Bilingual patient intake form for UAE clinics

• Identity. Full name as on the Emirates ID or passport, the ID number, date of birth and sex. Article 21 of Federal Law No. 2 of 2019 requires the ID number in all health transactions, records and files, emergencies apart, and Abu Dhabi asks facilities to read it with an Emirates ID card reader connected to the EMR (DOH HIE Standard 1).
• Contact and emergency contact. Mobile number, email and one person to call in an emergency.
• Insurance. Insurer, member or policy number and expiry, so the front desk can check eligibility before the visit. A wrong member number can come back as an ELIG denial; our claim rejection decoder explains those codes.
• Medical history, medicines and allergies. Long-term conditions, past surgery and admissions, everything the patient takes (including supplements) and drug, food, latex, anaesthetic and contrast allergies.
• Consents. Consent to examination and treatment, the health information exchange notice for your emirate, and an optional consent for reminders and updates.

Ask only for what you need. Abu Dhabi's data security standard tells facilities to “collect sufficient and limited PII and PHI, necessary in accordance with the purpose” ( ADHICS V2), which is a sound rule everywhere. The builder leaves the lifestyle and family history sections off by default; add them only if your specialty needs them.

For consent forms in Dubai, yes: the Dubai Health Authority's patient consent guidelines say “Forms shall be in Arabic and English” and that a form must show the patient's full name as on the passport or Emirates ID, age, gender and patient identification number (DHA consent guidelines, section 7). We found no rule that sets the language of the registration form itself, but putting both languages side by side means one form serves every patient and its consent wording already meets the Dubai rule. The builder prints English and Arabic next to each other, with the Arabic laid out right to left.

Consent to examination and treatment

Under Article 5 of Federal Decree-Law No. 4 of 2016 on medical liability, a doctor may not treat a patient without consent except in an emergency, and Article 8 requires written consent for surgery (Medical Liability Law). Abu Dhabi's 2025 patient consent standard describes a general consent that covers admission, registration, assessments and examinations (DOH consent standard), and that is the role of the treatment consent in this form. Procedures that carry specific risks still need their own informed consent form.

Children

A minor is anyone under 18. A parent or legal guardian signs for them; in Dubai, where parents are divorced, the parent with custody gives consent, and in Abu Dhabi a substitute consent giver must be at least 18.

Photographs

Dubai's guidelines require a separate informed consent for clinical photography, which matters for dermatology, dental and aesthetic clinics that take before-and-after photos. Add it as its own question rather than folding it into the general consent.

Dubai (NABIDH):the Dubai Health Authority's data protection policy says a facility “must get consent from Data Subject for accessing his/her PHI through Nabidh HIE”, that the consent should include an easy opt-out, and that it lasts for life unless the patient opts out (DHA policy, section 4.11). NABIDH's patient rights document confirms that records are shared unless the patient opts out, and that patients can opt back in at any time (NABIDH subject of care rights).

Abu Dhabi (Malaffi):participation is mandatory. The Department of Health's exchange policy makes “universal patient participation in and sharing of data” with the platform compulsory (DOH HIE policy), and its security standard lists information exchange with Malaffi among the uses that do not need consent (ADHICS V2). The 2025 consent standard still refers to consent for sharing under that policy, so tell patients clearly that their records are shared through Malaffi and check your wording against the current standard (DOH consent standard).

Northern emirates (Riayati): Riayati is the National Unified Medical Record (u.ae). Check the ministry's current patient notice wording before you print.

The builder's data-sharing section is one checkbox written to cover all three exchanges. Edit it to match your emirate: a NABIDH consent with an opt-out in Dubai, a clear Malaffi notice in Abu Dhabi.

The main law is Federal Law No. 2 of 2019 on the use of information technology in health. It requires health data to be kept confidential (Article 4), bars using patient information for anything other than health purposes without the patient's written approval, apart from listed exceptions such as insurer review and requests from the courts (Article 16), requires health data about services provided in the UAE to be stored and processed inside the country (Article 13, with fines of AED 500,000 to 700,000 under Article 24) and sets a minimum retention period of 25 years from the last procedure (Article 20) (Law No. 2 of 2019).

The general data protection law, Federal Decree-Law No. 45 of 2021, does not apply to “Personal Health Data that has legislation regulating its protection and processing” (Article 2) (PDPL). Its consent rules are still a useful model for the optional marketing consent: consent must be clear, the clinic must be able to prove it, and the patient must be able to withdraw it easily (Article 6). Keep that consent separate from the treatment consent and leave it unticked.

Two practical consequences. If you put the downloaded form online, make sure the responses are stored by a system that keeps health data in the UAE. And file completed forms with the patient record, because they fall under the same 25-year retention period.