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PROVIDER:KRIS DINUCCI480.342.99997304 East Deer Valley Road, Suite 100Scottsdale, Arizona 85255www.arizonafoot.comPATIENT INFORMATIONNAME: ___ DATE OF BIRTH:MALEFEMALEHOME ADDRESS:___ZIP___MARITAL

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The Form Role of Race is a document used to collect and report demographic information related to the racial and ethnic background of individuals involved in certain studies or programs.

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Organizations, institutions, or researchers that receive federal funding for studies or programs that necessitate collecting demographic data on race and ethnicity are required to file the Form Role of Race.

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The purpose of the Form Role of Race is to ensure accurate representation and analysis of racial and ethnic diversity in federally funded studies and programs, promoting equity and inclusion.

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The form must report the race and ethnicity of individuals, categorizing them according to federal standards, and may require additional demographic information as specified.

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