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The Ministry Of Health Of The Republic Of Latvia, The Republic Of Estonia, The Ministry Of Social Affairs And The Ministry Of Interior Of The Republic Of Estonia Agreement On Mutual Assistance In Emergency Medical Care In The Border Area

Original Language Title: Par Latvijas Republikas Veselības ministrijas, Igaunijas Republikas Sociālo lietu ministrijas un Igaunijas Republikas Iekšlietu ministrijas vienošanos par savstarpējo palīdzību neatliekamās medicīniskās palīdzības sniegšanā pierobežas teritorijā

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Cabinet of Ministers Regulations No 822 in Riga august 31, 2010 (pr. No 44 39) of the Ministry of health of the Republic of Latvia, the Republic of Estonia, the Ministry of Social Affairs and the Ministry of Interior of the Republic of Estonia agreement on mutual assistance in emergency medical assistance in the border area Issued under Cabinet installations Act article 31 2 of the first subparagraph of paragraph 1 the Republic of Latvia, the Ministry of health of the Republic of Estonia, the Ministry of Social Affairs and the Ministry of the Interior of the Republic of Estonia, the arrangements for mutual assistance for emergency medical assistance in the border area (hereinafter referred to as the agreement) with these terms are accepted and approved.
2. the obligations of the agreement to coordinate the Ministry of health.
3. the agreement shall enter into force on its article 9 on time and in order.  
Prime Minister Dombrovskis v. Minister of health d. Douglas, adopted and approved by the Cabinet on august 31, 2010 regulations No 822, Ministry of health of the Republic of Latvia, the Republic of Estonia, the Ministry of Social Affairs and the Ministry of the Interior of the Republic of Estonia, the arrangements for mutual assistance for emergency medical assistance in the border area of the Republic of Latvia, the Ministry of health of the Republic of Estonia Ministry of Social Affairs and the Ministry of Interior of the Republic of Estonia (hereinafter referred to as "the parties") realizing the need to ensure cooperation between the responsible authorities and emergency medical service providers, considering this agreement on the basis of mutual emergency medical service cooperation and pledging to implement further cooperation in this field, agreed on the following.
Article 1, the terms used in the text of the agreement to the following terms and their definitions: "emergency medical assistance service"-ambulatory health care services provided by the emergency medical team for initial diagnosis and care in health in critical condition, injuries and poisoning, and additional treatment if necessary, transfer the person to the nearest medical institution, which is provided to hospital care, as well as emergency medical teams and emergency call.
"the limit" – the Latvian-Estonian State boundary, as defined in 20 March 1992 the Treaty on the State border between the Republic of Latvia of renewal and of the Republic of Estonia and the additional Protocol thereto.
"border areas" of the Republic of Latvia and the Republic of Estonia, the local (territorial) administrative units, located on the border or 40 km away from them; the border area is considered belonging to the administrative part of the territory located 40-60 km away from the border. The Parties shall agree on a list of the frontier territory within a reasonable time but not later than 2 (two) months after the date of entry into force of the agreement. That list is an integral part of this agreement.
Article 2 scope of agreement covers the responsible authorities of the parties and the emergency medical service provider cooperation, focused on emergency medical service more accessible frontier territory.
Article 3 competent authorities in agreement the right to maintain direct contacts and conclude in addition to mutual agreement between the competent authorities of the following: 1. in the Republic of Estonia, the Republic of Estonia: 1.1. Health Care Council (hereinafter referred to as "health care Council"), which is responsible for contracting with emergency medical teams, owners, service pay and medical service providers, binding requirements;
1.2. the Republic of Estonia, the emergency call centre (hereinafter referred to as "the emergency") responsible for the adoption of emergency call and emergency medical crews.
2. The Republic of Latvia: the Latvian Republic 2.1 emergency medical service (hereinafter referred to as "emergency medical assistance service"), which is responsible for emergency medical services, emergency, emergency medical teams, and the payment of the services provided in the territory of the country;
2.2. The health of the Republic of Latvia settlement Center (hereinafter referred to as "settlement center of health"), responsible for the health care provider's compliance with the mandatory statutory requirements control of contracts and for international payments for health care services received.
Article 4 emergency medical services within the meaning of this arrangement 1 emergency medical service of the Republic of Estonia and the territory of the Republic of Latvia begins when the relevant national authority sends emergency medical team, and ends when the emergency medical team returns to its permanent location database, or receive new instructions on the emergency call from your country of origin authorities. Providing necessary medical assistance to a patient, emergency medical team decides the next patient treatment hospital in the home, the need for hospitalization of the patient to the nearest hospital or to patient transfer the emergency medical crew, in which the accident or illness has occurred.
2. the responsible authority for emergency medical assistance team (in accordance with the conditions laid down in article 3), at any point in the delivery of assistance by telephone to communicate with the other responsible authorities emergency medical dispatcher service and ask it to send an emergency medical team to a destination in the requesting country.
3. where the competent authority receiving such calls, it has the obligation to provide assistance in the same way as provided for in its national legislation. If necessary calls sorted by importance, all calls are rated on the same national standards.
4. Emergency medical service in the course of providing the responsible authorities for emergency medical dispatching teams to constantly exchange information. The responsible authority shall ensure that its national emergency medical crew are transferred to the relevant information.
5. in cases where the emergency call from A country's population, from A State bordering the areas with country B is received (B) a national body responsible for emergency medical crews call, the call is diverted to A public authority for emergency medical teams to be sent.
6. the precise order in which is requested and provided assistance, covers in a separate contract between the health care tips, emergency call centers and emergency medical services.
7. in cases where the emergency medical service is to provide rescue operations, the accident site together assistance is organized in accordance with the Government of the Republic of Latvia and the Government of the Republic of Estonia agreement on mutual assistance in case of disasters.
8. While in the territory of the other party: 8.1. emergency medical assistance team provides second-the quality of the services provided in the country of origin in accordance with its national laws and regulations. Emergency medical assistance team shall assume full responsibility for the service provided, according to its country of origin national regulations.
8.2. emergency medical assistance team provides second country documenting the services provided to the extent as provided for in the national legislation of the country of origin. After the provision of the service (i.e. by patient transported to a medical institution, the patient's country of origin, transfer the emergency medical crew, leaving the patient's residence to continue outpatient treatment at home or in other types of care), the emergency medical team handed the completed copies of the document to the other hospital or emergency medical crew or person who needed emergency medical help. Emergency medical teams fill out special arrangements for their implementation, by shipping form. The Parties shall ensure the forms content used the English translation and transfer the required amount in the form of emergency medical teams, which under the agreement could be involved in a cross-border emergency medical services.
9. in cases where emergency medical care to be involved in additional resources, it organizes its national authority in which the emergency incident occurred.

10. assistance by the requested State the competent authority may at any time withdraw the request for assistance, informed the competent authority of the other country.
11. The competent authorities responsible for emergency medical teams, equipment according to national laws and regulations. This requirement also applies to emergency medical services in the other State in accordance with the agreement.
5. Article 1. Expenses in case of services not fixed price in national legislation of the country where the emergency medical service provider to provide the service, provided by the emergency medical service is calculated as follows: the emergency medical services provider of the year by the joint budget of the previous year the number of the service call.
2. in the cases described above, the estimated average service fee does not cover the actual expenditure, the appropriate national authority shall provide the necessary assurances to the other country's competent authority. Costs are calculated based on actual assisting public expenditure. The exact course of settlement and its practical application are stipulated in a separate agreement between health care and the Health Council of the settlement Centre.
3. The parties ' settlement made between health care and the Health Council of the settlement Centre. The settlement used to carry currency is the euro. Help requested Party shall compensate for all emergency medical services direct cost assisting party. Depending on the provided emergency medical help magnitude and complexity, the parties may also agree on other payment terms.
4. in cases where the assistance requested Party has withdrawn its request without sufficient legal, economic or technical justification, help put the party receives compensation full service fees. Detailed arrangements for the payment in such cases is determined by a separate agreement between the responsible authorities of the parties.
5. payment of services is made not later than 60 (sixty) days of the receipt of the invoice, except health care Council and the health center of settlement agreed on other arrangements for payment.
Article 6 compensation for damage or injury case 1. Each Party undertakes to renounce any claims for remuneration against the other side of death, bodily injury or damage to health or other emergency medical team member personal property damage if the damage resulted in the performance of their duties pursuant to this agreement.
2. If any party to the assisting emergency medical team member causes injury to a third party for assistance requested in the territory of the party in the performance of the obligations arising out of this agreement, then the party requesting assistance shall reimburse the damages under the same regulations that determine damages if it leads to help the Parties requested employee.
Article 7 settlement of disputes procedures 1. All disputes arising from the interpretation of this agreement and in the context of enforcement, and that is not solvable in a discussion between the responsible authorities, are dealt with between the representatives of the parties.
2. all medical complaints related directly to provide emergency medical services that the patient has made their country of origin, the competent supervisory authority must be addressed in cooperation with other relevant authorities, according to national regulations, and agreement terms. Accurate complaint handling policy is determined by a separate additional agreements between the two parties ' competent authorities.
Article 8 information 1. the competent authorities of the Parties shall undertake to ensure a regular flow of information necessary for the performance of the terms of the arrangement. The competent authorities have the right to separately agree on exact information.
2. the parties and their authorities are discussing the terms of the agreement and, at its sole discretion.
Article 9 final conditions 1. This agreement is concluded for a limited period of time and shall enter into force 30 (thirty) days after receipt of the last notification in which the Parties inform each other of the full internal completion of the legal procedures necessary for the entry into force of this agreement.
2. each party may suspend the operation of this arrangement, informing about it in writing. In such cases, the contract has ended, there's six (6) months after the date of receipt by the other party notice of termination of this agreement.
3. This agreement may be amended and supplemented the parties mutually agreed upon in writing. Any amendments and additions to the entry into force of this article.
4. the competent authorities of the parties may conclude additional agreement that determines the specific conditions of the arrangement.
The agreement is drawn up in duplicate in the 3 (three)-the Latvian, Estonian and English languages. All copies have the same legal force. Different interpretations of the event, notable based on the English version.
Ministry of health of the Republic of Latvia, the Republic of Estonia Ministry of Social Affairs of the Republic of Estonia, the Ministry of internal affairs.............................................................................................................. "
Health Minister didzis Gabor Social Affairs Hanna is Interior Minister of Pevkur Marco Pomerant agreement between the Ministry of Health of the Republic of Latvia, the Ministry of Social Affairs of the Republic of Estonia and the Ministry of Interior of the Republic of Estonia on Mutual Aid for Providing ambulance services in the Border Area of the Ministry of Health of the Republic of Latvia the Ministry of Social Affairs of the Republic of Estonia and the Ministry of the Interior of the Republic of Estonia (hereinafter referred to as "the parties"), recognising that collaboration between the competent authorities and to the providers of ambulance services is not considering this agreement cessary, a framework agreement on providing the mutual aid of ambulance services and being determined for further collaboration in this field , have agreed on the following: article 1 Definition of the terms used in this Agreement shall mean the following: "ambulance service"-out-patient health care services carried out by an ambulance crew concerning the initial diagnosis and treatment of life-threatening diseases, injuries and, if not, intoxication and cessary for the transportation of a person requiring care to the ares not a hospital capable of providing the cessary in-patient health care as well as the dispatch of ambulance crew and processing emergency calls;
"border" – the Latvian-Estonian State border, in accordanc with the agreement between the Republic of Latvia and the Republic of Estonia on the Renewal of the State Border of 20 March 1992 and its additional protocol;
"border area" means a municipal administrative areas (territorial) of the Republic of Latvia and the Republic of Estonia is adjacent to the border and located within 40 km from it; If a part of such an administrative area is located within a range of 40 to 60 km of the border, then such an administrative area is also considered to be part of the border area. The Parties shall agree on the list of border areas as soon as possible but not later than within 2 (two) months after this agreement comes into force. The agreed list will become an integral part of this agreement.
Article 2 scope this agreement covers the collaboration among the competent authorities and to the providers of ambulance services of the parties with the intent of improving ambulance service accessibility within the border area.
Article 3 the Competent authorities the competent authorities, to having the right to make direct contacts and additional agreements conclud under the terms of this agreement, the following: 1. in the Republic of Estonia: 1.1. The Health Board of the Republic of Estonia (hereinafter – "the Health Board") responsible for drawing up contracts with the owners of the ambulance crew, executing payment for provided services and executing supervision over compliance with the requirements provided for health care providers;
1.2. the Emergency Response Centre of the Republic of Estonia (hereinafter-"the Emergency Response Centre") responsible for emergency call processing and the dispatch of an ambulance crew;
2. in the Republic of Latvia: 2.1. The State Emergency Medical Services of the Republic of Latvia (hereinafter – "the State Emergency Medical Service") responsible for providing ambulance services, emergency call processing, dispatching an ambulance crew and payments for provided services;
2.2. The Health payment Center of the Republic of Latvia (hereinafter – "the Health payment Center") responsible for executing supervision over compliance with the requirements provided by the health care provider under the agreements and for executing the respectiv international payments for health care services provided.
Article 4 Provision of ambulance service

1. For the purpose of this agreement, in both the Republic of Estonia and the Republic of Latvia, the ambulance service with the dispatch of the commenc of an ambulance crew by the competent authority of the country and the respectiv terminate when an ambulance crew reach the base of its permanent location or receive a new dispatching order from the competent authority of its country of origin. When providing the required health care services to a patient, the ambulance crew decide whethers of the patient can be released for further out-patient treatment at home, not to be transported to the hospital or an adequat ares handing the patient over to the ambulance crew of the country where the event takes place.
2. The competent authority responsible for the dispatch of an ambulance crew (as stated in article 3) in all of the dispatching stage, has the right to make a direct call to the ambulance crew dispatching of an authority of the other Party and ask for dispatching of the ambulance crew to the place of destination in the territory of the requesting country. 
3. When called, the competent authority is obliged by respectiv to organize the provision of help in the same manner as in the case of the national requirement. If the prioritization of an ambulance dispatch is required, all cases have to be treated according to the same national rules.
4. The competent authorities responsible for dispatching the ambulance crew will permanently exchange information during the respectiv service provision. Each competent authority of ensur that the relevant information is delivered to the ambulance crew of it in the country.
5. in cases when the emergency call from a person from country A, being in country A, but whose location is close to the border with the country, (B) is received by the competent authority responsible for the dispatch of an ambulance crew in country B, the call is to be transferred to the competent authority responsible for the dispatch of an ambulance crew in the country (A). 6. The exact procedure of requesting and providing AIDS shall be governed by agreement between the Health Boards, the Emergency Response Center and the State Emergency Medical Service.
7. In cases where the ambulance service event is related to the rescue event, cooperative action at the scene of an accident is conducted within the "Framework Agreement between the Government of the Republic of Estonia and the Government of the Republic of Latvia on Mutual assistance in the event of a Disaster".
8. When being present in the country of the other Party: 8.1 the ambulance crew of ensur that the quality of service is in accordanc with the requirements and the rules of its state of origin. The ambulance crew is held liabl for the service provided, in a manner that is consistent with the national laws and regulations of its state of origin.
8.2. the ambulance crew of ensur that the service provided is documented as is the case when the service is provided in respectiv in country of origin. At the end of the provision of the service (i.e. any other. the transportation of the patient to the hospital, handing the patient over to the ambulance crew of the patient's country of origin, leaving the patient's home for out-patient treatment, or any other outcomes of the service) the ambulance crew is also required to hand over a copy of the document either to the hospital or the ambulance crew of the other Party or to the person in need. Ambulance crew will prepare all the documentation using the template of the referral specially designed for the enforcement of this agreement. Each Party is to make a translation of their national templates into English and of ensur that ut300r2u at the disposal of the ambulance crew that could be involved in the provision of cross-border emergency health care with regards to this agreement.
9. In cases where the ambulance event requires additional resources, it is to be organised by the competent authority of the country in which the ambulance event occure.
10. The competent authority which ask for help may withdraw its request at any time regarding the specific event, by informing the competent authority of the other country.
11. The authorities competent to ensur that ambulance crew with is equipped according to the requirements and rules of their countries. This requirement also has to apply to the provision of an ambulance service in the territory of another country in accordanc with this agreement.
Article 5 of the Expense 1 expense into ambulance service cas, if there is not a fixed price per service set in the national legislation of the country of which the ambulance service provider is providing a service, calculated according to the following principles: the total budget of the ambulance service provider in the present year divided by the number of service provision cases in the preceding year.
2. In cases where the average price, calculated in the way mentioned above do not cover the real expense, the authority responsible for ambulance service payment of that country provides the evidence needed to the òàæó authority of another country. Expense will be counted on the basis of the actual expense of the country that is providing AIDS. The exact procedure and practical arrangements needed for account settings shall be governed using the agreement between the Health Board and the Health payment Center.
3. The setting of accounts takes place between the Health Board and the Health payment Center. The accounting currency is euros. The demanding Party the Party offering compensat for all direct-expense related to the ambulance service cost. Depending on the nature and the scope of a specific ambulance event, the parties may come to a different agreement if such (a) cessity «arise.
4. The demanding Party that has withdrawn the request for aid without any legally, economically or technically-based reasons concerning a specific event at that time the offering Party compensat the price of the service. The detailed procedure shall be described in the agreement of the competent authorities to be of the parties.
5. In cases where the Health Board and the Health payment Centre have not agreed otherwise, shall be compensated for the expense after submitting a reasoned invoice within sixty (60) days.
Article 6 Compensation for damage or injuries 1. Each Party shall renounc any claim of compensation on the other Party in cases of death, bodily injury or any other damage to the health and personal effects of the members of the ambulance crew, provided that such damage has occurred in the course of fulfilling duties deriving from this agreement.
2. If a member of the ambulance crew of the Party rendering assistance causes damage to a third party in the territory of the Party requesting assistance by fulfilling duties deriving from this agreement, the Party requesting assistance shallcompensat the damage according to the same legal acts as would be the case if the damage had been caused by an employee or the ambulance crew members of the Party requesting assistance.
Article 7 settlement of dispute 1 Any dispute of that may occure in the process of the interpretation or execution of this agreement which cannot be resolved by negotiation between the competent authorities shall be be resolved between the parties.
2. Any complaints of a medical nature or directly related to the provision of ambulance service submitted by the patient to the surveillance authority of the responsible country of origin of it, shall be in collaboration with its deal respectiv authority in the country of the other Party in accordanc with the provision of its national laws and regulations and provision of this agreement. The detailed procedure shall be described in the agreement of the competent authorities to be of the parties.
Article 9 Information Exchange 1. The competent authorities of both the parties will regularly exchange the relevant information that is not cessary for executing this agreement. The competent authorities may agree to be on separate agreements which would exact the prescrib procedure of the information exchange.
2. The parties and the competent authorities may meet to in order to discuss or review this agreement as often as they find not cessary.
Article 9 Final provision 1. This agreement is concluded for an indefinite period of time and shall enter into force thirty (30) days after receipt of the last notification whereby the parties have notified each other of the fulfilmen of the internal legal procedures for the entry cessary not into force of this agreement.
2. Either Party may terminate this agreement by a written notification. In such case, the termination shall take effect six (6) months after the date of receipt by the other Party of the notification on the termination of this agreement.
3. This agreement may be amended and supplemented by mutual written agreement of the parties. The amendments and supplements shall enter into force in accordanc with paragraph 1 of this article.
4. The competent authorities of the parties may in the separate agreements conclud it specify the circumstanc of the implementation of this agreement.
Signed....................................... "in three original cop to each in Latvian, Estonian and English languages, all texts being equally authentic. In case of any divergenc of interpretation, the English text shall prevails.
Ministry of Health-the Republic of Latvia Ministry of Social Affairs-the Republic of Estonia Ministry of the Interior-the Republic of Estonia............................................. "
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Didzis Gabor Minister of Health Minister of Social Affairs of Hannu Pevkur Marco Pomerant is Minister of the Interior