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  1. Surveys
  2. 2011
  3. March
  4. N
  5. N-L Patient Demographics
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Patient ID
   
 
 
 
Gender
 
Male
 
Female
 
 
 
Date of Birth
 
 
 
Race
 
White
 
Black or African American
 
American Indian
 
Asian or Pacific Islander
 
Other
 
 
 
 
Ethnicity
 
Hispanic
 
Non-Hispanic
 
Other
 
 
 
 
Preferred Language
 
Spanish
 
English
 
Other
 
 
 
 
Is the patient insured?
 
Yes
 
No
 
Don't Know
 
 
 
Insurance Company:
 
Blue Cross/Blue Shield
 
Lovelace
 
Presbyterian
 
Molina
 
Medicaid
 
Medicare
 
Other
 
 
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