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MPH SelfIdentication Form (Please print the form, complete it and submit it to Human Resources.) Partners Healthcare and Massachusetts General Hospital are equal opportunity/affirmative action employees.
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How to fill out mgh self-identification form
How to fill out the MGH self-identification form:
01
Start by opening the MGH self-identification form document.
02
Read the instructions carefully to understand the purpose and importance of filling out the form.
03
Begin by providing your personal information such as your name, address, and contact details.
04
Next, indicate your ethnic background by selecting the appropriate option from the provided list.
05
If you identify as a person with a disability, specify the nature of your disability and any accommodations you may require.
06
Indicate your gender identity by choosing the option that best represents your identity.
07
If you have a veteran status, select the appropriate option and provide any additional information if required.
08
If you have any prior experience with healthcare disparities, select the relevant options and provide additional details as necessary.
09
Finally, review your responses to ensure accuracy and completeness before submitting the form.
10
Remember, the MGH self-identification form is confidential and used for statistical purposes only.
Who needs the MGH self-identification form:
01
Individuals who are seeking medical treatment or services from Massachusetts General Hospital (MGH) are typically required to fill out the MGH self-identification form.
02
Employees and job applicants at MGH may also be asked to complete this form as part of their employment processes.
03
The MGH self-identification form is designed to gather demographic and diversity information to help MGH better understand its patient and employee populations and to address any healthcare disparities that may exist.
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