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PATIENT REGISTRATIONPatient Informational: FirstMiddleLastAddress: Social Security Number: Home phone: () Cell Phone: () Date of Birth: Marital Status: Gender: M F Race: American Indian/Alaska Native
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Anyone who needs to provide their US citizenship status may need to fill out the 'Are you a US citizen?' form. This can include individuals applying for jobs, government benefits, or certain legal processes that require proof of citizenship. Additionally, non-US citizens may also need to complete this form to indicate their immigration status accurately.
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