The Work Permit Medical Check Up Form is a mandatory document required under Dutch immigration law for foreign nationals seeking employment authorization in the Netherlands. This form is designed to ensure that incoming workers meet the health and safety requirements established by Dutch authorities and is a crucial component of the work permit application process. The document must comply with multiple regulatory frameworks, including the Foreign Nationals Employment Act (Wav), the Medical Examinations Act (WMK), and the General Data Protection Regulation (AVG). It is typically required before the issuance of a work permit and must be completed by authorized medical professionals. The form includes comprehensive health screening sections, consent declarations, and medical certifications, all structured to meet both immigration requirements and Dutch healthcare standards.
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1. Personal Information: Basic details of the person being examined, including full name, date of birth, passport number, and contact information
2. Purpose Declaration: Statement explaining the purpose of the medical examination in relation to the work permit application
3. Consent Statement: Written consent from the examined person for the medical examination and data processing
4. Medical History Questionnaire: Standard questions about past medical conditions, current medications, and family history
5. Required Examinations List: Checklist of mandatory medical examinations to be performed
6. Examination Results: Section for recording the results of various medical tests and examinations
7. Physician's Declaration: Official statement from the examining physician about fitness for work
8. Data Protection Notice: Information about how medical data will be processed and protected under AVG/GDPR
9. Signatures: Space for signatures of the examined person, physician, and other relevant parties
1. Specialist Referral: Section for referring to specialists for additional examinations, used when initial results require further investigation
2. Workplace Specific Requirements: Additional medical checks based on specific job requirements or workplace conditions
3. Previous Employment Medical History: Section for detailed work-related medical history, used for high-risk occupations
4. Vaccination Record: Documentation of relevant vaccinations, used when required for specific work environments
5. Travel History: Section for recent travel history, used during periods of public health concerns or for specific industries
1. Appendix A - Medical Tests Results: Detailed results of all medical tests performed
2. Appendix B - Radiological Reports: X-ray or other imaging results if required
3. Appendix C - Laboratory Results: Blood tests and other laboratory examination results
4. Appendix D - Specialist Reports: Any additional specialist examination reports if applicable
5. Appendix E - Privacy Statement: Detailed privacy policy and data processing information
Relevant legal definitions
Examining Physician
Medical Institution
Work Permit
Medical Examination
Competent Authority
Personal Data
Medical Data
Occupational Health Service
Data Processing
Data Controller
Consent
Immigration Authority
Medical History
Physical Examination
Laboratory Tests
Specialist Examination
Confidential Medical Information
IND (Immigratie- en Naturalisatiedienst)
UWV (Uitvoeringsinstituut Werknemersverzekeringen)
Fitness Declaration
Medical Professional
Healthcare Provider
Authorized Representative
Privacy Notice
Medical Records
Occupational Requirements
Health Assessment
Medical Certificate
Data Subject
Data Protection Officer
Medical Institution
Work Permit
Medical Examination
Competent Authority
Personal Data
Medical Data
Occupational Health Service
Data Processing
Data Controller
Consent
Immigration Authority
Medical History
Physical Examination
Laboratory Tests
Specialist Examination
Confidential Medical Information
IND (Immigratie- en Naturalisatiedienst)
UWV (Uitvoeringsinstituut Werknemersverzekeringen)
Fitness Declaration
Medical Professional
Healthcare Provider
Authorized Representative
Privacy Notice
Medical Records
Occupational Requirements
Health Assessment
Medical Certificate
Data Subject
Data Protection Officer
Clauses
Personal Information
Consent
Data Protection
Medical History
Physical Examination
Laboratory Testing
Medical Certification
Privacy Notice
Information Processing
Disclosure Authorization
Confidentiality
Document Verification
Medical Professional Declaration
Rights and Obligations
Examination Requirements
Health and Safety
Record Keeping
Data Subject Rights
Authority Recognition
Regulatory Compliance
Consent
Data Protection
Medical History
Physical Examination
Laboratory Testing
Medical Certification
Privacy Notice
Information Processing
Disclosure Authorization
Confidentiality
Document Verification
Medical Professional Declaration
Rights and Obligations
Examination Requirements
Health and Safety
Record Keeping
Data Subject Rights
Authority Recognition
Regulatory Compliance
Relevant Industries
Healthcare
Manufacturing
Information Technology
Construction
Agriculture
Education
Scientific Research
Oil and Gas
Maritime
Logistics
Hospitality
Professional Services
Mining
Energy
Telecommunications
Relevant Teams
Human Resources
Legal
Compliance
Global Mobility
Occupational Health
Immigration
Employee Relations
Medical Records
Data Protection
International Assignments
Relevant Roles
HR Manager
Immigration Specialist
Compliance Officer
Occupational Health Physician
HR Administrator
Legal Counsel
Recruitment Manager
Global Mobility Specialist
Employee Relations Manager
HRIS Specialist
Privacy Officer
Medical Records Administrator
Immigration Law Paralegal
International HR Coordinator
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