Chapter I: Tasks of healthcare institutions.

I.- Local hospitals are public or private healthcare establishments, or identified sites within these establishments. They provide the first level of the gradation of hospital care and refer patients who need it, in accordance with the principle of appropriate care, to referral and reference healthcare establishments or to other structures adapted to their needs. The tasks of local hospitals are carried out with the joint participation of outpatient medical structures and professionals with whom they share territorial responsibility.

II. -Taking into account the health projects of territorial professional health communities and in cooperation with outpatient medical structures and professionals, medico-social establishments and services and other health establishments and players, including home hospital care establishments, local hospitals :

1° Provide support to ambulatory healthcare professionals and other healthcare providers to meet the needs of the population, in particular the hospital framework required for these providers to continue caring for their patients when their condition so requires;

2° Promote the care of people in vulnerable situations and help them to remain in their place of residence, in liaison with the attending physician;

3° Participate in prevention and in the implementation of health promotion initiatives in the region;

4° Contribute, depending on what is available in the region, to the continuity of care and the continuity of treatment, in conjunction with outpatient medical structures and professionals.

III.In order to carry out the tasks defined in I and II, under conditions that guarantee the quality and safety of care, local hospitals are required to carry out a medical activity, which may include technical procedures, offer consultations in several specialities, in addition to the private sector services available in the area, have or provide access to technical imaging and medical biology facilities and telehealth equipment, and do not carry out surgery or obstetrics.

By way of derogation and under conditions laid down by decree in the Conseil d'Etat, in order to promote access to care and in the light of the needs of the population and the services available in the area concerned, a local hospital may, by decision of the Director General of the Regional Health Agency, perform certain scheduled surgical procedures. The Minister for Health will issue a decree setting out the limitative list of procedures that may be included in these derogations, after receiving the assent of the Haute Autorité de santé.

Depending on the needs of the population and the range of healthcare services available in the areas in which they are located, community hospitals carry out other activities, in particular emergency medicine, antenatal and postnatal activities, follow-up and rehabilitation care and palliative care activities, and may provide their expertise to other players through mobile teams.

IV. -The list of local hospitals is drawn up for each region by the Director General of the Regional Health Agency, taking into account the activity of the establishment or site mentioned in I and its capacity to carry out the tasks set out in I, II and III.

Inclusion on the list of local hospitals is subject to a prior application by the candidate establishment or the health establishment to which the candidate site belongs. The decision of the Director General of the Regional Health Agency is notified to the applicant within six months of receipt of the application. If no response is received within this period, the application for authorisation will be rejected. In this case, and if the applicant so requests within a period of two months, the reasons justifying the rejection are notified within a period of one month. The time limit for appealing against the rejection decision runs from the date of notification.

V.-A decree in the Conseil d'Etat defines the conditions for application of this article. In particular, it shall determine the conditions under which unincorporated health establishments and sites of such establishments may be included on the list of local hospitals and the procedures for submitting and examining applications for inclusion on and removal from the list.