Patient Declaration Form

Patient Declaration Form Template for England and Wales

Create a bespoke document in minutes, or upload and review your own.

4.6 / 5

4.8 / 5

Let's create your Patient Declaration Form

1. Select your governing law and document type:

2. Enter your key requirements:

3. Create your document to edit, review or download

Get your first 2 documents free

Your data doesn't train Genie's AI

You keep IP ownership of your information

Key Requirements PROMPT example:

"I need a Patient Declaration Form for my private dental clinic in Cardiff that includes specific consent for dental X-rays and permission to share records with referring dentists, compliant with Wales NHS requirements for January 2025."

Document background

The Patient Declaration Form is a crucial document in the English and Welsh healthcare system, designed to protect both patients and healthcare providers. It serves multiple purposes: documenting informed consent, confirming the accuracy of patient-provided information, and establishing clear communication about proposed treatments or procedures. This form is particularly important in situations requiring explicit patient consent, such as surgical procedures, clinical trials, or when sharing medical information with third parties. It must align with the UK GDPR, Data Protection Act 2018, and various healthcare regulations, while following NHS guidelines and professional standards.

Suggested Sections

1. Patient Information: Basic demographic and contact details of the patient including full name, date of birth, NHS number, address, and contact information

2. Declaration of Truth: Patient's confirmation that all provided information is accurate and true to the best of their knowledge

3. Consent Statement: Express consent for specific medical procedures, treatments, or data processing, including acknowledgment of risks and benefits

4. Privacy Notice: Information about how patient data will be used, stored, shared and protected in accordance with UK GDPR and Data Protection Act 2018

5. Signature Block: Space for patient signature, date, and witness signature where required, including capacity verification

Optional Sections

1. Emergency Contact Details: Section for recording next of kin or emergency contact information, used for ongoing care or emergency situations

2. Medical History Summary: Section for recording relevant medical history, allergies, and current medications, used for new patient registration or specific treatments

3. Advance Decisions: Section for documenting patient's preferences for future medical treatment and care decisions

4. Mental Capacity Assessment: Section for documenting assessment of patient's capacity to make decisions, used when capacity might be in question

Suggested Schedules

1. Information Leaflet: Detailed information about specific procedures, treatments, or services being provided

2. Rights and Responsibilities: Comprehensive summary of patient rights and responsibilities under NHS and relevant healthcare legislation

3. Privacy Policy: Detailed data protection and privacy information, including data sharing agreements and patient rights under UK GDPR

4. Consent Forms: Additional specific consent forms for particular procedures or data processing activities

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 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

Relevant Teams

Relevant Roles

��������Ƶ

How ��������Ƶ reduced drafting time by 75% for a legal firm

Let's create your Patient Declaration Form

Authors

Alex Denne

Find the exact document you need

Supplier Declaration Form

Self Declaration Form For Rc Transfer

Self Declaration Form For Passport

Self Declaration Form For Birth Certificate

Self Declaration Form For 11th Admission

Residency Declaration Form

Self Declaration Affidavit

Police Declaration Form

Online Wealth Declaration Form For Public Servants

Non Employment Declaration Form

New Declaration Form

Name Declaration Affidavit

Medical Declaration Form

International Declaration Form

Income Self Declaration Form

Immigration Declaration Form

Employment Declaration Form For New Employee

Declaration Of Trust Form

Declaration Of Solvency Form

Declaration Of Income Form

Declaration Of Identity Form

Declaration Of Goods Form

Declaration Of Assets And Liabilities Form

Declaration Letter To Whom It May Concern

Declaration Letter For Subsidiary Company

Declaration Form For Job Application

Declaration Form For Courier

Customs Declaration Form

Custodian Declaration Form

Conflict Of Interest Declaration Form For Employees

Beneficial Ownership Declaration Form

Asset Declaration Form For Govt Employees

Arrival Declaration Form

Customs Entry Form

Non Employment Certificate Self Declaration

Rent Agreement For Tax Declaration

House Rent Declaration Form For Income Tax

Declaration Form For Delayed Birth Certificate

Declaration For Federal Employment

Declaration Of Non Ownership

Social Development Declaration Form

Health Declaration Card Form

Form 1 Self Declaration

Income Declaration Letter

Resident Visa Declaration Form

Foreign Transfer Duty Declaration

Self Declaration Form For Name Change

Self Declaration Form For Income Certificate

Self Declaration Form For Legal Heir Certificate

Nominee Declaration Form

Declaration Of Independent Contractor Status Form

Declaration Form For Change Of Home Address

State Declaration Form

Self Declaration Form For Medical Reimbursement

Manufacturer Declaration Letter

Job Declaration Letter

Sponsorship Declaration Letter

Relationship Declaration Letter

Employer Declaration Form

Custom Passenger Declaration Form

Airline Declaration Form

Self Declaration Letter

Self Declaration Form For Unemployment

Property Declaration Form

Occupancy Declaration Form

Name Change Declaration Form

House Rent Declaration Form

Declaration And Certification Of Finances

Birth Declaration Form

Self Declaration Form For Marriage Certificate

Social Declaration Form

Job Declaration Form

Electronic Health Declaration

Change Of Name Declaration

��Ƶ

How ��Ƶ reduced drafting time by 75% for a legal firm

�ұ�Ծ��’s Security Promise