Medical Declaration Form Template for Saudi Arabia

Create a bespoke document in minutes, or upload and review your own.

4.6 / 5

4.8 / 5

Let's create your Medical Declaration Form

1. Select your governing law and document type:

2. Enter your key requirements:

3. Create your document to edit, review or download

Get your first 2 documents free

Your data doesn't train Genie's AI

You keep IP ownership of your information

Key Requirements PROMPT example:

Medical Declaration Form

"I need a Medical Declaration Form for my private clinic in Riyadh that complies with Saudi MOH regulations, specifically for pre-surgical procedures, with extra emphasis on medication allergies and previous surgical history."

Document background

The Medical Declaration Form is a fundamental document used across healthcare facilities in Saudi Arabia to collect and verify patient medical information. This document is required in various healthcare settings, from routine medical examinations to pre-procedure declarations, and must comply with the Law of Healthcare Professions (Royal Decree No. M/59) and Ministry of Health regulations. The form captures essential medical information, including patient history, current conditions, medications, and relevant declarations, while ensuring adherence to Saudi data protection requirements and Islamic medical ethics. It serves as both a legal record and a clinical tool, facilitating proper patient care while protecting healthcare providers and patients through comprehensive documentation of medical status and informed consent.

Suggested Sections

1. Personal Information: Patient's full name, national ID/Iqama number, date of birth, gender, and contact information

2. Medical History: Overview of patient's significant medical conditions, surgeries, and chronic illnesses

3. Current Health Status: Declaration of current health conditions, symptoms, and ongoing treatments

4. Medication Information: List of current medications, allergies, and adverse reactions

5. Declaration of Truth: Patient's confirmation that all provided information is accurate and complete

6. Consent Section: Patient's agreement to share medical information with relevant healthcare providers

7. Authentication: Signature fields for patient/guardian, date, and witness if required

Optional Sections

1. Family Medical History: Include when genetic or hereditary conditions are relevant to the current medical assessment

2. Travel History: Required during epidemics or for infectious disease screening

3. Guardian Information: Necessary for minors or individuals unable to provide consent

4. Pregnancy Declaration: Required for female patients of childbearing age when relevant to treatment

5. Religious/Cultural Considerations: Special medical or treatment preferences based on religious or cultural beliefs

6. Emergency Contact: Additional contact information for emergency situations

Suggested Schedules

1. Appendix A - Medical Terms Glossary: Definitions of medical terms used in the form in both Arabic and English

2. Appendix B - List of Restricted Medications: Standard list of controlled substances and medications that require special declaration

3. Appendix C - Privacy Notice: Detailed information about how medical data will be handled and protected

4. Schedule 1 - Specific Condition Checklist: Detailed checklist for specific medical conditions relevant to the declaration

5. Schedule 2 - Required Medical Tests: List of medical tests or examinations that may be required based on declarations made

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

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Medical Insurance

Pharmaceuticals

Public Health

Healthcare Administration

Medical Tourism

Occupational Health

Clinical Research

Medical Education

Relevant Teams

Legal

Compliance

Medical Records

Patient Services

Quality Assurance

Risk Management

Clinical Operations

Healthcare Administration

Data Protection

Insurance Coordination

Relevant Roles

Medical Director

Hospital Administrator

Physician

Nurse Practitioner

Clinical Coordinator

Healthcare Compliance Officer

Medical Records Manager

Patient Services Coordinator

Quality Assurance Manager

Risk Management Officer

Medical Insurance Coordinator

Legal Counsel

Data Protection Officer

Healthcare Operations Manager

Find the exact document you need

Nomination Declaration Form

A mandatory declaration form under Saudi Arabian law for board and executive nominations, ensuring compliance with CMA regulations and Companies Law requirements.

How a Sales & Marketing Lead uses Genie AI to reduce contract drafting time by 95%

Let's create your Medical Declaration Form

Authors

Alex Denne

Find the exact document you need

Nomination Declaration Form

Form Of Declaration

Nomination And Declaration Form

Payment Declaration Letter

Salary Declaration Letter

Vat Declaration Form

Sponsorship Declaration Form

Salary Declaration Form

Referee Declaration Form

Medical Fitness Declaration Form

Supplier Declaration Form

Self Declaration Form For Passport

Medical Declaration Form

Declaration Of Trust Form

Declaration Of Goods Form

Declaration Letter For Subsidiary Company

Declaration Form For Courier

Custodian Declaration Form

Beneficial Ownership Declaration Form

Declaration Of Relationship Letter

Declaration Of Support

Foreign Transfer Duty Declaration

Declaration Letter

Sponsorship Declaration Letter

Property Declaration Form

Electronic Health Declaration

Declaration Of Finances

Declaration For Application Form

Self Declaration Form For Address Proof

Self Attested Declaration Form

Third Party Declaration Form

Education Declaration Form

Declaration Of Ownership Form

Self Employed Declaration Form

Land Declaration Form

Company Declaration Letter

Background Declaration Form

Loan Declaration Form

Guardian Declaration Form

Beneficial Ownership Declaration

Major Declaration Form

Address Declaration Form

Staff Declaration Form

Wealth Declaration Form

Patient Declaration Form

Partner Declaration Form

Dependent Declaration Form

Self Declaration Form

Import Declaration Form

Financial Declaration Form

Vendor Declaration Form

Safety Declaration Form

Landlord Declaration Form

Compliance Declaration Form

Copyright Declaration Form

Beneficiary Declaration Form

Beneficial Owner Declaration Form

Rent Declaration Form

Relationship Declaration Form

Medical Self Declaration Form

Client Declaration Form

Applicant Declaration Form

Conflict Of Interest Declaration Form

Author Declaration Form

Download our whitepaper on the future of AI in Legal

Genie’s Security Promise

Your documents are private:

Your documents are protected:

Organizational security

Innovation in privacy:

Want to know more?

Commercial

Employment

IP

Administration