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Patient Information (Please print)Full Legal Name: Lactate of Birth:FirstMiddle SS#: Month/Day/Complete YearPreferred Name: Sex: Male Female Ethnicity:Hispanic/LatinoPrimary Care Physician: Preferred
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What is african american black?
African American Black refers to individuals of African descent with black skin.
Who is required to file african american black?
Anyone who identifies as African American Black may choose to report their race on official forms.
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To indicate African American Black on forms, simply check the box or select the option provided.
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The purpose of reporting African American Black is to provide demographic data and ensure representation.
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Typically, only the individual's race as African American Black needs to be reported.
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