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Addiction Blood coagulation disorder Chronic pain Depressive disorder Disease of liver Heart disease Immunodeficiency disorder Kidney disease Malignant neoplastic disease Mental disorder Sexual abuse FAMILY HISTORY Family member s SOCIAL HISTORY Do you have Advance Directives to guide your healthcare in the event you are unable to make decisions YES NO 2C Smoking Status NEVER SMOKER FORMER SMOKER CURRENT EVERYDAY SMOKER CURRENT SOME DAY SMOKER SMOKER CURRENT STATUS UNKNOWN UNKNOWN IF EVER...

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