The Health Declaration Form is a crucial document used in the Philippines for monitoring and managing public health risks while ensuring compliance with data privacy laws. It became particularly significant during public health emergencies but remains relevant for ongoing health monitoring and risk management. The form collects essential information including current health status, travel history, and potential exposure to infectious diseases, while incorporating privacy notices and consent mechanisms as required by Philippine law. This document is typically required before entry into facilities, attendance at events, or participation in activities where health monitoring is necessary for public safety. The form must comply with the Data Privacy Act of 2012, the Mandatory Reporting of Notifiable Diseases Act, and other relevant Philippine healthcare regulations.
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1. Personal Information: Collection of basic identification details including full name, date of birth, contact information, and ID numbers
2. Health Status Declaration: Current health condition, symptoms checklist, and recent medical history
3. Travel History: Recent travel details, including dates and locations within the past 14 days
4. Contact History: Information about exposure to persons with infectious diseases or symptoms
5. Privacy Notice: Statement about data collection, use, and protection in compliance with the Data Privacy Act
6. Declaration and Consent: Formal attestation of truth and accuracy of provided information, with signature and date
7. Emergency Contact Information: Details of person to contact in case of emergency
1. Vaccination Status: Details of COVID-19 or other relevant vaccinations - optional unless required by specific circumstances
2. Medical History: Detailed medical history section - include when form is for healthcare provider use
3. Workplace Information: Employment details - include when form is for workplace health monitoring
4. Temperature Reading: Current temperature reading - include when form is used for immediate screening
5. Insurance Information: Health insurance details - include when form is for healthcare service provision
1. Symptom Checklist: Detailed list of symptoms to be checked by declarant
2. Privacy Policy: Detailed privacy policy and data handling procedures
3. Contact Tracing Protocol: Procedures for contact tracing if required
4. Guidelines for Self-Monitoring: Instructions for self-monitoring of symptoms
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Education
Corporate
Government
Hospitality
Events and Entertainment
Travel and Tourism
Manufacturing
Retail
Transportation
Relevant Teams
Human Resources
Health and Safety
Operations
Legal
Compliance
Risk Management
Security
Medical Services
Facilities Management
Administrative Services
Relevant Roles
Human Resources Manager
Health and Safety Officer
Facility Manager
Medical Director
Compliance Officer
Risk Manager
Operations Manager
School Administrator
Event Coordinator
Travel Manager
Occupational Health Nurse
Security Manager
Legal Counsel
Privacy Officer
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