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Health Information Form

Health Information Form Template for Hong Kong

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Key Requirements PROMPT example:

Health Information Form

"I need a comprehensive Health Information Form for my new private clinic opening in Hong Kong in March 2025, compliant with local privacy laws and suitable for both general practice and specialist consultations, with particular emphasis on chronic disease management."

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Document background
The Health Information Form serves as a fundamental document in Hong Kong's healthcare system, designed to collect comprehensive patient health information while ensuring compliance with local data protection laws and medical regulations. This document is typically used during patient registration at healthcare facilities, medical screenings, or when establishing new patient-provider relationships. It captures essential health data including medical history, current conditions, medications, allergies, and lifestyle factors, while incorporating necessary privacy notices and consent mechanisms required under Hong Kong's Personal Data (Privacy) Ordinance and healthcare regulations. The form is structured to balance detailed information gathering with patient privacy protection, making it suitable for various healthcare settings from private clinics to public hospitals.
Suggested Sections

1. Personal Information: Basic identification details including name, ID number, date of birth, gender, contact information

2. Privacy Notice: Statement explaining how personal health information will be collected, used, and protected in accordance with the Personal Data (Privacy) Ordinance

3. Emergency Contact Information: Details of primary and secondary emergency contacts

4. Current Health Status: Present health conditions, medications, allergies, and ongoing treatments

5. Medical History: Past medical conditions, surgeries, hospitalizations, and significant health events

6. Family Medical History: Relevant family health conditions and genetic predispositions

7. Lifestyle Information: Information about diet, exercise, smoking, alcohol consumption, and other lifestyle factors

8. Current Healthcare Providers: List of current doctors, specialists, and other healthcare providers

9. Consent Declaration: Patient's consent for information collection, storage, and sharing with relevant healthcare providers

10. Signature Section: Space for patient signature, date, and witness signature if required

Optional Sections

1. Insurance Information: Details of health insurance coverage, to be included when form is used for insurance purposes

2. Specialist Medical Information: Detailed questions about specific medical conditions, to be included based on patient's known conditions or specialist requirements

3. Vaccination History: Detailed vaccination record, to be included when required for specific medical or administrative purposes

4. Mental Health History: Specific section for mental health conditions and treatments, to be included when relevant to the medical context

5. Reproductive Health History: Section for reproductive health information, to be included when relevant to the medical context

6. Travel History: Recent travel history and related health concerns, particularly relevant during infectious disease outbreaks

7. Occupational Health Information: Work-related health risks and exposures, to be included when form is used for occupational health purposes

Suggested Schedules

1. Schedule A - Detailed Medical History Form: Comprehensive questionnaire for detailed medical history

2. Schedule B - Medication List: Detailed list of current and past medications, including dosages and frequencies

3. Schedule C - Allergy and Adverse Reaction Log: Detailed documentation of known allergies and adverse reactions

4. Appendix 1 - Specific Condition Questionnaire: Detailed questions for specific medical conditions (e.g., diabetes, heart disease)

5. Appendix 2 - Privacy Policy Details: Detailed explanation of data protection measures and patient rights regarding their health information

6. Appendix 3 - Consent Forms: Additional specific consent forms for particular treatments or information sharing

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Linkedin in social icon imageX social icon image
alex.den.21@genieai.co
Relevant legal definitions
Personal Data
Health Information
Medical History
Healthcare Provider
Medical Professional
Consent
Emergency Contact
Authorized Representative
Medical Record
Confidential Information
Treatment
Prescribed Medication
Pre-existing Condition
Chronic Condition
Data Processing
Data Protection
Privacy Notice
Medical Facility
Hospital Authority
Healthcare Services
Patient
Guardian
Next of Kin
Sensitive Personal Data
Electronic Health Record
Data Subject
Data User
Medical Practitioner
Registered Healthcare Institution
Allergies and Adverse Reactions
Relevant Industries

Healthcare

Insurance

Occupational Health

Education

Sports and Recreation

Elder Care

Child Care

Mental Health Services

Public Health

Corporate Wellness

Relevant Teams

Medical Records

Compliance

Patient Services

Administrative Services

Risk Management

Data Protection

Clinical Operations

Quality Assurance

Front Desk Operations

Insurance Processing

Relevant Roles

Medical Doctor

Nurse

Healthcare Administrator

Medical Records Officer

Compliance Officer

Privacy Officer

Insurance Claims Processor

Occupational Health Manager

Clinical Director

Practice Manager

Data Protection Officer

Healthcare Facility Manager

Medical Secretary

Patient Services Coordinator

Risk Management Officer

Industries
Personal Data (Privacy) Ordinance (Cap. 486): The primary legislation governing collection, use, and handling of personal data in Hong Kong, including sensitive health information. Contains specific provisions for medical data protection.
Code of Practice on the Protection of Patient Data: Guidelines issued by the Hong Kong Medical Council specifically addressing the handling and protection of patient medical information.
Hospital Authority Ordinance (Cap. 113): Governs the management and control of public hospitals and their handling of patient information and medical records.
Electronic Health Record Sharing System Ordinance (Cap. 625): Regulates the electronic health record sharing system and protection of health data in electronic format.
Medical Registration Ordinance (Cap. 161): Contains provisions regarding medical practitioners' obligations in maintaining patient records and confidentiality.
Contract Law under Common Law System: General principles of contract law that govern the formation and execution of the health information form as a legal document.
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,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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