The Medical Declaration Form is a crucial document in the Dutch healthcare system, used to formally document and communicate a patient's medical status or fitness for specific purposes. This document is required in various contexts, including employment assessments, insurance claims, educational institutions, sports participation, or travel clearance. The form must comply with Dutch healthcare legislation, particularly the Medical Treatment Agreement Act (WGBO) and privacy laws (AVG/GDPR). It contains detailed medical information, professional assessments, and necessary declarations while ensuring patient privacy and data protection. The Medical Declaration Form serves as an official medical statement and may be requested by various organizations or institutions requiring formal medical documentation.
Your data doesn't train Genie's AI
You keep IP ownership of your information
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
OR
Let Ƶ's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.
1. Personal Information: Patient's identification details including full name, date of birth, BSN number, contact information, and insurance details
2. Medical Professional Information: Details of the examining physician or healthcare provider, including name, BIG registration number, and institution
3. Medical Declaration Purpose: Clear statement of the purpose for which the medical declaration is being made
4. Medical History: Relevant medical history and current health status related to the declaration purpose
5. Current Medical Status: Statement of current medical condition or findings relevant to the declaration
6. Declaration Statement: Formal medical declaration based on the examination and findings
7. Data Processing Consent: GDPR-compliant consent section for processing medical data
8. Signatures: Signature fields for the medical professional, patient, and date of signing
1. Third Party Authorization: Section for authorizing disclosure to specific third parties, used when the declaration needs to be shared with other organizations
2. Research Participation: Additional section for consent to use data in medical research, required when the declaration may be used for research purposes
3. Specialist Referral Details: Section for including information from specialist consultations, used when the declaration requires input from multiple medical professionals
4. Translation Declaration: Section certifying that the contents have been explained in patient's preferred language, used for non-Dutch speaking patients
5. Emergency Contact: Section for emergency contact information, included when required by the requesting organization
1. Medical Examination Results: Detailed results of specific medical examinations or tests relevant to the declaration
2. Supporting Documentation List: List of all medical documents and test results reviewed in making the declaration
3. Privacy Notice: Detailed information about how the medical data will be processed, stored, and shared
4. Rights and Obligations: Summary of patient's rights and obligations under Dutch healthcare laws
Authors
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Insurance
Education
Employment
Sports & Recreation
Transportation
Immigration
Legal Services
Occupational Health
Public Administration
Relevant Teams
Human Resources
Medical Administration
Compliance
Legal
Privacy & Data Protection
Operations
Quality Assurance
Customer Service
Documentation
Risk Management
Relevant Roles
Medical Doctor
General Practitioner
Medical Specialist
Occupational Health Physician
Insurance Medical Advisor
Healthcare Administrator
Compliance Officer
HR Manager
School Administrator
Sports Administrator
Immigration Officer
Legal Counsel
Privacy Officer
Medical Records Manager
Find the exact document you need
Form Of Declaration
A legally binding written statement under Dutch law where a party formally declares specific facts or circumstances.
find out more
Self Declaration Letter For Documents
A formal written declaration under Dutch law confirming the authenticity and accuracy of specified documents, with legal accountability for the declarant.
find out more
Declaration Letter For Employee
A Dutch-law governed formal letter containing employee declarations regarding employment status, responsibilities, or specific workplace matters.
find out more
Declaration Form For Scholarship
A Dutch-compliant legal form for scholarship applications and declarations, incorporating personal, academic, and financial information under Netherlands education law.
find out more
Living Will Declaration Form
A Dutch legal document allowing individuals to specify advance healthcare directives and end-of-life decisions under Netherlands law.
find out more
Declaration Letter For Passport
A formal written declaration used in the Netherlands for passport-related matters, complying with Dutch passport legislation and administrative requirements.
find out more
Resident Declaration Form
A mandatory Dutch legal document for registering residence with local municipalities, governed by the Basic Registration of Persons Act (BRP).
find out more
Flight Declaration Form
A regulatory document required under Dutch and EU aviation law for declaring flight operations details and safety compliance in Dutch airspace.
find out more
Self Employment Declaration
A Dutch legal document confirming independent contractor status under Wet DBA legislation, establishing a clear self-employment relationship between contractor and client.
find out more
Declaration Of Ownership
A formal Dutch legal document declaring ownership rights over property, compliant with the Dutch Civil Code requirements.
find out more
Salary Declaration Letter
A Dutch-compliant official document confirming an employee's income and employment status, typically used for mortgage applications and rental agreements in the Netherlands.
find out more
Driving Licence Declaration Form
A Dutch legal form for declaring personal information, medical fitness, and driving history for driving license applications or renewals, compliant with Netherlands traffic laws.
find out more
Arrival Health Declaration
A mandatory health screening document required under Dutch law for travelers entering the Netherlands, serving as part of border control and public health measures.
find out more
Age Declaration Form
A Dutch law-compliant form for formal age declaration, used for accessing age-restricted services or products in the Netherlands.
find out more
Declaration Of Domicile
A Dutch legal document for officially declaring one's residential address with local municipal authorities under Netherlands law.
find out more
Affidavit Declaration
A formal sworn statement made under Dutch law, executed before a notary public or authorized official, serving as legally binding testimony of facts or intentions.
find out more
Sworn Declaration
A formal legal document under Dutch law where an individual makes statements under oath, typically used for official proceedings and administrative matters in the Netherlands.
find out more
Statutory Declaration Form
A formal sworn statement under Dutch law, witnessed by an authorized person, declaring certain facts to be true for official purposes.
find out more
Medical Declaration Form For Employees
Dutch-compliant medical declaration form for documenting employee medical conditions and work fitness, adhering to Netherlands employment and privacy laws.
find out more
Declaration Card
A standardized Dutch legal document used for making formal declarations or statements, compliant with Netherlands administrative law.
find out more
International Travel Declaration Form
A Dutch law-compliant International Travel Declaration Form for documenting and validating international travel details under Netherlands and EU regulations.
find out more
Declaration Of Origin
A formal customs document under Dutch and EU law certifying the country of origin of goods for international trade purposes.
find out more
Vat Declaration Form
A mandatory Dutch VAT declaration form for reporting VAT transactions and determining VAT payment or refund position with the Netherlands tax authorities.
find out more
Sponsorship Declaration Form
A Dutch legal document where a sponsor formally declares financial responsibility for another person's stay in the Netherlands, as required by immigration authorities.
find out more
Salary Declaration Form
A legally required Dutch document that formally declares and documents an employee's salary arrangements and tax details for employment and tax purposes in the Netherlands.
find out more
Referee Declaration Form
A Dutch-compliant declaration form for sports referees establishing their qualifications, commitments, and responsibilities under Netherlands law.
find out more
Medical Fitness Declaration Form
A Dutch-compliant Medical Fitness Declaration Form documenting an individual's health status and fitness for specific activities or employment, adhering to Netherlands medical and privacy regulations.
find out more
Supplier Declaration Form
A Dutch-law governed supplier declaration document confirming product compliance, origin, and regulatory adherence for supply chain management within the Netherlands and EU framework.
find out more
Self Declaration Form For Passport
A Dutch legal self-declaration form required for passport applications, renewals, or replacements, processed by Dutch municipal or diplomatic authorities.
find out more
Residency Declaration Form
A Dutch legal document for declaring and registering residential address with municipal authorities (Gemeente), required under Netherlands residency laws.
find out more
Name Declaration Affidavit
A Dutch legal document providing sworn declaration of an individual's name details, variations, and usage, compliant with Netherlands civil law requirements.
find out more
Medical Declaration Form
A Dutch-compliant medical declaration form for documenting patient health status and medical professional assessments, meeting Netherlands healthcare legislation requirements.
find out more
Immigration Declaration Form
A mandatory declaration form under Dutch immigration law for foreign nationals seeking residence in the Netherlands, requiring personal information and various legal statements.
find out more
Declaration Of Trust Form
A formal Dutch legal document establishing a trust arrangement under the Hague Trust Convention, detailing asset management and beneficiary rights.
find out more
Declaration Of Identity Form
A Dutch legal document where an individual formally declares their identity details, governed by Netherlands identification laws.
find out more
Customs Declaration Form
A mandatory customs declaration document for goods movement in/out of the Netherlands, compliant with EU and Dutch customs regulations.
find out more
Custodian Declaration Form
A Dutch regulatory document used by custodians to declare compliance with financial regulations and confirm proper asset segregation under Dutch law.
find out more
Beneficial Ownership Declaration Form
A mandatory Dutch legal document declaring ultimate beneficial owners of legal entities under Netherlands UBO legislation and EU AML directives.
find out more
Declaration Of Non Ownership
A formal Dutch law declaration confirming non-ownership of specific property or assets, typically used for legal and administrative purposes.
find out more
Superannuation Declaration Form
A Dutch legal document recording an employee's pension arrangements and choices under the Netherlands' pension system.
find out more
Declaration Of Support
A Dutch law-governed document where one party formally declares their commitment to provide support (financial, material, or other) to another party.
find out more
Common Law Declaration Form
A formal legal document containing sworn statements, combining Dutch legal requirements with common law declaration principles for domestic and international use.
find out more
Declaration Of Trust Beneficial Interest
A Dutch law document establishing a trust arrangement where assets are held by a trustee for designated beneficiaries, compliant with Dutch civil law and EU regulations.
find out more
Primary Producer Declaration
A Dutch legal document where primary producers declare their compliance with agricultural regulations and production standards under Netherlands and EU law.
find out more
IT Declaration Form
A Dutch legal document recording IT resource assignments and responsibilities between employer and employee, ensuring compliance with Netherlands data protection and security requirements.
find out more
Permit Declaration
A formal declaration document under Dutch law used to confirm compliance with permit requirements or initiate permit applications.
find out more
Missing Receipt Declaration
A Dutch-compliant formal declaration document that serves as a substitute for lost or missing expense receipts, meeting Netherlands tax and accounting requirements.
find out more
Job Declaration Letter
A mandatory Dutch employment document that outlines key employment terms and conditions, compliant with Dutch Civil Code requirements.
find out more
Relationship Declaration Letter
A Dutch legal document that formally declares and establishes the cohabitation status of unmarried partners, outlining their shared living arrangements and responsibilities.
find out more
Employer Declaration Form
A standardized Dutch document verifying employment status and income details, commonly used for mortgage applications and rental agreements in the Netherlands.
find out more
Custom Passenger Declaration Form
A mandatory declaration form for international passengers entering the Netherlands, compliant with Dutch customs, immigration, and public health regulations.
find out more
Airline Declaration Form
A mandatory aviation declaration form used in the Netherlands, compliant with Dutch and EU aviation regulations, documenting flight operations and safety compliance.
find out more
Self Declaration Letter
A formal written statement under Dutch law where an individual declares certain facts to be true, used for official and legal purposes.
find out more
Property Declaration Form
A Dutch legal document for declaring property details and ownership information, complying with Netherlands property law and registration requirements.
find out more
Name Change Declaration Form
A Dutch legal form for officially requesting a change of first name(s) and/or surname, complying with Netherlands civil law requirements.
find out more
Personal Self Declaration Letter
A legally-binding personal declaration document under Dutch law used to formally state facts or circumstances about oneself.
find out more
House Rent Declaration Form
A standardized Dutch legal document for declaring residential rental arrangements, regulated under Dutch housing law and the Civil Code.
find out more
Self Declaration Form For Marriage Certificate
A mandatory self-declaration form under Dutch law required for obtaining a marriage certificate in the Netherlands, containing personal attestations of marriage eligibility.
find out more
Social Declaration Form
A Dutch legal document for declaring social security-relevant information to authorities in the Netherlands, used for benefit eligibility and social security administration.
find out more
Power Of Attorney Declaration
A Dutch law-governed document authorizing one party to act on behalf of another, establishing the scope and limitations of delegated authority.
find out more
Electronic Health Declaration
A Dutch-compliant electronic declaration of health status and medical information, used for official purposes such as employment, insurance, or travel requirements.
find out more
Change Of Name Declaration
A legal declaration document used in the Netherlands to formally request and process a change of an individual's name under Dutch civil law.
find out more
Declaration Of Finances
A Dutch legal document providing a comprehensive statement of financial position, assets, and liabilities, compliant with Netherlands financial reporting requirements.
find out more
Declaration Of Assets And Liabilities
A Dutch legal document providing a comprehensive declaration of an individual's or entity's assets and liabilities, used for financial disclosure under Netherlands law.
find out more
Third Party Declaration
A Dutch law-governed formal declaration by a third party providing legally recognized statements or confirmations about specific facts or circumstances.
find out more
Sworn Declaration Form
A Dutch law-compliant sworn statement made before a notary public, serving as a legally binding declaration of facts under penalty of perjury.
find out more
Self Declaration Form For Address Proof
A Dutch-law compliant self-declaration form used to formally verify an individual's residential address in the Netherlands.
find out more
Quarantine Declaration Form
A mandatory health declaration form under Dutch law requiring individuals to commit to quarantine requirements when entering or residing in the Netherlands during public health emergencies.
find out more
Guarantor Declaration Form
A Dutch law-governed declaration where a guarantor formally commits to secure the obligations of a debtor to a creditor, complying with Dutch Civil Code requirements.
find out more
End User Declaration Letter
A Dutch law-governed declaration document providing legally binding assurances about the intended use and handling of controlled goods or technology.
find out more
Third Party Declaration Form
A Dutch law-governed formal declaration document used to make official statements or confirmations by third parties for legal or business purposes.
find out more
Declaration Of Guardianship
A Dutch legal document establishing guardianship over an individual, outlining guardian responsibilities and protections under Dutch Civil Code.
find out more
Declaration Form For International Travel
A Dutch-compliant international travel declaration form for entering or leaving the Netherlands, meeting both national and EU requirements for travel documentation.
find out more
Application Declaration
A Dutch law-compliant formal declaration document used to make official statements in support of applications or requests to authorities or relevant parties.
find out more
Declaration Form For Passport
A Dutch legal declaration form required for passport applications under the Netherlands Passport Act, capturing essential applicant information and declarations.
find out more
Indemnity Declaration
A Dutch law-governed declaration where one party commits to protect another against specified losses or liabilities.
find out more
Declaration Of Trust
A legal document establishing a trust arrangement under Dutch law and the Hague Trust Convention, defining the management and distribution of assets for beneficiaries.
find out more
Birth Certificate Declaration Form
A Dutch legal document for registering newborn children with local authorities, governed by Dutch civil law and municipal regulations.
find out more
Simple Declaration Form
A Dutch law-compliant formal statement document used to declare specific facts or circumstances, suitable for legal and administrative purposes in the Netherlands.
find out more
Residence Declaration Form
Dutch municipal Residence Declaration Form required for official address registration under BRP regulations.
find out more
House Declaration Form
A Dutch legal document used for registering residential occupancy with municipal authorities, complying with Netherlands housing registration requirements.
find out more
Declaration Of Ownership Form
A Dutch law-compliant formal declaration asserting ownership rights over specified property or assets, requiring proper execution and potential notarization.
find out more
Declaration Of Interest Form
A Dutch law-compliant document for declaring potential conflicts of interest and significant personal, professional, or financial interests that might influence professional duties.
find out more
Trust Declaration Form
A legal document establishing a trust arrangement under Dutch law, compliant with the Hague Trust Convention and local regulations.
find out more
Land Declaration Form
A statutory Dutch document for declaring and recording land parcel details and characteristics, required under Netherlands property law for official land registry purposes.
find out more
Company Declaration Letter
A formal document under Dutch law where a company makes official statements or declarations regarding specific facts or circumstances.
find out more
Background Declaration Form
A Dutch-compliant form for collecting and verifying candidate background information, incorporating GDPR and local privacy requirements.
find out more
Affidavit Self Declaration
A formal sworn statement under Dutch law where an individual declares specific facts or circumstances to be true, often requiring notarization.
find out more
Affidavit Of Age Declaration
A Dutch legal document containing a sworn statement verifying an individual's age, authenticated by a notary public under Netherlands law.
find out more
Standard Declaration Form
A formal Dutch legal document used for making official statements or declarations, compliant with Netherlands law and administrative requirements.
find out more
Plagiarism Declaration Form
A Dutch-compliant declaration form for students/authors to affirm the originality of their academic work and acknowledge understanding of plagiarism consequences.
find out more
Employee Self Declaration Form
A Dutch-law compliant declaration form capturing essential employee information and statements required for employment administration and legal compliance.
find out more
Beneficial Ownership Declaration
A Dutch legal document declaring and verifying ultimate beneficial owners of legal entities under Netherlands UBO registration requirements.
find out more
Cargo Declaration Form
A mandatory customs declaration document under Dutch/EU law for declaring cargo details to customs authorities for goods movement through the Netherlands.
find out more
Tax Declaration Form
A Dutch tax declaration form for reporting income and tax-relevant information to the Belastingdienst under Netherlands tax law.
find out more
Solemn Declaration Form
A formal sworn statement under Dutch law where an individual declares specific facts or circumstances, carrying legal weight and consequences for false declarations.
find out more
Major Declaration Form
A legally binding declaration document under Dutch law used for formal statements or declarations with legal consequences.
find out more
Asset Declaration Form
A Dutch legal document for formal declaration of assets and their values, complying with Netherlands financial and regulatory requirements.
find out more
ұԾ’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; ұԾ’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it
.png)