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EFTA00307789
you a cigarette smoker? K Yes K Never K Quit — How long ago did you quit? If you answered "yes" or "quit", how much do or did you smoke per day? K Less than 1/2 pack K I pack K More (How many?) 20. Do you drink any alcoholic beverages? (Check one) 0 None K 1 to 2 drinks per day K Socially 21.
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