The Medical Declaration Form is a crucial document used in Hong Kong's healthcare system to gather comprehensive medical information from patients or declarants. It is typically required when establishing new patient relationships, before medical procedures, for insurance purposes, or in occupational health contexts. The form must comply with Hong Kong's Personal Data (Privacy) Ordinance (Cap. 486) and various healthcare regulations, including the Medical Registration Ordinance (Cap. 161). The document captures essential information such as current health status, medical history, medications, and allergies, while including necessary privacy notices and consent clauses. This Medical Declaration Form serves as both a medical record and a legal document, requiring careful attention to accuracy and completeness from all parties involved.
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1. Personal Information: Basic identification details including full name, HKID/passport number, date of birth, gender, and contact information
2. Data Privacy Notice: Statement explaining how personal data will be collected, used, and protected in accordance with the Personal Data (Privacy) Ordinance
3. Current Health Status: Declaration of present health conditions, symptoms, or concerns
4. Medical History: Details of past medical conditions, surgeries, hospitalizations, and chronic conditions
5. Family Medical History: Information about significant medical conditions in immediate family members
6. Current Medications: List of all current medications, supplements, and treatments
7. Allergies and Reactions: Documentation of known allergies to medications, foods, or other substances
8. Declaration of Truth: Statement confirming all provided information is true and accurate
9. Consent and Authorization: Patient's consent for information use and medical procedures
10. Signature Section: Space for signature, date, and witness details if required
1. COVID-19 Status: Section for declaring COVID-19 vaccination status, recent exposure, and test results - include when required by current health protocols
2. Travel History: Recent travel history section - include during disease outbreaks or when epidemiologically relevant
3. Mental Health Declaration: Section for mental health history and current status - include when the form is for mental health services or when specifically required
4. Pregnancy Status: Declaration of pregnancy or possibility of pregnancy - include for female patients of childbearing age when medically relevant
5. Lifestyle Factors: Information about smoking, alcohol consumption, and exercise - include when relevant to the medical assessment
6. Emergency Contact: Details of emergency contact person - include when the form is for ongoing medical care or procedures
7. Insurance Information: Health insurance details - include when the form is used in conjunction with insurance claims or coverage
1. Appendix A - Medication List Template: Detailed template for listing current medications, dosages, and frequencies
2. Appendix B - Privacy Policy: Detailed privacy policy and data handling procedures
3. Appendix C - Medical Terms Glossary: Definitions of medical terms used in the form for patient reference
4. Schedule 1 - Specific Condition Checklist: Detailed checklist for specific medical conditions relevant to the purpose of the declaration
5. Schedule 2 - Consent Details: Detailed explanation of what the patient is consenting to and the implications
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