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PATIENT INFORMATION Patient LEGAL Name First Middle Preferred Name DOB: Last Whom may we thank for referring you? SSN: Marital Status: S M Other Sex: Male / Female Address Street Address City State
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How to fill out dob
How to fill out dob?
01
Locate the field labeled "Date of Birth" or "DOB" on the application form or online registration.
02
Enter the month, day, and year of your birth in the corresponding spaces provided. For example, if you were born on January 15, 1990, you would enter "01" for the month, "15" for the day, and "1990" for the year.
03
Make sure to use the correct format for the date of birth. In some countries, the format may vary (e.g., month/day/year or day/month/year), so double-check the instructions if available.
Who needs dob?
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Employers often require your dob for hiring and background check purposes.
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Government agencies and offices may need your dob to verify your identity or process certain applications.
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Financial institutions may ask for your dob as part of their customer identification and compliance requirements.
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Healthcare providers and insurance companies may need your dob for medical records and insurance coverage purposes.
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Educational institutions may require your dob for enrollment and academic record keeping.
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