Source: https://www.riigiteataja.ee/en/eli/505032015002/consolide
Timestamp: 2019-05-20 13:01:35
Document Index: 124454153

Matched Legal Cases: ['§ 42', '§ 55', '§ 59', '§ 594', '§ 42', '§ 29', '§ 27', '§ 40', '§ 766', '§ 55', '§ 59', '§ 594']

§ 42 Maintaining records of provision of health services
1 Emergency Care
§ 55 Development plan of hospital network
§ 59 Health care organisation in emergencies
§ 594 Ethics committee of Health Information System
(1) Health care providers, who have the obligation to maintain confidentiality arising from law, have the right to process personal data required for the provision of a health service, including sensitive personal data, without the permission of the data subject.
§ 42. Maintaining records of provision of health services
(1) Use of the classifications, directories, address details of the State Information Systems and standards of the Health Information System is mandatory upon maintaining records of the provision of a health care service.
[RT I 2009, 29, 176 – entry into force 01.07.2009]
(11) Documents certifying the provision of health care services may be created and preserved in digital form and digital records may be created if preservation of the integrity and authenticity thereof is ensured during the prescribed retention period and these are arranged and described pursuant to the Archives Act.
(12) Health care providers may digitalise the paper documents which certify the provision of health care services if the integrity and authenticity thereof is ensured pursuant to the requirements provided for paper documents in the Archives Act and the Personal Data Protection Act. Paper documents which certify the provision of health care services and which have been digitalised may be destroyed prematurely on the basis of an assessment decision of the public archives.
(2) The conditions and procedure for maintaining records of the provision of health services and preservation of the documents thereof shall be established by a regulation of the minister responsible for the area.
(1) The following persons without the registration of a health care professional may participate in the provision of health services:
1) students undergoing dentistry training who have completed the compulsory subjects in the curriculum of the IV course, under supervision of a dentist;
2) students undergoing medical training who have completed the compulsory subjects in the curriculum of the IV course, under supervision of a doctor;
3) students undergoing the training of midwife who have completed the compulsory subjects in the curriculum of the II course, under supervision of a midwife or nurse;
4) students undergoing the training of nurse who have completed the compulsory subjects in the curriculum of the II course, under supervision of a nurse or midwife;
5) students undergoing medical training or dentistry training who have completed the compulsory subjects in the curriculum of the III course, under supervision of a nurse.
(2) The activity of the persons specified in subsection (1) of this section shall be deemed to be the activity of the health care professional under whose supervision and responsibility the persons practice.
[RT I, 05.01.2011, 12 – entry into force 15.01.2011]
(3) The following shall participate in the provision of health services:
1) a person who has been registered in the national register of pharmacists and assistant pharmacists maintained by the Health Board pursuant to subsection 55 (1) of the Medicinal Products Act if he or she engages in the dispensing of medicinal products subject to medical prescription;
2) a person who directly sells medical devices on the basis of a medical device card.
(4) The participation of the persons specified in subsection (3) of this section in the provision of health services has been regulated with the Medicinal Products Act and Medical Devices Act respectively.
Division 1 Emergency Care
(4) Emergency care provided to a person not covered by health insurance shall be paid for out of the funds prescribed for such purpose in the state budget, on the basis of a contract entered into between the Ministry of Social Affairs and the Estonian Health Insurance Fund and pursuant to the Health Insurance Act.
[RT I 2002, 62, 377 – entry into force 01.10.2002]
(43) The Health Board shall appoint a person not registered in a practice list of a family physician to a list, compare the lists and approve the amended lists and shall notify the person, family physician and the Estonian Health Insurance Fund of the amendment as necessary but not less frequently than by the twentieth date of the calendar month following the last month of each quarter. In order to compare the lists, the Health Board shall have the right to receive data from the health insurance database established on the basis of subsection 15 (1) of the Health Insurance Act. The appointment of a person to a practice list of a family physician shall be calculated as of the first day of the calendar month following the appointment.
(44) The Health Board shall exclude a person from the practice list of a family physician if the person is not a subject of the Estonian population register or if the place of residence of a person not covered by health insurance is not in the Republic of Estonia according to the population register. The Health Board shall notify a person of appointment to and exclusion from a list in writing or by electronic means within seven working days as of making the decision. If a document needs to be delivered to more than a hundred persons of if the data on residence of a person are not known to the Health Board, the decision shall be published in the official publication Ametlikud Teadaanded.
[RT I, 15.04.2014, 2 – entry into force 25.04.2014]
(47) Upon the establishment of the maximum number of practice lists, the minister responsible for the area shall proceed from the number of persons being the subjects of the Estonian population register and considering the better organisation and availability of general medical care.
(48) The Health Board shall publish the information on practice lists of family physicians on its website setting out the names of the family physician and the health care professionals working together with the family physician, service area and place of business of the family physician, maximum number of persons on a practice list, data on substitution of the family physician and the company through which the family physician provides general medical care.
(1) A company providing general medical care shall not have another area of activity besides provision of general medical care, independent provision of nursing, independent provision of midwifery care, provision of social services, and teaching and scientific research in health care.
(2) A family physician entered in the commercial register as sole proprietor may provide only general medical care, independent nursing, independent midwifery care, social services and engage in teaching and scientific research in health care under the business name entered in the commercial register.
2) local governments in whose administrative territory the place of business of the company which provides general medical care is located.
(11) Owners of ambulance crews are providers of service of vital importance specified in clause 34 (2) 2) of the Emergency Act.
[RT I 2009, 39, 262 – entry into force 24.07.2009]
(2) The Government of the Republic shall establish the procedure for co-operation in emergency medical care between the emergency medical staff, hospitals, rescue service agencies and police authorities.
1) the number of ambulance crews financed from the state budget;
(4) The Health Board shall:
1) organise contracting for emergency medical care and enter into a contract with an owner of an ambulance crew under public law for up to five years pursuant to the conditions provided for in the Administrative Co-operation Act. If a contract is entered into with an owner of an ambulance crew for the first time, the contract shall be entered into for up to three years;
2) approve the number and location of service areas of ambulance crews financed from the state budget and the distribution of ambulance crews by service areas;
3) organise the temporary substitution of ambulance crews.
4) [Repealed - RT I 2006, 56, 416 – entry into force 01.01.2007]
(41) Upon deciding on entry into a contract, renewal of a contract and the term of a contract, the Health Board shall take into account the following circumstances:
1) the term of validity of the activity licence required for the provision of emergency medical care;
2) the need of the specific service area for emergency medical care;
4) the quality and conditions of the emergency medical care service;
5) compliance with legislation regulating the provision of health services by the owner of the ambulance crew;
6) the number of ambulance crews established on the basis of clause (3) 1) of this section.
(42) The Health Board shall enter into a new contract with an owner of an ambulance crew who has provided service in compliance with the conditions provided for in subsection (41) of this section and the contract under public law. The owner of an ambulance crew and the Health Board may amend the contract only by taking account of the circumstances provided for in subsection (41) of this section.
(43) The Health Board is not required to enter into a contract for provision of emergency medical care with all the owners of ambulance crews.
(44) The Health Board shall organise a public competition for selecting a provider of emergency medical care if at least one of the following circumstances exists:
1) the owner of an ambulance crew who has provided the service so far withdraws from providing the service and the need for emergency medical care remains in this specific service area;
2) the Health Board decides not to enter into a contract with the owner of an ambulance crew who has provided the service so far or terminates the contract due to non-compliance of the owner of the ambulance crew or the service provided thereby with the requirements established by this Act;
3) the Health Board has revoked the activity licence for the provision of emergency medical care of the owner of an ambulance crew;
5) temporary substitution lasts for more than thirty days.
(45) A competition shall be announced within fifteen days as of the occurrence of a circumstance specified in subsection (44) of this section. If necessary, the Health Board shall organise the provision of the service through temporary substitution until entry into contract with the winner of the competition.
[RT I, 29.06.2012, 4 – entry into force 09.07.2012]
(2) A legal person which owns an ambulance crew shall engage in no other area of activity than the provision of emergency medical care or teaching and scientific research in health care. A sole proprietor who owns an ambulance crew may provide only emergency medical care under the business name entered in the commercial register.
(1) Emergency medical care shall be paid for from the state budget through the Ministry of Social Affairs.
(2) The minister responsible for the area shall establish the procedure for the financing of emergency medical care.
(2) The minister responsible for the area shall establish the list of specialist fields of specialised medical care.
(3) A company or foundation which operates a hospital shall not have another area of activity besides providing specialised medical care, emergency medical care, independent provision of nursing services and social services, teaching and scientific research in health care, maintaining a hospital pharmacy, manufacture of full blood and blood components and procurement and handling of cells, tissues and organs.
[RT I, 26.02.2015, 1 - entry into force 01.03.2015]
(41) Owners of regional hospitals and central hospitals are providers of service of vital importance specified in clause 34 (4) 1) of the Emergency Act.
(11) The restriction on the legal form of the provision of nursing specified in subsection (1) of this section does not apply to the providers of social services specified in clause 10 16) of the Social Welfare Act and to 24-hour social welfare institution of the elderly and disabled persons in case of provision of home nursing service specified in the regulation established under subsection 25 (3) of this Act.
(3) The list of out-patient nursing services which are permitted to be provided independently and the operations being part thereof shall be established by a regulation of the minister responsible for the area.
(3) A company or foundation which operates a nursing hospital, except for the owner of a hospital providing specialised medical care, shall not have another area of activity besides independent provision of nursing services, out-patient specialised medical care and social services, teaching and scientific research in health care and maintaining a hospital pharmacy.
(1) In order to register health care professionals, the national register of health care professionals shall be established by a regulation of the Government of the Republic.
(3) Health care professionals are obliged to submit information to the authorised processor.
(4) The authorised processor has the right make inquiries by way of cross-usage in order to obtain information entered in the register and to obtain information from other registers.
(6) The Health Board is the chief and authorised processor of the national register of health care professionals.
(1) A person applying for registration shall submit a registration application and a copy of the document certifying his or her qualifications to the Health Board.
(9) If a person fails to submit the documents within the term of registration specified in subsection (8) of this section, he or she may apply for the registration of himself or herself with the Health Board if he or she passes a theory examination and practice examination of health care professionals pursuant to the procedure established by the minister responsible for the area and submits a document certifying the results of the examination to the Health Board.
(10) In order to apply for the registration of himself or herself as health care professional, a person whose document certifying qualifications is not included in the list established pursuant to subsection (3) of this section shall pass a theory examination and practice examination of health care professionals pursuant to the procedure established by the minister responsible for the area.
(2) The Health Care Board shall compare the qualifications of a person applying for registration with the qualifications required in Estonia, shall verify the correctness of information submitted in the documents certifying the qualifications and make a registration decision within three months as of submission of the documents specified in subsection 28 (1) of this Act. The procedure for comparing the qualifications acquired in a foreign state with the qualifications required in Estonia shall be established by the minister responsible for the area.
(3) In order to assess the compliance of qualifications, the Health Board may require that the persons who have acquired qualifications in foreign states not specified in § 29 of this Act take aptitude tests. The procedure for compilation, conduct and evaluation of aptitude tests shall be established by the minister responsible for the area.
3) the profession or speciality of the health care professional;
A person who has acquired his or her qualifications in a Member State of the European Economic Area or in Switzerland may temporarily provide health services in Estonia without the registration obligation required pursuant to § 27 of this Act and an activity licence required pursuant to § 40 of this Act in compliance with the provisions of Chapter 3 of the Recognition of Foreign Professional Qualifications Act. The competent authority for the purposes of Chapter 3 of the Recognition of Foreign Professional Qualifications Act is the Health Board.
1) a digitally signed notice concerning a change in the staff of health care professionals working together with him or her and persons specified in subsection 43 (1) of this Act immediately after becoming aware of the change and shall indicate the date of occurrence of such change;
2) a notice concerning a change in the place of business and address within thirty days after the change takes place;
(2) Upon deprivation of the right to practise as family physician, the family physician or his or her successor is required to hand over documents concerning the practice list to the Health Board pursuant to the procedure established by the minister responsible for the area.
(2) An activity licence for the provision of health services shall be issued to an owner of a hospital specified in the development plan of the hospital network only with respect to a type of hospital approved for the owner in the development plan of the hospital network.
9) information concerning registration of processing of sensitive personal data with the data protection supervision authority;
5) the staff, facilities, installations, equipment, instruments and medicinal products necessary for the independent provision of nursing comply with the requirements established on the basis of this Act;
(1) In order to register activity licences for the provision of health services, the national register of activity licences for the provision of health services shall be established by a regulation of the Government of the Republic.
(6) The Health Board is the chief and authorised processor of the national register of activity licences for the provision of health services.
(1) The health care provider shall submit to the patient all the relevant information specified in § 766 of the Law of Obligations Act, including information on the treatment possibilities, availability of health services, quality and safety, and unambiguous invoices and information on the prices and, upon the patient’s request, information on activity licences.
(2) The functions of the contact point shall be performed by the Ministry of Social Affairs or the person with whom the Ministry of Social Affairs enters into a contract under public law for the performance of functions of a contact point.
Health care shall be financed:
1) the provision of emergency medical care;
2) the formation, maintenance and renewal of national health care stockpile;
[RT I, 22.12.2014, 1 - entry into force 01.01.2015]
6) state investments on the basis of the development plan of the hospital network approved by the Government of the Republic;
7) preparedness to provide health services in an emergency;
71) preparedness for treatment of intoxications with antidotes;
8) provision of emergency care to persons not covered by health insurance;
11) the Health Information System, except for the expenses of health care providers made for interfacing with the Information System and forwarding of data, including for forwarding of data necessary in order to make the waiting list and medical images available;
3) the establishment, storage and replenishment of the medical stockpile, including medicinal products, of the Defence Forces necessary for the functioning of peace-time and war-time health care organisation;
4) the provision of medical rehabilitation for members of the Defence Forces, persons in alternative service, persons who have been caused damage to health in the performance of their duties, family members of persons in active service who have died or have been caused permanent damage to health in the performance of their duties during participation in international military operations and the persons specified in subsections 2 (1) and (2) and 4 (1) of the Persons Repressed by Occupying Powers Act;
(3) Health care shall be financed from the funds designated for health insurance in the state budget pursuant to the procedure provided for in the Health Insurance Act.
1) has completed residency and acquired the speciality of family medicine or a speciality of specialised medical care required for the provision of compulsory health services at a central, general or local hospital according to the requirements for types of hospitals established under subsection 22 (4) of this Act;
2) at one or many central, general or local hospital(s) specified in the development plan of the hospital network established under subsection 55 (1) of this Act;
3) in a position the provision of health services in the corresponding speciality of which is compulsory for the hospital where the physician works according to the requirements for types of hospitals established under subsection 22 (4) of this Act, and
§ 55. Development plan of hospital network
(1) A development plan of the hospital network shall be established by a regulation of the Government of the Republic and the plan shall set out:
(3) A development plan of the hospital network shall be developed for at least fifteen years and shall be amended by the Government of the Republic, if necessary. The Ministry of Social Affairs shall organise the preparation of the development plan of the hospital network and shall involve appropriate non-governmental organisations therein.
(4) The list of hospitals set out in the development plan of the hospital network may be amended on the proposal of the minister responsible for the area which has been approved by the Estonian Health Insurance Fund.
(5) The minister responsible for the area has the right to make a proposal, which has been approved by the Estonian Health Insurance Fund, to the Government of the Republic regarding amendment of the list of hospitals set out in the development plan of the hospital network if the owner of a hospital has acted in accordance with law and the activity licence issued to the owner, and has not violated the contract for payment for health services entered into with the Estonian Health Insurance Fund.
(6) The minister responsible for the area has the right to make a proposal, which has been approved by the Estonian Health Insurance Fund, to the Government of the Republic regarding exclusion of an owner of a hospital from the list of hospitals set out in the development plan of the hospital network if the owner of the hospital does not act in accordance with law or the activity licence issued to the owner, or violates the contract for payment for health services entered into with the Estonian Health Insurance Fund. If the activity licence of the owner of a hospital is revoked or the hospital has terminated its activities, the minister responsible for the area shall make a proposal to the Government of the Republic regarding immediate exclusion of the owner of the hospital from the list of hospitals set out in the development plan of the hospital network. This proposal need not be approved by the Estonian Health Insurance Fund.
(9) The costs of preparation of a development plan of the hospital network shall be covered from the state budget.
(2) An institution determined by the Ministry of Social Affairs or by the minister responsible for the area shall publish statistical data on health of the previous calendar year within the third quarter of each year in the Internet.
(2) The Health Board shall maintain the registers of health care professionals and activity licences in accordance with the Personal Data Protection Act and the Public Information Act and is appointed as the chief processor of the specified state registers.
(2) An institution determined by the Ministry of Social Affairs or by the minister responsible for the area shall have the right to delegate performance of the duties assigned thereto by this Act to the local government on the basis of a contract under public law.
(2) The stockpile of antidotes is compiled by the Health Board who shall determine the list, quantities and division of the stockpile.
(3) The Health Board shall ensure the maintaining records of issue for use of the stockpile as well as the use and writing off of the stockpile.
(7) Compilation and renewal of the stockpile of antidotes according to the division established under subsection (2) of this section shall be financed from the state budget on the basis of clause 52 (1) 71) of this Act.
§ 59. Health care organisation in emergencies
(1) Health care organisation in emergencies and organisation of the consistency of vitally important health services shall be established by a regulation of the Government of the Republic which shall set out:
1) the competence and duties of the Government of the Republic, the minister responsible for the area, the Health Board and the persons providing services in health care, including the providers of a service of vital importance, in responding to emergencies and organisation of emergency preparedness;
2) the procedure for the renewal, maintenance and use of the national health care stockpile required for the functioning of health care organisation and the procedure for the use of income gained from the renewal of such stockpile;
3) the terms and amounts of and procedure for the establishment of the operation stockpile of medicinal products and medical supplies of health care providers.
(2) Health care providers are required to act upon preparing for emergencies and in emergencies and upon ensuring the consistency of a service pursuant to the regulation of the Government of the Republic established on the basis of subsection (1) of this section.
(1) The Health Information System is a database belonging to the State Information Systems where the data related to health care are processed for entry into and performance of contracts for the provision of health services, for guaranteeing the quality of health services and the rights of patients and for the protection of public health, including for maintaining registers concerning the state of health, for the organisation of health statistics and for the management of health care.
[RT I, 13.12.2013, 2 – entry into force 23.12.2013]
(2) The chief processor of the Health Information System is the Ministry of Social Affairs.
(3) The Health Information System shall be established and the statutes of the register shall be established by a regulation of the Government of the Republic.
(11) A forensic expert of a state forensic institution shall have the obligation to forward to the Health Information System data on the cause of death if in the course of forensic examination it appears that death has arrived as the result of an illness or injury.
[RT I, 10.03.2011, 1 – entry into force 01.01.2013]
(2) The following shall be established by a regulation of the minister responsible for the area:
1) compositions of the data of documents to be forwarded to the Health Information System;
2) the conditions and procedure for the preservation of the documents to be forwarded to the Health Information System.
(2) A health care provider has access to the personal data in the Health Information System for entry into and performance of a contract for the provision of a health service.
(3) A patient has the right to prohibit the access of a health care provider to the personal data in the Health Information System.
(5) A forensic expert of a state forensic institution has access to the personal data in the Health Information System for ascertaining the characteristics of injuries on the basis of clause 88 (1) 2) of the Code of Criminal Procedure and for conducting forensic autopsy of a deceased person.
(51) In order to make the surveys, analyses and organise health statistics necessary for the management of health policy and performance of international obligations, the officials of the Ministry of Social Affairs engaging in the analysis of data concerning health statistics and the employees of an institution administered by the Ministry of Social Affairs engaging in the health statistics have access to the following personal data of a patient in the Health Information System in a way which does not enable the identification of a patient:
1) data on the person of a patient;
2) data on the health service provider;
3) data on in-patient health services;
4) data on out-patient health services, including day care;
5) data on diagnoses;
6) data on the indicators describing the state of health of a patient;
7) data on medicinal products;
8) data on performed operations, analyses, examinations and procedures.
(52) Decoding of the data specified in subsection (51) of this section and processing of additional data for identification of a patient is prohibited.
§ 594. Ethics committee of Health Information System
(1) The ethics committee of the Health Information System shall assess whether the release of personal data from the Health Information System for the purposes of scientific research or statistics is necessary and justified and shall develop good practice guidelines. The assessment of the ethics committee is not legally binding.
(2) The ethics committee shall act pursuant to generally recognised principles of medical ethics and personal data protection and international and national legislation.
(3) An application for release of personal data for the purposes of scientific research or statistics shall be submitted to the chief processor of the Health Information System. The application shall comply with the good practice in scientific research.
(4) The rules of procedure, the number and the procedure for the appointment of the members of the committee shall be established by a regulation of the minister responsible for the area.
1Directive 2011/24/EU of the European Parliament and of the Council on the application of patients’ rights in cross-border healthcare (OJ L 88, 04.04.2011, p. 45–65). [RT I, 29.11.2013, 1 – entry into force 09.12.2013]