ENGAGE IN THE PRACTICE OF MEDICINE ARTICLE 3. The Principles of Regulating the Medical Practice of a Physician 1. The licenses for physicians to engage in the practice of medicine (general and specialised) shall be issued, registered, re-registered, suspended, renewed and revoked by the Ministry of Health, according to the procedure established by this Law and the regulations of licensing of physicians for medical practice. The Ministry of Health (amended 19 May 1998) shall approve the regulations of licensing of physicians for medical practice. 2. The Ministry of Health shall set up a permanent commission for the purpose of carrying on the activity indicated in part one of this Article, whose makeup, procedure of formation and activity shall be regulated by the Regulations of Licensing of the Medical Practice of a Physician. (amended 19 May 1998) ARTICLE 4. The Right to Engage in the Practice of Medicine The persons who have a valid license issued in accordance with the procedure established by this Law may engage, in the practice of medicine (general and specialised) in the Republic of Lithuania. ARTICLE 5. The Procedure for Issuance of Licenses for the General Practice of Medicine 1. A person applying to the Ministry of Health for the purpose of obtaining a license for the general practice of medicine, must submit the following documents: 1) the passport of a citizen of Lithuania or a document granting him the right of permanent residence in the Republic of Lithuania; 2) a medical university diploma which, according to the procedure established by laws, is accepted in the Republic of Lithuania. 3) a document, certifying completion of the residency in general medical practice; 4) a health certificate inthe form stipulated by the Ministry of Health. 2. In issuing the license, the Ministry of Health must make certain that the individual professional preparation shall be commensurate with the requirements of the general practice of medicine, the person knows the state language according to the categories of language expertise established by the Government, may engage in medical practice according to the state of his health and the person’s right to engage in medical practice has not been revoked by the court. If more than two years have passed since residency in general medical practice, the person must submit a document attesting to additional training, the duration and scope whereof shall be established by the Ministry of Health. The Ministry of Health may require from a person explanations and additional documents directly pertaining to the issuance of a license. 3. Additional requirements (additional practice, speciality examinations and other) may be applied to aliens and persons without citizenship, who have a permit of permanent residence in the Republic of Lithuania, which shall be established by the Ministry of Health, if not provided otherwise in international agreements of the Republic of Lithuania. 4. The Ministry of Health is required to examine, within a period of one month, a person’s request of a license to engage in the general practice of medicine. 5. If the Ministry of Health shall refuse to issue a license to engage in the general practice of medicine, it is obliged to present to the petitioner, within a period of fifteen days, a written explanation of the reasons for the refusal to issue the license. The person may appeal in court, against the refusal by the Ministry of Health to grant a license for the general practice in medicine. 6. The Minister of Health shall sign a license for the general practice of medicine. ARTICLE 6. The Procedure of Issuance of Licenses for the Specialised Practice of Medicine 1. A physician desirous of engaging in the specialised practice of medicine must apply to the Ministry of Health with a request for a license to engage in the specialised practice of medicine and must submit the following documents: 1) the passport of a citizen of the Republic of Lithuania or a document granting him the right of permanent residence in the Republic of Lithuania; 2) The license to engage in the general practice of medicine or a document attesting to the completion of the residency in the general practice of medicine. If the person shall submit a document attesting to the completion of residency in the general practice of medicine, he must also submit a health certificate of the form established by the Ministry of Health; 3) a document attesting the fulfilment of the residency requirement in the specialised practice of medicine. Additional requirements (additional practice, speciality examinations and other) may be applied to aliens and persons without citizenship, which shall be established by the Ministry of Health, unless it shall be otherwise established in the international agreements of the Republic of Lithuania. 2. In issuing a license, the Ministry of Health, must make certain that the professional qualifications of the person meet the requirements of the specialised practice in medicine, the person knows the state language in accordance with the language expertise categories established by the Government, may engage in the practice of medicine as far as the condition of his health is concerned and that the court has not revoked the person’s right to engage in the practice of medicine. If more than two years have elapsed since completion of residency in the specialised practice of medicine, the person must submit a document attesting to additional training, the duration and scope whereof shall be established by the Ministry of Health. The Ministry of Health may require of the person explanations and additional documents, directly related to the issuance of the license. 3. In issuing a license, The Ministry of Health may take into consideration the opinion of a physicians’ association of a corresponding speciality which has been registered in accordance with the procedure established by laws. 4. The Ministry of Health must, within the course of two months, examine a person’s request for issuance of a license for the specialised practice of medicine and to inform him of the decision. 5. A refusal by the Ministry of Health to issue a license for the specialised practice of medicine, may be appealed in court, by the person. 6. The Minister of Health shall sign the license to engage in the specialised practice of medicine. ARTICLE 7. The Procedure of Issuance of Licenses to Engage in the Temporary Practice of Medicine 1. A license to engage in the temporary practice of medicine may be issued to physicians of foreign states, who have a permit for temporary residence in the Republic of Lithuania, who wish to temporarily perform individual health care in Lithuania solely for the purposes of training and (
  2. or)charity. 2. Licenses to engage in the temporary specialised practice of medicine shall be issued to cover no more than a three-month period. ARTICLE 8. The Fee for the Issuance of Licenses A person who obtains or re-registers a license and also, one who obtains a certificate, must pay a stamp duty in the established sum. ARTICLE 9. The License Register 1. Having adopted a decision to issue, re-register, suspend, renew, and revoke a license, the Ministry of Health must enter this decision on the license register, within a period of five (amended 15 May 1998) work days. 2. The Government shall approve the regulations of the license register. ARTICLE 10. LICENSE RE-REGISTRATION 1. A person must apply to the Ministry of Health, every five years from the date of the issuance or re-registration of the license (general medical practice or specialised medical practice) for re-registration of the license. 2. The person applying for re-registration of a license, must submit documents: 1) confirming that over the past five years he had been improving his professional skills. The Ministry of Health shall establish the procedure and scope of professional improvement; 2) confirming three-years of medical practice over the last five years. 3. The license for general or specialised (amended 15 May 1998) practice in medicine shall per decision by the Ministry of Health, be re-registered over a two-month period from the day (amended 19 May 1999) of the person’s appeal to the Ministry of Health. 4. The decision by the Ministry of Health to refuse re-registration of the license, must be elaborated in writing, over a period of fifteen work days, providing the reasons for the refusal and the requirements, following the implementation whereof, the license may be re-registered. 5. The license, which within the period of one year, from the term of time indicated in part one of this Article, had not been re-registered, shall be equated to a license the validity whereof has been interrupted and whose validity may be renewed according to the procedure established in Article 11 of this Law. ARTICLE 11. RENEWAL OF LICENSE 1. A person who wishes to renew a license which has been suspended, due to the circumstances indicated in part 5 of Article 10 or personal initiative, must apply to the Ministry of Health in order to effect renewal of the validity of a license and its re-registration. 2. In applying for renewal of a license, an individual must submit documents attesting to the fulfilment of additional medical practice, or a document attesting to the fact that that he has spent at least 200 hours in improving his professional qualifications. The Ministry of Health shall establish the duration, procedure and scope of additional medical practice and professional improvement. A personal appeal for renewal of a license must be examined within a period of two months. ARTICLE 12. The Principles of Revocation of License The licence shall be revoked, if: 1) a person who applied for the issuance of a license, has submitted falsified or unsuitable documents; 2) the person’s qualifications do not correspond with the requirements of indicated speciality; 3) the person has committed a serious medical practice error or frequently-repeated medical practice errors. (amended 15 May 1998) 4) person has seriously violated the rights of a patient; 5) person is unable to perform his professional duties, for reasons of health; 6) a person is prohibited from engaging in the practice of medicine as result of the coming into effect of a court decision. ARTICLE 13. The Procedure of Revoking a License 1. The Ministry of Health shall revoke the licenses to engage in the specialised or general practice of medicine,upon its own initiative or when the institutions indicated in part 2 of this Article apply in this regard for reasons indicated in Article 12 of this Law. The question of the revocation of a license must be examined within one month from the day of submitting an applycation to the Ministry of Health. The Ministry of Health shall inform the physician and his employer, of the decision which has been adopted within five work days. The empl;oyer must terminate the labour contract with the physician according to the procedure established by the Law On Labour Contract. (amended 19 May 1998). 2. The Committee of Medical Ethics of Lithuania, the State Medical Audit Inspectorate, municipal authority doctors, medical ethics committee of a health care institution, county or municipality physicians, administration of a health care institution, and a scientific association of physicians in a corresponding speciality. may apply for the revocation of a license. (amended 19 May 1998) 3. Disputes arising due to the revocation of a license shall be resolved by court procedure. 4. A person, whose license has been revoked, may repeat his application for obtaining it, to the Ministry of Health, but no earlier than one year after its revocation. ARTICLE 14. Suspension of License 1. A license may be suspended during examination of the question of the suspension or revocation thereof. Upon suspension of a license upon this basis the physician is barred from engaging in medical practice for the duration of license suspension. 2. A license may be suspended, if the circumstances indicated in part 5 of Article 10 of this Law, are present. 3. A license may be suspended also, upon the request of the physician himself. 4. A suspended license is not valid. A person whose license has been suspended, shall not have the right to engage in medical practice which had been accorded the right by virtue of the license. 5. The Ministry of Health shall adopt the decision to suspend a license and inform the physician and his employer of this within a period of five work days. In accordance with this decision by the Ministry of Health, the employer must for the duration of suspension of the license validity, remove the physician from his job (duties) according to the procedure established by laws. (amended 19 May 1998) 6. The decision by the Ministry of Health to revoke the license may be appealed in court. ARTICLE 15. The Issuance, Suspension and Revocation of Certificates 1. Certificates for provision of certain medical services shall be issued, nostrified suspended and revoked according to the procedure established by the Ministry of Health. 2. The Ministry of Health, upon the recommendation of physicians speciality associations shall approve the list of the kinds of medical services which require a certificate. 3. Disputes concerning the issuance, nostrification, suspension and revocation shall be resolved by the Minister of Health and the court. ARTICLE 16. Illegal Practice of Medicine 1. Illegal practice of medicine is the result of activity, whereby a person: 1) shall engage in medical practice without having a license or else it is no longer valid; 2) shall provide medical services without having a certificate, in cases wherein it is required; 3) shall engage in the practice of medicine not according to the speciality indicated; 4) shall illegally assume the name of a physician. 2. A person, who shall engage in the illegal practice of medicine, shall be liable according to the laws. CHAPTER III PROFESSIONAL RIGHTS, OBLIGATIONS AND LIABILITY OF PHYSICIANS. THE CONTROL OF MEDICAL PRACTICE ARTICLE 17. The Professional Rights of Physicians The physician shall have the right to: 1) engage in the practice of medicine in accordance with the procedure established by laws and other legal acts; 2) select and prescribe medicines. The Ministry of Health shall regulate the procedsure of selection and prescription of medicine. (amended 19 May 1998) 3) certify a person’s birth and date facts in accordance with the procedure established by the Ministry of Health; 4) issue personal health certificates in accordance with the procedure established by the Ministry of Health; 5) refuse to apply individual health care methods (treatment), which contradict ethics principles of the physician and moral norms, provided that this shall not endanger a person’s life or health. ARTICLE 18. The Professional Obligations of Physicians A physician must: 1) provide required medical assistance; 2) properly engage in medical practice, in accordance with the requirements of this Law and other legal acts and improve professional skills; 3) respect patients’ rights and protect medical confidentiality; 4) observe the requirements of medical ethics; 5) provide the required statistical and other required accounting data in accordance with the procedure established by the Ministry of Health. The legal acts of the Ministry of Health shall establish the list of required accounting documents; 6) maintain medical documents properly; 7) to inform the police and (or)the prosecutor’s office about injured patients, who may have been crime victims; 8) explain circumstances of medical practice when requested by the Ministry of Health, prosecutor’s office, police, and court; 9) perform other duties stipulated by laws and other legal acts. ARTICLE 19. The Professional Liability of Physicians A physician in violation of requirements of this Law, shall be liable in accordance with the procedure established by laws. ARTICLE 20. The Control of Medical Practice The Ministry of Health and other State institutions authorised by laws shall control the professional activities of physicians. CHAPTER IV CONCLUDING PROVISIONS ARTICLE 21. Coming into Force of the Law This law shall come into force in accordance with the procedure established by the coming into force and implementation of the Republic of Lithuania Law on Medical Practice of Physicians. I promulgate this Law passed by the Seimas of the Republic of Lithuania PRESIDENT OF THE REPUBLIC ALGIRDAS BRAZAUSKAS

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