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Get Patient Race/Ethnicity Select All That Apply - Mytruehealth

That apply. American Indian/Alaskan Native Asian Black/African American Native Hawaiian Other Pacific Islander White/Caucasian Other Is the patient Hispanic? Yes No Emergency Contact Name Relationship to Patient Mother/Guardian Name PARENT/GUARDIAN INFORMATION Date of Birth (MM/DD/YY) U.S. Citizen? Yes No Type of Housing Own Subsidized Other Shelter Rent Transitional Housing Homeless Staying with Friends/Family Emergen.

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