Yeah, Caroline Islands -- but I betcha 93% of patients who come into a random doctor's office in North and South Carolina don't remember that, and at least 20% will probably check the box.
This form is so incredibly stupid that I don't think even the US gov't could be responsible for providing it.
If the doctor in question came from some third-world ****hole, I would run, not walk out of the office.
No mine is American....so I will leave the Carolinian box check alone. I agree, the whole racist/nationality form is unnecessary.