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Patient Demographic and Information Form HESS

Patient Demographic and Information Form HESS

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miss Rothschild hi nice to meet you I'm Karen yin and I'm the social worker here before you go in to see the doctor we have a few questions that we started asking patients I have them right here in front of you so these are questions we want to ask to find out more about who our patients are what needs do they have how can we provide quality care does that sound okay to you sure that my appointments in 10 minutes is there time um oh yes it'll only take a few minutes I just want to point out that for any of the questions you can see prefer not to answer and i do want to let you know that the only people who can see this in your file are the people who take care of you while you're in our care okay otherwise it's used for research and nothing can be linked back to you personally okay okay so the first question is what language would you feel most comfortable speaking in with your healthcare provider English okay which of the following best describes your racial or ethnic group a white Eu

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