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PATIENT INFORMATION Patients Last Name: Date of Birthright Name: Middle Name:(MM/DD/YYY)Sex: Male FemaleSchool: Grade: Ethnicity: Hispanic Black White American Indian Asian/Pacific Islander Other
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To fill out ethnicity hispanic black white, follow these steps:
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Start by locating the ethnicity section on the form you are filling out.
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Check the box that corresponds to your ethnicity.
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If you identify as Hispanic, mark the hispanic box.
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If you identify as Black, mark the black box.
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If you identify as White, mark the white box.
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If none of these options apply to you, look for the 'Other' or 'Not specified' option and mark that instead.
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