The Medical Self Declaration Form is a crucial document in New Zealand's healthcare and employment landscape, designed to collect and record individual health information in compliance with local privacy and health information laws. It is commonly used when organizations need to assess an individual's health status for various purposes, including employment screening, insurance applications, sports participation, or activity enrollment. The form typically includes sections for personal information, current health status, medical history, medications, and lifestyle factors, with optional sections added based on specific requirements. All information collected through this form is protected under the Privacy Act 2020 and the Health Information Privacy Code 2020, ensuring confidential handling of sensitive health data. Organizations commonly require Medical Self Declaration Forms as part of their risk management and duty of care obligations.
Your data doesn't train Genie's AI
You keep IP ownership聽of your information
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
OR
Let tiktok成人版's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.
1. Personal Information: Collection of basic identifying information including full name, date of birth, contact details, and NHI number if applicable
2. Privacy Notice: Statement explaining how the personal health information will be collected, used, stored, and shared, in compliance with the Privacy Act 2020
3. General Health Status: Overview questions about current health status, including general wellbeing and any ongoing medical conditions
4. Medical History: Questions about past significant medical conditions, surgeries, and hospitalizations
5. Current Medications: List of all current medications, including prescribed, over-the-counter, and supplements
6. Family Medical History: Relevant family medical history for hereditary conditions
7. Lifestyle Factors: Questions about smoking, alcohol consumption, exercise, and other relevant lifestyle factors
8. Declaration and Consent: Final declaration of truth and accuracy, consent for information use, and signature section
1. Specific Condition Questionnaire: Detailed questions about specific medical conditions relevant to the purpose of the declaration (e.g., cardiovascular health for sports participation)
2. Occupational Health Requirements: Additional questions specific to job-related health requirements when the form is for employment purposes
3. Emergency Contact Information: Contact details for emergency situations, particularly relevant for sports or employment-related declarations
4. Physical Examination Results: Section for healthcare provider to document examination findings when the form requires medical verification
5. Mental Health Status: Questions about mental health conditions when relevant to the purpose of the declaration
6. Vaccination Status: Documentation of relevant vaccinations when required for specific purposes
7. COVID-19 Status: Specific questions about COVID-19 exposure, vaccination, and history when required
1. Schedule A - Detailed Medical Conditions List: Comprehensive list of medical conditions for reference when completing the form
2. Schedule B - Medications Guide: Reference guide for common medications and their generic/brand names to assist in accurate completion
3. Appendix 1 - Privacy Policy: Detailed privacy policy explaining how medical information will be handled
4. Appendix 2 - Glossary of Medical Terms: Definitions of medical terms used in the form to ensure accurate understanding and completion
Authors
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Education
Sports and Recreation
Transportation
Manufacturing
Construction
Mining
Aviation
Maritime
Public Service
Insurance
Professional Services
Food and Beverage
Childcare
Aged Care
Relevant Teams
Human Resources
Occupational Health
Health and Safety
Risk Management
Compliance
Medical Administration
Operations
Recruitment
Employee Relations
Legal
Insurance
Sports Administration
Relevant Roles
Human Resources Manager
Occupational Health Nurse
Health and Safety Officer
Risk Management Coordinator
Compliance Officer
Medical Administrator
Sports Coordinator
Insurance Underwriter
Recruitment Specialist
Employee Relations Manager
Workplace Health Coordinator
Operations Manager
School Administrator
Camp Director
Flight Operations Manager
Maritime Operations Supervisor
Construction Site Manager
Mining Safety Officer
Find the exact document you need
Statutory Declaration Name Change
A legal document used in New Zealand to formally declare and record a person's intention to change their name under NZ law.
find out more
Payment Declaration Letter
A formal New Zealand-compliant document declaring payment details and source of funds, used for legal and regulatory compliance purposes.
find out more
Declaration Of Value Form
A mandatory New Zealand customs document for declaring the true value of imported goods for duty and GST assessment purposes.
find out more
Declaration Of Ownership
A formal New Zealand legal document declaring ownership rights over specific property or assets, requiring proper execution under New Zealand law.
find out more
Declaration Of Indemnity
A New Zealand legal document where one party formally agrees to protect another against specified losses or damages.
find out more
Self Declaration Form For Vehicle Ownership Transfer
A New Zealand compliant self-declaration form for legally transferring vehicle ownership between parties, meeting Transport Agency requirements.
find out more
Declaration Of Residence
A formal legal document used in New Zealand to declare an individual's residential status for tax, immigration, and administrative purposes.
find out more
Cargo Declaration
A mandatory customs document required under New Zealand law that details cargo information for imports and exports, ensuring compliance with customs and biosecurity regulations.
find out more
Salary Declaration Form
A New Zealand-compliant form for declaring employee tax codes, KiwiSaver status, and salary details for payroll processing.
find out more
Referee Declaration Form
A New Zealand-compliant declaration form for sports officials that documents qualifications, commitments, and responsibilities under NZ law.
find out more
Medical Fitness Declaration Form
A New Zealand-compliant declaration form for assessing and documenting an individual's medical fitness for specific roles or activities, adhering to local privacy and health and safety regulations.
find out more
Supplier Declaration Form
A New Zealand-compliant declaration form for suppliers to verify their business details, capabilities, and compliance status under NZ law.
find out more
Police Declaration Form
A New Zealand legal document for declaring criminal history and consenting to police background checks, used for employment and licensing purposes.
find out more
Declaration Of Trust Form
A New Zealand legal document establishing a trust arrangement, defining trustee powers and beneficiary rights under NZ Trusts Act 2019.
find out more
Declaration Of Income Form
A New Zealand legal document for formally declaring all sources of income to authorities, subject to NZ tax legislation and administrative requirements.
find out more
Declaration Of Identity Form
A legally binding identity verification document used in New Zealand to formally declare and confirm an individual's identity details under New Zealand law.
find out more
Declaration Of Goods Form
A mandatory customs document for declaring imported goods to New Zealand Customs Service, detailing goods' nature, value, and compliance with import regulations.
find out more
Custodian Declaration Form
A New Zealand regulatory document where custodians declare their compliance and capability to safeguard assets under NZ financial markets legislation.
find out more
Superannuation Declaration Form
A New Zealand-compliant form for declaring KiwiSaver retirement savings scheme participation details and preferences.
find out more
Income Declaration Letter
A New Zealand-compliant formal letter declaring an individual's income sources and amounts for official purposes, subject to NZ tax and declaration laws.
find out more
Declaration Of Support
A New Zealand legal document declaring formal commitment to provide support to another person, commonly used in immigration and family support contexts.
find out more
Residency Declaration
A legally binding document under New Zealand law where individuals formally declare their residency status for tax, immigration, or other official purposes.
find out more
Self Declaration Form For Income Certificate
A New Zealand legal document where individuals formally declare their income sources and amounts, used for official income verification purposes under NZ law.
find out more
It Declaration Form
A New Zealand-compliant IT Declaration Form for documenting user acceptance of IT policies and security responsibilities.
find out more
State Declaration Form
A legally binding declaration document used in New Zealand for making formal statements under the Oaths and Declarations Act 1957.
find out more
Permit Declaration
A formal legal declaration used in New Zealand's regulatory system for permit-related matters, requiring proper witnessing and carrying legal weight.
find out more
Statutory Declaration
A formal written statement declared to be true under New Zealand law, witnessed by an authorized person and carrying legal consequences for false declarations.
find out more
Name Change Declaration Form
A legal form used in New Zealand for officially declaring and registering a change of name under the Births, Deaths, Marriages, and Relationships Registration Act 1995.
find out more
Sponsorship Declaration
A New Zealand legal document establishing sponsorship commitments and obligations between parties, compliant with NZ immigration and contract law.
find out more
Power Of Attorney Declaration
A New Zealand legal document authorizing one or more persons to act on behalf of another, governed by the Protection of Personal and Property Rights Act 1988.
find out more
Declaration For Application Form
A New Zealand legal document where an individual formally declares the truth of statements made in an application, witnessed by an authorized person under NZ law.
find out more
Court Declaration Form
A formal sworn statement used in New Zealand courts to provide evidence or testimony under oath, requiring authorized witness verification.
find out more
Third Party Declaration
A formal legal document under New Zealand law where a third party makes a sworn statement of facts or circumstances, typically used as evidence or formal confirmation of matters within their knowledge.
find out more
Self Declaration Form For Address Proof
A legally binding document used in New Zealand where individuals formally declare their residential address, witnessed by an authorized person under NZ law.
find out more
Self Attested Declaration Form
A legally binding declaration document under New Zealand law where individuals formally attest to the truth of stated facts, witnessed by authorized persons.
find out more
Quarantine Declaration Form
A mandatory declaration form required under New Zealand law for all individuals entering the country, used to identify and control biosecurity risks at the border.
find out more
Guarantor Declaration Form
A New Zealand legal document where a guarantor formally declares their commitment to assume responsibility for another party's financial obligations under New Zealand law.
find out more
Customs Clearance Form
A mandatory customs declaration form for importing/exporting goods through New Zealand borders, compliant with NZ Customs and Excise Act 2018.
find out more
Declaration Of Guardianship
A New Zealand legal document that formally establishes guardianship rights and responsibilities for a child under the Care of Children Act 2004.
find out more
Declaration Form For International Travel
A mandatory declaration form for international travelers entering New Zealand, required under New Zealand customs, immigration, and biosecurity legislation.
find out more
骋别苍颈别鈥檚 Security Promise
Genie is the safest place to draft. Here鈥檚 how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; 骋别苍颈别鈥檚 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)