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Patient Information
Name:MI:Address:City:Home Phone:Cell Phone:Email:
DOB:
Emergency Contact:Gender:MaleFemaleZip:Appointment Reminders:
Last 4 of SSN:TextEmailNoneReferring MD:Phone:Relationship:Whom
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Start by providing a space for individuals to self-identify their gender identity.
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Organizations, companies, and institutions who prioritize inclusivity and diversity in their policies and practices.
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What is transgender people and form?
Transgender people are individuals whose gender identity differs from the sex they were identified as at birth. The form is a document used to record information about transgender individuals for various purposes.
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