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Sample Patient Registration Forms -English

Year Developed: 2016

Resource Type: Template .

Primary Audience: Administrative Staff
Secondary Audience: Enabling Services

Language(s): English

Developed by: National Center for Farmworker Health (See other resources developed by this organization).

Resource Summary: A template questionnaire for new patient registration.

Resource Topic: Special and Vulnerable Populations, , Health Equity

Resource Subtopic: Population Health , , , Programs and Services, Patient Engagement.

Keywords: Agricultural Workers , Hispanic Americans/Lations, Latinas , Access to Care.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $6,625,000 with 0 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.