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COVID-19 IMMUNIZATION SCREENING AND CONSENT FORM PATIENT INFORMATION Please Print Clearly Last NameFirst Name. I. Race/Ethnicity: American Indian/Alaska Native Hawaiian/OtherBlack/African American
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To fill out race/ethnicity as American Indian/Alaska Native, follow these steps:
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Start by locating the race/ethnicity section on the form.
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Look for the option that includes American Indian/Alaska Native.
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Select or mark the box next to American Indian/Alaska Native to indicate your ethnicity.
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If there are additional sub-categories or specific tribal affiliations, provide the necessary information if required.
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Individuals who identify themselves as American Indian or Alaska Native should fill out the race/ethnicity as American Indian/Alaska Native. This category is specifically designed to capture this particular racial or ethnic background. It is important to provide accurate and complete information to ensure proper representation and understanding of the diverse population.
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Race/ethnicity American Indian/Alaska Native refers to individuals who identify as being of American Indian or Alaska Native descent.
Individuals who self-identify as American Indian or Alaska Native are required to report their race/ethnicity as American Indian/Alaska Native.
To fill out race/ethnicity American Indian/Alaska Native, individuals can simply check the box or select the option that corresponds to this racial/ethnic category on the form provided.
The purpose of collecting race/ethnicity American Indian/Alaska Native data is to ensure diversity and inclusion, track demographics, and monitor disparities in access to resources and opportunities.
Individuals must report whether they identify as American Indian or Alaska Native. Additional information such as tribal affiliation may also be requested.
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