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Subject Legal Name:
D.O.B.:
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Ethnicity:
Race:Please indicate if this visit
is an INPATIENT
admission or an
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What is subject legal name?
Subject legal name refers to the official name of a business or entity as registered with the relevant government authority.
Who is required to file subject legal name?
The business or entity owners are required to file the subject legal name.
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The subject legal name can be filled out by providing the official registered name of the business or entity in the designated form or document.
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The information that must be reported on subject legal name includes the full and official registered name of the business or entity.
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