Patient Demographic and Information Form - HESS 2025

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What Does Patient Demographic Include? Name. Gender. Date of Birth. Ethnicity/race. Address. Social Security number. Contact Information. Drug/ allergies Information.
In the simplest of terms, patient demographics describe a patients most basic information. It encompasses a wide range of information, including their age, gender, race, ethnicity, income, name, allergies, occupation, address, contact details, insurance information, and medical history.
Patient demographic data refers to all of the non-clinical data about a patient, including: name, date of birth, address, phone number, email address, sex, race, etc.
Examples of demographic characteristics include age, race, gender, ethnicity, religion, income, education, home ownership, sexual orientation, marital status, family size, health and disability status, and psychiatric diagnosis.
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