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The form requests disclosure of relevant medical history and current health details, including disability status, with answers completed in capital letters and supplemented by further medical assessment where necessary. Employment offer is conditional on satisfactory return and no newly disclosed issues. It also includes a consent section explaining how the employer may request confidential medical reports from a doctor as part of recruitment, and outlines rights under the Access to Medical Reports Act 1988.","MEDICAL QUESTIONNAIRE\n[Company] is committed to the health and safety of its staff. As part of these commitments, this Medical Questionnaire should be completed by all staff prior to commencing employment with us.\n[Company], is a diligent employer and takes its legal obligations very seriously. Consequently, we are required to make assessments of risks to which our employees may be exposed at work, and a proper risk assessment involves considering not only the nature of the job, but also the fitness of the employee to carry out that work. All questions asked are asked in the spirit of the Equality Act 2010. This questionnaire, where necessary, will be supplemented by a further medical assessment and, as indicated in your Offer Letter, our offer of employment is conditional on your satisfactory completion and return of this questionnaire and there being no new issues that cause concern upon which we were not previously informed/aware pre your receipt of your offer of employment.\nThis questionnaire should be completed as fully as possible and to the best of your knowledge.\nPLEASE COMPLETE IN CAPITAL LETTERS\nMEDICAL HISTORY\nPlease complete the following questions by ticking the appropriate box. If the answer is ‘yes’, give details including (a) date, (b) amount of time lost from work, (c) treatment, as appropriate.\n1.\tHave you ever suffered from any of the following illnesses?\n2.\tPlease confirm if you have ever:\n3.\tDetails of your current health status:\nDo you suffer from a disability?\nDeclaration\nI declare that the information I have given in this form is, to the best of my knowledge, true and complete. I understand that if it is subsequently discovered any statement is false or misleading, or that I have withheld relevant information, I may be dismissed. I hereby give my consent to the Company processing the data supplied on this application form.\nSigned:\nDate:\n\u000f\nACCESS TO MEDICAL INFORMATION – CONSENT FORM\nIn order to clarify the information that you have given in this questionnaire (but only where we believe that it reasonably necessary), it may be necessary for [Company] to apply to your doctor for a report. The content of any such report is confidential. This consent relates only to a request to your doctor as part of the recruitment process and will not be used later in any other context.\nOnce you have filled in the relevant details below, ensure that you have carefully read your rights under the Access to Medical Reports Act 1988 (as summarised below) and sign the declaration at the bottom.\nGUIDANCE OF ACCESS TO MEDICAL REPORTS\nBefore you give your consent for an application to be made for a report giving medical information, you should be aware that you have certain rights under the Access to Medical Reports Act 1988.  In summary these rights are:\n1.\tto withhold your consent for an application to be made to your doctor;\n2.\tto arrange to see a medical report before it is supplied by your doctor;\n3.\tto ask your doctor to amend any part of the report which you consider to be inaccurate or misleading; and\n4.\tif your doctor declines to amend the report, he must attach a written statement giving your views on its content; or\n5.\tto withhold your consent to the report being supplied.\nYour rights under the Act and the procedures for applying them are set out in detail below:\nUnder the Act an employer cannot without your consent apply for a medical report from a doctor who has been responsible for your physical or mental health care.  The consent form also asks, in accordance with the Act, whether you wish to see the report before it is sent.\nIf you decide that you would like to see the report first, the employer will advise the doctor of the fact and will notify you of the date that the application for the medical report is actually made.  You will then have 21 days in which to make arrangements with the doctor to see the report.  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