PRIORITY PRIVATE CARE SOCIAL HISTORY Tobacco Use (cigarettes) Other Tobacco Used K Pipe K Cigar Do you drink alcohol? K Snuff K Chew Number of drinks per week: Is your alcohol use a concern for you or others? K Yes K No Caffeine intake (cup ner day incliidinn raft'," tea and soda (please state if none) 170 East 77th Street, New York, NY 1007 EFTA00314176