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Personal Health Information Form Template for England and Wales

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Key Requirements PROMPT example:

Personal Health Information Form

"I need a Personal Health Information Form for our new private medical clinic opening in March 2025, which must comply with NHS data sharing requirements and include specific sections for mental health history and lifestyle information."

Document background
The Personal Health Information Form serves as a standardized method for collecting health-related data in compliance with English and Welsh law. It is designed to meet the requirements of the UK GDPR, Data Protection Act 2018, and other relevant healthcare legislation. This document is essential when gathering comprehensive health information from individuals, whether for medical treatment, insurance purposes, or research. It includes provisions for patient consent, data protection notices, and specific health information collection fields, ensuring both legal compliance and practical utility in healthcare settings.
Suggested Sections

1. Personal Information: Basic identifiers including name, date of birth, NHS number, contact details

2. Medical History: Current and past medical conditions, surgeries, hospitalizations

3. Medications: Current medications, dosages, and allergies

4. Consent Declaration: Patient's agreement for data processing and information sharing

5. Privacy Notice: Information about how personal data will be used, stored and shared

Optional Sections

1. Emergency Contacts: Contact details for next of kin, used when immediate family contact needed

2. Mental Health History: Specific section for mental health conditions, used in psychiatric settings

3. Lifestyle Information: Diet, exercise, smoking status etc., used for preventive care

4. Family Medical History: Hereditary conditions, used for risk assessment

Suggested Schedules

1. Consent Forms: Additional specific consent forms for particular treatments or data sharing

2. Medical Records: Copies of relevant medical records or test results

3. Privacy Policy: Detailed privacy policy and data protection information

4. Information Sharing Agreement: Details of how information may be shared with other healthcare providers

Authors

Alex Denne

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

Relevant legal definitions






























Clauses

























Relevant Industries
Relevant Teams
Relevant Roles
Industries

UK General Data Protection Regulation (UK GDPR): Core data protection legislation covering principles of data processing, legal basis for processing health data, special category data requirements, and data subject rights

Data Protection Act 2018: UK's implementation of GDPR, including additional requirements for health data and provisions for special category data

Access to Health Records Act 1990: Legislation governing rights of access to health records and management of deceased persons' records

Common Law Duty of Confidentiality: Legal principle covering medical confidentiality obligations and patient consent requirements

Human Rights Act 1998: Legislation incorporating Article 8 (right to privacy) and other human rights protections into UK law

Health and Social Care Act 2012: Legislation setting out information governance requirements and health service data sharing protocols

Mental Capacity Act 2005: Legislation covering consent considerations and decision-making capacity in healthcare

Caldicott Principles: Guidelines and protocols for handling patient information and information sharing in healthcare settings

NHS Act 2006: Legislation establishing statutory obligations regarding health records within the NHS

Professional Standards and Guidelines: Collection of professional guidelines including GMC guidance, NHS Digital standards, and ICO guidelines for healthcare information management

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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