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NEW PATIENT REGISTRATION FORM Patient Information: First Name:Mi:Date of Birth:Age:Last Name:Sex: M / Home Address:SSN: Apt. #:City:State:Language:Race:White Black Asian Native American Other Ethnicity:
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White, Black, Asian and Native American are racial categories used for demographic reporting purposes.
Individuals and organizations collecting demographic data are generally required to report information on white, black, Asian, and native populations.
When filling out demographic forms, individuals can self-identify their race as white, black, Asian or native American based on their own perception of identity.
The purpose of collecting data on white, black, Asian, and Native American populations is to track demographic trends and ensure representation and resources for diverse communities.
Data on the number of individuals identifying as white, black, Asian, and native American must be reported in demographic forms.
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