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APM Demographic / Insurance / Release Form Physician: Dr. DOSS / Dr. KING / Dr. KIZINADate: / / Patient Information: Name: Last Name First Name Middle Social Security #: DOB: / / Age: Sex: M / Marital
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The demographics form - advanced is a detailed document used to collect specific demographic information from individuals or organizations for statistical analysis and reporting purposes.
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The information that must be reported includes details such as age, gender, ethnicity, income level, and other relevant demographic characteristics.
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