.:: TURKISH HEALTH LEGISLATION ::.  Acupuncture Regulation;Turkish Ministry of Health, bearing the date of 29 May 1991.* FIRST CHAPTER Aim, Scope and Definitions Aim Section 1: The aim of this regulation is to arrange and regulate the fundamentals and principles of acupuncture treatment with scientific methods, like the other treatment methods, in Turkey. Scope Section 2: This regulation comprises public associations, establishments along with legal and factual persons’ actions in regards to the acupuncture. Legal Basis Section 3: This regulation was prepared by taking the 43rd section of the “Ministry of Health’s Written Decree Having the Force of Law concerning Organizations and Duties” as a basis. Definitions Section 4: The terms which can be read throughout this regulation stand for: Ministry: Ministry of Health Acupuncture: The treatment implemented by stimulating some special points in the body with scientific methods which were/will be found i.e. needle, laser rays (laser acupuncture). Electro-Acupuncture: The treatment which can be carried out by piercing needles in the body and ear in order to stimulate them electrically. Electro-Stimulation Anesthesia (ESA): With the aim of anesthesia and analgesia, piercing needles to the acupuncture points both in the ear and in the body according to a stimulator. Acupuncturist: The doctor, who has been educated on acupuncture, has the ability to apply it and holds a certificate from Ministry. SECOND CHAPTER The Establishment of Higher Acupuncture Commission, Its Duties and Authorities The Establishment of Higher Acupuncture Commission Section 5: In order to decide who and under which circumstances they can treat various diseases and give the necessary education for the acupuncture treatment together with a certificate, an “Higher Acupuncture Commission” is established under the Ministry of Health. The Chair and Members of Higher Commission Section 6: The Undersecretary or his/her deputy charged by him is the Chair of this Higher Commission. Higher Acupuncture Commission consists of; three doctor members who work under the Ministry of Health and proficient in the acupuncture science, 7 members who have done scientific research in the field and of whom will be determined by the Deans of the Medicine Faculties of the universities, 1 member from the Central Council of the Turkish Medicines Association, 6 quota members, of whom will be asked to participate by the Ministry of Health. Moreover, the 1st Legal Undersecretary of the Ministry, the Headmasters of the Basic Health Services and Treatments are the permanent members of this commission. The secretary of the Higher Commission is carried out by the Headquarters of the Treatment Services. The Meeting Procedure of Higher Commission Section 7: Higher Commission comes together at least twice a year (being March and October). Furthermore, the commission can be called to meet with the written proposal of the absolute majority. The Duty Duration of Higher Commission Section 8: The members who are elected to the commission have two years of duty duration. The ones who finish their durations can be elected again. The Meeting Quota and Decision Process of Higher Commission Section 9: Higher Commission starts working with the participation of at least 11 members. For the decision, the absolute majority is required. Under the case of equal votes, the vote of the Chair has taken for two votes. The Duties of Higher Commission Section 10: The Duties of Higher Commission are listed below: a) In order to help to the Ministry in terms of helping the acupuncture to evolve and to be applied in a scientific way takes recommending decisions. b) Examines the certificates (either received from homeland or from abroad) of the applicants and confirms the ones of which are considered appropriate. c) Instructs the acupuncture applicants without certificate and in the end of the course awards the certificates for those. d) Settles the acupuncture instruction places along with their durations and in agreement with that prepares the course. Additionally, establishes the education and the application type. e) Undertakes research which enlightens and guide the acupuncture treatment method. Supports the acupuncture units by every means which are/will be established under the Ministry or universities. f) Determines the indication and contraindication of acupuncture. g) Determines the necessary equipments of the acupuncture treatment places. THIRD CHAPTER Specific Divisions The Authorization of Acupuncture Treatment Application Section 11: Those who are going to implement acupuncture treatment in our country must have to hold a medicine degree according to the law numbered 1219, concerning the Art of Medication and Treatment applications. Dentists can also apply acupuncture treatments in their field on condition that they would obey the decisions of the regulation Additionally, those who are going to apply acupuncture treatment, a) If holding a certificate received abroad must have to be regarded as an appropriate and confirmed by the Higher Commission, b) Have to be successful in the course which is going to be held by Acupuncture Higher Commission, c) They should keep their certificates in the consulting room and should be displayed in the inquiries carried by the authorities of the Ministry of Health Acupuncture Clinics Section 12: In the clinics, policlinics and private hospitals which are established by public associations, establishments along with legal and factual persons, acupuncture treatment can be applied in agreement with the decisions of this regulation by the doctors who hold a certificate. The Characteristics of Acupuncture Clinics and Consulting Rooms Section 13: The establishing of acupuncture clinics, policlinics and consulting rooms are due to the same procedures of the other clinics, policlinics and consulting rooms. Minimum Equipments Which Must be provided by the Acupuncture Treatment Places Section 14: In the acupuncture treatment places, the equipments, which would be determined by the Higher Acupuncture Commission, must be present. Conditions Which Acupuncture Cannot Be Applied Section 15: Under contraindication conditions which will be determined by the Higher Acupuncture Commission, acupuncture cannot be carried out. FOURTH CHAPTER Validity-Accomplishment Validity Section 16: This regulation comes into force once published. Accomplishment Section 17: The decisions of this regulation are carried out by the Minister of Health.   Acupuncture Regulation of the Ministry of Health, bearing the date of 17 September 2002. Regulation concerning the Application of Treatment and Private Health Institutions in Which Acupuncture is Applied.   Official Gazette Date: 17.09.2002; Issue: 24879.   FIRST CHAPTER Aim, Scope and Definitions Aim Section 1: The aim of this regulation is to arrange and regulate the fundamentals and principles of acupuncture treatment with scientific methods along with the establishing of private health institutions applying this treatment in our country, in order to protect the individual and society health. Scope Section 2: This regulation comprise the applicants of acupuncture in public associations and establishments along with private health institutions together with the owners and the actions of the managers’ of those institutions in which this treatment is being applied. Legal Basis Section 3: This regulation was prepared by taking the 43rd section of the Ministry of Health’s Written Decree Having The Force of Law concerning Organizations and Duties, the law numbered 1219, concerning the Art of Medication and Treatment applications and the 9th section and the (c) division of the law numbered 3359 entitled Basic Law of the Health Services as a basis. Definitions Section 4: The terms which can be read throughout this regulation stand for: a) Law: The law numbered 1219, concerning the Art of Medication and Treatment applications, b) Ministry: Ministry of Health, c) Headquarters: Headquarters of Basic Health Services, d) Directorate: City Health Directorate, e) Health Institution: The private institutions or other places which hold a license according to the regulation concerning On-foot Diagnosis and Treatment Applied Private Health Institutions, f) Appropriateness Certificate: The certificate which is designed by the Headquarters for a health institution to function, g) Acupuncture: The treatment implemented by stimulating some special points in the body with scientific methods which were/will be found i.e. needle, laser rays (laser acupuncture). SECOND CHAPTER The Types and Basic Properties of the Health Institutions The Types Section 5: This regulation concern; the health institutions, their activity fields, service and infrastructure properties along with the units, centrals and consulting rooms established according to the health crew specialties’. Acupuncture Units: Section 6: The acupuncture treatments carried out in private hospitals which were granted certificate in agreement with the regulation of the private hospitals, and other private institutions which hold a license according to the regulation concerning On-foot Diagnosis and Treatment Applied Private Health Institutions are regarded as a sub-branch and a unit of this health institution on which the institute functions. Acupuncture Centers: Section 7: According to the regulation concerning On-foot Diagnosis and Treatment Applied Private Health Institutions, acupuncture treatment together with their centers has been accepted as a specific field. Consulting Rooms Section 8: Consulting rooms are the private health institutions which the doctors establishing in order to perform their arts and if the acupuncture treatment is undertaken in this institution, it is evaluated under the consulting room. People Who Have the Authority to Establish and Run Health Institution Section 9: The health institutions mentioned in the 6th and 7th sections of this regulation can be established and managed by the doctors who have to authority to perform their arts and work as a freelancer together with the civil servants of the government along with the doctors who have the public employee statute according to the regulations concerning; On-foot Diagnosis and Treatment Applied Private Health Institutions bearing the date of 09/03/2000 and number 23988, and Compensation and Working Principles of the Health Staff numbered 2368. THIRD CHAPTER Application and Establishing Permission Procedure Documents Necessary for Application Section 10: Those who are going to carry out acupuncture treatment under the Ministry of Health apply to the Headquarters either with a petition or personally. The documents and information which should be attached to the petition are listed below: a) The certificate which was awarded according to the regulation concerning On-foot Diagnosis and Treatment Applied Private Health Institutions or hospital license granted according to the law decisions regarding the private hospitals, b) In the consulting room principle of the health institution, an architectural plan sample, showing all the places according to their functions, drawn with at least scale of 1/100 and plan sample approved as “plan is appropriate for the local” by the doctor of the health organization of the responsible area, c) The minimum medicine equipments which are going to be used and have to be available in the health institution together with equipment and medicine list prepared in the light of the medicine lists signed and approved by the director of the health organization of the responsible area personally, d) The sample of the diplomas or proficiency certificates (if available) which are arranged by the Ministry, and confirmed by the notary of the doctors who are going to implement acupuncture treatment in the health institution together with two passport photos, e) The sample document or a photocopy of the identity card proving that the doctors who are going to implement acupuncture treatment in the health institution are registered in the area medicine association, f) The petitions of the doctors (who are going to implement acupuncture treatment in the health institution) which declare that they are either working or not in the public association, and a document which confirms that the compensations which are going to be received will be available once the permission is received and will be cut off from their salaries according to the regulation of Compensation and Working Principles of the Health Staff numbered 2368, for the ones who work in a public association, g) The sample diplomas which are going to be approved by the Headquarters of the crew who are not doctors together with two passport photos, The certificate which can be read in the (a) division of this regulation does not concern those who are going to establish a consulting room or a centre. Those who are going to establish a consulting room are also due to the decisions of On-foot Diagnosis and Treatment Applied Private Health Institutions. According to this, all conditions are fulfilled when establishing a special field center and the related documents are attached (two copies) to the application file. The Assignment of the Application and Conditions When Re-Application is Required Section 11: First of all, the application which has been done in agreement to the 10th section of this regulation is examined in the file. The application file is inspected by the Headquarters in 15 day (following the application day) and in the presence of any lacks these are consulted to the ones who want to establish the health institution. If there is no deficiency in the application file, the crew charged by the Headquarters examines the health institution personally. As a result of this examination, Appropriateness Certificate (which can be found in Attachment-1) is prepared by the Headquarters who have the sufficient requirements. In addition to that, two copies of the Personal Working License (which can be found in Attachment-2) are prepared on the behalf of the doctor who is going to apply the acupuncture treatment. Those certificates and a sample of the application file is restored in the Headquarters and the other copies are given to the concerning one with signature. The evaluation in the establishments of the centers is carried out together with the decisions of On-foot Diagnosis and Treatment Applied Private Health Institutions regulation. As a consequence of the evaluation which is going to be carried out according to the decisions of the regulation of On-foot Diagnosis and Treatment Applied Private Health Institutions and regulation concerning the Application of Treatment and Private Health Institutions in Which Acupuncture is Applied, the relating documents are prepared together. If the address of the institution is changed the application procedure has to be undertaken again with the documents mentioned in the 10th section by the ones who establish and manage a health institution within the scope of this regulation. FOURTH CHAPTER Establishment Infrastructure Standards Minimum Obligatory Units of the Centers and Unities Section 12: In addition to the obligatory (according to the related regulations) divisions of places which are going to function in terms of unity and centers another examining room (minimum 10 square meter surface area) which include the minimum medical equipments and supplies. In the room; on the door signboard which indicate that the room is the acupuncture examining room and on the wall original copy of the “Certificate of Acupuncture Treatment Application” (granted by the Ministry) is hanged. Minimum Obligatory Units of the Consulting Rooms Section 13: In the consulting rooms, below mentioned units are provided: a) Patient waiting room: A separate place which has minimum 20 square meter surface area, designed appropriate for patient use and comprises patient admission and recording employee, b) Consulting room: A separate room which has minimum 6 square meter surface area, and comprises minimum medical equipments and supplies, c) Acupuncture treatment room: A separate room which has minimum 10 square meter surface area and comprises minimum medical equipments and supplies, d) Achieve unit and a place or a room (for this unit) isolated from the patients and their relatives. In consulting and waiting rooms; the original copy of the appropriateness certificate, working certificates of the whole health crew, patient rights signboard are hanged up to a place where can be read by the patients and their relatives comfortably. Furthermore, a price list concerning the treatment, examination and scrutiny prices, in case asked by the patients and their relatives, is provided. On the door of the consulting room a signboard on which the name (and if possible, the field of specialty) of the doctor is written and on the wall, the diploma (and if possible, the certificate concerning the field of specialty) of the doctor who works in that consulting room must be hanged to a place where can be read by the patients easily. On the wall of the acupuncture treatment room, the original copy of the “Certificate of Acupuncture Treatment Application” (granted by the Ministry) is provided and in this room, only acupuncture treatment is applied. In order to apply another type of medicine treatment to the patient (other than acupuncture) or to observe him/her, there should be provided another treatment room appropriate for those. Medical Equipment, Supplies and Medicines: Section 14: According to the circular which is going to be published by the Ministry, in health institutions, minimum medical equipment, supplies and medicines should be provided. Eradication of the Remains Section 15: It is obligatory to eradicate and send away from the health institution, the expenditure supplies and remains which were used (and as a matter of fact, cannot be used again) in the treatment and diagnosis services, in a way which would not threat the society and environment health according to the regulation concerning the issue. The remains collector containers should be provided in an isolated place from the patients and their relatives. Outer Signboard Section 16: The arrangements in the regulations related to the unities are basis and they can declare that, their acupuncture treatment is in agreement with these regulations and they cannot use any other signboard other than that of acupuncture treatment. In terms of the signboards for centers, however, following the indication “Private” the name of the health institution and following that name the title “Acupuncture Centre” in agreement with the decisions of the regulation and granted by the Headquarters) is written. The consulting rooms, on the other hand, can use outer signboards according to the principles determined in the Medicine Deontology Regulations. FIFTH CHAPTER Acupuncture Scientific Commission The Establishment of the Acupuncture Scientific Commission Section 17: In order to declare an opinion relating to the doctors (whom and which diseases that they are going to treat and under which circumstances they are going to take those actions, their instruction together with the necessary theoretical and practical curriculum and granting of the certificate and evaluation of the given certificates) who are going to undertake acupuncture treatment, “Acupuncture Scientific Commission” is established by the Ministry. This commission consists of: a) 5 members which are going to be elected between, either lecturers who have done scientific research on acupuncture, or specialists who have undertaken scientific research regarding this field in Ministry education hospitals, b) Two doctors who hold an acupuncture certificate and work as a freelancer, c) Ministry, Basic Health Services General Director or assistant, Treatment Services General Director or assistant and Ministry’s First Law Consultant. The scientific commission is formed by the Headquarters’ proposal and confirmation of the Minister. Those who are selected, service for three years. It is possible to be selected again. In the case of dismission from the commission, a new one is elected according to the same procedure. The Working Procedure of Acupuncture Scientific Commission Section 18: Higher Commission comes together under the chairmanship of the General Director of the Basic Health Services at least twice a year (being March and October) by the call of the Ministry. The Ministry can also call the Commission to meet in case of extraordinary conditions. a) Meeting agenda is organized according to the proposals of the Commission Chair or Commission members by the Headquarters and members are informed with a written note about the meeting invitation and the agenda by the Headquarters. b) Commission meets with the participation of at least six members and decides with the absolute majority. In case of equality in votes, the opinion in which the Chair is in support of is regarded valid, c) Headquarters run the secretary services of the Commission, d) Commission examines the agenda and prepares its report, The Duties of Acupuncture Scientific Commission Section 19: Acupuncture Scientific Commission takes recommending decisions in order for acupuncture to evolve and to be applied as a scientific way on the issues mentioned below: a) Examines the certificates (either received from homeland or from abroad) of the people who wish to apply acupuncture treatment in our country and prepares the evaluation reports, b) Gives opinion to the Ministry concerning acupuncture education principles, c) Determines the indications and contraindications of the acupuncture treatment, d) Undertakes guiding, enlightening research in regards to the acupuncture treatment, e) In case of necessity by the Ministry, carries out the necessary work in scientific and technical issues, f) Gives opinion to the Ministry with regards to the necessary medical equipments, supplies, crew and places provided. The Authorization of Acupuncture Treatment Application Section 20: Those who are going to implement acupuncture treatment must have to hold a Medicine degree according to the law and posses the “Certificate of Acupuncture Treatment Application” approved by the Ministry. In the instruction courses established by the permission of the Ministry or those who document that they have studied abroad and have confirmed their studies by the Ministry, can be evaluated by a jury consisting of Scientific Commission members, if necessary and certificate of acupuncture treatment application is prepared for those who are regarded sufficient. Moreover, those who have studied abroad must have to document their knowledge (sufficient enough to follow the education) of foreign language. Acupuncture Treatment in Places Pertaining to Public Associations and Establishments Section 21: Places pertaining to public associations and establishments have the authority to undertake acupuncture treatment once provided the necessary conditions mentioned in the 20th section of this Regulation. Aimed at the application of acupuncture treatment with scientific methods, places pertaining to public associations and establishments have to obey the directions of the Ministry, based on the recommending decisions taken by the scientific commission according to the 19th section of this Regulation. Public associations and establishments, and places pertaining to those are not dependent on the other rules of this Regulation. SIXTH CHAPTER Registration and Announcement System Registration Section 22: Every patient who applies to the health institution is registered in the protocol notebook. Every doctor uses the prescription of his/her own, however, in the centers and unities uses the name of the health institution mentioned in the regulation and puts his own signature and cachet on the prescription. In the consulting rooms, on the other hand, prescription arranged on the behalf of the doctor is used. Even if the procedure (correspondence, registration, and etc) is realized in a computer system in the health institution, still the record system must be provided according to the Regulation. Protocol Registration Notebook Section 23: Protocol Registration Notebook is a notebook confirmed by the Headquarters in order to be used to record the identity information of the patients and medical processes. Every patient who applies is recorded in this notebook. Moreover, the reposing reports given to the patients are recorded in this notebook by the doctor who gives the record. Inspection and Inquiry Notebook Section 24: Two numbers of inspection and inquiry notebooks are provided in order to record the results of the extra and the extraordinary inquiries which are going to be undertaken by the Ministry or the Headquarters in the health institution. SEVENTH CHAPTER Various Concluding Rules Inquiry Section 25: Health institutions are inquired by the groups which are constituted by the Headquarters. Except for the extraordinary inquiries which are going to be undertaken as a request of Ministry central organization or Headquarters, complaint and investigation, ordinary inquiries are done at every four months. In the inquiries, the inquiry form which can be found in Attachment-3 is used. The findings and results concerning the inquiry are recorded in inspection and inquiry notebook of the Headquarters. Inquiries are carried out by minimum two health crew members of whom one has to be a doctor. Ordinary inquiries are undertaken between regular periods. For the deficiencies which would be determined in these inquiries, designated periods are given to quench the needs in the inquiry from. Health institution which cannot satisfy the needs in the provided period is charged with acupuncture treatment detaining within the period provided for quenching the needs in the inquiry form. In this sense, in case of health institutions charged with temporary detaining should satisfy the needs and in terms of health institutions charged with permanent detaining should satisfy the needs in three months, otherwise the appropriateness certificate of the health institution becomes invalid and taken back. In the cases when many deficiencies are observed in the inquiry form, the time which is going to be provided to quench the needs or the treatment detaining period in case of not satisfying the needs the longest duration is applied in the inquiries. The Responsibilities of the General Directors Section 26: The responsibilities of the general directors concerning the establishment, functioning, inquiries, and on other issues of health institutions are listed below: a) Undertaking of the inspections and examination of the health institutions and consulting rooms which apply to receive appropriateness certificate personally, and as a consequence of the examination, grant certificate for the ones who are regarded appropriate in terms of this Regulation, b) Inquiring the health institutions and consulting rooms within the periods mentioned in the regulation with crews ordinarily and extraordinarily, c) Taking the necessary actions for the health institutions and consulting rooms which does not obey the determined principles of this Regulation, d) Sending the inventory form pertaining to the health institutions to the Ministry in January, April, July and September every year, e) Undertaking the other duties given by the Ministry. Prohibitions Section 27: Health institutions, consulting rooms and people which this Regulation comprises must obey the rules of the Regulation, and mind the points mentioned below: a) Without having the appropriateness certificate, cannot be functioned, b) In this health institutions, no other staff can be employed other than the doctors and the health crew who posses personnel working certificate, c) Any type of advertising out of the scope and prices of the health institution is prohibited, d) Doctor or non-doctor personnel whom do not posses personnel working certificate arranged by the Headquarters cannot be employed in the health institution, e) The doctors who do not posses Acupuncture Treatment Application Certificate cannot apply acupuncture treatment in health institutions, f) Under the contraindication circumstances which are going to be determined by the acupuncture scientific commission, acupuncture cannot be undertaken. Advertisement, Promotion and Information Section 28: Health institutions cannot work in a commercial method and therefore cannot manipulate people in a panic driven way and cannot make competitions between the similar establishments and their employees. On the other hand, they can prepare education material in terms of improvement and protection of health, the medical problems of the field in which the health institution functions, and the side-effects of the health problems on the individual and protection or reduction from those problems just for the use of the patients who apply to the health institution. Health institutions and their employees must have to follow the terms described above and must to get the permission of the Headquarters for any advertisement, promotion and information activities. Sanctions Section 29: The sanctions are applied according to the rules of this Regulation for those who do not follow the principles and fundamentals of this Regulation and this are due to the general rules in terms of penal and law responsibilities. Conditions which do not Comprise Rule and Additional Arrangements Section 30: Minimum equipments, medical supplies, the quality and amount of the health crew which is going to be present in the health institution and every type of recording notebook, forms, announcements and other issues mentioned in this Regulation will be arranged by the circular of the Ministry which is going to be announced after the publication of this Regulation. Rules Abrogated Section 31: The Acupuncture Treatment Regulation, bearing the date of 29 May 1991 and which was published in Official Gazette’s 20885th issue is abrogated. Temporary Section 1: For those who posses confirmed certificates by the Ministry prior to the validity of the regulation, is obligatory to apply to the Ministry in order to get a “Acupuncture Treatment Application Certificate” so that they can undertake acupuncture treatment, other certificates which can be obtained in other ways are not valid. Temporary Section 2: The health institutions which are under the scope of this Regulation and started to function prior to the validity of this Regulation, must decide under which conditions in terms of the Regulation (paying attention to the rules in regards to the minimum medical supplies, equipments, personnel, divisions and units) they are going to function and submit their request for appropriateness certificate to the Headquarters. As a result of the application (not including the surface area and related rules) basic documents are granted to those who are regarded appropriate to function and for those who have deficiencies are given six months period in order for them to satisfy the needs and this is declared in a written form to them. For the health institutions which cannot fulfill the needs in six months are granted an extra period of three months for once. And if still, a health institution cannot satisfy the needs at the end of the period is banned from functioning by the Governorship. Validity Section 32: This regulation comes into force once published. Accomplishment Section 33: The decisions of this regulation are carried out by the Minister of Health. * This regulation was published in Offical Gazette in 29.05.1991, Issue: 20885, (pp.3-5).