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SelfAssessmentSubstanceAbuse/ChemicalDependency 1. Isyouruseaffectingyourrelationshipswithfriendsorfamily? 2. Haveyoueverregrettedsomethingyoudidwhileundertheinfluence? 3. Hasyourdrinkingordruguseeveraffectedyourworkperformance?
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Have you ever experienced memory loss blackout refers to a form where an individual discloses whether they have ever had episodes of memory loss or blackout.
Individuals who have experienced memory loss or blackout are required to file the form.
The form can be filled out by providing accurate information about any past experiences of memory loss or blackout.
The purpose of the form is to gather information about individuals' history of memory loss or blackout for evaluation and research purposes.
The form requires individuals to report details about any instances of memory loss or blackout they have experienced.
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