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MEDICAL HISTORY FORM PATIENT NAME: ___ TODAYS DATE: ___ BIRTH DATE: ___ PHONE: ___ EMAIL: ___ RACE: African American Indian Asian/Pacific Islander Caucasian Hispanic/LatinoPRIMARY CARE PHYSICIAN (NAME):

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Identify the heritage months that are relevant to your department.

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Departments within organizations that value diversity, inclusion, and cultural awareness.

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What is heritage months - department?

Heritage months - department refers to the designated department responsible for overseeing and managing the heritage months initiatives.

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All organizations and institutions participating in heritage months celebrations are required to file with the heritage months - department.

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To fill out heritage months - department forms, organizations must provide detailed information about their planned activities and events for the heritage months celebrations.

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The purpose of the heritage months - department is to promote and celebrate the rich and diverse cultural heritage of various communities.

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Organizations must report on their planned activities, events, funding sources, and community outreach efforts related to heritage months celebrations.

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