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Patient Declaration Form

Patient Declaration Form Template for Hong Kong

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Key Requirements PROMPT example:

Patient Declaration Form

"I need a Patient Declaration Form for my private healthcare clinic in Hong Kong that specializes in aesthetic medicine, with specific emphasis on photo consent and cosmetic procedure documentation, to be implemented by March 2025."

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Document background
The Patient Declaration Form is a crucial document required in Hong Kong healthcare settings before providing medical services to patients. It serves multiple purposes: documenting patient consent for treatment, collecting essential medical history, ensuring compliance with data privacy laws, and establishing financial responsibility for services. This document is mandatory under various Hong Kong healthcare regulations and must be completed prior to non-emergency medical treatment. It includes provisions aligned with the Personal Data (Privacy) Ordinance, Hospital Authority Ordinance, and other relevant healthcare legislation. The form is designed to protect both patient rights and healthcare provider interests while ensuring clear communication of important healthcare policies and procedures.
Suggested Sections

1. Patient Information: Basic personal details including name, ID number, date of birth, contact information, and emergency contact details

2. Medical History Declaration: Patient's declaration of relevant medical history, allergies, current medications, and pre-existing conditions

3. Consent for Treatment: General consent for medical examination, treatment, and procedures

4. Data Privacy Statement: Declaration regarding the collection, use, and sharing of personal health information in accordance with the Personal Data (Privacy) Ordinance

5. Financial Responsibility: Acknowledgment of financial obligations and payment terms for medical services

6. Hospital Policies: Acknowledgment of understanding and agreement to comply with hospital rules and policies

Optional Sections

1. Research Participation: Optional consent for anonymized data to be used in medical research

2. Photography Consent: Optional permission for clinical photography for treatment documentation

3. Student Training Consent: Optional consent for medical students to observe/participate in care (for teaching hospitals)

4. Interpreter Declaration: Required when patient requires language interpretation services

5. Guardian Declaration: Required for minors or patients lacking mental capacity

Suggested Schedules

1. Schedule 1: Hospital Services Information: List of available hospital services and associated costs

2. Schedule 2: Patient Rights and Responsibilities: Detailed explanation of patient rights and responsibilities within the healthcare facility

3. Appendix A: Privacy Policy: Detailed privacy policy and data handling procedures

4. Appendix B: Specific Procedure Consent Forms: Additional consent forms for specific medical procedures if required

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 Industries

Healthcare

Medical Services

Hospital Administration

Private Healthcare

Public Healthcare

Medical Insurance

Healthcare Technology

Relevant Teams

Legal

Compliance

Patient Services

Registration

Medical Records

Risk Management

Quality Assurance

Operations

Administration

Clinical Governance

Relevant Roles

Hospital Administrator

Medical Director

Compliance Officer

Legal Counsel

Privacy Officer

Chief Medical Officer

Patient Services Manager

Registration Staff

Healthcare Operations Manager

Risk Management Officer

Medical Records Manager

Quality Assurance Manager

Industries
Personal Data (Privacy) Ordinance (Cap. 486): Governs the collection, handling, and protection of patients' personal data in Hong Kong, ensuring privacy rights are protected during medical treatment
Medical Registration Ordinance (Cap. 161): Regulates medical practitioners and establishes the framework for professional medical practice in Hong Kong, including patient care standards
Mental Health Ordinance (Cap. 136): Relevant for cases involving mental health patients, covering consent and treatment decisions for patients with mental incapacity
Hospital Authority Ordinance (Cap. 113): Establishes the legal framework for public healthcare services and hospital management in Hong Kong
Undesirable Medical Advertisements Ordinance (Cap. 231): Ensures medical information provided to patients is accurate and not misleading
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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