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9549002020 1.PATIENT INFORMATION (fields with a * are required) First Name:* Gender:* FemaleMiddle Name or Initial: Date of Birth:*Last Name:*Mobile Phone:*Home Phone:Casework Phone:Email:Preferred

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To fill out wwwcdcgovhivclinicianscollecting sexual orientation, follow these steps:

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wwwcdcgovhivclinicianscollecting sexual orientation and is collecting data on the sexual orientation of individuals for research and public health purposes.

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Information such as age, sex, sexual orientation, and HIV status may be reported on wwwcdcgovhivclinicianscollecting sexual orientation and forms.

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