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Patient Profile Date: Physician Name: PATIENT INFORMATION Email Name: Address: Employed Retired Unemployed Student Employer: City, ST, Zip EMERGENCY CONTACT Primary Phone () Homework Other Secondary
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01
Start by identifying the category you fall under. If you are currently employed, select the "employed" option. If you are retired, choose the "retired" option. If you are currently not employed but actively seeking employment, select the "unemployed" option. And if you are a student, select the "student" option.
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Once you have identified your category, proceed to fill out the relevant information. This may include providing details about your current employment status, such as the name of your employer, job title, and duration of employment. For retired individuals, you may need to provide information about your previous occupation and the year of retirement. If you are unemployed, you may be asked to provide details about your job search efforts or any unemployment benefits you may be receiving. Students may need to provide information about their educational institution, major, and expected year of graduation.
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After filling out the necessary information, review your responses to ensure accuracy and completeness. Double-check if any additional documentation or proof is required to support your chosen category. Make any necessary corrections or additions before submitting the form.

Who needs employed retired unemployed student?

01
Individuals who are currently employed need to choose the "employed" option to accurately represent their current work status.
02
Retired individuals, who are no longer actively working, need to select the "retired" option to provide a clear indication of their post-employment status.
03
Unemployed individuals who are actively seeking employment or receiving unemployment benefits need to choose the "unemployed" option to accurately reflect their current job-seeking situation.
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Students who are pursuing their education need to select the "student" option to indicate that they are currently enrolled in an educational institution and not part of the workforce.
It is important to accurately fill out and select the appropriate category to ensure that the information provided aligns with your current situation and helps to provide a clear understanding of your employment status.
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Employed retired unemployed student refers to individuals who are currently working, retired, unemployed, or students.
Anyone who falls under the categories of employed, retired, unemployed, or student is required to file employed retired unemployed student.
To fill out employed retired unemployed student, you need to provide information about your employment status, retirement status, unemployment status, or student status.
The purpose of employed retired unemployed student is to collect data on individuals in different employment statuses for statistical and regulatory purposes.
You must report your current employment status, retirement status, unemployment status, or student status on the employed retired unemployed student form.
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