Patient Declaration Form

Patient Declaration Form Template for Denmark

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Document background

The Patient Declaration Form is a mandatory document required in Danish healthcare settings before initiating medical treatment or procedures. It serves multiple critical purposes: documenting patient consent, confirming understanding of rights and responsibilities, and ensuring compliance with Danish healthcare regulations. This form must be completed at the outset of patient care and updated as necessary during the course of treatment. It includes sections for patient identification, medical history disclosure, consent to treatment, and data protection acknowledgments. The document is designed to meet requirements set forth in Danish healthcare legislation, including the Danish Health Act and Patients' Rights Act, while also addressing GDPR compliance through the Danish Data Protection Act. Healthcare providers must ensure this form is properly completed and maintained as part of the patient's medical record.

Suggested Sections

1. Patient Information: Basic identification details including full name, CPR number (Danish personal ID), address, and contact information

2. Healthcare Provider Information: Details of the healthcare facility, department, and treating physician

3. Medical Information Disclosure: Declaration regarding the accuracy of provided medical information and authorization to access existing medical records

4. Consent to Treatment: General consent for medical examination, treatment, and necessary procedures

5. Data Protection Declaration: Acknowledgment of how personal health data will be processed and stored in accordance with GDPR and Danish law

6. Emergency Contact Information: Details of person(s) to be contacted in case of emergency

7. Patient Rights Acknowledgment: Confirmation that patient has been informed of their rights under Danish healthcare law

8. Signature and Date: Space for patient signature, date, and witness signature if required

Optional Sections

1. Interpreter Declaration: Required when patient needs language interpretation services, confirming information has been accurately translated

2. Legal Representative Authorization: Required for minors or adults unable to provide consent, including guardian/representative details

3. Research Participation: Optional consent for use of medical data in research studies

4. Photography Consent: Optional authorization for medical photography if needed for treatment documentation

5. Special Treatment Risks: Required for specific procedures with significant risks or side effects

6. Insurance Information: Required for private healthcare facilities or specific treatment arrangements

Suggested Schedules

1. Patient Rights Information Sheet: Detailed explanation of patient rights under Danish healthcare law

2. Data Protection Privacy Notice: Detailed information about personal data processing and privacy rights

3. Specific Procedure Information: Detailed information about specific medical procedures when applicable

4. Hospital/Clinic Policies: Relevant facility policies and procedures that patient should be aware of

5. Contact Information Sheet: List of important contacts including department numbers, emergency contacts, and patient support services

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