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13 Cards in this Set
- Front
- Back
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What is your ethnic group?
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Cual es su grupo etnico?
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What is your marital status?
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Cual es su estado civil?
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Are you married?
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Es ud. casada?
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Who do you live with?
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Con quien vive ud.?
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How many people total live in your house?
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Cuantas personas en total viven en su casa?
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How many years did you go to school?
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Cuantos anos fue a la escuela?
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Do you work?
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Trabaja ud.?
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What is your family's monthly salary?
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Cual es el salario mensual de su familia?
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Do you have insurance?
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Tiene ud. seguro?
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Do you have Medicaid or Medicare?
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Tiene Medicaid o Medicare?
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What is your doctors name?
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Cual es el nombre de su medico?
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When is the last time you saw your doctor?
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Cuando fue la ultima vez que vio a su medico?
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That is fine. These are the questions that we have for now. We need your signature that indicates the information is correct. Sign here, please.
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Muy bien. Estas son todas las preguntas por ahora. Necesitamos tambien su firma que indica la informacion es corecta. Firme aqui, por favor.
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