Arab Any other ethnic group (please give details in box below) Details of person’s ethnic group: Status of the person who died Single (never married) Married / civil partnership Separated (but legally married / in a civil partnership) Divorced Widowed I don’t know which area of England was the person registered with a GP? North: Yorkshire & the Humber Lancashire North: Greater Manchester Cumbria & the North East North: Cheshire & Merseyside Midlands & East: North Midlands Midlands & East: Central Midlands Midlands & East: West Midlands Midlands & East: East Midlands South: South West South: South East South: Wessex South: South Central London Region I don’t know Not registered with a GP Number (This should be in the following standard format: 000 000 0000) NHS number: the person who died have any medical conditions or health problems? Details:
Arab Any other ethnic group (please give details in box below) Details of person’s ethnic group: Status of the person who died Single (never married) Married / civil partnership Separated (but legally married / in a civil partnership) Divorced Widowed I don’t know which area of England was the person registered with a GP? North: Yorkshire & the Humber Lancashire North: Greater Manchester Cumbria & the North East North: Cheshire & Merseyside Midlands & East: North Midlands Midlands & East: Central Midlands Midlands & East: West Midlands Midlands & East: East Midlands South: South West South: South East South: Wessex South: South Central London Region I don’t know Not registered with a GP Number (This should be in the following standard format: 000 000 0000) NHS number: the person who died have any medical conditions or health problems? Details: