American Indian or Alaskan Native Client does not know ○ ○ Asian Client refused ○ ○ Black/African American Data Not Collected ○ ○ Hawaiian or Pacific Islander ○ White/Caucasian ○ ETHNICITY​ Clients] Client does not know ○ ○ Client refused ○ Data Not Collected ○ Hispanic/Latino ○ Other ○ VETERAN STATUS​ Adults] Client doesn’t know No ○ ○ Client refused ○ Yes ○ Data not collected ○ IF ANSWERED TO VETERAN STATUS “YES” Year entered military service (year) Year separated from military service (year) Theater of Operations: World War II No Client doesn’t know ○ ○ Client refused ○ Yes ○ Data not collected ○ Theater of Operations: Korean War No Client doesn’t know ○ ○ Client refused ○ Yes ○ Data not collected ○ Theater of Operations: Vietnam War No Client doesn’t know ○ ○ Client refused ○ Yes ○ Data not collected ○ Theater of Operations: Persian Gulf War (Desert No Client doesn’t know ○ ○ Client refused ○ Yes ○ Data not collected ○ Theater of Operations: Afghanistan (Operation Enduring Freedom) No Client doesn’t know ○ ○ Client refused ○ Yes ○ Data not collected ○ Theater of Operations: Iraq (Operation Iraqi Freedom) No Client doesn’t know ○ ○ Client refused ○ Yes ○ Data not collected ○
○ American Indian or Alaskan Native ○ Client does not know ○ Asian ○ Client refused ○ Black/African American ○ Data Not Collected ○ Hawaiian or Pacific Islander ○ White/Caucasian ETHNICITY​ Clients] ○ ○ Client does not know ○ Client refused ○ Hispanic/Latino ○ Data Not Collected ○ Other VETERAN STATUS​ Adults] ○ No ○ Client doesn’t know ○ Yes ○ Client refused ○ Data not collected IF ANSWERED “YES” TO VETERAN STATUS Year entered military service (year) Year separated from military service (year) Theater of Operations: World War II ○ No ○ Client doesn’t know ○ Yes ○ Client refused ○ Data not collected Theater of Operations: Korean War ○ No ○ Client doesn’t know ○ Yes ○ Client refused ○ Data not collected Theater of Operations: Vietnam War ○ No ○ Client doesn’t know ○ Yes ○ Client refused ○ Data not collected Theater of Operations: Persian Gulf War (Desert ○ No ○ Client doesn’t know ○ Yes ○ Client refused ○ Data not collected Theater of Operations: Afghanistan (Operation Enduring Freedom) ○ No ○ Client doesn’t know ○ Yes ○ Client refused ○ Data not collected Theater of Operations: Iraq (Operation Iraqi Freedom) ○ No ○ Client doesn’t know ○ Yes ○ Client refused ○ Data not collected