Medical Declaration Form

Medical Declaration Form Template for Singapore

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Key Requirements PROMPT example:

"I need a Medical Declaration Form for my Singapore-based medical clinic that includes comprehensive health history sections and specific Covid-19 vaccination status, to be implemented by March 2025 for all new patients."

Document background

The Medical Declaration Form is a crucial document in Singapore's healthcare ecosystem, designed to collect comprehensive medical information from individuals for various purposes including treatment, insurance, employment, or travel. It adheres to Singapore's strict healthcare regulations and data protection laws, requiring accurate disclosure of medical conditions, treatments, and health history. The form serves as both a legal record and a medical reference document, helping healthcare providers, insurers, and other authorized parties make informed decisions while protecting patient privacy rights.

Suggested Sections

1. Personal Information: Basic identification details including full name, NRIC/passport number, date of birth, contact information, and address

2. Medical History Declaration: Comprehensive section for declaring current and past medical conditions, surgeries, hospitalizations, and treatments

3. Current Medications: Declaration of all current prescriptions, supplements, and regular medications being taken

4. Emergency Contact Information: Details of primary and secoNDAry emergency contacts

5. Declaration Statement: Formal statement confirming the truth and accuracy of provided information, with legal implications under Singapore law

Optional Sections

1. Family Medical History: Section for declaring relevant family medical conditions and hereditary diseases

2. Travel History: Details of recent travel, particularly relevant during infectious disease outbreaks

3. Vaccination Records: Section for declaring vaccination status and history

4. Lifestyle Factors: Information about smoking, alcohol consumption, and other lifestyle factors affecting health

5. Insurance Information: Details of medical insurance coverage and policy numbers

Suggested Schedules

1. Schedule A - Medical Reports: Attachment of relevant medical reports, test results, or specialist letters

2. Schedule B - Vaccination Certificates: Copies of official vaccination records and certificates

3. Schedule C - Privacy Notice: Detailed information about data protection rights and medical privacy under PDPA

4. Schedule D - List of Notifiable Diseases: Reference list of diseases that must be declared under Singapore law

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok��˰� | 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
Employment
Travel

Relevant Teams

Human Resources
Medical Records
Compliance
Legal
Risk Management

Relevant Roles

Medical Officer
HR Manager
Insurance Underwriter
Compliance Officer
Healthcare Administrator

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Let's create your Medical Declaration Form

Authors

Alex Denne

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