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Medical Self Declaration Form for the United Kingdom

Medical Self Declaration Form Template for England and Wales

A Medical Self Declaration Form is a legal document used in England and Wales where an individual formally declares their current health status, medical history, and relevant health conditions. The document complies with UK data protection legislation and healthcare regulations, serving as an official record of self-reported medical information. It typically includes provisions for data protection, consent for information sharing, and declarations of truth under English law.

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What is a Medical Self Declaration Form?

The Medical Self Declaration Form is a crucial document used across various sectors in England and Wales where individuals need to officially disclose their health status. It serves multiple purposes, from employment requirements to insurance applications, and must comply with the UK GDPR and Data Protection Act 2018. The form typically includes current health status, medical history, medications, and relevant health conditions, with the declarant confirming the truth of their statements. This document is particularly important in contexts where self-reported health information forms the basis for significant decisions or risk assessments.

What sections should be included in a Medical Self Declaration Form?

1. Personal Information: Basic identifying information of the declarant including full name, date of birth, address, and contact details

2. Declaration of Truth: Statement confirming that all information provided is accurate, complete and truthful to the best of the declarant's knowledge

3. Medical History: Comprehensive section covering current and past medical conditions, treatments, medications, surgeries, and hospitalizations

4. Consent Statement: Explicit consent for processing and sharing of medical data, including acknowledgment of data protection rights under UK GDPR

5. Signature Block: Space for declarant's signature, printed name, date, and witness signature if required

What sections are optional to include in a Medical Self Declaration Form?

1. Family Medical History: Section for declaring relevant hereditary conditions and family medical history when genetic factors are relevant to assessment

2. Lifestyle Factors: Optional section covering diet, exercise, smoking, alcohol consumption, and other lifestyle factors when relevant to medical assessment

3. Occupational Health Details: Section for work-related health factors and occupational hazards when form is used for employment purposes

What schedules should be included in a Medical Self Declaration Form?

1. Privacy Notice: Detailed information about how personal data will be collected, processed, stored, and shared, including rights under UK GDPR

2. Medical Conditions List: Comprehensive reference list of medical conditions and terms to assist in completing the form accurately

3. Guidance Notes: Detailed instructions for completing each section of the form, including explanations of medical terminology

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Jurisdiction

England and Wales

Publisher

Genie AI

Document Type

Declaration Form

Cost

Free to use
Relevant legal definitions

























Clauses

























Industries

UK GDPR and Data Protection Act 2018: Primary legislation governing the processing of personal data, with special provisions for medical data as 'special category data' requiring enhanced protection and specific processing conditions

Health and Social Care Act 2012: Fundamental legislation governing healthcare provision and standards in England and Wales, including requirements for medical documentation and reporting

Medical Act 1983: Core legislation governing medical practice and professional standards, including requirements for medical documentation and professional responsibilities

Access to Medical Reports Act 1988: Legislation governing rights of access to medical reports and requirements for consent in medical reporting

Equality Act 2010: Legislation protecting individuals from discrimination, including on grounds of disability or medical conditions, which must be considered in medical documentation

Mental Capacity Act 2005: Legislation governing decision-making capacity and consent, crucial for ensuring valid self-declaration and medical consent

Health and Safety at Work Act 1974: Workplace safety legislation that may be relevant if the medical declaration is for employment purposes

Human Rights Act 1998: Legislation protecting fundamental rights including privacy (Article 8), which must be considered in medical data collection and processing

GMC and Professional Guidelines: Professional standards and guidelines from the General Medical Council and other medical bodies that govern medical documentation and patient interactions

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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