Medical Self Declaration Form - United Arab Emirates

Medical Self Declaration Form for United Arab Emirates

Medical Self Declaration Form Template for United Arab Emirates

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What is a Medical Self Declaration Form?

The Medical Self Declaration Form is a crucial document in the United Arab Emirates' healthcare and employment landscape, designed to capture comprehensive information about an individual's health status and medical history. This form is commonly required during employment processes, insurance applications, travel clearances, or institutional registrations. The document must comply with UAE Federal Law No. 2 of 2019 regarding healthcare practices and Federal Decree Law No. 45 of 2021 concerning data protection. The form typically includes declarations about current health conditions, medical history, ongoing treatments, and lifestyle factors that might affect health status. It serves as a legal record of an individual's health status and carries implications for false declarations under UAE law.

What sections should be included in a Medical Self Declaration Form?

1. Personal Information: Basic details including full name (as per passport), Emirates ID, date of birth, gender, and contact information

2. Declaration Purpose: Clear statement of why this medical declaration is being made (e.g., employment, insurance, travel)

3. Current Health Status: Declaration of current general health condition and any ongoing medical treatments

4. Medical History: Details of past medical conditions, surgeries, and hospitalizations

5. Family Medical History: Information about hereditary conditions and significant family medical history

6. Medications: List of current medications, including prescribed and regular over-the-counter medicines

7. Allergies and Sensitivities: Declaration of known allergies to medications, foods, or environmental factors

8. Lifestyle Factors: Information about smoking, alcohol consumption, and physical activity

9. Truth Statement: Legal declaration confirming all provided information is true and accurate

10. Consent Statement: Agreement for the information to be used and processed as per UAE data protection laws

What sections are optional to include in a Medical Self Declaration Form?

1. COVID-19 Status: Recent COVID-19 history and vaccination status - include for travel or current employment requirements

2. Occupational Health: Specific health conditions related to work environment - include for employment-related declarations

3. Pregnancy Status: Declaration of pregnancy status - include when relevant for medical or employment purposes

4. Mental Health: Mental health conditions and treatments - include when specifically required by the requesting entity

5. Insurance Details: Current health insurance information - include when form is used for insurance or healthcare provider purposes

6. Emergency Contacts: Contact details for emergency situations - include for employment or institutional purposes

What schedules should be included in a Medical Self Declaration Form?

1. Medical Conditions Checklist: Detailed checklist of common medical conditions for the declarant to mark

2. Vaccination Record: List of vaccinations received and dates

3. Medical Test Results: Recent medical test results if required (e.g., blood tests, COVID-19 tests)

4. Physician's Notes: Additional space for physician's comments or endorsements if required

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

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Declaration Of Exemption

A UAE legal document declaring eligibility for and claiming specific exemptions from legal requirements or regulations, requiring proper authentication under UAE law.

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Download a Standard Template

What is a Medical Self Declaration Form?

What sections should be included in a Medical Self Declaration Form?

What sections are optional to include in a Medical Self Declaration Form?

What schedules should be included in a Medical Self Declaration Form?

Authors

Alex Denne

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