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.
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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
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
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
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Relevant Teams
Human Resources
Health & Safety
Occupational Health
Compliance
Risk Management
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Medical Services
Employee Relations
Recruitment
Administration
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Relevant Roles
HR Manager
Health and Safety Officer
Occupational Health Nurse
Medical Director
Compliance Officer
Risk Manager
Insurance Underwriter
Employee Relations Manager
Recruitment Manager
School Administrator
Company Doctor
Facility Manager
Operations Manager
Travel Coordinator
Immigration Specialist
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