Transparent Administration

MultiMedica S.p.A. has adopted an Organization, Management, and Control Model (OMCM) and a Code of Conduct (CC), two crucial tools for promoting a corporate culture based on ethics, transparency, and compliance with the law.

• The Organizational Model is a structured system of principles and procedures aimed at preventing the offenses outlined in Legislative Decree 231/2001.
• The Code of Conduct, an integral part of the Organizational Model pursuant to Legislative Decree 231/2001, sets out the general standards of behavior that all individuals interacting with the Company must follow, promoting responsible conduct aligned with the values of integrity and fairness.

Both documents are accessible on our website, as a proof of our commitment to transparency and accountability, and ensuring that all company activities are conducted in full compliance with applicable regulations and ethical principles.

Organization Model 231 – General Section

Code of Conduct

The Company has designated the General, Legal & Compliance Affairs Office as the corporate contact for fulfilling the publication obligations pursuant to Legislative Decree No. 33 of 14/03/2013 and subsequent amendments, Law No. 24 of 08/03/2017 and subsequent amendments, and Law No. 124 of 04/08/2017 and subsequent amendments, applicable to the Hospital Facilities of the MultiMedica Group.

For information on the prevention of corruption and transparency: affarigeneralilegali@multimedica.it 

Certification of compliance with data publication obligations – ANAC Resolution No. 203/2023 

DOWNLOAD THE 2025 MONITORING GRID

DOWNLOAD THE 2025 CERTIFICATION DOCUMENT

Download the 2024 monitoring grid and certification document

Download the 2023 monitoring grid and certification document

DOWNLOAD THE 2022 MONITORING GRID

DOWNLOAD THE 2022 CERTIFICATION DOCUMENT

DOWNLOAD THE 2020 MONITORING GRID

DOWNLOAD THE 2020 CERTIFICATION DOCUMENT

DOWNLOAD THE 2019 MONITORING GRID

DOWNLOAD THE 2019 CERTIFICATION DOCUMENT

Download the 2022 Monitoring Summary Sheet

Download the 2020 Monitoring Summary Sheet

Download the 2019 Monitoring Summary Sheet

In accordance with the obligations set forth in Article 1, paragraphs 125–129, the relevant information is included in the financial statements already published in the dedicated section, to which full reference is made.

On April 1, 2017, Law No. 24/2017 — known as the Gelli-Bianco Law — came into effect. It addresses patient safety and the liability of healthcare professionals. The law requires healthcare facilities to publish:

• An annual report (Law 24/2017, Art. 4, para. 3) providing data on compensation paid over the past five years, as part of the monitoring of the prevention and management of healthcare risk;    
  Download the 2020/2024 document
• An annual report on adverse events occurring within the facility, including the underlying causes and the corrective actions implemented thereafter. (Law 24/2017, art. 2, para. 5).  
  Download the 2022 document
  Download the 2023 document
  Download the 2024 document

MultiMedica S.p.A., in compliance with Article 10 of Law 24/2017, declares that it has adopted and effectively implemented “similar measures” for the coverage of civil liability towards third parties for healthcare professionals operating within its facilities.

Section being updated

Download the 2024 Annual Report

Download the 2023 Annual Report

Download the 2022 Annual Report

Download the 2021 Annual Report

Download the 2020 Annual Report

Download the 2019 Annual Report

Acts of granting, subsidies, contributions, and the allocation of economic benefits to individuals and public or private entities (Articles 26 and 27 of Legislative Decree No. 33/2013).

There are no documents to publish.

The Charter of Services is intended to briefly present our facility, assisting citizens in understanding and making our services more accessible and understandable.
Download here the Charter of Services and Q>uality Standards of our facilities:

• IRCCS MultiMedica

• Ospedale San Giuseppe

• Ospedale MultiMedica Castellanza

• Ospedale MultiMedica Limbiate

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  Quality Standards of our facilities

5 x 1000 Financial Year: 2020

Project Title: Molecular identification in individuals at cardiovascular risk during aging and as a consequence of COVID-19.

Total 5 x 1000 allocation: 38,041.68
Project Start date: 01/01/2022
Project End date: 31/12/2022

Project Summary – Abstract:

Based on the results achieved in the 2018-2019 financial years, we intend to continue a study on early markers of cardiovascular damage in elderly individuals, with particular focus to the role of frailty and COVID-19 in susceptibility to adverse cardiovascular events.

Frailty is a syndrome affecting approximately 20% of the elderly population, in which musculoskeletal and cognitive decline is associated with an increased risk of cardiovascular disease and mortality. The characterization of this syndrome and the identification of early markers of its onset and progression are of crucial importance for the clinical management of the elderly population, particularly during the COVID-19 health emergency. Indeed, COVID-19 affects older adults more frequently and, although the primary clinical manifestations involve the respiratory system, the implications for the cardiovascular system occur at various levels, with both acute and chronic harmful consequences.

At IRCCS MultiMedica, clinical research data (frailty index, lung capacity, and cardiac function) and basic research data (abundance of CD34+ cardiovascular regenerative cells and their gene profile) were collected from 35 pre-frail subjects over the age of 65. Even at early stages of frailty, alterations in cardiac and respiratory function have been observed, as well as a pro-inflammatory shift in CD34+ cells expressing high levels of the alarmins S100A8 and S100A9, two proteins with negative effects on the heart. Furthermore, an association has been identified between the inflammatory profile (cytokines and cells) in circulation and parameters of diastolic dysfunction. In collaboration with the University of Padua, the levels of CD34+ cells and alarmins were studied in a cohort of more frail subjects, demonstrating an association with the risk of adverse cardiovascular events (MACE). These results have been published in the journal Aging Cell (Bonora & Spinetti, Hematopoietic progenitor cell liabilities and alarmins S100A8/A9–related inflammaging associate with frailty and predict poor cardiovascular outcomes in older adults).

Furthermore, in order to assess the risk of cardiovascular damage associated with COVID-19, a biobank of biological material (peripheral blood) from patients hospitalized at the MultiMedica hospital was established (protocol approved by the MultiMedica Ethics Committee, code: CE-111-2020, entitled COVID-19: Creation of a biobank to study circulating predictors of disease progression. CANADA Study).

The current objectives are as follows:
1) To confirm inflammatory markers of risk for cardiovascular events in frail elderly individuals by enrolling a new cohort of subjects, on whom an in-depth in vitro analysis of the molecular mechanisms of interaction between circulating hematopoietic/inflammatory cells and vascular cells will also be conducted;
2) Conduct a study to identify molecular markers of severe progression and cardiovascular damage from COVID-19 through follow-up of subjects for whom a biobank was established in previous years (protocol CE-80-200271, title: Identification of Circulating Indicators of Severe Progression and Cardiovascular Damage in Patients Affected by COVID-19 – TORONTO Study).

Date of receipt of 5 x 1000 funds: 10/21/2021

Budget

 Status updated as of July 2022

Project Title:

Project Title: “MATISSE—A Model of Artificial Organ of the Human Bone Marrow Vasculature”

Total 5 x 1000 allocation: €35,900.39
Project Start date: 01/01/2023
Project End date: 31/12/2023

Project Summary – Abstract:
The identification of the molecular mechanisms regulating cellular function could lead to the development of innovative therapies. In this context, the study of the interaction between cells of the cardiovascular system (both mature and progenitor) and the immune system is of fundamental importance in order to prevent and counteract the progression of cardiovascular diseases.
Central regulation of vascular homeostasis is exercised by the bone marrow, the primary source of leukocyte cells that provide protective action for the cardiovascular system. The bone marrow is the principal organ responsible for the synthesis of hematopoietic stem cells, which enable the continuous renewal of erythrocytes and leukocytes (granulocytes, monocytes, and lymphocytes) present in the blood, and also give rise to mononuclear cells specialized in reparative angiogenesis. The evidence collected through the study of altered mechanisms in cardiometabolic diseases has led us to hypothesize that functional deterioration of the bone marrow represents one of the main mechanisms responsible for the disease, through the dysfunction of the regenerative cells it contains.

Such deterioration may have consequences for peripheral organs, with impairment of the cardiovascular system even at early stages of geriatric frailty. To date, there are no available in vitro experimental models suitable for the cellular and molecular characterization of alterations in the bone marrow niche, and in particular of the vasculature, using primary human endothelial cells from bone marrow.
This project therefore aims to further investigate the mechanisms of crosstalk between hematopoietic/inflammatory cells and human bone marrow vascular cells (endothelial cells and pericytes), utilizing innovative in vitro models of functional interaction.

A model of artificial organ composed of primary human bone marrow vascular cells is currently under development in the laboratories of the project’s external collaborator, Dr. Camilla Cerutti at IEO, whose main research interest is the study of bone marrow metastases. The aim is therefore to combine the expertise of researchers at IRCCS MultiMedica with that of IEO to develop and test a new artificial organ model of human bone marrow vasculature.
In particular, models of cell co-culture in 2D and 3D will be developed. At MultiMedica, endothelial cells and pericytes from human bone marrow will be isolated and characterized; these cells will then be cultured at IEO on dedicated microfluidic supports (chips) in 2D and 3D, with the application of a controlled flow containing circulating cells to mimic the physiological conditions of human bone marrow. Upon completion of an initial phase of collection and characterization of vascular cells from the bone marrow, these cells will be analyzed and characterized within the in vitro artificial organ model in co-culture with circulating cells.

Initially, with funding provided by Dr. Cerutti, leukemic and breast cancer cells will be analyzed. These analyses will enable us to assess the bone marrow capillary network within the context of disease (tumor metastasis), which will serve as our prototype for subsequently transferring the acquired information to the non-oncological field for the study of aging and frailty.

Subsequently, we will examine the interaction between the bone marrow vasculature and progenitor or mature immune system cells with a protective function for the cardiovascular system. In addition to the functional aspects of circulating and vascular cells studied in the in vitro organ model—such as proliferation, adhesion, and migration—the molecular mechanisms involved in cellular interaction will also be analyzed.

Date of receipt of 5 x 1000 funds: 22/09/2022

Budget

 Status updates as of July 2023

Project Title:

Development of a 3D in vitro model of bone marrow vasculature for the study of cellular and molecular determinants shared by cardiovascular and neoplastic diseases

Total 5 x thousand allocation: 36,918.44 €
Project Start: 01/01/2024
Project End: 31/12/2024

Project Summary – Abstract:

Among chronic-degenerative diseases, cardiovascular and oncological diseases represent the leading cause of mortality. Although considered separate nosological entities, with distinct preventive, diagnostic, and therapeutic pathways, a strong connection between the two has emerged over the past decade. Indeed, on the one hand, antitumor treatments are associated with the development of cardiovascular diseases, which cardio-oncology seeks to investigate in terms of causes and consequences, in order to develop targeted preventive approaches. Conversely, patients with cardiovascular diseases have a higher risk of developing tumors compared to the general population, a topic addressed by the emerging field of ‘reverse cardio-oncology.’ It is important to note that cardiovascular and oncological diseases not only share risk factors such as obesity, diabetes mellitus, alcoholism, and smoking, but also multiple molecular mechanisms. In light of this evidence, the Scientific Directorate of IRCCS MultiMedica has decided to allocate the relevant 5×1000 donation funds to conduct new translational, clinical, and population studies aimed at understanding the mechanisms underlying this association. The capacity of IRCCS MultiMedica to operate actively in both clinical and translational research in the cardiovascular and oncological fields will enable the development of innovative strategies, based on the results of these studies, that can improve the primary prevention of both diseases, refine early diagnostic mechanisms, and identify new and precise therapeutic pathways.

Among the mechanisms shared by cardiovascular diseases and neoplastic conditions, the understanding of the biological processes that regulate cell trafficking in the bone marrow is of great interest. In particular, it is essential to understand the determinants of the release from the bone marrow of circulating CD34⁺ progenitor cells, which are protective for the cardiovascular system (a process altered in both diabetes and atherosclerotic disease, known as mobilopathy), as well as the entry of tumor cells (bone marrow metastasis), in order to guide shared precision therapies.

Sophisticated in vitro systems composed of human cells cultured in a physiologically similar environment represent a recent tool that offers a valid alternative to the variability observed with traditional animal models. In this project, we therefore intend to develop a 3D model of human bone marrow in vitro for the study of cell migration through the bone marrow vasculature. To this end, patients with atherosclerotic disease, with or without diabetes, as well as controls, will be enrolled. Bone marrow samples will be collected from waste material obtained during hip prosthesis surgery and/or from peripheral blood. In the first phase of the project, vascular cells (pericytes) and CD34⁺ cells collected from controls, together with commercial tumor cells, will be used to optimize the migration model in vitro. In parallel, using a single-cell sequencing approach, the gene expression profile of CD34⁺ cells associated with the disease will be assessed to identify molecular targets for intervention with targeted therapies. Subsequently, various compounds or drugs known for their ability to promote or inhibit the migration of CD34⁺ and tumor cells, respectively, will be tested in the new model.

In conclusion, this project will primarily enable the identification of new disease biomarkers and targets for innovative therapies. Furthermore, it will lead to the development of an innovative model useful for studying the mechanisms of tumor metastasis and diabetic mobilopathy, thereby enabling the development of effective and personalized therapies.

Date of receipt of 5 x 1000 funds: 22/09/2023

Budget

 Status updated as of July 2024

Project Title:

V.I.T.A.S. – Evaluation of Immunotherapy Toxicity Associated with Statins

Total 5×1000 allocation: 37.304,66 €
Project start date: 01/01/2025
Project end date: 31/12/2025

Project Summary – Abstract:

Despite numerous clinical and epidemiological studies, the effectiveness of statins in cancer prevention remains controversial. A 2008 analysis in post–myocardial infarction patients suggested a potential antitumor effect of lipophilic statins, such as simvastatin, due to the inhibition of neoangiogenesis, i.e., the formation of new blood vessels that nourish tumors. Subsequently, other studies have investigated how metabolism influences cancer and the immune system. It has emerged that metabolic changes, caused by drugs or genetic modifications, can:

1. reactivate the immune system against cancer, particularly by acting on cells within the tumor microenvironment;

2. enhance the efficacy of certain immunotherapeutic drugs, helping the immune system to better recognize and combat cancer, thereby improving patient survival.

Simvastatin, in particular, may enhance the activity of immune checkpoint inhibitors (CPI), improving recognition and elimination of tumor cells by immune cell populations. Furthermore, cancer and cardiovascular diseases share common mechanisms, such as immune, metabolic, and vascular alterations; moreover, cancer therapies themselves can cause cardiovascular toxicity.

Our study aims, on one hand, to evaluate the effectiveness of combining simvastatin with CPIs (specifically anti–PD-1) against tumors, and on the other, to assess whether this combination may induce potential toxic effects on the cardiovascular system. We will focus on two tumor types in which immunotherapy has shown very promising results: melanoma (a highly aggressive skin cancer) and lung cancer.

In vitro models will be generated to study both the antitumor effects of the simvastatin + anti–PD-1 combination and, at the same time, its impact on endothelial cells and cardiomyocytes, which represent the main “healthy” cells potentially at risk of damage from the combination under investigation.

Melanoma and/or lung cancer cell lines will be cultured in the laboratory together with commercial lines of human monocytes/macrophages and Natural Killer (NK) cells, i.e., effector cells of our immune system, to test the effects of immunotherapy with and without simvastatin. We will assess whether simvastatin stimulates activation of immune cells and the production of inflammatory and cytotoxic cytokines, in order to identify a possible mechanism that enhances the efficacy of immunotherapy.

We will also evaluate whether the proposed combination can trigger excessive and uncontrolled activation of the immune system, as a potential cause of cardiovascular damage mechanisms. To address this critical issue, conditioned media collected from the co-culture systems will be used to treat, in vitro, human endothelial cells (HUVECs), human cardiomyocytes, and/or human cardiac fibroblasts. Induction of cardiovascular toxicity will be assessed through assays of cell proliferation, activation of molecular pathways associated with endothelial and cardiac damage, using qPCR, flow cytometry, secretome analysis, and western blotting.

Based on the results obtained from the in vitro models described above, and subject to the availability of clinical samples, we will perform an experimental validation using a cohort of melanoma patients before and after receiving anti–PD-1 therapy. For these experiments, sera from these patients will be tested on cardiomyocyte, endothelial cell, and PBMC cultures, which will be analyzed using the same experimental approaches described for the in vitro models above. Patient sera will also be analyzed to assess the presence of circulating biomarkers of cardiotoxicity induced by immunotherapy, through biochemical assays.

Date of receipt of 5 x 1000 funds: 01/10/2024

Budget

 Status updated as of July 2025

There are currently no ongoing class actions

Download the 2018–2022 Report of Accounted Costs

Download the 2022-2023 Report of Accounted Costs

Download the 2023-2024 Report of Accounted Costs

The tables show the waiting times for services monitored by the Lombardy Region:

• IRCCS MultiMedica

• San Giuseppe Hospital

• MultiMedica Castellanza Hospital

• MultiMedica Limbiate Hospital

• MultiMedica San Barnaba Outpatient Clinic

Criteria for the creation of waiting lists and measures for their containment

For further details and additional information, you may visit the page on the MultiMedica website dedicated to Lists with Waiting Times and consult the institutional portals, specifically:

• the Lombardy Region website, where the Regional Plan for the Management of Waiting Lists (PRGLA) is available among the documents in PDF format
• the websites of ATS Milano, ATS Insubria and ATS Brianza, where the Corporate Implementation Plans (PAA) are available among the documents in PDF format

To book an outpatient service through the National Health Service, you may use the MultiMedica booking services or the booking services of the Lombardy Region.

Reporting Time Table: Pathological Anatomy

The right to ‘simple’ civic access (as provided by Article 5, paragraph 1 of Legislative Decree 33/2013) allows citizens to request data, documents, and information held by public administrations or public service concessionaires, for which publication in the ‘Transparent Administration’ section is required but has been omitted. Accredited healthcare facilities and those under contract with the Health Service are subject to the right of civic access solely with regard to data, documents, and information relating to the provision of healthcare services.

Download the form for ‘Simple Civic Access’

The right to “general” civic access, as established by Article 5, paragraph 2 of Legislative Decree 33/2013, grants every citizen the right to access data, documents, and information held by public administrations or public service concessionaires beyond those already subject to mandatory publication. This right is exercised in compliance with limitations related to the protection of legally relevant public and private interests, as outlined in Article 5-bis of the same decree.

Download the form for ‘General Civic Access’

Below are the contact details of the office to which the request should be addressed:

• Phone: 02/8599.4020 – dal lunedì al venerdì dalle ore 8:30 alle ore 13 e dalle ore 14 alle ore 15:30
• E-mail: urp.sg@multimedica.it

In the event of a delay or lack of response, the substitute authority is the General Management:

• Phone: 02/554061
• E-mail: direzione.generale@multimedica.it

For further information

• First half of 2023:
  No requests for civic access, either general or simple, were submitted.
  

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• Second half of 2023:
  Download the register of simple and general civic access requests
  

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• First half of 2024:
  Download the register of simple and general civic access requests
  

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• Second half of 2024:
  Download the register of simple and general civic access requests
  

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• First half of 2024:
  Download the register of simple and general civic access requests

Download the Assembly Minutes

In implementation of EU Directive 2019/1937, the Italian legislator enacted Legislative Decree No. 24 of March 10, 2023, concerning the protection of individuals who report violations of Union law, and introducing provisions for the protection of those who report breaches of national regulations (“whistleblowers”).

In accordance with both European and national whistleblowing regulations—and with the goal of promoting transparency—MultiMedica has established a safeguard system to ensure confidentiality and to allow employees, collaborators, interns, volunteers, and all individuals legally authorized to report misconduct to do so freely and securely. To support this, multiple reporting channels have been made available, including a dedicated whistleblowing portal.

“Whistleblowing” refers to any report, submitted to protect the integrity of the Company, concerning unlawful conduct as defined by Legislative Decree 231/2001, the Organizational Model 231, violations of the Code of Ethics, internal procedures adopted by the Company, or acts or omissions constituting violations of European provisions pursuant to Legislative Decree 24/2023.

Reports must be made in good faith and must be sufficiently detailed to allow for easy verification.

Further information is available in the ‘whistleblowing’ procedure, which outlines the reporting methods as well as the management process.

Finally, with regard to the processing of personal data required for the management of reports, the information notice on the processing of personal data may be consulted.

Download the Procedure

Go to the Dedicated Platform

• dgr. 175/2019 – Integrity Pact concerning public contracts of the Lombardy Region and entities of the Regional System
• Information notice regarding the processing of personal data pursuant to Article 13 of Regulation (EU) 2016/679 (GDPR) used within the context of the procurement procedure

For more details visit the italian version of this page, at “Bandi di gare e Contratti” section.

Request for Copy of Medical Record

The request for a copy of the medical record may be submitted by completing the appropriate Request for Copy of Medical Record form, accompanied by a photocopy or scan of an identity document.

Download the form for the Milan, Sesto San Giovanni, and Limbiate facilities

Download the form for the Castellanza facility

How to request it

The completed form and scan may be submitted in the following ways:

IRCCS MultiMedica – Sesto San Giovanni

• Inpatient Admissions Office: Monday to Friday, from 8:00 a.m. to 2:45 p.m.
• degenze@multimedica.it
• fax 02/24.20.94.89

San Giuseppe Hospital – Milan

• Inpatient Admissions Office: Monday to Friday, 09:00 to 14:00
• osg@multimedica.it

Santa Maria Nursing Home – Castellanza

• Inpatient Admissions Office, 1st floor: Monday to Friday, 08:00 to 14:00
• accdegenzesm@multimedica.it

Villa Bianca Nursing Home – Limbiate

• Inpatient Admissions Office: Monday to Friday, 09:00 to 16:00
• vb@multimedica.it
• fax 02/99.65.610

San Barnaba Outpatient Clinic – Milan

• Outpatient Admissions Office: Monday to Friday, 09:00 to 16:00
• sanbarnaba@multimedica.it
• fax 02/24.20.99.49

Further information

For further information, you may contact the Medical Records Archive at the following numbers:

IRCCS MultiMedica – Sesto San Giovanni: tel. 02/24.20.95.82, Monday to Friday, 9:00 a.m. to 4:00 p.m.

San Giuseppe Hospital – Milan, tel. 02/85.99.48.71, Monday to Friday, 8:30 a.m. to 4:00 p.m.

Villa Bianca Nursing Home – Limbiate, tel. 02/24.20.97.35, Monday to Friday, 9:00 a.m. to 4:00 p.m.

Santa Maria Nursing Home – Castellanza, tel. 0331393106, Monday to Friday, 9:00 a.m. to 4:00 p.m. 

Holder of the substitutive authority

The holder of the substitutive authority in the event of inactivity is the Medical Directorate, through the Public Relations Office, which can be contacted at:

I.R.C.C.S. MULTIMEDICA

Telephone: 02/2420.9288, Monday to Friday from 9:00 a.m. to 5:00 p.m. Email: urp@multimedica.it

SAN GIUSEPPE HOSPITAL

Telephone: 02/8599.4020, Monday to Friday from 8:30 a.m. to 1:00 p.m. and from 2:00 p.m. to 3:30 p.m.

Email: urp.sg@multimedica.it

MULTIMEDICA CASTELLANZA HOSPITAL

Telephone: 0331/393214, Monday, Tuesday, Thursday, and Friday from 9:00 a.m. to 1:30 p.m.; Wednesday from 11:30 a.m. to 4:00 p.m.

Email: urpsm@multimedica.it

MULTIMEDICA LIMBIATE HOSPITAL

Telephone: 02/24209700, Monday to Friday from 9:00 a.m. to 3:30 p.m.

Email: urpvb@multimedica.it

Regulatory source: Article 22 of Law 241/1990 and Article 4 of Law 24/2017.

The Advance Healthcare Directives (DAT), also known as a biological will or biotestament, are a legal instrument that enables an adult who is capable of understanding and making decisions to express in advance their wishes regarding healthcare treatments, in the event that they are unable to express their will independently. Introduced by Law No. 219 of 22 December 2017, the DAT are intended to safeguard the right to self-determination of the individual, particularly in situations of serious, advanced, or terminal illness.

What are Advance Healthcare Directives (DAT)?

The DAT allow individuals to:

1. Express their wishes regarding healthcare treatments, diagnostic assessments, therapeutic choices, and individual healthcare interventions.
2. Appoint a trustee, that is, a trusted person who represents the Ordering Party in dealings with physicians and healthcare facilities.

This instrument ensures that treatment choices are respected, even when the patient is no longer able to express their wishes, thereby relieving family members from making difficult decisions in critical situations.

Who can express Advance Healthcare Directives?

All persons of legal age and capable of understanding and willing may express Advance Healthcare Directives. Minors or persons declared incapable of understanding and willing (interdicted or incapacitated, as provided by Article 3 of Law 219/2017) cannot draft Advance Healthcare Directives.

How are Advance Healthcare Directives drafted?

Advance Healthcare Directives may be drafted in various forms:

1. At the notary’s office: Advance Healthcare Directives (DAT) may be executed as a public deed or as a privately authenticated document. In both cases, the notary retains the original document.
2. At the Civil Registry Office of the Municipality of Residence: Once the document has been executed, it is filed with the competent office.
3. At healthcare facilities: Following the adoption of the measures provided for by Law 219/2017, Advance Healthcare Directives (DAT) may be executed and retained at healthcare facilities.
4. At Italian Consular Offices abroad: For Italian citizens residing abroad.
5. For persons with communication disabilities: Advance Healthcare Directives (DAT) may be executed by means of video recording or communication devices.

Advance Healthcare Directives (DAT) may be modified, renewed, or revoked at any time, following the same procedures as for their original execution.

The role of the physician

The physician is obliged to comply with the Advance Healthcare Directive. However, the physician may disregard the provisions in certain specific cases:

• If the Advance Healthcare Directives appear incongruous or do not correspond to the patient’s current clinical condition.
• If there are new or unforeseeable therapies that offer concrete possibilities for improving the patient’s quality of life.

In the event of conflicts between the physician and the trustee, legal representative, or support administrator, the final decision is entrusted to the guardianship judge.

The trustee

The trustee is a person appointed by the Ordering Party to represent them in dealings with physicians and healthcare facilities, should the Ordering Party no longer be able to express themselves autonomously. The trustee must be of legal age and capable of understanding and making decisions. The appointment is optional, may be revoked at any time, and must be formally accepted.

Storage and Access to Advance Healthcare Directives

Advance Healthcare Directives must be stored in:

• Municipality of Residence of the Ordering Party.
• Competent healthcare facilities.
• Notaries or Italian consulates abroad (for Italian citizens residing abroad).

Advance Healthcare Directives are registered in the National Database of Advance Healthcare Directives, managed by the Ministry of Health, which ensures the storage and accessibility of the document, both for the Ordering Party and for attending physicians, the trustee, and family members, through digital authentication (SPID, CNS, or CIE).

Modification or Revocation of Advance Healthcare Directives

Advance Healthcare Directives may be modified or revoked at any time, following the same procedures established for their drafting. In urgent cases, a verbal revocation may be made in the presence of a physician and two witnesses.

Shared Care Planning (PCC)

Shared Care Planning (PCC) is a dynamic and ongoing process involving the patient, the family, the trustee (if appointed), and the multidisciplinary healthcare team. This instrument, provided for by Article 5 of Law 219/2017, applies primarily to patients affected by chronic and disabling conditions or with a poor prognosis. PCC is based on open and empathetic dialogue between the patient and the physician, with the aim of planning the care pathway in a personalized manner that respects the patient’s preferences. The PCC allows for the avoidance of unwanted treatments and ensures that care is consistent with the patient’s values and choices, even in situations of incapacity. This process may be formalized through a written document attached to the medical record and can be updated over time in accordance with the progression of the illness or changes in the patient’s wishes.

Further information

For further details regarding the procedures for drafting, registering, amending, or revoking Advance Healthcare Directives, you may consult the official website of the Ministry of Health.

https://www.salute.gov.it/portale/dat/homeDat.jsp

Article 5 of Law 24/2017, entitled “Good clinical and care practices and recommendations provided by the guidelines,” assigns a fundamental role to the Guidelines (LG), designating the ISS as the methodological guarantor and national authority for the governance of the process for producing high-quality guidelines, informed by the best available evidence and responsive to the health needs of the country based on criteria of relevance and clinical, economic, and social impact.

The SNLG therefore serves as the institutional access point to clinical practice guidelines or public health policies developed for the National Health Service, as well as for decision-makers, professionals, and patients.

For further information, click here

MultiMedica has promoted equal opportunities and the inclusion of all individuals working within its organization for many years.

For this reason, we have prepared a Gender Equality Plan, developed with the full collaboration of various departments and offices within our Group.
This represents an additional path of cultural and organizational growth that MultiMedica is undertaking in the spirit of continuous improvement, in order to respond dynamically to the evolving needs of its workforce.

Download the Gender Equality Plan (GEP) of the MultiMedica Group