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13 Cards in this Set

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