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Date PATIENT REGISTRATION AND MEDICAL HISTORY (PLEASE PRINT)Home Phone Cell Phone Email Patient Last NameFirst NameInitialStreet Address City State Zip Sex M F Age Birth date Single Married Widowed
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To fill out single, you need to indicate that you are not currently married or in a civil partnership.
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To fill out married, you need to indicate that you are legally married or in a civil partnership.
03
To fill out widowed, you need to indicate that you have been legally widowed.
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To fill out separated, you need to indicate that you are legally separated from your spouse or partner.

Who needs single married widowed separated?

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Individuals who are filling out marital status forms or applications need to choose from the options single, married, widowed, and separated based on their current relationship status.
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Single, married, widowed, and separated are different marital statuses that individuals can have.
Individuals are required to report their marital status as single, married, widowed, or separated when filling out official forms and documents.
To fill out the marital status section, individuals can simply select the option that best describes their current marital status: single, married, widowed, or separated.
The purpose of indicating marital status as single, married, widowed, or separated is to provide accurate demographic information and determine eligibility for certain benefits or legal rights.
Individuals must report their current marital status accurately as either single, married, widowed, or separated.
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