Form Table 3B Table 3B Race Ethnicity Collection

Uniform Data System

Revised RaceEthnicityTable

Uniform Data System

OMB: 0915-0193

Document [doc]
Download: doc | pdf


Patients by race

Hispanic


Not Hispanic

Unreported/ refused to report

Total

1.

Asian





2a.

Native Hawaiian





2b.

Other Pacific Islander





2.

Total Hawaiian/Pacific Islander (Sum Lines 2a + 2b)





3.

Black/African American





4.

American Indian/Alaska Native





5.

White





6.

More than one race





7.

Unreported / Refused to report





8.

Total Patients (Sum Lines 1, 2, 3 to 7)







File Typeapplication/msword
File TitlePATIENTS BY RACE
AuthorHRSA
Last Modified ByHRSA
File Modified2008-12-23
File Created2008-12-23

© 2024 OMB.report | Privacy Policy