Electronic Health Declaration

Electronic Health Declaration Template for Denmark

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Document background

The Electronic Health Declaration serves as a standardized digital format for individuals to declare their health status and medical history in Denmark. This document type emerged from the increasing digitalization of healthcare services and the need for secure, standardized methods of collecting health information. It complies with the Danish Health Act, Danish Data Protection Act, and EU GDPR, particularly regarding the handling of sensitive personal data. The declaration is commonly used in healthcare settings, insurance applications, employment processes, and public health monitoring. It includes comprehensive health information, current medications, medical history, and necessary consents for data processing. The electronic format ensures efficient processing while maintaining strict security standards required for handling sensitive health data. The document's structure allows for various use cases while ensuring consistency in health information collection and processing across different sectors in Denmark.

Suggested Sections

1. Declaration Details: Basic information including the declarant's identification details, date of declaration, and unique reference number

2. Purpose of Declaration: Clear statement of the purpose for which this health declaration is being made

3. Personal Information: Declarant's personal details including full name, CPR number (Danish personal ID), contact information, and emergency contact details

4. Health Information: Core health information being declared, structured according to relevant medical categories

5. Medical History: Relevant medical history including past conditions, surgeries, and ongoing treatments

6. Current Medications: List of current medications, including dosage and frequency

7. Consent and Data Processing: Explicit consent for processing health data and sharing with relevant healthcare providers

8. Declaration of Truth: Statement confirming that all provided information is true and complete to the best of declarant's knowledge

9. Electronic Signature: Section for electronic signature and verification method used

10. Data Protection Notice: Information about how the declared health data will be processed, stored, and protected

Optional Sections

1. Family Medical History: Section for relevant family medical history when genetic factors are important for the declaration purpose

2. Lifestyle Information: Information about lifestyle factors affecting health, used when relevant to the specific purpose of the declaration

3. Insurance Details: Section for insurance information when the declaration is being made for insurance purposes

4. Workplace Information: Details about workplace and occupational health factors when the declaration is for employment-related purposes

5. Travel History: Recent travel history when relevant for infectious disease monitoring or similar purposes

6. Vaccination Records: Detailed vaccination history when required for specific purposes

7. Disability Information: Information about any disabilities when relevant for accommodation or support purposes

Suggested Schedules

1. Schedule A - Medical Categories Checklist: Detailed checklist of medical conditions and symptoms to be completed

2. Schedule B - Medication List Template: Structured template for listing current and recent medications

3. Schedule C - Supporting Documentation List: List of any supporting medical documents or test results attached to the declaration

4. Schedule D - Data Processing Details: Detailed information about data processing procedures and data controller information

5. Schedule E - Terms and Definitions: Definitions of medical and technical terms used in the declaration

6. Appendix 1 - Rights and Obligations: Detailed information about the declarant's rights and obligations under Danish healthcare and data protection law

7. Appendix 2 - Privacy Notice: Comprehensive privacy notice detailing how personal and health data will be handled

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