The My Health Declaration is a formal document used in Ireland to capture and document an individual's health status and medical history. It is designed to comply with Irish healthcare legislation, the General Data Protection Regulation (GDPR), and the Data Protection Act 2018, particularly regarding the handling of special category health data. This declaration is commonly required in various contexts, such as new employment, insurance applications, healthcare service provision, or participation in certain activities. The document includes comprehensive sections covering current health status, medical history, lifestyle factors, and relevant health conditions, while incorporating necessary data protection notices and consent mechanisms. It serves as a legally compliant tool for collecting and processing health information while protecting both the declarant's rights and the receiving organization's obligations under Irish law.
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1. Personal Details: Declarant's full name, date of birth, address, and contact information
2. Purpose of Declaration: Statement explaining the purpose and intended use of the health declaration
3. Data Protection Notice: Information about how the health data will be processed, stored, and protected in compliance with GDPR
4. Current Health Status: Declaration of current medical conditions, medications, and general health status
5. Medical History: Overview of past medical conditions, surgeries, and significant health events
6. Family Medical History: Relevant hereditary conditions and family health background
7. Lifestyle Factors: Information about smoking, alcohol consumption, exercise, and other relevant lifestyle factors
8. Declaration of Truth: Statement confirming all information provided is true and accurate
9. Consent and Authorization: Explicit consent for data processing and sharing with relevant parties
10. Signature and Date: Space for declarant's signature and date of completion
1. Disability Status: Additional section for declaring any disabilities or long-term conditions requiring accommodation
2. Mental Health History: Specific section for mental health conditions and treatments, when relevant
3. Pregnancy Status: Section for female declarants regarding current or recent pregnancy status when relevant
4. COVID-19 Status: Information about COVID-19 vaccination, previous infections, and current status
5. Occupational Health Risks: Section for work-related health risks or exposures when declaration is for employment purposes
6. Emergency Contacts: Contact details for next of kin or emergency contacts when required
7. Healthcare Provider Details: Information about current healthcare providers when ongoing medical care is relevant
1. Schedule A - Medical Test Results: Recent medical test results or reports if required
2. Schedule B - Vaccination Records: Details of vaccinations and immunization history
3. Schedule C - Medication List: Detailed list of current medications, dosages, and prescribing doctors
4. Appendix 1 - Medical Documents: Copies of relevant medical certificates or documentation
5. Appendix 2 - GP Statement: Statement from general practitioner confirming health status when required
6. Appendix 3 - Specialist Reports: Any relevant specialist medical reports or assessments
Relevant legal definitions
Declarant
Health Data
Medical History
Healthcare Provider
Medical Practitioner
Chronic Condition
Pre-existing Condition
Data Controller
Data Processor
Consent
Special Category Data
Medical Records
Treatment
Prescription Medication
Over-the-Counter Medication
Emergency Contact
Healthcare Institution
Medical Certificate
Occupational Health Provider
Personal Data
Processing
Sensitive Personal Data
Health Status
Medical Professional
Authorized Representative
Medical Assessment
Disclosure
Confidentiality
Material Information
Medical Examination
Health Data
Medical History
Healthcare Provider
Medical Practitioner
Chronic Condition
Pre-existing Condition
Data Controller
Data Processor
Consent
Special Category Data
Medical Records
Treatment
Prescription Medication
Over-the-Counter Medication
Emergency Contact
Healthcare Institution
Medical Certificate
Occupational Health Provider
Personal Data
Processing
Sensitive Personal Data
Health Status
Medical Professional
Authorized Representative
Medical Assessment
Disclosure
Confidentiality
Material Information
Medical Examination
Clauses
Data Protection
Consent
Confidentiality
Medical History
Current Health Status
Information Accuracy
Disclosure
Authorization
Privacy Notice
Medical Records
Information Sharing
Declaration of Truth
Rights and Obligations
Amendments
Regulatory Compliance
Data Processing
Medical Examinations
Information Updates
Record Retention
Access Rights
Consent
Confidentiality
Medical History
Current Health Status
Information Accuracy
Disclosure
Authorization
Privacy Notice
Medical Records
Information Sharing
Declaration of Truth
Rights and Obligations
Amendments
Regulatory Compliance
Data Processing
Medical Examinations
Information Updates
Record Retention
Access Rights
Relevant Industries
Healthcare
Insurance
Employment and HR
Education
Sports and Recreation
Travel and Tourism
Financial Services
Professional Services
Manufacturing
Construction
Transportation
Childcare
Food Services
Pharmaceutical
Relevant Teams
Human Resources
Occupational Health
Health and Safety
Legal and Compliance
Risk Management
Employee Relations
Medical Administration
Insurance Operations
Privacy and Data Protection
Recruitment
Clinical Operations
Relevant Roles
Human Resources Manager
Occupational Health Nurse
Health and Safety Officer
Insurance Underwriter
Medical Administrator
Compliance Officer
Risk Manager
Employee Relations Manager
Healthcare Administrator
Recruitment Manager
Company Doctor
Insurance Claims Officer
School Administrator
Sports Facility Manager
Clinical Director
Privacy Officer
Legal Counsel
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