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Medical Self Declaration Form

Medical Self Declaration Form Template for Saudi Arabia

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Key Requirements PROMPT example:

Medical Self Declaration Form

"I need a Medical Self Declaration Form for our oil and gas company in Saudi Arabia, compliant with both Ministry of Health and industrial safety regulations, to be implemented by March 2025 for all new employees working in offshore facilities."

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Document background
The Medical Self Declaration Form is a crucial document used across various sectors in Saudi Arabia to collect and verify individual health information. It serves as a legal instrument for declaring one's medical status and history, complying with Saudi Arabian healthcare regulations and privacy laws. The form is commonly required for employment processes, insurance applications, educational enrollment, travel requirements, or general medical record-keeping. It typically includes sections for personal information, current health status, medical history, family health background, and relevant lifestyle factors. The document must adhere to standards set by the Saudi Ministry of Health and the Saudi Commission for Health Specialties, while also respecting Islamic Shariah principles regarding privacy and consent.
Suggested Sections

1. Personal Information: Basic identification details including full name (in Arabic and English), national ID/Iqama number, date of birth, gender, and contact information

2. Declaration Purpose: Clear statement of why the declaration is being made (e.g., employment, insurance, travel) and which institution requires it

3. Current Health Status: Statement of present health conditions, medications, and ongoing treatments

4. Medical History: Comprehensive section covering past medical conditions, surgeries, hospitalizations, and chronic conditions

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

6. Lifestyle Factors: Information about smoking, exercise, diet, and other relevant lifestyle factors

7. Declaration of Truth: Legal statement confirming that all provided information is true and complete

8. Consent and Authorization: Permission for the relevant institution to verify information and share with necessary parties

9. Signature and Date: Space for declarant's signature, date, and witness signature if required

Optional Sections

1. COVID-19 Status: Additional section for declaring COVID-19 vaccination status and history - include when required by specific institutions

2. Travel History: Section for recent travel history and potential exposure to diseases - include for travel-related declarations

3. Occupational Health Risks: Section specific to work-related health risks - include for employment-related declarations

4. Pregnancy Status: Section for female declarants regarding current or planned pregnancy - include when relevant to medical assessment

5. Mental Health History: Detailed mental health information - include when specifically required by the requesting institution

6. Vaccination Record: Detailed vaccination history - include when required for specific purposes like travel or employment

Suggested Schedules

1. List of Medications: Detailed list of current medications, dosages, and duration of use

2. Medical Test Results: Recent relevant medical test results or reports to be attached

3. Vaccination Certificates: Copies of relevant vaccination certificates

4. Supporting Medical Documentation: Any additional medical reports or documentation referenced in the main form

5. Institution-Specific Requirements: Additional forms or documentation required by the specific institution requesting the declaration

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok成人版 | 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

Insurance

Education

Aviation

Oil & Gas

Construction

Manufacturing

Hospitality

Transportation

Government Services

Professional Services

Sports & Recreation

Relevant Teams

Human Resources

Legal

Compliance

Risk Management

Occupational Health

Medical Services

Insurance

Health and Safety

Employee Relations

Medical Records

Privacy and Data Protection

Relevant Roles

Human Resources Manager

Medical Director

Occupational Health Officer

Compliance Officer

Risk Manager

Health and Safety Manager

Insurance Underwriter

School Nurse

Corporate Medical Officer

Employment Manager

Healthcare Administrator

Legal Counsel

Privacy Officer

Employee Relations Manager

Medical Records Manager

Industries







Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks, 聽Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination, 聽Severance Pay, Governing Law, Entire Agreemen

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