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Índice

01. Health as a Right and as a Public Service
02. Healthcare Administration (Structure and Service Portfolio)
03. Who are the Users of the Public Healthcare System?
04. Healthcare Assistance Agreement - Community of Valencia.
05. The Healthcare Card
06. How is medical care provided?
           Primary care
           Specialised care
           Emergency care
           Clinical Record
           Informed Consent
07. Medicines and Pharmacies
08. Protection of Public Healthcare System User Rights
           Patient assistance and information service
           Complaints, suggestions and thanks
           Claims
09. Living Wills and Organ Donation
10. Recommendations
11. Basic Glossary
12. Structure of the Public Healthcare Service in the Province of Alicante
13. Useful telephone numbers and addresses
14. Useful links
15. Relevant legislation

1. Health as a Right and as a Public Service

Every Social State must guarantee its citizens, and others, the right to health. This means that public authorities must protect and promote the health of individuals.

In this sense, the Spanish Constitution recognises in article 43 the right of all citizens to health protection and
attributes to public authorities the obligation of organising and overseeing public health.

Spanish legislation establishes that all citizens, Spanish and those of other nationalities who are resident in Spain, have the right to health protection and healthcare. It also recognises that people who are in Spain temporarily have the right to healthcare. In both cases a series of administrative requirements must first be satisfied.

In Spain, the powers and responsibilities in the matter of healthcare are distributed between the State, the
Autonomous Communities and the Local Governments. However, the main role is assumed by the Autonomous
Communities who have been assigned the majority of the powers and responsibilities in the matter.

Thus, article 54 of the Statute of Autonomy for Valencia establishes that the Government of Valencia has exclusive powers and responsibilities for the organisation, administration and management of all the public healthcare institutions within the territory of the Community of Valencia.

2. Healthcare Administration (Structure and Service Portfolio)

In Spain, the National Health System (in Spanish called the Sistema Nacional de Salud, SNS) is the combined coordinated system made up of the Health Service of the Spanish General Administration and of the Health Services of each of the Autonomous Communities. It includes all the healthcare functions and provisions that, in accordance with the Law, are the responsibility of the public authorities.

Thus, each Autonomous Community has its own Health Service, which must act in coordination with the rest of the SNS, although it has the capacity to adapt its services and provisions to the needs of the local population.

In the case of the Community of Valencia, the body charged with the direction and execution of healthcare policy is the Healthcare Department. Reporting to the Healthcare Department is the Health Agency of Valencia, an autonomous organisation that has been assigned the responsibility for managing and administering the Health System of Valencia and for ensuring quality healthcare provision in the Community of Valencia.

For healthcare purposes, the territory of the Community of Valencia is divided into various Health Areas, which
are equivalent to the Health Areas as established by state legislation. In turn, each Health Area is divided into Basic Health Zones. You can see the Health Areas of the Province of Alicante and the municipalities included in each of them in section 12 of this guide.

Basic primary care services are mainly provided to the individual and the family through Health Centres (in Spanish called Centros de Salud). When there are population groups some distance away from a Health Centre, surgeries or Medical Dispensaries are sometimes provided close by. These bring basic healthcare closer to citizens and does not force them to travel when their health problems are not serious.

Specialised care provides more complex healthcare services and is carried out in hospitals or Specialist Centres
within these hospitals.

Healthcare services offered by the Public Healthcare System of Valencia is made up of the services contained in the SNS Portfolio of Common Services, which are the same for all Autonomous Communities, and by those improvements and additional services provided by the Community of Valencia.

The services contained in the SNS Portfolio of Common Services must always be provided when the citizen has the right to healthcare.

The SNS Portfolio of Common Services is set out in Royal Decree 1030/2006, and the detailed provisions are listed in a series of its Appendices. Because of the size, it is not possible to reproduce all the services and healthcare provisions here. However, an electronic address where you can see the full catalogue is included in the Useful Links section of this guide.

3. Who are the Users of the Public Healthcare System?

In Spain everyone, irrespective of their nationality or administrative status, has the right to health protection, and consequently has access to the services and corresponding healthcare provisions. However, the cost of this care to be borne by the Healthcare Administration depends on the mode of insurance of the person in question.

In the Public Healthcare System of Valencia, all people, irrespective of their nationality or residence, have the right to receive healthcare but this may or may not be free of charge depending on their administrative status.

Thus, every resident in the Community of Valencia who is registered with Social Security (employed or selfemployed) will have their healthcare covered, along with other rights. The spouse, the children and the parents of the worker also benefi t from this healthcare provision, provided that they comply with a series of requirements such as living with the worker, not being in paid employment and not receiving a pension that exceeds a certain amount.

This right has been extended to those citizens with legal residence in Spain who have made Social Security contributions and are now not making contributions because they are not working or are not covered in some
other way.

Pensioners who reside in Spain and have regularised their status with Spanish Social Security by having presented the relevant forms and corresponding documentation also have healthcare coverage, whether they are Spanish or of other nationalities.

The law also recognises the right to healthcare provision of those people who are registered with a Local Council who have demonstrated that they do not have suffi cient fi nancial means. This amount is determined by reference to the minimum wage, taking into consideration other questions such as if they are responsible for children or disabled people. In the case of the Community of Valencia, this right is extended to those foreign citizens who are not yet registered with a Local Council while they are regularising their administrative status. They have the right to what is called the “Solidarity Card”, which is described in section 5 of this guide.

In every case, people in Spain, irrespective of their nationality, residence, or administrative status, have the right to public healthcare provision for serious illness or accident, whatever the cause, and to the continuity of this provision until they have been medically discharged.

Young people under eighteen who are in Spain also have the right to healthcare provision under the same conditions as Spanish young people.

Pregnant foreign citizens who are in Spain also have the right to healthcare during their pregnancy, birth and postpartum irrespective of their administrative status. Postpartum is considered to be a period no longer than six weeks.

In addition, coverage for public healthcare provision in the Community of Valencia for people who are resident in other Autonomous Regions where they enjoy this provision is recognised while they are temporarily in the Community of Valencia. In such cases, the Community of Valencia will claim back from the corresponding Autonomous Community the expenses arising from healthcare provision.

Equally, holders of the European Healthcare Card (in Spanish known as Tarjeta Sanitaria Europea), which is referred to in section 5 of this guide, are also eligible for healthcare provision. The healthcare expenses arising will be claimed back from the countries of origin.

Nationals of countries with which Spain has established Agreements or Treaties on healthcare provision may also enjoy more or less healthcare coverage under the terms of these Agreements or Treaties.

All those not included in any of the cases described above will be considered as “private patients” or “not insured” and must themselves pay for any expenses arising from the healthcare provision that they receive. For such people, the Public Healthcare System of Valencia establishes the possibility for these patients to pay directly for each service they receive or for their private insurance company to cover their healthcare costs. There is also the possibility of contracting a Healthcare Assistance Agreement with the Healthcare Administration of Valencia so that by the payment of a certain sum (monthly quota scheme), the person would have coverage for healthcare expenses within the Public Healthcare System of Valencia (for more details, see the next section).

It should be noted that whenever citizens of any European Union Member State, the European Economic Area or Switzerland seek to benefi t from healthcare provision by any system or method that requires habitual residence in Spain, they must provide their Certifi cate of Registration with a Local Council and their Certifi cate of Inscription in the Central Foreigners Register on applying for their SIP Card.

Lastly, it should be noted that irrespective of the healthcare coverage enjoyed by the citizen, there are a series of common medical services that are excluded from the public system which must be addressed by other organisations. The most common of these are: traffic accidents, where the healthcare costs must be borne by the insurance companies of the vehicles involved; accidents at work, where the healthcare costs must be borne by the Industrial Insurance companies; sports accidents, where the costs must be borne by the insurance companies of the appropriate Federations or organisers of the competition involved; accidents at school, which are covered by the corresponding insurance; blood tests to verify alcohol breath tests, which when positive must be borne by the driver. In all these cases, the patient must provide the Healthcare Administration with the necessary information for properly identifying the insurance organisation that is responsible for payment. Failing to do this, the invoice for costs of services provided will be presented to the patient directly.

It should be noted that access to healthcare services, irrespective of the method of insurance and the provisions made to the individual, implies the establishment of a set of rights and a series of obligations for all users of the Public Healthcare System of Valencia. These rights and obligations are mainly described in articles 10 and 11 of Law 14/1986, dated 25 April, on General Healthcare, Law 41/2002, on the autonomy of the patient, and Law 1/2003 on Rights and Information to the Patient of the Community of Valencia.

4. Healthcare Assistance Agreement

Spanish or foreign residents of the Community of Valencia can be benefi ciaries of the Healthcare Assistance Agreement (monthly quota scheme) mentioned above if they so request and comply with the following requirements at the time of their application:

a) Apply for subscription to the Healthcare Assistance Agreement to the regional directorate of the Healthcare Department where they live.

b) Be registered with the Local Council in any of the municipalities of the Community of Valencia for at least six months prior to the presentation of their application and provide proof of effective residence.
In the case of foreign citizens, they must demonstrate their residency on Spanish territory by providing one of the official documents provided my the Ministry of the Interior for this purpose, which must be valid and in force at the time of the application.

c) Do not have a legal obligation to make Social Security contributions or to any other public healthcare system, in Spain or abroad.

d) Do not have access as a benefi ciary of a public healthcare protection system provided by Social Security or any other public organisation, Spanish or foreign, that offers coverage for healthcare provision, nor have the possibility of access to any such system.
Those people who have the possibility of voluntarily accessing the services and healthcare provisions of Social
Security through subscription or adhesion to a Healthcare Assistance Agreement with the National Institute of
Social Security will be considered as not complying with this requirement.
It is important to note that this Healthcare Agreement is with the individual and that the right of access to healthcare provision is individual and non-transferable, only applicable to the person with whom the agreement
is made.

The application, on an official form, can be presented at any time of the year and must be accompanied by the following documentation:

1.- Photocopy of the applicant’s DNI or passport and, where applicable, of their representative.
2.- Photocopy of the NIF, Fiscal Identity Number.
3.- Foreigner’s Card or Certifi cate of Inscription in the Central Foreigners Register if the applicant is a citizen of the EU.
4.- Photocopy of the Family Book if the applicant is a minor.
5.- Up-to-date certifi cate of registration with a Local Council in the municipality of the Community of Valencia for the current residence or previous residence where the date of fi rst registration appears.
6.- Certificate from the Local Council or any document proving effective residence in the Community of Valencia.
7.- Completed offi cial Mantenimiento de Terceros form showing the details of the bank account from which the payment of quotas will be directly debited.
This documentation must be presented, preferably at the General Registry of the Healthcare Department or in the Territorial Directorates of Health of each province, although it can be presented at any authorised administrative registry.
Subscription to the Healthcare Assistance Agreement requires the applicant to pay a sum currently fixed at 270 euros per quarter for people under 65 years of age and 330 euros per quarter for people older than 65, although these amounts can be changed each year. In the case of under-age young people or those judged to be disabled, the obligation to pay these quotas falls on the legal representative.

Failure to pay a quota will give rise, in the first instance, to the suspension of the Healthcare Agreement during the first month of the quarter in which the quota was not paid. If the payment is still not made after this period has elapsed, the Healthcare Agreement will be deemed cancelled.

Other reasons for cancellation are: loss of one of the requirements for being a benefi ciary, as listed above; the death of the benefi ciary; renunciation by the benefi ciary communicated formally to the Administration; fraudulent use of the benefi ts granted by the Agreement; lack of explicit consent by the benefi ciary to any modifications in the Agreement advised by administrative notice, which arise from legislative changes that may affect the provisions of the Public Healthcare Service of Valencia and its Portfolio of Services.

The official form of SOLICITUD DE SUSCRIPCIÓN DE CONVENIO DE ASISTENCIA SANITARIA A PACIENTES PRIVADOS CON LA GENERALITAT, (Application for Subscription to the Healthcare Assistance Agreement by Private Patients with the Government of Valencia) can be obtained from the following electronic address:
http://www.gva.es/downloads/publicados/IN/19162_ES.pdf

The offi cial form of MANTENIMIENTO DE TERCEROS PARA PAGOS POR DOMICILIACIÓN (Bank details for payments by direct debit) can be obtained from the following electronic address:
http://www.gva.es/downloads/publicados/IN/19163.pdf

5. The Healthcare Card

To access the provisions of the Public Healthcare System in the Community of Valencia, it is necessary to have an Individual Healthcare Card otherwise known as the SIP Card (Tarjeta SIP).

This card is the personal document identifying each citizen to the Healthcare Administration and provides evidence of the type of services and healthcare provisions to which the holder is legally and individually entitled.

The SIP Card must be always be presented when requesting or receiving healthcare services in public healthcare provision centres and in Pharmacies.

As the SIP Card is a document for personal and exclusive use by the title holder, healthcare centres and institutions can additionally request to see an offi cial document of identity that reliably proves that the card holder is its title holder. If the healthcare authorities recognise inappropriate use of the SIP Card, they may retain it as a precaution and withdraw it if applicable.

The SIP Card becomes invalid when the time for which it was issued expires, when a new Card is issued to the
same title holder for any reason or when the Administration identifi es that the Card no longer faithfully reflects the identity or the relationship of the insured to the title holder.

The contents of this Card are detailed below:

Source: Healthcare Department

To obtain a Health Card or to communicate any changes in identifi cation or address details, you must go to the nearest Health Centre or telephone the Call Centre that appears in the appropriate section of this guide.

In those cases when the person has the right of access to the healthcare provisions of the Community of Valencia but not to a Health Card, for example when temporarily travelling from other Autonomous Regions or title holders of the European Health Card, the Healthcare Administration will issue a Document of Inclusion in the SIP. This document is issued for the purpose of simplifying the healthcare provided but the person will always have to present this document together with Healthcare Card (of another Autonomous Community or the European) that demonstrates the right of access to healthcare provision.

Solidarity Card - Tarjeta Solidaria
This is awarded to those foreign citizens who lack suffi cient fi nancial resources and are not benefi ciaries of any other system of public healthcare coverage. It will not be issued to citizens of the European Union, nor to those of other nations where there is an agreement on healthcare matters such as, for example, Andorra, Brazil, Ecuador or Morocco.

Foreigners who are registered with a Local Council in the Community of Valencia and those who are not yet registered while they regularise their administrative status may apply.

To do this, the interested person must go to the Social Worker, either in the Primary Care Centre or in the Local Council or to any of the NGOs legally recognised by the Healthcare Administration, to whom they will deliver the documentation demonstrating their stay in Spain and the lack of fi nancial resources. A report will be issued and all the documentation will be delivered to the Healthcare Administration to start the corresponding file.

The Solidarity Card has a validity of one year. This period can only be extended when objective reasons are demonstrated for preventing the process of normalising the administrative status of the person.

The Solidarity Card looks the same as the SIP Card, except that it carries a specific administrative code.

European Healthcare Card - Tarjeta Sanitaria Europea
The European Healthcare Card is the personal and non-transferable document by virtue of which the title holder has the right to receive any healthcare provision that might be required, from a medical point of view, during their temporary stay in a EU Member State, the European Economic Area or in Switzerland for reasons of work, study or tourism. They will receive healthcare provision under the same conditions as the nationals of the State they are visiting.

It is important to take into account that the European Healthcare Card is not valid if the reason for travel is to receive specifi c medical treatment for a pre-existing health problem at the time of obtaining this card. It is also invalid for private medical care.

Citizens intending to habitually reside in Spain must obtain the SIP Card, provided that they comply with the administrative requirements.

The European Healthcare Card is applied for in the country of origin prior to travel. It is therefore necessary to
fi nd out about the specifi c procedure in each State.

In the case of Spain, when a citizen resident in Spain who has the right to receive healthcare wishes to visit another EU Member State, a state of the European Economic Area or Switzerland, they must personally visit a
Social Security Assistance and Information Centre, or apply via the Internet through the Social Security Virtual Office.

If for any reason the citizen was not able to obtain the European Healthcare Card, they must apply for the Provisional Substitution Certificate (Certificado Provisional Sustitutorio). Application is through the same sources but, in contrast to the European Healthcare Card, it can be obtained immediately from the Social Security Assistance and Information Centres or if it has been applied for electronically, by the printing of a document obtainable using the Digital Certificate.

In general, the European Healthcare Card is valid for one year. The expiry date is indicated on the card itself. The Provisional Substitution Certifi cate is only valid for a maximum of 90 days from the date of issue.

6. How is medical care provided?

As explained in the second section of this guide, public medical care is structured in two levels: Primary Care and Specialised Care. There is also an Emergency Care service.

Primary care - Atención Primaria
Primary Care is the fi rst level of access to the healthcare system. The fi rst place to go if you have a health problem is the Primary Care Centre, also known as the Health Centre or Doctor’s surgery (in Spanish these are know as: Centro de Atención Primaria, Centro de Salud or Ambulatorio).

Each user has assigned a specifi c Primary Care Centre, which is determined by the address where they are registered with the Local Council and is listed on their Healthcare Card. The INFOSALUT service (for contact details see section 12 of this guide) can provide the information necessary about your assigned Health Centre. However, citizens have the right to choose freely which doctor, paediatrician or centre they attend.

In order to access the Primary Care services in the Community of Valencia, you must apply for an appointment. You can do this by one of the following methods:

• Application at the Primary Healthcare Centre itself. Each Centre has an administrative service for the user that assigns appropriate appointments. This service is provided by public sector employees, although computer terminals have been installed in the majority of Health Centres through which it is possible to obtain a medical appointment using the Healthcare Card.
• Application by telephone. The appointment can be requested through a voice recognition system available in Spanish, Valencian and English and which is available 24 hours per day and 7 days per week on the telephone number that is given in section 13 of this guide.
  
• Application through the Internet. An appointment can be obtained by the procedure described on the web page http://www.san.gva.es/cas/ciud/solicitud.html.

  
The telephone and Internet methods of applying are currently in the process of implementation, so it is possible that they may not be available for all the Health Centres.

Specialised care - Atención especializada
This is the second level of access for citizens to the healthcare service. It is made up of diagnostic and therapeutic services of high complexity and cost. Access to this level is by prescription from Primary Care doctors.

Basically, it includes:
- Hospital care.
- Social health care.
- Psychiatric and mental health care.
- Care for those dependent on drugs.
- Other specialised care resources (for example, rehabilitation).

It is provided in Specialist Centres or in Hospitals. In the latter case by walk-in or admission.

Emergency Care - Atención de Urgencia
What to do in case of Emergency depends on its severity.
If the problem demands immediate attention but the patient is able travel, the most appropriate procedure is to attend the doctor’s surgery in the Health Centre and ask for a ‘turn number’, without waiting to arrange an appointment.

If the patient cannot travel, the Health Centre has a home care service so that healthcare staff can travel to the home of the patient. If the problem is very serious, you should go directly to the Emergency Service of any Hospital, although it is recommended that you attend the hospital closest to your home. In the case of a lifethreatening risk, any medical centre, including private centres, have the obligation to assist patients irrespective of their healthcare coverage status.

If the emergency occurs on the public road or the patient cannot travel, the public healthcare system provides an ambulance service that includes appropriate staff and equipment.

The emergency telephone number 112 is the most appropriate point of contact with the Emergency Services. Citizens can provide through this number all the information required by the emergency operatives to ensure that they work as effectively as possible.

Clinical Record - La Historia Clínica
At the end of the process of care, the patient has the right to receive a report including their personal information and a summary of their medical record, the details of the healthcare provided, the diagnosis and the therapeutic recommendations to follow.

Irrespective of the level of care (Primary, Specialised or Emergency) to which the citizen fi rst attends, all the healthcare processes to which they have been subjected will be refl ected in the set of documents that is known as the Clinical Record.

The Clinical Record is a set of confi dential documents, kept by those responsible for healthcare provision, to which the patient or representative has access. The healthcare authorities also have access to them for the purposes of diagnosis, administrative management and statistical or epidemiological information.

Informed Consent - El Consentimiento Informado
Before any healthcare intervention that carries or may carry a signifi cant risk for the health of the patient, the patient must provide what is called Informed Consent.

Informed Consent consists in the patient’s explicit statement of agreement to the intervention and after having obtained appropriate information about it in terms that they can understand and with suffi cient time to consider it.

7. Medicines and Pharmacies

Medicines
There are two main types of medicines:

a) Medicines for unrestricted sale. These are distributed without restriction by Pharmacies without the need for a medical instruction or prescription. They are pharmaceuticals for the relief, treatment or prevention of minor problems that have been explicitly authorised as medicines for unrestricted sale.

b) Medicines with medical prescription (medicamentos con receta médica). They are distributed uniquely and exclusively under a medical prescription, from either public or private medical staff, and are for the treatment of a more severe illness or symptom.

The external packaging of the medicine must indicate if it can be dispensed with or without a medical prescription.

The prescription is a formal document by which legally authorised medical staff can prescribe medication for the patient. The law regulates the characteristics and contents of prescriptions, both for Public Healthcare and Private practice. Prescriptions for narcotic or psychotropic drugs are subject to a stricter special regime.

In Spain, medicines are only dispensed, distributed and sold in Pharmacies. This guarantees that you have the professional advice of a university qualified Pharmacist. Sale over the Internet of medicines for which a medical prescription is necessary is not permitted.

The cost of a large proportion of medicines is assumed by Public Healthcare, with the percentage that the citizen must pay for them depending on the insurance cover held. Thus, for example, an active worker or someone in a similar situation must pay 40% of the value of the medicine. A pensioner, or someone in a similar situation, will receive most medicines free of charge.

In the case of specific medicines for ongoing or chronic use, identified with a black circle on the packaging, the patient only pays 10% of the price and with a maximum limit.

Pharmacies
These are establishments whose main purpose is the acquisition, safe keeping and dispensing of medicines and
other healthcare products.

Outside normal commercial hours, care is guaranteed to the population through emergency pharmacy care. In the Community of Valencia, this service is provided through Duty Pharmacies (known in Spanish as Farmacias de Guardia).

In every pharmacy there is a Used Medicines Collection Point (known in Spanish as Punto SIGRE - Sistema Integrado de Gestión y Recogida de Envases). This is a system for the collection of containers and old medicines that are no longer required or that are not in good condition. In this way, citizens can dispose of these products without harming the environment.

8. Protection of Public Healthcare System User Rights

Patient Assistance and Information Service (SAIP-Protection of Public Healthcare System User Rights)
The SAIP, part of Healthcare Administration, is responsible for responding to and informing citizens using the Public Healthcare System of Valencia. It transmits suggestions, complains and thanks that the citizens may make.

The citizen can make use of this service in searching for general information about Healthcare Administration or about their particular situation. You can also use this service to present appropriate complaints. This service is found in all Hospitals in the Public Healthcare network of Valencia and also in other centres, such as Specialist Centres and in some of the Primary Care Centres. You can also access these services by telephone (numbers are given in section 13 of this guide).

Complaints, suggestions and thanks

Patients can present complaints, suggestions and thanks in relation to the operation of healthcare institutions,
which helps the service strive for continuous improvement in quality.

Through complaints, the patient expresses their dissatisfaction with the quality of the healthcare service received in the broadest sense (treatment received, state of the facilities, waiting times, etc.).

Suggestions are the patient’s proposals for improving the quality of public healthcare services and especially those which could help to simplify, reduce or eliminate paperwork or hassles in dealings with Healthcare Administration.

Thanks are an acknowledgement by the patient to the staff or service for the work done or treatment received.

Complaints, suggestions or thanks can be presented at any administrative registry. However, it is preferable to
present them directly to the Patient Assistance and Information Service (SAIP), to the General Registry of the Healthcare Department or to the Regional Directorate in Alicante.

Section 13 of this guide lists the addresses and contact telephone numbers of the General Registry of the Healthcare Department and of the Regional Directorate in Alicante.

The citizen must receive a response to their complaint or suggestion no later than one month after it has been
received in the registry. The patient can obtain information about the progress of their complaint at any time, as well as present a new complaint for failure to respond, if appropriate.
 
Claims
In accordance with the general principle of responsibility of the Public Administration for any damages caused, citizens can demand, through the corresponding administrative procedure, compensation for damages or injuries caused by the operations of the healthcare services or the actions of the staff. In making such a claim, they must prove the existence of the harm or injury, that the Healthcare Administration was responsible for it, and justify the financial valuation of the claim.

The right to make a claim is restricted to the year in which the event occurred, or the act that motivated the compensation occurred or when the injury became manifest.

The claim can be presented at any administrative registry in accordance with administrative legislation and, preferably, at the registry of the Regional Directorate of Alicante of the Healthcare Department.

The Administration will have a period of six months, extendable by another six, to conclude the process. If this
period has passed without the process being resolved, the citizen can understand that their claim has been rejected.

If the Healthcare Administration does not accept the claim made by the citizen, the citizen may present it at the Administrative Litigation Courts.

9. Living Wills and Organ Donation

Living Wills
In line with respect for and promotion of patient’s autonomy, the law provides for the possibility of leaving instructions to be followed about health care and treatment in the event when the patient is unable to declare their wishes or, after death, about their body or organs.

This is the Living Will (known in Spanish as Documento de Voluntades Anticipadas). In it, an elderly person or emancipated minor, with suffi cient legal capacity and freely, communicates their instructions about medical actions that should be taken into account should they reach a situation in which they can no longer freely express their wishes. If the person maintains the ability to let their wishes be known, this will always prevail over the contents of the Living Will document. The Living Will can also be revoked, changed or replaced at any time by the interested party. The Living Will is also known in Spanish as Testamento Vital.

The Living Will Document can be formalised in one of two ways:

- By Public Deed executed before a Notary.
- By a declaration before three witnesses, adults with full capacity to act, two of which must not have any direct relationship with the grantor.

The Living Will Document, which must not include any dispositions contrary to law, may include:

A) An expression of life goals and personal values.This provides guidance for the interpretation of the remainder of the document and serves to help the medical team before they take decisions.

B) Instructions about medical treatment. It can refer both to an illness or injury that is being suffered at the time of granting the document or to any future situation. With the only limitation being good clinical practice and respect for the law, the medical interventions that the person wishes to receive or not to receive may be indicated.

C) Naming a representative. This person would act for the grantor in healthcare matters. The representative must comply with a series of legally established requirements.

D) Decisions about organ donation. The person can leave instructions with respect to the donation of their organs for therapeutic, teaching or research purposes. In this case, after death, the consent of relatives for removal or use of organs would not be required.

It is possible to register the Document in the Central Living Will Register. This is a register held by the Healthcare Department that seeks to ensure the effectiveness of the document throughout the country, while respecting the principles of confi dentiality, security and control.

Registering the Document is highly recommended as if it is registered, the medical team will know about it because such registration will be included in the Clinical Record and must be taken into account before taking any medical action. If it is not registered, the obligation of letting people know of its existence will fall on the patient who must deliver a copy to the Healthcare Centre so that it is included in their Clinical Record or the patient must carry it with them.

Organ Donation
Any person, who while alive has not expressed their disagreement, can be a donor of organs or tissues.

As indicated above, organ donation can form part of the content of the Living Will document. In this case, organs can be removed and used without the need to consult with relatives.

If there is no Living Will, once a patient’s cardio-respiratory and brain functions have irreversibly stopped, authorisation will be sought from family and friends for the donation. Therefore, if you want to be a donor, you
must communicate this decision to your family.

The Healthcare Department website provides a card that the user can complete and which, when the time comes, is proof of their wish to donate their organs.

Absolute confi dentiality is maintained throughout the process, guaranteeing that its purpose is to encourage health or the conditions of life of the recipient.

10. Recommendations

When accessing the healthcare services, it is useful to take the following into consideration:

• Before starting on any healthcare process, it can be useful to visit the Healthcare Department web portal, call the information telephone numbers or ask the patient assistance service.
• If you have any question or complain, you should visit the Patient Assistance and Information Service (SAIP) located in various Healthcare Centres.
• If the problem persists despite using this service, without prejudice to the right of the citizen to use the
  existing judicial or administrative resources, you can present a complaint to the Síndic de Greuges (the Ombudsman of the Community of Valencia).
• The Consulates and Embassies often have lists of doctors and Medical Centres in which care can be provided in languages other than Spanish or Valencian.
• The Emergency Medical Services must only be used when the seriousness of the situation for the patient makes it necessary. Whenever possible, in order not to overwhelm the Emergency Services, you must attend the Primary Care Centres.
• The fact that some medicines do not require a prescription for sale does not imply that these substances are not be harmful for health. You must always act responsibly when using medicines.
• Before travelling to any country of the European Union, the European Economic Area or Switzerland, the citizen must ensure that they have the European Healthcare Card and that it is valid to include the planned date of return. If this is not the case, you must apply for a new Card to ensure healthcare coverage during your stay abroad.
• The European Healthcare Card is issued free of charge by the healthcare authorities.
You must keep the Individual Healthcare Card (SIP Card) with you. To keep it safely, do not fold it, write on it, do not allow it to come into contact with magnets and do not place it on equipment connected to electric current.

11. Basic Glossary

Alta médica (medical discharge): Document in which the doctor certifi es the end of hospital admission. It is accompanied by a medical report about the progress of the illness and the recommendations to follow, need to return for reviews, etc.

Alta médica forzosa (involuntary medical discharge): If the patient refuses to sign the voluntary medical discharge, the Healthcare Centre, at the proposal of the doctor responsible, can issue an involuntary medical discharge under the conditions regulated by Law, except when there is an alternative treatment provided by the same hospital and which is acceptable to the patient. (Law 41/2002 dated 14 November. Art. 21, section 1)
Alta médica voluntaria (voluntary medical discharge): Following the exercise by the patient of their right not to receive the prescribed treatment, the medical staff can propose that the patient sign a voluntary medical discharge, except when there is a risk to public health for healthcare reasons. Similarly to the case of a normal medical discharge, a report is provided by the doctor.

Atención Primaria (Primary care): First level of access to healthcare provision.

Ambulatorio (doctor’s surgery): Primary Care Centre.

Centro de Salud (Health Centre): Primary Care Centre.

Consentimiento informado (informed consent): The patient’s explicit statement of agreement to the intervention or treatment after having obtained appropriate information about it in terms that they can understand and with sufficient time to consider it.

Dispensario (dispensary): Facility attached to a Primary Care Centre but some distance away or in an area of low population density.

Farmacia de guardia (duty pharmacy): Pharmacy that provides an emergency pharmaceutical service to the population. In a particular area, normal pharmacies provide this role though a system of turns.

Historia clínica (clinical record): Set of documents that record all the healthcare interventions to which a patient has been subjected.

Medicamento (medicine): Substance or set of substances with therapeutic or preventative properties that have been explicitly approved as such.

Medicamento genérico (generic medicine): All medicines that have the same qualitative and quantitative composition in terms of active principles and the same pharmaceutical form as an original medicine. A generic medicine can be recognised as such by the initials EFG on the label.

Médico de cabecera (general practitioner): Synonym for family doctor.

Médico de Familia (family doctor): Medical staff performing Primary Care. This is the medical professional closest to the population.

Médico General (general doctor): Synonym for family doctor.

Oficina de Farmacia (pharmacy): Establishment whose main purpose is the acquisition, safe keeping and dispensing of medicines and other healthcare products.

Prospecto (leaflet): Document that indicates the composition, purpose, method of use and possible adverse effects of medicines that accompanies medicines in their packaging.

Receta médica (medical prescription): Standard document by which legally authorised medical staff prescribe medicine to the patient and the dose and frequency at which it should be taken.

Sigre: System for selective collection of old medicines and their disposal in an environmentally friendly way.

12. Structure of the Public Healthcare Service in the Province of Alicante

From the institutional point of view, the Healthcare Department is represented by a Regional Directorate, the contact details of which can be found in the corresponding section of this guide.

From the service point of view, the province of Alicante is divided into 9 Health Areas:

-Health Area No. 13. Denia hospital. Includes the municipalities of: Adsubia, Alcalalí, Beniarbeig, Benigembla, Benidoleig, Benimeli, Benissa, Benitachell, Calp, Castell de Castells, Denia, Els Poblets, El Verger, Gata de Gorgos, Xaló, Jávea, Jesús Pobre, La Llosa de Camacho, Llíber, Murla, Ondara, Orba, Parcent, Pedreguer, Pego, El Ràfol d’Almunia, Sagra, Sanet y Negrals, Senija, Teulada, Tormos, La Vall d’Ebo, Vall de Gallinera, La vall de Laguar.
 
-Health Area No. 15. Alcoy hospital. Includes the municipalities of: Alcocer de Planes, Alcoleja, Alcoy, Alfafara, Almudaina, L’Alquería d’Asnar, Agres, Balones, Banyeres de Mariola, Benasau, Beniarrés, Benifallim, Benilloba, Benillup, Benimassot, Benimarfull, Castalla, Cocentaina, Facheca, Famorca, Gaianes, Gorga, Ibi, La Vall d´Alcalà, Lorcha, Millena, Muro de Alcoy, Penàguila, Planes, Onil, Quatretondeta, Tollos.
 
-Health Area No. 16. Villajoyosa hospital. Includes the municipalities of: L’Alfàs del Pi, Altea, Beniardá, Benifato, Benidorm, Benimantell, Bolulla, Confrides, Finestrat, El Castell de Guadalest, La Nucia, Orxeta, Polop, Relleu, Sella, Tàrbena, Villajoyosa.

-Health Area No. 17. Alicante- San Juan hospitals. Includes the municipalities of: Aigües, Alicante, Busot, El Campello, Jijona, Mutxamel, Sant Joan d’Alacant, Santa Faz, Tibi, Torremanzanas.
 
-Health Area No. 18. Elda hospital. Includes the municipalities of: Algueña, Aspe, Beneixama, Biar, Campo de Mirra, Cañada, Elda, Hondón de los Frailes, Hondón de las Nieves, La Romana, Monóvar, Novelda, Petrer, Pinoso, Sax, Salinas, Villena.
 
-Health Area No. 19. Alicante General hospital.  Includes the municipalities of: Agost, La Alcoraya, Alicante, Cañada, Monforte del Cid, El Moralet, San Vicente del Raspeig, Verdegás, 
 
-Health Area No. 20. Elche General hospital.  Includes the municipalities of: Crevillent, Elche, Isla de Tabarca, Santa Pola.
 
-Health Area No. 21. Orihuela hospital. Includes the municipalities of: Albatera, Algorfa, Almoradí, Benejúzar, Benferri, Bigastro, Callosa de Segura, Catral, Cox, Daya Nueva, Daya Vieja, Dolores, Granja de Rocamora, Jacarilla, Rafal, Redován, San Isidro.
 
-Health Area No. 22. Torrevieja hospital. Includes the municipalities of: Benijófar, Campoamor, Formentera del Segura, Guardamar del Segura, Los Montesinos. Pilar de la Horadada, Rojales, San Fulgencio, San Miguel de Salinas, Torremendo, Torrevieja.

Each Health Area has a Primary Care Directorate, to which the Health Centres and auxiliary surgeries report. In
the fi eld of Specialised Care, each Area also has a Hospital and a Specialist Centre.

The addresses and telephone numbers of the Primary Care Directorates, the Specialist Centres and the Hospitals are listed in section 13 of this guide.

There are also two hospital centres serving the province and focussed on chronic and long-stay patients.These are La Pedrera hospital in Denia and San Vicente del Raspeig hospital. Their addresses are also listed in section 13 of this guide.

In order to provide residential services and rehabilitation for patients with chronic mental illnesses, the Council of Alicante has the Centro Socio-Asistencial Dr. Esquerdo y Servicio de Salud Mental, in the old Hospital Psiquiátrico of the province. The Mental Health Service provides care and improves the health of the hospitalised mentally ill. It also provides non-hospital assistance, including a home assistance unit.

13. Useful telephone numbers and addresses

Infosalut
Telf. 900 161 161

Call Centre. Información Tarjeta SIP
Telf. 900 662 000

Centro de Especialidades Alcoy “La Fabrica”
C/Alcoleja, 4.Alcoi/Alcoy 03802 Telf. 96 652 10 12.Telf. SAIP 96 652 08 60. Fax 96 652 09 27

Centro de Especialidades Alicante “Babel”.
C/ Fernando Madroñal 5 y 7. Alicante 03007. Telf. 96 593 89 36. Telf. SAIP 96 593 89 30. Fax. 96 511 29 40.

Centro de Especialidades Alicante «Santa Faz»
C/Gerona 24. Alicante 03001.Tef. 96 593 81 23. Telf. SAIP 96 59381 63. Fax 96593 89 65

Centro de Especialidades de Benidorm “Foietes”.
C/ Venezuela s/n. 035022. Benidorm. Telf. 96 680 82 34. Telf. SAIP96 680 75 61. Fax 96 586 13 07.

Centro de Especialidades de Dénia
Partida de Beniadlá s/n 03700. Denia. Telf. 96 642 93 50.

Centro de Especialidades Elx/ Elche “San Fermín”
.C/ Jorge Juan 46. Elche/ Elx 03201. Telf. 96 667 94 44. Telf. SAIP 96 667 94 12. Fax. 96 667 94 77.

Centro de Especialidades de Elda.
C/ Padre Majón, 5. Elda 03600.Telf. 966989011. Telf. SAIP 965397805. Fax 966989022.

Centro Especialidades “Nuestro Padre Jesús” Orihuela
Avda. Teodomiro, 22. Orihuela. 03300. Telf. 96 690 40 00. Telf. SAIP 96 690 40 01. Fax. 96 690 40 06

Conselleria de Sanidad. Generalitat Valenciana.
Av. Campanar, 32. CP 46015. Valencia. 96 386 60 00.

Dirección Territorial de la Conselleria de Sanidad en Alicante.
C/ Gerona 26. 03001. Alicante. Telf. 965 93 80 00  Fax 965 93 80 66

Dirección de Atención Primaria de Alcoy
Plaza de España, 2.Alcoy 03801.Telf. 96 652 89 20. Telf. SAIP 96 652 03 05. Fax 96 652 89 25.

Dirección de Atención Primaria Alicante-Hospital General
C/ Isla de Cuba, 39 (CS de Los Ángeles).Alicante 03009.Telf. 96 593 79 96. Telf. SAIP 96 518 18 94. Fax 96 521 45 23.

Dirección de Atención Primaria de Denia
Partida de Beniadlá s/n   03700. Denia. Telf. 96 642 93 50.

Dirección de Atención Primaria Elx-Hospital General
Camino de la Almazara, 11.Elche/Elx 03203.Telf. 96 667 95 40. Telf. SAIP 96 667 96 18. Fax 96 667 95 66.

Dirección de Atención Primaria de Elda
Av. de las Acacias, 31.Elda 03600.Telf. 96 538 72 20. Telf. SAIP 96 538 72 20.
Fax 96 539 68 35.

Dirección de Atención Primaria Marina Baixa
C/ Tomas Ortuño, 69.  03500 Benidorm. Telf. 96 687 89 09. Telf. SAIP 96 687 89 35.
Fax. 96 687 89 01

Dirección de Atención Primaria de Orihuela.
Ctra. Orihuela-Almoradi, s/n (Ptda. de San Bartolomé).Orihuela. 03314. Telf. 96 587 75 00. Telf. SAIP 96 587 77 33. Fax. 96 677 60 60

Dirección de Atención Primaria Sant Joan d´Alacant
Ctra. Alicante-Valencia. Sant Joan d´Alacant (Alicante) 03550Telf. 96 593 87 00. Telf. SAIP 96 593 86 23. Fax 96 593 86 52.

Dirección de Atención Primaria de Torrevieja.
Ctra.CV-95 Torrevieja-San Miguel de Salinas. Ptda. Ceñuelo. Torrevieja. 03186.
Telf. 96 572 12 00

Dirección General para la Calidad y Atención al Paciente de la Conselleria de Sanidad.
C\ Micer Mascó, 31, 46010. Valencia. Tfno. 963866600 Fax 963866607

Emergencias
Telf. 112

Hospital Alcoy “Virgen de los Llirios”
Polígono Caramanxell s/n 03804. Alcoy. Telf. 96 553 74 00. Fax 96 553 74 48.

Hospital General Universitario de Alicante.
C/ Pintor Baeza, 12.Alicante 03010.Telf. 96 593 30 00. Fax. 96 593 82 34.

Hospital Dénia “Marina Salud”
Partida de Beniadlá  03700 Denia. Telf. 96 642 90 00. Fax 96 578 17 88.

Hospital de La Pedrera de Denia
Partida Plana Est, 4.Dénia 03700.Tfno 96 557 97 00. Fax 96 557 97 25.

Hospital General Universitario de Elx-Elche.
Camino de la Almazara, 11.Elche/Elx 03203.Telf. 96 667 90 00. Fax 96 667 91 08

Hospital General de Elda “Virgen de la Salud”.
Ctra. Elda-Sax. Ptda. La Torreta (Elda) 03600.Telf. 96 698 90 00. Fax 96 698 90 79.

Hospital Vega Baja  de Orihuela
Ctra. Orihuela-Almoradi, s/n (Ptda. de San Bartolomé).Orihuela. 03314. Telf. 96 587 75 00. Fax 96 587 75 21.

Hospital de San Vicente del Raspeig
C/Lillo Juan, 137.San Vicente del Raspeig 03690.Telf. 96 590 77 00. Fax 96 590 77 45

Hospital de Sant Joan d'Alacant.
Ctra. Alicante-Valencia. Sant Joan d´Alacant (Alicante) 03550Telf. 96 593 87 00. Fax 96 593 86 52.

Hospital de Torrevieja
Ctra.CV-95 Torrevieja-San Miguel de Salinas. Ptda. Ceñuelo. Torrevieja. 03186.Telf. 96 572 13 13. Fax 96 572 13 68.

Hospital La Vila Joiosa “Marina Baixa”
Avda. Alcalde En Jaume Botella 7.Villajoyosa 03570.Telf. 96 685 98 00. Fax. 96 685 99 00

Oficina del Síndic de Greuges
C\ Pascual Blasco, 1. 03001. Alicante. Telf. 900 21 09 70  Fax 965 93 75 54

Registro General de la Conselleria de Sanidad
C\ Micer Mascó, 31-33. 46010. Valencia. Telf. 012

Registro de la Dirección Territorial de Sanidad. Alicante.
C\ Girona, 26. 03001. Alicante. Telf. 012

Sección de Afiliación y Validación Conselleria de Sanidad. Alicante
Rambla de Méndez Núñez, 41. 03002. Alicante. Telf. 966478309.

Seguridad Social. Centro de Atención e Información. Alicante. Nº.2
C/Mayor,3. 03002 .Alicante Telf: 96 5233300 / 96 5233301

Seguridad Social. Centro de Atención e Información Alicante Nº 3
C/ Doctor Ayela, 26.-28. 03013. Alicante. Telf. 965 205 909. Fax 965 143 756

Seguridad Social. Centro de Atención e Información. Alcoy
C/ Doctor Sempere, 28. 03803. Alcoy. Telf. 965 333 073. Fax 965 525 952

Seguridad Social. Centro de Atención e Información. Benidorm.
C/ Júpiter, 1 bajo. 03501 Benidorm. Telf. 965 855 905. Fax 965 855 906

Seguridad Social. Centro de Atención e Información. Denia.
Pº Saladar, 41. 03700. Denia. Telf. 965 780 022. Fax 965 780 530.

Seguridad Social. Centro de Atención e Información. Elche.
C/ Fra Jaume Torres, 32 AC. 03204. Elche. Telf. 96 6630670. Fax 966 630 671

Seguridad Social. Centro de Atención e Información. Elda.
C/ González Bueno, 2. 03600. Elda. Telf. 966 981 140. Fax 966 981 141

Seguridad Social. Centro de Atención e Información. Jijona.
Avda. De la Constitución, 39 bajo. Telf. 965 610 284. Fax 965 612 856

Seguridad Social. Centro de Atención e Información. Orihuela.
C/ San Agustín, 20. 03300 Orihuela. Telf. 965 300 006. Fax 966 740 389

Seguridad Social. Centro de Atención e Información.
C/ Constitución, 10. 03570. Villajoyosa. Telf. 965 890 194. Fax 965 891 465.

Centro Socio-Asistencia Dr. Esquerdo y Servicio de Salud Mental
C/ Ramón de Campoamor, 25. 03550. San Juan de Alicante. Telf. 965 939 033.

14. Useful links

Web portal of the Ministry of Healthcare and Social Policy with information about health protection in Spain and the provisions of the National Healthcare System. http://www.msps.es

Website of the Healthcare Department summarising all the information about healthcare infrastructure in the province of Alicante and the relevant administrative procedures.. http://www.san.gva.es

Requesting an appointment for Primary Care
www.san.gva.es/cas/ciud/homeciud.html

Website of the European Residents Area of Alicante Provincial Council, where there is a great deal of legal, administrative, news and leisure information specifi cally directed at European residents of the province of Alicante.
http://www.residenteseuropeos.com

Web portal of the Síndic de Greuges of the Community of Valencia giving information about the role of this institution in protecting fundamental rights, amongst which is the right to health. 
http://www.sindicdegreuges.gva.es

Social Security Virtual Offi ce. Citizens’ assistance service on the Internet where Social Security procedures can be carried out electronically.
www.seg-social.es

Website of the Pharmacists School of Alicante. Duty Pharmacies by place and date.
http://www.cofalicante.com

15. Relevant legislation

• Spanish constitution of 1978. Articles 13, 41 and 43.
  
• Organic Law 1/2006, dated 10 April, reforming Organic Law 5/1982, dated 1 July, on the Statute of Autonomy of the Community of Valencia.
  
• Organic Law 4/2000, dated 11 January, on the rights and freedoms of foreigners in Spain.
  
• Law 28/2009, dated 30 December, modifying Law 29/2006, dated 26 July, on guarantees and rational use of medicines and healthcare products.
  
• Law 16/2003, dated 28 May, on Cohesion and Quality of the National Healthcare System.
  
• Law 41/2002, dated 14 November, on basic regulation of the autonomy of the patient and of rights and obligations in the matter of information and clinical documentation.
  
• Law 16/1997, dated 25 April, on regulation of pharmacy services.
  
• Law 14/1986, date 25 April, on General Healthcare.
  
• Royal Decree 1030/2006 of the Common Services Portfolio management of the SNS (repealing Royal Decree 63/1995 on the regulation of SNS healthcare provisions).
  
• Law of the Government of Valencia 6/2008, dated 2 June, on healthcare insurance of the Public Healthcare System of Valencia.
  
• Law of the Government of Valencia 7/2006, dated 9 June, amending the Law of the Government of Valencia 6/1998, dated 22 June, on pharmaceutical management of the Community of Valencia.
  
• Law of the Government of Valencia 4/2005, dated 17 June, on Public Healthcare in the Community of Valencia.
  
• Law of the Government of Valencia 3/2003, dated 14 February, on healthcare management in the Community of Valencia.
  
• Law of the Government of Valencia 1/2003, dated 28 January, on patients’ rights and information in the Community of Valencia.
  
• Decree of the Council 25/2005, dated 4 February, by which the regulating statutes of the Health Agency of Valencia were approved (amended by Decree of the Council 164/2005).
  
• Council Decree 149/2009, dated 25 September, regulating the Healthcare Assistance Agreement for private patients.
  
• Order of 27 September 2007 of the Healthcare Department regulating the complains, suggestions and thanks within healthcare institutions of the Health Agency of Valencia and the Healthcare Department.
  
• Resolution of 30 September 2009 of the Subsecretariat of the Healthcare Department, approving the form for subscription to the Healthcare Assistance Agreement for private patients with the Government of Valencia and the Mantenimiento de Terceros form for direct debit instructions, as foreseen in Council Decree 149/2009, dated 25 September, regulating the healthcare assistance agreement with private patients.