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PATIENT INTERVIEW FORM PATIENT INFORMATION First Name Last Name Date of Birth Age RACE White/Caucasian Black or African American Asian Hispanic or Latino American Indian or Alaska Native Hawaiian
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White, Caucasian, Black, or African are categories used to classify a person's race or ethnicity.
Individuals who are asked to identify their race or ethnicity on forms or surveys may be required to indicate whether they are White, Caucasian, Black, or African.
To fill out the white, Caucasian, Black, or African category, simply select the option that best describes your race or ethnicity when prompted on a form or survey.
The purpose of collecting this information is to gather data on the racial and ethnic diversity of a population for statistical and research purposes.
Individuals may be asked to report their race or ethnicity by selecting the option that best describes them as White, Caucasian, Black, or African.
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