General terms and conditions for the provision of health care services

1.1 The Tartu University Hospital Foundation (the “Clinic”) General Terms and Conditions for the Provision of Health Care Services (the “General Terms and Conditions”) set out the rights, the obligations, and the responsibilities of the Clinic and the patient in the provision of health care services at the Clinic.

1.2 The General Terms and Conditions are regarded as standard conditions for the provision of health care services within the meaning of section 760 of the Law of Obligations Act.

1.3 The contract for the provision of health care services consists of the general terms and conditions individually agreed with the patient orally or in writing and the terms of use of the ePatsient patients’ portal if the patient is an ePatsient user. In addition to the above, the relationship between the patient and the Clinic is governed by internal rules made known to the patient (namely doctors’ appointment times, internal procedures in medical institutions, patient good practice) and the relevant legislation of the Republic of Estonia and the European Union (including the Law of Obligations Act, the Health Services Organisation Act, the Health Insurance Act, the European Union’s General Data Protection Regulation).

1.4 In the event of a conflict between the general terms and conditions and other documents governing the relationship between the patient and the Clinic, the general terms and conditions shall apply.

2.1 Patient – a person to whom the Clinic provides health care services or who has expressed a request for the Clinic to provide them with health care services.

2.2 Health insured person – a person who is generally insured by the Estonian Health Insurance Fund or by a Member State of the European Union, as evidenced by a health insurance card of the European Union, or whose obligation to pay health care costs is assumed by another person determined by legislation.

2.3 Health care service – the activities of a healthcare professional to prevent, diagnose, and treat illness, injury, or poisoning. The aim for the provision of the health care service is to alleviate the patient’s ailments, to prevent the deterioration or the exacerbation of their condition, to restore and to maintain health, and to improve their quality of life.

2.4 Healthcare professional – doctor, dentist, nurse, and midwife registered with the Health Board.

2.5 Health care provider – both the healthcare professional and the legal person providing the health care service, namely the Clinic.

2.6 Outpatient health care service – health care service for which a patient is not required round-the-clock stay in the hospital.

2.7 Inpatient health care service – health care service for which a person is required round-the-clock stay in the hospital.

2.8 Emergency care – health care service provided by a healthcare professional in a situation where delaying or failing to provide assistance may result in the death or the permanent damage to the health of a person in need.

2.9 Medical institution – the Clinic’s buildings providing the health care service.

3.1 The contract for the provision of health care services shall be deemed to have been concluded between the Clinic and the patient upon the booking of an appointment for the provision of an outpatient (including day care) or inpatient health care service to the patient at the Clinic or, in the absence of a reservation, upon the commencement of the provision of the service.

3.2 The patient shall undertake to comply with the general terms and conditions for the provision of a health care service when booking an appointment from the time the booking is made and otherwise from the start of the provision of the service.

3.3 The Clinic shall have the right to refuse to conclude the contract if the contract terms requested by the patient are contrary to the law or the terms and conditions of the contract for the provision of health care services specified in clause 1.3 or the internal rules of the Clinic.

3.4 The Clinic shall refuse to conclude the contract if:

3.4.1 the provision of the service requested by the patient is not necessary or not indicated for the patient’s health;

3.4.2 the patient who is insured by a Member State of the European Union other than Estonia does not submit, prior to the commencement of the provision of the health care service, a certificate issued by the competent authority of the insuring country or a valid European Union Health Insurance Card or its replacement certificate as a proof of insurance cover, unless the patient pays for the healthcare themself;

3.4.3 the patient is in arrears before the Clinic from previous provision of health care services and wishes to receive paid health care services;

3.4.4 if there is a circumstance that would entitle the Clinic to terminate the contract already concluded (clause 3.8).

3.5 The contract for the provision of the health care service ends:

3.5.1 with the termination of the provision of the health care service;

3.5.2 with the takeover of the provision of the health care service by another health care provider;

3.5.3 with the cancellation of the contract;

3.5.4 with the death of the patient (clause 772 (1) 1) of the Law of Obligations Act).

3.6 The patient may terminate the contract for the provision of the health care service at any time without disclosing the reason.

3.7 The Clinic may cancel the contract only for compelling reasons. However, in the case of a compelling reason, the Clinic has the obligation to provide the health care service until the patient obtains the health care service elsewhere.

3.8 For the purposes of clause 3.7, the following situations in particular shall be deemed to constitute a compelling reason:

3.8.1 the patient is in breach of the contractual obligations, and the violation puts the staff of the Clinic, other patients, or their health at risk;

3.8.2 the patient is in breach of the obligation to collaborate (for example, does not allow the necessary examinations, procedures) or the obligation to provide information (for example, does not disclose the information necessary for the provision of the health care service to a healthcare professional);

3.8.3 the provision of the health care service requested by the patient is not medically justified or would result in a higher risk to the patient’s life and health than not providing the health care service;

3.8.4 under the operating licence, the Clinic does not have the right to provide the health care service requested by the patient;

3.8.5 the staff of the Clinic cannot communicate with the patient in a language understandable to the patient, and the patient is not able to involve an interpreter, so the Clinic cannot obtain the patient’s informed consent for the provision of the health care service;

3.8.6 the patient is under the influence of alcohol or drugs during the outpatient or inpatient treatment at the Clinic, or the patient, according to the assessment of the Clinic’s staff, shows signs of intoxication by alcohol or drugs, which are listed in the Regulation No. 37 of the Ministry of Social Affairs of 26 June 2014 “The list of signs of a state of intoxication and the manner in which the exhibition or non-exhibition of the said signs is to be established”;

3.8.7 the patient behaves rudely with the Clinic’s staff or uses verbal or physical violence against them, other patients, or other people present in the Clinic.

4.1 The appointment for scheduled outpatient health care services (except day care) is booked for the patient by the patient themself, the patient’s legal representative or next of kin, or a healthcare professional. The need for the provision of inpatient health care services is decided and referred by a healthcare professional of the Clinic or another health care provider, or by another person designated by law.

4.2 It is possible to book an outpatient appointment for a health care service at the Clinic: 4.2.1 in all the registrations of the medical institution;

4.2.2 by phone, calling the phone number 731 9100 (M–F 7.30 a.m.–6.00 p.m.);

4.2.3 on the Clinic’s patients’ portal ePatsient, https://epatsient.kliinikum.ee;
4.2.4 on the Clinic’s website, https://www.kliinikum.ee/et/eriarsti-vastuvott.

4.3 Patients are treated equally when booking an appointment for health care services. Patients whose provision of health care services is paid for by the Estonian Health Insurance Fund or another insurer are booked for the first available time in the respective specialty or, according to the patient’s wishes, for the available time that suits them.

4.4 Outpatient appointments are generally booked on the basis of a digital referral letter. There is no requirement to have a referral letter for specialised medical care for trauma, tuberculosis, eye, skin, or sexually transmitted diseases. There is also no requirement to have a referral letter for dental, gynaecological, and psychiatric care.

4.5 Patients who pay for health care services under the Clinic’s price list of paid services shall be booked for the time of the chargeable health care services.

4.6 Patients can cancel and change the time of an outpatient appointment (by cancelling the existing booking and booking a new time) by giving at least 24 hours’ notice:

4.6.1 by phone, calling the phone numbers 731 9099 or 731 9100 (M–F 7.30 a.m.–6.00 p.m.);

4.6.2 on the patients’ portal ePatsient;

4.6.3 on the Clinic’s website,

https://kodu.kliinikum.ee/lisa/index.php?mod=doctor_unreg#top

4.7 The clinic has the right to change the time for the provision of the health care service, including to postpone it, if:

4.7.1 due to an organisational problem (for example, malfunction of a medical device, sickness of a healthcare professional, or other unscheduled absence from work), the provision of the health care service cannot be provided at the scheduled time and, in the opinion of the Clinic, it is possible given the patient’s condition;

4.7.2 a change of doctor is necessary due to a conflict between the patient and the doctor;

4.7.3 the patient is late for the provision of the health care service at the agreed time.

4.8 The Clinic shall inform the patient of the change of the time for the provision of the health care service as soon as possible and offer a new time as soon as possible.

5.1 The patient shall arrive at the medical institution at least 20 minutes before the start of the outpatient appointment. For the provision of inpatient health care services, the patient shall be present at the agreed time.

5.2 When coming to receive the health care service, the patient shall take with them an identity document with a photograph issued by a state authority (within the meaning of paragraph 2 (2) of the Identity Documents Act), the referral letter of the healthcare professional who referred the patient for the health care service, if it is mandatory and if the referral letter was given to the patient in paper form, the money needed to pay the visit fee, and the data of previous examinations (if the data is not available to the healthcare professional from the health information system).

5.3 When coming to receive an inpatient health care service, in addition to the items mentioned in clause 5.2, the patient shall also take with them their personal hygiene items and daily medications.

5.4 If a patient arrives for an outpatient appointment more than 15 minutes after the scheduled appointment time, the Clinic has the right to refuse to provide the health care service to the patient at the scheduled time. If it is not possible to provide the service because of the delay, it is considered that the patient did not appear at the appointment. If the patient does not come to the provision of the inpatient health care service at the agreed time, the patient is deemed to have withdrawn from the provision of the health care service.

5.5 If a patient changes a reservation or cancels the contract for the provision of the health care service less than 24 hours before the agreed time for the provision of the health care service or fails to appear for the performance of the contract for the provision of the health care service at the agreed time, the health care provider has the right not to return the paid visit fee to the patient and to deduct it as a contractual penalty, if the patient has paid the visit fee in advance, or to charge the patient double the visit fee for the performance of the next contract for the provision of the health care service.

 

6.1 The clinic and the patient treat each other with respect.

6.2 By concluding a health care service contract, the Clinic undertakes:

6.2.1 to provide outpatient or inpatient health care services to the patient as appropriate. At the discretion of the health care provider and with the agreement of the patient, the patient may be consulted by telephone or e-mail. Health care shall not be provided via text message, Facebook messages, or other social networks, nor without the patient being examined in advance by a healthcare professional;

6.2.2 to provide the service in Estonian. With the agreement of the healthcare professional, communication between the patient and that healthcare professional may also take place in another language;

6.2.3 to inform the patient about the results of their examination and the state of health, possible diseases, and their course;

6.2.4 to inform the patient about the nature and purpose of the health care service provided to them, the risks and consequences of its provision, and other possible and necessary health care services, as well as the possibility of obtaining information from the treating physician both before and during the provision of the health care service;

6.2.5 to document the provision of the health care service in accordance with the applicable requirements. In addition to Estonian, a case summary or another document may also be drafted in another language;

6.2.6 to maintain the confidentiality of information about the patient’s identity and medical condition disclosed in the course of the health care service (duty of confidentiality);

6.2.7 at the request of the patient, to provide the information referred to in clause 6.2.3 in a form that can be reproduced in writing.

6.3 By concluding a health care service contract, the patient undertakes:

6.3.1 to pay the fee for the provision of the health care service to the extent that the costs of the provision of the health care service is not covered by the Estonian Health Insurance Fund or any other person (duty to pay a fee);

6.3.2 to disclose to the health care provider, to the best of their knowledge, all the circumstances necessary for the provision of the health care service (duty to provide information);

6.3.3 to provide the collaboration that the health care provider needs to provide the service (duty to collaborate);

6.3.4 to comply with the medically justified treatment and prescriptions of the healthcare professional, both during and after the provision of the health care service;

6.3.5 to leave the hospital during inpatient treatment only with the permission of the treating physician;

6.3.6 to comply with the internal procedures for the patients and other rules and requirements communicated to the patients during their stay at the Clinic medical institutions.

7.1 The provision of health care services is carried out only with the consent of the patient.

7.2 When a patient arrives at a medical institution for outpatient or inpatient health care, the patient’s consent to the provision of the health care service is assumed. If necessary, and in cases required by law, the patient’s consent to the provision of the health care service shall be formalised in a form that can be reproduced in writing.

7.3 In the case of incapacitated patients, the consent to the provision of the health care service shall be given by the patient’s legal representative, unless the patient is capable of responsibly weighing the pros and cons of the provision of the health care service. The Clinic shall not comply with the decision of the legal representative if it is clearly prejudicial to the patient’s interests.

7.4 The patient may withdraw their consent for the provision of the health care service at any time. The application for the withdrawal of consent shall always be made in a form that can be reproduced in writing.

7.5 If the patient withdraws their consent for the provision of the health care service after the commencement of the provision of the health care service, and:

7.5.1 the healthcare professional is able to interrupt the provision of the health care service without risk to the life or continued health of the patient, the healthcare professional shall interrupt the provision of the health care service;

7.5.2 it is not possible for the healthcare professional to interrupt the provision of the health care service without risk to the life or continued health of the patient, the healthcare professional shall, before interrupting the provision of the health care service, take the actions which are minimally necessary to interrupt the provision of the health care service without risk to the life and health of the patient.

7.6 The withdrawal of the consent does not render the provision of the service unauthorised until the consent has been withdrawn.

7.7 If the patient is unconscious or otherwise incapable of expressing their will, and the patient has no legal representative, or it is not possible to reach a legal representative, the health care service may be provided without consent if the provision of the health care service is in the best interests of the patient and is in accordance with the patient’s previously expressed or presumed will, and the immediate non-provision of the health care service would endanger the patient’s life or seriously harm the patient’s health.

7.8 The patient’s previously expressed or presumed will shall be ascertained, as far as possible, through the patient’s relatives. The patient’s relatives shall be informed of the patient’s state of health, the provision of the health care service, and the risks involved, if this is possible under the circumstances.

7.9 The patient’s spouse, parents, children, sisters, and brothers are considered as relatives. Other people close to the patient may also be considered as relatives if this is due to the patient’s living arrangements, such as the patient’s partner.

7.10 By way of exception, the Clinic may provide health care services without the patient’s consent if such right is required by law (for example, involuntary psychiatric treatment and treatment necessary to prevent infectious diseases).

8.1 The patient shall pay for the health care services provided to them in accordance with the terms and conditions of the contract for the provision of health care services and the Clinic’s price list of paid services, unless the obligation to pay is assumed by the Estonian Health Insurance Fund or another person.

8.2 If the health care services of the insured person are paid by the Estonian Health Insurance Fund or another person, the patient shall pay to the Clinic:

8.2.1 a visit fee of 5 euros when receiving outpatient health care services, except in cases where the visit fee is not charged;

8.2.2 in the case of inpatient health care services, an inpatient daily fee of 2.5 euros for each calendar day started during the hospital stay, except in cases where the inpatient daily fee is not charged. The maximum number of days for an inpatient daily fee is 10 calendar days per illness case;

8.2.3 co-payment for health care services, which is the part of the maximum price of the health care service that is not paid by the Estonian Health Insurance Fund.

8.3 Paid health care services shall be charged according to the Clinic’s price list of paid services in force at the time the service is provided. Health care services that are not described in the Clinic’s price list of paid services are provided on the basis of the prices established in the list of health care services of the Estonian Health Insurance Fund.

8.4 The current Clinic’s price list of paid services is published on the Clinic’s website at: https://www.kliinikum.ee/et/teenused.

8.5 The patient pays for the health care service according to the price list valid on the day of the provision of the health care service or, when booking the health care service via the patients’ portal, according to the price list valid on the day of the booking.

8.6 Visits fees and fees for paid services are payable by bank transfer when booking an appointment (via the patients’ portal) or by cash or bank card at the registration desk when arriving on the spot. Additional paid services are payable on the spot at the registration desk, in cash or by bank card, after the service has been provided. The inpatient daily fee and the co-payment fees are paid at the Clinic’s department or at the registration desk when the patient is discharged. In exceptional cases, the patient pays for the services provided by bank transfer within 7 calendar days.

8.7 In the event of non-payment of the fees referred to in clauses 8.2 and 8.6, the Clinic has the right to authorise third parties to collect the outstanding invoices on behalf of the Clinic and to transfer the patient’s personal data necessary for the fulfilment of the obligation to a third party involved in the collection of the debt, with whom the Clinic has concluded a confidentiality agreement.

9.1 The Clinic has the legal right to disclose the personal data of a patient staying at the hospital or to provide access to the patient’s personal data to the patient’s next of kin, unless the patient has prohibited the disclosure of the data.

9.2 Next of kin are, in particular, the patient’s relatives within the meaning of clause 7.9 of the General Terms and Conditions.

9.3 In order to contact the patient or to inform the patient’s relatives about the patient’s stay at the hospital, the Clinic shall ask the patient for contact details. The Clinic stores these data in the Clinic’s hospital information system.

9.4 The Clinic shall provide the patient with information concerning their health, in particular during the outpatient or inpatient stay, in the Clinic’s patients’ portal ePatsient and in the national health information system (digilugu). With the patient’s agreement, the Clinic may also provide the data to the patient by telephone, post, or e-mail, or by making a request to the Clinic’s office.

9.5 The Clinic has the right to refuse the transmission of data by means of telecommunication if the Clinic has doubts about the identity of the person receiving the personal data or the security of the transmission of the personal data.

9.6 The patient has the right to have the provision of the health care service audio-recorded for their own personal use, as long as this does not interfere with the provision of the health care service. Photography and filming at the Clinic are only allowed with prior agreement with the Clinic.

9.7 The clinic has the right to record the provision of the health care service to the patient for the purpose of documenting the provision of the health care service. For the purpose of training healthcare professionals and students, the Clinic has the right to record the provision of the health care service only if the patient has given their consent.

9.8 As a university hospital, the Clinic may involve students and trainees in the provision of health care services by informing the patient. If the patient does not wish to include the aforementioned people in the provision of the health care service to them, the patient shall inform the healthcare professional providing the health care service.

9.9 The Clinic may use security cameras for the purpose of protecting the security of people and property by marking the area of operation of the security cameras with appropriate signs.

10.1 The Clinic shall provide emergency care to all patients where delay or failure to provide assistance may result in the death or permanent damage to the health of the patient in need.

10.2 The general terms and conditions shall apply to the provision of emergency care to the extent that their application does not conflict with the nature of the provision of the emergency care and to the extent not otherwise provided for in this Chapter.

10.3 The Clinic has the right to refuse to provide emergency care and to terminate the contract for the provision of health care services on the grounds set out in clauses 3.4 and 3.7 of the General Terms and Conditions if:

10.3.1 the person’s state of health allows them to wait in the waiting list for scheduled medical treatment; or

10.3.2 the person’s life or health is at risk, but the provision of the emergency care would endanger a member of the Clinic’s staff.

11.1 A minor patient shall present a passport, an ID card, or a student card for identification purposes when seeking health care services. In the absence of the aforementioned documents, a birth certificate or a copy of it, or the personal identification code of the minor patient may be provided.

11.2 In the event that a minor patient is accompanied by another person, the Clinic has the right to identify the accompanying person, who shall present an identity document upon request by the Clinic. The legal representative of a minor patient may be required by the Clinic to provide proof of legal representation (or a copy thereof).

11.3 In the event of a breach of the obligation to provide collaboration in the provision of a health care service by a minor patient or their legal representative, the health care provider has the right to contact the local authority to report a child in need of assistance or to report a child in distress to the emergency number 112.

11.4 The Clinic shall have the right to disclose to the legal representative of the minor patient any facts that have come to the knowledge in the course of the provision of the health care service to the minor patient, if failure to disclose the information could result in significant harm to the minor patient or to other people (for example, if the minor patient has been found to be intoxicated), even if the minor patient is sufficiently responsible in weighing the pros and cons of the provision of the health care service.

11.5 The Clinic has the right to prohibit the accompanying person of the minor patient from accompanying the minor patient to the provision of the health care service if the accompanying person is under the influence of alcohol or drugs, or if the accompanying person, according to the assessment of the Clinic’s staff, shows signs of intoxication by alcohol or drugs, which are listed in the Regulation No. 37 of the Ministry of Social Affairs of 26 June 2014 “The list of signs of a state of intoxication and the manner in which the exhibition or non-exhibition of the said signs is to be established”, or if the accompanying person behaves rudely with the staff of the Clinic or uses verbal or physical violence towards them, other patients, or other people present in the Clinic, or otherwise significantly interferes with the provision of the health care service.

12.1 The Clinic cannot promise the patient’s recovery or the success of the examination/surgery. The Clinic provides health care services in accordance with the general state of medical knowledge at the time the health care service is provided, exercising the care normally expected of a health care provider.

12.2 The Clinic and the healthcare professional involved in the provision of the health care service shall be liable for any negligent breach of their duties, in particular for errors in diagnosis and treatment and for breach of the duty to inform the patient and obtain their consent.

12.3 The Clinic is also responsible for the actions of people assisting it and for errors in the equipment used in the provision of the health care service.

12.4 It is the patient’s responsibility to prove the circumstance on which the liability of the Clinic or the people referred to in clauses 12.2 and 12.3 is based, unless the provision of the health care service is in breach of the duty to document. A causal link between the breach and the harm is presumed if, through normal treatment, the patient would have been able to avoid the damage to their health caused by the breach.

12.5 The limitation period for a patient’s claim for damages is 5 years from the time when the patient became aware of the breach of duty or the damage.

13.1 For the submission of a complaint or a proposal:

13.1.1 the patient may fill in the Suggestions, Thanks, and Complaints form at the Clinic’s medical institutions and place it in the appropriate box at the medical institution;

13.1.2 the patient may fill in the form on the website of the Clinic (www.kliinikum.ee) or the Suggestions, Thanks, and Complaints form and sends it to the Tartu University Hospital Foundation at the address L. Puusepa 1a, 50406 Tartu;

13.2 If the patient has expressed the wish to receive a reply, the Clinic shall respond to the application within 10 working days. The Clinic shall not respond to anonymous applications.

13.3 If the patient is dissatisfied with the quality of the health care service, in addition to contacting the Clinic, the patient may also contact the following institutions:

13.3.1 the Expert Committee on the Quality of Health Services at the Ministry of Social Affairs (address: Gonsiori 29, 15027 Tallinn, e-mail address: info@sm.ee);

13.3.2 the Tartu Department of the Estonian Health Insurance Fund (address: Põllu 1a, 50303 Tartu, e-mail address: tartu@haigekassa.ee);

13.3.3 the Health Board (address: Paldiski mnt 81, 10617 Tallinn, e-mail address: kesk@terviseamet.ee).