Health Declaration Card Form Template for England and Wales

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Key Requirements PROMPT example:

Health Declaration Card Form

"I need a Health Declaration Card Form for our private medical clinic opening in March 2025, which must include sections for COVID-19 vaccination status and comprehensive travel history, while complying with NHS England guidelines and UK GDPR requirements."

Document background

The Health Declaration Card Form is a crucial document used across various sectors in England and Wales to gather and document individual health information. It serves multiple purposes, from pre-employment health screening to travel health declarations and medical facility intake processes. The form must comply with strict data protection requirements under UK GDPR and healthcare regulations, while collecting necessary health information in a standardized format. This document is particularly important during public health emergencies, institutional health monitoring, and when specific health verifications are required by law or organizational policy.

Suggested Sections

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

2. Current Health Status Declaration: Current symptoms, conditions, or health concerns requiring disclosure

3. Medical History: Relevant past medical conditions and treatments that may affect current health status

4. Privacy Notice: Information about how personal data will be collected, used, stored and protected in accordance with UK GDPR

5. Declaration and Signature: Confirmation of truth and accuracy of provided information, including date and signature

Optional Sections

1. Travel History: Recent travel details for international travel or infection control purposes

2. Vaccination Record: Details of relevant vaccinations and immunization status verification

3. Emergency Contact Information: Details of who to contact in case of emergency during medical treatment or high-risk situations

Suggested Schedules

1. Privacy Policy: Detailed information about data protection and privacy practices under UK GDPR

2. Medical Terms Glossary: Explanations of medical terms used in the form for patient understanding

3. Additional Health Guidelines: Relevant health and safety information or instructions for specific conditions or situations

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

alex.den.21@genieai.co

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Authors

Alex Denne

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