REPUBLIC OF LITHUANIA

REPUBLIC OF LITHUANIA REPUBLIC OF LITHUANIA L A W ON THE HEALTH SYSTEM The Seimas of the Republic of Lithuania, recognizing, that the health  of the  population is  the greatest  social  and economic value of society, health is  not only  the absence  of diseases  and  physical deficiencies, but  physical,  spiritual  and  social  welfare  of people as well, the potential  of health  and conditions  of its maintaining are determined  by  stability  of  the  development  of  economic system, guarantees  for social security and education of society, employment and  sufficient income  of the  population,  provision with dwellings,  accessible, acceptable and adequate health care, proper  nutrition,   quality  of   work,   living   and   natural environment, as  well as  by the  efforts of  the  population  to promote health, person's efforts  to stay  healthy may  only be  promoted by social and  economic measures which are acceptable from the point of view of human dignity and the current time, the best  possible public health is a necessary prerequisite for the  security and  prosperity of  the State  of Lithuania, as well as  for creating  of an  open,  just  and  harmonious  civic society; taking into  consideration  the  provisions  of  the  global strategy "Health  to Everybody  - 2  000", adopted  at  the  30th Session of  the World  Health Assembly in 1977, the Ottawa Health Promotion Charter and the National Health Concept of Lithuania; seeking to  ensure the in-born human right to enjoy the best possible  health,   as  well   as  the   right  to  have  healthy environment, acceptable, accessible and adequate health care; acting in  compliance with  the Constitution of the Republic of Lithuania, enacts this Law on the Health System. Part I The Health System Chapter 1 General Provisions Article 1. The Purpose of the Law of the Republic of Lithuania on the Health  System The Law  of the  Republic of  Lithuania on the Health System shall regulate  the national  health  system  of  Lithuania,  its structure, limits  of legal  regulation of  health  care,  health strengthening and  health recovery, fundamentals of establishment of the scope of health activities, organization and management of individual and  public health  care, health promotion, conclusion of contracts  concerning health  activities, fundamentals  of the liability for  violations of  legal norms  of health  activities, rights and  duties  of  the  residents  and  subjects  of  health activities. Article 2. Legal Regulation of Health Relations Health relations  arising from protection, strengthening and assistance in recovering of individual and public health, as well as relations  concerning the  implementation of  the individual's rights to  have the  best possible  health, protection  of health interests of  an individual  and society,  shall be  regulated by this Law,  other laws  on health  activities, as well as laws, if they do  not contradict  the meaning of the above mentioned laws, concerning the  structure and  institutions of  state  power  and government, local  self-government, public  organizations,  human rights  and   other  social  affairs,  environmental  protection, economy,  national   defense  and   internal  order,  subordinate legislation acts,  contracts  and  agreements  concerning  health activities and working conditions. Article 3. The Scope of the Legal Regulation of Health Relations The following  shall only  be established by the laws of the Republic of Lithuania on health activities: 1) the  sphere, tasks and principles of the effectiveness of health law; 2) the  system of  types and  subjects of health activities, the  competence   of  the  main  subjects  of  health  activities management,  rights  and  duties  of  state  services  and  state inspectorates of  health activities coordination and health care, institutions of individual and public health care and subjects of pharmaceutical activities  in the  individual and  public  health care or  pharmaceutical activities,  legal  framework  for  their establishment, activities and termination thereof; 3)  the   legal  framework   of  establishment,  activities, reorganization of  the state hygiene inspectorate, conditions and procedure for the state hygiene control; 4) the  structure of resources of the national health system and basis for their management; 5) the  basis  for  organizing,  management  of  the  health activities, as well as for health support and financing; 6) the  necessary conditions  of health  activities and  the legal framework of their control; 7) the  rights  and  duties  of  the  population  in  health activities, legal framework of participation of the population in the management of health matters; 8) the  legal framework  of accrediting  of the  persons who have the  higher or  special secondary medical or other education for health  and  pharmaceutical  activities,  basic  professional rights  and   duties  of   medical  specialists,   procedure  for establishing  of   the  qualification   requirements,   for   the improvement of  their qualification and the restrictions of their practice, legal  framework of  the  restriction  of  health  care advertising, for  establishing of  civil responsibility  for  the damage done to the patients' health while carrying out the health care of individuals; 9) the  procedure for making health activities contracts and basic terms and conditions thereof; 10) the  legal framework of organizing and management of the primary health care, of the control over the conditions thereof; 11) the system of public health care, legal framework of its organizing,    management,    of    the    hygiene    regulation, epidemiological protection  against contagious  diseases, hygiene and epidemiology control, and hygiene expert examination; 12) the  legal framework  of labour  protection  and  labour medicine, for  organizing and  management  of  consumers'  health protection; 13) the  general requirements  for  food  products  quality; procedure for  the conditions  of producing,  importing, trading, advertising of  such products,  control over  the quality of food products and their tare, marking thereof; 14) the  general requirements  for the  quality of  drinking water, legal  framework of  water treatment,  rendering harmless, and quality improvement; 15) the  procedure for  controlling  of  production,  trade, import,  export,   licensing  and  consumption  of  narcotic  and psychotropic  substances,   alcohol  products,  tobacco  and  its products, the  system of  reducing the  consumption of  alcoholic beverages and  tobacco products,  the procedure  for narcological supervision, prohibition  of advertising  of alcoholic  beverages and tobacco products; 16) the  conditions for  production, trade,  import, export, transportation,  utilization   of   poison,   other   toxic   and radioactive material,  requirements  for  working  with  ionizing radiation sources,  conditions for  ensuring radiation safety and the procedure for the control thereof; 17) the  system of  the prophylaxis  of contagious diseases, legal framework  of organizing and management of the control over said diseases; 18) the  conditions  of  public  health  monitoring,  expert examination of public health, legal framework of their organizing and management; 19) the  legal framework  of organizing  and  management  of physical culture and sport, control over dope and sex; 20) the  rights of persons in the sphere of supervision over the psychic  health; the conditions of psychic health supervision and the legal framework of its organizing and management, as well as of the control over the conditions thereof; 21) the  legal framework of organizing of medical and social rehabilitation of the handicapped; 22)  the   conditions  of  stomatological  and  narcological supervision and  the legal framework of organizing and management thereof; 23)  the   procedure  for   family  planning   and   genetic consulting, the  legal  framework  of  birth-control,  artificial insemination, foetus  protection, termination  of pregnancy,  and sterilization; 24) the requirements for the ethics of biomedical tests, the procedure for the control of observing said requirements, as well as liability for violations of the requirements for the ethics of biomedical tests; 25) the  conditions and  procedure for giving human blood by donors, production  of blood products, transfusion of human blood and its products; 26) the  basic  principles,  conditions  and  procedure  for taking organs  or tissues  for  transplantation,  their  use  for transplantation, medical research, diagnostics, and treatment; 27)  the   criterion  of   the  establishment   of  terminal conditions and  the fact of death of an individual, conditions of an individual's  refusal from  all or  part of  life prolongation services, conditions  and procedure  for  postmortem  examination (autopsy) of a corpse; 28) the  legal  framework  of  providing  of  pharmaceutical services, organizing and management of pharmaceutical activities; 29) the conditions and procedure for granting of a permit to dispense drugs  and medicinal  substances, for the control of the quality thereof; 30)  the   health  insurance   system,  the   procedure  for collecting funds for compulsory health insurance, legal framework of voluntary  health insurance,  rights and duties of the insured and insurers, procedure for establishing and activities of health insurance institutions  as well  as rights  and duties  of  these institutions; and 31) basic  principles of  liability for  violations  of  the requirements of laws concerning health activities. The Government  of the  Republic of  Lithuania,  ministries, state services  and state  inspectorates shall enjoy the right to adopt within  their competence  legal acts  on the  issues of the regulation of  health relations,  with  the  exception  of  those issues  which   are  regulated  by  the  laws  concerning  health activities. Provisions  of legal  acts of  the Government  of the Republic of  Lithuania,  ministries,  state  services  and  state inspectorates, which  worsen the  conditions of health activities comparing to  those conditions  which are established by the laws concerning health activities, shall be deemed invalid. Within  their   competence,  enterprises,  institutions  and organizations  shall   have  the   right  to   adopt  legal  acts establishing,  in  comparison  to  laws  and  other  legal  acts, additional economic  and social incentives for citizens to foster their health,  for economic  entities -  to engage  in  economic- commercial activities beneficial to health, additional support to socially vulnerable  groups of the population by compensating the expenses  of  their  health  care,  additional  requirements  for implementing of  public health  care. Provisions of legal acts of enterprises, institutions  and  organizations  which  worsen  the level of  health activities  comparing  to  the  level  which  is established by  laws  and  other  legal  acts  concerning  health activities, shall be deemed invalid. Article 4. Health Activities The health activities shall comprise: 1) individual health care; 2) public health care; 3) pharmaceutical activities; and 4) traditional  medicine,  folk  medicine,  and  non-medical methods of health recovery. Article 5. The Purposes of Health Activities The purposes of health activities shall be as follows: 1) to  reduce the  falling  behind  of  certain  social  and professional groups  of society  from other  groups of society as shown by  the health  condition indicators, without worsening the general level of the population's health; 2) to  protect population  against diseases, avoidable death or invalidity; 3) to  extend  the  length  of  life  without  diseases  and traumas, and improve its quality; and 4) to increase economic and social efficiency of life. Article 6. Principles of Regulating of the Health Activities The following  principles shall be applied to the regulation of the relations specified in Article 1 of this Law: 1) the  all-round protection  of the  individual and  public health; 2) the  coordination of  individual, public health and state interests; 3) the  equality of  individual's rights  to have  the  best possible health  regardless of his or her sex, race, nationality, citizenship, social status and profession; 4)  the   individual's  freedom  to  chose  as  good  health conditions as possible; 5) the  acceptability, accessibility  and  adequacy  of  the individual health care; 6) the  persons' freedom to unite into public organizations, defending the  interests of public and individual health, and the State  support   of  the   programmes  of   activities  of  these organizations; 7) the  all-round, rightful  and  timely  informing  of  the population about  the conditions  of promoting  the best possible health and advertising of these conditions; 8) the  participation of  public organizations in the health activities  management   directly  as   well   as   through   the democratically elected representatives; 9) the  State support  of persons  in protecting, recovering and improving their health; 10) the partial or full compensation, which is guaranteed by the State, of health care costs which might worsen the quality of life; 11)  the  all-round  prevention  of  threat  and  damage  to individual and  public health  exercised by  all subjects  of the health activities; and 12) the  promotion by  the State  of  economic  efforts  and initiatives beneficial to health. If the  relations specified in Article 1 of this Law are not regulated by  laws and  provisions of legal norms, which regulate similar relations,  cannot be applied thereto, the principles set forth in  Par.  1  of  this  Article  shall  be  applied  in  the settlement of any disputes that may arise. Chapter 2 The Lithuanian National Health System Article 7. The Foundations of Forming of the Lithuanian National Health System The foundations of forming of the Lithuanian National Health System shall be as follows: 1) ensuring of social justice in health activities; 2) integration  of all resources of health activities into a unified system,  their planning and use according to the national priorities of health activities; 3) integration  of individual  health care and public health care into a unified system; 4) introducing  of the elements of the social market economy into health  activities without violating the national priorities of health activities; 5) ensuring  of the  implementation of the Lithuanian health programme, and the programmes of the health system reform; 6)  ensuring  of  intersector  coordination  of  the  health activities; and 7) ensuring  of participation  of the  public in  the health activities management. Article 8. The Structure of the Lithuanian National Health System The Lithuanian  National Health System (hereinafter referred to as the LNHS) shall consist of: 1) the executive bodies of the LNHS; 2) the managing bodies of the LNHS; 3) the resources of the LNHS; and 4) the  activities and  a range  of services rendered by the LNHS. Article 9. The Executive Bodies of the LNHS The executive bodies of the LNHS shall be: 1) state  and municipal individual and/or public health care institutions; and 2) enterprises,  accredited  for  certain  types  of  health activities and  having concluded health activities contracts with the customers  of activities  and a range of services by the LNHS in accordance with the procedure established by this Law. Article 10. The Managing Bodies of the LNHS The managing bodies of the LNHS shall be: 1) bodies of state management of the LNHS activities; 2) municipalities and their institutions; 3) institutions coordinating the LNHS activities; 4) special managing bodies of the LNHS; and 5) institutions  exercising control  over the  conditions of the LNHS activities. The  managing   bodies  of   the  LNHS  shall  within  their competence supervise  and coordinate  the  health  activities  of other health  activities bodies  which do  not belong to the LNHS system, according  to the procedure established by this and other laws and legal acts. Article 11. The Resources of the LNHS The LNHS resources shall comprise: 1) the land, which belongs to the State or municipalities by the public  ownership right  and  it  intended  for  recreational purposes and organizing of health resorts; 2) natural  resources (mineral  water, curative  mud,  etc.) intended for medical rehabilitation activities carried out by the LNHS; 3) material  resources intended  for ensuring  of  the  LNHS management; 4) the property of the LNHS executive and managing bodies; 5) financial  resources from the State and municipal budgets intended for ensuring of the LNHS activities; 6) funds of compulsory health insurance; 7) any  other property, assigned by laws for ensuring of the LNHS activities; 8) specialists  and other  employees of  state and municipal institutions  of   individual  and   public  health  care,  state enterprises which  are accredited for individual or public health care and pharmaceutical activities; and 9) databases of information concerning individual and public health. The LNHS resources shall be regulated by this and other laws and legal acts. A claim  to property  cannot be  made to  state or municipal institutions of individual or public health care. Article 12. The LNHS Activities and Services The activities  and a range of services rendered by the LNHS shall comprise: 1) individual health care; 2) public health care; 3) pharmaceutical activities; and 4) paid  services specified  in Chapter  4 of Part 1 of this Law. Article 13. Levels of Organizing of the LNHS Activities The levels  of organizing of the LNHS activities shall be as follows: 1) primary  (hereinafter  referred  to  as  "primary  health activities"); 2) secondary  (hereinafter referred  to as "secondary health activities"); and 3) tertiary  (hereinafter referred  to as  "tertiary  health activities"). The primary  health activities shall comprise administrative units of  municipal territories.  It shall  be carried out by the LNHS bodies  subordinate to  municipalities. Other LNHS executive bodies  belonging  to  the  levels  of  organizing  of  the  LNHS activities may  within their  competence perform  this work  on a contractual basis. The secondary  health activities shall comprise higher-level administrative units.  It shall be carried out by the LNHS bodies of higher-level  administrative units.  The LNHS executive bodies belonging to  the  tertiary  level  of  organizing  of  the  LNHS activities may  within their  competence perform  this work  on a contractual basis. The tertiary  health activities  shall be carried out within their competence  by university  and academic  clinics and  other medical treatment  centers, which  provide specialized  and  very specialized medical  treatment to  persons  without  taking  into consideration their  places of  residence. These  LNHS  executive bodies may  within their  competence carry  out the  primary  and secondary health activities on a contractual basis. The  procedure  and  conditions  of  implementation  of  the primary health  activities shall be established by laws and other legal acts. The list  of types  of the  primary, secondary  and tertiary health  activities  and  the  LNHS  executive  bodies  of  health activities which  implement them, their competence, procedure and conditions of  the secondary and tertiary health activities shall be established by laws and other legal acts. Article 14.    The Exclusive Rights of Health Activities of the LNHS Executive Bodies The LNHS  executive bodies  shall have  the right to provide and carry out: 1) individual  health care (free of charge) supported by the State and local authorities; 2)  medical   and  social   examination,  forensic   medical examination, forensic  psychiatric and  narcological examination, and pathologoanatomical examination; 3)  public   health  care   measures  entered  in  the  list established by the Government of the Republic of Lithuania; and 4) state  monitoring  of  public  health  and  state  expert examination of public health. Article 15. Customers of the LNHS Activities and Rendered Services The main  customers of  the  LNHS  activities  and  rendered services shall  be the  Government of  the Republic of Lithuania, its  institutions,   local  authorities,  state  and  territorial patients' funds, other legal and natural persons. The limits  of  the  orders  for  the  LNHS  activities  and rendered services  which  can  be  established  by  the  relevant customers of  the LNHS activities, shall be regulated by the laws and other legal acts. Chapter 3 Levels of Health Activities Section 1 The Required Level of Health Activities Article 16. The Indicators of the Required Level of Health Activities The required  level of health activities shall establish the scope of  health activities  which are  supported by the State or local authorities,  necessary conditions  for health  activities, the list  of measures  and institutions  which are  necessary for retaining or  maintaining of the already achieved level of public health. The required level of health activities shall be defined by: 1) the  lists of  necessary diagnostic  measures approved by the Ministry of Health; 2) the  necessary assortment  of medicines and other medical articles approved by the Ministry of Health; 3) the  list of individual health care measures supported by the State and local authorities free of charge; 4) the list of state institutions and services of individual and public  health care,  and pharmacies  according to  the  type thereof; 5) the list of necessary measures of public health care; 6) the  established necessary  conditions of  individual and public health care; 7) obligatory State and municipal health programmes; and 8) the  basic volume,  established by this Law, of financing of health  activities which  are carried  out by  the  Lithuanian National Health  System, from  the State,  municipal budgets  and compulsory health insurance funds. The required level of health activities shall be established taking   into   consideration   the   demographic,   health   and environmental  quality   indicators  and  tendencies  of  changes thereof. The required  level of health activities, with the exception of the indicators of acceptability and adequacy of individual and public health  care established in items 1 and 2 of Par.2 of this Article, shall  be established  by the Government of the Republic of Lithuania  on the  joint recommendation  of  the  Ministry  of Health and the National Health Council. Article 17.The Structure of Individual Health Care Supported (Free of Charge) by the State and Local Authorities The individual health care supported (free of charge) by the State and local authorities shall comprise: 1) the preventative medical treatment; 2) restorative medical treatment; 3) medical rehabilitation; 4) nursing; 5)  social   services  and   social  assistance  in  medical treatment; and 6) services  which are  attributed to  medical treatment  in accordance with the manner prescribed by this Law. Article 18. Individual Health Care Supported (Free of Charge) by the State The following  shall be  attributed to the individual health care supported (free of charge) by the State: 1) necessary medical treatment on the secondary and tertiary levels of health activities; 2) individual health care provided to servicemen, cadets and law and order and law-enforcement officers and volunteers; 3) individual  health care  provided to  persons detained by the police,  put into  places of  detention, prisoners  (with the exception of  medical rehabilitation  in  sanatorium  and  resort institutions); 4) individual  health care  provided  to  persons  who  have suffered from violations of law, provided that they are witnesses in criminal cases according to the procedure established by legal acts; 5) individual  health care  in accordance  with the  list of categories of civil servants established by the law; 6) individual  health care  provided to  persons who are ill for an uninterrupted period of more than four months; 7) provision  of persons ill with diseases, the list thereof is approved  by the Government of the Republic of Lithuania, with prostheses of teeth, limbs, joints and other organs; 8) individual  health care  provided to  persons who are ill with   tuberculosis,   sexually   transmitted   diseases,   AIDS, infectious  and   endocrinal  diseases   entered  in   the   list established by  the Government  of the  Republic of Lithuania, as well as  mental diseases,  oncogenic diseases,  alcoholism,  drug dependence, and toxic substance addiction; and 9)  blood   donorship,  haemodialysis,   organ  and   tissue transplantation. The scope  of individual  health care  (types of  individual health care  and the list of measures thereof) which is supported by the  State, with the exception of the case specified in item 5 of Par.1  of this Article, shall be established by the Government of the  Republic of  Lithuania on the joint recommendation of the Ministry of Health and the National Health Council. Article 19. Individual Health Care Supported (Free of Charge) by Local Authorities The following  shall be  attributed to the individual health care supported (free of charge) by local authorities: 1) necessary medical treatment provided on the primary level of health activities; 2) individual health care of pregnant women; 3) individual health care provided to mothers until the baby is one year of age; 4) individual  health care provided to the family members of unemployed and disabled persons; 5) individual health care provided to persons under 16 years of age; 6) individual  health care  provided to persons whose income is less  than the level of income supported by the State, as well as orphans under 18 years of age; 7) individual  health care  provided to invalids of group I; and 8) provision  of  persons  of  established  categories  with prostheses of teeth. The scope  of individual  health care  (types of  individual health care  and the list of measures thereof) which is supported by local  authorities shall  be established  by the Government of the Republic  of Lithuania  on the  joint recommendation  of  the Ministry of Health and the National Health Council. Local authorities  shall have  the right,  when possible, to establish an additional scope, comparing to the scope established by the Government of the Republic of Lithuania, of individual and public health  care supported  by local authorities, on the joint recommendation  of   a  physician   of  the   town  or   district municipality and the community health council. Article 20. Necessary Conditions of Health Activities The  necessary   conditions  of  health  activities  in  the Republic of Lithuania shall be as follows: 1) accrediting for individual, public health care activities or pharmaceutical activities; and 2) accessibility,  acceptability and  adequacy of individual and public health care. Health activities  shall comprise  only the territory of the State  of   Lithuania,   unless   otherwise   provided   for   in international treaties of the Republic of Lithuania. The procedure  and conditions of accrediting for individual, public  health   care  or   pharmaceutical  activities  shall  be established by this Law and other legal acts. The indicators  of accessibility  of individual  health care shall be  established  by  the  Government  of  the  Republic  of Lithuania on  the joint  recommendation of the Ministry of Health and  the  National  Health  Council.  The  requirements  for  the acceptability of  individual health  care shall be established by laws and other legal acts. The requirements  and norms of adequacy of individual health care   shall    be   regulated    by   normative   documents   of standardization,  which  are  prepared  by  university,  academic clinics and centres. Normative documents of standardization which regulate the  requirements for  adequacy of  public  health  care shall be  within their  competence prepared  by the  State Public Health Care  Service in the Ministry of Health of the Republic of Lithuania, institutions  of control  over the  health  activities conditions in  other governmental  institutions. These  normative documents shall  within  their  competence  be  approved  by  the Ministry of  Health or  the Lithuanian  Standardization Agency in the Ministry of Economics. The  necessary  conditions  of  health  activities  must  be ensured by  all subjects  of health activities. Health activities subjects which do not ensure the established necessary conditions of health activities, shall be liable under laws. Section II Contractual Level of Health Activities Article 21. Conditions of Establishing of the Contractual Level of Health Activities The health  activities which  do not  belong to the required level of health activities shall be attributed to the contractual level of health activities. The scope  and conditions of the contractual level of health activities  shall  be  established  by  the  contract  of  health activities provided  by this Law. The scope and conditions of the contractual level of health activities, determined by the parties to those  contracts, must not worsen the required level of health activities. Article 22. A Health Activities Contract and the Procedure for Concluding It A health activities contract shall be an agreement between a subject  or   subjects  of   health  activities   (contractor  or contractors) who  have the right to engage into health activities or  carry  out  them  and  a  customer  of  customers  of  health activities, by  which the subject (subjects) of health activities shall undertake  an obligation  to carry out health activities of certain scope  and types,  render a  range of  services  of  this field, and  the customer  (customers) of  health activities shall undertake an  obligation  to  pay  for  the  performed  work  and rendered services. Article 23. The Parties to Health Activities Contracts Governmental institutions, bodies of administration of local authorities,   health    insurance   institutions,   enterprises, institutions, organizations, legal and natural persons may be the parties to  the health  activities contracts  on the one part and legal persons,  enterprises without  a status  of a legal person, accredited for health activities - on the other part. Article 24. Conclusion of a Health Activities Contract The health activities contract must normally be concluded in writing. It  shall be considered concluded, if the parties to the contract agree  upon the basic terms and conditions of the health activities contract. Article 25. The Structure, Text and Validity of the Health Activities Contract The parties  to health  activities contracts shall establish the structure, chapters and appendices of the contracts. The text  of the  health activities  contract shall  be  the terms and  conditions of the contract specified by the parties to it, defining  the rights and duties of the parties, the procedure for carrying  out thereof  and the responsibility of the parties, as well  as basic  terms  and  conditions  of  health  activities contracts established by this Law. The parties to the contract cannot establish in the contract such  conditions   of  health   activities  which   would  worsen conditions of  health activities  comparing them with those which are established  in this  Law, other  laws and legal acts. In the case of  a  dispute  concerning  application  of  the  terms  and conditions of the health activities contract, it shall be settled in the court. The health activities contract shall become effective on the moment of  its signing. Terms of the duration of a contract shall be established upon mutual agreement of the parties. Article 26. Basic Terms and Conditions of the Health Activities Contract In each  contract of  health activities,  its  parties  must agree on the following basic terms and conditions: 1) the types of health activities, scope of these activities and terms of implementation; 2)  prices  of  health  activities  and  the  procedure  for financing of  the scope  of health  activities agreed upon by the parties,  as   well  as  compensation  for  general,  particular, additional expenses; 3)  the   procedure  for   compensation   of   expenses   of transportation of patients, medicines and medicinal substances; 4) the  provision of  time for  engaging in  private  health activities; 5) procedures  for amendment,  supplement and termination of the health activities contract; 6) an additional, comparing to this Law, material liability, which is  established by  the parties  to the  contract,  for  an improper  fulfillment   of  the   contract  obligations  and  the unilateral termination thereof; and 7) the  procedure and  terms of  fulfillment of the contract obligations and the control over them. Item 4  of Par.1  of this  Article shall  be applied only to private health activities subjects, who have concluded a contract with the  LNHS customers  concerning performance  of work  on the required level of health activities. Article 27. Control over the Execution of the Health Care Contract Control  over   the  fulfilment  of  obligations  of  health activities contract  shall be  carried out  by the  parties which have entered  into such  contract. The  procedure and time limits for reporting  on the  fulfilment  of  obligations  under  health activities contract,  by representative  of the  parties  to  the contract shall be set forth in the contract. Article 28. Liability for Failure to Perform the Health Activities Contract Both parties  to the contract shall be liable for performing of health activities contracts. The  grounds   for  the  unilateral  termination  of  health activities contract shall be established by the Civil Code of the Republic of Lithuania. If the obligations of the health activities contract are not fulfilled or  the contract is terminated unilaterally through the fault of  the subject  of health  activities (contractor), losses incurred by  health activities customer shall be compensated with the funds  of the  health activities subject (contractor). If the obligations of  the health  activities contract  are failed to be fulfilled or  the contract is unilaterally terminated through the fault of  the health  activities customer, the losses incurred by the health  activities subject  (contractor) shall be compensated with the funds of the health activities customer. Chapter 4 Paid Services in Health Activities Rendered by State and Municipal Institutions of Individual and Public Health Care and Subjects of Pharmaceutical Activities Article 29. Paid Individual Health Care Services Paid individual  health care  services  shall  comprise  the following: 1) individual health care measures entered in the list drawn up by  the Ministry of Health and the National Health Council and approved by the Government of the Republic of Lithuania; 2) services  (bed linen,  hospital clothing,  telephone,  TV set, etc.),  entered in  the list  established by the Ministry of Health, which  are rendered  in in-patient individual health care institutions; 3)  sending   of  individuals   to   foreign   health   care institutions in the established procedure; 4) provision  with medicines  which are  more expensive, but possessing  analogous  effect  in  in-patient  medical  treatment institutions; and 5) services  entered in the list established by the Ministry of  Health,   which  are   rendered  in  individual  health  care institutions upon the death of a patient. The procedure  for rendering  of paid individual health care services, rates,  procedure for  paying and reduced charges shall be established  by the Government of the Republic of Lithuania on the basis  of this  Law, Law  on State Social Insurance and other laws. Article 30. Paid Pharmaceutical Services Paid pharmaceutical services shall comprise: 1) registration of medicines; 2) expert  examination of  the quality  of medicines  on the order of legal and natural persons; 3) sale  without a  prescription of  medicines  (except  for medicines possessing narcotic and psychotropic effects, which are entered in the established list) to the population in pharmacies; 4) accepting  of orders  by telephone from medical treatment institutions and  legal persons  accredited for individual health care for compounding of extempore medicines (except for medicines possessing narcotic and psychotropic effects which are entered in the established list); 5) delivery of medicines to customers; and 6) other services. The procedure for rendering of paid pharmaceutical services, rates,  procedure   for  paying  and  reduced  charges  shall  be established by the Government of the Republic of Lithuania on the basis of this Law and other legal acts. Article 31. Paid Public Health Care Services Paid public health care services shall comprise: 1) health training of workers of professions, jobs, branches of production  established by  the  Ministry  of  Health  of  the Republic of Lithuania; 2)  public   health   monitoring,   public   health   expert examination conducted  on  the  order  of  interested  legal  and natural persons; 3) preventive  vaccination of  adults, with the exception of the  vaccination   carried  out   in  the  centers  of  dangerous infections and for the purpose of treatment; 4) disinfection,  disinsection, deratization of premises and territories, except  for works,  carried out  in the  centers  of dangerous and extremely dangerous infections; 5)  issue   and  distribution   of  normative  documents  of standardization and  other publications concerning the matters of public health care; 6)  drawing   up  of  health  programmes  on  the  order  of interested legal and natural persons; and 7) other public health care services. The procedure  for rendering  of  paid  public  health  care services, rates, procedure for paying shall be established by the Government of  the Republic of Lithuania on basis of this Law and other legal acts. Part II Health Activities Chapter 1 Engaging in Health Activities Article 32. The Right to Engage in Health Activities in the Republic of Lithuania The right  to engage  in individual or public health care or to apply  its measures  shall be  enjoyed  by  persons  who  have received education and special training in institutions preparing these  specialists  and  authorized  by  the  Government  of  the Republic of  Lithuania to  issue documents certifying an adequate qualification of  an individual or public health care specialist, as well  as who  are accredited  in the manner prescribed by this Law and other legal acts for individual or public health care and who possess the license to engage in these types of activities in the Republic of Lithuania. The conditions  and procedure for accrediting of persons for other types of health activities shall be established by this Law and other laws. In the  procedure established  by the  Ministry  of  Health, individual or  public health  care services  may be  rendered  by foreign individual  or public  health care  specialists only  for charity purposes  or for  the purposes  of  specialist  training, unless otherwise  provided for  in international  treaties of the Republic of Lithuania. Upon obtaining  in the  established procedure  a license  to engage in  private practice,  specialists of  state or  municipal institutions of  individual or  public health care shall have the right  to   engage  in   private  practice   only  outside  these institutions. The Ministry of Health shall determine the qualification and the procedure for recognizing of the qualification of persons who have received  individual or public health care education, but do not have a special training. The right  to engage  in health activities may be taken away only on the basis and in the procedure established by laws. Article 33. Professional Duties, Rights, Professional Training and Responsibility of Individual and Public Health Care Specialists Laws and  other legal acts shall establish main professional duties, rights  of individual and public health care specialists, text of  the Hippocratic  oath and  the conditions  and manner in which it  is taken,  procedure for restriction of their practice, as well  as the  responsibility for the health damage done in the process of health care. Article 34. The Duty of Health Care Specialists to Keep the Secret of  Individual's Health (Medical Secret) Individual  or  public  health  care  specialists  shall  be restricted from  violating of  confidentiality of the information about  individual's   health,  which  they  have  acquired  while performing professional  duties. The  medical ethics requirements for   keeping   the   information   about   individual's   health confidential shall be established by the Ministry of Health. Chapter 2 Individual Health Care Section 1 Preventive Medical Aid Article 36. Information Services Regarding Prophylaxis Questions All those  involved in  individual health care shall provide information  services  on  issues  of  disease  prophylaxis.  The Ministry of  Health shall  determine the  conditions and order of provision of such services. Article 37. Selective Individual Health Examinations Selective individual  health examinations  are conducted  in accordance with  the decision of and the order established by the Ministry of Health. The Health  Information Services  shall determine the number of  respondents,   who  shall  be  subject  to  selective  health examinations, and  the methods  of collection,  accumulation  and processing of the statistical information. Article 38. Immuno-prophylaxis and Chemical Prophylaxis of Communicable Diseases The Ministry of Health shall establish the list of those who must carry out the immuno-prophylaxis and chemical prophylaxis of communicable diseases,  as well  as the  contents, conditions and order of the immuno-prophylaxis and chemical prophylaxis of these diseases. Compulsory  measures   of  immuno-prophylaxis  and  chemical prophylaxis may  only be  applied on the grounds and according to the procedure  provided by laws, in the event of an actual threat that they  may succumb  to particularly  dangerous  or  dangerous communicable diseases. Medical specialists who are in violation of the requirements of this Article, are held responsible under the laws. Article 39. Prophylactic Examinations Workers of  certain professions  and individuals, working in certain fields  and lines  of production, must submit to a health examination prior to engaging in professional activity and during the course  of such  activity. The  Government of the Republic of Lithuania compiles the list of workers in these professions, jobs and production branches and sectors, as well as the procedure for individuals' prophylactic examinations. The  health   of  workers   of  the  professions,  jobs  and production branches  and  sectors,  listed  by  the  Ministry  of Health, as  well as  of those individuals who had associated with those who  had contracted  the diseases  specified on the list of communicable diseases,  established by  the Ministry  of  Health, shall be subject to required health examinations. Medical aid  institutions shall  within the  prescribed time limit, examine the health of: 1) pregnant women, and children under 16 years of age; 2) mothers, until the infant reaches the age of one. 3) individuals  who had  associated with  patients, who  had contracted  communicable   diseases,   included   on   the   list established by the Ministry of Health. Workers of  the professions,  jobs, production  branches and sectors, listed  and other  individuals, who  had associated with patients, who  had contracted  communicable diseases, included on the list  of communicable  diseases, provided  by the Ministry of Health, shall  be quarantined and held under observation, for the purpose of  having their  health monitored,  over the  period  of time, specified  by this  Law or  other laws.  In the event these individuals, the persons close to them, or their representatives, do not  agree with  the doctor's decision regarding isolation and health status  observation, these individuals must, in accordance with the established order, be placed under compulsory quarantine and compulsory  health  observation.  The  police  must,  at  the request of  the institutions  of  health  protection,  assist  in placing such persons under quarantine. Individuals working in the professions, branches and sectors of  production   established  by   the  Government,  as  well  as individuals who have associated with those who had contracted the communicable diseases  included  on  the  list  provided  by  the Ministry of  Health, who  refuse to have their health examined in the prescribed  time period,  shall be held responsible under the laws. Section 2 Medical Recovery Aid Article 40. Vital Medical Aid The following shall be attributed to vital medical aid: 1) first medical aid; 2) institutional  (in-patient or out-patient) urgent medical aid. For those  individuals, who must be rendered medical aid, in order to  save their  lives,  because  of  accidents,  accidental emergencies, ecological  or natural  disasters, or  due to sudden onset of  illness, medical  and pharmaceutical  specialists,  who were present together with the victims or patients at the site of an accident  or sudden  acute and  life-threatening illness, must render first medical aid. Out-patient medical aid must be provided by: 1) mobile, urgent first aid services; and 2) the nearest individual health-care institutions. Urgent  in-patient   medical  aid   must  be   rendered   in specialised in-patient  medical care  institutions or specialised sections of  medical aid institutions, for rendering this type of aid. In the  event the  life  of  this  individual  is  seriously endangered, urgent in-patient medical aid may be rendered without the consent  of the  individual, following a decision by at least two consultant  physicians, and  having informed the patient, his family members  or his representative, and in instances where the victim or  suddenly taken  ill individual, happens to be a minor, his parents  or guardians  must be  notified of  the medical  aid rendered to him. The Ministry of Health shall determine the content of urgent medical care,  the basis,  conditions, and  order of rendering it and the  competence of  institutions of personal health care, and medical/pharmaceutical  specialists  on  questions  of  rendering urgent medical  aid, in  keeping within the allotted fund limits. The  Ministry   of  Health   shall   determine   the   structure, establishment and  order of  financing, and  competence of mobile urgent medical aid services. Individuals, who are bound by this Law and other legal acts, to furnish  vital medical  aid, who  have by  their  inaction  or actions,  contributed   to  the   health  damage  of  victims  or individuals  experiencing   sudden  illness,   shall  be  applied disciplinary,    administrative,     material,    and    criminal responsibility, as prescribed by laws. Article 41. Application of Diagnostic and Treatment Measures The scope of diagnostic measures, applied at the medical aid institutions of  the Republic  of Lithuania,  must not be smaller than those  prescribed by  the lists  of obligatory  measures  in disease diagnostics. Medical aid  specialists shall  have  the  right  to  choose treatment technologies,  in the  order prescribed by this Law and other legal  acts. The  order of  application  of  the  treatment technologies shall  be established  by the normative documents of health care standardisation. Medication shall  be apportioned to diagnostic and treatment measures, provided that it is: 1) prescribed by a physician or another individual, entitled to prescribe it; 2) they  are registered in the Republic of Lithuania, in the prescribed order; A  medical   specialist  may   employ   all   scientifically substantiated, but  not yet  registered, in  the prescribed order medicines,  prophylactics,   diagnostic  and  treatment  methods, medical equipment  and instruments  only in  trying to  cure  the patient and,  to save  or prolong  his life. In this instance, he must obtain  permission of  the patient,  and if  the patient  is unconscious, or  is  a  minor,  of  his/her  parents,  relatives, guardians, or  his  representative's  permission  and  also,  the consent of  the ethics commission, of the health aid institution, regarding the  use of  such individual  health care  technologies use. This  consent must  be executed in writing. When the patient is in  an unconscious state and there is no information available regarding  his   relatives,   parents,   guardians   or   his/her representatives, these  technologies shall  only  be  applied  by written  consent   and  with  the  approval,  by  at  least,  two physicians in  consultation,  as  well  as  that  of  the  ethics commission of the medical aid institution. The application  of compulsory  hospitalisation,  compulsory diagnostic, and  compulsory treatment  measures  to  individuals, shall only  be allowed in accordance with the order prescribed by law, in  the presence of a genuine threat, that these individuals by actions,  or because  of the  state of  their health may cause substantial harm  to their own health or life or to that of other persons. Medical  experts, who  violate these requirements, shall be held  responsible in  accordance with  the order prescribed by law. Article 42. Transfusions of Human Blood and its Products Human blood  for transfusion  purposes  or  blood  products' production, may  be taken  from a  donor solely, of the free will and by the consent of the donor. Human blood and its products may only be  imported in  and transported  out  of  the  Republic  of Lithuania,  for  donor  purposes,  on  the  basis  of  agreements concluded with  legal persons of foreign countries, by individual health care facilities accredited for this purpose. The conditions  and order  of importing into the Republic of Lithuania and  exporting from it of human blood and its products, the quantity  of donor's  blood and  its products,  intended  for individual treatment  use, to  be imported  into the  Republic by Lithuanians and  foreign nationals,  and the conditions and order of conducting  tests of  human blood and its products in order to ascertain their  harmlessness to  human health,  to be  used  for transfusion, shall be established by the Ministry of Health. The conditions  and order  of  taking  of  human  blood  for donorship, production  of blood  products and use of human organs and tissue  for transplants,  medical research,  diagnostics  and treatment, order and conditions shall be established by laws. Individuals in  violation of  this  Article  shall  be  held responsible in accordance with laws. Article 43. Transplantation of Human Tissue and Organs Human tissues and/or organs may not be objects of commercial transactions and  must  be  used  only  for  transplants  or  for biomedical research  purposes. The  purchase  or  sale  of  human tissue and/or  organs of  the human body and the advertisement of such activities, shall be punishable in accordance with the laws. Conditions and  order of the use of human tissues and organs taken from  a body, for use in transplantation, medical research, diagnostics and  treatment and  tissue and/or organ donor rights, are established by laws. Section 3 Medical Rehabilitation, Nursing , Social Services, Care and Assistance Attributed to Individual Health Care Article 44. Medical Rehabilitation The  conditions  and  order  of  Medical  rehabilitation  of patients, in  medical assistance  and nursing facilities, patient selection and  their dispatching  to rehabilitation hospitals and sanatoriums shall be established by the Ministry of Health. The fundamentals  of the  invalids'  medical  rehabilitation organising system  shall be  established by  the  Law  on  Social Integration of  Invalids. The  conditions and  order  of  medical rehabilitation of  invalids is  established by  the Government of the Republic of Lithuania. The order  of  identification  of  localities  suitable  for medical (and  social) rehabilitation,  as resorts, as well as the conditions of  resort organisation,  shall be  established by the Government of the Republic of Lithuania. Article 45. Nursing Individuals shall  be nursed at home, as well as, in medical aid, nursing and social care institutions. The content, conditions and order of nursing of disabled and senior individuals  shall be established by the Government of the Republic of Lithuania. Article 46. Social Services and Social Care Provided under Individual Medical Care Provision of  social  services  and  social  care  shall  be organised within  the auspices  of individual health care for the purpose of  reducing the  psycho-emotional stress  level  and  to assist them  in fighting stress and ensure their social security. The social  services and  social care  are managed  by the social workers of medical aid institutions. The order  and conditions  of the  social services kinds and the scope  of supplying  them, the  content of  social care of an individuals in  health care,  as well  as the regulations guiding health care  social workers, are established by the Government of the Republic of Lithuania. The order  of social  workers preparation and the raising of their qualifications  is  established  by  Ministries  of  Social Protection and Labour. Article 47. Services and Other Assistance, Attributed to Medical Aid The following  services and  other types  of assistance  are attributed to medical aid: 1) pharmaceutical aid (prescription acceptance and checking, selection of  medicine of  equivalent  effect,  oral  or  written information of  the individual  regarding  administering  of  the medicine, informing  about the  safe use of the medicine, issuing of non-prescription  medicine, issuing  for self-administering of medicines, or  other means  of medicinal  purpose, in  accordance with the  health condition  problems, indicated by the individual and in  the order  established  for  issuance  of  the  medicine, provision of information regarding its availability); 2)   patient    transportation,   prosthesis,    orthopaedic appliances, provision with compensational equipment, articles and products (including  food products),  used in  medical  aid,  and services. The services,  as well as other assistance, specified in the first part  of this  article, shall be attributed to medical aid, provided they: 1) prescribed  by a  doctor, or  another person,  having the right to prescribe them; 2) they  are included  in the  list of  prescribed services, compiled by  the medical  aid subject  and the  customer  of  his activities, the  Ministry of  Health, or  municipal  governments, when these  services  belong  to  an  individual's  health  care, supported by state or municipalities. The medical  aid shall  not comprise  services and  products intended for  cosmetic or  hygienic use,  even if  they are  also beneficial for individual health purposes. Section 4 Expert Examination of Individual's Health Article 48. Expert Examination of the Health Potential of an Individual Individual health  potential expert  examinations  shall  be performed  by  health  centres.  The  Ministry  of  Health  shall establish the  order of  the performance and organisation of this expert examination. Article 49. Medical Expert Examination of Ability To Work Temporary individual  expert  examination  of  work  ability shall be  performed by medical aid institution doctor or doctors' commission. The  order of  organisation and  performance of  this expert examination  shall  be  established  by  the  Ministry  of Health. Article 50. Medical and Social Expert Examination In instances of long-term or permanent disability, a medical and social  expert examination  shall be  performed  by  a  state medical aid  institution social and medical commissions and State medical-social expert  commissions.  The  order  of  approval  of regulations  and   competence  of  these  commissions  and  their competence is  regulated by  the Law  on  Social  Integration  of Invalids. The medical and social criteria, regarding long-term or permanent work  disability, shall  be established by the Ministry of Health  along with  the Ministry  of Social Protection and the Ministry of Labour. Article 51. Forensic Expert Medical Examination The forensic  medical expert  examination shall be performed based  upon   the   decision   of   the   interrogation   bodies, investigation bodies, or per decision by the prosecutor, or court decision, as  well. Expert examinations shall be performed by the State  Forensic   Medicine  Service.  The  order  of  the  expert examination and  performance is  established by the Government of the Republic of Lithuania. Article 52. Forensic Psychiatric and Forensic Narcological Expert Examination Forensic  psychiatric   and   forensic   narcologic   expert examinations  shall  be  conducted  based  on  the  decisions  by interrogation bodies, investigation bodies, or the prosecutor, as well as court decision. Expert examinations shall be performed by the State Forensic Psychiatric and Forensic Narcological Service. The  order   of  organisation   and  performance  of  the  expert examination  shall  be  established  by  the  Government  of  the Republic of Lithuania. Article 53. Pathoanatomical Expert Examination Pathoanatomical  expert   examination  shall  be  performed, following the death of an individual. The conditions and order of the pathoanatomical  examination (autopsy)  shall be regulated by laws and other legal acts. Chapter 3 Public Health Care Article 54. Universal Character of Public Health Care The duty  of all  natural and legal persons shall be to take care of  public health, the aim of which consists in promoting of health,  preventing  of  the  deterioration  of  the  quality  of consumer goods,  food products,  drinking water  and residential, work,  and   natural  environment,  preventing  of  diseases  and traumas, and  decreasing the  morbidity rate.  Legal and  natural persons who  are in  violation of this re …