Patient Demographic Form

The word Demography means the study of statistics. It is the analysis of the number of births, deaths, incidence, and prevalence of different diseases within a community over a specific period of time. It also studies the changes occurring in the human population.

Demography is a vast subject which includes the study of the size, structural build-up, and distribution of human populations. It measures the changes in these statistics whether in time or in space over a determined period of time. These changes include births, deaths, and migrations.

Demographic Data

Data can be collected and analyzed using various rates and ratios, some of which are described below:

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  • Crude birth rate – number of live births per thousand people in a year
  • Crude death rate – number of deaths per thousand people in a year
  • Expectation of life – the number of years an individual is expected to live at a certain age, according to current mortality rates
  • Infant mortality rate – number of deaths of children less than 1 year of age per thousand live births in a year
  • Total fertility rate – the number of live births per woman completing her reproductive life according to current age-specific fertility rates

Demographic Cycle

The demographic cycle also known as population cycle is the evolution of a specific population over time.

Stages of Demography

Stage 1: Pre transition/ high stationary: High birth rates and high death rates.

Stage 2: Early transition/ early expansion: Death rate begins to fall, the birth rate remains high, and the population starts to grow rapidly. Examples: Afghanistan and Palestine.

Stage 3: Late transition/ late expansion: Decrease in birth rate and deceleration of population growth. Examples: India and the United Arab Emirates.

Stage 4: Post transition/ low stationary: Low birth and death rates, population growth is minimal. Examples: Japan and Denmark.

Stage 5: Declining: Birth rate is lower than the death rate hence the population growth is declining. Examples: Sweden and Norway.

Importance of Demography

Demography helps to identify the issues and causes related to morbidity and mortality in the population. Moreover, it aids in categorizing demands of growth and aging of population.

Characteristics of Demography

There are various factors that can be described statistically like age, sex, level of education, income, marital status, religion, occupation, employment, rate of births, rate of deaths, rate of reproduction and the average size of a family.

Patient Demographic Form

The patient demographic form consists of:

  • Patient information: Full name, father’s name, age, sex, date of birth, occupation, race, religion, street address, phone number, ethnicity, marital status, email address and language
  • Date and time of filling the form
  • Emergency contact; name, age, contact number, address and relationship to patient
  • Source of finance: name, occupation, address and contact number
  • Information about a referral: name of the physician, address and contact number
  • Insurance information: insurance company, patient’s relationship to the insured person, social security number, sex and date of birth
  • Agreement to privacy and confidentiality
  • Name and signature of consenter/patient


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Source: med-docs.creighton.edu


Simi Karton

Dr. Simi Karton is a regular contributor to National Science Quarterly and an enthusiastic Lakers fan. She recently collaborated on a manuscript with friends and colleagues. Dr. Simi Karton, entitled Parkinsons and the Genetic Response to Eastern Medicine, in which she and Dr. Inshal presented research compiled during a summer spent in United States. She currently resides in Los Angeles with her husband. This website is a voluntary work of Dr. Karton to provide people with useful health related information stuff at an easy approach. The information has been collected from different sources at one place.

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