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PATIENT HISTORY DATE LAST NAMEFIRST NAME MIDDLEGENDERBIRTH DATES SN STREET ADDRESS MAILING ADDRESS (IF DIFFERENT) CITY STATE ZIP HOME PHONE WORK PHONE (OKAY TO CONTACT YOU AT WORK?) Y N CELL PHONE
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SSN stands for Social Security Number. It is a unique nine-digit number assigned to individuals by the Social Security Administration in the United States.
Individuals who are eligible to work in the United States are typically required to have a Social Security Number.
To apply for a Social Security Number, individuals can visit their local Social Security Administration office with the required documentation, such as a birth certificate and proof of identity.
The purpose of a Social Security Number is to track individuals' earnings for Social Security benefits and to help prevent identity theft.
Information such as name, date of birth, and gender must be reported when applying for a Social Security Number.
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