hat
Tanpri bay enfòmasyon annapre yo pou tout moun nan fanmi pwòch ou ki abite nan kay ou. Yo defini kòm fanmi, pasyan an, mari/madanm pasyan an, ak tout timoun pasyan an ki poko gen 18 ane (natirèl oswa adoptif) k ap viv nan kay pasyan an. Si pasyan an poko gen laj 18 ane, fanmi an dwe gen ladan pasyan an, paran natirèl oswa adoptif pasyan an, ak paran (natirèl oswa adoptif) timoun ki poko gen laj 18 an ki abite nan kay pasyan an.
eng
Please provide the following information for all of the people in your immediate family who live in your home. Family is defined as the patient, the patient’s spouse, and all of the patient’s children under 18 (natural or adoptive) who live in the patient’s home. If the patient is under the age of 18, the family shall include the patient, the patient’s natural or adoptive parent(s), and the parent(s) children under 18 (natural or adoptive) who live in the patient’s home.