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PATIENT INTRODUCTION Date: Social Security Number Patients Name: Gender: male females: Birth date: Marital Status: single separated widowed married divorced significant terrace or ethnic background:
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How to fill out race or ethnic background

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Begin by identifying the race or ethnic background categories provided in the form.
02
Select the category that best represents your race or ethnic background.
03
If none of the provided categories accurately represent your race or ethnic background, choose the option that states 'Other' or 'Prefer not to say'.
04
Fill out any additional demographic information that may be required along with the race or ethnic background section.
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Double-check your selection and make sure you have accurately filled out the race or ethnic background section.
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Submit the form or application.

Who needs race or ethnic background?

01
Various institutions and organizations may require race or ethnic background information for statistical purposes, research studies, or to monitor diversity and inclusion efforts.
02
Government agencies, educational institutions, healthcare providers, employers, and survey researchers are some examples of entities that may ask for race or ethnic background.
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Race or ethnic background refers to a person's racial or cultural identity.
Individuals may be required to provide information on their race or ethnic background in various forms or surveys.
Individuals can fill out race or ethnic background information by selecting their race or ethnicity from the options provided.
The purpose of collecting race or ethnic background information is to monitor and address any disparities or discrimination based on race or ethnicity.
The information typically includes categories such as White, Black or African American, Asian, Hispanic or Latino, Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native, and more.
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